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Health Assessment Exam 1 (PART 2: Skin and Nails)
Terms in this set (154)
Is Tinea Capitus a fungal or bacterial infection?
What is griseofulvin p.o used to treat?
What is the clinical term for ring worm?
Tinea capitus/ tinea corporus
Is tinea corporis fungal or bacterial?
What is ketoconazole used to treat? (Three different things!)
Tinea Corporis, Tinea versicolor and Seborrhea Dermatitis
What does tinea versicolor look like?
Reddish-tan or hypopigmentation
How is tinea versicolor described?
d) both b and c
b and c! It's a yeast infection, which is a TYPE of fungal infection
Who gets tinea versicolor the most?
What are the two treatment options for tinea versicolor?
Ketoconazole or selenium sulfide
What looks like thin pencil marks?
Is scabies fungal or bugs/mites?
Where do we see scabies (3 places)?
2) Webs of fingers
What is Permethin 5% used to treat?
What do you use to treat scabies?
What skin thing appears on the webs of fingers?
"I have these thin pencilly lines ALL over me and they itch like hell. What's wrong with me??"
"My mom bought me shower shoes but those are dumb so I don't wear them. Now I have these red, raised itchy areas with shiny centers. What's wrong with me???"
"I rubbed my head all over my dog because he's so soft and then I didn't shower for a week now I have these bald, round demarcated areas and pus sores on my head. What's wrong with me??
Can be carried in pets
"I'm a 13 year old boy and I have these strange discolored reddish-tan hypopigmented patches with sharp borders all over, what is it??"
"I have some ketoconazole at home from my last bout of tinea corporus. Now you're telling me I have tinea versicolor, can I use the ketoconazole or do I need a different medication?
You sure can! Ketoconazole is used for both tinea corporus and tinea versicolor.
NOT used for tinea capitus though
"I have this itchy red rash on my fingers, I've heard that people get scabies kind of near this area (fact check: scabies presents on webs of fingers) !! Do I have scabies??? Oh, by the way I just got a new ring from a street market in Indonesia isn't it so beautiful? Huge bummer though, my redness is right under it so I might need to stop wearing it for now! Weird coincidence huh?"
Is this truly a coincidence? What else could be happening?
NO! This is not a coincidence! The pt probably has:
ACUTE CONTACT DERMATITIS
What is acute contact dermatitis?
A red, itchy rash caused by direct contact with a substance or an allergic reaction to it. The rash isn't contagious or life-threatening, but it can be very uncomfortable. Can be caused by reactions to soaps, cosmetics, fragrances, jewelry and plants
What are two risk factors for developing squamous cell carcinomas?
1) Fair skin
2) Age 60 or older
"I'm 65 and I love being in the sun, and recently I developed this gross crusted, scaling, red, ulcerated lump thing on my face. What is it??"
Squamous cell carcinoma
Your grandma calls you and says "I was recently diagnosed with a squamous cell carcinoma. I was so scared I scooted out of the office before the nurse practitioner could tell me what to do. Is it fine if I just leave it and don't follow up?"
NO! It may metastasize
"My 3 year old is super picky and only eats carrots and yellow peppers. He's turning yellow!! What's wrong with him?"
You see a child with carotemia on the playground.
1) Are we concerned? Is it harmful or is it contagious?
2) Do we think his eyes will be yellow too?
1) NO! It's not harmful. Tell the mom to feed him other foods and hold off the carrots
2) No! It does not affect the sclera
What is reiters syndrome a reaction to?
A bacterial infection typically to the urinary tract, genitals or intestines.
What swells in reiters syndrome?
Joints and eyes
"Help! I got a UTI and now I have reiters syndrome, can you give me something to make it better??"
Nope. No treatment
"No treatment for reiters sydrome?? How long will I have to deal with this joint and eye inflammation for?"
What is herpes zoster known as by common folk?
Which childhood virus is herpes zoster the reactivation of?
Varicella (chicken pox!)
I had varicella when I was 6 months old, I'm in the hospital for a chemo treatment and I'm 65. Am I likely to get herpes zoster? Why? (3 risk factors)
1) varicella before age 1
2) Immune compromised
3) Age over 60
Are herpes zoster painful/tingling/itchy blisters bilateral or unilateral?
Is herpes zoster a fungus or virus?
1) What are zovirax and acyclovir used to treat?
2) How soon should they be used?
On which three body areas do varicella vesicles appear first?
Trunk, face and scalp
1) When does varicella start being contagious?
2) What do you look for to decide if it's no longer contagious?
1) 1-2 days before lesions appear
2) Until the lesions are crusted over
"I'm pregnant and want the varicella vaccine ASAP so my kid pops out vaccinated. Can you do that for me?"
Poor lady is so misinformed.
