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Integumentary infections Flashcards

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USMLE® Step 1 flashcards
1
Q

Atopic dermatitis: Definition

A
  • chronic or relapsing inflammatory skin disease
  • Characterized by pruritus
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2
Q

Atopic dermatitis Risk factors

A
  • Multifaceted - include genetic, immunologic and environmental factors
  • Family history and aberrant skin barrier gene coding
  • Can go along with allergic reaction sometimes
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3
Q

Atopic Dermatitis: clinical manifestations

A
  • rash: Red, oozing, crusting, mainly on flexor side
  • Xerosis: dry skin
  • Pruritus: itching
  • Typically rash spares diaper area
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4
Q

Atopic dermatitis: medical management

A

Medical management
- Topicals (lanolin): coat the skin to add protection
- Systemic medications (antibiotics, antihistamines, antimicrobials, corticosteroids, immunosuppressants, nonsteroidals)
- UV irradiation: dries out the skin
- Education: controlling and minimizing triggers
- Goal of treatment: break inflammatory cycle causing dryness, cracking, itching and scratching

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5
Q

Atopic dermatitis: PT concerns

A
  • Caution with modalities, gels, creams, soaps, cleansers
  • Avoid agents containing alcohol as it can dry out the skin making it crack/open to further infection/irritation
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6
Q

Contact dermatitis: definition

A

a local inflammatory reaction due to external exposure

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7
Q

Contact dermatitis: risk factors

A

immunocompromised

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8
Q

Contact dermatitis: Clinical manifestations

A
  • Erythema: reddening of skin
  • Pruritus
  • Edema
  • Wheals
  • Maculopapular vesicles
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9
Q

Medical management of contact dermatitis

A
  • Examination, patch testing for allergens, topicals, antihistamines
  • Removal of agent
  • Similar to AD
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10
Q

PT concerns for contact dermatitis

A
  • Prosthetics, silicone, gels, lotions, soaps, cleaning products
  • Learn what to avoid
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11
Q

Eczema and dermatitis: definition

A

periods of remittance and relapse of superficial itch, inflammation of the skin

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12
Q

Eczema and dermatitis types

A
  • Types: seborrheic (scalp), nummular (discoid = disc shaped), and stasis dermatitis (related to circulation usually)
  • relapsing/remitting
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13
Q

Eczema and dermatitis: risk factors

A

Risk factors:
- Common in children and adults
- Can be genetic
- Medications
- Stasis dermatitis = venous hypertension/venous insufficiency)

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14
Q

Eczema and dermatitis: Clinical manifestations:

A

Discoid lesions, circular
Red itchy patches

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15
Q

Eczema and dermatitis: Medical management:

A
  • Topical to bring down the superficial irritation
  • Regulation BP/cholesterol if its related to circulation
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16
Q

PT concerns for eczema and dermatitis

A
  • modalities can irritate
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17
Q

Rosacea:
Definition

A

chronic facial disorder of middle-aged and older people; condition caused by vascular and inflammatory componenets)

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18
Q

Rosacea: Risk factors:

A

no known cause

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19
Q

Rosacea: Clinical manifestations:

A
  • Acneiform rosacea can occur with papules (oil in it), pustules and oily skin
  • Cheeks, nose and chin have persistent rosy appearance
  • Pustules, papules, burning or stinging
  • Fascia edema
  • Certain things may cause it to flare up
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20
Q

Rosacea: Medical management:

A
  • Topical or systemic therapy
  • Pulsed dye lasers to seal superficial vessels and help with discoloration
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21
Q

Incontinence-associated dermatitis:
Definition:

A

damage from chronic exposure to urine of feces

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22
Q

incontinence-associated dermatitis:
Clinical manifestations:

A
  • Person may be uncomfortable in seated position or positions that put pressure on genital area
  • Burning, itching or tingling
  • Erosion of skin and maceration
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23
Q

incontinence-associated dermatitis: Medical management

A
  • Gentle cleaning, moisture barrier cream, pressure relief
  • High-grade moisture-wicking underpads
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24
Q

Skin bacterial infections

A
  • Impetigo contagiosa - contagious
  • Pyoderma - contagious
  • Folliculitis (pimple/boil) = contagious but minimal chance of spread
  • Cellulitis - contagious
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25
Q

Skin viral infections

A
  • Verrucae (warts) - contagious, self inoculable
  • Verruca plantaris (plantar wart) - contagious; self inoculable
  • Herpes type 1: cold sore = contagious
  • Herpes 2: genital = contagious
  • varicella -zoster virus: contagious (chickenpox)
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26
Q

Skin fungal infections

A
  • Tinea corporis (ringworm): person to person, animal to personal, object to person
  • Tinea capitis (scalp) = person to person, animal to person
  • Tinea cruris (jock itch) = person to person, animal to person
  • Tinea pedis (athletes foot) = transmission to other people rare
  • Candidiasis = person-person; transmitted during birth from mother to neonate
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27
Q

Impetigo definition

A

superficial skin infection, highly contagious, more in children 2-6 or older adults commonly caused by staph or strep.

