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PM3A: Spring > Scabies, Lice, Boils, Impetigo, Burns, Photosensitivity, Wound Healing > Flashcards

Scabies, Lice, Boils, Impetigo, Burns, Photosensitivity, Wound Healing Flashcards

1
Q

What is scabies

A

Infestation of the skin with the mite that can be transferred person to person through physical contact or animals

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2
Q

What are the symptoms of scabies

A

Pruritic lesions that are worse at night with erythematous papules and burrows in web areas of hands, wrists, waistline and genitals

Lasts up to 3 weeks even after treatment despite killing of mites (droppings)

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3
Q

What are the different form of scabies

A
  1. Classic scabies: erythematous papules that appear in finger web spaces, wrists, elbows and axillary folds
  2. Crusted scabies: due to impaired immune system
  3. Nodular scabies: more common in infants and young children- due to hypersensitivity
  4. Bullous scabies: occurs in children and elderly
  5. Scalp scabies: occurs in infants
  6. Scabies incognito: wide atypical form
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4
Q

How do you treat scabies

A

Permethrin (1st line)

Apply to entire body from neck down and wash off after 8-14 hours

Repeat treatment after 7 days

Lindane not recommended in children (<2 years)

Ivermectin

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5
Q

What population do lice commonly affect and what area of the body

A

Girls between 5-11

Affect SCALP , PUBIC HAIR (crabs) and eyelashes

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6
Q

What are the symptoms of lice

A

Intense pruritus caused by bites on shoulder, abdomen and buttocks

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7
Q

How do you remove head lice

A
  1. mechanical removal: use of nit comb to comb back wet hair (scalp) at 4 day intervals
  2. Dimeticone (4%) for dry hair and scalp, allow to dry naturally, wash off after 8 hours. Repeat after 7 days.
  3. Malathion (0.5%): apply to dry hair and scalp, allow to dry naturally, wash off after 12 hours. Repeat after 7 days.
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8
Q

How do you remove pubic (crabs) lice

A
  1. Malathion (0.5%): apply over body and wash over naturally after 12 hours
  2. Permethrin: apply 5% cream all over body, dry naturally, leave for 12 hours or overnight then wash off
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9
Q

What are furuncles and carbuncles, and causes

A

Furuncles: infected spot found on face or nose mainly

Carbuncles (multiple furuncles): commonly found on buttocks, breasts, face and neck

Causes: Staphyloccocus infection

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10
Q

How do you treat boils like furuncles

A

Topical antibiotics for small area

Larger regions use of systemic antibiotics for patients with expanding cellulitis or immunocompromised

Application of soap containing containing CHLORHEXIDINE GLUCONATE with ISOPROPYL ALCOHOL or 2-3% CHLOROXYLENOL

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11
Q

What is impetigo and ecthyma

A
  1. A superficial skin infection that causes crusting caused by streptococci and staphylococci
  2. Ecthyma: ulcerative form of impetigo, punched out like ulcers with thick, brown and black crusts
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12
Q

What are the symptoms of impetigo

A
  1. Clusters of vesicles, pustules that rupture or development of honey coloured crust
  2. Mild discomfort or pain
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13
Q

How do you treat impetigo and ecthyma

A
  1. Fusidic acid (2%)
  2. Mupirocin (2%)
  3. Oral antibiotics: Flucloxacillin and clarithromycin
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14
Q

What can photosensitivity lead to symptom wise and how do you treat it

A

Symptoms: Redness, urticaria, rash: all occurs within minutes of sunlight exposure

Treatment: Sunlight induced following cosmetic use (topical corticosteroids and avoiding causative agents)

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15
Q

How do drugs induce photosensitivity/toxicity

A

Light absorbing compounds directly generate free radicals and inflammatory mediators

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16
Q

What drugs typically cause phototoxic reactions

A
  1. Acne drugs: Isotretinoin
  2. Antibiotics: Tetracyclines, trimethoprim, quinolone, sulphonamides
  3. Tricyclics
  4. Griseofulvin
  5. Sulphonylureas
  6. Antipsychotics
  7. Diuretics: Furosemide, thiazides
  8. Cardiovascular drugs; Amiodarone
  9. Topical preparations: antibacterial (chlorhexidine), antifungals, coal tar, fragrances
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17
Q

What is a burn

A

Injuries to skin or tissue caused by thermal, radiation, chemical or electrical contact

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18
Q

What causes chemical burns

A

Strong acids or alkalis
Phenols or cresols
Skin and deeper tissue necrosis

19
Q

What causes thermal burns

A

Liquids, flames, solids, gases and object

20
Q

What is the end result of a burn

A

Protein denaturation and coagulation necrosis

Platelet aggregation

Vessel constricting around coagulated tissue

Skin necrosis

Inflammation in inflamed region and infection due to epidermal layer - leads to oedema and external fluid leakage

Thermoregulation of damaged dermis leads to impaired heat loss and fluid leakage and increased evaporative heat loss

