Integumentary Flashcards
What type of burn: dry, red, no blisters, involves epidermis only
First degree
Moist, blisters, extends beyond epidermis
Second degree–partial thickness
Dry, leather, black, pearly, waxy; extends from epidermis to dermis to underlying tissues, fat, muscle and/or bone
Third degree–full thickness
What age can you begin to use the rule of 9’s to measure burns?
9 years old
What would require prophylactic intubation if present following a burn?
Singed nares/eyebrows, soot in nares/mouth
What should be the first process when dealing with a burn?
Stop the burning process by removing burned clothing and dousing the burn in cool water
What is a particular risk in young children following burns?
Hypothermia
What is the most critical time frame following a burn?
The first six hours
What are the three systemic approaches to evaluating skin disorders?
Morphology, configuration, and distribution
A flat discoloration. Example: ephelides (freckles), petechiae, flat nevi (moles)
Macule
An elevated, firm lesion greater than 1 cm. Examples: xanthoma and fibroma
Nodule
A flat discoloration that looks as though it is a collection of multiple, tiny pigment changes; may be some subtle surface changes. Examples: Mongolian spot, cafe au lait spot
Patch
A firm, elevated lump
Tumor
A small, less than 1 cm, elevated and firm skin lesion. Examples: ant bite, elevated nevus (mole), verruca (wart)
Papule
A scaly, elevated lesion; the classic lesion of psoriasis
Plaque
A small, greater than 1 cm lesion filled with serous fluid. Examples: herpes simplex, varicella, herpes zoster (shingles)
Vesicle
Serous fluid-filled vesicles greater than 1 cm. Examples: burns, superficial blister, contact dermatitis
Bulla
A lesion raised above the surface and extending a bit below the epidermis; many times an allergic reaction (either contact or systemic)
Wheal
A small, less than 1 cm pus-filled lesion. Example: Acne and impetigo
Pustule
A pus-filled lesion greater than 1 cm
Abscess
Large, raised lesions filled with serous fluid, blood, and pus
Cyst
Individual or distinct lesions that remain separate from one another
Solitary or discreet
How the lesions present on the body
Configuartion
A linear cluster of lesions
Grouped
Lesions that run together, cannot tell where one starts and the next ends
Confluent
Scratch, streak, line, or stripe lesions
Linear
Circular, beginning in the center and spreading to the periphery
Annular
Annular lesions merged together
Polycyclic
This defines where on the body the lesions appear
Distribution
A polymorphic skin disorder characterized by comedones, papules, pustules, and cysts
Acne
Acne is more common and severe in _______.
Males
These can either be open or closed. If open, it is a blackhead and if closed, it is a whitehead.
Comedones
What topical treatment is useful in mild acne?
benzoyl peroxide (2.5-10%)
What topical antibiotics are useful in treating MILD acne?
Erythromycin or clindamycin lotions or pads
For MODERATE acne should be given in conjunction with topical treatments. What is the first antibiotic that should be tried, and the dose?
Doxycycline 100 mg BID
If Doxycycline does not respond to acne, what is the next antibiotic of choice?
Erythromycin 1 gram in 2-3 divided doses
What is the third antibiotic of choice for acne treatment?
Minocycline 50-100 mg BID
Severe acne that does not respond to these treatments, what is the next step?
Refer to dermatology
Where is tinea capitus found?
Scalp
What is tinea corporis?
Body ringworm
What is tinea cruris?
Jock itch
What is tinea manuum and tinea pedis?
Athlete’s foot
Hypo/hyperpigmentation macules on the limbs is called:
Tinea versicolor
What is the primary treatment for fungal infections?
griseofulvin 20 mg/kg/day x6 weeks
For tinea corporis (ringworm), what topical anti fungal is adequate for treatment?
Miconazole or ketoconazole 2%
This cream is curative for tinea cruris in more than 80% of cases when used twice daily.
terbinafine cream
For tinea manuum and pedis, this solution should be used to soak for 20 minutes twice a day
aluminum subacetate solution
What is the treatment for tinea versicolor?
Selenium sulfide shampoo for 5-15 minutes/day x 7 days
Acute, contagious disease caused by herpes virus, transmitted by direct contact with lesions or airborne particles.
Varicella Zoster Virus (Chickenpox)
How long are individuals infectious with chicken pox?
48 hours BEFORE the outbreak and until lesions have crusted over
Most common age to get chicken pox is ages __ to __
5 to 10 years
What does the rash look like in chicken pox?
Erythematous macules with papules developing over the macules and then erupting vesicles
Treatment for pruritus with chicken pox
supportive care
Oral ____________ is given at 20 mg __ times a day in the first 24 hours can reduce the magnitude and/or duration of symptoms
acyclovir
5 times a day
A common, benign viral skin infection; frequently these lesions disappear on their own in a few weeks to a few months and are not easily treated.
Molluscum Contagiosum
Diagnostic criteria for molluscum contagiosum includes ______, the presence of a very small, ______, pink-to-flesh colored discrete _______, which becomes _________ papules with a _______ core.
