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NSG 6665 Test 2: Dermatology
Questions With Correct Answers
largest organ - ANSWER skin example of primary skin lesions - ANSWER macule ▪nodule ▪tumor ▪vesicle ▪bulla ▪pustule ▪Cyst ▪papule ▪patch ▪plaque ▪wheal secondary skin lesion examples - ANSWER scale lichenification keloid scar excoriationfissure erosion ulcer atrophy difference between primary and secondary skin lesions - ANSWER secondary is a resultof primary - open blister, scratched papule, ruptured vesicles, crusting, scabs secondary extends into dermis most common inflammatory disorder - ANSWER eczemaeczema other name - ANSWER dermatitis what mediates atopic dermatitis - ANSWER IgE atopic dermatitis other names - ANSWER pruritic dermatitis or eczemawho is more at risk for atopic dermatitis - ANSWER individuals with either a personal or family history of allergies, asthma, or eczema Atopic contact dermatitis - ANSWER immune mediated skin rash at the site of contactwith a chemical allergen what mediates atopic contact dermatitis - ANSWER sensitized T-cells Irritant contact dermatitis cause - ANSWER contact of irritant with skin causesinflammation atopic dermatitis description - ANSWERrecurrent, and usually symmetric ▪Type of eczematous eruption that is itchy, atopic dermatitis commonly found - ANSWER flexor surfaces ▪surfaces Lesions usually involve neck, wrists, area behind ears, antecubital and popliteal flexor chronic atopic dermatitis causes - ANSWER Intense itching leads to scratching,eczematous change, and lichenification
wet vs dry dressing atopic dermatitis - ANSWERlesions WET ▪Keep wet lesions DRY ▪Keep dry atopic dermatitis treatment - ANSWER avoid precipitants ▪lower potency for controlTopical corticosteroids: short course of higher potency (%) for flare-ups; reduce to ▪Systemic corticosteroids (PO) can be used for severe flareups ▪Oral antibiotics for secondary infections (Penicillin or Erythromycin) Allergic contact dermatitis - ANSWER Erythematous pruritic rash that occurs at point ofcontact with skin Allergic contact dermatitis causes - ANSWER soaps, cosmetics, fragrances, jewelry, orplants such as poison ivy, poison oak, or poison sumac contact dermatitis most common cause - ANSWER irritant (80%) % of people allergic to poison oak and ivy - ANSWER 90%- on a varying scale of severity poison ivy and oak allergen - ANSWER urushiolwhy are poison oak and ivy leaves shiny - ANSWER urushiol is the oil that makes it an allergen poison oak and ivy description - ANSWER Young poison ivy plant looks very differentfrom mature plant - grows about 2 feet high but spreads out in vines. Poison oak can grow as a bush. The one thing that doesn't vary is the pattern of three leaflets branching from a single,independent stem. Two leaves are attached directly to the stalk opposite each other. The third leaf juts out from them at a right angle, so the 3-leaf pattern forms a triangle.There are no additional leaves on the same stalk, except with sumac. poison oak and ivy nickname and why - ANSWER the great mimic because they tend toadopt the leaf shape and growth pattern of the plants that surround them. poison oak/ivy saying - ANSWER "Leaves of 3, let them be" why is poison sumac worse than ivy or oak - ANSWER Reaction is similar but moresevere than with poison oak and ivy, because oily resin is on all parts of sumac, not just the leaves ▪Oil is more potent ▪Poison sumac may grow as a tree poison oak, ivy, sumac rash - ANSWER itchy, blister when does poison oak, ivy, sumac rash occur - ANSWER 24 to 72 hours after exposureto the oil (delayed hypersensitivity reaction), so the patient may not remember coming does reaction occur after first exposure to poison oak, ivy, sumac - ANSWER Reactiondoes not occurs with first exposure (cell mediated immunity) but with subsequent
-description: skin is red, painful, and tender, but does NOT posses blisters -example: sunburn -treatment: symptomatic treatment alone, generally resolves within one week partial thickness burns - ANSWER -formally called second degree-erythema with superficial blisters -split into superficial-partial and deep-partial -both effect epidermis and dermis-pain depends on nerve involvement
superficial partial vs deep partial burn - ANSWER superficial partial includes superficial(papillary) dermis deep partial includes deep (reticular) dermis sunburn classification - ANSWER superficial thickness = no blistering superficial partial = blistering Full thickness burns - ANSWER major thermal injuries in which the epidermis anddermis are completely destroyed
