Diagnosis and Management of Integumentary Disorders Flashcards
The lesion that develops on previously unaltered skin
Primary Skin Lesions
The lesion that either changes impression over time or occurs when a primary lesion is scratched it may become infected, etc.
Secondary skin Lesion
________
1) A circumscribed flat area of skin
2) Different in color and texture form its surrounding tissue
3) < 1 cm in size
4) Examples: Ephelides (freckles), petechiae, flat nevi (moles)
Macule
___________
- A large macule
- > 1 cm in diameter
- Examples: Mongolian spot, cafe’ au lait spot
Patch
_______
- Small, solid, elevated lesion
- < 1 cm in diameter
- Example: Ant bite, elevated nevus (mole), verruca (wart)
Papule
______
1) Elevation of skin
2) > 1 cm in diameter
3) Example: Psoriasis lesion
Plaque
______
1) A visible accumulation of purulent fluid under the skin
2) < 1 cm in diameter
3) Examples: Acne and impetigo
Pustule
_______
1) A circumscribed elevation of the skin
2) Contains serous fluid
3) < 1 cm in diameter
4) Examples: Herpes simplex, Varicella (chickenpox), herpes zoster (shingles)
Vesicle
_______
1) A solid mass of skin
2) Observed as an elevation or can be palpated
3) > 1 cm in diameter
4) Often extends into the dermis (deeper)
5) Examples: Xanthoma and fibroma
Nodule
_______
1) “Blister”
2) Circumscribed elevation containing fluid
3) > 1 cm in diameter
4) Extends only into the epidermis
5) Example: Burns, superficial blister, contact dermatitis
Bulla
________
1) Elevated white or pink compressible papule or plaque
2) A red, axon mediated flat often surrounds it
3) Commonly associated with allergic reactions
4) Examples: PPD test and mosquito bites
Wheal
_________
1) Any closed cavity or sac
2) Contains fluid or semisolid material
3) Normal or abnormal epithelium
4) Example: Sebaceous ____
Cyst
___________
1) A localized collection of purulent fluid in a cavity formed by disintegration or necrosis of tissues
2) > 1 cm in size
Abscess
__________
1) “Mass”
2) > few cetimeters in diameter
3) FIrm or soft
4) Benign or malignant
Tumor
Rash configuration:
1. _________: Circular, begins in the center and spreads to periphery
Annular
- _______: Lesions run together
Confluent
- ______: Lesion cluster
Grouped
- _____: Twisted, coiled, spiral, snake-like
Gyrate
- _____: Scratch, streak, line, stripe
Linear
- _______: Annular lesions merge
Polycyclic
- ____________: Individual and disticnt lesions that remain separate
Solitary or discrete
- _______: Resembles iris of eye; lesions with concentric rings of color
Target (iris)
- ________: Linerar arrangment along a nerve route
Zosteriform
The most common of all skin disorders
acne
_______________: Openings capped with a blackened skin debris
Open comedones (“blackheads”)
______________: Obstructed opeing of skin
Closed comedones (“whiteheads”)
Signs and symptoms of acne:
1) Pustules and papules (pimples, zits), typically on the face and upper torso
2) __________ (blackheads whiteheads)
3) ______
4) Nodules
5) Scarring
2) Comedones
3) Cysts
Laboratory/ Diagnostics of Acne:
1) ______ specifically indicated for diagnosis
None
Management: Of Acne
1) Non- pharmacologic therapies
a) Wash several times daily with mild soap
b) Avoid topical oil-based products
c) Use oil-free cleansers and moisturizers
2) Pharmacologic agents
(a) Comedolytic agents: Similar effects after
90 days; creams are less irritating than
gels
ii) ___ ____: Bacteriocidal
iii) ____ _____ (Neutrogena 2% wash):
Keratolytic; reduces comedones
formation
iv) Azelaic acid (Azelex): Bactericidal and
reduced comedones formation
v) _____ (Retin - A)
a) Increased risk of sunburn;
pregnancy category C
vi) Adapalene (Differin): Less skin
irritation than Tretinoin; pregnancy
category C
vii) Tazarotene (Tazorac): Expensive;
pregnancy category X
ii) Benzoyl peroxide
