Review Flashcards
When viewing the chest x-ray film of a 25 year-old adult male recently diagnosed with pulmonary tuberculosis, which lobe of the lung is most likely to be affected: a lower lobes b middle lobes c upper lobes d lateral lobe
c. upper lobes
A 60 year-old obese female with hx of DM type 2 is seen by the NP. She has been taking metformin 500 mg PO BID with sitagliptan (Januvia) 10 mg in the morning. She is complaining of a tingling sensation with some numbness on both her lower legs, which has been present for several months. Which of the following is recommended for his patient:
A. A1C, serum B12 level, serum folate level
B A1C, CBC with differential, creatinine
C Serum potassium, serum sodium, serum magnesium
D Fasting blood glucose, eGFR, SED rate
A. A1c, serum B12 level, serum folate level
A 13 year-old is brought in by his mother. She reports that her son has rashes on his left arm for several weeks that do not itch or hurt. During the skin examination, the NP notices several 2 mm discrete smooth papules with central umbilication on the adolescent's left hand and arm. The lesions do not appear irritated. Which is the most likely diagnosis?: A Verruca vulgaris B Molluscum contagiosum C Condyloma acuminatum D Folliculitis
B Molluscum contagiosum
An 18 year-old presents to the college health clinic with a two-day history of fever, malaise, myalgia, and dry cough. During the physical exam, the pharynx was erythematous with mild tonsillar hypertrophy with no exudate. There are bluish white small spots on the buccal mucosa by the second molars bilaterally. Which of the following conditions is most likely? A Rubella B Rubeola C Varicella D Herpes simplex type I
B Rubeola
They are describing KOPLIK spots
A 62 year-old Asian woman is complaining of episodes of tinnitus in both ears. She denies hearing loss and vertigo. Which of the following should the NP perform initially?
A Prescribe Antivert and advise the patient to return for follow-up in one week
B Refer the patient to an ENT specialist
C Review the patient’s current medications including OTC drugs
D Perform a careful examination of the head, eyes, ears, and neck
C. Review the patient’s current medications including OTC drugs
*Remember “SOAPE” - Follow the steps and do NOT jump ahead.
Subjective - Review meds
Objective - Perform exam
Assessment - tinnitus
Plan - Prescribe Antivert
Evaluation - Make referral if pt does not respond or is worse
A 40 year-old woman presents with swelling behind her left knee after running a 5K race. She deines problems with walking and bending her knees. Upon physical exam, the NP palpates a soft round cystic mass in the posterior popliteal space that is not tender to palpation. Which of the following conditions is most likely? A Baker's cyst B DVT C Lymphedema D Venous insufficiency
A Baker’s cyst
A 17 year-old male college athlete presents with a complaint of a sore throat with enlarged “glands” on his neck for the past 3 weeks. He denies coryza. On PE, the posterior pharynx is bright red color with no exudate. The tonsils appear erythematous. The uvula is at midline. There is posterior cervical lymphadenopathy. The rapid strep test is positive. The NP suspects that the pt may have mono. Which of the following antibiotics is indicated for this patient?:
A Amoxicillin
B Clarithromycin
C Doxycycline
D Levaquin
B Clarithromycin
Never give Amoxicillin to someone with mono due to 80-90% risk for non-allergic amoxicillin drug rash.
Mrs S is a 35 year-old female with a hx of ADD and COPD. She is complaining of headaches and nervousness. The pt is taking prescription medications and herbal teas. Which of the following is the most likely cause?:
A Isosorbide mononitrate
B Atrovent
C St John’s Wort
D Ritalin
D Ritalin
This is 1st line for ADD
EYES:
_______ are larger than _______ and are darker in color
veins
arteries
The ______ (and ____ ______) are responsible for central vision; Are the areas with the sharpest vision
macula; fovea centralis
The ______ (CN__) contains rods and cones (photoreceptors)
retina; II
The ______ of the retina are responsible for color.
cones
The ______ of the retina are responsible for night vision and black and white contrast
rods
Blurred disc margins are called ___________ and are a sign of increased ______ as seen in severe HTN, bleeding, tumor, swelling in the brain
papilledema
ICP
Papilledema is a sign of increased ICP. Manifestations of ICP are changes in ______, _____, & _______, and _____, seizures, & ____
LOC, behavior, vision
headache; vomiting
Blepharitis presents with bilateral ______ and _____ edge of the eyelids.
