APEA PREDICTORS EXAM 2024/ACTUAL EXAM QUESTIONS WITH WELL REVISED QUESTIONS AND VERIFIED A, Exams of Nursing

Download APEA PREDICTORS EXAM 2024/ACTUAL EXAM QUESTIONS WITH WELL REVISED QUESTIONS AND VERIFIED A and more Exams Nursing in PDF only on Docsity!

APEA PREDICTORS EXAM 2024/ACTUAL EXAM

QUESTIONS WITH WELL REVISED QUESTIONS AND

VERIFIED ANSWERS ALREADY RANKED A+

What is the biggest side effect of colchicine?

• ANSWER-diarrhea How would you describe the appearance of molluscum contagiosum?
• ANSWER-papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant?
• ANSWER-no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSWER-week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus?
  • ANSWER-week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus?
  • ANSWER-week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus?
• ANSWER-week 28 At what week of pregnancy is the fundus just below the xiphoid process?
• ANSWER-week 34 Increased sweat production is a sign of what endocrine disorder?
  • ANSWER-hyperthyroidism

What is the biggest side effect of colchicine?

• ANSWER-diarrhea How would you describe the appearance of molluscum contagiosum?
• ANSWER-papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant?
• ANSWER-no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSWER-week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus?
• ANSWER-week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus?
• ANSWER-week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus?
• ANSWER-week 28 At what week of pregnancy is the fundus just below the xiphoid process?
• ANSWER-week 34 Increased sweat production is a sign of what endocrine disorder?
• ANSWER-hyperthyroidism What is Paget's disease?
• ANSWER-there is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highlyvascular bone putting the

indiv at increased risk of fractures How do we treat Paget's diseease?

• ANSWER-bisphosphonates How should pregnant women wear their seatbelt? – ANSWER-with the shoulder straplike a normal person and then the groin strap below the belly and across the hips What is another name for fifth disease? ANSWER-parvovirus aka slapped cheek disease aka erythema infectiosum Which type of prevention are vaccinations ? - ANSWER-primary When should patients begin antiretroviral therapy for HIV infection?
• ANSWER-as soonas it is detected, even if in the acute phase What are the first generation antihistamines?
• ANSWER-diphenhydramine (benadryl)and chlorpeniramine (actifed) What are s/s of the secondary stage of syphilis?
• ANSWER-rash on hands and feet,lymphadenopathy, fever What is the recommended treatment for chronic bacterial prostatitis?
• ANSWER-afluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for acute prostatitis?
• ANSWER-cipro (if not STI related) or ceftriaxone What are s/s of an intraductal breast papilloma? ANSWER-clear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in thenipple area

If a patient has GABHS but has an allergy to penicillins, what is the second line option?

• ANSWER-first generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a - mycin PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSWER-in those who are on any type of nitrate or triptan because it could result in hypotension What class of drug is sildenafil (viagra)?
• ANSWER-a PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on thisand maybe do an EKG What are the symptoms of peripheral artery disease?
• ANSWER-think P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What is first line treatment for PAD?
• ANSWER-walking and physical activity to improvecirculation. second line is an aspirin or anti-platelet What should we tell our patients with PAD NOT to do?
  • ANSWER-do not elevate thefeet; keep them down How do we diagnose PAD? – ANSWER-an ABI < 7; doppler can also be used todiagnose as well but is the second choice What are s/s of peripheral vascular disease? - ANSWER-think V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration If a patient is on Coumadin but then they may need to go on an antibiotic for an infection

and Bactrim is the drug of choice, what should you do? - ANSWER-Bactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSWER-Rifampin decreases INR so we'd want to increase the coumadin dose

If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSWER-decrease the weekly dose by 5 - 10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANSWER-hold one dose then decrease the weekly dose by 10% If a patient's INR is greater than 5, what should you do? - ANSWER-consult cards, likely would hold two doses then decrease the weekly dose An anorexic patient will have a BMI of what? - ANSWER-less than 18 What is primary amenorrhea? - ANSWER-when the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics Secondary amenorrhea is a lack of menses after of not having a period; but you have had one before - ANSWER- 3 months What do we need to do first when a patient comes in with secondary amenorrhea? - ANSWER-rule out pregnancy Anorexia can put you at risk for what? - ANSWER-osteoporosis, amenorrhea, cardiac damage Amenorrhea is considered a risk factor for what? - ANSWER-osteoporosis What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSWER-they get their period back

