SM NP review skin, eyes, neuro, cardio Flashcards
(214 cards)
1
Q
What is the difference in location from aphthous stomatitis and herpes?
A
herpes- painful vesicles outside of mouth
apthous stomatitis- inside the mouth
2
Q
What is chronic ulcerative stomatitis (CUS)
A
autoimmune with the same lesion but larger in size but more of them with no relief. takes months to go away. treat with Plaqunil and steroids
3
Q
What is the main difference in treatment between bullous and non bullous impetigo
A
Bullous (0 honey crust)- oral meds; Keflex
Non bullous- mupirocin ointment
4
Q
What condition is known for starting with a Herald patch and a Christmas tree pattern?
A
Pityriasis rosea
5
Q
How would a patient with a brown recluse spider bite present
A
Tender, deep, purple with white halo around it
6
Q
What key words are used to describe the presentation of a patient with Rocky mountain fever? What is the treatment
A
North Carolina, tick bite, rash on soles/ palms
Doxycycline- even when pregnant
7
Q
How can we distinguish a Lyme Disease rash
A
bull’s eye lesion
8
Q
What is the medical term for Lyme Disease
A
Erythema migrans
9
Q
How do we treat Lyme disease?
A
Doxycycline
If pregnant, amoxicillin
10
Q
What is another name for Measles?
A
Rubeola
11
Q
What are the 3 C’s associated with measles (rubeola)
A
Cough
Congestion
Conjunctivitis
12
Q
When can babies get the MMR vaccines?
A
12 months
13
Q
What develops in the mouth with measles?
A
Koplik spots
14
Q
What is the most common symptom of mumps?
A
Parotitis- swelling of the glands between jaw and ear
Sialotitiasis- salivary gland stone- mass under chin while eating
15
Q
Characteristics of actitic keratosis
A
dry, scaly lesions on sun exposed skin
16
Q
What are characteristics of squamous cell carcinoma
A
slow growing, scaly, ulceration, more red, bleeds easily
17
Q
What are cafe au lait spots and how are they treated?
A
Benign but more than 8 think neurofirbomatosis
18
Q
What the mnemonic for malignant melanoma
A
A- Asymmetry
B- Board irregular
C- Color variation
D- Diameter > 6
E- evolution
19
Q
What lesion is “pasted on” and does not need to be removed?
A
Seborrheic keratosis
20
Q
What are key words to describe basal cell carcinoma?
A
telangiectasias (dilated small blood vessels), visible, shiny, waxy, pearly
** most common type of skin cancer **
21
Q
How would you describe eczema?
A
flexor surface of body, itch that rashes
22
Q
What is another term for eczema? 3 A’s?
A
Atopic dermatitis
Asthma Allergies
23
Q
How can we recognize plaque psoiasis?
A
thick, silvery, scales
24
Q
Auspitz Sign
A
plaques are scratched and pinpoint bleeding occurs
25
Koebner's phenomenon
trauma to skin leads to plaque formation
26
How would we describe contact dermatitis? Treatment?
linear distribution; topical steroids'; avoid irritant
27
How would we describe shingles?
on a dermatone, vesicular, burning/tinglings before the rash appears
28
If the skin is still intact but non-blanchable, what stage of pressure ulcer is that
stage 1, foam dressing
29
What are the stereotypical signs of Scabies and treatment?
intensely pruritic between fingers and toes, contagious
permethrin cream
wash everything in hot water
30
How would we describe chicken poxs and when can these kids get the vaccine and go back to school?
various stages of healing
12 months
when all the lesions are crusted over
31
What symptoms will someone with head lice have and how do we treat it?
incessant puritis of scalp
permethrin for live bugs nits need to be combed out and bedding washed
32
How would you describe molluscum contagiosum?
indent in middle of lesion, umbilicate, dimple, flesh color, contagious, suspicious in the groin area of children
33
What are the key words for Anthrax?
cattle farmer, painless, ulcerated
34
What is the treatment for Anthrax?
