Skin & Integumentary System Flashcards
Rocky Mountain Spotted Fever (RMSF) clinical presentation
Abrupt onset of high fever, chills, severe headache, nausea/vomiting, photophobia, myalgia, arthralgia, followed by rasg that erupts 2 to 5 days after onset of fever
RMSF rash appearance
Small red spots (petechiae) that erupt on both the wrist, forearms, and ankles. Can be present on palms and soles. Progresses toward the trunk until it becomes generalized
When does RMSF occur? Who does it affect?
April-September (spring to summer)
Highest frequency among males, native Americans, people >40 years old
Onset 2-14 days
RMSF treatment
1st line treatment doxycycline
DEET containing repellent on skin and permethrin on clothing and gear can repel dog and deer ticks
What is the clinical presentation for brown recluse spider bites?
Systemic sx fever, chills, nausea, and vomiting
Located on the arms, upper legs, trunk
May feel like a pinprick, painless
Swollen, red, tender, blisters appear within 24 to 48 hours
What is Erythema Migrans?
Early Lyme disease
What is the characteristic Erythema Migrans?
Classic lesion is an expanding red rash with central clearing that resembles a target (bulls-eye)
Onset within 7-14 days after a deer tick bite (range, 3-30 days)
Erythema migrans location
Rash is hot to touch and rough texture
Common locations= belt line, axillary area, behind the knees, and groin area
What is erythema migrans symptoms
Flu-like sxs
Most common in the northeastwr regions
Erythema Migrans treatment:
DEET containing repellent on skin and permethrin on clothing and gear to repel deer ticks
What is meningococcemia (meningitis) classic symptoms?
Sudden onset of sore throat, cough, fever, headache, stiff neck, photophobia, and changes in level of consciousness (drowsy, lethargy, coma)
Meningoccemia rash look like
Abrupt onset of petechial to hemorrhage rashes (pink to purple colored)
Occurs in the axillae, flanks, wrist, and ankles
Whomat patient population is at risk for meningococcemia?
1st year college students residing in dormitories & individuals with asplenia (no spleen), defective spleen (sickle cell anemia), HIV infection
What is the treatment for meningitis?
Prevention-vaccination
Rifampin BID for 2 days for closd contacts
Define shingles infection
Sight-threatening condition caused bu reactovation of the herpes zoster virus that is located on the opthalmic branch of the trigrmjnal nerve CN V
What are chief complaints of shingles
Reports sudden eruption of multiple vesicular lesions (ruptures into shallow ulcers with crusts)
Location- one side if the scalp, forehead, sides and the tip of the nose. Eyelid is swollen and red
Photophobia, eye pain, and bluered vision
What are the characteristics of melanoma?
Dark-colored moles with uneven texture, variegated colors, irregular borders (diameter of 6 mm) or larger
Melanoma sx
May be pruritic
If in nail beds (subungual melanoma) aggressive form, lesions located anywhere on the body, including the retina
Melanoma risk factors
Family history, extensive/intense sunlight exposre, blistering sunburn in childhood, tabbing beds, high nevus count/atypical nevus, lighg skin/eyes
Acral lentiginous melanoma
Most common type of melanoma in African Americans & Asians.
Dark brown to black lesions, located on the nail beds (subungual), palmar, and plantar surfaces
Basil cell carcinoma (BCC)
Superfical=pearly or waxy skin lesion, atrophic or ulcerated center that does not heal.
Color-white, light pink, brown, or flesh colored
Risk factor-severe sunburns as a child
Actinic keratosis
C/C- numerous dry, round, and red/colored lesions with a rough texture that do not heal
Lesions are slow growing
Actinic keratosis location
Sun-exposed areas such as cheeks, nose, face, neck, arms, and back
Subungual hematoma
Trauma to the nail beds
Pain & bleeding between the nail bed and the finger/toenail
Stevens-Johnson Syndrome (SJS) & toxic epidural necrolysis (TEN)
Appearance like a target or bulls-eye
Multille leaions start erupting abruptly and can range from hives, blisters, petechiae, purpura, and necrosis, soughing of epidermis
SJS
Mucosal surfacw involvement
Prodrome of fever with flu like sxs by 1-3 days
Most common triggers-medications such as allupurinol, anticonvulsants (lamotrigine, carbamazepine, phenobarbital), sulfonamides, and oxicsm NSAIDS
Risk factors-HIV infection, genetics, lupus, malignancies
Screening for Melanoma
ABCDE
A-asymmetry B-border irregular C-color varies in the same region D-diameter>6mm E-enlargement or change in size
Macule
Flat nonpalpable lesion less than 1cm diameter
Ex. Freckles (ephelis), lentigo or lentigjnes
Papule
Palpable solid lesions less than or equal to 0.5cm in diameter
Ex. Nevi(moles), acne, small cherry angiomas
Plaque
Flattened elevated lesion with variable shape greater than 1cm
Ex, psoriatic lesions
Bulla
Elevated superficial blistered filled with serous fluid and more than 1cm in size
Ex. Impetigo, 2nd degree burn with blisters, SJS lesions
Vesicle
Elevated superficial skin leaions less than 1cm in diameter and filled with serous fluid
Ex. Herpetic lesions
Pustule
Elevated superficial skin lesion leas than 1cm in diameter filled with purulent flui
Ex. Acne pustules
Secondary skin lesions
Primary skin lesion that changes; complication of a primary lesion or injury
Lichenification
Thickening of the epidermis with exaggwration of normal skin lines due to chronic itching (eczema)
Scale
Flaking skin (psoriasis)
Crust
Dried exudate, may be serous exudate (impetigo)
Ulceration
Full-thickness loss of skin (decubiti or pressure injury)
Scar
Permanent fibrotic changws following damage ro the dermis
Ex. Surgical scars
Keloids/hypertrophic scar
Overgrowth of scar tissue
Common in blacks and asians
Acral
Distal portions if the limbs such as the hand or feet
Annular
Ring-shaped
Ringworm or tines corporis
Exanthem
Cutaneous rash
Flexural
Skin flexures are body folds
Psoriasis
Classic case:
Patient complains of pruriticbeeythematous plaques covered with fine silvery-white scalesbalong with pitted fingernails and toenails. The plaques are distributed in the scalp, elbows, knees, sacrum, and the intergluteal folds.
