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FNP boards > Skin disorders > Flashcards

Skin disorders Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

How many grams of topical cream/ointment are needed for a single application to the hands, head, face, anogenital region?

A

2 g

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2
Q

How many grams of topical cream/ointment are needed for a single application to one arm, anterior or posterior trunk?

A

3 g

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3
Q

How many grams of topical cream/ointment are needed for a single application to one leg?

A

6 g

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4
Q

How many grams of topical cream/ointment are needed for a single application to the entire body?

A

30-60 g

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5
Q

How many grams of a topical cream/ointment can be expected in one fingertip unit (FTU)?

A

From very end of the finger to the first crease in the finger

0.5 g

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6
Q

Low potency topical corticosteroids (class V to VII)

A
  • Hydrocortisone (0.5%, 1%, 2.5%)
  • Desonide (0.05%)
  • Triamcinolone (0.025%, 0.1%)
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7
Q

High potency topical corticosteroid (class II)

A

Betamethasone dipropionate 0.05%

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8
Q

Super high potency topical corticosteroid (class I)

A
  • Clobetasol propionate 0.05%
  • Halobetasol propionate 0.05%
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9
Q

True/false: Topical corticosteroids should not be used longer than 3 months to avoid adverse effects including SQ tissue atrophy

A

True

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10
Q

First generation vs second generation antihistamines

A

First generation → diphenhydramine (benadryl)

Second generation → loratidine (claritin), cetirizine (zyrtec), fexofenadine (allegra)

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11
Q

Precautions that should be taken when prescribing first generation antihistamines

A

Crosses the BBB → sedation

  • Caution in geriatrics (drying of secretions, visual changes, urinary retention, used as sleep aid)
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12
Q

What is impetigo?

A

Contagious skin infection with typical presentation of purulent skin lesions

  • Common in children 2-5 years old
  • Causative agents: s. aureus, GAS
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13
Q

Impetigo clinical presentation

A
  • Can be bullous or nonbullous
  • Honey colored crusting with erythematous base
  • Common on face and extremities
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14
Q

Impetigo treatment

A
  • Usually resolves without treatment in 1-2 weeks
  • Can consider topical antimicrobial therapy to minimize contagion → mupirocin (bactroban)
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15
Q

True/false: Children with impetigo should be kept out of school or daycare for 24 hours after initiation of antibiotic therapy, and family members should be checked for lesions

A

True

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16
Q

When can the provider consider using oral therapy for impetigo treatment?

A

Beta-lactamase (dicloxacillin, amoxicillin-clavulanate) or cephalosporin

  • Patients with bullous impetigo
  • Have numerous lesions
  • Not responding or cannot tolerate topical agents
  • During outbreaks
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17
Q

Mild acne classification

A
  • Fewer than 20 comedones
  • Fewer than 15 inflammatory lesions
  • Total lesion count fewer than 30
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18
Q

Moderate acne classification

A
  • 20-100 comedones
  • 15-50 inflammatory lesions
  • Total lesion count 30-125
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19
Q

True/false: During acne treatment, patient education should include that improvement will not be seen with medication until 2-4 weeks of therapy is completed

A

False - will take 4-6 weeks before improvement is seen

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20
Q

Examples of keratolytic/comedolytic agents used for acne treatment

A
  • Tretinoin (Retin-A)
    • Should be used with sunscreen due to photosensitivity
  • Adapalene
  • Tazarotene
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21
Q

Hormonal therapy for acne treatment

A
  • COC pills → suppress ovarian androgen production
  • Aldosterone antagonist (spironolactone) → reduces free testosterone
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22
Q

When is isotretinoin (accutane) therapy indicated for acne treatment?

A

For severe and/or cystic acne that does not respond to conventional therapy

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23
Q

Isotretinoin (accutane) considerations

A
  • Teratogenic → use two forms of contraceptive, avoid sex 1 month after d/c
  • Assess for depressed mood, SI
  • Monitor for pseudotumor cerebri, hypertriglyceridemia, elevated hepatic enzymes, chelitis
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24
Q

Treatment recommendations for mild acne (comedonal, inflammatory, mixed lesions)

A

Benzoyl peroxide OR topical retinoid (tretinoin, adapalene, tazarotene)

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25
Q

Treatment recommendations for moderate acne (comedonal, inflammatory, mixed lesions)

A

Topical combination therapy:

  • Benzoyl peroxide + topical antibiotic
  • Benzoyl peroxide + retinoid
  • Retinoid + benzoyl peroxide + topical antibiotic
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26
Q

Treatment recommendations for severe acne (inflammatory, mixed, and/or nodular lesions)

A
  • Oral antibiotic + topical combination therapy:
    • BP + topical antibiotic
    • BP + retinoid
    • BP + retinoid + topical antibiotic
  • Oral isotretinoin
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27
Q

Antibiotic of choice for patients coming in with bite wounds

A

Amoxicillin with clavulanate

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28
Q

First degree burn classification

A

Superficial

  • Red
  • Somewhat painful
  • Easily blanched
  • Warm to touch
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29
Q

