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NR 511 MIDTERM REVIEW
NR 511 MIDTERM REVIEW
• Actinic keratosis: pre-cancerous lesion. The main assessment technique is INSPECTION, which will
show as flesh colored, hard and sand paper like.
▪ TX: cryotherapy
o Risk factor: sun exposure, can progress to squamous cell carcinoma
o Referrer pt to dermatology to prevent progression
• Fungal skin infection: assess rash and satellite lesions.
o DX: based on clinical presentation, most common is candida albicans
o Tx: antifungal cream, pills, keep area as dry as possible. The fungus likes moisture and poor air
circulation
o At risk: opportunistic, pts who are immunocompromised, older and younger pts, diabetics, and
antibiotic therapy.
o Refer patient if there's no improvement
• Common types of fungal infections:
o Tinea vesicolor: flat to slightly elevated brown papules and plaques that scale when they are
rubbed along with areas of hypopigmentation, pruritic, most commonly found on trunk and
shoulders.
o Balanitis: candidiasis in the glands of the penis
o Tinea corporis: annual lesions with scaly borders and central clearing on the trunk
o Tinea pedis: athlete's foot, and between toes
o Tinea cruis: jock-itch groin
• Bacterial skin infections: warm, red, painful w/o sharply demarcated border
o Cellulitis: is a spreading infection of the epidermis and sub-cut tissue that usually begins after a
break in the skin.
o Folliculitis: bacterial infection of the hair follicle, papules are characteristics of folliculitis
• Viral skin infections
o Erythema infectiosum (fifth disease) erythematous, warm rash, gives the appearance of
slapped cheeks. Sore throat, slight fever, upset stomach, headache, fatigue, and itching.
Resolves on its own.
o Varicella rash: contagious 48 hours before the onset of the vesicular rash, during the rash
formation and during the several days it takes the vesicles to dry up. Characteristics rash
appears 2-3 weeks after exposure.
o Warts: caused by the human papillomavirus, most warts recur despite treatment. Contrary to
popular opinion, warts do not have roots, the underside of a wart is smooth and round.
Abrading the skin can spread the virus, vigorous rubbing, shaving, and nail biting can do the
same.
• Skin inflammations:
o Pityriasis rosea: common, self-limiting, usually asymptomatic eruption with a distinct initial
lesion. This "HERALD PATCH", which appears suddenly and without symptoms, usually is on the
chest or back.
▪ Secondary lesions appear 1-2 wks later while the herald patch remains.
▪ The collarette scaling is another classic symptom of pityriasis rosea.
▪ The lesions usually resolve suddenly in 4-12wks w/o scarring.
▪ Outbreaks are known to occur in close quarters like military barracks or dormitories.
o Hives: look at the location of the rash, the first step is to determine the need for epinephrine.
Look for respiratory symptoms, SOB, hoarseness, look at location. If the rash is on the neck,
face- admin epinephrine.
o Cholinergic urticaria: hives or wheals that are pruritic and occur on the trunk and arms
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NR 511 MIDTERM REVIEW
following exercise, anxiety, elevated body temp. hot bath and showers.
▪ Hx taking about when the rash started is important for dx
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NR 511 MIDTERM REVIEW
o Contact dermatitis: poison ivy: a form of contact dermatitis, it is not contagious and it cannot
be spread from one area of the body to another by touching it. Type of SPORE reaction.
▪ Another type is Latex sensitivity
o Keratosis pilaris: mild pruritic and looks like GOOSEFLESH, the rash appears as small, pinpoint,
follicular papules on a mildly erythematous base. It is a benign conditions that resolves by
adulthood.
o Atopic Dermatitis: consider ALLERGY!!
▪ Atopic triad: ASTHMA, ECZEMA, ALLERGIC RHINITIS
▪ RAST may be done to ID the antigen-specific mast cell activation or to quantify levels of
antigen-specific IgE. RAST is usually available to PCPs, where as scratch testing is
usually done by allergists.
▪ RAST results requires specialized knowledge, and should be used as general atopic
screening tool.
• Hair loss
o Alopecia areata: systemic cause of alopecia, nonscarring hair loss of rapid onset, the pattern of
which is most commonly sharply defined round or oval patches.
o Trichotilomania: non-scarring, non-systemic causes of alopecia include trauma, bacterial or
local fungal infections, and radiation to the head.
o Minoxidil(Rogaine) vasodilator and may stimulate vertex hair growth.
