Exam 7 (final content) Flashcards
(212 cards)
1
Q
There’s no cure for rosacea. It can be managed with the avoidance of triggers and the use of this topical medication
A
Ivermectin
2
Q
People with this genetic disorder are more susceptible to Pseudomonas aeruginosa, which cause infections like otitis externa, nosocomial pneumonia, and sinusitis
A
Cystic fibrosis
3
Q
Patients with a history of these two things are at increased risk of pancreatitis
A
- ETOH
- Gall stones
4
Q
Which dermatologic condition is associated with use of warfarin, and how does it present?
A
Anticoagulant-induced skin necrosis
- purpura and necrosis 3-5 days after starting warfarin
- painful red plaques in adipose rich sites such as breasts, buttocks, hips
5
Q
Treatment for tympanic membrane perforation
A
- Antibiotic drops
- avoid water near ear
6
Q
Which granulomatous vasculitis is more common, is associated with a saddle nose deformity, palpable purpura on the legs, and is treated more conservatively?
A
- GPA/Granulomatosis with polyangitis/Wegener’s
7
Q
Name this autosomal dominant familial tumor syndrome:
- triad of fibrofolliculomas, trichodiscomas, acrochordons
- predisposition to renal cancers
A
Birt-Hogg Dube syndrome
8
Q
Your 40 year old patient presents with a new onset tremor, bilaterally, in her hands with activity that she states improves with alcohol ingestion
How will you treat this patient?
A
- With activity, younger, improves with alcohol = essential tremor (not Parkinson’s)
- Treat with propranolol
9
Q
BUZZWORD ASSOCIATION!!
Dimple sign
A
Dermatofibroma
10
Q
This complication of a bacterial infection is associated with a migrating arthritis, carditis with mitral regurgitation, chorea, nodules on the elbows, and erythema marginatum
A
- Rheumatic fever
- complication of group A strep (strep pyogenes/GAS)
11
Q
BUZZWORD ASSOCIATION!!
Lateral surface of the tongue
A
Oral hairy leukoplakia
12
Q
BUZZWORD ASSOCIATION!!
Erythema chronicum migrans
A
Lyme disease
13
Q
Treatment for snake bites
A
- Compressive dressings and immobilization of bitten area
- Elastic band (not tourniquet!) to impede lymphatic flow
- Antivenom if within 4 hours of bite
- Correct clotting abnormalities with blood replacement, only after giving antivenin
DO NOT:
- incise wound
- put ice on it
- use suction extraction device
14
Q
BUZZWORD ASSOCIATION!!
- Gottron papules
- Heliotrope erythema
A
Dermatomyositis
15
Q
Which granulomatosis is less common, is associated with tender nodules on the extensor surface of the elbows, digits, and legs, and is treated with cyclophosphamide and systemic steroids?
A
- EGPA/Eosinophilic granulomatosis with polyangiitis/Churg-Strauss
16
Q
Rank these conditions in order of youngest to oldest average age of onset:
- Parkinson’s
- Dementia with Lewy Bodies
- Normal pressure hydrocephalus
- Huntington disease
- Wilson disease
- Tourette syndrome
- Essential tremor
A
- Tourette: before 11
- Wilson: 15-21
- Huntington: 35 to 45
- Essential tremor: 35 to 45
- Parkinson’s: 65
- Hydrocephalus: 70+
- Lewy Body: 75
17
Q
What is the Centor score used for?
A
Used to determine when to test for and treat group A streptococcal pharyngitis, based on symptoms
18
Q
This dermatologic condition is a strong risk factor for acoustic neuroma/vestibular schwannoma that can cause unilateral sensorineural hearing loss
A
Neurofibromatosis 2
19
Q
Diverticulitis is usually limited to this area of the GI system
A
Left and sigmoid colon
20
Q
How can you differ alopecia areata from tinea capitis on physical exam?
A
Alopecia areata has no scaling, is smooth, and you may see exclamation mark hairs
21
Q
Which two conditions can cause “hot potato voice”?
A
- Peritonsillar abscess
- Epiglottitis
22
Q
Describe the symptoms of rosacea
A
- Up and down with triggers
- Central facial erythema, erythematous papules, pustules, and/or telangiectasias
23
Q
Which toxicity, commonly seen in children, causes GI ulcers and bleeding, and will NOT be helped with the use of charcoal?
