Family Medicine Core Rotation - Acute Complaints_3 Flashcards Preview

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Flashcards in Family Medicine Core Rotation - Acute Complaints_3 Deck (126):
1

what is a spermatocele?

asymptomatic nodule generally found attached to the spermatic cord

2

for what is a scrotal ultrasound useful?

to evaluate enlarging masses or to determine if a mass is solid (neoplastic) or not (varicocele, hydrocele)

3

what is the use of CT scan in the work up of scrotal complaint?

to evaluate hernia

4

what is the use of urinalyses or urethral smears in the workup of scrotal complaints?

infectious causes like epididymitis or UTI

5

the true causes of acne are what?

multifactorial, but familal factors are involved

6

what are the key factors contributing to acne?

follicular keratinization • androgens • propionibacterium acnes

7

what is the change in the keratinization pattern of the pilosebaceous unit seen in acne?

keratin becomes more dense, blocking the secretion of sebum

8

the keratin plugs in acne are called what?

comedones

9

contributory factors to acne include what?

certain medications • emotional stress • occlusion and pressure on skin

10

what is an example of occlusion and pressure on skin causing acne?

leaning the hands on the face --> ance mechanica

11

acne is not caused by what commonly blamed things?

dirt • chocolate • greasy foods • presence or absence of any foods in the diet

12

when are laboratory examinations warranted in the diagnosis of acne?

when history and physical indicates the need to exclude hyperandrogenism and/or polycystic ovarian syndrome

13

in the vast majority of patients with acne, the hormone levels are what?

normal

14

what works best for mild acne?

combination therapy with topical anitbiotics, benzoyl peroxide gels, and topical retinoids

15

how long does acne treatment take to work?

2-5months

16

when should topical acne medications be applied?

topical retinoids should be applied in the evening and benzoyl peroxide and topical antibiotics should be applied during the day

17

the indications for oral isoretinoin include what?

nodular acne • severe acne • moderate recalcitrant acne • -patient must be resistant to other acne therapies including oral abx

18

what is the major contraindication for isoretinoin?

is teratogenic so pregnancy must be prevented during its use

19

what is the major drug interaction to watch out for when prescribing isoretinoin?

since both tetracycline and isoretinoin cause pseudotumor cerebri, they should never be taken together

20

can you use tylenol while on isoretinoin?

yes, despite rare cases of hepatotoxicity

21

how does isoretinoin affect the eye?

dry eyes is a side effect, so contacts may be difficult but they can still be worn

22

what are the psychiatric considerations for prescription of isoretinoin?

some reported cases of depression, but no screening protocol because rarely occurs

23

what is the relationship between topical glucocorticoids and isoretinoin?

topical glucocorticoids are safe for use during isoretinoin therapy and are sometimes used if eczematous rashes occur during treatment

24

what is the difference between acne and rosacea?

comedo formation, the hallmark of acne, is absent in rosacea

25

what is stage I rosacea?

there is persistent erythema, generally with telangiectasia formation

26

what is stage II rosacea?

stage I plus the addition of papules and tiny pustules

27

what is stage III rosacea?

the erythema is deep and persistent, the telangiectases are dense, and there may be a solid appearing edema of the central part of the face due to sebaceous hyperplasia and lymphedema (rhinophyma and metophyma)

28

what are some very effective first line therapies for rosacea?

minocycline or doxycycline

29

are topical steroids effective for rosacea?

no

30

what are some alternative treatments for rosacea?

topical metronidazole, and sodium sulfacetamide can work

31

keratoacanthoma is difficult to distinguish visually from which conditions?

basal cell cancers • nodular squamous cell cancers • molluscum

32

how can you tell keratoacanthoma from similar conditions?

history

33

keratoacanthoma are characterized by what history feature?

rapid growth, achieving a size of 2.5cm within a few weeks

34

how do you differentiate verruca from keratoacanthoma?

verruca do not generally have the depressed center or the pearly borders

35

how do you differentiate molluscum from keratoacanthoma?

molluscum do have a central dimple, but don't have such a significant keratotic plug present

36

skin lesions of psoriasis can be confused with what?

eczema, fungal dermatitis, other lesions

37

what is the appropriate therapeutic management for localized psoriasis skin rashes?