Pruritis Firm Papule Umbilicated Cheesy
Treatment of molluscum contagiosum
Will resolve spontaneously if left alone
Chronic skin condition characterized by intense itching along a typical pattern of distribution with periods of remission and exacerbation
Atopic dermatitis (eczema)
Is eczema a primary or secondary skin condition?
secondary
Often times eczema presents with ________ skin
lichenified (thickened)
What is the hallmark management for dry skin in eczema?
Moisturizing lotion immediately after bathing; blot dry
What is the topical steroid cream that is first-line treatment in eczema?
hydrocortisone
In acute weeping spell with eczema, use saline or _______ ______ solution and oatmeal baths
aluminum subacetate
An acute or chronic dermatitis that results from direct skin contact with chemicals or allergens
Allergic contact dermatitis
Common skin irritation of the genital-perianal region
Irritant (diaper) dermatitis
What can be used in mild cases of irritant diaper dermatitis?
barrier emollients
If erythema/papules are present in diaper rash, what cream is used?
hydrocortisone 1%
What is the best treatment for diaper rash
allow diaper area to air several times daily
A common benign hyperproliferative inflammatory skin disorder based on genetic predisposition
Psoriasis
In psoriasis, the epidermal turnover time is reduced from ___ days to ___ days
14 days to 2 days
In psoriasis, lesions are red, sharply defined _____ with silvery ______.
plaques
scales
What nail changes are associated with psoriasis?
fine pitting of the nail and separation of the nail plate from the bed
Droplets of blood when scales are removed:
Auspitz’s sign
For treatment of the scalp, use what types of shampoos
Tar/salicylic acid
If more than 30% of the body surface is involved, what should you use for treatment of psoriasis:
UVB light and coal tar exposure
A mild, acute inflammatory skin disorder; usually self-limiting lasting 3-8 weeks. Patients will often report a recent URI
Pityriasis rosea
What is the initial lesion in pityriasis rosea called
Herald patch
“Soap-sud” lesions associated with what
Psoriasis
General mild infection caused by group A beta-hemolytic strep. Contracted through contact with infected respiratory droplets or skin exudate, as a complication of strep throat, or as a result of food-borne bacteria. Most common in children aged 5-15 years.
Scarlet Fever
Scarlet Fever rash: confined, bright red, flat blotches that progress into widespread _______-like papillae
sandpaper-like
Where does the scarlet fever rash present first? then where does it spread?
First: neck/armpits/groin
Next: across trunk and extremities
What is the treatment for scarlet fever?
10 to 14 day course of penicillin or amoxicillin
A bacterial infection of the skin typically caused by gram positive strep or staph organisms.
Impetigo
What area of the body is imeptigo primarily located?
Face
When is impetigo most common?
Summer
Lesions that are present in impetigo are described as:
honey-crusted
For minor impetigo infections, what should be used first?
topical antimicrobials (mupirocin)
Impetigo is highly contagious, and patient should abstain from school events until __ hours of treatment has been completed.
48 hours
A highly contagious skin infestation caused by a parasitic mite that burrows into stratum corneum
Scabies
Thin, white roundworms that live in the colon and rectum of humans; occurs most commonly among school-aged children and younger; spread by fecal-oral route
Pinworms
What test is used to detect pinworms?
Tape test–placed around the anus then look under microscope
A spirochetal disease, the most common vector-borne disease in the US caused by infected mice and deer tick bites
Lyme Disese
What is the organism responsible for causing Lyme disease
Borrelia burgdorferi
In stage one of Lyme disease, A flat or slightly raised red lesion that expands over several days but has a central clearing; commonly appears in areas of tight clothing
Erythema migrans
Stage 2 of Lyme Disease:
HA, stiff joints, bell’s palsy
Stage 3 of Lyme disease:
Joint and periarticular pain
What is a bluish red discoloration of the distal extremities with edema that presents in Stage 3 of Lyme Disease
Acrodermatitits chronicum atrophicans
Treatment for Lyme disease if:
Under 7
Over 7
Under 7: Amoxicillin
Over 7: Doxycycline
Ordinary measles; red measles is calleda;
Rubeola
What is present in rubeola that is specific to this disease process
Koplik’s spots
“German measles; 3-day measles”
Rubella
The rash with Rubella starts where? spreads where? when does it disappear?
Starts on face, spreads to extremities/trunk, and disappears in 72 hours
Official name for Fifth disease
Erythema infectiosum
What causes Erythema infectiosum?
Human parvovirus B19
Define the facial race with Fifth disease
slapped-cheek appearance
lacy reticular exanthema
Children with Fifth disease are/are not contagious after fever breaks.
Are not
This disease is associated with high fever that abruptly stops when the rash develops
Roseola
What does the roseola rash look like? Where does it start first and then spreads to where?
small pink, flat to raised bumps that starts on the trunk and spreads to the extremities
A highly contagious viral illness resulting in ulceration and inflammation of the soft palate (herpangina) and papulovesicular exanthem on the hands and feet
Coxsacki Virus (Hand-Foot-and-Mouth Disease)
What treatment is needed is needed for HFMD?
Self-resolving
A highly contagious viral infection primarily affecting the salivary glands which resolves within 2 weeks
Mumps
What lab test is helpful to diagnose mumps
Mumps immunoglobulin M (IgM)
