12 ⼀PSYCH/DERM Flashcards
1
Q
130
What is the clinical criteria for hypOmania -2
A
- ≥3 [BIPOLAR] sx PLUS
- [Elevated | irritable mood 4< x <7 days]
2
Q
How do you risk assess patients with [possible/confirmedSuicidal ideation] ?
A
i[SAD PERSONS]
i = { finish test (iNTENT with PLAN?) HOSPITALIZE NOW! }
___(if “i” no, cont to “[SAD PERSONS]” & finish test )____
Sex Male
[Age external to 19-45]
Depression diagnosis
[PREVIOUS SUICIDE ATTEMPT (STRONG RISK FACTOR!)]
EtOH/drug abuse
[Rational thinking impaired (psychosis, delusions, hallucinations)]
Social support lacking
Organized plan
No spouse
[Sickness physically (i.e. chronic pain)]
_________________
each 1 point: [normal <-4 -(Outpt tx)-7–>HOSPITALIZE!]
3
Q
diagnosis?
________________
How do you confirm diagnosis for this? (4)
A
Bullous Pemphigoid
________________
bx showing
{[IgG and C3 autoantibody deposits]
at basement membrane
attacking hemidesmosomes}
4
Q
initial tx for Insomnia
A
CBT
_________________
sleep hygiene / sleep restriction / relaxation techniques
5
Q
cp for Mild Drug Allergy
________________
What type of hypersensitivity reaction is this?
A
[Pruritic Urticarial RASH with NO systemic sx]
_________________
[Type 1 IgE Hypersensitivity reaction]
6
Q
What is the age limit for removing Tattoos?
A
NO HOST|INK AGE LIMIT FOR REMOVAL!
________________
tattoos can be removed whenever
7
Q
Diagnosis? | Tx?
A
[vpHPV (Verrucae Plantar wart HPV)]
_________________
[saliCylic acid topical (or liquid nitrogen) x ≥2 wks –(if success)–> cont 2 more weeks]
hyperkeratotic papules on soles of the foot
8
Q
Somatic Symptom disorder clinical presentation
A
excessive thought and behavior toward ≥1 unexplained (but proven to be benign) SYMPTOM
9
Q
Describe a Dermatofibroma
A
benign fibroblast proliferation that forms hyperpigmented nodule usually on LE that causes center dimpling when pinched
10
Q
In addition to skin, Patients with Rosacea may also experience ⬜ symptoms
A
Ocular
burning/foreign body sensation/blepharitis/keratitis/conjunctivitis/recurrent chalazion
11
Q
Diagnostic criteria for Panic disorder - 2
A
- Panic attacks +
- Persistent concern about additional attacks and +/- attempts to avoid them
Be sure to r/u medical conditions that mimic them
12
Q
Rash description: scaly, erythematous, pruritic rash with a raised border and central clearing
________________
tx?-2
A
[Tinea Corporis ringworm]
________________
Tx = [topical clotrimazole] or [topical terbinafine]
13
Q
Identify
A
[Epidermal Inclusion Cyst]
14
Q
diagnosis? | Tx?-2
A
dx= [Pityriasis Rosea “Christmas tree”]
tx = [self limited x 2 months], sunlight
15
Q
A
Basal Cell Carcinoma
_________________
although usually [shiny, pearly, skin-colored nodule with telangiectasia, rolled border and ulceration] ⼀atypical presentations are frequent
16
Q
List all possible Treatments? (6)
A
INDIVIDUAL coverage: [[excision] or [destruction via liquid nitrogen cryotherapy]]
_________________
FIELD coverage(widespread/numerous):
-top[5FU cream] |
-imiquimod |
-Photodynamic therapy |
-tirbanibulan
dx = [Actinic-Solar Keratosis] ||5FU: 5-Fluorouracil
17
Q
[Pressure decubitus Ulcers] require local wound care, repositioning and pain/nutrition control
How are shallow ulcers managed?
_________________
How are Full-Thickness ulcers managed?
A
s: [occlusive or semipermeable dressings to maintain moist wound environment]
FT: DEBRIDEMENT OF DEVITALIZED TISSUE
18
Q
This diagnosis of ⬜ is made based on what?