topical corticosteroids

38

when do you give topical pimecrolimus for psoriasis?

inverse psoriasis (located on the perianal and genital regions) or on the face and ear canals, but is generally not used for lesions on the trunk or extremities

39

when do you give antibiotics for psoriasis?

there is no place for antibiotics in treatment, except in the case of guttate psoriasis, a form that follows streptococcal infection and appears as multiple teardrops that erupt abruptly

40

when are oral retinoids and methotrexate used for psoriasis?

to treat generalized psoriasis and help with nail involvement

41

what is pityriasis rosea?

a self limited papulosquamous eruption

42

what is the classic history for pityriasis rosea?

a single herald patch (an oval, slightly raised plaque with scale) followed in the next 1-2 weeks with a more generalized eruption

43

what is the course of pityriasis rosea?

spontaneous resolution in 6-12 weeks, recurrence is uncommon

44

what is the treatment for pityriasis rosea?

symptomatic- antihistamines or corticosteroids to relieve itch

45

when should the diagnosis of impetigo be considered?

in the face of well demarcated erythematous lesions that when disrupted, develop a secondary golden crust

46

most cases of impetigo are caused by what?

S aureus

47

impetigo responds well to what?

topical antibiotics like mupirocin

48

hot tub folliculitis is generally caused by what?

P aeruginosa or P cepacia

49

course of hot tub folliculitis?

self limited, reassurance is all that is necessary

50

when is abx tx required for hot tub folliculitis?

recalcitrant or symptomatic cases

51

what is the appropriate abx tx for hot tub folliculitis?

cipro 500mg bid

52

what is the management for chronic HSV infection?

topical or oral antiviral therapy

53

when are antiviral therapies more effective for HSV?

better for primary than recurrent infections

54

what is the dosing for antivirals for HSV?

pulse dosing at the first sign of outbreak may shorten or reduce severity

55

what are the treatment options for genital herpes?

episodic therapy • suppressive therapy

56

what is recommended for discordant couples for genital herpes tx?

daily suppressive therapy

57

what is the benefit of antiviral therapy for shingles?

decrease the time for lesion healing and shorten the overall duration of pain if initiated within 72 h- start tx regardless of onset in pt >50yo, immunosuppressed, or eye involvement

58

what decreases the likelihood of postherpetic neuralgia in shingles?

corticosteroids

59

what causes 5th disease?

parvovirus B19

60

what child rash is caused by enteroviruses?

hand foot and mouth disease

61

parainfluenza causes what in children?

croup

62

varicella causes what in children?

chicken pox

63

CMV causes what in children?

mono like symptoms

64

how do you treat tinea capitis?

systemic therapy with griseofulvin (or terbinafine, itraconazole, fluconazole, ketoconazole) + topical ketoconazole or selenium sulfide shampoo

65

how long do you give fluconazole for tinea capitis?

3-4 weeks

66

tinea corporis is most commonly caused by what?

trichophyton rubrum

67

tinea infections can also be cause by what?

T tonaurans (tinea capitis) • T mentagrophytes (tinea cruris) • M canis (inflammatory tinea)

68

what is the best choice treatment for warts?

topical liquid nitrogen

69

what treatment for warts should be avoided in pregnancy?

podophyllum resin

70

what is the treatment for anal warts?

imiquimod

71

when do you laser warts?

warts resistant to other treatment modalities

72

can you use bleomycin injection on finger warts?

no bc of terminal digital necrosis

73

what helps differentiate atopic dermatitis from other causes of rash?

rash may look like rough red plaques with some flaking that can affect the face, neck, upper trunk, behind the knees. flexural surfaces often involved. • severe pruritus

74

when does eczema present?

usually in childhood, rarely after 30

75

what is a diagnostic clue to molluscum contagiosum vs basal cell?

absence of telangiectasia in molluscum

76

how can you treat mollusum contagiosa?

cryotherapy • cautery • curettage

77

symptoms of conjunctivitis include what?

increased redness • irritation • tearing • discharge • photophobia • itching

78

does discharge character differentiate bacterial from viral conjunctivitis?

no

79

eye pain is suggestive of what?

serious: • acute angle closure glaucoma • uveitis • scleritis • keratitis • foreign body • corneal abrasion

80

of the symptoms of conjunctivitis, what is more specific for allergic conditions?

itching

81

what is the characteristic presentation of allergic conjunctivitis?

bilateral

82

what is the MC virus causing conjunctivitis?

adenovirus

83

how is adenovirus conjunctivitis transmitted?

ocular and respiratory secretions

84

what are the incubation and shedding period for adenovirus conjunctivitis?