iii) Salicyclic acid
v) Tretinoin
Management: Of Acne
(b) Combination agents: Comedolytics + antibiotics
i) Benzoyl peroxide + _______
(Benzamycin): Requires refrigeration
ii) Benzoyl peroxide gel + ________
(BenzaClin)
iii) Benzoyl peroxide + drying agents:
Sulfacetamide sulfur (Novacet or
Sulfacet)
i) Erythromycin
ii) Clindamycin
Management: Of Acne
(c) Topical antibiotics
i) \_\_\_\_\_\_\_\_: Most frequent used
topically antibiotic for acne
ii) \_\_\_\_\_\_\_: Second most frequently
used
iii) Tetracycline: Not commonly used
iv) \_\_\_\_\_\_\_: Used frequently for
rosaceai) Clindamycin
ii) Erythromycin
iv) Metronidazole
Management: Of Acne
(d) Oral antibiotics
i) ________: Most widely prescribed;
contraindicated in pregnancy and
children < 9 years of age
ii) Erythromycin
iii) ________
iv) Doxycycline
v)
vi) Isotretinoin (Accutane): For severe,
unresponsive acne; always obtain
informed consent
i) Tetracycline
iii) Minocycline
v) Clindamycin
Management: Of Acne
(e) Oral contraceptives
i) \_\_\_\_\_\_ therapy is most effective
ii) Ortho Tri-Cyclen and Estrostep
iii) May cause brownish blotches or
melasma
(hyperpigmentation) on the skin
iv) Contraindicated in pregnancy: Two forms
of birth controlled neededi) Combination
Management: Of Acne
(f) Other therapies
i) Periodic intralesional triamcinolone
(\_\_\_\_\_\_) injection
ii) Refer for dermabrasioni) Kenalog
____________:
- Inflammation of the hair follicle
- Most commonly, staphylococci
Folliculitis
_________
- “Boil”
- Localized infection originating in the hair follicle
- Caused by Staphylococcus aureus
Furuncle
_______
- Much larger than a furuncle
- Maybe necrotizing
- Usually Staphylococcus aureus
Carbuncle
Most common causes in outpatient/ bacterial infections:
1) ____ ____ (Gp A Strep): usual cause
2) S. aureus: Less common
3) Other Strep. (Gp. B, C, G): Rare
1) Strep. pyogenes
The most common cause of inpatient/ bacterial infections:
1) Gram-negative organisms
a) E. coli
b) ___________
c) Pseudomonas
d) Enterobacter
1) b) Klebsiella
The most common cause of inpatient/ bacterial infections:
2) S. aureus
a) ______
b) CA- MRSA
a) MRSA
The most common cause of inpatient/ bacterial infections:
3) _____
3) Strep
CA-MRSA:
1) Trimethoprim-sulfamethoxazole (\_\_\_\_\_%)
2) Doxy/ minocycline (\_\_\_\_\_%)
3) Clindamycin (\_\_\_%)
4) In the area of very low CA- MRSA
prevalence:
a) Dicloxacillin or \_\_\_\_\_ (Keflex)1) 95 to 100
2) 90 to 95
3) 85 to 95
4) a) cephalexin
Group A Strep:
1) _____-_____ + beta-lactam [ PCN, Amoxicillin, 1st Generation Cephalosporin (Keflex)] or
2) Doxy/minocycline + Beta lactam [PDN, Amoxicliin, 1st Generation Cephalosporin (Keflex)]
3. Clindamycin
1) Trimethoprim-Sulfamethoxazole
_______
1) Usually caused by streptococcus
2) Rapid progression of an erythematous, warm, indurated area
Erysipelas
Hidradenitis suppurativa
- ____ _____ infection commonly in the groin or axilla
- Abscess formation is common
- Staph aureus
_______
- Infection of the skin classically caused by Staph aureus
- The primary lesion is a thin-walled vesicle that breaks easily
- The honey-colored crust at the edge
- Commonly, satellite lesions can appear and spread to remote area of the skin
Impetigo
_______
1. Staphylococci around the nail fold
Paronychia
Signs of inflammation/ bacterial infection:
a) Regional lymphadenopathy
b) ______
c) Redness
d) Pustules
e) Pain
f) _____
g) Vesicle
h) Purulent drainage
b) Swelling
f) Warmth
In systemic infections:
a) ______
b) malaise
c) _______
d) Anorexia
a) Fever
c) chills
Laboratory/ diagnostics: bacterial infection
1) _____ ______
2) Culture
- None indicated
Management:
1) Incision and drainage, as warranted
2) Systemic treatment should be directed at the offering organism
3) Minor infections: Consider topical antimicrobials [Bacitracin, Bactroban (Mupirocin), etc.]