Second degree burn classification

A

Partial thickness

  • Deeply red
  • Blistered
  • Swollen
  • Hot to touch
  • Raw
  • Moist surface
  • Very painful
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30
Q

Deep second degree burn classification

A

Deep partial thickness

  • Involves deep layers of dermis
  • Appears white
  • Does not blanch
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31
Q

Third degree burn classification

A

Full thickness

  • Whitish
  • Charred or translucent
  • Not painful
  • Affected area lacks pinprick sensation
  • Surrounded by painful first and second degree burns
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32
Q

Rule of nines for calculating total burn

A
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33
Q

Indications for referral to burn center for care

A
  • Partial thickness burns >10% of total body surface area in adults or >5% for children
  • Burns that involve the face, hands, feet, genitals, perineum, major joints, and/or circumferential
  • Third degree burns in any age group
  • Electrical burns including lightening
  • Chemical burns
  • Inhalation injury
  • Burn injuries in patients with preexisting medical disorders that complicate management
  • Burned children in hospitals with qualified personnel or equipment
  • Burn injury in patients who will require special social, emotional, or rehab
34
Q

Under what conditions can burns be treated outpatient?

A

Small (<10% of BSA), minor (second degree or lower) burns not involving high function areas and of minimal cosmetic consequence

35
Q

What is atopic dermatitis?

A

Eczema

  • Type I hypersensitivity reaction resulting from IgE antibodies occupying receptor sites on mast cells
36
Q

Atopic dermatitis clinical presentation

A
  • Itchiness
  • Xerosis (dry skin)
  • Lichenification (from rubbing or scratching)
  • Eczematous lesions
  • Any age → flexural surfaces; children → face and neck
37
Q

Medications available for atopic dermatitis (eczema)

A
  • Oral antihistamines for flare ups (oral hydroxyzine, doxepin)
  • Intermediate potency topical corticosteroid
  • Pimecrolimus and tacrolimus
    • NOT for children younger than 2 years
38
Q

Herpes zoster (shingles) prodrome symptoms

A

1-2 days before rash eruption

  • Generalized body aches
  • Itching, burning, painful sensation
39
Q

Herpes zoster (shingles) clinical presentation

A
  • Burning, throbbing, stabbing pain
  • Intense itch
  • Rash follows dermatome (doesn’t cross midline)
  • Crusting lesions after 14-21 days as rash resolves
40
Q

Herpes zoster (shingles) treatment

A
  • Antivirals → acyclovir, valacyclovir, famciclovir
  • Topical lidocaine
41
Q

What is a complication of herpes zoster (shingles)?

A

Postherpetic neuralgia (PHN) → pain persisting at least one month after the rash has healed

42
Q

What is onychomycosis?

A

Nail fungus → found on the toenails or fingernails

  • Can involve the nail matrix, nail bed, and/or nail plate
43
Q

Onychomycosis diagnostic testing

A
  • Microscopic examination of nail scraping and KOH for hyphae
  • Fungal culture
  • PCR analysis to detect fungal DNA
44
Q

Onychomycosis treatment

A
  • Oral antifungals → itraconazole, terbinafine, fluconazole
    • Pulse cycles
  • Laser therapy
45
Q

Scabies mode of transmission

A

Close personal, skin to skin contact

  • Contact with used, unwashed bedding and clothing from affected person
46
Q

Scabies clinical presentation

A
  • Linear burrows
  • Older adults → excoriated lesions on back
  • Infants and young children → palms and soles
47
Q

Scabies treatment

A
  • Permethrin lotion → must be left on for 8-14 hours
  • Oral antihistamines or low potency topical corticosteroids for itchiness
  • Wash bedsheets and clothes in hot water, placed in dryer for a normal cycle, or in plastic storage bag for 1 week
48
Q

What is psoriasis?

A

Chronic skin disorder caused by accelerated mitosis and rapid cell turnover leading to decreased maturation and keratinization

49
Q

Psoriasis clinical presentation

A
  • Extensor surfaces (elbows and knees), scalp
  • Silvery scales
50
Q

How to differentiate psoriatic arthritis from rheumatoid arthritis and gout?

A
  • Negative rheumatoid factor
  • ESR normal
  • May have elevated uric acid
  • Pencil-in-cup deformity and joint space narrowing in interphalangeal joints on x-ray
51
Q

Psoriasis treatment

A
  • First line → topical corticosteroids
  • Tar preparations
  • Referral to dermatologist for severe disease
52
Q

What is seborrheic dermatitis?