May have fine _______.
Is more common with seborrheic dermatitis.
red; swollen
scales
Blepharitis treatment includes to ______ _____ in _____ ____ & _____ ______.
scrub eyelids
warm water baby shampoo.
If an infection is suspected with blepharitis, treat with __________ _________ such as _________
antibiotic ointment
Cipro
EYES:
A __________ is a traingular-shaped white to yellowish superficial growth on the _______ side and is bilateral. Is caused by long term ____ damage. Prevention is to wear sunglasses,
pterygium
nasal
UV
EYES:
A ______ is a white to yellowish small round superficial lesion on EACH SIDE of the cornea, caused by long-term ____ damage. Prevention is to wear sunglasses,
pinguecula
UV
think of “ping-pong”. PINGuecula —> ping-pong —> BOTH SIDES of the cornea like a ping pong bouncing back and forth
EYES: A _______ is a small PAINLESS nodule on the upper and lower eyelids
chalazion
THINK - Being LAZy is PAINLESS
EYES:
There is ___ ______ needed for a chalazion. If it is large, a ____ _____ can be used QID. If persistent or recurring, refer to rule out basal cell/meibomian gland cancer, and refer to ophthalmologist.
No treatment
warm compress
EYES:
A _____ _____ is a bilateral white-gray ring on edge of cornea in elderly. It DOES / DOES NOT impede vision?
senile arcus
does NOT
EYES:
Senile arcus is due to _____ ______. It is a _____ finding in the elderly. If the age is > 50, check a _____ profile.
lipid deposits; normal
lipid
EYES:
A ________ is a soft yellow flat cholesterol plaque on the upper/lower lids by the inner canthus and/or palpebrum.
Order a _______ ______ profile to rule out hypercholesterolemia.
xanthelasma
fasting lipid
EYES:
A _________ can be removed by trichlorocetic acid, surgery, or lasers by a plastic surgeon.
xanthelasma
EYES: A \_\_\_\_\_\_\_ (or "\_\_\_\_") is an acute onset localized lesion on the eyelid that HURTS. It is a small abscess.
hordeolum or “stye”
THINK - “Hordeolum - Hurts” - H —> H
This is different from a chalazion that is painless.
EYES:
A hordeolum or “stye” is due to staph. Treatment is to avoid _____ _____ and to apply _____ ______ ____, as well as a possible prescription of topical eye antibiotics.
wearing makeup
warm compresses QID
EYES:
An acute onset of red eye with dried, yellow-green crusting on the eyelids upon awakening: _________ ________
bacterial conjunctivitis
EYES:
Treatment for bacterial conjunctivitis is topical ophthalmic __________ every 2-4 hours for 2 days.
fluoroquinolones
EYES:
A very contagious acute onset of red eye in one or both eyes that is itchy and has periauricular lymphadenopathy: __________ _________
viral conjunctivitis or “pink eye”
EYES:
Treatment for viral conjunctivitis is to keep away from ______ for ___ _____.
A fluoroscein exam IS/ IS NOT needed?
school; one week
IS NOT
EYES:
Allergic conjunctivitis features bilateral _____ eyes with increased __________ with __________ conjunctiva. May be seasonal or more frequent.
itchy
tearing; reddened
EYES:
Treatment for allergic conjunctivitis is to use ____ _____ _____ and to avoid allergens. _______ may be used for short-term use only, otherwise hyperemia may occur.
cool eyelid compresses
Visine
EYES:
Allergic conjunctivitis:
An antihistamine with mast cell stabilizer may be used, such as _________. Put the drops in the ________ for extra relief.
Patanol; refrigerator
What does Snellen 20/60 signify?
