Exam 2 Flashcards
(161 cards)
1
Q
Warning signs for skin CA
A
open sore that does not heal for 3 weeks, a spot or sore that burns, itches, stings, crusts or bleeds; any mole or spot that changes in size or texture, develops irregular borders, or appears pearly, translucent, or multicolored
2
Q
Skin photaged by sun damage
A
Coarse with yellow discoloration (solar elastosis), irregularly pigmented, rough or atrophic with deep wrinkling
3
Q
ABCDE screening for MM
A
asymmetry, border irregularities, color, diamet >6mm, elevation
4
Q
Shave or punch biopsy for
A
non-melanocytic skin cancer
5
Q
Excisional biopsy for
A
MM
6
Q
Solar actinic keratosis
A
Pre-malignant
7
Q
Disorder of pilosebaceous follicles causing increased sebum production, keratinization, inflammation, and bacterial colonization
A
Acne Vulgaris
8
Q
Blackhead
A
Obstruction of follicle filled with stratum corneum cells
Open comedone
9
Q
Whitehead
A
Cystic swelling of the comedone–precursor of inflammatory papules and pustules
Closed comedone
10
Q
Length of time for acne treatment
A
6-12 weeks to be effective
11
Q
First line therapy for acne
A
Topical
Trentinoin (Retin A), Adapalen, tazarotene, benzoyl peroxide, salicylic acid
12
Q
Tx for inflammatory acne
A
Erythromycin, clindamycin, metronidazole, sulfonamide, azelaic acid
13
Q
Oral abx for severe acne
A
Erythromycin, tetracycline, doxycycline, minocycline
14
Q
Rosacea
A
age 30-50
No comedones
Facial flushing, facial erythema, inflammatory papules and pustules, edema, watery or irritated eyes
Avoid triggers
15
Q
Tx of acne rosacea
A
Topical metronidazole, azelaic acid, sulfacetamide-sulfur
16
Q
Signs of compartment syndrome
A
Pain, pallor, paresthesia, paralysis
17
Q
Tx of bite wounds
A
Irrigate with 150ml sterile saline solution, tetanus vaccine, do not suture
18
Q
Prophylactic abx for bite wounds
A
Augmentin 875mg/125mg BID for 5-7 days
19
Q
superficial or partial thickness burns involving only the epidermis—glossy, red and painful
A
First degree
20
Q
partial thickness burn involving the dermis—dull or glossy with pink, red or white pigmentation; may blister and be severely painful
A
2nd degree burn
21
Q
full thickness burns that extend to subcutaneous fat—matte and may be white, brown, red, or black loss of sensation
A
3rd degree burn
22
Q
Management of 1st degree burn
A
Cool tap water, closed wound dressing (silver sulfadiazine cream–silvadene), gels, hydrocolloids, aloe vera
23
Q
Most prevalent organisms in cellulitis
A
Group A strep
Staph if deep penetrating wounds
24
Q
spreading erythema, warmth, induration and pain, possible lymphadenitis
A
Cellulitis
25
Tx of mild cellulitis
Penicillin, amoxicillin, augmentin, cephalexin, clindamycin
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Tx for purulent cellulitis
Bactrim, doxycycline, cephalexin, dicloxacillin
| ED
27
exophthalmos, orbital pain, restricted eye movement, occasional visual disturbances
Orbital cellulitis--medical emergency
28
Irritant contact dermatitis
Due to direct cytotoxic action of an agent on the cells of the epidermis and dermis
Ex. Soaps, detergents, acids, alkalis
lichenification, scaling, fissuring
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Most common cause of allergic contact dermatitis
nickel, neomycin, bacitracin, poison ivy or oak
30
Diagnostics for contact dermatitis
KOH slide, cultures, inspection
31
Tx of contact dermatitis
1. avoid offending agent
| 2. medium to high dose steroid ointments
32
grouped round vesicles containing cloudy fluid on an erythematous base
Herpes
33
Diagnostic test for herpes
Tzanck smear or PCR
34
Tx of herpes
Acyclovir 400mg PO TID for 7-10 days OR acyclovir 200mg PO 5X day for 5 days
35
How to diagnose fungal infections
Woods lamp
36
Tx of pain in shingles
Gabapentin, amitryptiline
| Narcotics do not help
37
Diagnostics for shingles
Tzanck test, PCR
38
Tx of shingles
Antiviral within 72 hours
| Topical agents for anesthetic--lidocaine patch, NSAID patch, capsaicin cream
39
well-circumscribed erythematous macular and papular lesions with loosely adherent silvery white scale
Psoriasis
