AH2 EXAM 1: Cary Review: Maryville NURS623 wit correct answers 2023-24

AH2 EXAM 1: Cary Review: Maryville NURS623 lyme disease - correct answer fever, rash, facial paralysis, arthritis, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes ELISA - correct answer most common diagnostic test for lyme disease immunoblot - correct answer used to confirm ELISA results stage 1: early localized lyme disease - correct answer circular rash that may expand overtime and may have bullseye appearance; flu-like symptoms stage 1 lyme disease treatment - correct answer doxycycline, cefuroxime, amoxicillin stage 2: early disseminated lyme disease - correct answer sxs can range from mild to severe, or not at all; most common are flu-like symptoms but worse than in stage one; paralysis or weakness in the face, heart palpitations, blurry vision stage 2 lyme disease treatment - correct answer azithromycin, doxycycline (not for pregnancy, children <8, or nursing women) amoxicillin cefuroxime stage 2 lyme disease - correct answer may occur weeks to months after infection stage 3: late disseminated lyme disease - correct answer may start six months or even years after original tick bite if treatment was not started in stage 1 or 2 stage 3: late disseminated lyme disease symptoms - correct answer severe headaches arthritis of large joints heart arrhythmia brain disturbance: memory loss, insomnia difficulty concentrating temporary amnesia difficulty following conversation or speaking extreme fatigue numbness/tingling of extermities temporary paralysis of facial muscles stage 4: late stage or chronic lyme arthritis - correct answer recurrent form of joint inflammation which may include episodes of severe arthritis symptoms; most common joint affected is the knee but may occur in other large or small joints as well stage 4 lyme disease sxs - correct answer episodes lasting longer than 6 months of swelling, redness, and fluid buildup systemic lupus (inside lupus) - correct answer more common in women of childbearing age chronic inflammatory disease affects skin, joints, kidneys, lungs, nervous system, serous membranes systemic lupus sxs - correct answer fatigue joint aches myalgia keratoconjunctivitis sicca (eye) photosensitivity BUTTERFLY RASH macular rash thrombocytopenia gastritis ulcers discoid lupus (outside lupus) - correct answer just involves skin characterized as production of antinuclear antibodies *refer these patients to rheumatology discoid lupus diagnostics - correct answer ana + titer (1:160 or higher) *refer these patients to rheumatology discoid lupus sxs - correct answer patches on skin *refer these patients to rheumatology RA - correct answer More women than men get rheumatoid arthritis. It often starts in middle age and is most common in older people. A patient might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime. RA can affect body parts besides joints, such as eyes, mouth and lungs. RA is an autoimmune disease, which means the arthritis results from the immune system attacking the body's own tissues. RA causes - correct answer No one knows what causes rheumatoid arthritis. Genes, environment, and hormones might contribute. RA treatment - correct answer Treatments include medicine, lifestyle changes, and surgery. These can slow or stop joint damage and reduce pain and swelling. RA sxs - correct answer Pain Swelling Stiffness loss of function in joints It can affect any joint but is common in the wrist and fingers. Ankylosing Spondylitis: - correct answer type of arthritis of the spine inflammation between your vertebrae and in the joints between your spine and pelvis. In some people, it can affect other joints. Ankylosing Spondylitis sxs - correct answer inflammation, pain, stiffness in other areas of the body such as the shoulders, hips, ribs, heels, and small joints of the hands and feet. Sometimes the eyes can become involved (known as iritis or uveitis), and -- rarely -- the lungs and heart can be affected. The hallmark feature of ankylosing spondylitis is the involvement of the sacroiliac (SI) joints during the progression of the disease. OA - correct answer Degenerative joint disease "wear and tear" arthritis, osteoarthritis (OA) is the most common chronic condition of the joints. OA causes - correct answer It occurs when the cartilage or cushion between joints breaks down leading to pain, stiffness and swelling. A type of arthritis that occurs when flexible tissue at the ends of bones wears down. OA treatment - correct answer There is no cure, but treatments are available to manage symptoms. Pain and Anti-inflammatory Medications -Analgesics: tylenol/narcs/tramadol -Nonsteroidal anti-inflammatory drugs (NSAIDs: asa/aleve/celebrex -Corticosteroids: PO or injection (hyalgan) Physical and Occupational Therapy Assistive Devices Natural and Alternative Therapies Surgery Positive Attitude. Long-term management of the disease will include several factors: • Managing symptoms, such as pain, stiffness and swelling • Improving joint mobility and flexibility • Maintaining a healthy weight • Getting enough of exercise OA sxs - correct answer Joint pain in the hands, neck, lower back, knees, or hips is the most common symptom. Pain areas: in the joints, hands, hip, knee, lower back, or neck Pain circumstances: can occur related to weather Pain types: can be severe in the joints Joints: stiffness, crackles, swelling, or tenderness Hand: bump on the finger or bony outgrowth in fingers or toes Also common: joint deformity