If a pregnant woman has syphilis, what should we do? - ANSWER-treat it with penicillin while she is pregnant because there is risk for spontaneous abortion What is the causative organism of mastitis? - ANSWER-staph What is the first line treatment for mastitis? - ANSWER-keflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is one of the biggest risk factors for cervical cancer? - ANSWER-numerous sexual partners Preeclampsia most commonly shows up at what time in pregnancy? - ANSWER-around week 20 How do we treat UTIs in a pregnant woman? - ANSWER-can either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSWER-about 10 days before menses What can be a sequelae of an ectopic pregnancy? - ANSWER-pelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What is the Coomb's test and when is this completed? - ANSWER-test given 8 weeks in to pregnancy to determine a woman's RH compatibility If a patient's Coomb's test is positive, what do we do? - ANSWER-nothing, she is RH positive so we do not need to treat

If a patient's Coomb's test is negative, what do we do? - ANSWER-give rhogam at 28 weeks and 72 hours after birth What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSWER-IUD The vaginal ring for contraception must be taken out how often? - ANSWER-every 3 weeks If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSWER-increase the progesterone How do we treat temporal arteritis? - ANSWER-steroids If a patient is on birth control and they miss one pill, what should they do? - ANSWER- double up If a patient is on birth control and they miss two pills, what should they do? - ANSWER- double up for 2 days If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSWER-do a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer used for diagnosis. - ANSWER-mammogram; ultrasound When do we screen for group B strep in pregnancy? - ANSWER-weeks 35 - 37 When do we perform alpha fetoprotein screening in pregnancy? - ANSWER- 15 - 20 weeks In terms of the breasts, is used for screening and is

Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSWER-spina bifida and anencephaly What is placenta previa? - ANSWER-when the placenta blocks the cervical opening of the uterus What is placenta abruptio? - ANSWER-when the placenta either fully or partially detaches from the uterine wall When does placental abruption most commonly occur? - ANSWER-in the third trimester What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSWER-a placental abruption is painful whereas placenta previa is painless If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSWER-placenta previa What is the recommended treatment for polymyalgia rheumatica? - ANSWER-steroids Patients with SLE are going to have what abnormal labwork? - ANSWER-elevated ESR and CRP How do we treat lupus flares? - ANSWER-steroids What are common sequelae of fibromyalgia? - ANSWER-insomnia and depression What is a great treatment option for fibromyalgia? - ANSWER-amitriptyline (a TCA) because it helps with chronic pain, sleep, and depression

How is fibromyalgia diagnosed? - ANSWER-when at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months What is slipped capital femoral epiphysis? - ANSWER-when the femoral head of the hip is out of place What is the trendelenburg sign and when is it positive? - ANSWER-when the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What is the main characteristic of a slipped capital femoral epiphysis? - ANSWER- walking with a limp SCFE is most common in which patient population? - ANSWER-adolescents What is legg-calve-perthe disease? - ANSWER-avascular necrosis of the femoral head due to a lack of blood supply Legg-calve-perthes disease is most common in which patient population? - ANSWER- young children What is the radiographic study of choice for the knee? - ANSWER-MRI What is the radiographic study of choice for the back? - ANSWER-x ray What is bursitis? - ANSWER-a fluid collection in the bursa of a joint How is bursitis treated? - ANSWER-a needle to instill intraarticular steroids and then pull off fluid Bursitis can be a issue - ANSWER-recurrent

The medical term for knock knees - ANSWER-genu valgum The medical term for bow legs - ANSWER-genu varum What is myasthenia gravis? - ANSWER-an autoimmune disorder that causes muscle weakness of the voluntary muscles Genu valgum is caused by a problem with what? - ANSWER-the medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSWER-the lateral collateral ligament What are shin splints? - ANSWER-a medial tibial syndrome caused by overuse of the muscles How do we treat shin splints? - ANSWER-rest and avoidance of exercise until the pain resolves What is the tell-tale difference between a herniated disc and sciatica? - ANSWER- sciatica feels better when you stand, a herniated disc feels better when you sit down When will spinal or lumbar stenosis feel better? - ANSWER-when the patient sits down What is Korsakoff syndrome? - ANSWER-a deficiency in thiamine and folate caused by alcoholism What changes to the vagina occur with aging? - ANSWER-dryness, loss of rugae, less pubic hair

What is a navicular fracture? - ANSWER-also known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSWER-osteoarthritis; rheumatoid arthritis What is Morton's neuroma? - ANSWER-a mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes How is Morton's neuroma diagnosed? - ANSWER-via a positive Muddler's or squeeze test causing pain What is the hook test? - ANSWER-used to assess for a bicep tendon issue How do we treat any rotator cuff injuries? - ANSWER-wear a sling to stabilize the arm and refer to ortho How long do migraine headaches last? - ANSWER- 4 - 72 hours How can we abort cluster headaches? - ANSWER-calcium or 100% oxygen application Which type of headaches come with lacrimation and sinus symptoms? - ANSWER- cluster headaches What does the apprehension test assess for? - ANSWER-used to assess for stability of the shoulder or knee; assesses for stability How does the parathyroid gland regulate calcium? - ANSWER-when parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine

What is the first line treatment for trigeminal neuralgia? - ANSWER-carbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the recommended treatment for Bell's palsy? - ANSWER-steroids and anti- virals How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSWER-in trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache What are the preventative treatment options for migraines? - ANSWER-beta blockers, amitriptyline, venlafaxine, topamax, valproate What is Addison's disease? - ANSWER-adrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What are s/s of Addison's disease? - ANSWER-bronze or discolored skin, salt cravings a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSWER-molar pregnancy What bacteria is the leading cause of urethritis? - ANSWER-neisseria gonorrhea What is the most common cause of hypercortisolism? - ANSWER-excessive ACTH production How do we treat developmental hip dysplasia in a child under 6 months? - ANSWER- Pavlik harness; if older than 6 months may need surgery

take daily prophylactic antibiotics. What antibiotic is this? - ANSWER-5 years old; penicillin When can cervical cancer screening stop if no abnormal screening history is present? - ANSWER-age 65 When should breast cancer screening begin and end with a biannual mammogram? - ANSWER-age 50 - 74 When should colorectal cancer screening stop? - ANSWER-age 85 Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSWER- age 50 - 80 years anyone who currently smokes or has stopped smoking within the last 5 years What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSWER-Do HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. Which pap smear result is considered to be HPV positive? - ANSWER-LSIL If a patient has LSIL with a negative HPV test, what would you do? - ANSWER-repeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSWER-refer for colposcopy If a patient's pap results show NILM, what should you do? - ANSWER-repeat in 3 years It is recommended that all children younger than with sickle cell anemia

If a patient's pap results show ASC-H or HSIL what should you do? - ANSWER-refer for colposcopy The valgus stress test assesses what? - ANSWER-the medial collateral ligament The varus stress test assesses what? - ANSWER-the lateral collateral ligament The Lachman's test assesses what? - ANSWER-the ACL The McMurray's test assesses for what? - ANSWER-a torn meniscus The anterior drawer test assesses what? - ANSWER-the acl The posterior drawer test assesses what? - ANSWER-the posterior cruciate ligament (pcl) a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSWER-dawn phenomenon How can you tell between the dawn and somogyi effect? - ANSWER-If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. Most common type of skin cancer in USA - ANSWER-Skin cancer Most common type of skin cancer - ANSWER-basal cell carcinoma basal cell carcinoma symptoms - ANSWER-Appearance varies; smooth, shiny bump, pink to pearly white Basal cell carcinoma common locations - ANSWER-cheeks, nose, face, neck, arms, back

basal cell carcinoma diagnosis gold standard - ANSWER-biopsy. if not an option, refer to derm Actinic keratosis - ANSWER-Precursor to squamous cell carcinoma numerous dry, round and pink to red lesions w/ rough and scaly texture --> does not heal, slow growing in sun exposed areas Actinic keratosis diagnosis gold standard - ANSWER-Biopsy. if not an option, refer to derm Actinic keratosis treatment gold standard - ANSWER-small- cryotherapy large- number 5 - FU (5-flouracil aka efudex). 5 - FU medication Causes skin to ooze, crust, scab and be red 5-flouracil/ efudex-wear sunscreen!! squamous cell cancer - ANSWER-chronic red scaly rough textured lesion w/ irregular borders crusting or bleeding may be present Squamous cell carcinoma common locations - ANSWER-rims of ears, lips, nose, face and top of hands precursor lesion to squamous cell cancer - ANSWER-actinic keratosis squamous cell carcinoma diagnosis by? - ANSWER-biopsy gold standard. if biopsy is not an option, refer to dermatology. Risk factors for skin cancer(melanoma and both non-melanoma) - ANSWER-Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to UV light (sunlight/tanning beds), moles, family hx for skin cancer Melanoma symptoms (ABCDE) - ANSWER-asymmetry (shape/uneven texture) border (irregular/notched/blurred)

color (variegated colors from black, blue, dark to light brown) diameter (size >6mm size of pencil eraser or larger) evolving (changes in color/size/shape) may be itchy Acral lengtiginous melanoma - ANSWER-Most common type of melanoma in dark skinned individuals (blacks & asians) --> look for longitudinal brown to black bands under the nailbed. a changing spot or mole in the palms, or the soles of the feet seborrheic keratosis - ANSWER-soft, round, wart-like growth that is light tan to black and looks pasted on asymptomatic &benign Bacterial Meningitis Bacteria - ANSWER-Streptococcus pneumoniae- most common strain