#1 cipro
#2 tetracyclines
35
What are the two risk factors for reoccurring hidradenitis suppurativa?
obesity and smoking
36
What is folliculitis?
skin infection of hair follicles and surrounding tissues
37
How do we treat folliculitis?
warm compresses, mupirocin, PCN, Keflex
38
What is the key distinguishing factor for rosacea and treatment
across nasal folds
metronidazole cream
39
How is the Lupus rash described?
malor rash, butterfly rash, spares nasal folds
40
What symptoms are consistent with Sjogren's syndrome?
Very dry eyes
very dry mouth
41
How would we describe erysipleas? Treatment?
more superficial cellulitis
sharply defined or well demarcated boarders
superficial and reddened
PCN or Keflex
42
What are the characteristics of cellulitis
angry, swollen
43
What is the treatment of purulent cellulitis?
Mneumonic?
B: Bactrim
C: Clindamycin
D: Doxycycline
44
What is the treatment of non-purulent cellulitis?
Keflex, PCN
45
What is the three step treatment for acne?
1. topical: benzoyl peroxide
2. topical antibiotic
3. Oral antibiotic: doxycycline
46
What is the three step treatment for acne?
1. topical: benzoyl peroxide
2. topical antibiotic
3. Oral antibiotic: doxycycline
47
What is important to teach with tetracyclines?
sunscreen/ avoid sun
48
What is geographical tongue?
from spicy or hot foods
benign
49
What is leukoplakia?
oral hairy leukoplakia, can't scrape off, common in HIV, refer to dentist
50
How does 5ths disease present?
slapped cheek rash
fever, then rash, then lacy net like all across body
51
When is 5ths disease no longer contagious?
when the rash appears
52
Who should be extra cautious around those with 5ths disease?
pregnant women
53
tinea capitis
head/scalp
54
tinea barbae
beard
55
tinea cruris
near groin
56
tinea pedis
foot
57
tinea versicolor
all over
58
How do we treat fungal infections?
topical antifungals unless more severe or reccurent
59
What is onychomycosis with treatment
nail bed fungal infection
treat with ORAL fluconazole
60
What is enetrobiasis?
Pinworm
61
How would the patient describe enterobiasis? How do you diagnose?
genital intently itchy at night
scotch tape test early in the morning
62
How do we treat enterobiasis
Mebendaozole or albendazole
63
How do we treat dog/cat bites?
augmentin
64
What is the #1 thing we do when a patient has an eye complaint?
Visual acuity
65
What does it mean to have 20/40 vision?
They can see at 20 feet what a person with normal eyesight can see at 40 feet
66
When is the patient considered legally blind?
20/200
67
What is amblyopia
Lazy eye
68
What usually causes amblyopia?
Strabismus
69
What test do we perform to asses for color blindness?
Ishihara chart
70
Which cranial nerves are related to the eyes?
II, III, IV, VI
71
How would you describe retinal arteries?
Arteries are light and thinner that veins
No hemorrhages or cotton wool spots
Optic disc with sharp margins and no swelling
Present red reflex
72
What are some things we don’t want to see in an eye exam?
Papilledema
Arteries crossing over veins
73
What is papilledema and how is it treated
Optic disc swelling
Refer!
74
What would we see on a fundoscopic exam of a patient with hypertension?
papilledema, AV nicking, copper wire arteries, flame hemorrhages
75
What would we see on a fundoscopic exam of a patient with diabetes?
cotton wool spots
blot hemorrhages
microaneurysm
neovascularization
76
How will a patient describe their symptoms if they are experiencing acute angle-closure glaucoma?
sudden eye pain, blurry vision, firm to touch, increased IOP
77
If we suspected acute angle-closure glaucoma what should we do?