A
Iron toxicity
- give deferoxamine
24
Q
Which itchy dermatologic condition is associated with a defective epidermal barrier leading to both water loss and an overstimulated immune system?
A
Atopic dermatitis
25
What are the four phases of migraine?
- Prodrome
- Aura (visual)
- Headache (n/v, photo/phonophobia, pain worse with activity)
- Postdrome (exhausted)
26
Describe the symptoms of bullous pemphigoid compared to pemphigus vulgaris
Bullous pemphigoid:
- tense, pruritic blisters
- *negative* Nikolsky sign
- more common over age 60
Pemphigus vulgaris
- flaccid easy to rupture, non-pruritic blisters
- *positive* Nikolsky sign
- more common age 30-60
27
What is the major pathogen that causes infections in cat bites?
Pasteurella multocida
28
*BUZZWORD ASSOCIATION!!*
Schamroth sign
Nail clubbing
29
What is the first priority in initial stabilization of poisoning and drug overdose?
Airway
30
What are the three pathogens associated with human bites?
- Staphylococcus
- Streptococcus
- Eikenella corrodens
31
Which patient demographics are most at risk of cluster headaches?
- Men
- Age 20-40
- Cigarette smokers
32
How to treat stings of coelenterates (jelly fish, fire coral, sea anemones)?
Rinse with sea water (*not freshwater!*)
33
Symptoms of Dementia with Lewy Bodies
- Parkinsonian symptoms (TRAP)
- Hallucinations
- Memory loss
34
Which medications/drugs most commonly cause seizures?
- Tricyclic antidepressants
- Cocaine and related stimulants
- Antihistamines
- Isoniazid
35
This toxicity can cause EKG changes including flattened T waves, presence of U waves, and prolonged QT interval as well as confusion, lethargy, tremors, and muscle twitching
Lithium toxicity
36
Patients with spina bifida are most at risk for this allergy
Latex
37
Treatment for anticoagulant-induced skin necrosis
Vitamin K
(reverses warfarin)
38
Treatment for auricular hematomas
- Drain asap
- Compressive bandage very important
39
Hemophilus influenza and Moraxella catarrhalis both cause:
1. this type of infection in children
2. this type of infection in adults
1. Otitis media
2. Pneumonia/COPD exacerbation
40
*Preventative* treatments for migraines
- Beta blockers (metoprolol, propranolol)
- Anticonvulsants (topiramate, valproate)
41
*BUZZWORD ASSOCIATION!!*
Rolled borders
Basal cell carcinoma
42
First line treatment for migraines in pregnancy
Acetaminophen
43
What is the most common type of headache?
Tension-type headache
44
What systemic symptoms are associated with yellow nail syndrome?
Nails + lungs + limbs!
- chronic cough and fluid in lungs
- edema in legs
45
What are the three most common causes of otitis media?
1. Strep pneumoniae
2. Hemophilus influenza
3. Moraxella catarrhalis
46
What are Mees lines?
- A kind of leukonychia
- Transverse white bands across nails
- Seen in arsenic/lead intoxication, Hodgkin's disease, sickle cell anemia, renal failure, and cardiac insufficiency
47
*BUZZWORD ASSOCIATION!!*
Pink-red, scaly raindrops
Guttate psoriasis
48
*BUZZWORD ASSOCIATION!!*
- Adenoma sebaceum
- Ash-leaf macules
- Confetti macules
- Shagreen patches
Tuberous sclerosis
49
What are Beau lines?
- Horizontal creases in fingernails
- Occur secondary to temporary arrest of nail matrix
- Can appear week after an acute illness (fever, hand foot & mouth, kawasaki)
50
Which infection is associated with a scarlatiniform (Scarlet Fever) rash, a fine papular rash that starts in the groin/axillae and moves to trunk/extremities?
Strep throat (strep pyogens/GAS)
51
*BUZZWORD ASSOCIATION!!*
High-output heart failure
Erythroderma
52
In what pattern does the dermatitis herpetiformis rash present?
- *Symmetrical*, both elbows or bum cheeks
- Intensely itchy papules/vesicles that appear suddenly
53
Which fever is caused by streptobacillus moniliformis?
Rat-bite fever
54
Which infection causes onychomycosis?