• Parasitic skin infections
o Pediculosis: (LICE!!) client education is important in the tx of pediculosis b/c pts should be
informed that itching may cause for up to a week after successful tx b/c of the slow resolution
of the inflammatory reaction caused by the lice infestation.
• Ear disorders
o Otitis externa: classic sign of acute otitis externa is tenderness on traction of the pinna and/or
pain on applying pressure over the tragus. There is typically an erythematous ear canal, and
usually a hx of recent swimming.
▪ Using ear drops made of a solution of equal parts alcohol and vinegar in ea. Ear after
swimming is effective in drying the ear canal and maintaining an acidic environment,
therefore preventing a favorable medium for the growth of bacteria, the cause of
swimmer's ears.
o Acute otitis media: ear infection that is dx by otoscopic examination. The tympanic membrane
will appear red and bulging with or w/o visible effusion.
▪ Light reflex is usually diminished or absent, and mobility id decreased NOT
INCREASED!!
▪ The external auditory canal is red and erythematous
▪ Tx of choice: amoxicillin 80-90mg/kg/day in children in daycare
▪ Note: it is important to note that if a child w/ O.M. with effusion has a change in
hearing threshold greater than 25 dB and has notable speech and language delays,
more aggressive tx is indicated. It is important that the provider evaluates the child's
developmental milestone in speech and language. Abnormal findings warrant a
referral.
o Meniere's disease: the triad of symptoms associated with Meniere's disease: PROGRESSIVE
HEARING LOSS, TINNITUS, AND VERTIGO.
• Hearing loss
o Sensorineural loss: come from exposure to loud noises, inner ear infections, tumors,
congenital, and familial disorders, and aging.
▪ Sensorineural loss comes from exposure to tumors such as acoustic neuromas,
Meniere's disease, medications, trauma, and certain disease.
o Conductive hearing loss: presbycusis- the conductive hearing loss- bone conduction is greater
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NR 511 MIDTERM REVIEW
than air conduction, so the patient will report the bone conduction sound longer than the air
conduction.
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NR 511 MIDTERM REVIEW
NR 511 MIDTERM REVIEW
• Actinic keratosis: pre-cancerous lesion. The main assessment technique is INSPECTION, which will
show as flesh colored, hard and sand paper like.
▪ TX: cryotherapy
o Risk factor: sun exposure, can progress to squamous cell carcinoma
o Referrer pt to dermatology to prevent progression
• Fungal skin infection: assess rash and satellite lesions.
o DX: based on clinical presentation, most common is candida albicans
o Tx: antifungal cream, pills, keep area as dry as possible. The fungus likes moisture and poor air
circulation
o At risk: opportunistic, pts who are immunocompromised, older and younger pts, diabetics, and
antibiotic therapy.
o Refer patient if there's no improvement
• Common types of fungal infections:
o Tinea vesicolor: flat to slightly elevated brown papules and plaques that scale when they are
rubbed along with areas of hypopigmentation, pruritic, most commonly found on trunk and
shoulders.
o Balanitis: candidiasis in the glands of the penis
o Tinea corporis: annual lesions with scaly borders and central clearing on the trunk
o Tinea pedis: athlete's foot, and between toes
o Tinea cruis: jock-itch groin
• Bacterial skin infections: warm, red, painful w/o sharply demarcated border
o Cellulitis: is a spreading infection of the epidermis and sub-cut tissue that usually begins after a
break in the skin.
o Folliculitis: bacterial infection of the hair follicle, papules are characteristics of folliculitis
• Viral skin infections
o Erythema infectiosum (fifth disease) erythematous, warm rash, gives the appearance of
slapped cheeks. Sore throat, slight fever, upset stomach, headache, fatigue, and itching.
Resolves on its own.
o Varicella rash: contagious 48 hours before the onset of the vesicular rash, during the rash
formation and during the several days it takes the vesicles to dry up. Characteristics rash
appears 2-3 weeks after exposure.
o Warts: caused by the human papillomavirus, most warts recur despite treatment. Contrary to
popular opinion, warts do not have roots, the underside of a wart is smooth and round.
Abrading the skin can spread the virus, vigorous rubbing, shaving, and nail biting can do the
same.