Refer to ED for risk of permanent vision loss
78
What is the stereotypical description of retinal detachment to distinguish it from other eye conditions?
curtain pulled over their eye or field of vision. sudden, painless, a lot of floaters, blurred vision/ flashes of light
79
What is arcus senilis?
gray halo around eyes
80
What is Xanthelasema?
Cholesterol deposits on the eyes
81
What do you do if a patient has arcus senilis or xanthelasma?
Run lipid profile
82
What is pterygium?
benign overgrowth of conjunctiva
eye redness
crosses cornea
83
What is Pinguecula?
will not go over cornea
84
What is hordeolum?
stye; infection; staph; drainage. Warm compresses/ antibiotics
85
What is a chalazion?
blockage of duct
warm compresses
86
What are the characteristics of allergic conjuctivitis?
serous, stringy ropey drainage
starts bilaterally
notes in cervical chain
87
What are the characteristics of viral conjunctivitis?
serous drainage
spreads from one eye to the other
lymph nodes = preauricular or submandibular
88
What are the characteristics of bacterial conjunctivitis?
purulent drainage
spreads from one eye to the other
no lymph nodes
89
What is the medical term for pink eye
adenoviral conjunctivitis
90
What is leukocoria?
white reflex
91
What is the description of cataracts?
leukocoria
no red reflex
older age
hard to drive at night
92
What is the description of macular degeneration?
central vision loss
age
larger print to read
93
What is presbyopia?
"my arms are too short"
hard to see things close up
starts around age 40
reading glasses
94
What condition is typically associated with corneal abrasions?
Bells Palsy
95
How do you diagnose a corneal abraison?
flurocein staining
96
How would a patient with iritis present?
sensitivity to light, inflammation and swelling of iris
97
What are the concerns with iritis? How do we treat it?
Permanent blindness/ refer to optho
98
What is a subconjunctival hemorrhage and how do we treat it?
broken blood vessels on the sclera
resolves itself; artificial tears
99
How would a patient present with a tumor headache?
dull, persistent headache always in the same spot
personality changes, nausea/vomiting, vision issues
order head CT
100
What kind of stroke does atrial fibrillation increase the risk of
ischemic stroke
101
What kind of stroke does hypertension increase the risk of
Hemorrhagic stroke
102
What is BEFAST?
B- Balance
E- Eyes
F- Face
A- Arms
S- Speech
T- Time
103
What is asphasia?
inability to understand or express speech
104
What is receptive asphsia?
Wernicke's area; cannot understand what is being said to them
105
What is expressive asphsia?
Broca's area; trouble expressing themselves or forming speech
106
What causes Wernicke- Korasakoff Syndrome?
chronic alcoholism
Vitamin B1 (thiamine) deficiency
107
How does a patient with a cluster head present?
one sided, tearing/ runny nose, occurs at the same time daily
108
How would you treat this patient?
100% oxygen
Calcium channel blockers
109
What are symptoms of temporal arteritis/ giant cell arteritis
1 sided, possible visual impairment, temporal pain/pulsing, increased ESR
110
What is the treatment of temporal arteritis?
long-term steriods
111
How do you make the definitive diagnosis of temporal arteritis?
temporal artery biopsy
112
Polymyalgia rheumatica is commonly associated with what other condition?
temporal arteritis
113
How would a patient with a hypertension headache present?
occipital headache, typically upon awakening
114
How would you treat a patient with hypertension headache?
anti-hypertensives or med adjustments
115
What is the most common time of day to see hypertension headache?
morning
116
How would a patient with migraine present?
difficulty with lights/noise, throbbing, pulsating, nausea/vomiting, aura
117
How would you treat a patient with a migraine
Abortive- triptans (avoid with CVD patients and pts on serotonin)
118
What is the typical migraine prophylaxis
avoid triggers, beta blockers
119
How would a patient with a tension headache present?
pain bilaterally
120
What neurotransmitter is responsible for Parkinson's?
dopamine
121
What are the three main symptoms of Parkinson's?
1. bradykinesia (most debilitating)
2. tremor
3. rigidity
122
How is Parkinson's treated?