A
Psoriasis
- well demarcated, erythematous, scaly plaques covered by thick silvery scales*
- _________________*
skin physical exam
19
Q
Sx of EtOH Withdrawal are similar to [Benzodiazepine withdrawal which onsets ⬜]
_________________
List the Sx of [EtOH (& Benzo)] withdrawal (9)
A
(Benzo withdrawal starts) [within 7 days] of abrupt Benzo cessation
PAST NITE
Psychomotor agitation but oriented
Anxious Irritable
Seizures
Tremor
NV
Insomnia
Transient Hallucinations
[Excitable autonomics (⬆︎HR, BP) –(if ⊕[Delirium and TempFever]) = ⊕DELIRIUM TREMENS]]
{[PAST NITE=EtOH🅆[⊕{D&T}=⊕🅳T]}
After last drink, [EtOH withdrawal/DT] sx onset after 0.5 Days, PEAKS after 2D, and resolves after 5D of EtOH abstinence
20
Q
Sx of EtOH Withdrawal are similar to [Benzodiazepine withdrawal which onsets ⬜]
_________________
Describe sx timing for EtOH Withdrawal
A
(Benzo withdrawal starts) [within 7 days] of abrupt Benzo cessation
_________________
After last EtOH⼀MonAM [EtOH withdrawal_“PAST NITE”]:
🍺[onsets after 0.5 Days]⼀MonPM,
🍺🍺[PEAKS Day2 {+/- DT_“D&T”}]⼀TUE,
🍺🍺🍺[resolves by Day5]⼀FRI
{[PAST NITE=EtOH🆆[⊕{D&T}=⊕🅳T]}
🔎DT_D&T = [Delirium Tremens is ⊕(Delirium/Confusion & Temp/FEVER)]
21
Q
Dx? | etx?
A
[PPP (Pearly Penile Papules)] | [(NORMAL (NON-STI) IDIOPATHIC VARIENT] row(s) of PPP wrapped circumferentially around corona of glans penis onset 20-30 yo
22
Q
What size is concerning for a skin lesion?
_________________
How is an excisional biopsy done?
A
GOE 6 mm
_________________
Excise ENTIRE SKIN LESION with 1-4 mm margins of surrounding fat
23
Q
A patient disagrees with plan and wants to go home
As the physician, what are your options?
A
[EMERGENCY HOLD] <–(absent)– [CURE Decision Making Capacity] –(present)– > [AMA is Ok]
_________________
24
Q
dx?
A
Tinea Corporis
pink annular plaques with scaly border and central clearing
25
*Differentiate [Pemphigus vulgaris] from [Bullous pemphigoid] using:*
Demographic affected
P = YOUNG
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
b = old
26
What is Factitious disorder?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
which 2 demographics does it occur most in?
faking/inducing illness **solely to assume the sick role** - WITHOUT OBVIOUS EXTERNAL BENEFIT
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Women | healthcare workers
27
b. diagnosis?
a. [Erythema ***"bull's eye"*****MIGRANS**]
b. Lyme disease
## Footnote
*▶If multiple [Erythema *b/e*Migrans] are present = early disseminated disease.
▶If Amox started → Fever/HA/Myalgia, c/s Jarisch-Herxheimer rxn*
28
Management? -3
*[Poison Ivy Type 4 Contact Dermatitis]*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**Minimize spread** (remove contaminated clothes + gently clean exposed areas)] ➜ [**Symptomatic Tx** (topical CTS+cool compress] ➜
[**PO CTS** *if dermatitis SEVERE/facial/genitalia*]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*pruritic linear papules and clear fluid-filled vesicles on exposed areas - after camping*
29
Causes? -2
**STAPH A** > GASP
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**IMPETIGO**
30
What tx regimen is considered for Bipolar *MANIA* that does NOT respond to [mood stabilizer monotherapy] ? -3
ADD [**a**ntipsychotic 2ND GEN]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
Treat Bipolar *MANIA* b4 they go **B(****aL****)D**!
{[***a*** *prn for* → **L**|V]= Bipolar *MANIA*Tx}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**a**ntipsychotic 2ND GEN] + [**L**ithium or Valproate]
31
prognosis for Alopecia areata?
**PERSISTENT** = reoccurs even after [successful treatment with temporary hair growth]
32
Tx for Acute Bipolar **Mania** -3
{[**A**ntiPsychotics (2nd gen)] \> (**L**ithium = **V**alproate)}
| NO ANTIDEPRESSANTS
## Footnote
33
Diagnosis? | Treatment?-5
BCC | [Mohs micrographic surgery]
34
Dx? | how do you confirm diagnosis?
[HAWCA (HPV Anogenital Warts Condylomata Acuminata)]; shave biopsy
35
What is the treatment for [sunburn superficial thickness burn]? (2)
cool compress / NSAID
36
Describe Trichotillomania is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
what's a serious complication of this?
compulsive **Hair pulling DO** in which pt attempts to stop pulling hair out of scalp, eyebrows and eyelashes BUT CAN'T!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Possibly ➜ trichophagia (swallowing hair) which ➜ bowel obstruction
*Related to OCD and has ⬆︎morbidity in those with hx or fam hx of OCD*
37
Pt with severe mania is treated with ⬜-2.