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28
Q

Impetigo: risk factors

A

Risk factors:
- Poor hygiene
- Close contact
- Malnutrition
- Minor skin trauma

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29
Q

Impetigo Clinical manifestations:

A
  • Erythematous macules (flat spots) that develop into papular lesions of vesicles (small blisters)
  • Become pustular (pus-filled)
  • Itching and scratching of vesicles after they break/crust
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30
Q

Impetigo Medical management:

A
  • Self-limiting with good hygiene
  • Topical and or systemic antibiotics (cover both staph/strep)
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31
Q

PT concerns for impetigo

A

highly contagious

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32
Q

Cellulitis:
Definition:

A

rapidly spreading bacterial infection of skin and subcutaneous tissue most common in extremities

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33
Q

cellulitis: risk factors

A

Risk factors:
Immunocompromised
Older adults
Venous insufficiency
Thrombophlebitis
Obesity
Surgery
Substance abuse
Open wounds

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34
Q

cellulitis Clinical manifestations:

A

Pain
Erythema
Edema
Elevated temperature of affected skin
fever/chills
Malaise
Most commonly affects extremities

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35
Q

cellulitis: Medical management:

A

Intravenous antibiotic infusion
Debridement

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36
Q

Cellulitis: PT concerns:

A

Monitor progression
Education
Wound care

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37
Q

Warts (verrucae)
Definition:

A

common, benign viral infections of skin and adjacent mucus membranes caused by human papillomaviruses

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38
Q

Warts verrucae: Risk factors:

A

Usually direct contact

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39
Q

Warts Verrucae: Clinical manifestations:

A

Depends on type and location
Verruca vulgaris (hands nad extremities)
Plantar (foot) - no drainage and occur on pressure points

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40
Q

Warts verrucae: Medical management:

A

Diagnosis on visual exam
OTC salicylic acid
Surgical removal
Cryotherapy
Laser
Chemical cautery
Oral medications
Immunotherapy

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41
Q

Ringworm (tinea corporis)

A
  • fungal
  • scales forming circular lesions with clear centers - commonly in hair, skin or nails
  • Transmission with direct contact
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42
Q

Athletes foot (tinea pedis)

A
  • peeling, itching, strong odor
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43
Q

Yeast (candidiasis)

A
  • wet moist areas; bright red rash with tiny macules and papules, scaly
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44
Q

Medical management of fungal infections

A

Medical management: antifungal cream or oral antifungal medications

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45
Q

PT concerns with fungal infections

A

PT concerns: education hygiene

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46
Q

Parasitic infections of the skin

A

Scabies: highly contagious, spread by mites
Lice

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47
Q

Scabies: clinical presentation

A
  • Intense pruritus (worse at night), excoriated skin, one or more burrows with vesicle at one end
  • Direct or indirect contact
  • Flexor surface of wrist, web spaces of fingers, axilla, waistline, nipples (females), genitalia (males), umbilicus
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48
Q

Scabies: treatment

A

Treatment; removal of mites - scabicide ) permethrin of lidane

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49
Q

Pediculosis (lousiness) - lice/human pediculus humanus parasite

A
  • Severe itching, eczematous changes, white or gray nits (eggs) at base of hair follicle
  • Spread by direct or indirect contact
  • Diagnosis: inspection
  • Treatment: disinfectant solution (shampoo or soap containing permethrin)
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50
Q

Seborrheic Keratosis
- where is it?
- when is it likely to occur?
- Describe characteristics
- treatment:

A
  • Basal cells
  • Usually middle age
  • Waxy, smooth, or raised
  • After inflammatory dermatosis
  • Don’t treat unless they become itchy/painful
  • Treatment: cryotherapy
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51
Q

Nev

A
  • Aggregation of melanocytes
  • Usually doesn’t spread
    bleed/itch = could be a problem
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52
Q

Benign lesions of the skin

A
  • serborrheic keratosis
  • nevi
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53
Q

Premalignant lesions

A
  • actinic keratosis (solar keratosis)
  • Bowen disease
54
Q

Actinic keratosis (solar keratosis)
- Caused by
- incidence
- characteristics
- treatment

