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Acute & Chronic I > Test 4 > Flashcards

Test 4 Flashcards

1
Q

Actinic Keratosis can progress to

A

squamous cell carcinoma

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2
Q

Risk factors for actinic keratosis

A

age greater than 40, UV light exposure, skin that burns easily, immunosuppresion

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3
Q

often more easily felt than seen

A

actinic keratosis

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4
Q

first line trx for actinic keratosis

A

cryotherapy

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5
Q

meds for actinic keratosis

A

fluorouracil

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6
Q

risk factors for basal cell caricinoma

A

age greater than 55, UV radiation, light complexion, blond, light eyes, family hx of cancer

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7
Q

Most basal cell carcinoma occur on

A

face, neck, trunk, lower limbs

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8
Q

pinkish, pearly papule, plaque, or nodule often with telangiectatic vessels, ulceration

A

basal cell carcinoma

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9
Q

presents as a translucent papule with “floating pigment”, more commonly seen in darker skin types.

A

Pigmented basal cell carcinoma

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10
Q

first choice trx for basal cell carcinoma

A

surgery

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11
Q

monitoring for BCC

A

monthly for 3 months, twice yearly x 5 years, then yearly after

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12
Q

Malignant epithelial tumor arising from epidermal keratinocytes.

A

squamous cell carcinoma

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13
Q

squamous cell carcinomas can arise from

A

actinic keratosis or HPV infection

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14
Q

metastasis of squamous cell carcinoma are more likely to occur in

A

thicker tumors > 6 mm deep, lesions on ears, border of lip, or mucous membranes

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15
Q

risk factors for squamous cell carcinoma

A

older men, sun exposure, multiple AKs, personal or family hx of skin cancer, Northern European descent

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16
Q

squamous cell carcinoma characteristics

A

slow growing, asymptomatic, smooth surface; red/brown/pearly

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17
Q

squamous cell carincoma can be mistaken for

A

warts

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18
Q

invasive SCC penetrates through

A

the dermis

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19
Q

a microscopically controlled method of removing skin cancers that allows for controlled excision and maximum preservation of normal tissue. It has the highest cure rate.

A

Mohs surgery

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20
Q

keratinizing (scaly) lesions in squamous cell carcinoma are

A

least likely to metastasize

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21
Q

SCCs that develop from AKs are generally

A

nonaggressive

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22
Q

greatest risk factor for melanoma

A

high number of nevi

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23
Q

HARMM risk for malignant melanoma

A

history of prior melanoma, age greater than 50, absence of a regular dermatologist, changing mole, male gender

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24
Q

ABCDE of melanomas

A

asymmetry, border irregularity, color variation, diameter greater than 6 mm, elevation above skin surface.

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25
Q

Common location of melanomas on whites

A

back and lower leg

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26
Q

common location of melanomas on blacks

A

hands, feet, nails

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27
Q

Lab that may be helpful in monitoring progression of metastatic disease

A

LDH

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28
Q

full surgical excision is more curative in melanoma stages

A

I-III

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29
Q

how often skin exams are done in patients with melanoma

A

every 3-6 months

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30
Q

meds for acne that are contraindicated during pregnancy

A

isotretinoin, tetracycline, doxycycline, minocycline

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31
Q

Do not use tetracyclines in children

A

less than 8 years old

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32
Q

stimulate sebum production and proliferation of keratinocytes in hair follicles

A

androgens

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33
Q

anaerobe that colonizes and proliferates in the plugged follicle causing inflammation

A

P. acnes

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34
Q

Closed comedones

A

whiteheads

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35
Q

open comedones

A

blackheads

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36
Q

trx for moderate inflammatory acne

A

systemic atbx + benzoyl peroxide

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37
Q

trx for comedones

A

salicylic acid

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38
Q

education for trx meds for acne

A

acne may worsen first 2 weeks of trx and full results take 8-12 weeks

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39
Q

recurrent episodes of facial flushing, erythema, papules, pustules, and telangiectasia in a symmetrical, facial distribution.

A

rosacea

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40
Q

risk factors for rosacea

A

30-50 females, thyroid disturbance

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41
Q

triggers for rosacea

A

stress, exposure to hot/cold, spicy foods, alcohol

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42
Q

predominant s/s of rosacea

A

facial warmth and redness

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43
Q

Men predominately have rosacea on

A

nose

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44
Q

common in 50% of patients with rosacea

A

ocular problems (blepharitis, dryness/irritation)

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45
Q

topical treatment for rosacea

A

metronidazole twice daily, erthyromycin/clindamycin

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46
Q

medication for rosacea

A

doxycycline

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47
Q

avoid tetracyclines with

A

antacids, dairy products, or iron.