The patient can see at 20 feet what a person with normal vision can see at 60 feet
With a Snellen chart exam, the patient is always at ____ feet (the ____ of the result)
20
numerator
By age ____ a child should have 20/20 vision
6
An eye exam in a patient with diabetic retinopathy will show _______ _____ ______. These are neovascularization (new and fragile arterioles) and ____________ due to the neovascularization that result in “dot and blot” hemorrhages.
cotton wool spots
microaneurysms
Cotton wool spots are a symptom of ________ _________.
diabetic retinopathy
Symptoms of diabetic retinopathy are _____ vision, ______, and ___________ (blind spot on visual field)
blurred
floaters
scotoma
AV nicking is caused by ________ __________ and is where an ________ is pressing down on a _____.
hypertensive retinopathy
arteriole; vein
_______ and _______ _____ arterioles are seen in hypertensive retinopathy
Copper; silver-wire
EYES:
_______ _______ is caused by a Herpes simplex virus or shingles of the _________ nerve (CN5) affecting the ophthalmic branch.
herpes keratitis
trigeminal
Herpes keratitis:
Classic scenario is one where the patient complains of acute onset of blurred _____, _______, and _____ in one eye.
blurred, tearing, pain
Herpes keratitis:
Physical exam with fluorescein stain shows a _____-____ _____ on the cornea on the affected eye
fern-like lesion
Herpes keratitis:
Treatment is to ______ to _____ ASAP or ____.
Herpes culture. Will be on acyclovir for a few weeks.
refer to ophthalmologist or ER
EYES:
A ______ _____ has an acute onset of severe eye pain, foreign body sensation, tearing, and injected sclera. Physical exam is with ________ (lower lids).
corneal abrasion
fluorescein —> “Floor-lower” - FLUORescein to LOWER lids.
NPs never ______ an eye - send to ophthalmologist.
patch
Treatment for a corneal abrasion is topical _____ therapy with __________ ointment, or a _________ eye drop. For severe eye pain, narcotics can be given.
antibiotic
erythromycin; fluroquinolone
Contact lens abrasions have a higher risk of infection with _________, and this is why they need to be removed every night. Topical antibiotic therapy with a __________ is recommended, and ____ patching!
pseudomonas
fluoroquinolone
NO
In open-angle or “primary open angle” glaucoma, ______ _______ is seen on physical exam.
disc cupping.
Think that CUPS are OPEN to help remember.
Open-angle glaucoma is rarely __________. It is caused by high _____. It is seen in those of _________-_________ descent.
symptomatic
IOP
African-American
Think of “when things are OPEN, you DON’T have symptoms. But when things are closed down, you’re going to see symptoms” to help remember the difference between open and closed-angle glaucoma.
Treatment for open-angle glaucoma is ____ ______ _____.
beta blocker eyedrops
Acute angle-closure glaucoma is a __________ ________.
ophthalmologic emergency
Angle closure glaucoma, in contrast to open-angle glaucoma, is symptomatic. Symptoms are ______ _____ ____ with decreased visual acuity, N/V, and _______ around lights.
severe ocular pain
halos
angle-closure glaucoma:
Drainage of aqueous fluid is ________, causing increased _____ which results in ischemic damage to the retina.
blocked
ICP
angle-closure glaucoma - Things (in vision) are ______. Treatment is to send to _________.
hazy
ED
________-_______ _______ _______ is a PAINLESS loss of central vision which often affects both eyes.
age-related macular degeneration
Age-related macular degeneration:
The macula is for ______ _______ and the ______ _____ is used to test for this condition.
central vision
Amsler grid
The red reflex test is a screening test for ________. No glow, dull, or white reflection are abnormal. In childhood, this could indicate a _______ _______.
cataracts
retinal blastoma
Cataracts: Affects the lens of the eyes and are common in the elderly. The lens becomes progressively cloudy which affects vision. The ____ ____ will be missing from the affected eye.
red reflex
Cataracts:
Classic presentation is where someone presents with ______ vision, increased sensitivity to _______, poor night vision, problems with ______ while driving at night, and sees
______ around lights.
blurred;
glare
headlights
halos
Allergic rhinitis:
Nasal turbinates are _____, ______, ______ and _____ with mucus discharge.