A
  • UV rays
  • Nearly 100% older caucasian population
  • Well-defined crusty patch (3-6mm)
  • Treatment: 5-fluorouracil, masoprocol cream, cryotherapy, curettage (cutting out)
  • Avoid sun
  • Can be multicolored - ask have you noticed a change in this
55
Q

Bowen Disease definition

A

Squamous cell in situ or SCC in situ
Definition: nonmelanoma skin cancer

56
Q

Bowen disease: risk factors

A

Risk factors:

  • fair-skinned men >50
  • Sun
  • Chemical exposure (arsenic)
  • HPV
  • Associated with internal malignancy
57
Q

Bowen disease clinical manifestations

A

Clinical manifestation
Persistent, brown to reddish brown, scaly plaque with well-defined margins

58
Q

Bowen disease: Medical management:

A

surgical removal,
cryosurgery,
curettage
5-fluorouracil

59
Q

bowen disease: PT concerns:

A

Potential to become invasive and metastasize

60
Q

Malignant non melanoma carcinoma

A
  • basal cell carcinoma
  • squamous cell carcinoma
61
Q

Basal cell carcinoma: Definition

A

slow growing epithelial

62
Q

Basal cell carcinoma: Etiologic and risk factors:

A

Sun exposure
Caucasian
Head and neck

63
Q

Basal cell carcinoma: Clinical manifestations:

A

Red
Crusty
Non-healing

64
Q

Basal cell carcinoma: Medical management:

A

Biopsy
Excision
Chemotherapy

65
Q

Basal cell carcinoma:PT concerns:

A

Potential to metastasize
Caution with contamination
Modalities
Patient education

66
Q

Squamous cell carcinoma: Definition and incidence:

A

2nd most common, epidermal keratinocytes, caucasian, ear, face, lips, dorsum of hand and nose

67
Q

Squamous cell carcinoma: Risk factors:

A

Sun exposure

68
Q

Squamous cell carcinoma: Clinical manifestations

A

Red to flesh colored surrounded by scaly tissue
Poorly defined margins
Discolored
Raised and crusty over

69
Q

Squamous cell carcinoma: Medical management - diagnosis

A

Biopsy
CT
MRI
Blood work: change in WBCs

70
Q

Squamous cell carcinoma: PT concerns:

A

Metastasis (lymph node)
Caution with modalities and contamination
education with patient

71
Q

Malignant melanoma: definition

A

invasive melanomas

72
Q

Malignant melanoma: risk factors

A
  • UV exposure (intensity>duration)
  • Personal or family history of melanoma
  • Fair skin, light hair, blue/green eyes
  • Presence of marked freckling on upper back, nevi, congenital melanocytic nevi
  • Ultraviolet radiation exposure
  • Immune suppression
  • Genetic disorder: xeroderma, pigmentosum
  • Age: older adults or individuals younger than 30
  • Being male
73
Q

Malignant melanoma: Clinical manifestation:

A

70% from pre existing nevi
Most common on head, neck, trunk, legs
Raised, changing appearance,
Pruritus
Hyperkeratosis

74
Q

Malignant melanoma: Medical Management

A

Excision
Oral chemotherapy
Immunotherapy

75
Q

Malignant melanoma: PT concerns:

A

Potential to metastasize
Caution with contamination, modalities
Education with patient

76
Q

Malignant melanoma: Types:

A
  • Superficial spreading melanoma: 70% of all cutaneous melanomas
  • Nodular melanoma: most aggressive
  • Lentigo maligna melanoma
  • Acral lentiginous melanoma
77
Q

Kaposi Sarcoma: definition

A

Connective tissue malignancy, 4 types
- Older Mediterranean or Eastern European men (classic),
- Younger African (endemic)
- Organ transplant (iatrogenic),
- Individuals with HIV (epidemic)

78
Q

Kaposi Sarcoma: Etiologic and Risk Factors-

A

Immunocompromised, male,
herpes virus

79
Q

Kaposi Sarcoma Clinical Manifestations-

A

usually Leg,
early- pink mistaken for bruise or nevi, later red/purple/blue macules-> ulcers,
itching

80
Q

Kaposi Sarcoma: Medical Management- (diagnosis and treatment)

A

biopsy, CT, MRI
Tx.
Antiviral therapy, chemotherapy, surgical removal, laser,
cryotherapy

81
Q

Kaposi Sarcoma: PT Concerns-

A

Potential to metastasize,
caution with friction, and open areas.
Prevent infection, education