If this patient does not respond to monotherapy, what should you do?
{(**L**|**V**) —**A**}
## Footnote
= [**L** or **V**] ---(prn)-->add **A** =
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
L = Lithium *mood stabilizer*
V = Valproate *mood stabilizer*
A = Antipsychotic 2ND GEN
38
Diagnosis? | Tx?-4
Irritant Contact Dermatitis* (PESTY)*
* * *
Tx = CTSTopical, Emollients, [Identify/avoid offending agent], [lukewarm handwashing]
39
How should you work up melanoma?
excisional bx with initial margins of 1-3 mm of normal tissue also
40
Describe clinical presentation for alopecia areata (5)
1. well-demarcated
2. round patches of complete hair loss
3. NO scarring
4. [**+/- exclamation point hairs** (*pathognomonic*)]
5. [+/- nail pitting]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*usually in patients with fam hx of autoimmune disease*
41
How do you manage Patient agitation when it's **escolated to violence**? -2
1. PHYSICAL RESTRAINTS
2. INTRAMUSCULAR ANTIPSYCHOTIC
42
*Pediatric patient p/w new diagnosis of Major Depressive Disorder*
In addition to CBT, what's 1st line pharmacotherapy for pediatric MDD?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the black box warning of this drug in pediatrics?
*”Sad peds need **Fluoxetine**”*
Fluoxetine
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**increased risk of suicidal thinking in pediatric patients**
43
[Nevus Simplex] are ⬜ , classically located on ⬜-3
[blanchable pink patches ➜ fade with time]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[eyelids / glabella (between eyebrows) / nape of neck]
44
Which dermatologic condition is Hepatitis C associated with?
*🅄ROPorph*[Porphyria Cutanea Tarda] with skin fragility and photosensitivity
| [HCV|OCP|EtOH] can → PCT → [🅄ROPorph-PCT *heme enzyme*❌]
45
MOD | Treatment?
*Keloids*
overproduction of extracell matrix and dermal fibroblast within a scar
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[intralesional CTS]
46
Number of weeks given for a trial of SSRI?
6
47
Tx for Somatic Symptom disorder
Regularly scheduled Med visits (*Goal: Improve functionality*)
## Footnote
*DO = preocupation with unexplainable (but proven to be benign) somatic sx*
48
# diagnosis?
What condition is this lesion associated with?
[HHV8 Kaposi Sarcoma]
*deep red purple brown macules on face, trunk, extremities*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
HIV⼀[AIDS defining illness]
49
Contact Dermatitis or Urticaria?
Contact Dermatitis
## Footnote
*Erythematous papules and vesicles*
50
schizoAffective disorder
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
dx -2
1. [**ISOLATED** (Schizo Criteria **A**) x GOE2wk]
+
2. [Major Mood (Bipolar vs MDD) Episode]
51
common causes of death following [2nd degree and 3rd degree] burn -3
*Loss of: Fluids, Protection, Oxygen*
1. hypOvolemia
2. infection
3. hypoxia*⬇︎O2 delivery 2/2 smoke → {[mechanical airway injury] + [inhalational ⇪ [carboxyhgb>25%]}*
[respiratory smoke injury*airway + inhalation* ] [smoke inhalation injury] ➜ [INC carboxyhemoglobin>25%] ➜ [DEC oxygen delivery]
52
# Clinical features of
Seborrheic Dermatitis -4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
✔︎[**oily greasy scales & flakes** on pruritic erythematous plaques]
✔︎scalp, eyelids, postauricular and nasolabial folds
✔︎usually occurs alone but (sometimes a/w HIV*acute & severe Seborrheic Dermatitis→r/o HIV!*| Parkinson's)
✔︎[Topical **CAC**]*(Calcineurin⛔ /Antifungals / CTS)* = tx
## Footnote
*⛔ = inhibitor*
53
how do you mitigate [DEC appetite] in kids taking Stimulants for ADHD? -3
1. [**growth❌?** --*(If yes)*➜ drug holiday vs nonstimulant alternative]
2. adjust administration time (i.e. after breakfast)
3. eat nutrient-dense meals around medication's active period
54
When should [Actinic⼀Solar Keratosis] be biopsied? -5
≥ 1 cm
rapid growth
ulcerated
TTP
initial tx failure
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*1-20% transforms to SQC*
| *ASK = [AK on SK (+/- ➜ SQC)]*
55
[⬜ and ⬜] are the tx options for [any (*FACIAL or intertriginous*) plaque psoriasis]
56
Lipomas and Epidermal inclusion cyst can both present as painless benign nodules
How do you differentiate the two? - 3
1. EIC **resolves spontaneously** and can come back. Lipoma don't resolve w/out surgery!
2. EIC are **FIRM** vs Lipoma which is soft rubbery
3. EIC may drain cheesey white discharge +/-
57
What is Functional Neurological Symptom Disorder?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
tx?
unexplainable neurological symptoms **2/2 emotional stressors**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
EDUCATION about the Disorder!