3rd vs 4th degree burns - ANSWER 3rd is epidermis and dermis 4th is hypodermis, dermis, epidermis what burn may affect muscle - ANSWER 4th (full thickness burns) full thickness burn treatment - ANSWER cover with gauze, stabilize patient, if head orneck involved monitor airway closely, transport to ER or burn center
minor burn tx - ANSWER Cool the burn - hold the burned area under cool (not cold)running water for 10-15 minutes or until the pain subsides or immerse the burn in cool water or cool it with cold compresseswrap gauze loosely to avoid putting pressure on the burned skin ▪Cover the burn with a sterile gauze bandage- ▪Take an OTC pain reliever: Tylenol, ibuprofen (Advil), naproxen (Aleve)- age 12 and older onlyburns usually heal without further treatment ▪Update tetanus vaccination if necessary if ▪Minor skin is broken most common complication of burns - ANSWER infection treatment of partial thickness burns - ANSWER Consider Silver Sulfadiazine cream (ifnot allergic to Sulfa drugs) loosely covered with gauze
when does most UV exposure occur - ANSWER 80% before 20 yo what causes pain and erythema in sunburns - ANSWER prostaglandins release What SPF sunscreen is recommended? - ANSWER 25 or greater (always usewaterproof) apply 30 min before exposure and q2hr with swimming % UV blocked in sunglasses - ANSWER 99-100% ibuprofen dose - ANSWER 5-10 mg/kg/dose every 6-8 hours
sunburn tx - ANSWERmg/kg q6-8 hours ▪Aloe gels ▪Rehydrate with plenty of fluids ▪Cool environment with loose cotton clothes ▪NSAIDs for pain-Ibuprofen 5- ▪Lotions-Aveeno, Eucerin ▪Cool compresses with Burow's solution Folliculitis - ANSWER inflammation of the hair follicles resulting in a pustule
impetigo - ANSWER bacterial skin infection characterized by isolated pustules thatbecome crusted and rupture
impetigo cycle - ANSWER Begin with vesicular or pustular lesion; develops intoexudative, crusted stages
Bolous - ANSWER blister impetigo etiology - ANSWER most often Staph aureus (may colonize nasal epitheliumfirst) or GABHS (group A betahemolytic strep)
impetigo out of daycare/school - ANSWER 24 hours after start of tx
impetigo tx - ANSWER Topical: Bactroban ointment TID x 7-10 days Dicloxacillin 15 to 50 mg/kg/day in 4 divided doses x 7 days OR ▪ Amoxicillin/clavulanate ▪Systemic: ▪ 50 to 90 mg/kg/day in 2 divided doses for 7 to 10 daysdays ▪ Cephalexin 40 mg/kg/day for 10 wash hands and trim nails Staphlococcal Scalded Skin Syndrome (SSSS) occurs when - ANSWER Seen in infantsand children <5 years old (have not developed Staph antibodies)
SSSS etiology - ANSWER Caused by infection with group II staphyloccus whichproduces a toxin that causes separation of layers of the dermis
how does SSSS toxin travel - ANSWERtoxin is carried to skin by cardiovascular system ▪Infection is somewhere else in the body and
SSSS S&S - ANSWER begins with fever, malaise, irritability, followed by generalizederythema with extreme tenderness of skin skin looks "scalded", erythema can cover entire body except palms, soles, mucous
membranes. SSSS occurs on all areas of skin except - ANSWER soles of feet, palms, mucousmembranes
when does skin lesions occur with SSSS - ANSWERbullae form and pain is severe ▪Within 48 hours, blisters and
what causes dehydration in SSSS - ANSWER ▪Fluid loss from ruptured bullae
how long does SSSS last - ANSWERoccurs in 10-14 days ▪If secondary infection is prevented, healing
SSSS tx - ANSWER burn tx scarlet fever rash location - ANSWER first appears on neck and chest and face texture of scarlet fever rash and blanch ability - ANSWERblanches on pressure ▪Feels like sandpaper, rash ▪Swollen tongue turns bright red how long does scarlet fever last - ANSWER Rash disappears in 2-7 days, but tongue mayremain swollen for a few more days ▪As the rash fades, skin may peel on the tips of the fingers and toes and in the groin area age group of scarlet fever - ANSWER 2- scarlet fever cause - ANSWER toxins produced by group A streptococcal bacteria
epidermis # of layers - ANSWER 5 layers stratified squamous epithelium which layers of skin are the thickest and thinnest - ANSWER epidermis is thinnestdermis is thickest
dermis purpose - ANSWER regulate heat loss dermis cell type - ANSWER adipose tissue hypodermis purpose - ANSWER energy and metabolism which kind of topical treatment typically burns and why - ANSWER gel because itcontains alcohol
potency order from most potent to least of oil, lotion, cream, ointment - ANSWERointment then oil then cream then lotion
cream vs ointment - ANSWER ointment is composed of mostly oil so it sits on skin(helpful as a protective layer) cream is absorbed more easily d/t higher water content but still contain oil that sits on skin so it is ideal for dry skin cream oil vs water makeup - ANSWER equal parts of each cream vs lotion - ANSWER lotion may contain small amounts or no oil so it is absorbedmore fully than cream which contains equal parts oil and water