82
Q

Psoriasis: Definition:

A

Chronic genetic recurrent inflammatory dermatosis, equal general incidence across lifespan, remitting/recurring

83
Q

Psoriasis: risk factors

A

Genetic link
Immune system dysregulation
Rapid skin turnover that can cause build up

84
Q

Psoriasis: clinical manifestations

A

Well-defined erythematous plaques covered with silvery scale
Does not spread

85
Q

Psoriasis: Medical management
- Dx
- Tx

A
  • Diagnosis history/presentation
  • Treatment: topical corticosteroids, vitamin D, UVB treatment (control flaky), oral meds - methotrexate, psoralens, retinoids
86
Q

Psoriasis:PT concerns

A

Skin care
Maintain mobility
Complications from immunosuppressants
Long term corticosteroid use

87
Q

Lupus Erythematosus: definition

A

cutaneous (discoid) incidence increases with age 60-69, women: men = 10:1
Systemic women:men = 3:1 characteristic rash – butterfly rash that spreads across nose and cheeks

88
Q

Lupus Erythematosus: Risk factors

A

Unknown, autoimmune defect
Thought to be related to infection or genetic

89
Q

Lupus Erythematosus: clinical manifestations

A
  • Cutaneous (Discoid) raised, red, smooth plaques
  • Follicular plugging: white, oily discharge
  • Central atrophy
  • Face, scalp, ears, neck, arms
  • Fatigue, arthralgia, anemia, arthritis
  • Acute cutaneous LE,
  • Butterfly rash over nose and cheeks and forehead
  • Rash on extensor surface of arms, widespread erythema and bullous lesion (concentrated in an area and has fluid)
  • Cardiovascular changes, pulmonary changes live and kidney
90
Q

Lupus Erythermatosus: medical management

A
  • Topical
  • Intralesional or systemic medication
  • Plaquenil for pulmonary inflammation
91
Q

Lupus Erythermatosus: PT concerns

A

Variable presentation
Caution with exercise intensity during flares
Skin care
Education
Watch for multisystem involvement

92
Q

Systemic Sclerosis:
definition/incidence:

A

Previously called scleroderma,
autoimmune disease affecting connective tissue → fibrosis of the skin, joints, blood vessels and internal organs
Women (3):men (1) onset around 20-50

93
Q

Systemic Sclerosis: Risk factors

A

Dysfunctional connective tissue repair following injury

94
Q

Systemic Sclerosis: clinical manifestations

A
  • B/L non pitting edema in fingers and hands
  • Thick, hardening skin
  • change in pigmentation and skin mobility
  • thinning –> ulcerations –> raynauds
  • Mulitsystem involvement
95
Q

Systemic Sclerosis: medical management

A

Difficult to diagnosis, antibody presence
CT, skin presentation
Symptoms management
Medications
Exercises, joint protection techniques
Skin protection techniques
Stress management

96
Q

Systemic sclerosis: PT concerns

A

Possible multisystem presentation
Education
Maintain mobility (stress strain curve)

97
Q

Raynaud phenomenon

A

Vascular vasoconstriction usually with cold exposure
Sudden blanching, cyanosis and erythema of fingers and toes
Hands/feet become white, numb, and then bluish
During rewarming, fingers and toes become painful

98
Q

Polymyositis and dermatomyositis: definition/incidence

A

Idiopathic inflammatory disease of muscle
More common in women than men

99
Q

Polymyositis and dermatomyositis: risk factors

A

Cause unknown, autoimmune
Related to environmental or genetic factors

100
Q

Polymyositis and dermatomyositis: clinical manifestations

A
  • Exacerbations and remissions
  • characterized by symmetric and progressive proximal weakness (pelvis, neck, pahryns)
  • Gottron papules of gottron sign
101
Q

Polymyositis and dermatomyositis: Medical management -diagnosis

A

Diagnosis difficult - progressive symmetric weakness
Labs (CK)
biopsy
EMG

102
Q

Polymyositis and dermatomyositis: PT concerns

A

Skin lesions
Immunosuppressed
Other system involvement
Education
Prevention of decreased mobility

103
Q

Cold injuries: definition

A

Cold (frostbite) can be superficial or deep and hypothermia

104
Q

Cold injuries risk factors

A

Prolonged exposure to cold
Lack of insulating body fat
Advanced age
Homelessness
drug/alcohol abuse
Various peripheral vascular vasoconstriction disease
Diabetes
Altered mental status
Improper clothing
Improper use of cryotherapy