Tinea unguium
55
Koilonychia can be caused by this condition
Iron deficiency anemia
56
Lung cancer is the most common cause of this nail change
Nail clubbing
(usually thumb and forefinger first)
57
Your patient with community acquired pneumonia has the unique symptoms of diarrhea, confusion, hyponatremia, and increased LFTs.
What bacteria is causing this patient's illness and how would you treat it?
- Those symptoms differentiate Legionella from other pneumonias
- Treat with Azithromycin or Levofloxacin
58
Which toxicity is treated with fomepizole or ethanol to block metabolism?
- Methanol or methylene glycol
- can also give folic acid, vitamin B6, B1
- and of course they get charcoal too
59
Symptoms of Parkinson's disease
TRAP
- Tremor (pill rolling)
- Rigidity
- Akinesia/bradykinesia
- Postural instability
60
Your patient presents with diffuse, severe abdominal tenderness. They have guarding and rigidity and are laying in bed with their hips and knees flexed, trying to be as still as possible and flinch with pain if you touch the bed.
Bowel sounds are absent.
What is the best imaging for the most likely diagnosis, and what would be seen?
- Peritonitis
- CT is best imaging modality
- Shows thickened peritoneal wall
(may see free air under diaphragm if peritonitis due to perforation)
61
*BUZZWORD ASSOCIATION!!*
Target lesions
Erythema multiforme
62
*BUZZWORD ASSOCIATION!!*
Beefy red with satellite papules/pustules
Candidiasis
63
What dermatologic manifestations can arise from the condition that causes granulomas/fibrosis in multiple body regions and bilateral hilar lymphadenopathy on chest x-ray?
- Sarcoidosis
- Papules on face/neck
- Lupus pernio: translucent, violaceous plaques on the ears, cheeks and nose
- Erythema nodosum: tender nodules on legs
64
How would you treat a patient with rheumatic fever?
- PCN G to treat group A strep (most common cause)
- NSAIDs for joints
- Treat heart failure if present
65
Acanthosis nigricans is associated with diabetes but can also appear in the obese patient without diabetes.
What dermatologic manifestation is more rare, but also more specific to diabetes?
Necrobiosis lipoidica:
- chronic, enlarging red patches on *shins*
66
Treatment for multiple sclerosis
Monoclonal antibodies (mabs)
67
In acute abdomen, the location of pain suggests the origin.
Pain in the epigastric region suggests foregut.
Pain in the periumbilical region suggests midgut.
And pain in the hypogastric/suprapubic region suggests hundgut.
Name the organs than make up the foregut, midgut, and hindgut.
Foregut: stomach, pancreas, duodenum, and biliary tree
Midgut: small bowel and right and transverse colon
Hindgut: left colon, sigmoid, and rectum
68
Symptoms of (acute form) mesenteric ischemia
- Sudden onset of very severe abdominal pain
(may have n/v, diarrhea, GI bleeding, hypotension, tachycardia, fever, and hypovolemia)
69
Which snakes, found from North Carolina, south and west to Texas, Arizona, and New Mexico, cause a neuromuscular blockade leading to flaccid paralysis with their bites?
Coral snakes
- neurototoxic
- cause of death is respiratory failure
70
Treatment for hot tub folliculitis
- Pseudomonas infection
- Treat with fluoroquinolones
71
Name this autosomal dominant familial tumor syndrome:
- multiple hamartomas
- microcephaly, facial trichilemmomas, acral fibromas
- increased risk of breast, thyroid, and GI tract, melanoma
Cowden syndrome
72
What is the gold standard pharmacologic treatment for dermatitis herpetifromis?
Dapsone
73
Treatment of mammalian bites is mostly done with this drug
Augmentin
(Pen G for rodent bites)
74
Name and briefly describe the three types of pemphigus
Pemphigus = painful blisters (not as deep as pemphigoid)
- Pemphigus vulgaris: flaccid blisters that easily rupture, no pruritus, mucosal involvement, *Nikolsky sign*
- Pemphigus foliaceous: *no mucosal involvement*, small pruritic, crusted lesions, resemble *corn flakes*
- Paraneoplastic pemphigus: *severe* mucosal involvement, most commonly associated with lymphoproliferative neoplasm
75
Which medication is first choice treatment for Hemophilus influenza and Moraxella catarrhalis infections?
Augmentin
(ceftriaxone if systemic infection or meningitis from Hib)
76
Which patient demographics are most likely to get migraines?
