Maryville Nurs 623 Exam 1
Basics with skin conditions - ANSWER: •Alopecia
•Rash
•Pruritus
•Uticaria
•Pigmentation change
Skin lesion—New vs. Change
HPI questions for skin problems - ANSWER: Duration of symptoms
Precipitating factors
•Medications
•Food
•Occupation
•Outdoors
•Hobbies/Sport participation
•Exposure to insects
•Jewelry/metals/chemicals
•Family history
Is it:
Local or systemic
Pruritus- all day or worse at night
Uticaria - duration
Pigmented changes
Pigmentation/Changes of the skin Diff diagnosis - ANSWER: Nevi- brown, beige or pink(< 5mm)
Melanoma
Related to pregnancy- melasma (mask of pregnancy)
Addison disease
,Side effect of medication- steroid therapy
skin lesions - ANSWER: Macule - flat, nonpalpable (freckle, petechia)
Papule - PALPABLE, solid elevation of skin (elevated nevus)
Nodule - elevated solid mass, deeper and firmer than papule (wart)
Tumor - solid mass deep in subcutaneous tissue (epithelioma)
Wheal - irregularly shaped, elevated area (hive, mosquito bite
Vesicle - elevation of skin with serous (clear) fluid
Pustule - similar to vesicle but filled with pus (acne)
Ulcer - deep loss of skin (venous statis ulcer)
Atophy - thinning of skin
Bullae-Clear fluid-filled blisters > 10 mm in diameter. These may be caused by burns, bites, irritant or allergic
contact dermatitis, and drug reactions.
primary versus secondary skin lesions - ANSWER: Primary skin lesions are those which develop as a direct
result of the disease process.
Secondary lesions are those which evolve from primary lesions or develop as a consequence of the patient's
activities.
Parasitic Skin Infections - ANSWER: scabies and lice
,Scabies - ANSWER: Highly contagious infestation that occurs mainly in children, young adults, health care
workers, and institutionalized persons of all ages.
Subjective: Complaints of intense itching that is usually more severe at night.
Objective:Earliest physical sign is small 1 to 2 mm red papules located in areas of body most attractive to
mites. Itching, excoriation, , crusting, and scaling may be present making it hard to see scabies.
Diagnostics:Ink burrow test
Scabies treatment - ANSWER: Permethrin 5% cream (Remember you have 5 fingers)- leave on for 8-14 hours
then shower- daily for 7 days.
Oral antihistamines for itching, topical steroids for itching.
The entire household must be treated. Everything should be washed with hot water/detergent, treat any
infection that is present.
Starve mites by sealing them in a bag for about 10 days.
Lice treatment - ANSWER: Permethrin 1% leave on for 10 mins then rinse. May repeat in 7 days if needed.
Fungal skin infections - ANSWER: · Candidiasis- bright, beefy red rash treat with topical antifungal,
· Dermatophytoses - the tineas (ringworm)
· Onychomycosis treat with Terbinafine for 6-12 weeks (only 73-79% effective, educate patient.
· Fungal infections survive on keratin, so considered superficial.
· Pathogens: Epidermophyton, trichophyton, microsporum.
· Those at risk are DM and immunocompromised.
, · Diagnostics: KOH
Tinea corporis
(Ringworm of body) - ANSWER: Hx of erythematous round and elevated pruritic lesion that grows in size &
starts to clear in the center
Miconazole 2% cream BID x4 weeks, Clotrimazole 1%, Terbafine 1%
Tinea capitus (ringworm of head) - ANSWER: Children common. Painless bald spot, may have kerion that looks
like honeycomb, inflammation. Boggy mass containing broken hairs and oozing purulent material from
follicular orifices
Systemic antifungals - Griseofulvin BID for 2-4 months or 2 weeks after negative cultures. Teratogenic - use
2nd method of contraception.
OR terbinafine cream
Tinea versicolor (skin, AKA pityriasis versicolor) - ANSWER: Round or oval lesions of hypo or
hyperpigmentation macule, located mainly on back chest, arms, sometimes neck/face. Sometimes very fine
scales seen. Agent P oribiculare causes round, pityrosporum ovale causes oval
Clotrimazole 1% cream and solution BID up to 4 weeks
Bacterial infections of the skin - ANSWER: · Impetigo
· highly contagious
Cellulitis
· Keflex (1st gen cephalosporine) 10-14 days, or dicloxacillin,
· PCN allergy use Erythromycin.