Levadopa/Carbidopa
123
What is Brudzinski's sign?
back of head
when you flex back of the head causes hip and knees to flex with it
124
What is Kernig's sign?
think knee
Can't extend knee past 90 degrees without pain
125
What disease are Brudzinski and Kernig's sign associated with?
meningitis
126
What are the three A's associated with Alzheimer's Disease?
Apraxia (skilled movement)
Agnosia (Recognition)
Aphasia
127
What is the goal treatment of Alzheimer's disease?
Slow progression
128
What assessment tools can we use to assess cognitive decline
Mini-mental status exam
129
CN1
olfactory- smell
S
130
CNII
optic- visual acuity
S
131
CNIII
oculomotor- eye movement
pupil dilation
M
132
CNIV
trochlear- vertical eye movement
M
133
CNV
trigeminal- facial expression and sensation
M & S
134
CNVI
Abducens- lateral movement of eyeballs
M
135
CNVII
Facial- taste and facial expression
M & S
136
CNVIII
Auditory- hearing and balance
S
137
CNIX
Glossopharyngeal- taste and swallowing
M & S
138
CNX
Vagus- sensation in throat and viseral muscles, vocal cords, peristalsis
M & S
139
CNX1
Accessory- head and shoulder movement
M
140
CNXII
Hypoglossal- tongue movement
M
141
What is the mnemonic for cranial nerves?
Oh, oh, oh to touch and feel a great vein- ah heaven
Some say marry money but my brother says big brains matter more than
142
What condition is associated with cranial nerve V?
trigeminal neuralgia
143
What are the symptoms of trigeminal neuralgia with treatment?
severe stabbing pain; Tegretol
144
What are we concerned about with unsuccessful treatment of trigeminal neuralgia?
increased suicide risk
145
What condition is associated with cranial nerve VII?
bell's palsy
146
What is a normal finding for Rinne test?
AC>BC
147
What is a normal finding for Weber test?
Sound will be heard equally by both ears
148
What will we see in the Weber test for conductive hearing loss?
think something you can see
sound lateralizes to the bad ear
149
What will we see in the Weber test for sensorineural hearing loss?
Sound will lateralize to the good ear
150
How will a patient with Meniere's Disease present?
Vertigo, tinnitus, ear pressure, nystagmus
151
What is our biggest concern with Meniere's disease?
Permanent hearing loss
152
What is the ASCVD risk cutoff for hyperlipdemia?
greather than 7.5%
153
How often do you check lipids?
every 5 years unless risk factors are present
154
What is the go to treatment for hyperlipidemia before medicine?
Lifestyle modifications
155
What are the two strongest statins we can prescribe?
Atorvastatin (greater than 40 mg)
Rosuvastatin (greater than 20 mg)
156
What are the signs of Rhabdomyolysis?
new muscle pain
CK level x5
Kidney failure
157
What are the signs of acute drug induced hepatitis
Jaundice
LFTs
158
What juice do we not mix with statins?
grape fruit juice
159
Are statins safe in pregnancy
No
160
What should we prescribe if a patient has a triglyceride over 500? What are we preventing?
Fenofibrate; pancreatitis
161
Cullens sign
bruising around umbillical
162
Grey Tuners sign
Bruising to flank
163
What is your B/P goal for JNC-8?
less than 140/90
164
When should you start treatment for HTN according to JNC8?
older than 60 > 150/90
Lifestyle 1st x3 months
165
When should we start treatment for HTN according to AHA?
ASCVD risk of 10 or higher
130/80
166
What is our initial plan of any new HTN?
lifestyle changes
167
According JNC 8 we initiate BP meds sooner if the patient has these two comorbidities?
diabetes and CKD
168
What ages with blood pressures do we start meds?
greater than 60= 150/90
less than 60= 140/90
169
With ACE- inhibitors what labs do we want to monitor?
renal function and potassium (at risk for hyperkalemia)
170
What are the first line HTN medications for non-black patients?
