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Varicella Zoster (Chickenpox & Shingles)

Total Questions: 12

1. What causes primary Varicella (Chickenpox)?

Answer:

  • Varicella Zoster Virus

2. What causes reactivation of Varicella Zoster?

Answer:

  • Herpes Zoster (Shingles)

3. Where does the Varicella Zoster virus live in the body?

Answer:

  • Trigeminal ganglion

4. What are the symptoms of primary Varicella (Chickenpox)?

Answer:

  • Fever for 24 hours

  • Rash: Dew drops on a rose petal, transitioning from macules to papules to vesicles

5. What are the symptoms of shingles (Herpes Zoster)?

Answer:

  • Pain along the affected dermatome

  • Rash: Vesicles that do not cross the midline

6. What is a specific symptom of shingles when it affects the ophthalmic or otic regions?

Answer:

  • Ramsay Hunt Syndrome (affects the trigeminal and facial nerves)

7. How is Varicella diagnosed?

Answer:

  • Tzanck smear

  • Dendritic lesions on slit lamp examination

8. What is the treatment for Varicella in unvaccinated or immunocompromised individuals?

Answer:

  • Antiviral medications (e.g., acyclovir)

Erythema Multiforme

Total Questions: 3

9. What is the typical presentation of erythema multiforme?

Answer:

  • Red, multi-layered lesions: center red blister/macule, second layer pallor, third layer erythematous ring

10. What is a key feature of erythema multiforme on physical exam?

Answer:

  • Negative Nikolsky sign (skin does not separate easily)

  • No itchiness, and the rash blanches

11. What is the treatment for erythema multiforme?

Answer:

  • Acyclovir for viral causes

  • Topical antibiotics if secondary infection occurs

SJS/TEN (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis)

Total Questions: 5

12. What is the pathophysiology of SJS and TEN?

Answer:

  • Necrosis of the epidermis

13. How are SJS and TEN classified by body surface area (BSA)?

Answer:

  • Grade 1: <10% BSA

  • Grade 2: 10-30% BSA

  • Grade 3: >30% BSA

14. What are the symptoms of Stevens-Johnson Syndrome (SJS)?

Answer:

  • Fever

  • Stinging of the eyes

  • Flat, target/purpuric macules with a central vesicle (on the trunk)

  • Mucosal involvement: Bullae, conjunctiva, ulceration

15. What are the symptoms of Toxic Epidermal Necrolysis (TEN)?

Answer:

  • Large blisters

  • Painful, erythematous base

  • Large BSA involvement

16. What physical exam sign is positive in TEN?

Answer:

  • Positive Nikolsky sign (separation of skin upon gentle pressure)

17. What is the treatment for SJS/TEN?

Answer:

  • Steroids (if severe)

  • Burn unit for severe cases

Cellulitis

Total Questions: 6

18. What is cellulitis?

Answer:

  • Inflammation of the dermis and subcutaneous tissue

19. What are the most common pathogens causing cellulitis?

Answer:

  • Group A Streptococcus (GAS)

  • Staphylococcus aureus

20. What are the symptoms of cellulitis?

Answer:

  • Erythema, swelling, warmth, and tenderness

21. What is the treatment for cellulitis caused by GAS or Staphylococcus aureus?

Answer:

  • PO antibiotics: Cephalexin or Dicloxacillin

  • IV antibiotics: Cefazolin

22. What is the treatment for cellulitis caused by a cat or dog bite?

Answer:

  • Augmentin

23. What is the treatment for MRSA cellulitis?

Answer:

  • PO antibiotics: Bactrim, Doxycycline, Clindamycin

  • IV antibiotics: Vancomycin

MRSA (Methicillin-Resistant Staphylococcus Aureus)

Total Questions: 4

24. What are the two types of cellulitis?

Answer:

  • Non-purulent (caused by GAS)

  • Purulent (caused by MRSA)

25. What are the characteristics of non-purulent cellulitis?

Answer:

  • No abscess or drainage

  • Systemic symptoms (fever, erythema, edema, TTP)

26. What are the characteristics of purulent cellulitis?

Answer:

  • Abscess with necrotic lesions

  • Folliculitis, furunculosis, carbuncle

27. How do you treat purulent cellulitis with abscesses?

Answer:

  • Bactrim, Doxycycline, Rifampin, Clindamycin for community-acquired MRSA

  • Vancomycin, Linezolid for hospital-acquired MRSA

Tetanus (for open wounds)

Total Questions: 1

28. What is the treatment for open wounds at risk for tetanus?

Answer:

  • Tetanus prophylaxis if the wound is contaminated or the patient's immunization is not up to date


Heat-Related Illnesses

Total Questions: 5

1. What is the treatment for heat cramps?

Answer:

  • Electrolyte and salt solution

2. What are the symptoms of heat exhaustion?

Answer:

  • Hypotension (HoTN)