40
Tx of psoriasis
Potent topical steroid + vitamin D analog first line
| Systemic: oral retinoids, methotrexate, cyclosporine
41
Tx of refractory psoriasis
Methotrexate
42
Tx scabies
Topical permethrin--leave for 8-12 hours, wash off and repeat in 1-2 weeks
Antihistamine for itching
43
Tx of seborrheic dermatitis
Topical antifungals or steroids
| Shampoos: keoconazole, selenium sulfide 1-2 times per week for 4 weeks
44
hemosiderin staining of skin—due to decreased blood flow to legs
Stasis dermatitis
45
Tx of stasis dermatitis
Compression therapy gold standard, topical emollients daily, systemic abx if cellulitis, topical steroids for itching
46
o Edematous pink or red wheals surrounded by bright red flare with pruritus
Hives
47
Tx for hives
Antihistamines first line--loratadine, cetirizine, fexofenadine, desioratadine
TCAs may be used
48
Classic triad of ruptured abdominal aortic aneurysm
Hypotension, pulsatile abdominal mass, abdominal or back pain
49
Who should undergo US screening for detection of aortic aneurysm
Men 60 years of age and older who are either a sibling or offspring of someone with AAA
Men who are 65-75 who have ever smoked
50
Pathophysiology of carotid artery disease
Carotid stenosis due to plaques and atherosclerosis
51
visual disturbances, monocular blindness (amaurosis fugax), weakness or numbness of the contralateral arm, leg or face, dysarthria, aphasia
Carotid stenosis
52
Modifiable risk factors for carotid artery disease
high BP, smoking, hyperlipidemia, DM, hyperhomocysteinemia, obesity, nutrition, physical inactivity, CKD, heavy alcohol use, sleep apnea, depression
53
First line diagnostic for carotid artery disease
Duplex ultrasound
54
Tx for carotid artery disease
Aspirin + statin + management of hypertension
55
dyspnea and fatigue, lower extremity edema, JV, patient’s history, ROS, and physical exam findings
Heart failure
56
Tx of heart failure
ACEI, Beta blockers, hydralazine, oral nitrates, aldosterone, loop diuretics, digoxin
57
Cough in HF
Moist and productive
58
Goal BP in hypertension
<140/90 <60 years or <150/90 if older than 60 (JNC 8 recommendation)
59
TX of hypertension in non-black with or without diabetes
Thiazide diuretic, CCB, ACEI, ARB
60
Tx of hypertension in black individual
Thiazide diuretic of CCB
61
Tx of hypertension in diabetic
ACEI
62
Hypertensive emergency
```
Hypertensive encephalopathy
Intracranial hemorrhage
Unstable angina pectoris
Acute myocardial infarction
Pulmonary edema
Eclampsia
```
63
Hypertensive urgency
Upper levels of stage 2 hypertension
Hypertension with optic disc edema
Progressive target organ complications
Severe perioperative hypertension
64
Stepwise tx in hypertension
Thiazide diuretic + ACEI/ARB/ beta blocker/ CCB
65
Risk factors for peripheral artery diseade
DM, HTN, Hyperlipidemia, hyperhomocysteinemia, tobacco use
66
exertional leg symptoms of claudication or with ischemic rest pain, abnormalities of lower extremity pulses
Peripheral artery disease
67
Tx of peripheral artery disease
Tobacco cessation, hypertensio and hyperlipidemia and diabetes management, compression stockings, daily exercise, low dose aspirin, anti-platelet therapy, statins
68
Systolic murmurs
Aortic stenosis, pulmonary stenosis, Tricuspid regurgitation, mitral regurgitation
69
Diastolic murmurs
Aortic regurgitation, pulmonary regurgitation, tricuspid stenosis, mitral stenosis
70
Dyspnea at rest, sense of chest tightness, feeling of suffocation and inability to get air in
Anxiety
71
chest pain that is tight or viselike, constricting or heavy pressure
MI
72
Chest pain that is positional, sharp or reproducible
Not cardiac
73
How . to rule out musculoskeletal source of chest pain
NSAIDs, rest, ice
74
Primary cause of acute bronchitis
Viral--Influenza A, B, RSV, parainfluenza
75
Causes of atypical CAP
Bordatella pertussis, mycoplasma pneumoniae, moraxella catarrhalis and chlamydia pneumoniae
More common in patients with comorbidities
76
Most common cause of bacterial CAP
strep pneumoniae
77