or limping anemia - correct answer men: hgb < 13 women: hgb <12 Microcytic, hypochromic anemia - correct answer based on SMALL SIZE OF THE RBCS identivied via one of the three indices of RBCS: MCV (mean corpuscular volume) S/S microcytic, hypochromic anemia - correct answer low H&H, low RBCS = reduced O2 causes/process of Microcytic, hypochromic anemia - correct answer inadequate oral intake or gastrointestinal uptake of dietary iron anemia of chronic disease thalassemia sideroblastic anemia lab data for diagnosis of Microcytic, hypochromic anemia - correct answer mcv 50-80 mch 12-25 mchc 25-30% treatment of Microcytic, hypochromic anemia - correct answer dietary supplements blood transfusions folic acid supplements medication removal of spleen blood and bone marrow stem cell transplant microcytic, normochromic anemia causes - correct answer • Renal disease • Infection • Liver disease • Malignancies (P 927) lab data for microcytic, nomochromic anemia - correct answer MCV <80 mm3 MCH 20-25 pg MCHC 27% Normocytic, normochromic anemia - correct answer anemia associated with normally sized RBCs MCV = 81-99fL causes of Normocytic, normochromic anemia - correct answer • Chronic disease states • Acute blood loss • Hemolysis • Volume overload (pg 929) labs for Normocytic, normochromic anemia - correct answer MCV 82-92 mm3 MCH 25-30 pg MCHC 32-36% macrocytic, normochromic anemia - correct answer anemia with a MCV equal to or greater than 100fL labs for macrocytic, normochromic anemia - correct answer MCV 95-150 mm3 MCH 30-50 pg MHCH 32-36% iron deficiency anemia - correct answer Treatment for this form of anemia usually involves taking iron supplements and making changes to your diet. If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery. hemolytic anemia causes - correct answer Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases, removal of the spleen can be helpful. hemolytic anemia treatment - correct answer Avoiding suspect medications, treating related infections and taking drugs that suppress immune system, which may be attacking red blood cells. vitamin b12 deficiency aka pernicious anemia - correct answer a macrocytic anemia caused by a hereditary auto immune disorder in which destructive antibodies are directed against intrinsic factor, a 45-kDa protein produced by gastric parietal cells that binds to dietary vitamin B12 during digestion and absorption of nutrients and is critical to DNA synthesis and RBC maturation. treatment of vitamin b12 deficiency aka pernicious anemia - correct answer Dietary supplements and increasing intake in diet. Vitamin B12 injections treatment of folate deficiency - correct answer Dietary supplements and increasing intake in diet Process of hemolytic anemia - correct answer : a condition in which red blood cells are destroyed at a high rate and removed from the bloodstream before their normal lifespan is over. In hemolytic anemia, the bone marrow can't make red blood cells fast enough to meet the body's needs of oxygen. Hemolytic anemia - correct answer Can be acquired or hereditary Can lead to many health problems, such as fatigue (tiredness), pain, irregular heartbeats, an enlarged heart, and heart failure. lab data that would suggest hemolytic anemia - correct answer Standard blood studies for the workup of suspected hemolytic anemia include the following: o Complete blood cell count: A low level of hemoglobin or hematocrit is a sign of anemia. o Reticulocyte count: measures the number of young red blood cells in your blood, showing whether your bone marrow is making red blood cells at the correct rate. (People who have hemolytic anemia usually have high reticulocyte counts because their bone marrow is working hard to replace the destroyed red blood cells.) o Peripheral smear: indicates a change in normal shape of red blood cells under microscope which can be caused by anemia o Serum lactate dehydrogenase (LDH): o Serum haptoglobin: A low level of haptoglobin in the bloodstream is a sign of hemolytic anemia. (When red blood cells break down, they release hemoglobin into the bloodstream. The hemoglobin combines with a chemical called haptoglobin.) o Indirect bilirubin: High levels of bilirubin in the bloodstream may be a sign of hemolytic anemia. Acute HIV infection - correct answer the period of time immediately following infection with the human immunodeficiency virus (HIV). S/S of acute HIV infction - correct answer o Acute retroviral syndrome usually begins within 2- 4 weeks of infection and usually lasts 3 to 14 days. o Symptoms and signs are often mistaken for infectious mononucleosis or benign, nonspecific viral syndromes, • fever, • nausea, • vomiting, • headache, • malaise, • fatigue, • several types of dermatitis, • sore throat, • arthralgias, • generalized lymphadenopathy, and • septic meningitis. secondary sxs of HIV infection - correct answer o After the first symptoms disappear, most patients, even without treatment, have no symptoms or only a few mild, intermittent, nonspecific symptoms for a highly variable time period (2 to 15 yr). o Symptoms during this relatively asymptomatic period may result from HIV directly or from opportunistic infections. • Lymphadenopathy • White plaques due to oral candidiasis • Herpes zoster • Diarrhea • Fatigue • Fever with intermittent sweats • Asymptomatic, mild-to-moderate cytopenias (eg, leukopenia, anemia, thrombocytopenia) are also common. Some patients experience progressive wasting (which may be related to anorexia