High-Impact Outline

Source: Classroom to Clinic Study System by Sedrak and Massey

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 Given a medical topic, complete a High-Impact Outline for the
topic

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 Your PowerPoint presentation will be a High-Impact Outline
 Writing High-Impact Outlines is an excellent way to prepare for
national board exams
 Relatively time-intense to set up
 You get out of it what you put into it
 Classroom to Clinic Study System by Mona M. Sedrak and Scott
L. Massey
 A good source for pre-created high-impact outlines
 The source of information for this presentation

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 Definition
 Etiology/Pathogenesis
 Pertinent Historical findings/Clinical Symptoms
 Pertinent Physical Exam Findings
 Differential Diagnosis
 Diagnostic Evaluations
 Medical Management
 Surgical Management
 Emergency Management
 Patient Education/Maintenance-Prevention

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 Definition
 Highly contagious disease caused by the mite Sarcoptes scabiei

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 Etiology/Pathogenesis
 The diagnosis can be easily missed and should be considered in a patient of any age
with complaints of generalized severe pruritus.
 The female mite thrives and burrows into skin shortly after contact with others infested
with scabies.
 Mites can remain alive for more than 2 days on clothing or bedding.
 The pruritic response takes place only after sensitization to S. scabiei has taken place,
which takes weeks to develop. After reinfestation, pruritis may occur within 24 hours.
 It only takes approximately 10 mites to qualify as an infestation.

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 Pertinent Historical Findings/Clinical Symptoms
 Persons most at risk include the young sexually active adults, the elderly who are
bedridden, or those who have come into contact with mite-infested sheets.
 Patients who live in communal settings such as nursing homes are highly susceptible to
contracting scabies.
 The most dominant symptom of scabies is intense generalized itching usually sparing
head and neck.
 Patients may complain of sleep disturbance secondary to the itch.
 Half of patients with crusting scabies do not itch.
 Patients are often aware of similar symptoms in those with whom they have had close
contacts.

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 Pertinent Physical Exam Findings
 The findings for scabies can be characterized by pruritic papular lesions, burrows, and
secondary excoriations.
 The dermatological findings for scabies are out of proportion to degree of pruritis.
Typically, there are few findings. Often, there are no findings.
 Tenderness over a scabies lesion suggests secondary bacterial infection.
 The majority of mites can be found on the hands, wrists, elbows, genitalia, buttocks, and
axillae.
 Dull red nodules, 3 to 5 mm in diameter may appear during active scabies.

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 Differential Diagnosis
 Pityriasis rosea
 Insect bites
 Eczema
 Atopic dermatitis
 Dermatitis herpetiformis
 Prurigo
 Seborrheic dermatitis
 Syphillis

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 Diagnostic Evaluations
 Skin biopsy of nodule will reveal portions of the mite in corneal layer.
 One method of finding burrows quickly is to drop a small amount of India ink to
infested area, then remove with alcohol. The ink will be drawn up into the burrows
highlighting thin threadlike burrows that have retained the ink.
 Locate a burrow and use a surgical blade or needle to remove the parasite. A drop of
mineral or immersion oil can be placed on a lesion and gently scraped away.
 Three microscopic findings are diagnostic of scabies: (1) S. scabiei mite, (2) fecal pellets
of the mite, and (3) eggs of the mite.

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 Medical Management
 Successful treatments must treat both the lice and the ova.
 Permethrin (Nix) is an over-the-counter treatment option.
 Lindane (Hexit) is a treatment option but has been found to cause seizures in epileptics
or if over used in children. It is safe and effective if used properly.
 Sulfur ointment applied to skin x 2-3 days
 Crotamiton cream
 Corticosteroids for persistent itching
 Persistent nodular lesions may necessitate intralesional steroids
 Patients should have weekly reevaluation appointments if the rash or itching persists

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 Surgical Management
 Not applicable

 Emergency Management
 Not applicable

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 Patient Education/Maintenance-Prevention
 Do not overuse Lindane cream when applying to skin.
 Clothing and bedding should be changed and laundered thoroughly.
 The lesions and intense pruritis typically improve in 1 to 2 days after
treatment.
 Sexual partners and close personal contacts within the last month should
be examined and treated.
 The most common source of animal mites is cats. The cat should be
taken to the vet for examination.

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 Now you are ready to make your own
High-Impact Outlines

Your PowerPoint Presentation for EOR will be a

High-Impact Outline

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