- Women
- Age 30-39
- Family history, first degree relative
- Stress and alcohol may trigger
77
Which insect bite may cause ECG changes and rhabdomyolysis?
Centipedes
(millipedes cause superficial burn)
78
What are three types of alopecia areata?
- Ophiasis: posterior/frontal hairline
- Totalis: whole scalp
- Universalis: whole body
79
What symptoms of an acute headache might a patient describe that make you think they are having a migraine?
- Nausea
- Photophobia
- Phonophobia
- Exacerbation with activity
80
You see a patient with abrupt fever, sore throat, and an erythematous, exudative throat on exam.
Suspecting a group A streptococcal infection you order a rapid strep test.
What is your next step if the test is positive, and what will you do if it's negative?
- Positive: Penicillin treatment (augmentin for adults, macrolide if PCN allergy)
- Negative: send for throat culture
81
Best imaging method for pancreatitis
CT more often than ultrasound
82
What is the Schamroth sign?
- Nail clubbing
- Nails put together don't line up normally
83
What symptoms might a patient with a tension-type headache describe?
- Pressing/tightening of head (*not throbbing*)
- Mild/moderate severity
- Bilateral location
- *Not aggravated with physical activity* (activity helps!)
- *No nausea/vomiting*
- Can have photo or phonophobia, but *not both*
84
What is the most common skin cancer, and what does it look like?
Basal cell carcinoma
- raised, rolled borders
- central ulceration
- pearly, translucent pink papules
- bleed easily
85
*BUZZWORD ASSOCIATION!!*
White strawberry tongue
Scarlet fever
86
What are Gottron papules?
- Cutaneous manifestation of *dermatomyositis*
- Erythematous scaling macules and papules on the dorsal surface of the knuckles
87
What builds up in Wilson's disease, and which systems of the body are affected?
- Copper accumulation
- Liver disease: abnormal labs to cirrhosis
- Hematologic: hemolytic anemia, thrombocytopenia, neutropenia
- Neurologic: dysarthria, *dystonia*, rigidity/Parkinsonism, postural and gait abnormalities, tremor
88
What condition can cause someone's tongue to look like a white strawberry?
Scarlet fever
89
Your patient, who is older, presents with cramping LLQ abdominal tenderness, is positive for rebound tenderness and guarding, has chills and fever, and has absent bowel sounds.
What is the gold standard imaging for the most likely diagnosis?
- Diverticulitis
- CT is gold standard
90
Which patient demographic is most likely to have restless leg syndrome?
Northern European ancestry
91
Acute and preventative treatment for tension type headaches
- Acute: NSAIDs
- Preventative: Amitriptyline
92
70-80% of cases of dyshidrotic eczema only involve this area of the body
Hands
93
Tuberous sclerosis is a genetic disorder with benign tumors in multiple organs and these four characteristic skin lesions ...
- Adenoma sebaceum: skin colored papules on face
- Ash-leaf macules: hypopigmented macules
- Confetti macules: small hypopigmented macules
- Shagreen patch: skin colored plaque
94
This dermatologic condition is thought to be an immune-mediated response to HSV or medications, is more common in younger patients (20-40), waxes and wanes, may be a precursor to SJS/TEN, and has the following pattern:
- symmetrical, *non*-pruritic lesions on the extensor surfaces
- raised erythematous halo = target lesions
Erythema multiforme
95
Which patient demographic get linear white papules specifically on the lateral surface of their tongues?
HIV/AIDS patients who get EBV:
- oral hairy leukoplakia
96
Describe the differences between black widow and brown recluse spider bites
Black widow:
- neurotoxin with paralysis
- dull ache, crampy pain, trismus, muscle fibrillations, tonic contractions, or lactrodectismica
Brown recluse:
- tissue necrosis, much more painful
- pain at site with ring of pallor, leading to necrosis that may take months to heal
- systemic symptoms of fever, chills, rash, nausea, vomiting, shock, renal failure, hemorrhage, DIC, or pulmonary edema
97
Name some common causes of allergic contact dermatitis
- Poison ivy
- Nickel
- Neosporin
98
What is the Jones criteria used for?
To diagnose rheumatic fever, a complication of strep pyogenes (GAS)
99
What is icthyosis?