a) First-generation cephalosporin (e.g.
_______) or
b) Penicillinase- resistant penicillin (e.g.
dicloxacillin)
c) Alternative: Clindamycin or amoxicillin-
clavulanate
3) a) cephalexin
A collection of blood in the space between the nail bed and fingernail; bleeding from the rich vascular nail bed results in increased pressure under the nail and can cause significant discomfort and intense pain
Fingernail Hematomas (Subungual Hematoma)
_____ _____ are common nail bed injuries caused by blunt or sharp trauma to the fingers or toes
Subungual hematomas
Management of Subungual hematomas:
1) ______: drilling a hole through the nail into the hematoma to release the pressure
a) Generally accomplished by using a heated instrument (e.g., small drill, needle, laser. or surgical blade) to pass through the nail into the blood clot
1) Trephination
Description:
Inflammation of the superficial tissues of the penile heard caused by Canida Albicans
Candida Balanitis
Management for Candida Balanitis:
1) Miconazole
2) ________
3) Steroids
4) Fluconazole
2) Clotrimazole
Irritation of the fold of skin, commonly occurring in warm, moist body areas
Candida Intertrigo
Management of Candida Intertrigo:
1) Drying agents such as tale or cornstarch
2) Topical antifungals (e.g. ______ (Loprox)
3) Oral antifungals [e.g. fluconazole (Diflucan) or itraconazole (Sporanox)]
2) ciclopirox
Dermatophyte infection of the scalp, commonly caused by Trichophyton (80%) or Microsporum genera
Tinea Capitus
Dermatophyte infection caused by genera Trichophyton or Microsporum
Tinea Corporis (ringworm)
Treatment for Tinea Corporis:
1) Topical antifungals (e.g. __________, clotrimazole, naftifine, econazole)
2) Severe cases: Systemic therapy (ketoconazole, etc.)
1) Miconazole
Description:
1) Dermatophyte infection of the groin caused by the genera of Trichophyton, Epidermophyton, and Microsporum. Most common caused: T. rubrum and E. Fluccosum
Tinea Cruris (jock itch)
Dermatophyte infection of the foot caused by T. Rubrum, T. mentagrophytes (less commonly by E. floccosum)
Tinea Pedis (Athletes Foot)
Dermatophyte infection of the hand/palm caused by T. Rubrum, T. mentagrophytes (less commonly by E. floccosum)
Tinea Manuum (hand/ palm)
Management of Tinea Pedis and Tinea Manuum:
a) _______ or clotrimazole (pedis)
b) Aluminum subacetate sole. soaks (manuum)
a) Miconazole
Persistent fungal infection affecting the toenails and fingernails caused by dermatophytes
Tinea unguium (onychomycosis)
Treatment of Tinea Unguium (onychomycosis)
Oral antifungals (e.g. itraconazole, terbinafine)
Fungal infection of the skin caused by the yeast. Pityrosporumorbiculare (Malassezia furfur)
Tinea Versicolor (hypo/ hyperpigmentation macules on limbs
Acute vesicular eruption due to infection with the varicella-zoster virus; may be life-threatening in immunocompromised adults
Herpes Zoster (Shingles)
Signs/ symptoms of Herpes Zoster:
a) Pain along with a dermatomal distribution, usually on the trunk
b) Grouped vesicle eruption of ______ and exudate along the dermatomo=al pathway
c) Regional lymphadenopathy may be present
b) erythema
Management of Herpes Zoster (Shingles):
- Treatment options include
a) _________
b) Famciclovir
c) Valacyclovir - If suspected ocular involvement, immediate referral to an ophthalmologist
- Postherpetic neuralgia: Gabapentin (Neurontin); pregabalin (Lyrica)
- Zostavax
1) a) Acyclovir
____ ____
- Small patches occurring on sun-exposed parts of the body
- Premalignant (1: 1,000) lesions progress to squamous cell carcinoma
- Asymptomatic; small patches; may be tender
- Rough, flesh-colored, pink or hyperpigmented
Actinic Keratosis
Actinic Keratosis is treated with?