and increased catabolism due to infections) and low-grade fevers or diarrhea. Risk factors for exposure of HIV - correct answer o Risk Factors for Exposure: o Sexual transmission o Needle- and instrument-related transmission o Maternal transmission • Transplacentally • Perinatally • Via breast milk o Transfusion- and transplant-related transmission diagnosis of HIV infection - correct answer infection can be diagnosed by antibody, nucleic acid (HIV RNA), or antigen testing. psoriasis presenatation - correct answer o An inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. o Bilaterally symmetrical o Commonly occurs in ear canal o Areas of the body most commonly affected are the back of the forearms, shins, navel area, extensor surfaces of the elbows and knees, umbilicus, gluteal cleft, and scalp o Varies in severity from small, localized patches to complete body coverage plaque psoriasis - correct answer presents as red patches with white scales on top guttate psoriasis - correct answer drop-shaped lesions pustular psoriasis - correct answer small non-infectious pus-filled blisters inverse psoriasis - correct answer red patches in skin folds erythrodermic psoriasis - correct answer widespread rash first line treatment for psoriasis (topical) - correct answer o Corticosteroids o Vitamin D3 analogs (e.g., calcipotriol [calcipotriene], calcitriol o Calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) o Tazarotene o Emollients o Salicylic acid o Coal tar o Anthralin First line phototherapy for psoriasis - correct answer UV light therapy first line systemic treatments for psoriasis - correct answer • Methotrexate • Systemic retinoids (e.g., acitretin, isotretinoin) • Immunosuppressants • Cyclosporine • Immunomodulatory agents true - correct answer t/f: acne rosacea is chronic acne rosacea treatment - correct answer o Topical metronidazole o Oral tetracycline atopic dermatitis (eczema) - correct answer o A chronic inflammatory skin disorder with a complex pathogenesis involving genetic susceptibility, immunologic and epidermal barrier dysfunction, and environmental factors. o Pruritus is the primary symptom; skin lesions range from mild erythema to severe lichenification. o Presents as red patches with white scales on top o Chronic and recurring. atopic dermatitis (eczema) testing - correct answer Diagnosis is by history and examination. Family history of allergic disease: o Asthma o Allergic rhinitis atopic dermatitis (eczema) treatment - correct answer o Moisturizers o Avoidance of allergic and irritant triggers o Topical corticosteroids or immune modulators. Childhood atopic dermatitis frequently resolves or lessens significantly by adulthood. contact dermatitis - correct answer o a rash that occurs at the site of exposure to a substance capable of producing an allergic or irritant skin response. contact dermatitis causes - correct answer o Noxious, irritating substances or substances to which the patient has developed a skin allergy. o Direct exposure to substance that triggers an immune response (T-cell mediated response) o May be allergic or irritant induced o Ex: poison ivy contact dermatitis treatment - correct answer o Treated topically with evaporative measures. • the application of repeated cycles of cool water compresses followed by drying. o Once the weeping and oozing have stopped, application of: • potent topical steroids two times a day to the affected areas for two to three weeks. o It may be necessary to treat with oral steroids for two to three weeks. o It will usually take one to three weeks for the allergen to be entirely removed from the skin so that the rash resolves entirely. Dyshidrotic eczema (pompholyx/ dyshidrosis) - correct answer o Vesicular dermatitis o Intensely pruritic blisters o Small fluid-filled blisters on the fingers, hands, and feet o Redness o Flaking o Scaly, cracked skin o Pain o Involves palms of hands and soles of feet o More common in women than men Dyshidrotic eczema (pompholyx/ dyshidrosis) causes - correct answer • Stress • allergies (such as hay fever) • moist hands and feet • contact with nickel (in metal-plated jewelry), cobalt (found in metal-plated objects and in pigments used in paints and enamels), or chromium salts (used in the manufacturing of cement, mortar, leather, paints and anticorrosives) Dyshidrotic eczema (pompholyx/ dyshidrosis) treatment - correct answer • At home treatment for dyshidrotic eczema includes soaking hands and feet in cool water or applying compresses to the affected area two to four times a day. • Topical steroid and a topical anesthetic like pramoxine to help with the itch and pain. • Using a rich moisturizer or a skin barrier cream is also recommended. hypersensitivity reaction s/s - correct answer Systemic Itch: o Renal/liver disease o Connective tissue disorders o Post Herpatic neuralgia o Multiple sclerosis o Psychotic itch o Burns/scars documentation/description of skin finding hpi - correct answer Location, color, shape and size. Measure length, width and depth and document. Detection of tenderness, firmness, and depth with palpation. Documentation: Noted areas of plaque are red patches with white scales on top, measuring 2 cm by 3 cm noted on the back of forearms, localized, bilaterally symmetrical. scale - correct answer heaped-up accumulations of horny epithelium that occur in disorders such as psoriasis, seborrheic dermatitis, and fungal infections. Pityriasis rosea and chronic dermatitis of any type may be scaly. crusts (scabs) - correct answer consist of dried serum, blood, or pus. Crusting can occur in inflammatory or infectious skin diseases (e.g. impetigo). erosions - correct answer open areas of skin that result from loss of part or all of the epidermis. Erosions can be traumatic or can occur with various inflammatory or infectious skin diseases. An excoriation is a linear erosion caused by scratching, rubbing, or picking. ulcers - correct answer result from loss of the epidermis and at least part of the dermis. Causes include venous stasis dermatitis, physical trauma with or without vascular compromise (e.g., caused by decubitus ulcers or peripheral arterial disease), infections, and vasculitis. petechiae - correct answer non-blanchable punctate foci of hemorrhage. Causes include platelet abnormalities (e.g., thrombocytopenia, platelet dysfunction), vasculitis, and infections (e.g., meningococcemia, Rocky Mountain spotted fever, other rickettsioses). purpura - correct answer a larger area of hemorrhage that may be palpable. Palpable purpura is considered the hallmark of leukocytoclastic vasculitis. Purpura may indicate a coagulopathy. Large areas of purpura may be called ecchymoses or, colloquially, bruises. atrophy - correct answer thinning of the skin, which may appear dry and wrinkled, resembling cigarette paper. Atrophy may be caused by chronic sun exposure, aging, and some inflammatory and neoplastic skin diseases, including cutaneous T-cell lymphoma and lupus erythematosus. Atrophy also may result from long-term use of potent topical corticosteroids. scars - correct answer areas of fibrosis that replace normal skin after injury. Some scars become hypertrophic or thickened and raised. Keloids are hypertrophic scars that extend beyond the original wound margin. Telangiectases - correct answer foci of small, permanently dilated blood vessels that may occur in areas of sun damage, rosacea, systemic diseases (especially systemic sclerosis), or inherited diseases (e.g., ataxia-telangiectasia, hereditary hemorrhagic telangiectasia) or after long-term therapy with topical fluorinated corticosteroids. linear lesion - correct answer the shape of a straight line and are suggestive of some forms of contact dermatitis, linear epidermal nevi, and lichen striatus. Traumatically induced lesions, including excoriations caused by the patient's fingernails, are typically linear. annular lesions - correct answer rings with central clearing. Examples include granuloma annulare, some drug eruptions, some dermatophyte infections (e.g., ringworm), and secondary syphilis. Nummular lesions - correct answer circular or coin-shaped; an example is nummular eczema. Target (bull's-eye or iris) lesions - correct answer appear as rings with central duskiness and are classic for erythema multiforme. Serpiginous lesions - correct answer have linear, branched, and curving elements. Examples include some fungal and parasitic infections (e.g., cutaneous larva migrans). Reticulated lesions - correct answer have a lacy or networked pattern. Examples include cutis marmorata and livedo reticularis. Herpetiform - correct answer describes grouped papules or vesicles arranged like those of a herpes simplex infection. Zosteriform - correct answer describes lesions clustered in a dermatomal distribution similar to those of herpes zoster. Verrucous lesions - correct answer have an irregular, pebbly, or rough surface. Examples include warts and seborrheic keratoses. Lichenification - correct answer thickening of the skin with accentuation of normal skin markings; it results from repeated scratching or rubbing. induration - correct answer deep thickening of the skin, can result from edema, inflammation, or infiltration, including by cancer. Indurated skin has a hard, resistant feeling. Induration is characteristic of panniculitis, some skin infections, and cutaneous metastatic cancers. umbilicated lesions - correct answer have a central indentation and are usually viral. Examples include molluscum contagiosum and herpes simplex. Xanthomas - correct answer yellowish, waxy lesions, may be idiopathic or may occur in patients who have lipid disorders. Lichen planus - correct answer frequently arises on the wrists, forearms, genitals, and lower legs. Vitiligo - correct answer may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth. Discoid lupus erythematosus - correct answer has characteristic lesions on sun-exposed skin of the face, especially the forehead, nose, and the conchal bowl of the ear Hidradenitis suppurativa - correct answer involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts. Red skin (erythema) - correct answer can result from many different inflammatory or infectious diseases. Cutaneous tumors are often pink or red. Superficial vascular lesions such as port-wine stains may appear red. Orange skin - correct answer is most often seen in hypercarotenemia, a usually benign condition of carotene deposition after excess dietary ingestion of beta-carotene. Yellow skin - correct answer is typical of jaundice, xanthelasmas and xanthomas, and pseudoxanthoma elasticum. green fingernails - correct answer suggest Pseudomonas aeruginosa infection. violet skin - correct answer may result from cutaneous hemorrhage or vasculitis. Vascular lesions or tumors, such as Kaposi sarcoma and hemangiomas, can appear purple. A lilac color of the eyelids or heliotrope eruption is characteristic of dermatomyositis. Shades of blue, silver, and gray - correct answer can