A

Chronic, recurrent skin condition found in areas with a high concentration of sebaceous glands (scalp, eyelid margins, nasolabial folds, ears, upper trunk)

53
Q

Seborrheic dermatitis clinical presentation

A
  • Cradle cap in young children
  • If mild → patchy scaling
    • Scaling may present over red, inflamed skin with hypo pigmentation, oozing, crusting
  • Moderate to severe → thick, adherent crusts
54
Q

Seborrheic dermatitis (cradle cap) treatment

A
  • Emollients (olive oil)
  • Topical corticosteroids
55
Q

Seborrheic dermatitis treatment in adults

A
  • Topical antifungals (ketoconazole)
  • Topical corticosteroids
  • Cool tar shampoo
56
Q

ABCDE of skin cancer screening (melanoma)

A
  • A = asymmetric with non matching sides
  • B = borders are irregular
  • C = color is not uniform
  • D = diameter >6 mm (size of pencil eraser)
  • E = evolving lesion
57
Q

PUT ON mnemonic for basal cell carcinoma screening

A
  • P = pearly papule
  • U = ulcerating
  • T = telangiectasia
  • O = on the face, scalp, pinnae
  • N = nodules (slow growing)
58
Q

NO SUN mnemonic for squamous cell carcinoma screening

A
  • N = nodular
  • O = opaque
  • S = sun exposed areas
  • U = ulcerating
  • N = non distinct borders
59
Q

What skin lesion can progress to SCC?

A

Actinic keratosis = UV induced skin lesions

  • Small rough patches, sandpaper like quality
  • Become large, red, and scaly over time
60
Q

Treatment for actinic keratoses

A
  • Cryotherapy
  • 1-5% fluorouracil cream
61
Q

True/false: “Watch and wait” therapy for warts is appropriate because most will self resolve within 12-24 hours

A

True

62
Q

Cellulitis clinical presentation

A
  • Warm, red, painful edematous area
  • Sharply demarcated borders
  • Local lymphangitis and lymphadenitis
63
Q

Cellulitis treatment

A
  • Dicloxacillin
  • Cephalexin
  • Azithromycin (PCN allergy)
64
Q

Abscess treatment

A
  • If afebrile and <5 cm in diameter = I&D, warm soaks (consider culture)
  • If >5 cm = add antimicrobial therapy
    • TMP-SMX (bactrim), doxycycline, clindamycin
65
Q

Risk factors for angular cheilitis

A

Loss of vertical facial dimension (loss of teeth) allowing for candida growth at skin folds

66
Q

Angular cheilitis clinical presentation

A
  • Erythema with painful cracking, scaling, ulceration at corners of mouth
  • Intermittent bleeding
  • Sudden onset
67
Q

Angular cheilitis treatment

A

Topical antifungals (nystatin, miconazole)

  • Oral antifungals if topical therapy didn’t work
  • Keep area moist with moisturizer for prevention
68
Q

How long does a tick need to feed on a human host for before spirochete transmission?

A

For at least 24 hours

69
Q

Stage 1 of Lyme disease

  • Early localized disease
A
  • Mild flu-like illness
  • Single annular lesion with central clearing (erythema migrans)
  • NO pain or itchiness
70
Q

Stage 2 of Lyme disease

  • Early disseminated infection (months later)
A
  • Rash reappears with multiple lesions
  • Arthralgia, myalgia
  • Headache
  • Fatigue
  • Cardiac manifestations
  • Neurologic findings (Bell’s palsy)
71
Q

Stage 3 of Lyme disease

  • Late persistent infection (1 year after initial exposure)
A
  • MSK symptoms persist (joint pain, arthritis)
  • Neuropsychiatric symptoms (memory problems, depression, neuropathy)
72
Q

Lyme disease diagnostic testing

A

Serum testing for b burgdorferi by enzyme linked immunosorbent assay and confirmatory Western blot for IgM antibodies

73
Q

What considerations should be made about diagnostic testing for Lyme disease in relation to IgM and IgG levels?

A

IgM antibodies decline after 4-6 months of illness

IgG is noted about 6-8 weeks after onset of symptoms (persists at low levels despite treatment)

74
Q

Lyme disease treatment

A

Doxycycline for 14-21 days for earlier disease and up to 28 days for more advanced disease

75
Q

True/false: Bed bug bites appear in a “breakfast, lunch, and dinner” pattern

A

True - Parasite will bite one location, then move laterally to bite again, and repeat the action for the third bite

76
Q

Bed bugs clinical presentation

A
  • Red with darker red spot int he middle
  • Itchy
  • Arranged in a rough line or in a cluster
  • Located on face, neck, arms, hands
77
Q

Bed bugs treatment

A

Usually not required unless there is secondary infection

  • Antiseptic lotion or topical antibiotic
  • Topical corticosteroids or oral antihistamines for itch

Professional extermination

78
Q

Possible triggers for rosacea

A
  • UV/sunlight exposure
  • Hot/cold exposure
  • Exercise
  • Stress
  • Coffee
  • Chocolate, caffeine
  • Alcohol
  • Spicy foods
  • Cosmetic products and medications
79
Q

What are the four types of rosacea?

A
  • Erythematotelangiectatic
  • Papulopustular
  • Phymatous
  • Ocular
80
Q

Rosacea treatment

A
  • Avoid triggers
  • Non ablative laser therapy, mechanical dermabrasion, laser peel, surgical shave
  • Metronidazole gel
  • Acne products
  • Oral antimicrobial for ocular rosacea

FNP boards (20 decks)

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