- Scaling disorder
- Dry skin with fine scales on extensors
- Moisturize after baths and keratolytics/retinoids can help treat
100
Alcoholic or malnourished patients in a coma that you believe is due to poisoning or overdose should be given this vitamin
B1 - Thiamine to prevent Wernicke's
101
Which dermatologic condition is associated with the CREAM acronym?
Kawasaki disease:
- Conjunctivitis
- Rash
- Edema
- Adenopathy
- Mucosal involvement
102
How is normal pressure hydrocephalus diagnosed and treated?
- Dx: Ventriculomegaly on MRI
- Tx: Ventriculoperitoneal shunt for drainage
103
What are the symptoms of Lichen Planus?
Four P's
- Pruritic
- Purple
- Polygonal Papules
Wrists, ankles, mouth, reticular, itchy
104
This gram-positive bacteria is the most common cause of community acquired pneumonia
Strep pneumoniae
105
Which bite *can* be treated with a Sawyer extraction device and when?
- Black widow spiders only
- Must be within 3 minutes of bite
106
What are the most common bacterial and fungal causes of otitis externa?
Bacterial:
1. Pseudomonas
2. Staph aureus
Fungal:
1. Candida
2. Aspergillus
107
Diagnostic method for pemphigus and pemphigoid disorders
- Perilesional biopsy + direct immunofluorescence (DIF)
108
Which condition is a 10cm or larger area of hyperpigmentation, overgrowth or epidermis, and hair follicles, usually on the shoulder or chest/back, and is most often late onset in men
Becker nevus (pigmented hairy epidermal nevus)
109
Which medications can increase a patient's risk of acne vulgaris?
- Occlusive cosmetics
- Corticosteroids
- Phenytoin
- Isoniazid
- Lithium
- Progestins
110
What symptoms might a patient with a cluster headache complain of?
- Rapid onset pain around one eye
- Unilateral
- Ipsilateral lacrimation and nasal drainage
- Restless and pacing
111
What are the ABCDs of initial stabilization in initial stabilization of poisoning and drug overdose?
- Airway
- Breathing
- Circulation
- Dextrose and Decontamination
112
What condition is linked to erythema chronicum migrans?
Lyme disease:
- borrelia burgdorferi
- expanding ring around tick bite with central clearing
113
Name two cutaneous manifestations of dermatomyositis
- Gottron papules
- Heliotrope erythema
114
*BUZZWORD ASSOCIATION!!*
5Ps
- Pruritic
- Polygonal
- Planar
- Purple papules
- Plaques
Lichen planus
115
*BUZZWORD ASSOCIATION!!*
Koebnerization and Auspitz sign
Psoriasis vulgaris
116
Best test to confirm a diagnosis of Huntington disease
Genetic testing (autosomal dominant)
117
Treatment for rhabdomyolysis
Aggressive volume expansion with IV fluids
118
What is the most common cause of chorea in adults?
Huntington disease
119
Treatment for sedative-hypnotic agent toxicity
Flumazenil
120
First line treatment for MSSA (methicillin susceptible staph aureus)
Cephalexin
121
Imaging of choice in mesenteric ischemia
CT angiogram
(lactate elevated in later stages)
122
Name some complications of untreated strep pyogenes (GAS) infections
- Rheumatic fever
- Acute glomerulonephritis
- Erythema nodosum
- Peritonsillar abscess
123
Which dermatologic condition is treated with intralesional steroid injections and 5-fluorouracil
Keloid and hypertrophic scar
124
Which bacterial exotoxin causes generalized bullae formation with desquamation, known as scalded skin syndrome (Ritter's disease)
Staph aureus exotoxin
125
Which neurologic condition is associated with Lhermitte symptom?
- Multiple sclerosis
- Paresthesias that radiate down the spine and into extremities on neck flexion
126
Which animal causes the most cases of rabies in the US?
Bats (75%)
127
What is the most common autoimmune subepidermal blistering disease?
Bullous pemphigoid
128
Which adult patient population are more at risk of acetaminophen toxicity at a lower dose?
Alcoholics
129
What is nummular eczema?
- Well demarcated, coin-shaped eczematous patches
- Usually on legs and arms
- Highly pruritic
130
What lab values are elevated in pancreatitis?
- Lipase elevated (most specific, up faster, and stays up longer)
- Amylase and WBC also elevated
131
Which condition is associated with a Herald Patch, and what follow it?