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48
Q

s/s of acute dermatitis

A

papules, vesicles with crusting and oozing

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49
Q

s/s of chronic dermatitis

A

erythematous base, thickening with lichenifcation

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50
Q

trx for dermatitis

A

topical or oral corticosteroids, antihistamines

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51
Q

Hand Foot & Mouth disease is most common in children less than

A

5 years old

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52
Q

s/s of Hand foot mouth disease

A

low grade fever, abd pain

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53
Q

Hand foot mouth disease is caused by

A

coxsackie A16

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54
Q

In hand foot and mouth disease, do not use this for treatment

A

topical lidocaine

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55
Q

prodrome phase of chicken pox

A

fever, malaise, anorexia, HA

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56
Q

rash in chicken pox

A

lesions on trunk turn into vesicles, then scab in 6-10 hours

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57
Q

varicella vaccine

A

12-15 months then 4-6 years

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58
Q

can be given to children with chickenpox ages 2-16 years

A

acyclovir

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59
Q

cause of fifth’s disease

A

parovirus b19

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60
Q

fifth’s disease is common in

A

children 4-12 years old

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61
Q

children with fifth’s disease can return to school when

A

rash appears and they have been afebrile for 24 hours

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62
Q

rash in fifth’s disease

A

slapped cheek, then lacy red rash on body. Last phase itches

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63
Q

Koplik spots appear in

A

rubeola (measles)

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64
Q

3 C’s of rubeola

A

croup, conjunctivitis, and coryza

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65
Q

rubeola rash

A

begins on face, then spreads to body and extremities; lasts 3-4 days

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66
Q

vaccine for measles

A

12-15 months then 4-6 years

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67
Q

common symptom of rubelle in adults

A

arthalgia and arthritis

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68
Q

roseola signs and symptoms

A

first a fever for 3-5 days, then maculopapular rash on trunk and extremities that does not itch.

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69
Q

roseola is cause by

A

Human herpes virus 6

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70
Q

s/s of eczema in children

A

erythema papules on antecubital and popliteal flexural surfaces

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71
Q

s/s of eczema in adults

A

lichenification of hands, feet, face, neck, and chest

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72
Q

Dennie sign is seen in

A

eczema (intraorbital fold)

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73
Q

these may be elevated in eczema

A

serum igE levels

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74
Q

side effect of use of high potency steroids

A

hypopigmentation

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75
Q

Malessezia (Plasmodium ovale) may be a contributing factor to

A

seborrheic dermatitis

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76
Q

risk factors for seborrheic dermatitis

A

Parkinson’s AIDS, stress

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77
Q

meds that can intensify seborrheic dermatitis

A

buspirone, gold, lithium, phenothiazine

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78
Q

seborrheic skin should be

A

washed more than usual

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79
Q

greasy scaling of scalp and diaper rash; resolves by 8-12 months

A

cradle cap

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80
Q

characteristics of seborrheic dermatitis

A

red, scaling, itching plaques that are bilateral and occur in hairy skin areas

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81
Q

risk factors for psoriasis

A

family hx, diabetes, obesity, HLD, strep infection, steroids, smoking

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82
Q

meds that can cause psoriasis

A

beta blockers, lithium, antimalarials

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83
Q

Auspitz sign is indicative of

A

Psoriasis

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84
Q

avoid live vaccines in those with

A

psoriasis

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85
Q

caused by Treponema pallidum

A

syphillis

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86
Q

secondary sypillis occurs

A

2-8 weeks after primary chancre

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87
Q

s/s of secondary sypillis

A

nonpruritic rash on palms or feet, fever, lymphadenopathy

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88
Q

diagnosis of syphillis

A

screening with VDRL/RPR positive within 7 days of exposure; treponemal test confirms diagnosis

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89
Q

those with syphillis are

A

positive for life

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90
Q

teaching for syphillis

A

avoid sex until trx is complete, test for HIV, test those exposed within 90 days

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91
Q

first line trx for syphillis

A

PCN G IM

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92
Q

caused by mast cell degranulation and subsequent histamine release.

A

urticaria

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93
Q

urticaria with angioedema reside in

A

72 hours

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94
Q

S/S of urticaria

A

pruritis and burning

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95
Q

acute urticaria

A

lasts less than 6 weeks, more in children, extrinsic factors a cause

96
Q

chronic urticaria

A

lasts more than 6 weeks, most have no obvious external stimuli

97
Q

the appearance of linear wheals at the site of friction, scratching, or any type of irritation.

