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
· NO 1st gen cephalosporine
· Consider MRSA- Bactrim, Cleocin, Doxycycline
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
· NO 1st gen cephalosporine
· Consider MRSA- Bactrim, Cleocin, Doxycycline