Pityriasis Rosea
- Herald patch followed 3-10 days later by a bilaterally symmetrical eruption on the trunk and upper extremities (Christmas tree pattern)
132
Treatment algorithm for acne
1. Topicals
2. Antibiotics
3. Hormonal (women only)
4. Isotretinoin
133
What dermatologic finding is associated with endocarditis?
Splinter hemorrhages
134
*BUZZWORD ASSOCIATION!!*
Buttonhole sign
Neurofibroma
135
You see a patient with melanonychia. You're not able to distinguish a subungual melanoma from a benign finding unless this sign is also present ...
Hutchinson sign/periungual hyperpigmentation = diagnostic for melanoma
136
Name this autosomal dominant familial tumor syndrome:
- triad of intestinal polyposis, bony tumors, and soft tissue lesions
Gardner syndrome
137
138
*BUZZWORD ASSOCIATION!!*
Hutchinson sign
- Periungual hyperpigmentation
- Diagnostic for subungual melanoma
139
What condition is associated with exclamation mark hairs?
Alopecia areata
140
Which dermatologic condition is associated with the Buttonhole sign?
Neurofibroma
141
Which condition is associated with lupus pernio?
- Bite of the wolf
- Sarcoidosis
142
What is the name for the separation of the nail plate from the nail bed, usually due to trauma?
Onycholysis
143
What is the most common cause of small intestine obstruction?
Adhesions (after surgery)
144
What is the cutaneous manifestation associated with gluten-sensitive enteropathy?
Dermatitis Herpetiformis is associated with celiac disease
(give them dapsone, if G6PD ok)
145
Which type of streptococcal infection is mostly seen in neonates, pregnant women, and the immunocompromised?
- Group B strep (strep agalactiae)
146
What lab values are elevated in appendicitis?
- CRP elevated (helps differ from constipation quickly)
- WBC elevated
147
*BUZZWORD ASSOCIATION!!*
Thumb sign
Epiglottitis
148
*BUZZWORD ASSOCIATION!!*
Double comedone
Hidradenitis suppurativa
(may also be called tombstone comedones or rope-like scarring)
149
What are some common triggers of rosacea?
- Alcohol
- Exercise
- Extremes of temperature
- Hot/spicy foods
- Vasodilating meds (niacin)
150
Your patient presents with so much abdominal pain that they are unable to tell you their symptoms!
Physical exam reveals:
- abdominal distension
- hyperactive and high-pitched bowel sound early on
- later they become decreased
What is the *first* imaging you would order?
- Small intestine obstruction
- Abdominal x-rays performed first
- Show dilated loops of bowel with air fluid levels
151
How to differ between an auricular hematoma and auricular cellulitis on physical exam
- Hematoma: fluctuant
- Cellulitis: indurated
152
You see a 30 year old patient who presents with ataxic gait and numbness in their legs.
On physical exam you note weakness and spasticity with hyperreflexia of extremities as well as pallor of the optic disc, pupillary defects, impaired color vision, and vision deficits that aren't correctable by refraction.
What are some tests you would like to run to confirm the most likely diagnosis?
- All signs of multiple sclerosis
- MRI is the single most useful test (plaques)
- CSF not required, but would likely show IgG oligoclonal bands
153
Which neurologic disorder can lead to loss of sense of smell before other symptoms are noticed?
Parkinson's
154
What is Nikolsky sign, and what condition is it associated with?
- Pemphigus vulgaris
- sliding pressure on normal-appearing skin causes the epidermis to separate from dermis
155
Which type of headache is examined with firm pressure applied by the clinicians fingers over muscles of the head and neck?
Tension-type headache
156
*BUZZWORD ASSOCIATION!!*
Nikolsky sign
Pemphigus vulgaris
157
Symptoms of erythroderma
- Erythema and scaling >90% of body surface
- Severe pain and itching
- Systemic symptoms and dehydration, high-output cardiac failure
158
What is the gold standard treatment for androgenic alopecia?
Minoxidil
159
*BUZZWORD ASSOCIATION!!*
Christmas-tree rash
Pityriasis rosea
160
What opportunistic disease is associated with human herpes virus 8 (HHV-8)?
Kaposi sarcoma
- most common tumor in HIV patients
161
In which toxicity or poisoning situation will you be using your Rumack-Matthew nomogram?
