FNP-Integument Flashcards
Rocky Mountain Spotted Fever (RMSF)
(Rickettsia rickettsii parasite)
>60% occur in south eastern to south central states, NC, OK, AK, TN, MO
caused by an infected wood tick bite
Most cases btw April to Sept. (Spring to Summer)
Highest incidence in >40 yo, Native Americans, and males.
- Aburpt onset of fever, chills, severe HA, n/v, photophobia, myalgia, arthralgia.
- followed by a rash 2-5 days later.
- petechiae, starts on wrists, forearms and soles. Progessses towards trunk and then becomes generalized.
- Labs: antibody R. rickettsii antibodies
- CBC, LFTs, CSF
- 1st line tx=doxycycline BID, for 7-14 days
- effective if within 5 days.
- Complications=death, neurological sequelae (hearing loss, paraparesis, neuropathy, etc.)
Erythema Migrans (Early Lyme Dz)
(Borrelia burgdorferi)
- Most common in North-eastern US
- Classic lesion is a “target lesion”
- appears ~7-14 days after a deer tick bite
- hot to touch, with rough texture.
- Commonly in belt area, axillary line, behind the knees, and groin
- Rash spontaneously resolves in a few weeks
- Flu-like symptoms
- Labs (two step/two tier testing recommended:
- enzyme immunoassay (EIA), if neg. no further testing necessary
- If pos., “western blot” test (indirect immunofluorescence assay)
- Tx (early Lyme only):
- Doxy BID, x10 days (first line for kids and adults)
- Alternative=amox. 500mg, TID or Ceftin 500mg BID, x14 day
- Complications:
- Neuropathy
- Lyme arthritis, chronic fatigue
Impetiago
“Honey colored” crusts
fragile bullae
pruritic
Measles
Koplik’s spots
- small, white, round spots on red base on buccal mucosa by rear molars
Scabies
(Sarcoptes scabiei mite)
- Caused by burrowing mites
- Transmitted by close contact
- itchiness may last or 2-6 weeks post tx d/t rxn to mites and their feces
- Extremely pruritic, esp. at NIGHT
- serpiginous rash on interdigit webs, waist, axilla and genitals
- Treatment:
- Elimite (permethrin 5%) from neck to feet for 8-14 hours
- treat entire household
- Itching may be treated with benadryl and topical steroids
Scarlet Fever
classic “sand paper” rash with fever
Tinea Versicolor
- Hyperpigmented round to oval macular rashes on upper shoulders and back
- not pruritic
Pityrisasis rosea
Classic “Christmas Tree” pattern (rash on cleavage lines)
starts with herald patch (looks like regular ringworm) is the largest lesion
Molluscum contagiosum
Smooth papules, 2-5 mm in size
Dome shaped with central umbilication (“white plug”)
Caused by poxvirus
Spread by direct skin to skin contact
Be concerned if on genitals of kids
CDC considers a STI if on sexually active adolescents and adults
- no need to treat, will clear in 6-12 months
Meningococcemia
(Meningitis)
- caused by Neisseria meningitidis.
- Aerosol droplet precautions
- high risk in 1st year college student in dorms and people with no spleen
- rapid progression to DEATH within 48 hours in fulminant form
- Sudden sore throat, cough fever, HA, stiff neck (nuca rigidity), photophobia, and changes in LOC
- petechial to hemorrhagic rashes in axillae, flanks, wrists and ankles (50-80% of cases)
- Refer to ED
- Prophylactic treatment for close contacts: Rifampin BID for 2 days
Shingles
(Secondary Varicella-Zoster Virus Infection)
- reactivation of varicella-zoster virus(primary infection=chickenpox)virus that was latent in a dermatome
- Contagious with onset of rash until lesions have crusted over
- Affects the elderly or older adults more often
- Acute onset of groups of papules and vesicles on a red base that rupture and become crusted
- lesions follow a dermatome on one side of body
- severe pain/burning at site prior to breakout
- May last 2-4 weeks
- Gold standard labs: viral culture, PCR for VZV
- Treat with acyclovir 5x daily or valcyclovir BID, 10 days
- Refer to opthalmology or ED if eye affected
Melanoma
ABCDE screening
A=asymmetry
B=border irregularity
C=color varies in same region
D=diameter >6mm
E=enlargement or chnage in size
Basal Cell Carcinoma
(BCC)
Pearly or waxy appearance
Atropic or ulcerated center that does not heal
Color: white, light pink, brown or flesh-colored.
Telangeictasias present
Actinic Keratosis
Precancerous (squamous cell carcinoma) lesion
Hx chronic sun exposure, past hx blistering sun burns as a child
Most common on cheeks, nose, face, neck, arms and back (high sun exposure)
- Numerous dry, round pink to red lesions with rough, scaly texture that do not heal
- Slow growing
- Refer to derm for biopsy (gold standard)
- Treatment=cryotherapy to 5 FU cream
Subungual hematoma
Blood blister under a nail
Treat by draining blood (trephination). Basically, creating a hole in the nail with a heated, sterile needle or paperclip
Seborrheic keratosis
Xanthelasma
Lipoma
Acanthus nigrans
Associated with: Diabetes, metabolic syndome, obesity, GI tract CA (rare)
Psoriasis
Atopic dermatitis (Eczema)
Clenched Fist Injuries
Erysipelas
Bites: Human, dog, cat
Hidradentitis suppurtiva
Tinea (ringworm) Infxns
types, treatment
Capitis=scalp
Pedis=foot
Corporis or Circinata=body
Cruris=groin (jock itch)
Manuum=hands
Barbae=beard area
Acne Vulgaris
mild and moderate treatment
mild
moderate
Severe Custic Acne
Burns
1st, 2nd, 3rd degree descriptions
Burns
Total Percentage Body Surface Area (TBSA)
Rule of Nines for Chiuldren & Adults
TBSA “Rule of Nines”
Children
- Body surface=9% for each arm
- Body surface=14% for each leg
- Body surface=18% for ant. truck and post. trunk
Adults
- Body surface=9% for each arm, head
- Body surface=18% for each whole leg, ant. truck or post. trunk
example:
adult with bright red skin on right arm and right thigh. Chest and abdominal area are bright red with several bullae.
Superficial thickness (1st deg) on arm=9%, right thigh= 9% (only helf of whole leg), and partical thickness (2nd deg.) on chest and abdomin (ant. trunk). TBSA=36%
Burns
Criteria for burn center referral
involvement of face, hands, feet, genitals, major joints
Skin Cancer facts
1 most common cancer in US
Basal cell carcinoma is the most common
Melanoma is the most deadly