Haemophilus influenzae Neisseria meningitidis Escherichia coli *others Bacterial meningitis symptoms (Classic Triad) - ANSWER-High fever Nuchal rigidity rapid change in mental status w/ headache Triad=neck up erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura) which are non-blanchable Is bacterial meningitis a reportable disease - ANSWER-yes! Treatment for Bacterial meningitis-patient - ANSWER-IV Abx ASAP, resp/droplet iso for first 24-48 hrs, hydrate (low maintenance after initial fluid correction), Maintain ventilation and reduce increased intra cranial pressure if present (dexamethosone(to reduce inflammation, mannitol to diurese the brain), low stim environment, tx complications that may arrive and support family Treatment for bacterial meningitis-close encounter - ANSWER-Close contacts should be treated w/ rifampin 600 mg q 12 hours x 2 days **Rifampin changes urine color to reddish orange and can stain contacts **AVOID RIFAMPIN IN PREGNANCY Brudzinkski sign (meningeal irritation) - ANSWER-Tests for meningeal irritation Patient supine, raise BACK of head and flex chin towards chest

• result if pt automatically beds both hips --Brudzinski and back of head start with B as well as bends--

Kernig's sign - ANSWER-Tests for meningeal irritation patient supine. flex patients hips and knees in a right angle, then slowly straighten/extend the legs up

• result if when the patient complains of pain during extension of leg MCV4 (meningococcal vaccine) Age 11- 19 - ANSWER-Give one dose of menactra or menveo primary dose given age 12 or younger give a booster at age 16 - 18 MCV4 (meningococcal vaccine) Age 19- 21 - ANSWER-Give one dose of menactra or menveo if never had either Rocky mountain spotted fever (RMSF) symptoms - ANSWER-Fever chills N/V myalgia arthralgia 2 - 5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk and becomes generalised. sometimes rash develops on palms and soles RASH DEVELOPS INWARDS RMSF pneumonic (RMSF) - ANSWER-R-Rash M-Muscle aches (myalgia) S-Stomach aches (nausea and vomiting) F-Fever (>102 F) Rocky Mountain Spotted Fever (RMSF): Located: - ANSWER-•Think "Rocky"- North Carolina, Oklahoma, Arkansas, Tennessee, Missouri Spring to Fall (April to September)

Rocky Mountain Spotted Fever (RMSF): DX - ANSWER-PCR assay by indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii Rocky Mountain Spotted Fever (RMSF): tx - ANSWER-Doxycycline is always first line for all ages 100 mg every 12 hours x 7 - 10 days Can be fatal if not treated within the first 5 days Erythema Migrans (early Lyme disease): Symptoms - ANSWER-Usually appears in 7- 14 days after being bitten by a deer tick; range 3- 30 days Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central clearing • Common locations are belt line, axillary area, behind the knees, and groin area • Positive for flu like symptoms. Lesions and rash resolve within a few weeks with or without treatment Erythema Migrans (early Lyme disease): DX - ANSWER-Dx: • First step is enzyme immunoassay (EIA) also knows as ELISA if negative no further testing needed. If positive confirm with Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi

1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA) Exam Tip: E before I Will have increased ESR Erythema Migrans (early Lyme disease): TX - ANSWER-Doxycycline is always first line for all ages 100 mg BID x 10 - 21 days

Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap and water. Dispose of the tick by flushing it into the toilet Tick repellant skin use - ANSWER-DEET Tick repellant clothing use - ANSWER-Permethrin Brown Recluse Spider Bite: SX - ANSWER-• Fever, chills • Nausea and Vomiting • Located in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender, or can be painless • Blisters appear within 24-48 hours • Necrotic in center, which kills the tissue **can be painless Brown Recluse Spider Bite treatment - ANSWER-Treatment: • Ice packs to wound as the cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and watch Skin lesions - ANSWER-primary skin lesions Macule Vesicle Papule MVP Size: <1 CM Macule - ANSWER-Flat, nonpalpable, but visually distinct areas on the skin surface with color different from the person's normal skin; less than 1 cm FRECKLE Vesicle - ANSWER-elevated, raised lesion filled with serous fluid (herpetic lesions) Papule - ANSWER-palpable solid lesion (acne, moles) primary skin lesions >1cm in size - ANSWER-Nodule Plaque