Liquid Nitrogen
_____ ______ _____
1) Arise out of actinic keratosis
2) Firm, irregular papule or nodule
3) Develop over a few months; 3 to 7% metastasize
4. Prolonged, sun-exposed areas in fair skin people
5. Keratotic, scaly bleeding
Squamous Cell Carcinoma
Treatment of Squamous Cell Carcinoma:
1) _____ and surgical excision (Mohs)
1) Biopsy
_____ _____
1) Benign, not painful lesions
2) Beige, brown or black plaque
3) “ Stuck on” appearance
4) Three to 20 mm in diameter
Seborrheic Keratoses
Treatment of Seborrheic Keratoses is:
1) _____ or liquid nitrogen
1) none
____ _____ ______
1) The most common skin cancer
2) Slow growing lesion (1 to 2 cm after years)
3) Waxy, “pearly” appearance (maybe shiny red)
4) Central depression or rolled edge
5) May have telangiectatic vessels
Basal Cell Carcinoma
Treatment Basal Cell Carcinoma:
_____/_____ biopsy and surgical excision
Shave/punch
Malignant Melanoma:
- Mortality rate highest of all skin cancers
- Median age at diagnosis: ____
- May metastasize to any organ
2) 40
Treatment of Malignant Melanoma:
a) ______and surgical excision
Biopsy
_____ (_____ _____)
1. A chronic skin condition characterized by intense pruritus
2. Acute flare-ups!
a. Red, shiny or thickened patches
b. Inflamed/scabbed lesions with
erythema/scaling
c. Dry, leathery lichenification
Eczema (Atopic Dermatitis)
Treatment Eczema (Atopic Dermatitis):
Topical ________ rubbed in well (e.g.,
Clorbetrasol cream/ lotion)
steroids
Allergic Contact Dermatitis:
- Topical steroids
- Do not scrub with soap and water
- ______ taper if severe
- Prednisone
_____ ______ _____
- An acute or chronic condition characterized by inflammation at the site of contact with chemical allergens
a. Redness, pruritus, scabbing, etc.