  • Nausea (N), vomiting (V), diarrhea (D)

  • No CNS involvement

3. What is the treatment for heat exhaustion?

Answer:

  • Cooling measures

  • Fluids (electrolyte-rich)

4. What are the symptoms of heat stroke?

Answer:

  • Hyperthermia

  • CNS dysfunction (e.g., confusion, seizures, coma)

5. What is the treatment for heat stroke?

Answer:

  • Immediate cooling (ice, cold water immersion)

  • IV fluids

  • Management of organ dysfunction

Cold Injuries

Total Questions: 4

6. What are the stages of trench foot?

Answer:

  1. Stage 1: Numbness, redness

  2. Stage 2: Swelling, pale skin

  3. Stage 3: Gangrene

  4. Stage 4: Dead tissue

7. What is the treatment for trench foot?

Answer:

  • Do NOT rewarm immediately

  • Tetanus vaccination (Tdap)

  • TCA + Gabapentin for pain

  • Air drying, fluid management, and possible surgery

8. What are the symptoms of chilblains?

Answer:

  • Inflammation of toes/fingers

  • Erythematous lesions

  • Burning, tenderness, and pain

9. What is the treatment for chilblains?

Answer:

  • Remove from cold

  • Stop smoking

  • Topical steroids

  • Nifedipine

Frostbite

Total Questions: 3

10. What are the stages of frostbite?

Answer:

  1. Stage 1: Redness, swelling

  2. Stage 2: Blisters, numbness

  3. Stage 3: Hemorrhage

  4. Stage 4: Muscle or tissue necrosis

11. What is the treatment for frostbite?

Answer:

  • Pain management: Morphine

  • NSAIDs for inflammation

  • Tetanus vaccination (Tdap)

  • Do NOT dry warm the affected area

Hypothermia

Total Questions: 1

12. What is the treatment for hypothermia?

Answer:

  • Rewarming (passive or active)

  • IV fluids (warmed)

  • Monitor core temperature

  • Active warming if severe


Brown Recluse Spider Bite

Total Questions: 3

1. Where is the Brown Recluse spider most commonly found?

Answer:

  • Southwestern and Midwestern United States

2. What are the local effects of a Brown Recluse spider bite?

Answer:

  • Burning and erythema for 3-4 hours

  • Blanching of affected area due to vasoconstriction

  • Erythematous margin around ischemic center (red halo) for 24-72 hours

  • Hemorrhagic bulla leading to eschar formation

  • 10% may develop skin necrosis

3. What is the treatment for a Brown Recluse spider bite?

Answer:

  • Local wound care: Clean with soap and water, apply cold packs, elevate the area

  • Pain control: NSAIDs, opioids if severe pain

  • Tetanus prophylaxis if indicated

  • Most bites heal spontaneously within days to weeks

Black Widow Spider Bite

Total Questions: 3

1. How can you identify a Black Widow Spider?

Answer:

  • Red hourglass shape on the underside of the abdomen

2. What are the local and systemic effects of a Black Widow spider bite?

Answer:

  • Local symptoms: Pain at the bite site

  • Systemic symptoms (onset within 30 min - 2 hrs):

    • Muscle pain (most prominent feature)

    • Muscle spasms

    • Rigidity

3. What is the treatment for a Black Widow spider bite?

Answer:

  • Mild: Wound care (soap and water), pain control (NSAIDs, opioids)

  • Moderate to severe: Muscle relaxants (e.g., benzodiazepines, methocarbamol)

  • Antivenom: Reserved for patients not responsive to the above treatments

Burns

Total Questions: 7

1. What are the different types of burns and their classification?

Answer:

  • Superficial (1st degree): Affects the epidermis, appears as a “sunburn” (dry, red), painful, heals in 3-6 days with no scarring.

  • Superficial partial-thickness (2nd degree): Affects the epidermis and superficial dermis, appears moist, red, weeping, painful to touch, air, & temperature. Heals in 7-21 days with no scarring or mild pigment changes.

  • Deep partial-thickness (2nd degree): Affects the epidermis and deeper dermis, appears mottled, cheesy white to red, painful only to pressure, may lead to hypertrophic scarring. Heals in 2-9 weeks without grafting.

  • Full thickness (3rd degree): Affects the epidermis, dermis, and subcutaneous tissue, appears waxy white to charred, inelastic, and dry with no blisters. Severe scarring and contractures, heals with surgery.

  • Deeper injury (4th degree): Involves epidermis, dermis, subcutaneous tissue, and deep structures like muscles, fat, fascia, and bones. Appears black, charred, or dull, with minimal sensation. Life- and limb-threatening.

2. What are the criteria for minor burns?

Answer:

  • Partial-thickness burns:

    • <10% TBSA in patients 10-50 years old

    • <5% TBSA in patients <10 or >50 years old

  • Full-thickness burns:

    • <2% TBSA in any patient without other injury

  • Other criteria: Isolated injury (without suspicion of inhalation or high-voltage injury), no involvement of face, hands, feet, perineum, or major joints, and no circumferential burns.