C/c painful red, warm, and swollen joints (migratory arthritis)
Psoriasis tx
Topical steroids, topical retinoids (tazarotene), tar preparations
Severe- methotrexate, cuclosporine, biologics
Actinic keratosis tx
Refer to dermatologist for biopsy
Tx ranges from surgery and cryotherapy to topical medications
Tines versicolor
Superficial skin infection caused by yeast pityrosporum orbiculare or pityrosporum ovale
Classic case- c/c multiple hypopigmented round macules on the chest, shoulders, and back
Labs- potassium hydroxide (KOH) slide: hyphae and spores
Medications- topical selenium sulfide and topical azole antifungals such as ketoconazole, lamisil bid x 2 weeks
Atopic dermatitis
Classic case: infants up to 2 ywars of age have a larger area of rash distribution compared to teens and adults. Rashes are typically found on the cheeks, wntire trunk, knees, and elbows.
Atopic dermatitis tx
Topical steroids and emollients 1st line treatment
Mild disease- low potent, group 5, hydrocortisone 2.5%
Moderate- triancinolone acetonide-medium potency, group 4
Contact dermatitis
Acute onset of one to multiple bright red snd pruritic lesions that evolve into billous or vesicular lesions; easily rupture, leaving bright red mosif areas that are painful. Burning or stinging
Superficial candidiasis
Superficial skin infection from the yeast candida albicans.
Overgrowth are increased warmth, humidity, friction, obesity, diabetes, and decreased immunity
Superficial candidiasis
Classic case:
Obese adult complains of bright-red and shiny lesions that itch or burn, located on the intertriginous areas
Tx: nystatin powder/cream in skin folds bid. OTC topical antifjngals are miconazoks, clotrimazole.
Thrush
Severe sore throat with white adherent olaques with a red base that are hard to dislodge on the pharynx
Tx-magic mouthwash
Clotrazols troches or miconazole mucoadhesive
Cellulitis
Acute skin infection of the deep dermis and underlying tissue, caused by gram positive bacteria.
Classic case: acute onset of diffused pink to red-colored skin that is poorly demarcatwd with advance margins. Lesions feel warm to touch, may become abscessed or it may ne fluctuant or draining pus.
Impetigo tx
Severe cases: cephalexin (keflex) QID, dicloxacillin QID x 10 days. PCN allergic: azithromycin 250 mg x 5 days, clindamycin x 10 days
Clean with antibacterial soap, betadine, or chlorhexidine
Shower/bathe daily with antibacterial soap untik healed
Meningococcemia
Serious life threatening infection caused bu neisseria meningitides that are soread by respiratory droplets.
Bacterial meningitis is a medical emergency.
Use droplet precautions
Close contacts shoukd have prophylaxis rifampin PO every 12 hours x2 days
Tx plan:
Ceftriaxone (rocephin) 2g IV every 12 hous plus vancomycin IV every 8-12 hours
Early lyme disease tx
Doxycycline BID x 10 days, 1st lien drug for both adults and children
Alternative: Amoxicillin 500mg TID or cefuroxime 500 mg BID x 14 days
Tick removal
Grasp part of tick closest to the skin and apply steady upward pressure. Do not remove ticks by using nail polish, peteoleum jelly, or heat
Scabies
Rashes that are pruritic at night and located on the interdigital webs and or penis
Treatment for human, dog, or cat bites
Augmentin amoxicillin-clavilanate
MRSA treatment
Bactrium
Allergic: doxycycline or minocycline or clindamycin
Pityriasis rosea
Herald patch
Cheistmas tree
Varicella
Macula papula vesiculr rash
1st line treatment for acne
Topicals
2nd line treatment for acne if topicals doesnt work
Oral antibiotics (tetracycline)
Acne treatments doesn’t work
Refer to dermatologist
Impetigo appearance?
Honey crusted lesions, vesicle that popped with oozing that golden
Imeptigo treatment
Muprocin