result from deposition of drugs or metals in the skin, including minocycline, amiodarone, and silver (argyria). Ischemic skin appears purple to gray in color. Deep dermal nevi appear blue. black skin - correct answer lesions may be melanocytic, including nevi and melanoma. Black eschars are collections of dead skin that can arise from infarction, which may be caused by infection (e.g., anthrax, angioinvasive fungi including Rhizopus,meningococcemia), calciphylaxis, arterial insufficiency, or vasculitis. Dermatographism - correct answer is the appearance of an urticarial wheal after focal pressure (eg, stroking or scratching the skin) in the distribution of the pressure. Up to 5% of normal patients may exhibit this sign, which is a form of physical urticaria. darier sign - correct answer refers to rapid swelling of a lesion when stroked. It occurs in patients with urticaria pigmentosa or mastocytosis. Nikolsky sign - correct answer is epidermal shearing that occurs with gentle lateral pressure on seemingly uninvolved skin in patients with toxic epidermal necrolysis and some autoimmune bullous diseases. auspitz sign - correct answer is the appearance of pinpoint bleeding after scale is removed from plaques in psoriasis. Koebner phenomenon - correct answer describes the development of lesions within areas of trauma (eg, caused by scratching, rubbing, or injury). Psoriasis frequently exhibits this phenomenon, as may lichen planus, often resulting in linear lesions. pustules - correct answer Sizes vary; superficial elevated lesion filled with purulent fluid. Ex: acne pustule Pustules are common in bacterial infections and folliculitis and may arise in some inflammatory disorders including pustular psoriasis. macules - correct answer Flat, nonpalpable lesion usually < 10 mm in diameter; caused by changes in skin pigmentation. Macules represent a change in color and are not raised or depressed compared to the skin surface Ex: freckles, flat moles, tattoos, and port-wine stains, and the rashes of rickettsial infections, rubella, measles (can also have papules and plaques), and some allergic drug eruptions. patches - correct answer Nonpalpable lesion; caused by changes in skin pigmentation on a larger area than macules. Ex: café-as-lait stain keloids - correct answer Sharply elevated bulky scar tissue that appears shiny and smooth. Formation of keloids may have a genetic component. Ex: psoriasis and granuloma annulare papules - correct answer Elevated, palpable lesions on top of the skin usually < 10 mm in diameter. Ex: nevi (moles), warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers. plaques - correct answer Palpable lesions > 10 mm in diameter that are elevated or depressed compared to the skin surface. Plaques may be flat topped or rounded. Ex: psoriasis and granuloma annulare nodules - correct answer Firm papules or lesions that extend into the dermis or subcutaneous tissue Ex: cysts, lipomas, and fibromas. vesicles - correct answer Small, clear, fluid-filled blisters < 10 mm in diameter. Vesicles are characteristic of herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders Ex: dermatitis herpetiformis bullae - correct answer Clear fluid-filled blisters > 10 mm in diameter. These may be caused by burns, bites, irritant or allergic contact dermatitis, and drug reactions. Classic autoimmune bullous diseases include pemphigus vulgaris and bullous pemphigoid. Bullae also may occur in inherited disorders of skin fragility. urticaria - correct answer Characterized by elevated lesions caused by localized edema. Wheals are pruritic and red. Wheals are a common manifestation of hypersensitivity to drugs, stings or bites, autoimmunity, and, less commonly, physical stimuli including temperature, pressure, and sunlight. The typical wheal lasts < 24 h. ex: wheals or hives Hematoma - correct answer Large collection of blood as a result of trauma or coagulation defects. Frequently tender and discolored. Colors change from dark blue to green, then yellow. Can take several weeks to resolve. eccymosis - correct answer Bleeding into the skin layers and surrounding tissue as a result of trauma or coagulation defects. ex: bruise lotion - correct answer least potent skin treatment cream - correct answer runner up of least potent skin treatment gel - correct answer second to most potent skin treatment ointment - correct answer most potent skin treatment Actinic Keratosis (precancerous growths) - correct answer o Most common o aka senile or solar keratosis o Usually in fair skinned people o Usually in people >age 40 due to years of sun exposure o More common in men o Usually head, neck, hands, forearms o Can progress to squamous cell carcinoma so treatment is important Actinic Keratosis (precancerous growths) testing - correct answer Actinic Keratosis (precancerous growths) Actinic Keratosis (precancerous growths) treatment - correct answer • Topical therapy (5-FU) creams: Efudex; Carac • Surgical destruction (cryotherapy) Actinic Keratosis (precancerous growths) description - correct answer o Primary lesions are macules or plaques which are poorly circumscribed o Small papules (0.2-5mm) which can be flesh colored or slightly hyperpigmented o Secondary lesions are erythematous, scaly and have uneven surface o Feel rough to touch due to hyperkeratosis (sandpaper) o Can be pruritic, tender, or have stinging sensation o Pg 239 squamous cell carcinoma - correct answer o A malignant tumor originating from keratinocytes, which can