21
Q

What is a first degree burn

A
  1. Red rash, blanching marked with light pressure, painful and tender
  2. LIMITED TO EPIDERMIS
22
Q

What is a second degree burn

A

Involves part of dermis: Superficial and deep

  1. Superficial: upper half of dermis that heals within 2-3 weeks
    Skin is: red and white, blanches with pressure
    Vesicles develop
  2. Deep: bottom half of dermis
    3 weeks to heal: common scarring
23
Q

What is a third degree burn

A

Full thickness

Extends over all layers and into underlying fat

24
Q

How do you treat burns

A
  1. Examination of Airway, breathing and circulation
  2. Removal of any clothing that covers burns
  3. Flush chemicals with water for at least 20 minutes (if involves acid and alkalis)
  4. Small burns: immersed with cold water until pain subsides
  5. After cleansing wound: application of topical antibacterial salve (silver sulphadiazine 1%) and sterile dressing
  6. Dressings are changed daily and cleaned with water
  7. Surgery grafting is for all third degree burn and ones that do not heal within 3 weeks
25
Q

What is a skin mesh

A

Skin taken from area like thigh and meshed to cover a large wound

Example: 5cm2 area of thigh, meshed to cover 10-20cm2 wound

26
Q

What is abrasion

A

graze, superficial epidermis layer removed off

27
Q

What is laceration

A

Irregular tear

28
Q

What is avvulsion

A

Removal of all skin layers by abrasion

29
Q

What are the four types of wounds and explain them

A
  1. Necrotic
    Dead (ischemic) tissue: black and covered with epidermis
  2. Sloughy
    Yellow due to accumulation of cellular debris, fibrin, serum exudate, bacteria
  3. Granulating
    Typically deep pink or red with a highly vascularised irregular granular appearance
  4. Epithelising
    Cells migrating from wound edges to start process of re-epithelisation
30
Q

Describe haemostasis

A
  1. Injury
  2. Vasoconstriction
  3. Platelet aggregation
  4. Coagulation Cascade PF3 (platelet factor 3)
  5. Haemostats plug/clot seal damaged vessel
31
Q

Describe Inflammation

A
  1. Redness, swelling, heat and pain: caused by capillary blood system, blood system increasing circulation and underlaying epithelial growth
  2. Initiate wound healing through wound stabilisation via platelet activity (stops bleeding and triggers immune response)
  3. Within 24 hours of initial injury: neutrophils, monocytes, macrophages: controls bacterial growth and removes dead tissue
32
Q

Describe proliferation

A

Begins 24 hours after injury and can last up to 21 days

Characterised by epithelialisation, granulation, collagen synthesis

33
Q

What is granulation

A
  1. Formation of new capillaries that generate and feed new tissue (angiogenesis)
  2. Creation of beefy looking tissues that bleed easily
  3. Fibrous connective tissue (replace fibrin clot)
  4. Grows from base of wound
34
Q

What is epithelialisation

A

Formation of epithelial layer that seals and protects the wound
Needs a moist environment

35
Q

What is collagen synthesis

A

Creates a new support matrix that provides tissue its strength

Essential: oxygen, iron, vitamin C, zinc, magnesium and protein

Actual rebuilding of barrier

36
Q

What is wound contraction

A

Occurs one week after post injury when skin starts to align itself along collagen to grow out

Larger wounds can be 40-80% smaller after contractions

37
Q

Describe maturation

A

Final wound healing stage: collagen synthesise and degradation

Replaces collagen type 3 made at proliferation with a stronger type 1 version

Disorganised collagen fibres are rearranged, cross linked and aligned across tension lines

38
Q

What is primary wound healing

A

Wounds are bought together so they are adjacent to each other

performed with sutures, staples or adhesive tape

Minimises scarring and infection risk

39
Q

What is secondary wound healing and the advantages/disadvantages

A

Wounds can granulate

Granulation results in broader scar than primary intent

Advantages: removal of foreign bodies, prevents haemotoma development

Disadvantages:
Healing can be slow due to drainage from infection

40
Q

What is tertiary healing

A

Healing by purposely leaving the wound open

Initially cleaned, debrided (removal of dead, damaged, infected tissue)

Phagocytosis occurs, epithelialisation, collagen deposition, maturation occurs

Wound is normally closed after 4-5 days

41
Q

What is a scar

A

Part of natural healing process

Formed due to collagen, sweat glands, hair follicles do not grow back

Wound does not clear normally

42
Q

What is a hypertrophic scar

A

Overproduction of collagen: causes scar to be raised above skin

Typical red raised lump on skin

43
Q

What is a keloid

A

Overgrowth of collagen forming shiny nodules that can be pink, red or brown

Caused by surgery, accident, acne or body piercings

Harmless can be itchy or painful though

44
Q

What is a atrophic scar

A

Sunken recess in the skin with a pitted appearance

Cause: underlying structure supporting the skin (fat and muscle) are lost

Associated with: acne, chicken pox

PM3A: Spring (16 decks)

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