Geriatrics Quiz Review (3)

Herpes simplex

vesicles on an erythematous base accompanied by itching, burning and pain

pruitis

itching

Herpes zoster

AKA shingles, vesicles that are preceded by pain, itching or paresthesia in a dermatomal pattern

Tinea

Superficial fungal infection often in the foot, groin, torso, hands and nails

pedis

foot

cruis

groin

mannus

hand

corposis

torso

unguium/onychomychosis

nails

Candidiasis

AKA yeast infection that can occur in moist areas including the groin, axilla, mouth, corners of the mouth and around the nails

thrush

mouth

perieche

corners of the mouth

paronychia

around the nails

impetigo

early vesicles that break down to form golden colored crusts caused by staph

Folliculitis

infection of hair follicles, causes erythematous pustules This is typically caused by sweating and occlusion like under a cast or splint

Erysipelas

hot, edematous plaques with well defined rapidly advancing margins. These people will have swollen lymph nodes. This is caused by group A or C hemolytic strep.

Cellulitis

red, swollen, tender skin that feels warm to touch, poorly defined borders

Scabies

lesions between fingers/toes, on flexor aspect of wrist, axilla, umbilicus, around nipples and on genitalia. This is transmitted through skin to skin contact.

Pediculosis

head lice, body lice, pubic lice; eczematous changes and swollen lymph nodes

Pruitis

caused by xerosis, systemic disease, skin eruptions or infestations

Xerosis

dry, flaky skin

Allergic Contact Dermatitis

Type IV hypersensitivity rxn causing puritis and painful bizarrely shaped lesions

Allergic Contact Dermatitis

Irritant contact dermatitis

occurs after contact with an irritant

Irritant contact dermatitis

Atopic dermatitis

chronic pruritis condition associated with asthma/allergic rhinitis

atopic dermatitis

Lichen Simplex Chronicus

localized pruritic eruptioin caused by constant itching, hyperpigmented and scaly

Lichen-simplex chronicus

Asteaotic Dermatitis

Scaly, red plaques with cracked porcelain appearance,. This is caused by dry/scaly skin with fissures that allow environmental irritants to penetrate skin.

Asteaotic Dermatitis

Stasis Dermatitis

Caused by venous HTN, causes edema, varicosities, hemosiderin staining and hyperpigmentation

Herpes Simplex

Herpes Zoster

Tinea

Candidiasis

Impetigo

Folliculitis

Erysipelas

cellulitis

xerosis

Seborrheic Dermatitis

Scaly erythematous eruption of the central part of the face, postauricular and beard areas, body flexures and scalp, common in those with neurological conditions

Intertrigo

Inflammation of intertriginous skin (areas of skin approximation) resulting from irritation, friction and maceration and impacted by obesity, poor hygiene, and hot/damp weather.

Seborrheic dermatitis

Intertrigo

Psoriasis

demacerated pink plaques with silver scales, commonly to extensor surfaces of UE/LE, scalp, gluteal cleft, & penis and areas of trauma such as scars or burn

Utricaria

hives, pruritic, edematous, and usually red papules and plaques, often surrounded by a red halo (flare)

Actinic (Bateman’s) purpura

results from aging and chronic sun exposure, causing degeneration of the collagen the surround and support small vessels.

Vasculitis

palpable purpuric papules caused by allergies, bloodborne infections, serum sickness (form of medication allergy), collagen vascular dz, and cryoglobulinemia

Pigmented purpura

Idiopathic purpuric eruptions in LE’s that are unrelated to systemic disease

vasculitis

actinic purpura

psoriasis

utricaria

A 1% decrease in A1C causes

35% decrease in microvascular complications

Diagnostic criteria for DM

FPG: over 126 (preferred for nonpregnant)

OGTT: 200 or higher

A1C: 6.5 or higher (T2 only)

Prediabetes diagnostic criteria

FPG: 100-125

A1C: 5.7-6.4%

Metabolic Sydrome

if you have 3 or more of the following:

• fasting glucose 100 or more

• obesity

• HLD (TAG 150 or over) or reduced HDL (less than 40 men, less than 50 women)

• HTN: over 130/85

T1DM

autoimmune destruction of B cells, redulting in insulin deficiency

T2DM

a metabolic disorder linked to stress, obesity, family hx, hx of GD, IGT

Buerger-Allen exercise protocol is used for people with

circulatory challenges

Buerger-Allen exercise protocol

3 cycles of 3 poistions maintained for 3 minutes or until appropriate response occurs. During position, the patient is encouraged to perform ankle pumps/circles and quad/glute sets

Position 1

supine with LE elevated to 45 degrees (for 3 minutes or until blanching)

Position 2

sitting up with LE in dependent position off the edge of the bed for 3 minutes or until rubor occurs

Position 3

supine with LE out flat

Pts with CV compromise may do the Buerger-Allen exercise protocol with

position 3 between 1 and 2

Prosthetic prediction level 0

no potential to ambulate or transfer, QOL will not be enhanced by prosthetic

Prosthetic prediction level 1

transfers or ambulates on level surfaces, household ambulation

Prosthetic prediction level 2

ability to transverse low level environmental barriers, community ambulator

Prosthetic prediction level 3

can transverse most environmental barriors, prosthetic beyond simple ambulation

Prosthetic prediction level 4

exceeds basic ambulation, capability for high stress, athlete

Contraindication to prosthesis

dyspnea at rest

BKA measurement points

proximal measure at fibular head, and at 4cm intervals

AKA measurement points

proximal measure at fixed distance distal to greater trochanter, and at 4cm intervals

Treatment for herpes simplex

self-limited infection, treated with chronic suppression using acyclovir

Treatment for herpes zoster

antiviral medications (acyclovir or famciclovie) within 24-72 hours

Tinea treatment

topical antifungal medication for 4 weeks

Unguium and capitis require

oral meds and CBC/liver function monitoring

Candidiasis treatment

topical fungal medication

impetigo treatment

bactroban ointment 3x/day

Folliculitis treatment

anti-staphylococcal meds

Erysipelas treatment

oral or intravenous antistrepococcal antibiotics like penicillin

Cellulitis treatment

oral or IV antibiotics

Scabies tx

Antiscabic creams over whole body, clothing washed in hot water and placed in a hot dryer

Xerosis tx

emollients, avoidants of hot showers/harsh detergent/topically applied alcohol

ACD tx

removal causative agent, apply a topical steroid

Irritant contact dermatitis tx

remove causative agnt and apply topical steroid

Atopic dermatitis tx

aggressive use of emolients

Lichen simplex chronicus

high potency topical steroids

Asteatotic dermatitis tx

aggresssive use of emolients

Pediculosis tx

head and pubic lice: lidocaine shampoo for 4 minutes, wash clothing in hot water and hot dryer

stasis dermatitis tx

address underlying venous HTN

Seborrheic dermatitis tx

suppress inflammation with a topical steroid or killing yeast with topical antifungal

Intertrigo tx

suppress inflammation with a topical steroid or killing yeast with topical antifungal, keep area clean and dry

Psoriasis tx

Use of topical steroids, vitamin-D derived Dovonex, tar containing bath additives, & newer biologics that treat specific components of the immune system

Utricaria tx

oral antihistamines, if anaphylaxis use epinephrine

Normal visual impairments that occur with aging

presbyopia

decrease in tear fluid production

decreased illumination when reading

peripheral vision decline

presbyopia

decreased ability to focus on a printed page, must hold object further away

This is associated with a loss of vision

increased risk of falls, d/t slower dark adaptation and macula degeneration

Macula

the critical zone of the retina that provides the highest resolution for sharp, central vision needed to see objects clearly