a cough without sputum production for 10-20 days or longer; burning substernal pain; cough may be dry and nonproductive or as it progresses it may be wet and productive or purulent sputum; low grade fever, wheezes, rhonchi and coarse rales may be present
Acute bronchitis
78
Tx of acute bronchitis
Antitussives--dextromethorphan, benzonatate, codeine/hydrocodone
Bronchodilators
ABX if pertussis--macrolides first line, bactrim second line
Anti-flu if influenza
79
When is chest X ray indicated for bronchitis
If cough >3 weeks
80
Chronic, reversible inflammatory disorder of the airways; increased responsiveness of tracheobronchial tree to various stimuli; episodic reversible narrowing and inflammation of airways
Asthma
81
Step 1 asthma treatment
SABA PRN
82
Step 2 asthma treatment
Low doseICS
83
Step 3 asthma treatment
Low dose ICS + LABA
OR
Medium dose ICS
84
Step 4 asthma treatment
Medium dose ICS + LABA
85
Step 5 asthma treatment
High dose ICS + LABA
86
Step 6 asthma treatment
High dose ICS + LABA + Oral steroid
87
Oral steroids for asthma
Prednisolone, prednisone, methylprednisilone
88
Inhaled steroids for asthma
Beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone
89
Most common complaint of COPD
Dyspnea on exertion
90
Clinical presentation of COPD
clubbing of nails, increase in AP diameter, abnormal retractions, pursed lip breathing with prolonged expirations, increased resonance on percussion, decreased breath sounds, early inspiratory crackles, maybe wheezing, neck vein distention, pedal and ankle edema
91
Gold standard diagnostic for COPD
spirometry
92
Blue boaters
chronic bronchitis and pulmonary hypertension, edema, cyanosis and polycythemia
93
Pink puffers
emphysema and severe dyspnea; relatively normal ABGs, barrel chest
94
First line treatment for COPD
Anticholinergics--ipatropium and tiotropium
95
1st line abx for COPD
Amoxicillin, clarithromycin, levofloxacin, ciprofloxacin, moxifloxacin
96
fever, chills, malaise, cough with or without sputum production; may have hemoptysis, dyspnea, and pleuritic chest symptoms
Pneumonia
97
Gold standard diagnostic for pneumonia
Chest X ray
98
Low risk management of CAP
macrolides
| doxycyline
99
High risk management of CAP (co-morbidities)
Respiratory fluoroquinolone or beta lactam + macrolide
100
Headache, myalgia, nasal congestion, rhinorrhea, sneezing, scratchy throat
Common cold URI
101
Abrupt onset, Fever, chills, malaise, myalgia, headache, nasal congestion, sore throat, nausea, cough, fever for 3-5 days
Influenza
102
dyspnea, tachypnea, pleuritic chest pain, calf or thigh pain and swelling
Pulmonary embolism
103
Key history to obtain for PE workup
recent surgery, trauma, fracture, travel, immobility, malignancy, stroke, paralysis, HF, smoking, pregnancy, estrogen
104
Mainstay of treatment for PE
Anticoagulation: heparin, LMWH (first line), fondaparinus, warfarin, rivaroxaban
105
Progressive loss of memory and behavioral changes which interferes with independence in ADLs
Dementia
106
Lewy body dementia
Decrease in dopamine and Ach
| Do not give antipsychotics
107
Initial symptom of AD
Usually short term memory loss with symptoms of depression and anxiety
108
Disgnostic tests for AD
get up and go, mmsr, montreal cognitive exam
109
Tx of AD
Cholinesterase inhibitors: donepezil, rivastigmine, galantamine
NMDA antagonists: memantine
SSRI for depression
110
Leading complication of hospitalization for older adults
Delirium
111
Acute, unilateral weakness or paralysis of the facial nerve with onset <72 hours and unknown etiology
Bell's palsy
112
What CN is bell's palsy
CN 7
113
Risk factors for bell's palsy
DM, hypothyroidism, recent URI, obesity, family history, hypertension
114
Bells Palsy may be due to
Virus
| HSV1, HSV2, ZVZ
115
smooth forehead and widened palpebral fissures; inability to close eye, flattened nasolabial fold, asymmetric smile
Bell's palsy
116
Tx of bells palsy
Prednisone or prenisolone within 72 hours
Acyclovir or Valacyclovir if viral
Critical to protect eye-lubricating eye drops, eyeclasses, close and tape shut eyelids
117
Presyncope or lightheadedness is commonly result of