105
Q

Cold injuries: clinical manifestations

A
  • Nose, cheeks and/or ears initial vasoconstriction
  • Freezing with ice formation on tissues
  • Additional injury with thawing
  • Superficial: burning, tingling, numbness, swelling and mottled blue, gray skin color
  • Deep: skin becomes white until thawed and then turns purplish blue, produces pain, blisters, tissue necrosis and gangrene
106
Q

Cold injuries: medical management

A
  • Diagnosis with history and presenting symptoms
  • Localized superficial
  • Slow rewarming
  • Avoid rubbing or massage
  • Deeper or more severe needs medical treatment - topical aloe vera cream
  • Foam dressings to maintain moisture and provide insulation
107
Q

Burns: defintion

A

68% of patients with burns are males
Most occur at home
Children vulnerable

108
Q

burns: risk factors

A

Exposure to thermal, chemical, electrical or radiation source
25% or greater of total body surface will have systemic response

109
Q

Burns clinical manifestations

A

Superficial to full thickness (down to muscle)

110
Q

Burns: medical management

A

Depends on type and extent
Major burn treatment 3 phases:

  • Emergent and resuscitation phase: right then and there of injury
  • Acute phase: other systems kick in
  • Rehabilitation phase: mobilizing
111
Q

Burns PT concerns

A
  • Infection
  • Multisystem involvement
  • Prevention mobility restrictions
  • More deep = more systemic
112
Q

What is the burn chart used for kids called

A

Pediatric burn chart = pediatric scald burn/corresponding lund and browder chart

113
Q

What other complications can arise from burns and what systems?

A
  • Urinary: fluids maintained and need to get things out of body (look for change in urine0
  • Respiratory: excess fluids puts pressure on the lungs; can also burn the lungs
  • Peripheral vascular: overload + swelling
  • Infection: increase risk
  • GI: exchanging in GI therefore it is in high alert with filtering
114
Q

Pressure injuries: risk factors

A
  • Poor health
  • Poor nutrition
  • Decrease mobility
  • Neuropathy
  • Skin perfusion
  • Microclimate
  • Prolonged pressure
  • Shearing
115
Q

Clinical manifestation sof pressure injuries

A

Over bony prominences
Circular pattern
Necrotic tissue

116
Q

Medical management of pressure injuries

A
  • Clinical observation
  • Eliminate cause
  • Wound care - topical antimicrobials/antibiotics
  • Surgical removal of tissue/repair and replace tissue
117
Q

PT concerns of pressure injuries

A
  • Prevent breakdown
  • Turning schedules, wound care
  • Caution with transfers
  • Bed mobility and positioning
118
Q

Pigmentation disorders: definition

A

Altered melanin primary or secondary

119
Q

Pigmentation disorders: risk factors

A

External
Other exogenous pigments

120
Q

clinical manifestations of pigmentation disorders

A
  • Hyperpigmentation pigmented nevi
  • Mongolian spots
  • Juvenile freckles
  • Lentigines (liver spots = darker) from sun exposure
  • Cafe au lait spots (flattened areas of dark skin)
121
Q

Early melanoma detection

A

A: asymmetry
B: borders - clear and even is good
C: color - multicolored is not good
D: Diameter - bigger than an eraser
E: evolution - changing over time

122
Q

Cutaneous sarcoidosis defintion

A
  • Abnormal masses or growths (granulomas)
  • 20% of diagnoses get skin lesions, women, scandinavians, african americans, more serious
123
Q

Cutaneous sarcoidosis risk factors

A

genetic

124
Q

Cutaneous sarcoidosis clinical manifestations

A

Raised patches, deep lumps
Open sores
Granulomas
Skin, lung, live, lymph nodes, eyes

125
Q

Cutaneous sarcoidosis medical management

A
  • X-ray, CT other
  • Corticosteroids, immunosuppressants
  • Methotrexate, azathioprine, hydroxychloroquine, tumor necrosis factor alpha
126
Q

PT concerns fo cutaneous sarcoidosis

A
  • Progression may limit motion
  • Fatigue
  • Other system involvement
127
Q

Blistering disease: Definition:

A

middle aged or older adults all races, unknown cause

128
Q

Blistering disease: Risk factors

A

None

129
Q

Blistering disease: Clinical manifestations:

A

Formation of flaccid bullae or blisters, oral mucous membranes or scalp

130
Q

Blistering disease: Medical management

A

Depends- hospitalization, symptomatic
Corticosteroids, intravenous antibiotics

131
Q

Blistering disease: PT concerns:

A

Protect open areas, caution with modalities, gels and creams

Medical Conditions 2 (22 decks)

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