boggy, bluish, pale; swollen
Allergic rhinitis: First-line treatment is ________ _______ sprays such as _______ and ________
intranasal steroid
Nasocort and Flonase
Allergic rhinitis: Use ______ _____ in home
HEPA filters
Nasal polyps: Avoid _______ (increased sensitivity)
ASA
Epistaxis: Two types: anterior and posterior. _______ are more common. Anterior nosebleeds are caused by bleeding at _________ __________ (lower one-third of anterior nose)
anterior
Kiesselbach’s plexus
Posterior nosebleeds are more _____ and the patient should go to ____.
severe
ED
Treatment for nosebleeds includes instructing the patient to sit and _____ _____ and _____ _____ half of nose for ___ to ___ minutes.
lean forward; pinch lower
15 to 20
Nosebleeds treatment:
Apply topical nasal _________ such as
_______.
decongestant
Afrin
Nasal septum perforation:
The cartilage does not _______.
Refer to _______.
regenerate
ENT
Vertigo has many causes (benign to life-threatening conditions): __________ ______, vestibular neuritis, acoustic neuroma, multiple sclerosis, brainstem timors and bleeding
Meniere’s disease
Meniere’s disease has recurrent attacks of ________ with N/V that may last several hours
vertigo
Meniere’s disease is a TRIAD of:
_______
_______
_______ ______
vertigo
tinnitus
HEARING LOSS
*These are the 3 cardinal S&S of Meniere’s. MUST have HEARING LOSS to have Meniere’s!
To have Meniere’s, the patient MUST have ______ ______
hearing loss
Meinere’s disease can be treated with low-salt diet, avoidance of alcohol & caffeine, and meds such as ______, dimenhydrinate, ______, Promethazine, and antiemetics
meclizine; antihistamines
Acoustic neuroma has a ______ onset of one-sided hearing loss with _______ that is insidious.
gradual
tinnitus
Acoustic neuroma is a ______ tumor causing compression of CN 8. Treatment is _________.
benign
surgery
________ is recurrent vertigo lasting under one minute caused by sudden changes in head position (looking up, lying down, getting up/rolling over in bed). May lose balance and fall.
BPPV
BPPV is characterized by vertigo caused by _____ _____ in _______ ________
sudden changes
head position
BPPV can be remedied by adjusting the _________ ________ in the vestibular system of the ear (cochlea). This is called the _______ ______.
canalith crystals
Epley maneuver
BPPV is the only vertigo that can be cured _______.
quickly
via the Epley maneuver
Vestibular neuritis and labrynthitis are caused by _____ _______. Treatment is with ________ taper, meclizine, and _________.
viral infection.
methylprednisolone
scopolamine
Vestibular neuritis and labrynthitis have a sudden onset of severe vertigo with N/V for _____ days, with gradual lessening of symptoms.
1-2
A normal Weber test is where the person hears sound ______ in ______ _______
equally; both ears
no lateralization
Rinne test:
Bone
Better
Blockage
When bone is better than air, there is a blockage, which means conductive hearing loss
The blockage is either serous otitis media, a foreign body, or cerumen
Rinne test:
____ conduction should be better than _____ conduction
Air; bone
Weber test: _________ to one side is abnormal
lateralization
A negative Rinne test is always considered _______.
abnormal.
A Rinne test that is negative means that BC > AC, which is ________.
abnormal
A positive Rinne test is ________ and means that ____ > ____.
normal; AC > BC
A “positive” Rinne test means that it is _______.
normal
Weber test: Example:
If sound lateralizes to the right ear, it means that the patient either has _________ hearing loss in the right ear, or ___________ hearing loss in the left ear
conductive
sensorineural
Acute otitis media:
The most objective finding is _______ ______ per ______ _______ _______.
Decreased mobility
tympanogram flat line
Acute otitis media:
Treatment for children and adults is _________.
