Midterm - Skin conditions & misc. Flashcards
Specificity
Ability of a test to accurately identify the individuals who don’t have the disease as negative.
High specificity means…
High percentage of healthy individuals show normal results
Low specificity means….
High number of false positives
How much do Medicare patients pay out of pocket?
20%
Medicare part A
Covers inpatient hospital stays, SNF, hospice and home care
Medicare part B
Covers outpatient services, surgery, lab tests, medical equipment and preventative exams
Medicare part C
Covers wellness services, vision and hearing exams, glasses and hearing aids.
Medicare part D
Covers prescriptions
Medicare Advantage Plans
Has additional benefits and has lower copays.
What rate are NPs reimbursed compared to MDs?
85%
List some third party payers
- Medicare
- Medicaid
- Indemnity insurance
- Managed care organizations
- Workers comp
- VA
- Auto liability
How do fungal skin infections present?
Papular rash with satellite lesions. Often found in dark, moist areas with less air circulation.
How are fungal skin infection diagnosed?
Based on presentation
What is the most common organism that causes fungal infections?
Candida albicans
How are fungal infections treated?
Topical anti fungal cream, oral anti fungal, keep the area as dry as possible.
What populations are at higher risk for fungal infections?
- Immunocomprimised
- Older/younger (diaper rash)
- DM
- antibiotic therapy
- AIDS/HIV
- Corticosteriods
- Chemo
- ICU
Tinea versicolor
Flat/slight elevated brown papules and plaques that scale when they are rubbed together.
Hypo or hyper pigmentation and pruritis.
Trunk and shoulders
Balanitis
Tinea of the penis, usually caused by yeast overgrowth
Tinea corporis
Lesions with scaly borders and central learning on the trunk. May be ring shaped (ringworm)
Tinea pedis
Athlete’s foot - usually presents between the toes
Tinea Cruris
Jock itch
Tinea unguium
Nail fungus causing white or yellow nail discoloration, thickening of nail bed, separation from nail bed. More common in toenails can also occur in fingernails.
Medications for fungal infections
- Nystatin
- Miconazole
- Terbinafine
Dry skin
Older adults at higher risk.
Education - wash with tepid water and mild soap/creams
What characterizes bacterial skin infections?
Warm, red, painful without a sharply demarcated border.
Cellulitis
Spreading infection of the epidermis and subcutaneous tissues that begin after a break in the skin.
Diabetics at increased risk.
Folliculitis
Superficial to deep skin infection of the hair follicles.
Lesions can range from minute white-topped pustules (children) to large, yellow-white tender pustules (adults). Bacteria infect the hair follicle at a superficial level, leading to erythematous papules and pustules.
Impetigo
Highly contagious bacterial infection characterized by bumpy rash, anywhere on body, with burning and pruritis. Pustules with 1-2mm of erythema surrounding. Lymphadenopathy.
Lesions should be debrided.
Epidermal inclusion cyst
Appears as a slowly enlarging, mobile, dome-shaped lump, filled with keratin material and located just below the surface of the skin.
Usually located in areas of the body where there is thicker skin and a large number of sebaceous glands, such as on the back and upper shoulders. Will be in the same place for months or years. Cheesy white discharge when expressed.
Urticaria
Hives.
Assess location of the rash, if it is head and neck look for respiratory symptoms, difficulty breathing, hoarseness. DO YOU NEED EPINEPHERINE? Prioritize ABCDE.
Type 1 allergic reaction
Cholinergic urticaria
Can be hives or wheals. presents with pruritus on the trunk and arms. Usually follows exercise, anxiety, elevated body temp, hot baths or showers.
Treated with antibiotics.
Atopic dermatitis
Long term inflammation. Characterized by intense pruritus which often occurs prior to the rash. Dry, itchy, red and cracked skin. Common areas include the antecubital fossa and the popliteal fossa.
Herpes simplex virus and the skin
May be oral or genital.
Symptoms include
- blistering sores
- itching
- Fever
- Headache
- Pain with urination (genital)
- Fatigue
-Lack of appetite
Can be infected and have no symptoms.
Treat with famcyclovir or valacyclovir
Herpes zoster - skin
Caused by the varicella zoster virus.
Presents with unilateral rash across a dermatome. Begins with erythema then papular lesions form and turn into vesicles, they release infectious fluid and then scab over.
Acne
Results from clogged or plugged hair follicles under the skin. Small to large red pustules that may be painful.
First line treatment for acne
Benzoyl peroxide
When to use antibiotics for acne?
For those at risk for pigmentation changes, scarring, nodulocystic acne and those that want quick relief from inflammatory acne
Patient education for acne
- always use sunscreen with acne mediations
- wash face gently 2x day with antibacterial soap
Rosacea
Skin condition that causes blushing/flushing and visible blood vessels in the face. May also produce small pus filled bumps that flare up for weeks at a time.
Has a familial component.
What causes rosacea?
- neurovascular dysregulation
- infection
- factors that trigger immune response (sun exposure, heat, alcohol, hot beverages, hormones)
First line treatment for rosacea
Topical metronidazole
6-8 weeks for results to be seen.
Teaching for patients with rosacea
- how to identify triggers
- sunscreen application
- protect face from sun and wind
Seborrheic keratosis
Superficial epithelial growths that result from benign proliferation of immature keratinocytes.
Older white women most at risk.
S/S - itching, irritation from rubbing on clothing.
Inspection may reveal dark keratin plugs of firm horny cyts on skin surface
Non-cancerous, benign
Look like dark, dry nevi
Actinic keratosis
Flesh colored lesion that is dry, hard and sandpaper-like.
Diagnosis based on presentation. Usually found in sun exposed areas.
Treat with cryotherapy
Can lead to squamous cell carcinoma. Refer to dermatologist to prevent progression.
Those most at risk for malignant melanoma
- age
- immunosuppression
- indoor tanning
Malignant melaoma
Most aggressive form of skin cancer. Size and depth of the lesion affects the prognosis.
A - asymmetry
B - borders
C - color
D - diameter
E - evolution
Lipoma
Benign, smooth, rubbery, round mass of compressible soft tissue. Benign fat tumor between the skin and muscle. Can be found anywhere on the body. Often neck, shoulders, armpits, thighs.
Scabies
Intensely itchy rash caused by scabies mites. Can last days or weeks. Transmitted through direct contact. Usually diagnosed after hypersensitivity occurs.
How are scabies treated?
Ivermectin
Differential diagnoses for scabies
- Atopid dermatitis
- Contact dermatitis
- Folliculitis
Pediculosis
Nits that are firmly cemented into place and do not slide on the hair shaft. Itching may continue for up to a week after treatment due to slow resolution of inflammatory response to lice infestation.
Furuncle
Painful red bumps under the skin caused by infection of hair follicles or oil glands. Starts as red tender lump at infection and may grow to form pus filled lumps.
If furuncle or carbuncle on the axilla what differential diagnosis should be considered?
Hidradenitis suppurativa -a long term skin condition characterized by painful bumps under the skin (armpits, groin, buttocks or breast)
Warts
- Caused by HPV, usually recur despite treatment
- Abrading skin can spread virus (rubbing, shaving, nail biting etc)
- Easily treatable but reoccurs