8 day incubation • 10-12 day shedding

85

what PE finding is characteristic of viral conjunctivitis?

palpable preauricular lymph node

86

what percent of conjunctivitis is bacterial?

15%

87

why are topical corticosteroids contraindicated in conjunctivitis?

increased duration of viral shedding, prolongation of the infectious period, • potential corneal ulceration and perforation

88

what do you give for herpetic conjunctivitis?

antiviral eye drops

89

how do you diagnose herpetic conjunctivitis?

fluorescin staining • corneal dendrites

90

bacterial conjunctivitis is most commonly caused by what?

Strep • Staph • MRSA

91

what is scleritis?

unilateral diffuse injection of the deeper vessels

92

what are the symptoms of scleritis?

deep boring eye pain and a surrounding headache

93

scleritis is usually associated with what?

autoimmune disease like RA or wegeners

94

diff. between episcleritis and scleritis?

episcleritis= mild irritation, no as intense as scleritis

95

corneal abrasion is associated with what?

decreased vision • intense pain • tearing • trauma

96

difference between glaucoma and scleritis?

glaucoma has pain, decreased vision, and redness, but the affected pupil is usually dilated

97

difference between iritis and scleritis?

in iritis pupil is small

98

what are the features of bacterial sinusitis?

purulent rhinorrhea • purulent secretions in the nasal cavity • tooth pain • biphasic history

99

MCC of recurrent sinusitis?

allergy

100

MC pathogen in bacterial sinusitis?

S pneumoneae

101

other causes of bacterial sinusitis?

h flu • moraxella • gAβh strep

102

what is the drug of choice for bacterial sinusitis?

amoxicillin

103

Tx for shoulder dislocation?

relocate • immobilize 7-10 days • ROM exercise • pain management

104

what is the MCC lateral knee pain in an athelete?

iliotibial band syndrome

105

who gets iliotibial band syndrome?

cyclists and runners

106

patellofemoral pain syndrome presents how?

diffuse knee pain and positive patellar grind test

107

what is the presentation of an ACL tear?

twisting injury • pop • immediate effusion • still weight bearing • sense of instability

108

what is the MC dx for pt with anterior knee pain in primary care?

patellofemoral pain syndrome (theater sign)

109

what are ottowa ankle pain rules?

get films if • 1. cant walk 4 steps immediately after injury • 2. tender over distal 6cm of tibia or fibula • 3. midfoot or navicular tenderness • 4. tenderness over proximal 5th metatarsal

110

what should be done in the majority of syncope cases?

hct • ck • glc • ECG • carotid massage • orthostatic BP • pulses

111

additonal testing for syncope?

holter • echo • ambulatory loop ecg • tilt table test

112

what do you order for syncopal patient with a murmur?

echo

113

holter and ambulator loop ecg for syncope help ID what?

arrhythmia

114

who gets tilt table test?

pt w/ unexplained recurrent syncope in whom cardiac causes have been ruled out

115

in a diabetic, silent ischemia is signaled by what?

dyspnea and diaphoresis

116

what do you order for suspect silent ischemia in diabetic?

stress test

117

abnormal tilt table suggests what?

vasovagal syncope

118

persistence of glabellar tap reflex is called what and seen in who?

myerson sign seen in parkinsons

119

what drug has been shown to modify disease progession in parkinsons?

selegiline (MAOBI)

120

tx for vaginal candidiasis?

oral fluconazole x1 or topical azole application

121

what do you do for a female with recurrent vaginal candidiasis?

treat partner

122

what is a strong diagnostic clue for trichomonas vaginalis?

strawberry cervix

123

clue to bacterial vaginosis?

clue cells

124

tx for bacterial vaginosis?

topical or oral metronidazole or clindamycin

125

pt with 1st episode of wheezing requires what?

cxr

126

when to get cxr in asthma?

fever, ronchi, sputum to rule out pneumonia