invade the dermis and occasional metastasize to distant sites. o More common on head and neck (55%) o More common in fair skinned o 2nd most common type of skin cancer o Tends to form in high sun exposure areas: o Rims of ears o Face o Neck o Arms o Chest o Back squamous cell carcinoma testing - correct answer • Test a suspicious area by gently rubbing with a tongue depressor. If it bleeds, be suspicious of squamous cell squamous cell carcinoma description - correct answer • Red firm bump or • Scaly patch or • Sore that heals then reopens squamous cell carcinoma treatment - correct answer • Early diagnosis/treatment can prevent this and stop SCC from spreading. basal cell carcinoma - correct answer o Malignant tumor of the skin that originates from the basal cells of the epidermis; o Slow-growing and locally invasive tumor that rarely metastasizes; o Common in 50-60 year-olds; o Common in fair skinned but can occur in darker skin; o Usually on head and neck but can occur anywhere; o Early diagnosis/treatment is important as it can invade surrounding tissue; basal cell carcinoma testing - correct answer biopsy basal cell carcinoma treatment - correct answer Simple excision: • Electrodesiccation and curettage • Cryosurgery • Laser surgery • Mohs microsurgery - highest cure rate basal cell carcinoma description - correct answer • Flesh colored, pearly domed nodule with overlaying telangiectatic vessels. • Pinkish patch of skin • Later stage, central ulceration and crusting. Malignant melanoma - correct answer o Deadliest form of skin cancer (75% of all skin cancer deaths) o Arises from malignancy of epidermal melanocytes o >90% arise from skin o few arise from eye (uveal melanoma) o <4% do not have primary site o If >4 mm in depth, poor prognosis (75% mortality) Malignant melanoma treatment - correct answer o Treatment depends on the stage of the lesion: o Biological therapy o Chemotherapy o Radiation o Surgery Malignant melanoma testing - correct answer o Full body inspection o Lesion biopsy o Excisional biopsy is preferred o Classification System: o Clark/Breslow methods o TNM (tumor, node, metastasis) pg 244 Malignant melanoma description - correct answer o Frequently develops in a mole with notable changes or o Suddenly appears as a new dark spot on skin, assymetrical lesion with irregular border, notching, and a diameter >6mm. o Variegation in color, with admixtures of blue, red, tan, brown, black, and white. Pneumonic: A = asymmetry B = border is irregular C = colors are different in same region D = diameter > 6 mm E = enlargement (evolution) malignant melanoma types - correct answer o Superficial spreading (70-85%), extensive lateral or radial growth before vertical growth o Nodular (15-30%), vertical growth only) o Lentigo maligna (5%), in situ form that may persist for years before vertical extension o Acral lentiginous (2-8%), aggressive form most common in darker skinned persons, especially when appearing on hands/feet atypical mole - correct answer o unusual-looking benign (noncancerous) moles, also known as dysplastic nevi (the plural of "nevus," or mole) o people who have them are at increased risk of developing melanoma in a mole or elsewhere on the body. o The higher the number of these moles someone has, the higher the risk. Those who have 10 or more have 12 times the risk of developing melanoma compared with the general population. o Heredity appears to play a part in the formation of atypical moles. They tend to run in families, especially in Caucasians; about 2 to 8 percent of Caucasians have these moles. Those who have atypical moles plus a family history of melanoma (two or more close blood relatives with the disease) have a very high risk of developing melanoma. atypical mole treatment - correct answer excision and biopsy atypical mole description - correct answer o itching, pain, elevation, bleeding, crusting, oozing, swelling, persisting open sores, bluish-black color and other features that may go right up to the edges of the mole. merkel cell carcinoma - correct answer o a rare, aggressive skin cancer that is at high risk of recurring and spreading (metastasizing) throughout the body, with most recurrences taking place within two years after diagnosis of the primary tumor. o also called neuroendocrine carcinoma of the skin. o disease is 40 times rarer than melanoma (an estimated 0.24 cases per 100,000 persons in the U.S.), it kills about one in three patients compared with one in nine for melanoma. o MCC most often arises on sun-exposed areas in fair-skinned individuals over age 50. o Its name comes from the similarity of these cancer cells to normal Merkel cells in the skin that are thought to be associated with touch sensation. Normal Merkel cells were first described more than 100 years ago by Friedrich Sigmund Merkel. merkel cell carcinoma treatment - correct answer • based mainly on the stage of the disease and the overall health of the patient. • Core treatments: • surgical excision • radiation • chemotherapy merkel cell carcinoma testing - correct answer o technique called sentinel lymph node biopsy (SLNB) to Merkel cell carcinoma patients, regardless of tumor size, to determine whether the disease has spread (metastasized) to the lymph nodes merkel cell carcinoma description - correct answer o usually appears as a flesh-colored or bluish-red nodule o firm, painless lesions or nodules on a sun-exposed area (about 48 percent of the time on the head and neck, and frequently on the eyelids) o