when to refer to dermatology for nevi - ANSWER fast growing, changes, more than 50,or 1 atypical
atopic dermatitis saying - ANSWER the itch that rashes When is atopic dermatitis worse? - ANSWER winter or hot summer atopic dermatitis infant common areas - ANSWER cheeks, forehead, scalp, trunknot usually in diaper area
atopic dermatitis ways to avoid flares - ANSWER apply lotion after bath, keep nails cleanand short
what to use for chronic atopic dermatitis - ANSWER ointment, cream, lotionacute use wet dressing or powder
prolonged topical steroid use - ANSWER skin atrophy, infection, folliculitis most common cause of burn in infants and children - ANSWER scalding liquid spills watch for what cause of burns in older children - ANSWER fumes how long for partial thickness sunburns to heal - ANSWER 7-14 days How long for a deep partial thickness burn to heal? - ANSWER 3 weeks Silvadene can not be applied to - ANSWER face because it stains skin how long to protect burns from sun - ANSWER 12 months
roseola presentation - ANSWER sudden high fever (around 103) that lasts 3-5 daysfollowed by erythematous rash that lasts about 24 hours rash starts on neck and is pinkHigh fever, cough, respiratory symptoms Erythematous pharynx, tonsils, and tympanic membranes common age of roseola - ANSWER <5 yo typically 7-24 mo most infectious time of roseola - ANSWER before rash roseola tx - ANSWER supportiveavoid febrile seizure
red measles - ANSWER rubeola rubeola cause - ANSWER morbillivirus rubeola transmission and prevention - ANSWER vaccine and droplet Rubeola incubation period - ANSWER 7-12 days rubeola S&S - ANSWER high fever, runny nose, conjunctivitis, "barking" coughKoplik spots: characteristic pinpoint white spots surrounded by an erythematous ring on buccal mucosa - precedes rash by 1-2 days
rubeola rash location - ANSWER Rash first appears on face , non-pruriticdown the chest, back, and trunk to arms, hands, legs, and feet ▪ Spreads
Rubeola rash characteristics? - ANSWER Rash starts as a macular, red patches buteventually develops itchy papules ▪ Rash lasts about 5 days then fades leaving skin dry and flaky Rubeola treatment - ANSWER supportiveaches ▪ rest to help boost immune system ▪ ▪ acetaminophen to relieve fever and muscle plenty of fluids ▪ humidifier to ease a cough and sore throat rubeola complications - ANSWER Secondary bacterial infection ▪pneumonia ▪ Encephalitis (Subacute sclerosing panencephalitis (SSPE)) ▪Otitis media
Subacute sclerosing panencephalitis (SSPE) - ANSWER very rare, but fatal disease ofthe central nervous system that results from a measles virus infection acquired earlier in life.person seems to have fully recovered from the illness. ▪ generally develops 7 to 10 years after a person had measles, even though the ▪ Since measles was eliminated in 2000, SSPE is rarely reported in the United States rubella other name - ANSWER German measles rubella spread - ANSWER respiratory droplets rubella virus - ANSWER Rubivirus
rubella S&S - ANSWERlasts 2-3 days ▪pruritic ▪ ▪Fine pink rash that starts on face and spreads over body andMay have mild fever, swollen post auricular nodes, a runny or stuffy nose, a headache, sore throat ▪Most cases are mild rubella treatment - ANSWER supportive rubella complications - ANSWER Transmission to woman in first four months ofpregnancy: congenital rubella syndrome (can cause critical congenital heart defects
Reye's syndrome trigger - ANSWER(particularly influenza, flu-like symptoms, and varicella) ▪Triggered by using aspirin to treat a viral illness — in children who have an underlying fatty acid oxidation disorder. Reye's Syndrome symptoms - ANSWER confusion, seizures and loss of consciousness fatal in days or hours without tx Pityriasis Rosea first signs - ANSWER may have flu-like symptoms followed by singlelarge patch (herald patch)
herald patch associated with - ANSWER Pityriasis rosea Pityriasis Rosea rash appearance and location - ANSWER single large patch (heraldpatch) then After several days, more rashes appear on the chest, back, arms, and legs ▪Scales flake off margins of lesions, a collarette pattern is seen, may be pruritic ▪"Christmas tree" patternRash is pink or pale red, oval in shape, may follow lines in skin or appear in a
Pityriasis Rosea rash lifetime - ANSWER Usually goes away within 6-12 weeks andrecurrence is common
Pityriasis Rosea rash tx - ANSWER gentle bathing, mild lotions, oral antihistamines, mildhydrocortisone cream
fifths disease virus - ANSWER Parvovirus B
fifths disease other names - ANSWER Also known as erythema infectiosumknown as "slapped cheek" disease ▪Commonly
fifths disease incubation - ANSWER 4-14 days after infected with parvovirus B19.
