Maryville Nurs 623 Exam 1With Complete Solution
Basics with skin conditions - correct answer ✔ •Alopecia
•Rash
•Pruritus
•Uticaria
•Pigmentation change
Skin lesion—New vs. Change
HPI questions for skin problems - correct 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 - correct 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 - correct 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)
,Maryville Nurs 623 Exam 1With Complete Solution
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 - correct 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 - correct answer ✔ scabies and lice
Scabies - correct 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 - correct 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.
,Maryville Nurs 623 Exam 1With Complete Solution
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 - correct answer ✔ Permethrin 1% leave on for 10 mins then rinse.
May repeat in 7 days if needed.
Fungal skin infections - correct 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) - correct 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) - correct 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) - correct 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
, Maryville Nurs 623 Exam 1With Complete Solution
Clotrimazole 1% cream and solution BID up to 4 weeks
Bacterial infections of the skin - correct 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
Impetigo - correct answer ✔ Honey crusted plaques, usually on face
Bullous: begin as small vesicles that rupture easily with serous fluid turning into
crust
Nonbullous, vesticulopustular: thick, adherent lesions, dirty yellow-colored crust
with erythematous margins
Treatment:
Clean lesions. Bactroban TID x 7 days. Antibiotic (Keflex, Augmentin, Cloxacillin).
With no treatment, it is self-limiting 2-3 wks
follilculitis - correct answer ✔ Staphylococcus. Multiple small papules on
erythematous base, can be large yellow white tender pustules in adults. Common
in places hair is present, widespread is characteristic, bumpy rash, no itching.
Treatment:
Only if becomes infected. Large lesions cleansed with weak soap solution,
followed by soaking with saline or aluminum subacetate BID. TAO can be used BID
for 5 days. Oral ABT 1st gen cephalo. if resistant
Localized cellulitis - correct answer ✔ The typical lesion of cellulitis is wide,
diffuse area of erythematous skin that is warm and tender to palpation. Infection
is occasionally accompanied by severe edema. Systemic symptoms such as fever,
chills, and malaise may also be present.