What should we tell her? When should she bring her child in to be vaccinated?
NO! Can't do that.
1) Can't give vaccine to pregnant women
2) She should bring her child in at 12-15 months and then back for a booster at 4-5 yrs
"Help! My 6 year old has honey colored crusted lesions filled with pus all over his nose and lips. What does he have?"
What is bactroban cream used to treat?
Which type of infection is impetigo associated with?
Option 1: Urinary Tract Infection
Option 2: Upper respiratory Infection
Option 2! URI
My kid got bactroban for his impetigo, but it's not working. Are there other drugs we can try?
There sure are! Augmentin and Ceftin
"I got my ear pierced but it got super infected so I took it out. Now I have this strange looking swollen connective tissue lump around where I got it pierced. What is it?"
What is a keloid?
An exaggerated connective tissue response of injured skin beyond the edges of the original wound
"I have these weird thick, pruritic, red/silver flakey scales on my elbows and butt. My mom said she used to get the same thing. What is it??"
P.S., it's usually familial
What types of areas usually get psoriasis?
a) face and neck
b) extensor areas
c) areas under a lot of pressure
B! Extensor areas (elbows, knees, buttocks)
How do you treat psoriasis?
Steroid creams, biologic modulators (systemic meds) and phototherapy
What are steroid creams, biologic modulators and phototherapy used to treat?
What does the ABCD melanoma acronym stand for?
B- border irregular
C- color variations (blue, black, red)
D- diameter ≥6 cm
Whats the diameter cut off in ABCD?
What does the HARMM melanoma risk model stand for?
H- History of or previous melanoma
A- Age (over 50)
R- Regular derm appointment absent
M- Mole changing
What are the 5 different factors involved in examining a skin lesion?
3) Pattern & Shape
Local Discos Patronize Sharing Sizable Dranks
(First 3 letters all the same)
Are sebaceous cycts cancerous?
When do we decide to drain a sebaceous cyst?
If it becomes inflamed and painful
What is the fluid like in a bullae?
1) What is the size cut off (in cm) for a bullae
2) What is it full of?
1) ≥ 0.5 cm
2) Serous fluid!
"Help! I spilled some hot water on my toe the other day and now I have this fluid filled blister on my toe. I measured it and it's an inch in diameter how gross is that! What is it??"
Are pustules flat or elevated?
Are pustules typically less than or greater than 1 cm in diameter?
Less than 1 cm
What honey colored crusty situation can arise from a popped pustule?
When we think infection, are we thinking more about pustules or bullaes?
When I say transient, red bordered pale centered large area of edema in upper epidermis, you say....
When I say hives, you say... (two options)
When you get a PPD to test for TB, what do we call the little lump that appears in the world of derm?
I'm a yellowish-brownish raised papule/plaque situation. I feel greasy, and look like I was just stuck on. I look like a wart, but I'm not a wart. What could I be??
Seborrheic keratosis typically appears on the ______ and ______ of _____ people
Hints: blanks one and two are body regions, blank three is either younger or older
What are the two risk factors for actinic kerotosis?
1) Fair skin
Unofficial risk: being bald (the slide for actinic kerotosis is a bald head)
"I'm a bald man who doesn't use sun screen but loves the beach. Upon shining my scalp one day I noticed these flat, yellowing, scaly crusts on my head! What's wrong with me?"
"I have actinic kerotosis, all I have to do is wear a hat and nothing else will happen right? I don't have to follow up on it do I?"
WRONG! You're at risk for squamous cell carcinoma
What do common folk call seborrhea dermatitis?
What do you use to treat seborrhea dermatitis?
Bonus! What other two things can you use this medication to treat?
Bonus: tineus capitus and tineus versicolor<---CORRECTION: not tineus capitus! tineus corporus*
"Oh no! My baby has these white, yellowy oily scales on her scalp, ears and forehead! My husband said he had this too but couldn't remember what it was called. What is it??"
Name two skin issues that are familial
2) Seborrhea dermatitis
What is something babies get that is the result of a combination of skin oil and yeast?
"My baby has seborrhea dermatitis and I see the white, yellowish oily scales on her scalp. Are there any other places the scales might appear?"
"My fingers are BLUE! Do I have central or peripheral cyanosis?"
"My baby's lips and the area around them is BLUE! Does he have central or peripheral cyanosis?"
What is urticaria?
What type of reaction is urticaria?
What do you use antihistamines to treat?
Urticaria, wheals, hives
How big is the diameter of a cherry angioma?
c) ≤ 1/8 inch
b) ≤ 1/4 inch
c) ≤ 1/2 inch
B) ≤ 1/4 inch
Are cherry angiomas malignant or benign?
What color are cherry angiomas?
Red and cherry colored!