b. Sharp, defined borders
Allergic Contact Dermatitis
______
- Benign hyperproliferative inflammation of the skin that can be acute or chronic
- HIV: It may present as the first sign of HIV infection (explosive onset)
- Itching, red, precisely defined plaques with silvery scales
- Fine pitting of the nails
- Auspitz sign: Droplets of blood when scales removed
Psoriasis
Psoriasis Treatment:
- Topicals for the scalp (____/salicylic acid
shampoo) - Topical steroids (betamethasone)
- UVB light exposure
- tar
______ ______
- Mild, acute inflammatory disorder
- More common in females (50% > males) during spring and fall
- Pruritic rash found on the trunk and proximal extremities
- Initial lesion 2 to 10 cm: “Herald patch”
- Generalized rash presents within 1 to 2 weeks
- Lesions follow a Christmas tree pattern (follows cleavage lines on the trunk)
- An eruption lasts 4 to 8 weeks
Pityriasis Rosea
Pityriasis Rosea
7. An eruption lasts ___ to ___ weeks
4 to 8
Pityriasis Rosea
7. An eruption lasts ___ to ___ weeks
4 to 8
Laboratory/Diagnostics for Pityriasis Rosea:
Serologic-test for syphilis should be performed if:
1. _____ are not itching
2. Lesions are present on palmar or plantar
surfaces
3. Lesions are few and perfect
- Lesions
Treatment Pityriasis Rosea:
- Oral __________
- Topical antipruritic
- Cool compresses
- Topical steroids
- UVB light
- Oral erythromycin
- antihistamines
_________
Yellow plaques as a result of fat build-up under the skin, usually near the inner canthus; hyperlipidemia is the underlying cause
Xanthelasma
Xanthelasma Causes/Incidence
1. More common in \_\_\_\_\_ (32%, vs. 17.4%)
2. Peak age-onset: 40 to 50 years
3. Uncontrolled diabetes is a common
cause of secondary hyperlipidemia- women
Signs/Symptoms of __________
- Soft yellowish lesions that form plaques
- Usually located on the medial side of the upper eyelids
- Generally, these lesions do not affect the function of the eyelids, but ptosis has been known to occur
Xanthelasma
Treatment for Xanthelasma:
1) Surgical
2) Argon and carbon dioxide laser ablation
3) Chemical cauterization
4) Electro-desiccation
5) Cryotherapy
1) excision
Treatment for Xanthelasma:
1) Surgical ________
2) Argon and carbon dioxide laser ablation
3) Chemical cauterization
4) Electro-desiccation
5) Cryotherapy
1) Surgical excision
____ _____
- Most common vector-borne disease in the U.S.
- Spread by the bite of infected black-legged ticks (or deer ticks, Ixodes scapularis)
- Takes 24 to 48 hours for a tick to feed and transmit the infecting organism, Borrelia burgdorferi, to the host
Lyme Disease
Signs and symptoms of ________ ________:
- Distinctive’’ bull’s eye,” macular or popular rash (50% of cases)
- Erythema migrans- expanding red lesion with central clearing
- Flu-like symptoms (50% of cases)
Lyme Disease
Laboratory/Diagnostics: Lymes Disease
- ____ testing: initial test
- Western blot: confirmatory
- ELISA testing
Treatment/Management: Lymes Disease
- Doxycycline
- ________
- Others
- Refer
- Amoxicillin
____ ____ ____ ___ (___):
- Lethal bacterial infection
- Transmitted by tick bites Takes 24 hours for Rickettsiae (R. rickettsii) to be transmitted to the host
Rocky Mountain Spotted Fever (RMSF)
Rocky Mountain Spotted Fever (RMSF):
- Maculopapular rash
- ____ ____(35 to 60%)
- Abdominal pain
- Joint pain
- Flu-like symptoms
- Petechial rash
Laboratory/Diagnostics: Rocky Mountain Spotted Fever (RMSF)
- _____ _____ _____ (____)
- Immunohistochemical(IHC) staining
- Indirect immunofluorescence assay (IFA) with R. rickettsii antigen
- Polymerase chain reaction (PCR)
Treatment for Rocky Mountain Spotted Fever (RMSF):
- _______
- Refer
- Doxycycline
____ _____:
Infectious disease unique to humans, caused by virus variants; localizes in blood vessels of the skin, mouth, and throat
Small Pox
____ _____:
Signs/Symptoms
1. Sudden onset of flu-like signs and symptoms
(e.g., fever, headache, fatigue, back pain,
vomiting, and diarrhea, etc.)
