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FNP Review > Skin & Integumentary System > Flashcards

Skin & Integumentary System Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Rocky Mountain Spotted Fever (RMSF) clinical presentation

A

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

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2
Q

RMSF rash appearance

A

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

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3
Q

When does RMSF occur? Who does it affect?

A

April-September (spring to summer)

Highest frequency among males, native Americans, people >40 years old

Onset 2-14 days

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4
Q

RMSF treatment

A

1st line treatment doxycycline

DEET containing repellent on skin and permethrin on clothing and gear can repel dog and deer ticks

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5
Q

What is the clinical presentation for brown recluse spider bites?

A

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

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6
Q

What is Erythema Migrans?

A

Early Lyme disease

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7
Q

What is the characteristic Erythema Migrans?

A

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)

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8
Q

Erythema migrans location

A

Rash is hot to touch and rough texture

Common locations= belt line, axillary area, behind the knees, and groin area

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9
Q

What is erythema migrans symptoms

A

Flu-like sxs

Most common in the northeastwr regions

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10
Q

Erythema Migrans treatment:

A

DEET containing repellent on skin and permethrin on clothing and gear to repel deer ticks

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11
Q

What is meningococcemia (meningitis) classic symptoms?

A

Sudden onset of sore throat, cough, fever, headache, stiff neck, photophobia, and changes in level of consciousness (drowsy, lethargy, coma)

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12
Q

Meningoccemia rash look like

A

Abrupt onset of petechial to hemorrhage rashes (pink to purple colored)

Occurs in the axillae, flanks, wrist, and ankles

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13
Q

Whomat patient population is at risk for meningococcemia?

A

1st year college students residing in dormitories & individuals with asplenia (no spleen), defective spleen (sickle cell anemia), HIV infection

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14
Q

What is the treatment for meningitis?

A

Prevention-vaccination

Rifampin BID for 2 days for closd contacts

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15
Q

Define shingles infection

A

Sight-threatening condition caused bu reactovation of the herpes zoster virus that is located on the opthalmic branch of the trigrmjnal nerve CN V

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16
Q

What are chief complaints of shingles

A

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

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17
Q

What are the characteristics of melanoma?

A

Dark-colored moles with uneven texture, variegated colors, irregular borders (diameter of 6 mm) or larger

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18
Q

Melanoma sx

A

May be pruritic

If in nail beds (subungual melanoma) aggressive form, lesions located anywhere on the body, including the retina

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19
Q

Melanoma risk factors

A

Family history, extensive/intense sunlight exposre, blistering sunburn in childhood, tabbing beds, high nevus count/atypical nevus, lighg skin/eyes

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20
Q

Acral lentiginous melanoma

A

Most common type of melanoma in African Americans & Asians.

Dark brown to black lesions, located on the nail beds (subungual), palmar, and plantar surfaces

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21
Q

Basil cell carcinoma (BCC)

A

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

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22
Q

Actinic keratosis

A

C/C- numerous dry, round, and red/colored lesions with a rough texture that do not heal

Lesions are slow growing

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23
Q

Actinic keratosis location

A

Sun-exposed areas such as cheeks, nose, face, neck, arms, and back

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24
Q

Subungual hematoma

A

Trauma to the nail beds

Pain & bleeding between the nail bed and the finger/toenail

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25
Q

Stevens-Johnson Syndrome (SJS) & toxic epidural necrolysis (TEN)

A

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

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26
Q

SJS

A

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

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27
Q

Screening for Melanoma

A

ABCDE

A-asymmetry
B-border irregular
C-color varies in the same region
D-diameter>6mm
E-enlargement or change in size
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28
Q

Macule

A

Flat nonpalpable lesion less than 1cm diameter

Ex. Freckles (ephelis), lentigo or lentigjnes

29
Q

Papule

A

Palpable solid lesions less than or equal to 0.5cm in diameter

Ex. Nevi(moles), acne, small cherry angiomas

30
Q

Plaque

A

Flattened elevated lesion with variable shape greater than 1cm

Ex, psoriatic lesions

31
Q

Bulla

A

Elevated superficial blistered filled with serous fluid and more than 1cm in size

Ex. Impetigo, 2nd degree burn with blisters, SJS lesions

32
Q

Vesicle

A

Elevated superficial skin leaions less than 1cm in diameter and filled with serous fluid

Ex. Herpetic lesions

33
Q

Pustule

A

Elevated superficial skin lesion leas than 1cm in diameter filled with purulent flui
Ex. Acne pustules

34
Q

Secondary skin lesions

A

Primary skin lesion that changes; complication of a primary lesion or injury

35
Q

Lichenification

A

Thickening of the epidermis with exaggwration of normal skin lines due to chronic itching (eczema)

36
Q

Scale

A

Flaking skin (psoriasis)

37
Q

Crust

A

Dried exudate, may be serous exudate (impetigo)

38
Q

Ulceration

A

Full-thickness loss of skin (decubiti or pressure injury)

39
Q

Scar

A

Permanent fibrotic changws following damage ro the dermis

Ex. Surgical scars

40
Q

Keloids/hypertrophic scar

A

Overgrowth of scar tissue

Common in blacks and asians

41
Q

Acral

A

Distal portions if the limbs such as the hand or feet

42
Q

Annular

A

Ring-shaped

Ringworm or tines corporis

43
Q

Exanthem

A

Cutaneous rash

44
Q

Flexural

A

Skin flexures are body folds

45
Q

Psoriasis

A

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)

46
Q

Psoriasis tx

A

Topical steroids, topical retinoids (tazarotene), tar preparations

Severe- methotrexate, cuclosporine, biologics

47
Q

Actinic keratosis tx

A

Refer to dermatologist for biopsy

Tx ranges from surgery and cryotherapy to topical medications

48
Q

Tines versicolor

A

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

49
Q

Atopic dermatitis

A

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.

50
Q

Atopic dermatitis tx

A

Topical steroids and emollients 1st line treatment

Mild disease- low potent, group 5, hydrocortisone 2.5%

Moderate- triancinolone acetonide-medium potency, group 4

51
Q

Contact dermatitis

A

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

52
Q

Superficial candidiasis

A

Superficial skin infection from the yeast candida albicans.

Overgrowth are increased warmth, humidity, friction, obesity, diabetes, and decreased immunity

53
Q

Superficial candidiasis

A

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.

54
Q

Thrush

A

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

55
Q

Cellulitis

A

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.

56
Q

Impetigo tx

A

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

57
Q

Meningococcemia

A

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

58
Q

Early lyme disease tx

A

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

59
Q

Tick removal

A

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

60
Q

Scabies

A

Rashes that are pruritic at night and located on the interdigital webs and or penis

61
Q

Treatment for human, dog, or cat bites

A

Augmentin amoxicillin-clavilanate

62
Q

MRSA treatment

A

Bactrium

Allergic: doxycycline or minocycline or clindamycin

63
Q

Pityriasis rosea

A

Herald patch

Cheistmas tree

64
Q

Varicella

A

Macula papula vesiculr rash

65
Q

1st line treatment for acne

A

Topicals

66
Q

2nd line treatment for acne if topicals doesnt work

A

Oral antibiotics (tetracycline)

67
Q

Acne treatments doesn’t work

A

Refer to dermatologist

68
Q

Impetigo appearance?

A

Honey crusted lesions, vesicle that popped with oozing that golden

69
Q

Imeptigo treatment

A

Muprocin

FNP Review (4 decks)

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