3. When should a burn patient be referred to a burn center?

Answer:

  • Partial-thickness burns >10% TBSA

  • Third-degree burns in any age group

  • Burns involving face, hands, feet, genitalia, perineum, or major joints

  • Electrical burns (including lightning)

  • Chemical burns

  • Inhalation injury

  • Burns in patients with medical conditions that could complicate management, prolong recovery, or affect mortality.

4. How do you estimate the total body surface area (TBSA) for burns?

Answer:

  • Rule of 9s:

    • Head/neck = 9%

    • Each arm = 9%, each leg = 18%

    • Anterior trunk = 18%, posterior trunk = 18%

    • Genitalia = 1%

    • Superficial (1st-degree) burns are not included.

  • Palmar Method: Uses the patient's palm to estimate 1% TBSA.

5. What is the Parkland formula for fluid resuscitation in burn patients?

Answer:

  • Parkland formula:
    4 mL × %TBSA × weight (kg)

    • First half of the volume in the first 8 hours, and the second half in the remaining 16 hours.

    • Lactated Ringer’s is typically used for fluid replacement.

6. What are the immediate measures for managing burn patients?

Answer:

  • Airway management: Intubation if inhalation injury is suspected or with >30-40% TBSA burns.

  • Vascular access: Obtain early intravenous access.

  • Fluid resuscitation: For patients with >15% TBSA burns, use the Parkland formula.

  • Burn care: Remove burnt clothing/jewelry, cool burns with cool water or saline-soaked gauze (never use ice), maintain body temperature ≥95°F (35°C).

7. What are the treatment options for burn wounds?

Answer:

  • Superficial & superficial partial-thickness burns:

    • Irrigation, topical moisturizers (calamine lotion, aloe vera gel), and topical antibiotics (e.g., triple ointment: bacitracin, neomycin, polymyxin B).

  • Deep partial-thickness, 3rd/4th-degree burns:

    • Early debridement, escharotomy/fasciotomy if needed (for vascular/respiratory compromise), skin grafts, and topical antibiotics like silver sulfadiazine (SSD) or mafenide acetate.


Your provided breakdown of burn classifications is accurate and well-organized. Here's a review with minor enhancements for clarity:

Burn Classification:

  1. Superficial (1st degree):

    • Affects: Only the epidermis.

    • Appearance: Red, dry, and "sunburn-like".

    • Sensation: Painful to the touch.

    • Healing: Typically 3-6 days, no scarring.

    • Example: Sunburn.

  2. Superficial Partial-thickness (2nd degree):

    • Affects: Epidermis and superficial dermis (papillary layer).

    • Appearance: Moist, red, weeping, with blisters.

    • Sensation: Painful to touch, air, and temperature changes.

    • Healing: Typically 7-21 days. No scarring or mild pigment changes.

    • Example: Blistering burn.

  3. Deep Partial-thickness (2nd degree):

    • Affects: Epidermis and deeper dermis (reticular layer).

    • Appearance: Mottled, waxy, cheesy white to red, blisters easily unroofed.

    • Sensation: Painful only to pressure, some areas may be insensitive due to deeper tissue involvement.

    • Healing: 2-9 weeks without grafting; potential for hypertrophic scarring.

    • Example: Severe scald burns or contact burns.

  4. Full Thickness (3rd degree):

    • Affects: Epidermis, dermis, and subcutaneous tissue.

    • Appearance: Waxy white, charred, or leathery in appearance. Dry, inelastic, no blisters.

    • Sensation: Deep pressure only—lack of sensation because nerve endings are destroyed.

    • Healing: Cannot heal without surgical intervention (e.g., skin grafts). Severe scarring and contractures.

    • Example: Severe electrical burns, prolonged exposure to flame.

  5. Deeper Injury (4th degree):

    • Affects: Epidermis, dermis, subcutaneous tissue, and deeper structures such as muscles, fat, fascia, and bones.

    • Appearance: Black, charred, or dull in appearance. Tissue may be necrotic.

    • Sensation: Minimal sensation due to nerve destruction.

    • Healing: Life- and limb-threatening; requires amputation or reconstructive surgery; not salvageable without extensive intervention.

    • Example: Burns involving prolonged contact with flames or electrical injuries.

Key Points:

  • First-degree burns are the least severe and heal with no scarring.

  • Second-degree burns (both superficial and deep partial-thickness) may require longer healing time and can cause scarring.

  • Third-degree burns are full-thickness injuries and usually require skin grafts for healing.

  • Fourth-degree burns involve deeper structures like muscles and bones, often requiring amputation or other extensive treatments.

This structure is clear and concise and covers all relevant aspects for understanding burn classifications.