Look at you go, you're so smart.
What procedures can we do to cherry angiomas if someone wants them removed?
(Burn or freeze)
What is borrelia burgdorferi??
The name of the lyme disease test, named after the type of tick
Someone comes into your office with a perfect bull's eye on their foot. How long ago would their tick bite have been? (Range of days)
Bonus: What's the average length of time after a bite for a rash to appear?
3-30 days ago
Bonus: 1 week
What percent of people with lyme disease develop a rash?
"Help! A week ago I was visiting a friend who has a cabin in the woods and we went hiking. Now I have joint pain, a headache and fevers. What's wrong with me??
Which of our fave tetracyclines is used to treat lyme disease?
What's a sebaceous gland?
It secretes fatty substances onto skin through hair follicles.
What two parts of your body do not have sebaceous glands?
Palms and soles
I'm a type of gland that secretes fatty substances onto the skin through hair follicles and I'm everywhere on your body except your palms and your soles. What am I?
A sebaceous gland!
What are the two types of sweat glands?
Bonus: what type of gland are these?
I'm a 12 year old boy and I'm going through puberty. Which type of sweat glands are the ones making me smell?
Where do you find apocrine glands?
Axillary and genital
I'm a sweat gland that's stimulated by stress. Am I an apocrine or eccrine gland?
I'm a sweat gland all over your body that's controlled by body temp. Am I an apocrine or eccrine gland?
Is molluscum contagiosum (harmless umbilicated bumps on your face) contagious?
You get them through direct contact (ex. toys, towels, faucets, sexual contact)
"Help! My three year old son came home from school with these strange round, fleshy, umbilicated raised bumps all over his body. Also, he absolutely loves playing with toys. I'm nervous the school doesn't clean them well... is there anything he could've picked up on them? He doesn't appear to be in any pain and they don't itch!"
Sounds like a harry potter spell, kids like harry potter, kids play with toys, kids can get molluscum contagiosum from toys!
Think: DIRECT CONTACT, viral
How big is a molluscum contagiosum legion?
a) <1 mm
b) <6 mm
c) <1 cm
d) <1/2 inch
b) <6 mm
My daughter has molluscum contagiosum?? That sounds so scary! When will it go away?
It will resolve on it's own in 12 long months from now
How does one get measles? (think method of transmission)
What skin problem is part of the paramyxovirus family?
"Help! My daughter has measles! Can we treat it with something?
Sadly, nope. No treatment
What symptoms are present during the prodromal period of the measles?
1) High fever
2) Runny nose
4) Sore throat
5) Red eyes
"My kid has measles and they currently have a runny nose, a high fever, a cough, a sore throat and red eyes. "
1) What's this stage called?
2) Also, is she contagious right now?
2) YES! This is the most contagious stage
What comes after the prodromal phase of measles?
What common kitchen staple do koplik spots look like?
Hint: Think fine, flakes, sea, coarse, best friends with pepper
Grains of salt!
I bet you knew it even without the hint! Look at you go.
How soon after the prodromal phase begins do people start developing a measles body rash?
I'm a type of rash. I'm flat and red, and I start at the hair line. I then spread to the neck, trunk, extremities and feet. Eventually I progress to small, red bumps over the flat red rash.
What type of rash am I?
Bonus: What's my temperature typically like at this point?
A measles body rash!
Bonus: High fever
"I've been keeping my kid with the measles away from my other kids because I know it's contagious. I was told once she develops this awful rash she won't be contagious for much longer. When can I let them be together again??"
4 days after the rash first appeared!
"My kid who has the measles still has a rash. Even though it's been 4 days since it appeared, are you sure my other kids can't catch it from him?? That doesn't sound right."
Lets practice some good NURSing here:
"I understand your concern, but as a matter of fact even if the rash is still there, after four days she is no longer contagious!"
Are these symptoms common or uncommon with measles?
Croup (barking cough in kiddos)
Otitis media (inflammation of middle ear)
(Think, most people know most of these terms)
Are these symptoms common or uncommon with measles?
Subacute sclerosing panencephalitis (SSPE)
(Think, most of us didn't have a clue what most of these terms meant before GEPN. Look how far we've come!!! We're wicked smart, but most common folk don't know them. Hence, they are uncommon.)
1) At what age can you vaccinate your child against measles?
2) At what age can you give your child the measles booster?
1) 12-15 months
2) 4-6 years
"Help! I have these incredibly itchy raised swollen bumps on my face, neck, hands and arms. When I went to sleep they weren't here. What are they? Oh by the way, I just picked up the comfiest mattress on the side of the road, how lucky am I!!!"
Poor fella, he's got a case of the bed bugs
What can be identified by fecal stains, blood stains or visually?