most commonly less than 20 mm in diameter The average size on detection is about the diameter of a dime (17 mm) 5 stages of AJCC classification of merkel cell carcinoma - correct answer o Stage 0: In situ tumors (superficial tumors that have not penetrated beyond the epidermis, the skin's outermost layer). o Stage I and stage II: Tumors not known to have advanced to the local lymph nodes, with stage I including relatively smaller, lower-risk tumors and stage II including larger and/or higher-risk tumors. o Stage III: Tumors known to have reached the local lymph nodes but not beyond. o Stage IV: Distant metastases, tumors whose cancer cells have spread to distant body areas, lymph nodes or organs beyond the local lymph nodes. fungal infection pathogens - correct answer epidermophyton, trichophyton, microsporum. fungal infection treatment - correct answer topical antifungals those at risk for fungal infections - correct answer dm, immunocompromised fungal infection diagnostics - correct answer KOH tinea - correct answer Superficial skin infections caused by three fungal species: trichophyton, epidermophyton and microsporum Transmitted primarily by contact with infected person or animal (dogs, cats). shingles - correct answer Painful vesicular rash onychomycosis - correct answer Nail fungal infection onychomycosis treatment - correct answer o Terbinafine for 6-12 weeks (only 73-79% effective, educate patient) *beware of hepatotoxicity and drug to drug interactions; topicals are poorly effective tinea corporis - correct answer Ringworm of the body Clinical Presentation: history of erythematous round and elevated pruritic lesion that grows in size and starts to clear in the center, classic shape of "ringworm" tinea corprois treament - correct answer Miconazole 2% cream, BID x 4 weeks Clotrimazole 1% cream and solution, BID for up to 4 weeks Terbafine 1% cream (Lamisil AT), BID for two week tinea corporis lab data to obtain prior to tx - correct answer skin scraping (KIH) tinea curis (jock itch) - correct answer Ringworm of the groin; more common in men Causative Agent: T rubrum Clinical Presentation: obese adult male who complains of a typically extremely pruritic rash on groin that is spreading to the medial inner aspect of the upper thigh. Most lesions show lichenification from chronic scratching. Typical lesion is round to a half circle, lesions will spread to medial inner thigh but spare scrotum. Color can be from bright red to dull discoloration. Lesions can become macerated from infection and scratching and become secondarily infected. tinea curis (jock itch) treatment - correct answer Miconazole 2% cream, BID x 4 weeks Clotrimazole 1% cream and solution, BID for up to 4 weeks Terbafine 1% cream (Lamisil AT), BID for two week tinea curis (jock itch) lab data to obtain prior to treeatment - correct answer skin scraping (KOH) Tinea versicolor (skin) - correct answer Aka pityriasis versicolor; Clinical Presentation: Round or oval lesions of hypopigmentation or hyperpigmentation macules, located mainly on the back, chest, arms, sometimes neck/face. Sometimes very fine scales are seen. Causative Agent: yeast P orbiculare which causes round lesions or Pityrosporum ovale which causes oval lesions; more common in summertime; Tinea versicolor (skin) treatment - correct answer Clotrimazole 1% cream and solution, BID for up to 4 weeks Tinea versicolor (skin) lab testing to obtain prior to treatment - correct answer skin scraping (koh) tinea capitis (head) - correct answer Ringworm of the scalp; more common in children until puberty; Most contagious; Clinical Presentation: painless bald spot, typically in school age children or toddlers; may have a kerion that looks like a honeycomb; inflammatory boggy mass containing broken hairs and oozing purulent material from follicular orifices. Infection occurs either inside (endothrix) or outside (ectothrix) of the hair shaft. Causative Agent: Ectothrix caused by Microsporum species (M canis and M andounii) Endothrix caused by Trichophyton tinea capitis (head) treatment - correct answer systemic antifungals tinea capitis (head) lab data to obtain prior to treating - correct answer fungal culture Tinea Pedis ("athlete's foot") - correct answer Ringworm of the feet; Causative Agent: trichophyton mentagrophytes; chronic tinea pedis us caused by Trichophyton rubrum Clinical Presentation: Strong foot odor; macerated soft, whitened skin between the toes. Infection usually starts in 3rd or 4th interdigital web space. Some patients have concurrent infections. *Ulcerative tinea Pedis causes scaling and thickening of the skin in a moccasin distribution on both feet. *"id" eruption - dermatophytid. Caused by a hypersensitivity reaction to fungus. Presents as vesicles on the sides of the fingers and/or palms of the hands. Tinea Pedis ("athlete's foot") treatment - correct answer 2-4 week course of topical treatment: Miconazole 2% cream, BID x 4 weeks Clotrimazole 1% cream and solution, BID for up to 4 weeks Terbafine 1% cream (Lamisil AT), BID for two weeks Tinea Pedis ("athlete's foot") lab data to obtain prior to treating - correct answer skin scraping (KOH) tinea unguinum (nail) - correct answer Onychomycosis; seen more frequently in adults and elderly patients tinea unguinum (nail) treatment - correct answer Systemic antifungals: o Terbinafine for 6-12 weeks (only 73-79% effective, educate patient tinea unguinum (nail) lab data to obtain prior to treatment - correct answer fungal culture