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)