2. Smallpox rash appears as fiat, red
spots/lesions
3. Within 2 days, lesions turn into small blisters
filled with clear fluid and later with pus
4. The distribution of lesions is a hallmark of
smallpox; the primary way of diagnosing the
disease:
a. First lesions on the oral mucosa/palate, face
or forearms
b. Centrifugal distribution with the greatest
the concentration of lesions on the face and
distal extremities
c. On any one part of the body, all the lesions
are in the same stage of development
d. Scabs lead to deep, pitted scars
5. Pain can be excruciating
Small Pox
Treatment: _________
1. ______ vaccine before the infection
2. No cure for smallpox once infected
3. Supportive therapy and antibiotics to treat
secondary bacterial infections
4. Isolation of infected persons to prevent
spreading to others
Smallpox
________
1. Acute disease caused by the bacterium
Bacillus anthracis (often referred to as
“spores” for short, but are not fungal spores)
2. Anthrax spores can be produced in vitro and
used as a biological weapon
3. The disease is mostly lethal; affects both
humans and animals
4. Spores are transported by clothing, shoes,
body of dead animals that died of anthrax
Anthrax
Anthrax
Signs/Symptoms
1. Cutaneous (most common, ___% of cases)
a. Occurs on exposed areas on the arms and hands, followed by face and neck
b. Pruritic papule leading to ulcer surround by vesicles
c. Develops into black necrotic central eschar with edema
d. After 1 to 2 weeks, eschar dries, loosens, separates, leaving a permanent scar
e. Regional lymphadenopathy
- Inhalation (= ___% of cases) follows deposition of spore-beating particles into alveolar spaces, the clinical presentation shows a biphasic pattern:
a. Prodromal phase: Non-specific flu-like
symptoms of fever, dyspnea, malaise,
myalgia
b. Fulminant phase: Fever, diaphoresis and
septic shock
- 95%
2. 5%
Laboratory/Diagnostics for Anthrax:
1. _____ _____ of specimen Treatment
Gram Stain
Treatment for Anthrax:
- A vaccine exists for those at risk (e.g., military, others)
- Antibiotics:
a. Penicillin
b. __________
c. Doxycycline
d. Others - Report to the Health Department
b. Ciprofloxacin (Cipro)
Signs/Symptoms:
Flesh-colored papule with a rough surface
Common Warts (verruca vulgaris)
Management: Common Warts
1) ___ _____
2) Liquid nitrogen
3) Electrocautery
1) Salicylic acid
Signs/ symptoms:
1) Finger-like appearance with various projections
Filiform Warts (digitate)
Management of FIliform Warts:
1) Tretinoin cream
2) Liquid nitrogen
3) _________
Electrocautery
Signs/ Symptoms:
1) Pink or light yellow
Flat Warts
Management of Flat Warts:
1) _____ cream
2) Liquid nitrogen
3) Electrocautery
1) Tretinoin cream
Signs/ Symptoms: Plantar Warts
1) _____ surface, slightly raised, may be painful
Roughened
Management: Plantar Warts
1) ____ _____ (Occlusal- HP or Mediplast)
2) Compound W Freeze Off
3) Blunt dissection
4) Laser therapy
1) Salicylic acid
Signs and symptoms:
Pale pink with several projections and a broad vase (cauliflower)
Genital Warts
Management of genital warts:
a) 20% podophyllin resin (Pododerm)
b) ______ (Condylox)
c) Cryosurgery
d) Trichloracetic acid (TCA) or bichloracetic acid (BCA)
b) Podofilox
Hypersensitivity reaction to a particular allergen; symptoms can vary greatly in intensity
Allergic reactions
Treatment of allergic reaction include:
a) Withdraw any medication that is causing the reaction
b) Antipruirutic agent- ________
b) antihistamine
Precipitated by any circumstance that dries a person’s skin
Senile Pruritus
Treatment of Senile pruritus:
a) ____ oils, moisturizing lotions, and massage are beneficial
b) Antihistamines and topical steroids may be prescribed for relief
a) Bath
Tissue damage resulting from exposure to cold
Frost Bite
Treatment for Frost Bite:
a) Assess for hypothermia
b) Soak in the water at \_\_\_\_ degrees
Fahrenheit
c) Treat for painb) 100
Insect bites and stings that cause toxic reactions that range from local and mild to life-threatening
Insect stings and bites
Treatment of insect stings and bites:
a) remove ______
b) Topical or intralesional corticosteroids
c) topical anesthetics
a) stinger