Bullae (Blister) Pustule Wheal Nodule - ANSWER-raised solid lesion (BCC) Plaque - ANSWER-solid raised lesion with flat top (psoriasis) Bulla/Bullae - ANSWER-elevated superficial blister filled with serous fluid (2nd degree burn, impetigo) Pustule - ANSWER-circumscribed elevated lesion containing pus (acne pustules) Secondary Skin Lesions-Lichenification - ANSWER-thickening of the epidermis with exaggeration of normal skin due to chronic skin itching (eczema) Secondary skin lesions- Scale - ANSWER-flaking skin (psoriasis) Secondary skin condition-crust - ANSWER-dried exudate (impetigo) Secondary skin condition-ulceration - ANSWER-eroding of epidermis and dermis (if deep can involve subcutaneous tissue) Secondary skin condition-scar - ANSWER-permanent fibrotic change following damage to dermis (surgical scars) Secondary skin condition-keloids/hypertrophic scars - ANSWER-overgrowth of scar tissue (more common in Black and Asian descent) Rule of 9's - ANSWER-Head and neck = 9% Upper Ex = 9% each

Lower Ex = 9% each Front trunk = 18% Back trunk = 18% Rule of 9's =-child leg - ANSWER-Chlid one leg=13.5% One leg adult =18% Rule of 9's =child head - ANSWER-Child head- 18% (half of adult %) First degree (superficial): - ANSWER-Red to bright red skin and tenderness/pain second-degree (partial-thickness) burns - ANSWER-Painful red skin, bullae (blisters), reddened/weepy skin --> BLISTERS START AT SECOND DEGREE third-degree (full-thickness) burns - ANSWER-Pain sensation absent. Pale/white color, charred skin, leather-like texture Criteria for Burn Center Referral: - ANSWER-Face, hands, feet, genitals, major joints Electrical burns, lightning burns Partial thickness burns >10% of total body surface area Third degree burns in any age group If pt. has a Sulfa allergy and can't use Silvadene what is the alternative? - ANSWER- Bacitracin, Polysporin/Triple antibiotic cream or ointment Cellulitis - ANSWER-Bacteria (Gram Positive): Streptococcus (beta hemolytic strep), Staph aureus (MRSA) Cellulitis Symptoms: - ANSWER-Diffused pink to red colored skin, warm to touch, and may become abscessed

If red streaks radiating from infection it has spread to lymph nodes (lymphangitis) Usually within the deep dermis and is poorly demarcated (poor boundaries) Most common location is the lower legs -->If pt. has DM and develops cellulitis watch for osteomyelitis Cellulitis treatment - ANSWER-First line: Abscess/cellulitis is I&D (if <5 cm no PO antibiotic needed) • Check for tetanus vaccine status Nonpurulent: Cephalexin (Keflex) 500 mg or Dicloxacillin q 6 hours for 5- 10 days Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If you suspect osteomyelitis order an MRI If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) Erysipelas: - ANSWER-Bacteria: Group A Streptococcus Located: • Involves upper dermis and superficial lymphatics • Found on the cheeks and shins Erysipelas: Symptoms - ANSWER-Symptoms: • Bright red plaque or induration with sharp or elevated margins on the face or lower legs • If fever and chills present pt. is septic (hospitalization is recommended) Erysipelas: Treatment - ANSWER-If treating facial erysipelas assume MRSA is present. Use appropriate antibiotics or refer to ER if septic Dicloxacillin QID, Cephalexin or Clindamycin x 10 days If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) MRSA: Treatment - ANSWER-Bactrim Doxycycline Minocycline Clindamycin

--> If patient is allergic to Sulfa do not use Bactrim Human bites - ANSWER-"Dirtiest" bite of all. Watch for closed-fist injuries of the hands (may involve joint capsule and tendon damage). Eikenella corrodens & numerous bacteria may be involved Animal bites: - ANSWER-Cat bites have a higher risk of infection that dog bites Redness, swelling, pain Systemic symptoms may develop within 12 - 24 hours Treatment for human bites and animal bites - ANSWER-•Augmentin 875/125 mg BID x 10 days or IV antibiotics in ER Penicillin Allergy § Doxycycline BID or Bactrim DS BID PLUS Flagyl BID or Clindamycin TID Also give Tetanus booster if needed Evaluate for rabies prophylaxis Tetanus Vaccination - ANSWER-Initial series (3 doses) DTaP (infants to age 6): 5 doses Ages 7 and older Td or Tdap Need every 10 years for lifetime Common reaction: pain at injection site in 24 - 48 hours Contaminated wounds: give one dose if last dose was more than 5 years ago or is due Impetigo - ANSWER-Bacteria (Gram Positive): Beta Streptococcus or Streptococcus aureus Most common bacterial skin infection in young children ages 2 - 5