Amoxicillin
THINK - “AOM - AMO”
Acute otitis media - AMOxicillin
Acute otitis media:
If the person had antibiotics in the past month, treat with __________.
Augmentin
Otitis media with effusion (serous otitis media):
The TM is not ______. It may look translucent but filled with clear serous fluid and you may see fluid level and ______ ________. Mild hearing loss with ________ sounds.
red
air bubbles
popping
A complication of otitis media:
Acute ___________. Pain, swelling, redness behind affected ear accompanied by fever and AOM symptoms. Refer to ER for hospitalization.
mastoiditis.
A cauliflower-like or round white growth draining purulent and foul-smelling discharge with hearing loss, due to chronic OM. Refer to ENT. Needs antibiotics and surgical debridement. What is this? ___________
cholesteatoma
What is the most common bacteria of Otitis externa or “swimmers ear”?
pseudomonas aeruginosa
Swimmer’s ear or otitis externa has ________ _____ discharge and a swollen and red ear canal. There is pain with manipulation of the pinna and/or tragus of the ear.
purulent green
treatment for otitis externa is ______ ______ and _________ combination such as ________ or Cipro HC. Keep water out of ear.
topical steroid
antibiotic; Cortisporin
Acute bacterial rhinosinusitis:
Hx of persisent URI symptoms for 10+ days, or a cold that resolved, but symptoms return and worsens. Complains of unilateral facial pain or pressure or toothache (upper molar pain) with nasal congestion, purulent nasal discharge and/or postnasal drip.
Pathogens are strep pneumoniae and H. influenzae most of the time.
Frontal sinusitis presents with _______ _______ or pain ________ ______ eye.
frontal headache
behind one
Maxillary sinusitis presents with ______ pain and ____ ______ _____ pain
facial
upper molar tooth
1st-line treatment for acute bacterial rhinosinusitis is ___________. If they are allergic to PCN, then give ________. May also give symptomatic relief such as saline irrigations, nasal steroids, and NSAIDs for pain.
Augmentin
doxycycline
Infectious mono: Classic case: Teenager presents with hx of: 1 \_\_\_\_\_\_\_\_\_\_ 2\_\_\_\_\_\_\_\_\_\_ 3\_\_\_\_\_\_\_\_\_\_ for several weeks.
1 sore throat
2 enlarged posterior cervical nodes
3 fatigue
The etiology of mono is the ______-______ _____.
Epstein-Barr virus
Epstein-Barr virus (cause of mono): EBV infection can cause __________ and _________ cancers, as well as ________ and __-____ _______. It can infect other organs such as the brain, spinal cord, optic nerve, and heart.
nasopharyngeal; oral
Hodgkins; T-cell lymphoma
Mono: Testing
Monospot test is not recommended for general use b/c it produces both false positives and false negatives.
____ _____ are usually not needed for typical cases, but are the gold standard.
A _____ shows increased WBCs and __________.
Peripheral smear is _________ with the presence of atypical lymphocytes with lymphocytosis .
_____ are elevated in most patients.
EBV titers
CBC; lymphocytosis
abnormal
LFTs
With mono, suspect ___________/__________.
splenomegaly/hepatomegaly
With mono, do a _______ abdominal exam with palpation and percussion. Order an _______ ______ of the __________.
gentle
abdominal ultrasound
spleen
Mono treatment:
Symptomatic.
______.
Avoid _____ ______ and ______ ______.
Rest.
contact sports; heavy lifting
Mono treatment:
Patient should avoid contact sports and heavy lifting for a minimum time of _____ to ____ _______.
4 to 6 weeks
Oral leukoplakia:
White colored thick patch, can be cheeks, gum, tongue, etc. It is _________. If on tongue, rule out cancer of the tongue by a _________.
painless
biopsy
sialolithiasis:
Salivary duct stone/calculi. White colored nodule under the tongue. Usually asymptomatic. May c/o pain _____ ______. Refer to ENT.
before meals
Aphthous stomatitis (canker sores)
A ______ ______ ______ ulcer on the tongue or cheeks. complains of pain with eating or drinking acidic foods.