· non purulent assume staph aureus
Purulent cellulitis
· I&D first line
Basics with skin conditions - ANSWER: •Alopecia
•Rash
•Pruritus
•Uticaria
•Pigmentation change
Skin lesion—New vs. Change
HPI questions for skin problems - ANSWER: Duration of symptoms
Precipitating factors
•Medications
•Food
•Occupation
•Outdoors
•Hobbies/Sport participation
•Exposure to insects
•Jewelry/metals/chemicals
•Family history
Is it:
Local or systemic
Pruritus- all day or worse at night
Uticaria - duration
Pigmented changes
Pigmentation/Changes of the skin Diff diagnosis - ANSWER: Nevi- brown, beige or pink(< 5mm)
Melanoma
Related to pregnancy- melasma (mask of pregnancy)
Addison disease
,Side effect of medication- steroid therapy
skin lesions - ANSWER: Macule - flat, nonpalpable (freckle, petechia)
Papule - PALPABLE, solid elevation of skin (elevated nevus)
Nodule - elevated solid mass, deeper and firmer than papule (wart)
Tumor - solid mass deep in subcutaneous tissue (epithelioma)
Wheal - irregularly shaped, elevated area (hive, mosquito bite
Vesicle - elevation of skin with serous (clear) fluid
Pustule - similar to vesicle but filled with pus (acne)
Ulcer - deep loss of skin (venous statis ulcer)
Atophy - thinning of skin
Bullae-Clear fluid-filled blisters > 10 mm in diameter. These may be caused by burns, bites, irritant or allergic
contact dermatitis, and drug reactions.
primary versus secondary skin lesions - ANSWER: Primary skin lesions are those which develop as a direct
result of the disease process.
Secondary lesions are those which evolve from primary lesions or develop as a consequence of the patient's
activities.
Parasitic Skin Infections - ANSWER: scabies and lice
,Scabies - ANSWER: Highly contagious infestation that occurs mainly in children, young adults, health care
workers, and institutionalized persons of all ages.
Subjective: Complaints of intense itching that is usually more severe at night.
Objective:Earliest physical sign is small 1 to 2 mm red papules located in areas of body most attractive to
mites. Itching, excoriation, , crusting, and scaling may be present making it hard to see scabies.
Diagnostics:Ink burrow test
Scabies treatment - ANSWER: Permethrin 5% cream (Remember you have 5 fingers)- leave on for 8-14 hours
then shower- daily for 7 days.
Oral antihistamines for itching, topical steroids for itching.
The entire household must be treated. Everything should be washed with hot water/detergent, treat any
infection that is present.
Starve mites by sealing them in a bag for about 10 days.
Lice treatment - ANSWER: Permethrin 1% leave on for 10 mins then rinse. May repeat in 7 days if needed.
Fungal skin infections - ANSWER: · Candidiasis- bright, beefy red rash treat with topical antifungal,
· Dermatophytoses - the tineas (ringworm)
· Onychomycosis treat with Terbinafine for 6-12 weeks (only 73-79% effective, educate patient.
· Fungal infections survive on keratin, so considered superficial.
· Pathogens: Epidermophyton, trichophyton, microsporum.
· Those at risk are DM and immunocompromised.
, · Diagnostics: KOH
Tinea corporis
(Ringworm of body) - ANSWER: Hx of erythematous round and elevated pruritic lesion that grows in size &
starts to clear in the center
Miconazole 2% cream BID x4 weeks, Clotrimazole 1%, Terbafine 1%
Tinea capitus (ringworm of head) - ANSWER: Children common. Painless bald spot, may have kerion that looks
like honeycomb, inflammation. Boggy mass containing broken hairs and oozing purulent material from
follicular orifices
Systemic antifungals - Griseofulvin BID for 2-4 months or 2 weeks after negative cultures. Teratogenic - use
2nd method of contraception.
OR terbinafine cream
Tinea versicolor (skin, AKA pityriasis versicolor) - ANSWER: Round or oval lesions of hypo or
hyperpigmentation macule, located mainly on back chest, arms, sometimes neck/face. Sometimes very fine
scales seen. Agent P oribiculare causes round, pityrosporum ovale causes oval
Clotrimazole 1% cream and solution BID up to 4 weeks
Bacterial infections of the skin - ANSWER: · Impetigo
· highly contagious
Cellulitis
· Keflex (1st gen cephalosporine) 10-14 days, or dicloxacillin,
· PCN allergy use Erythromycin.
· non purulent assume staph aureus
Purulent cellulitis
· I&D first line