A

dermatographism

98
Q

lesions of urticaria

A

plaques with central pallor, lasts less than 24-48 hours

99
Q

Inflammation of the lateral and posterior folds of skin surrounding the fingernail or toenail.

A

paronychia

100
Q

acute paroncyhia usually caused by

A

Staph aureus

101
Q

risk factors for acute paronchyia

A

ingrown nail, DM, nail biting, thumb-sucking

102
Q

chronic paronchyia is caused by

A

candida albicans

103
Q

risk factors for chronic paronchyia

A

frequent handwashing, DM

104
Q

Green changes in nail may indicate

A

pseudomonas

105
Q

trx for acute paronchyia

A

warm soaks, atbx cream, topical steroid

106
Q

trx for chronic paronchyia

A

topical steroids

107
Q

cat bites are more likely to

A

cause infection with osteomyelitis, septic arthritis

108
Q

vaccine for those who got bit if last tetanus was more than 5 years ago

A

tetanus immunoglobulin and tetanus vaccine

109
Q

trx for animal/human bites

A

augmentin, keep wound open

110
Q

risk factors for pityriasis rosea

A

age 10-35

111
Q

s/s of pityriasis rosea

A

herald patch on trunk, generalized rash 1-2 weeks later that are salmon oval plaques

112
Q

trx for pityriasis rosea

A

oatmeal bath, calamine lotion, resolves in 1-14 weeks

113
Q

inflammatory disorders leading to permanent hair loss and follicle destruction.

A

scarring alopecia

114
Q

lack of inflammation, no destruction of follicle. Includes focal, patterned, and diffuse hair loss.

A

nonscarring alopecia

115
Q

check these labs for nonadrenergic alopecia

A

TSH, CBC, and ferritin

116
Q

adverse effects of propecia

A

decreased libido, gynecomastic, infertility

117
Q

s/s of abdominal obstruction

A

abd pain, N/V, anorexia, obstipation, abd distention

118
Q

imaging for abd obstruction

A

CT scan

119
Q

imaging for peritonitis

A

abd ultrasound

120
Q

alarm features for abd pain

A

age > 50, weight loss, vomiting, dysphagia, anemia, abd mass

121
Q

highly suspicious for gastrointestinal malignancy in elderly

A

iron deficiency anemia

122
Q

most common etiologies of acute lower abdominal pain in women include:

A

PID, ectopic pregnancy, endometritis

123
Q

s/s of appendicitis

A

umbilical pain that migrates to RLQ, vomiting after pain, fever

124
Q

pain in the right lower quadrant with palpation of the left side

A

Rovsing sign

125
Q

pain on flexion and internal rotation of the right hip, which is seen when the inflamed appendix lies in the pelvis and causes irritation of the obturator internus muscle

A

obturator sign

126
Q

pain on extension of the right hip, which is found in retrocecal appendicitis

A

iliopsoas sign

127
Q

elicited by the examiner placing steady pressure with his or her hand in the right lower quadrant for 10 to 15 seconds and then suddenly releasing the pressure; a positive finding consists of increased pain with removal of pressure

A

rebound tenderness

128
Q

Appendicitis is more frequent in

A

children 5-12 years old

129
Q

should not be used in isolation to make or exclude the diagnosis of appendicitis.

A

lab tests

130
Q

colic is definied as

A

crying for more than 3 hours a day on more than 3 days a week in a infant less than 3 months old.

131
Q

etiology of colic is

A

unknown

132
Q

possible etiologies of colic

A

over/underfeeding, cow milk/lactose intolerance, smoke exposure, temperament

133
Q

Colic episodes have a

A

clear beginning and end

134
Q

colic typically occurs in

A

the evening

135
Q

colic typically resolves by

A

4 months of age

136
Q

first line interventions of colic

A

feeding baby in vertical position with curved bottle; soothing techniques

137
Q

second line intervention for coli

A

one week trial of hydrolysate infant formula

138
Q

s/s of acute cholecystitis

A

prolonged, RUQ or epigastric pain that may radiate to back, fever, leukocytosis, and + Murphy’s sign

139
Q

pain in acute cholecystitis is described as

A

steady and severe

140
Q

pain in acute cholecystitis lasts for

A

more than 4-6 hours

141
Q

Murphy’s sign for cholecystitis

A

Deep inspiration causes the gallbladder to press against examiner’s fingers, causing discomfort and patient catching his breath.