o What lab data would you want to obtain prior to starting antifungal agents? - correct answer Liver and kidney function Shingles/Herpes Simplex/Varicella Zoster causitive organism - correct answer varicella zoster virus Shingles/Herpes Simplex/Varicella Zoster risk factors - correct answer immunocompromised, stress Shingles/Herpes Simplex/Varicella Zoster treatment - correct answer • High dose NSAIDs and Narcotics • Antiviral agents within 72 hours of onset • Acyclovir • Famciclovir • Valcyclovir • Vaccinate immunocompromised adults over 60 Sjogren's Syndrome (bronchiectasis) - correct answer Bronchiectasis is dilation and destruction of larger bronchi Sjogren's Syndrome (bronchiectasis) causative organism - correct answer chronic infection and inflammation Sjogren's Syndrome (bronchiectasis) risk factors - correct answer o cystic fibrosis o immune defects o recurrent infections o some cases seem to be idiopathic Sjogren's Syndrome (bronchiectasis) symptoms - correct answer o chronic cough o purulent sputum expectoration o some patients may also have fever and dyspnea Sjogren's Syndrome (bronchiectasis) diagnosis - correct answer o based on history, physical examination, and radiologic testing, beginning with a chest x-ray o distinguished by increased purulence and volume of daily sputum and by dilated airways shown on imaging studies Sjogren's Syndrome (bronchiectasis) treatment/prevention - correct answer o regular vaccinations o suppressive antibiotics o Measures to help clear airway secretions o Bronchodilators/sometimes inhaled corticosteroids if reversible airway obstruction is present o Antibiotics and bronchodilators for acute exacerbations o Sometimes surgical resection for localized disease with intractable symptoms or bleeding o The key treatment goals are to control symptoms and improve quality of life, reduce the frequency of exacerbations, and preserve lung function. Bullous Pemphigoid - correct answer a chronic autoimmune skin disorder resulting in generalized, pruritic, bullous lesions in elderly patients. Mucous membrane involvement is rare. Bullous Pemphigoid sxs - correct answer o Pruritus is the first symptom. o Skin lesions may not develop for several years, but often characteristic tense bullae develop on normal-appearing or erythematous skin of the trunk and in the flexural and intertriginous areas. o Localized disease may occur at trauma sites, stomas, and anogenital and lower leg areas. o Bullae usually do not rupture, but those that do often rapidly heal. o Polymorphic, annular, dusky-red, edematous lesions, with or without peripheral vesicles, can occur. o Rarely, small blisters develop on the mucosa. o Leukocytosis and eosinophilia are common, but fever is rare. o The Nikolsky sign, where upper layers of epidermis move laterally with slight pressure or rubbing of skin adjacent to a blister, is negative Bullous Pemphigoid treatment - correct answer o Topical and systemic corticosteroids are used initially. o Most patients require long-term maintenance therapy, for which a variety of immunosuppressants can be used Bullous Pemphigoid diagnostics - correct answer o by skin biopsy o immunofluorescence testing of skin and serum. Polymyalgia Rheumatica - correct answer a syndrome closely associated with giant cell arteritis (temporal arteritis). It affects adults > 55. Polymyalgia Rheumatica sxs - correct answer • Characterized by bilateral proximal aching of the shoulder and hip girdle muscles and the back (upper and lower) and neck muscles. • Stiffness in the morning is typical and lasts > 60 min. • Shoulder symptoms reflect proximal bursitis (e.g., subdeltoid, subacromial) and less often bicipital tenosynovitis or joint synovitis. • Discomfort is worse in the morning and is occasionally severe enough to prevent patients from getting out of bed and from doing simple activities. • ESR and C-reactive protein are usually elevated Polymyalgia Rheumatica treatment - correct answer o low-dose corticosteroids (prednisone or methylprednisolone) Polymyalgia Rheumatica diagnostics - correct answer diagnosis is clinical fibromyalgia - correct answer a common nonarticular disorder of unknown cause fibromyalgia sxs - correct answer • characterized by generalized aching (sometimes severe); • widespread tenderness of muscles, • areas around tendon insertions, and adjacent soft tissues; • muscle stiffness; • fatigue; • mental cloudiness; • poor sleep; and • a variety of other somatic symptoms. fibromyalgia treatment - correct answer • exercise, • local heat, • stress management, • drugs to improve sleep, and • nonopioid analgesics fibromyalgia diagnosis - correct answer diagnosis is clinical cellulitis sxs - correct answer redness, warmth, edema cellulitis pathogen - correct answer 90% staph 10% strep cellulitis treatment - correct answer o Mark area o Patient to watch and call if worsening o Patient to return in 48 hours o Cephalexin (Keflex) o Cefadroxil (Duricef) o Cefdinir (omnicef) purulent cellulitis treatment - correct answer 1st: I&D 2nd: Bactrim Doxycycline Clindamycin o Patient to return in 48 hours Pyoderma (impetigo) - correct answer Symptoms: o Honey crusted Cause: o Poor hygiene o Elevated glucose levels o HIV infection Pathogen: o Staph bites - correct answer o Common injury Pathogen: o Pasturella (gram -) o Staph o Strep bites treatment - correct answer Treatment: o Clean/flush wound o Give tetanus/rabies vaccine prophylaxis if indicated o Antibiotic therapy x 3 days o NEVER STITCH BITES