Acetaminophen toxicity
- plot serum APAP level four hours after ingestion
- predicts toxicity and indicates whether or not the patient should be NAC'd
162
Treatment for eczematous disorders
Steroids generally
163
Which creature has a neurotoxin that causes the following symptoms and what is the treatment?
- tachycardia
- agitation
- hypertension
- hypersalivation
- dysphagia
- GI symptoms
- Scorpion sting
- Treat HTN and tachycardia with captopril or prazosin
- Sedative hypnotics for agitation and restlessness
164
Diagnostic criteria for a medication overuse headache
- Headaches on 15 or more days per month
- Due to more than 3 months of use of headache medication
(Excedrin, opioids, and butalbital carry highest risk)
165
What is the most common cause of eustachian tube dysfunction?
Obstructive is most common:
- URIs
- allergies
- irritants (smoke, pollution)
- GERD
- pressure (airplane, scuba)
166
Diagnostic tests for acoustic neuroma/vestibular schwannoma
- Audiometry first
- MRI is imaging of choice
167
What is the leading cause of bacterial meningitis in unvaccinated children under 5 years old?
Hemophilus influenza B (Hib)
168
*BUZZWORD ASSOCIATION!!*
Osler nodes and Janeway lesions
infective endocarditis
169
It is normal to shed this many hairs every day
100
170
You see a pearly mass behind the tympanic membrane. What could it be?
Cholasteatoma
171
Name the *systemic* treatments for acne and when you would use them
Systemic reserved for when topical treatment failed OR if patient has nodular acne, extensive skin involvement, scarring, or psychological distrubances
- Antibiotics
- Hormonal agents (spironolactone, OCPs)
- Isotretinoin (monotherapy)
172
Mesenteric lymphadenitis is most often caused by ...
Viral gastroenteritis
173
Bordetella pertussis infection is most common in these types of patients
Premature infants
174
Tell me the difference between Osler nodes and Janeway lesions, and what condition they are associated with
Both associated with infective endocarditis:
- Osler nodes = painful on fingers and toes
- Janeway lesions = non-tender on palms and soles
175
Which snakes, found in all states except Maine, Alaska, and Hawaii,, cause hypercoagulability, thrombocytopenia, decreased fibrinogen, and increased fibrin degeneration with their bites?
Pit vipers
- hematotoxic
- cause of death is hemorrhage
176
What is the best diagnostic test for mastoiditis?
Culture of middle ear via tympanocentesis/myringotomy
177
Treatment for Parkinson's
Carbidopa-Levodopa
178
What is the gold standard diagnostic test for allergic contact dermatitis?
Patch test
179
When should you order a CT in a patient with complaints of headache?
- First/worst HA in their life
- New/unexplained neuro signs/symptoms
- HA refractory to treatment
- New onset HA over age 50
- New onset HA in patient with HIV/cancer
- Fever/stiff neck/papilledema/cognitive issues/personality change
180
Symptoms of appendicitis
- Cramping or aching pain in periumbilical region
- Becomes more localized (and sharp!) to RLQ within 12-24 hours
- Nausea (vomiting AFTER pain)
- Anorexia
- Fever
181
What lab tests can help diagnose Wilson disease, and how is it treated?
- Dx: Ceruloplasmin (decreased), 24hr urinary copper excretion (increased)
- Tx: Penicillamine - chelates copper
182
Which patient demographics are most likely to get multiple sclerosis?
- Women
- White
- Age 20-50 (peak at 30)
183
Which dermatologic condition is sometimes diagnosed with a Sezary count?
Cutaneous T-Cell Lymphoma
(but mycosis fungoides more common type)
184
Symptoms of pancreatitis
- Severe epigastric pain radiating to the back
- Anorexia and n/v
- Relieved by sitting and leaning forwards
185
Symptoms of small intestine obstruction
- Nausea
- Bilious vomiting
- Sudden, sharp abdominal pain (most painful!)
186
Acute and preventative treatment for cluster headaches
- Acute: 100% oxygen
- Preventative: Verapamil
187
Which toxicity, seen more commonly in children, can cause wrist drop, and Burton's lines (blue-black gums) in adults?