Treatment is _______ _________ swish and swallow.
painful shallow annular Magic mouthwash (viscous lido, Benadryl, Maalox ina 1:1:1 ratio)
Peritonsillar abscess/cellulitis:
Has a _____ _________ with red mass on area of tonsils. Has a high fever. Severe sore throat and _______ with _______. Refer to ER ASAP. It is a complication of pharyngitis.
displaced uvula
pain; swallowing
Diphtheria:
Presents with a ____-to _______ colored _______ that is ______ to _________. Swollen neck. Refer to ER.
Notify _________ ______ department for contact tracing.
gray to yellow; pseudomembrane
hard to displace
State health
Diphtheria: Treatment is 1\_\_\_\_\_ 2\_\_\_\_ 3\_\_\_\_\_
1 antibiotic
2 antitoxin
3 strict isolation
Diphtheria:
For close contacts such as household members:
Obtain _______/_______ swabs for C. diphtheriae cultures
nasal/pharyngeal
Benign findings of mouth/pharynx:
______ _______: A bony protuberance/growth on the hard palate at midline
_______ _________: Uvula that is split into two sectionsn
Torus palatinus
Fishtail uvula
Most common skin cancer is _______ ________ ________
basal cell carcinoma
Basal cell carcinoma appears ______ or _______ (___-tone) with ______ edges and __________
waxy; pearly (flesh-tone)
raised TELANGIECTASIA
Actinic keratosis:
Multiple dry scaly lesions that do not heal on areas of the skin ________ to _______ ______.
exposed; chronic sunlight
Actinic keratosis is treated with ______
5-Flouracil
Actinic keratosis is a precursor lesion of ______ _____ skin cancer
squamous cell
Squamous cell cancer:
Chronic _______ _______ rough textured lesion with ______ borders. Sometimes crusting or bleeding. Common locations are rim of the ears, lips, nose, face and tops of the hands. The precursor lesion is actinic keratosis.
red scaly
irregular
Squamous cell cancer:
Treatment is _____ ________ if on face/cartilage.
Moh’s microsurgery
An important risk factor for skin cancer (both non-melanoma and melanoma) is:
_______ ________ as a child.
History of _________.
_____ skin.
Excessive chronic exposure to UV light from sun and tanning beds.
Moles.
Positive family history.
blistering sunburn
sunburns
Light
Important risk factor for skin cancer:
Avoid sun exposure at the time of day when the sun is most damaging, which is from ____ to _____
10 AM to 3 PM
Melanoma: Remember the ABCDE rule: A B C D E
Asymmetry Border Color Diameter Evolving
Acral lentiginous melanoma is the most common type of melanoma in ______-_____ individuals. Most common locations are the ______, _______ surface, and ______ areas. Remove shoes to inspect.
Remove shoes.
Palms.
Soles of feet.
dark-skinned
palms, plantar; subungal
Acral lentiginous melanoma:
Look for _______ _______ to ____ bands on the nailbed.
longitudinal brown black
___________: a darkened band under or within the nail plate located on a fingernail that may be seen in Blacks, Latinos, and Asians. It can resemble subungal melanoma which can be fatal if not caught early. In Whites, rule out subungal melanoma. If this is only in ONE nail, it is _______.
melanonychia
ABNORMAL
Bacterial meningitis: Has an acute and rapid onset of the classic triad of: \_\_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_, and rapid change in \_\_\_\_\_\_\_ \_\_\_\_\_\_
high fever
nuchal rigidity
mental status
bacterial meningitis:
has generalized rashes ranging from ______ to ________ to purple-colored lesions (purpura)
petecchiae
ecchymosis
Bacterial meningitis:
For close contacts exposed to it, give ______ as early as possible after exposure to patient’s oral secretions.