142
Q

imaging for acute cholecystitis

A

US

143
Q

pain in biliary colic

A

RUQ pain that reaches a crescendo then resolves completely,

144
Q

different b/t biliary colic and cholecystitis

A

no peritoneal signs, fever, or abnormal labs in biliary colic

145
Q

Left untreated, symptoms of cholecystitis may

A

go away in 7-10 days

146
Q

defined as biliary pain resulting from a primary gallbladder motility disturbance in the absence of gallstones, sludge, microlithiasis, or microcrystal disease.

A

Functional gallbladder disorder

147
Q

Rome III criteria for functional gallbladder disorder

A

located in epigastrum or RUQ;
Recurrent but occurs at variable intervals;
Lasts at least 30 min;
Builds up to a steady level;
severe enough to interrupt daily activities;
not relieved by BMs, postural changes, antacids

148
Q

trx of functional gallbladder disorder

A

cholecystectomy

149
Q

not required for GERD symtpoms

A

endoscopy

150
Q

problem with H2 antagonists

A

they have diminished effect the longer they are taken, so its recommended to take PRN for those with less than 2 episodes a week

151
Q

PPIs should be discontinued except for patients with

A

erosive esophagitis and Barrett’s

152
Q

presence of hepatic steatosis when no other causes for secondary hepatic fat accumulation

A

nonalcoholic fatty liver disease

153
Q

risk factors for nonalcoholic fatty liver disease

A

age 40-50, obese, dyslipidemia, HTN, hx of chole, diabetes

154
Q

s/s of nonalcoholic fatty liver disease

A

usually asymptomatic; hepatomegaly on physical exam, high ALT/AST

155
Q

diagnosis of nonalcoholic fatty liver disease requires:

A

hepatic steatosis on imaging; exclusion of alcohol or other causes of hepatic steatosis.

156
Q

test all those with hepatic steatosis for

A

hep A, B, and C

157
Q

the most common cause of death in those with nonalcoholic fatty liver disease

A

cardiovascular disease

158
Q

trx for nonalcoholic fatty liver disease

A

weight loss, hep A&B shots

159
Q

there is limited evidence that supports this is beneficial for patients with nonalcoholic fatty liver disease

A

vitamin E

160
Q

s/s of pancreatitis

A

sudden onset of epigastric pain, N/V, anorexia

161
Q

imaging for pancreatitis

A

CT

162
Q

most useful lab for pancreatitis

A

serum lipase as it peaks in 24 hours and returns to normal in 8-14 days.

163
Q

main causes of peptic ulcer disease

A

H. pylori, smoking, NSAIDs

164
Q

there is no evidence that ___ have any advantages over ____ for patients with unhealed ulcers

A

COX2 inhibitors; NSAIDS

165
Q

these should be stopped during healing of a gastric ulcer

A

both COX2 and NSAIDS; restart COX2 + PPI after healed

166
Q

most peptic ulcers are

A

asymptomatic

167
Q

The “classic” pain of duodenal ulcers occurs

A

2-5 hours after meals and between 11-2 am

168
Q

The diagnosis of peptic ulcer disease is definitively established by

A

upper endo

169
Q

All patients diagnosed with peptic ulcer disease should undergo

A

testing for H.pylori

170
Q

Characterized by forceful, nonbilious, vomiting in young infants

A

pyloric stenosis

171
Q

risk factors for pyloric stenosis

A

male, preterm, first-born, maternal smoking, macrolide atbx

172
Q

pyloric stenosis mostly occurs at

A

3-5 weeks of age

173
Q

s/s of pyloric stenosis

A

projective vomiting; “olive-like” mass in RUQ, strong appetitie

174
Q

imaging for pyloric stenosis

A

abd ultrasound

175
Q

the definitive management of pyloric stenosis.

A

pyloromyotomy

176
Q

s/s of hemorrhoids

A

painless; irritation/itching

177
Q

trx for external hemorrhoids and low grade internal hemorrhoids

A

high fiber diet; avoid lingering at toilet

178
Q

trx for grade II and III internal hemorrhoids that don’t respond to conservative measures

A

rubber band ligation

179
Q

rubber band ligation should not be done for

A

external hemorrhoids

180
Q

a tear in the anoderm distal to the dentate line, and is the result of the stretching of the anal mucosa beyond its normal capacity.

