skin

Question 1

rocky mountain spotted fever

Answer 1

small red spots on hands/feet that progress toward the trunk
fever, n/v
rash day #3
south central common

Question 2

actinic keratosis

Answer 2

dry, red round lesions with rough texture

sun exposed areas

Question 3

meningococcemia

Answer 3

meningitis rash
“sudden” stiff neck, fever, changes in LOC
hemorrhagic rash in the axillae, flanks, wrist, and ankles
rifampin prophylaxis

Question 4

erythema migraines

Answer 4

early lyme disease 
bulls eye rash 7-14 days after deer tick bite 
flu like s/s
most common northeast region
use DEET

Question 5

herpes zoster opthalmicus

Answer 5

herpes soter on the trigemnal ( V) nerve. sudden vesicular lesions on the ONE side of the scalp, forehead, and tip of the nose. blurry vision. ED

Question 6

melanoma

Answer 6

> 6mm, irregular borders. can appear in the nail pads or retina

Question 7

basal cell carcinoma

Answer 7

pearly or waxy lesion with ulcerated center.

Question 8

acral lentiginous melanoma

Answer 8

most common type of melanoma in AA and asians. located on the nailbes, palmar, and plantar surface. longitudinal brown to black bands on the nail beds

Question 9

subungual hematoma

Answer 9

draining

use heated paperclip or 18 g neede press down to create 3-4mm hold. blood may drain for 24-36 hrs

Question 10

steven johnson syndrome (erythema multiform major)

Answer 10

bulls eye lesions
bulla
painful
involves eyes nose, mouth, esophagus
fever before rashes appear
hypersensitivity caused by medicines, infections,a nd malignancies
PNS, sulfas, barbiturates, and phenytoid ( dilantin)
HIV have 40 fold risk of SJS dt to trimethoprim/sulfa

Question 11

lyme disease s/s

Answer 11

erythema migraines ( rash that can span 12 inches bulls eye), facial palsy, swollen knee

Question 12

what skin lesions show bulla (superficial blister >1cm)

Answer 12

impetigo, 2nd degree burn, SJS lesion

Question 13

vesicle

Answer 13

herpatic lesions

Question 14

seborrheic keratoses

Answer 14

soft wart like growths, esp on the back

Question 15

xanthelasma

Answer 15

yellow colored plaques under the brow or upper.lower lids of the eyes. hyperlipidemia if

Question 16

lipoma

Answer 16

soft fatty cystic tumors, painless, located on trunk, legs/arms, neck

Question 17

xerosis

Answer 17

extremely dry skin and may involve mucosal or eyes (xerostomia, xeropthalmia)

Question 18

acanthosis nigrans

Answer 18

thickening of the skin behind the neck/axilla. DM, metabolic syndrome, obesity, cancer of the GI tract

Question 19

psoriasis

Answer 19

skin cells undergo rapid mitotic division=plaques
koebner phenomenon= new plaques over area of skin trauma
auspitz sign- pinpoint areas of bleeding when plaque is removed

black box warning for topical tacrolimus: skin malignancy. use spf . biologics/anti TNF agents
tx: steroids, retinoids, tar prep (psoralen)
humira, enbrel, ad remicade are associated with malignancy, TB, sepsis. Take baseline PPD

Question 20

actinic keratosis

Answer 20

precurser to squamous sell.

cryotherapy of 5fu

Question 21

tinea versicolor

Answer 21

yeast. hypo pigmented maculates that “appear” after skin becomes tan.
labs- koh (potassium hydorxide) slide shoes hphae and spores.
topical selenium sulfide or ketoconazaole

Question 22

atopic dermatitis (eczema)

Answer 22

pruritic rash on the hands, neck, folds. worse with stress, winter, related to allergies

topical steroids hydrocortisone
traimcinolone

Question 23

oral thrush

Answer 23

nystatin (mycostatin) oral suspension

severe- lidocaine, diphenhydramine, and maalox mouth wash.

Question 24

hidradenitis supprativa

Answer 24

bacterial infection of the sebaceous glands of the axilla
augmentin
mupirocin ointment to nares/fingernails

Question 25

impetigo

Answer 25

skin infection by gram +, s. progenies or s. auras. contagious and pruritic. honey colored tx: keflex qid x 10 days if pcn allergy, azithroymycin

Question 26

meningococcemia

Answer 26

life threatening infection by N. meningitides spread by droplets The skin rash may advance from a few ill-defined lesions to a widespread petechial eruption within a few hours. Meningococcemia’s potential rapidity of progression cannot be stressed enough. ie: college students labs: lumbar CSF, blood culture, throat culture, mdi brain tx: cefriaxone (rocephin) 2g IV q 12 hours plus vancomycin IV q 8-12 hours

Question 27

lyme disease tx

Answer 27

erythema migraines by tick B. burgdorferi. labs: antiboy igM and igG. tx doxy

Question 28

rocky mountain tx

Answer 28

dog tick or wood reck infected with rickettsia rickets. small papules on hands/feet and spread to trunk fever doxy or tetracycline x 21 days. refer STAT biospy lesion 3mm punch

Question 29

varicella tx

Answer 29

chickenpox- contagious 1-2 days before onset and unit chicken pox crusts over (1-2 wks) shingles: contagious with onset of rash until crusts over medications: acyclovir (zovirax) or valtrex

Question 30

herpatic whitlow

Answer 30

viral infection of the fingers (herpes) painful red bumps on fingers. self limited, or tx with acyclovir.

Question 31

paronychia

Answer 31

vacterial infection of the cuticle . painful smollen area of the nail that becomes abscessed. soak in warm water for 20 minutes tie, topical antibiotic, incision and drainage prn

Question 32

pityriasis rosea

Answer 32

christmas tree rash on trunk self limiting, 4-8 wks "herald patch" if high risk std, check PRP to r/o syphilis

Question 33

scabies

Answer 33

tx: permetherin for 8-14 hrs rash on webs of hands , breats, buttocks, scrotum. rash appears snakelike (serpinginous) or linear burrows labs- scarpe burrow or scales with glass slide treat everyone in the house

Question 34

tinea capitus

Answer 34

most common in AA children block dot tines capitis- ring worm hairs break off and leave block dots on the scalp medications: antifungal tx Griseofulvin daiy (microsize/ultramicdrosize), 6-12 weeks avoid hepatotoxic substances (alcohol, statins, acetaminophen) baseline LFT and repeat 2 weks after initiating

Question 35

Total body surface area (TBSA) burns

Answer 35

each arm: 9% head: 9% each leg 18%, anterior trunk 18%, posterior trunk 18%

Question 36

anthrax

Answer 36

3 types: cutaneous, GI, and pulmonary pulmonary- (animals, wool, hides, hair) post exposure (bioterrorism) cipro

Question 37

ricin toxin (castor beans)

Answer 37

oral ricin causes vomit, diarrhea, multi organ failure in 6 hours. no antidote

Question 38

small pox

Answer 38

eliminated in 1977. vaccine 3-4 days post exposure. incubation 2 weeks

Question 39

pruritic rashes located in the webs of fingers, penis are scabies until proven otherwise. treat entire family.

Answer 39

true

Question 40

preferred antibiotic for human or animal bites

Answer 40

augmentin

Question 41

post herpatic neuralgia prophylaxis

Answer 41

TCA (antidepressents), amitriptyline (elavil)

Question 42

cellulitis clue

Answer 42

walking barefoot

Question 43

if Beta B infection cellulitis treat for 10 days dt risk of developing postglomerular nephritis

Answer 43

true