fifths disease S&S - ANSWERred rash may appear on face ▪▪A few days later other rashes appear on chest, back,Fever, runny nose, and headache ▪After several days, buttocks, arms or legsintensity and come and go for several weeks ▪May be pruritic, esp. on soles of feet ▪Rash can vary in itchy rash As the rash starts to fade, may look "lacey"20% have no symptoms
5ths disease rash duration and tx - ANSWER Rash usually goes away in 7-10 days, butcan last several weeks Supportive - *acetaminophen as needed for fever, H/A. *drink lots of fluids and get extrarest.
fifths disease contagious until - ANSWER red rash appears- can return to school fifths common season - ANSWER late winter/early spring Hand-foot-mouth disease - ANSWER mild viral infection common in children under 5years of age; characterized by sores in the mouth and throat and a rash on the hands and feet HFMD virus - ANSWER coxsackievirus HFMD spreading timeline - ANSWER Spread from person to person through saliva, fluidfrom blisters, or the stools of an infected person. Most likely to spread the disease during the first week of the illness, but the virus can stay in the stool for several monthsand may spread to others. Good handwashing and hygiene will help prevent spread
HFMD initial symptoms - ANSWER fever- 1 st sign, malaise, irritability, loss of appetite Painful, red, blister-like lesions on the tongue, gums and inside of the cheeks ▪ A red ▪
comedones - ANSWER also called blackheads; masses of sebum trapped in the hairfollicles-primary acne
mild acne - ANSWER closed comedones(white heads) open comedones (black heads)occasional pustules
moderate acne - ANSWER comedones open and closed papules, pustules severe acne - ANSWER comedones(open and closed), erythematous papules, pustules,cysts
how common is acne - ANSWER 80-85% of people 11-30 yo mild acne treatment - ANSWER topical antibiotic 2x per year ▪q AMGentle facial soap-Dove or Neutrogena ▪Topical tretinon (Retin-A) 0.025% cream or 0.01% gel nightly after cleansing skin ▪Topical benzoyl peroxide gel (2.5%, 5%, 10%)
Moderate acne treatment - ANSWERfor mild acne, stop Benzoyl peroxide and start topical antibiotic solution (Clindamycin, ▪Cleansing regimen ▪If no response to regimen erythromycin) AM and PMor Erythromycin 250-500 mg BID, or Doxycycline 50-100 mg/dose/day ▪Oral antibiotics: Tetracycline 250-500mg BID x 1-2 months ▪Consider referring to dermatologist ▪ - pregnancy test before prescribing tetracycline requires what before treatment can start - ANSWER pregnancy test education for acne - ANSWER may get worse before better neonatal acne cause - ANSWER response to maternal androgen
neonatal acne timeframe - ANSWER appears at age 2-4 weeks, subsides by ages 4-6months
Acne vulgaris - ANSWERfemales ▪ Begins preadolescence ▪ Peak ages 16-19 males & 14-
order of most contaminated bites between cats, dogs, and humans - ANSWER (most)human, cat, dog (least)
bite tx - ANSWER ▪Assessment for possible presence of foreign body ▪Irrigation of wound with normal saline ▪Assessment of need for surgical ▪Debridement of area closure- usually bite wounds are not sutured because of the risk of infection from thecontaminated wound
give tetanus shot with bite if - ANSWERwithin last 5 years ▪Immunization status is unknown (unless hxof anaphylaxis, ▪Incomplete immunization ▪No booster dose immunization is not harmful)
dog or cat bite bacteria - ANSWER ▪Pasteurella multocida ▪Strep ▪Staph ▪Anaerobes
human bite contaminants - ANSWER ▪Staph ▪Strep ▪anaerobes
bite antibiotic tx - ANSWER Augmentin 40 mg/kg/day in 3 doses X 7-10 daysV 50 mg/kg/day in 3 doses X 7-10 days ▪ Doxycycline 2-4 mg/kg/day in 2 doses X 7-10 ▪ Penicillin days (do not give < 8 yo) ▪ Erythromycin 30-50 mg/kg/day in 4 doses X 7-10 days doxy can not be given to children under - ANSWER 8 yo benadryl dose - ANSWER 1-2 mg/kg q4-6hr