Lead poisoning
- give IV calcium EDTA or oral succimer
188
Treatment for echinodermata (starfish, sea urchins, and sea cucumbers) and toxic vertebrate stings
Hot water immersion
189
What is the most life threatening gynecologic cause of acute abdomen? and what tests would you use to diagnose it?
- Ruptured ectopic pregnancy
- hCG first
- Then transvaginal ultrasound
190
This self-limited condition causes pain in the RLQ of the abdomen, can mimic appendicitis, and is often found on CT/US while looking for appendicitis
- Mesenteric lymphadenitis
- Imaging would show enlarged lymph nodes
191
Treatment for acetaminophen overdose
- Oral charcoal
- NAC 'em! (if above Rumack-Matthew toxicity line)
192
*BUZZWORD ASSOCIATION!!*
Cornflake lesions
Pemphigus foliaceous
193
What condition is pyoderma gangrenosum a cutaneous manifestation of?
Inflammatory bowel disease (Crohn's or UC)
194
*BUZZWORD ASSOCIATION!!*
Exclamation point hairs
Alopecia areata
195
A 5-year-old child with a history of no vaccinations presents with complaints of an abrupt sore throat, odynophagia, dyspnea, and drooling.
On physical exam you notice the child is sitting in a tripod position and sounds like he has a hot potato voice.
What imaging might you want to get to confirm the most likely diagnosis?
- Epiglottitis (Hib infection)
- Laryngoscopy (swollen erythematous epiglottis)
- Lateral neck x-ray (*thumb sign*)
196
What are the three stages of a Bordetella pertussis infection, and how would you treat it?
1. Catarrhal (cold symptoms, infectious)
2. Paroxysmal (violent cough with whoop)
3. Convalescent (recovering)
- Treat with macrolides
197
*BUZZWORD ASSOCIATION!!*
CREAM
- conjunctivitis
- rash
- edema
- adenopathy
- mucosal involvement
Kawasaki disease
198
What is the dermatologic manifestation of hyperlipoproteinemia?
Xanthomas:
- deposits of lipids
- most often around medial eye and eyelids
199
An elevated venous blood oxygen level over 90% suggests this diagnosis that may also cause a severe lactic acidosis and bitter almond odor
Cyanide poisoning
- give activated charcoal and immediate nitrites
200
Hearing loss is an early sign or symptom associated with this dermatologic condition
Neurofibromatosis (2)
201
Symptoms of normal pressure hydrocephalus
- Wacky: cognitive changes
- Wet: urinary frequency, urgency, incontinence
- Wobbly: Gait abnormality (1st symptom), short, shuffling steps with wide base, frequent falls
202
Which dermatologic condition is associated with the Dimple sign?
Dermatofibroma
203
A patient who presented with sudden upper abdominal tenderness and back pain now appears to be in hypovolemic shock. What might you feel on physical exam if you palpate their abdomen?
- Ruptured aortic aneurysm
- Pulsatile supraumbilical mass
- If stable, can diagnose with US or CT (whichever is quicker)
204
Best imaging for appendicitis
CT is better than ultrasound
205
*BUZZWORD ASSOCIATION!!*
Herald patch
Pityriasis rosea
206
On abdomen exam [ABSENCE OF/HIGH PITCHED] sounds is consistent with ileus and [ABSENCE OF/HIGH PITCHED] sounds suggests small intestine obstruction
- ABSENCE of sounds is consistent with ileus
- HIGH PITCHED sounds suggests small intestine obstruction
207
What type of rash is commonly seen in rickettsia rickettsii infections?
- Rocky mountain spotted fever
- Rash that starts on wrists and ankles and spreads to the extremities, trunk, and face
208
*BUZZWORD ASSOCIATION!!*
Kayser-Fleischer ring
Wilson disease
209
Which bacteria, that can cause a rapidly progressive pneumonia is the elderly or immunosuppressed, is associated with hot tubs, infected water supplies, ventilation systems/AC?
Legionella pneumophila
210
Define multiple sclerosis
- More than one episode of dysfunction
PLUS
- White matter lesions (MRI) in more than one area of the CNS
211
*Acute/abortive* treatments for migraines
- Triptans
- CGRP antagonist if moderate/severe and triptan not tolerated
212
Name the *topical* treatments for comedonal and inflammatory acne
Comedonal:
- topical retinoids
Inflammatory:
- topical retinoids + benzoyl peroxide +/- topical clindamycin