Hint: what sucks your blood?? (We're not talking mosquitos or vampires, keep thinking people)
Shoot I have bed bugs!
First, what can I use to get rid of them on my body?
Second, can I just wash my sheets to get rid of them for good?
1) Steroid creams, antihistamines
2) Absolutely not! You need a professional bed bug patroller to come get rid of them
What does this so called Herald Patch/Pityriasis look like?
It begins as a single large lesion and then spreads, usually followed by smaller lesions
Common folk call this Herald Patch, we nursing students call it...
Is pityriasis rosea transmitted from person to person or is it viral?
What common Christmas item does pityriasis rosea look like?
(Upside down) Christmas tree!
If you're concerned it's upside down, turn your patient upside down and then it will be right side up. (Kidding plz don't do that, I don't think that's the "Yale" way)
"Help! I had this large single lesion on my arm and now it's turning into many small legions. It's pink/ pale red, oval, scaly and itches a bit. And funny enough, if I turn my head upside down, they kind of look like christmas trees! What the heck is it?"
AKA Herald Patch
"Ugh, I have Pityriasis Rosea? Did I get it from my friend Herald? He was just telling me he had a rash"
No sir, you certainly did not! Pityriasis Rosea cannot be transmitted from person to person, it's either a viral or allergic reaction!
Perhaps you're allergic to your friend Herald. Then maybe you did get it from him.
"I have staph, strep and MRSA, just my luck. My lower leg is swollen, hot, tender and I also have a fever. I've heard this situation is most common on your lower legs, but you'll never believe it, I also got it on my body and face! Fingers crossed it doesn't spread to my deep tissue too, because it could cause sepsis!
What do I have??"
Cellulitis is a virus that can develop as a result of:
Staph, strep or MRSA
Shoot I have cellulitis? Is there anything I can do to treat it?
You betcha! Antibiotics
What has a cauliflower appearance?
(Hope you're not eating cauliflower right now!!)
The HPV virus causes what type of verruca/warts?
What can we use to treat verruca/warts?
"Help! I have these weird cauliflower type tan lesions on my penis. So gross. They itch and burn, and they even bleed sometimes! What's wrong with me!!"
You, my friend, have genital warts.
Is there a vaccination to prevent genital warts?
There sure is! HPV vaccine
How long can it take genital warts to appear?
(Hint, first number is in weeks, the second is in months. And they're the same number. Take a guess)
6 weeks to 6 months
Does all HPV cause genital warts?
Nay nay! Only types 6 & 11
"Help!!!! My boyfriend gave me HPV! Am I for sure going to get cervical cancer? What about genital warts? Genital warts sound GROSS"
Depends on your luck. Only two types (16 & 18) put you at risk for cervical cancer, and only two types (6 &11) cause genital warts.
Can my 5 year old get the gardisal vaccine?
P.S. What's the gardisal vaccine for?
1) Nope. The age range is 9-26
What's the name of the vaccine for HPV?
Some might call me "a simple painless canker." I can be transmitted from direct contact with a fellow "simple painless canker" through vaginal, anal, or oral sex, or from infected mother to fetus. What am I?
Also, if I'm just a "simple painless canker," what stage am I at?
What's going on during the first stage of syphilis?
You have a single, painless, non pruritic sore
How long does the primary stage of syphilis last?
What's the treatment for the primary stage of syphilis?
Penicillin G 2.4 mg IM
What happens during the secondary stage of syphilis?
You develop a non pruritic skin rash on your palms and soles, or even all over.
During which stage of syphilis is the rash reddish/brownish?
I'm experiencing lymphadenopathy, weight loss, a headace and a fever. I have a rash all over my palms and soles. What stage of syphilis am I?
I'm hiding in your nervous system, I'm damaging your internal organs. But on the outside you look totally fine! What am I?
When someone is in the latent stage of syphilis, what kind of rash do they have?
Trick question! No rash. Just nervous system and internal organ damage. No biggie
How long can the latent stage of syphilis last?
I'm a nail fold, and I'm currently red, sore, swollen and in pain. My human's name is Sharon loves to get frequent manicures and bites her nails when she's nervous. What am I?
What can you do to treat paronychia?
Soak nails in warm water and use antibiotics
Is paronychia bacterial, fungal or both?
You're so smart, I bet you knew if both was an option it would be the answer. Way to use your thinking cap!
Which skin situation can be decribed as "umbilicated?"
(Word on the street is Deb loves this one)
What is Rapid Plasma Reagin (RPR) used for with measles?
Treatment when it's still just a single painless canker
This set is often in folders with...
Health Assessment Exam 4: Women's Health
Health Assessment Exam 4: Musculoskeletal
Health Assessment Exam 4: Abdomen
Health Assessment Exam 3: HEENT
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