Rifampin
Bacterial meningitis:
______ (treatment) changes color of urine to reddish orange and can stain contacts. Do not give to pregnant women.
Rifampin
Diagnosing bacterial meningitis:
_______ sign is for nuchal rigidity. Patient supine. Raise _______ and flex _____ toward ______.
Brudzinski
head chin chest
Brudzinski sign for bacterial meningitis:
Positive result if patient automatically _______ ______ ____
bends both hips
Diagnosing bacterial meningitis:
_______ sign is for the hip. Patient supine. Flex patient’s hips and knees in a right angle, then slowly straighten/extend the leg. Positive result is when the patient complains of pain during ___________ or ______.
Kernig’s
extension
resisting
MCV4 (Menactra, Menveo):
Give one dose of Menactra or Menveo at age ___ to ___ years
11 to 19
MCV4 (Menactra, Menveo)
First year living in college residence halls, military recruits: Give one dose of Menactra or Menveo if never had a dose, age ___ to ___.
19 to 21
Rocky Mountain Spotted Fever:
Onset of fever, HA, myalgia, N/V, and anorexia. Spot-like red rashes (______) start within 2 to 5 days of fever onset, located on the ________/_______ and on the _____/_____, which spread toward the ______ and becomes generalized. Can be life-threatening.
petechiae
hands/palms
feet/soles
trunk
Rocky Mountain Spotted Fever:
Due to the deer/dog tick bite infected with _______ _______. States where 60% of cases are found are North Carolina, Tennessee, Oklahoma, Arkansas, and Missouri.
rickettsia ricketsii
Rocky Mountain Spotted Fever:
Treatment is with ___________
doxycycline
Rocky Mountain Spotted Fever:
______ ____ ______ for rash to appear, start doxycycline immediately if RMSF is suspected. >20% fatality rate if not treated.
Do not wait!
The ticks that cause Rocky Mountain Spotted Fever are in _____ _____/____ of TN, NC, Oklahoma, Arkansas, Missouri
grassy areas / fields
Erythema Migrans aka Lyme Disease:
Acute onset target rash or “______-_____” shaped red-colored rash that feels hot to touch on the extremities or trunk. Some have migratory oligoarthritis (swollen red and painful joints) - the ____ _____ of the knee.
bulls-eye
bulge sign
Lyme Disease (erythema migrans):
Treatment is _______.
Use DEET.
For clothing, use ________.
Doxycycline
permethrin
Rosacea (acne rosacea):
Fair skinned Celtic (Irish, Scot, English) middle-aged woman with history of chronic symmetric redness, small pustules, papules, and telangiectases on central areas of the face. Easy flushing with ETOH and spicy foods.
First-line treatment is to _____ ______ of flushing.
Afterward, ________ _____ once to twice daily is indicated.
Avoid triggers (ETOH, excessive sun) metronidazole gel
Rosacea (acne rosacea):
A patient with rosacea has been taking metronidazole gel for her acne rosacea and it is not working. What is the next step?
Put her on PO ___________ or ___________ daily
tetracycline or doxycycline
Derm Review: Primary Lesions:
Changes in skin color (flat and non-palpable), < 1 cm. Example are freckles. What are these? _______
macules
Derm Review: Primary Lesions:
Palpable solid lesions < 1 cm in diameter
Ex. Comedones, acne
What are they?
papules
Derm Review: Primary Lesions:
Raised solid lesions > 1 cm
Ex. Basal cell cancer, hydradenitis suppurativa nodule
What are these?
nodules
Derm Review: Primary Lesions:
Circumscribed elevated lesions that contain pus
ex. acne pustules
pustules
Derm Review: Primary Lesions:
Elevated superficial blister filled with serous fluid - larger than 1 cm in size
Ex. bullous impetigo, 2nd degree burn
bulla / bullae
Derm Review: Primary Lesions:
Elevated raised skin lesion <1 cm in diameter and filled with serous fluid.