ACE, thiazides, CCB
171
When do we change from ACE to ARB?
angioedema
172
What is bad for thiazides?
Triglycerides, uric acid, glucose
but good for osteoporosis
173
Are ACE good for the kidneys or bad?
Both; but they are renal protectant
174
What are the typical side effects of CCB?
GERD- relaxes lower esophageal sphincter
Ankle edema/ headache
175
What heart rhythm do we not give CCB
heart block
176
What is the first line med for HTN in black patients?
thiazides/ CCB
177
What are the three BP meds that are safe in pregnancy?
New Little Momma
Nifedipine
Labetalol
Methyldopa
178
What are some meds we should not give to pregnant women
ACE
ARBS
Statins
DMARDS
179
Which hypertensive medication should we use if our patient has hypertension and diabetes?
ACE/ ARBS (renal protectant)
180
What is the preferred medication in the elderly for isolated systolic hypertension?
CCBS/ thiazides
181
What occurs when there are variances in heart rate upon inspiration and expiration?
respiratory sinus arrhythmia
182
What is the common population for respiratory sinus arrhythmia?
young healthy athlete
183
What is pulsus paradoxus?
10 point drop in SBP upon inspiration, very serious, cardiac tamponade, status asthmaticus
184
What are common diagnostic labs/tests for CHF?
BNP, EKG, chest xray, echo (less than 40% is diagnostic)
185
When should patients be educated to follow up with you with heart failure?
weight gain 2kg in a day
186
What heart sound is common with heart failure?
S3
187
Where does the fluid go with right sided heart failure?
body
188
Where does the fluid go with left sided heart failure?
lungs
189
What meds should you avoid in heart failure due to swelling?
TZDs, CCBs, NSAIDS
190
What two medications are patients with Afib typically on?
anticoagulation, beta blockers
191
What is the goal INR for afib? Prostetic valve?
2-3
2.5-3.5
192
What is the antidote for warfarin?
vitamin K
193
What is Raynaud's Phenomenon?
Decreased blood flow
194
What participates Raynauds?
exposure to cold or stress
195
How do we treat Raynaud's?
CCB/ avoid triggers
196
What is the mnemonic for heart valves?
All People Take Money
Aortic
Pulmonic
Tricuspid
Mitral
197
When is hearing a split S2 not normal?
Inspiration and expiration
198
What is heard at s1?
closure of AV (mitral and tricuspid)
199
What is heart at S2?
closure of semilunar (aortic and pulmonic)
200
When do we hear an S4?
uncontrolled HTN, and LVH
201
At what grade murmur do we feel a palpable thrill?
Grade 4 or higher
202
What mnemonic do we use for systolic murmurs?
MR PASS MVP
Mitral
Regurgitation
Physiological
Aortic
Stenosis
Systolic
Mitral
Valve
Prolapse
203
What syndrome do we see with mitral valve prolapse?
Marfan Syndrome
204
Which murmur radiates to the armpit?
Mitral regurgitation
205
What murmur radiates to the neck?
Aortic stenosis
206
What is the mnemonic we use for diastolic murmurs?
MS ARD
Mitral
Stenosis
Aortic
Regurgitation
Diastolic
207
Diastolic =
Doom
Refer!
208
What signs/symptoms do we see in PAD?
purple/hyperpigmentation
shiny skin
decreased blood flow
intermittent claudification
209
What is our go to diagnostic test for PAD?
Ankle-brachial index
Less than 0.9= PAD
210
How do we calculate ankle brachial index?
SBP leg / SBP arm
211
What signs/symptoms might you see in chronic venous insufficiency?
reddish brown edematous
hyperpig
212
What can chronic venous insufficiency lead to due to that pooling of blood?
increased risk of DVT
213
Where do we refer patients with varicose veins?
vascular
214
What are signs/symptoms of DVT?
swelling, calf pain, erythema