• Skin inflammations:
o Pityriasis rosea: common, self-limiting, usually asymptomatic eruption with a distinct initial
lesion. This "HERALD PATCH", which appears suddenly and without symptoms, usually is on the
chest or back.
▪ Secondary lesions appear 1-2 wks later while the herald patch remains.
▪ The collarette scaling is another classic symptom of pityriasis rosea.
▪ The lesions usually resolve suddenly in 4-12wks w/o scarring.
▪ Outbreaks are known to occur in close quarters like military barracks or dormitories.
o Hives: look at the location of the rash, the first step is to determine the need for epinephrine.
Look for respiratory symptoms, SOB, hoarseness, look at location. If the rash is on the neck,
face- admin epinephrine.
o Cholinergic urticaria: hives or wheals that are pruritic and occur on the trunk and arms
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, lOMoARcPSD|44532475
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NR 511 MIDTERM REVIEW
following exercise, anxiety, elevated body temp. hot bath and showers.
▪ Hx taking about when the rash started is important for dx
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, lOMoARcPSD|44532475
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NR 511 MIDTERM REVIEW
o Contact dermatitis: poison ivy: a form of contact dermatitis, it is not contagious and it cannot
be spread from one area of the body to another by touching it. Type of SPORE reaction.
▪ Another type is Latex sensitivity
o Keratosis pilaris: mild pruritic and looks like GOOSEFLESH, the rash appears as small, pinpoint,
follicular papules on a mildly erythematous base. It is a benign conditions that resolves by
adulthood.
o Atopic Dermatitis: consider ALLERGY!!
▪ Atopic triad: ASTHMA, ECZEMA, ALLERGIC RHINITIS
▪ RAST may be done to ID the antigen-specific mast cell activation or to quantify levels of
antigen-specific IgE. RAST is usually available to PCPs, where as scratch testing is
usually done by allergists.
▪ RAST results requires specialized knowledge, and should be used as general atopic
screening tool.
• Hair loss
o Alopecia areata: systemic cause of alopecia, nonscarring hair loss of rapid onset, the pattern of
which is most commonly sharply defined round or oval patches.
o Trichotilomania: non-scarring, non-systemic causes of alopecia include trauma, bacterial or
local fungal infections, and radiation to the head.
o Minoxidil(Rogaine) vasodilator and may stimulate vertex hair growth.
• Parasitic skin infections
o Pediculosis: (LICE!!) client education is important in the tx of pediculosis b/c pts should be
informed that itching may cause for up to a week after successful tx b/c of the slow resolution
of the inflammatory reaction caused by the lice infestation.
• Ear disorders
o Otitis externa: classic sign of acute otitis externa is tenderness on traction of the pinna and/or
pain on applying pressure over the tragus. There is typically an erythematous ear canal, and
usually a hx of recent swimming.
▪ Using ear drops made of a solution of equal parts alcohol and vinegar in ea. Ear after
swimming is effective in drying the ear canal and maintaining an acidic environment,
therefore preventing a favorable medium for the growth of bacteria, the cause of
swimmer's ears.
o Acute otitis media: ear infection that is dx by otoscopic examination. The tympanic membrane
will appear red and bulging with or w/o visible effusion.
▪ Light reflex is usually diminished or absent, and mobility id decreased NOT
INCREASED!!
▪ The external auditory canal is red and erythematous
▪ Tx of choice: amoxicillin 80-90mg/kg/day in children in daycare
▪ Note: it is important to note that if a child w/ O.M. with effusion has a change in
hearing threshold greater than 25 dB and has notable speech and language delays,
more aggressive tx is indicated. It is important that the provider evaluates the child's
developmental milestone in speech and language. Abnormal findings warrant a
referral.
o Meniere's disease: the triad of symptoms associated with Meniere's disease: PROGRESSIVE
HEARING LOSS, TINNITUS, AND VERTIGO.
• Hearing loss
o Sensorineural loss: come from exposure to loud noises, inner ear infections, tumors,
congenital, and familial disorders, and aging.
▪ Sensorineural loss comes from exposure to tumors such as acoustic neuromas,
Meniere's disease, medications, trauma, and certain disease.
o Conductive hearing loss: presbycusis- the conductive hearing loss- bone conduction is greater
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, lOMoARcPSD|44532475
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NR 511 MIDTERM REVIEW
than air conduction, so the patient will report the bone conduction sound longer than the air
conduction.
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