Ex. herpes simplex, herpes zoster
vesicle
Derm Review: Primary Lesions:
Solid raised lesion with flat top > 1 cm in diameter
Ex. psoriasis
plaque
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Thickening of the epidermis with exaggeration of normal skin lines (due to chronic itching): _____________
Lichenification
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Flaking skin: _______
scale
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Results from drying of exudate: ________
crust
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Eroding of epidermis and dermis (if deep, can involve subQ tissue): ___________
ulceration
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Permanent fibrotic change following damage to the dermis: ________
scar
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Overgrowth of scar tissue common in Blacks, Asians: ______
keloids/ hypertrophic scars
Thermal burns:
Red to bright red skin and tenderness/pain:
_________ degree (___________)
first degree (superficial)
Thermal burns:
Painful red skin, bullae (blisters), redeened/weepy skin:
_________ degree (________ ________)
second (partial thickness)
Thermal burns:
Pain sensation absent.
Pale/white color, charred skin, leather-like texture.
_____ degree (_____ _________)
third (full thickness)
For treatment of burns in someone allergic to sulfa, an alternative to Silvadene is ________.
Bacitracin
If a patient presents with thermal facial burns with soot around the nose/mouth, singed eyebrows/nasal hair/eyelashes, facial burns, and/or black particles in sputum, hoarseness, suspect _____ ______ ______. Assess for airway patency, breath sounds, wheezing, respiratory distress. ABCs are always the priority! Refer to ED. On exam will be given 4 people and asked who should be seen right away - go by ABCs!
smoke inhalation injury
American Burn Association defines minor burns as:
Age 10 to 50 years: < ____ % TBSA ____ _____ burns
Age < 10 or > 50 years: < ____ % TBSA ______ ____ burns
10; partial thickness
5; partial thickness
Minor burns should meet these criteria:
Does not involve the _____, _____, _____, _____
Face, perineum, hands, feet
Minor burns should meet these criteria:
Does not cross ______ _____.
Is not ________.
major joints
circumferential
A restaurant cook who is 22 years old is in the urgent care center for burns due to spilling hot cooking oil. On PE, the NP notes bright red skin with several bullae on the patient’s left arm and chest and bright red skin on the right thigh.
- What is the patient’s diagnosis?
- What is the TBSA?
- Partial thickness thermal burns (2nd degree) of the left arm and chest with superficial thickness (1st degree) burns on the right lower leg and foot.
- 36% (serious burn)
All of the following are true statements about thermal burns except:
- If debris, jewelry, and/or clothing is stuck to the skin, it can be removed gently.
- Avoid ice-cold water when cooling the skin.
- Do not rupture intact blisters.
- Saran wrap plastic can be used as temporary dressing for large burns until patient reaches the hospital.
- If debris, jewelry, and/or clothing is stuck to the skin, it can be removed gently.
For thermal burns, do not forget to check _________ status. Analgesics can be given PRN for pain.
Td/Tdap
Cellulitis: The causative bacteria is ________ or _______.
streptococcus; staph aureus incl. MRSA
Cellulitis: Acute skin infection. Localized skin _____ with _______ __________. Skin feels warm/hot and tender.
erythema
diffused margins
Lymphangitis:
Look for ______ _______ that follow _______ ________ deep under the skin emerging from the infected area (cellulitis). Go to hospital for ____ ____.
red streaks
lymphatic channels
IV abx
Erysipelas:
Bright red plaque or induration with sharp or well-demarcated elevated margins on the _____ or _____ ____. Uncommon. If located on the _____, refer to ER for IV abx.
face; lower legs
face
Also known as a boil or skin abscess - due to an infection of a hair follicle (staph, MRSA, group A strep). Red, tender, dome-shaped lesion that drains purulent discharge when it ruptures. Patient will say they have a spider bite.
________
furuncle
“For uncle” - one spot
(carbuncle - a “car full of uncles” - more than 1 furuncle)
A cluster of coalesced boils which are connected subcutaneously. Tender to palpation. Common location is the area behind the neck. Purulent discharge.
__________
carbuncle
Furuncles and carbuncles treatment:
First-line tx of abscesses is _____ with ___ ______.
If at risk for bacterial endocarditis, give abx prophylaxis. Check _____ ______ status.
If abscess is < ____ cm in size, no PO abx needed.
I&D local anesthesia
tetanus vaccine
< 5
For nonpurulent cellulitis (mild), give ______ or ____ (antibiotic).
Keflex dicloxacillin