CV problem--orthostatic hypotension, vasovagal episodes, hyperventilation, decreased CO
118
Physical exam tests for dizziness
Gait, balance, rinne, weber
119
Symptoms are precipitated by change in head position
| Nystagmus is characteristic
Benign paroxysmal positional vertigo
120
Diagnostics for Benign paroxysmal positional vertigo
Hallpike-dix maneuver
121
Tx of BPPV
Canalith repositioning proceudre
| Meclizine for severe vertigo
122
Factors of headache to ask
Provocation, quality, region, strength, timing
123
Targeted physical exam for headaches
Fundoscopic, vascular, musculoskeletal, neuro, mental status
124
ipsilateral headache that is pounding or throbbing, moderate to severe intensity, aggravated by physical activity, lasts 4-72 hours, may be associated with N/V, phototobia and phonophobia; usually has a trigger
Migraine
125
tight band around head; no N/V, mild to moderate pain, not exacerbated by physical activity; commonly triggered by stress
Tension headache
126
usually awakened at night with severe unilateral retro-orbital pain; usually lasts 90 minutes with agonizing pain and can not sit still; may be suicidal; usually resistant to medications
Cluster headache
127
Diagnostics for temporal arteritis
ESR or CRP
128
Preventative headache medications
CCB, Beta blocker, anticonvulsants
129
First line for mild to moderate headache
Acetaminophen and aspirin
130
Tx of moderate to severe migraine
Ergot derivatives
Ergotamine tartrate and dihydroergotamine
Need anti-emetic
131
Most prevalent stroke
Ischemic
132
o Hemiparesis, hemisensory loss, visual field defects, ataxia, dysarthria, reflex asymmetry, babinski’s sign
Stroke
133
Most common initial imaging for stroke
Head CT, non-contrash
134
Management of post-stroke
Statin, BP control,thrombolytic therapy, ACEI
| aspirin, smoking cessation, blood sugar and cholesterol management
135
Biggest risk factor for stroke
History of previous stroke
136
Causes of meningitis
Herpes virus, GABS, E coli, H. Influenzae
137
Causes of encephalitis
CMV, EBV, HIV
138
fever, headache, stiff neck, N/V, phototobia
Bacterial meningitis
139
nuchal rigidity, kernig sign, Brudzinski sign (neck flexion), purpura and petechiae, neuro focal deficits
Bacterial meningitis
140
Tx for meningitis
Refer to ED
| Ampicillin usually
141
Prophylaxis for meningitis oubreak
rifampin (600mg BID 2 days), ceftriaxone (250mg IM once) or cipro (500mg once)
142
Tx for essential tremor
Beta blockers, anticonvulsant, benzos, alcohol
143
o Slowly progressive neurodegenerative disease; insidious onset with cardinal features of asymmetric resting tremor, bradykinesia, rigidity, postural changes
PD
144
PD due to decrease in
Dopamine
145
Tx of PD
Selegiline: monoamine oxidase type B inhibitor
Levodopa-Carbidopa
Dopamine agonists: ropinirole, pramipexole, bromocriptine
Anticholinergics: trihexyphenidyl and benzotropine
Amantadine
146
1st line for seizure
Levetiracetam: Keppra
| Must monitor blood levels
147
Burning, stabbing, sharp, penetrating or electric shock-like and usually on one side of the face
Trigeminal neuralgia
148
CN in trigeminal neuralgia
CN 5
149
1st line tx for trigeminal neuralgia
Anticonvulsants--carbamezapine, oxcarbazepine
150
Microcytic anemia
MCV <80
| Iron deficiency, anemia of chronic disease, thalassemia, sideroblastic
151
S/S of microcytic anemia
Tachycardia/palpitations, fatigue, SOB, dyspnea, dizziness, pale mucous membranes
152
Normocytic anemia
MCV 81-99
| Chronic disease state, acute blood loss, hemolysis
153
Macrocytic anemia
MCV >100
Vitamin B12 deficiency, folate deficiency
Chronic alcoholism, liver disease
154
stomatitis, glossitis, nausea, anorexia, diarrhea, peripheral neuropathies, malaise
macrocytic anemia
155
SMooth beefy red tongue
Vitamin B12 deficiency
156
Tx of vitamin B12 deficiency
IM or SQ injections of 1000mcg of vitamin B12 daily for first week, then weekly for first month, then monthly for life
157
CURB 65 stands for
Confusion, BUN >19, RR >30, BP <90/60
158
Most common type of anemia
iron deficiency
159
Elevated reticulocytes
Sickle cell anemia
160
Hgb SS
Sickle cell disease
161
Hgb AS
Sickle cell trait