A

anal fissure

181
Q

primary anal fissures are caused by

A

hard stool, prolonged diarrhea, vaginal delivery, anal sex

182
Q

secondary anal fissures are caused by

A

IBD, malignancy, HIV

183
Q

s/s of anal fissure

A

tearing pain with BMs, bleeding of bright red blood; appears as fresh laceration

184
Q

The most common location for a primary anal fissure is the

A

posterior anal midline

185
Q

raised edges exposing the white, horizontally oriented fibers of the internal anal sphincter muscle fibers at the base of the fissure

A

chronic anal fissure

186
Q

most colorectal cancers arise from

A

adenomas

187
Q

Crohns and ulcerative colitis have an increased risk for

A

colorectal cancer

188
Q

con of flexible sigmoidoscopy

A

can only identify lesions in the distal 60 cm of the colon

189
Q

discontinue screening for colon cancer when

A

life expectancy is less than 10 years

190
Q

those who should have a screening colonoscopy at 40

A

first degree relative with colon cancer, or two first-degree relatives at any age

191
Q

Erythematous, macerated plaques found in skin folds

A

intertrigo

192
Q

referred pain felt in the epigastrium upon continuous firm pressure over McBurney’s point. It is indicative of appendicitis.

A

Aaron’s sign

193
Q

Blumberg sign

A

rebound tenderness

194
Q

bruising and swelling around umbilicus

A

Cullen sign

195
Q

Cullen sign helps diagnose for

A

pancreatitis

196
Q

long term PPI use has been associated with

A

osteoporosis and fractures

197
Q

H2 blockers provide relief for

A

6-12 hours

198
Q

Barrett’s esophagitis increases the risk for

A

adenocarcinoma

199
Q

pyrosis

A

heartburn

200
Q

IgM anti-HAV +

A

acute hepatitis infection

201
Q

If IgM anti-HAV and IgG anti-HAV antibodies are negative

A

there is no infection

202
Q

HBsAg+

A

viral infection for Hep B

203
Q

HBsAb+

A

Immunity for hep B

204
Q

route of transmission for Hep E

A

fecal-oral

205
Q

ALT is greater than AST in

A

hepatitis

206
Q

AST is greater than ALT in

A

alcohol, statin, and tylenol

207
Q

route of transmission for hep D

A

parenteral

208
Q

most cost effective testing for H.pylori is

A

serologic titers

209
Q

trx for H.pylori

A

PPI and 2 atbx

210
Q

The most common cause of anorectal abscesses and fistulas is bacterial infection of the

A

anal crypt gland

211
Q

Chronic diarrhea is defined as diarrhea lasting more than ___________ during without improvement.

A

1 month

212
Q

GI problem associated with trisomy 21

A

hirschprung disease

213
Q

bloody, nocturnal diarrhea is suggestive of

A

inflammatory bowel disease.

214
Q

Rome III criteria is used to diagnose

A

IBS

215
Q

In gastroenteritis, nausea & vomiting

A

occurs before abd pain

216
Q

s/s of giardia

A

abd cramping, diarrhea, greasy stools

217
Q

Constipation must have at least two of the following criteria

A

straining, hard stools, incomplete emptying, sensation of blockage, fever than 3 stools a week.

218
Q

initial trx of toddlers and children with constipation, pain, bleeding, initial trx should include

A

polyethylene glycol

219
Q

Diarrhea that begin within 6 hours suggest ingestion of a preformed toxin of

A

Staph aureus

220
Q

Diarrhea that begin at 8 to 16 hours suggest infection with

A

Clostridium

221
Q

diarrhea that begin at more than 16 hours can result from

A

E. coli, virus

222
Q

not cost effective for the majority of patients with acute diarrhea

A

sending stool for ova and parasites

223
Q

An acute diarrheal illness is typically defined as a duration of

A

5 days of less

224
Q

risk factors for diverticulitis

A

low fiber, high red meat and fats, obesity, NSAIDs, steroids

225
Q

s/s of diverticulitis

A

LLQ pain, fever, leukocytosis

226
Q

imaging for diverticulitis

A

CT

227
Q

recommended after being treated for diverticulitis

A

colonoscopy 6 weeks of trx.

228
Q

meds for diverticulitis

A

metrodinazole and cipro

229
Q

most children with fecal incontinence have

A

constipation

230
Q

steps in bowel retraining for fecal incontinence

A

disimpaction, laxative & behavioral trx, dietary changes, tapering off laxatives

231
Q

ulcerative colitis is characterized by relapsing and remitting episodes of inflammation limited to the

A

mucosal layer of the colon

232
Q

ulcerative colitis mostly involves the

A

rectum

233
Q

crohn’s disease is characterized by inflammation of

A

transmural layers that skips

234
Q

crohn’s disease mostly involves the

A

whole GI tract

235
Q

s/s of IBS

A

less than 3 BMs a week or more than 3 BMs a day; cramping, passing mucus

236
Q

alarm symptoms not associated with IBS

A

rectal bleeding, nocturnal pain, weight loss

237
Q

this is not indicated for acute gastroenteritis

A

atbx

Acute & Chronic I (4 decks)

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