*AKA CONVERSION DISORDER*
58
How should you manage a nonsuicidal teen who cuts themself ?
full psych eval (if suicidal ideation ➜ inpatient)
59
Tx for Rosacea -5
1. Avoid Triggers (hot/spicy foods/EtOH/cold/stress)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**Erythema + Telangiectasia] only**
*2.* Topical Brimonidine
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**+papules or pustules**
3. Topical Metronidazole
4. Azelaic acid
5. oral abx (severe / refractory)
60
# Diagnosis?
Describe this lesion- 4
[Cherry Senile Angioma]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. *[multiple small vascularized dome-shaped papules*]
2. **IN ADULTS** that *(although they are senile = ⇪ with age)*...
3. [do NOT *PROgress* to maligancy = do not req tx] but...
4. [do NOT *REgress* either]
61
[\_\_\_\_\_\_\_\_white lacy lesion] is caused by Lichen Planus, and Lichen Planus is caused by \_\_\_\_
[Wickham Striae] ; [Hep C Advanced Liver Disease]
62
Although this disease ( ⬜ ) typically occurs alone, it is also a/w with 2 conditions. What are they?
Seborrheic DERMATITIS ;
HIV |Parkinson's
## Footnote
***oily greasy scales & flakes** on pruritic erythematous plaques(sometimes) a/w HIV|Parkinson's*
63
[Actinic⼀Solar Keratosis] cp (3)
⭐[AK on SK (+/- ➜ SQC)] ⭐
## Footnote
🌞{[(AK):SANDPAPER papules|plaque lesions] on
🌞[(SK):Solar damaged skin background*(telangiectasia/dyspigmentation/atrophy)*]*}
🌞...and possibly→SQC*
64
When treating EtOH withdrawal, why must [Thiamine B1 IV] be given 1st!? (before [Dextrose IVF])?
1st: [Thiamine B1] is used in glucose catabolism and Alcoholics have high Glucose diet ➜Alcoholics have DEC [Thiamine B1]
2nd: Giving Glucose without [Thiamine B1] ➜ Wernicke Korsakoff Syndrome
65
Which medication clinically decreases Suicide Risk?
Lithium
66
When is it appropriate to trial a different rx for ADHD? - 2
1. [Continued Side Effects] after 4 wk trial
2. [Poor clinical response] after 4 wk trial
67
For Bipolar **I** dx, you need [\_\_ mania sx +/- \_\_\_] that last for ___ duration.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What are the mania sx? (7)
[≥3 sx *+/- major depression episode*]; 1 week duration;
**BIPOLAR**
**B**uying excessively (⬆︎ in pleasurable activity)
**I**nflated self-esteem
**P**sychomotor agitation (pacing)
aw**O**ke - won't sleep
**L**ots of Language
**A**DD distractability
**R**acing thoughts
68
Lithium is eliminated exclusively by the ⬜ and has a narrow therapeutic index *(serum level ⬜ = toxic )*
Which drugs INC serum Lithium level? (6)
Kidney ; [≥1.5 *“**g**otta **NAC** for lithium" = sx]*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. [HCTZ, chlorthalidone (*compensatory PCT Na-Lithium reabsorption 2/2 DCT Na inhibition*)]
2. NSAIDs *(DEC GFR*)
3. [Angiotensin inhibitors (ACE/ARB)] *(DEC GFR)*
4. Tetracycline
5. metronidazole
6. any *Volume Depletion* med
69
# There are 4 options to screen for Alcohol Use Disorder
Describe the **SINGLE ITEM SCREENING** method
*How many times this past year have you had more than* {[4 --(women)--\>] [5--(MEN)--\>]} *drinks in 1 day?*
SIS ≥1= positive result
70
give a description of skin with
photoaging -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What social factor worsens this?
[**ROUGH** skin] with [coarse deep wrinkles]
possibly accompanied by [Actinic⼀Solar Keratosis] / telangiectasia / brown liver spots
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
smoking
71
Diagnosis?
[Kaposi Sarcoma HHV8]
72
Which patient demographics in the ED **always** need Suicide Risk Assessment ? -3
psychotic
neurotic
[*drunk*otic (inebriated)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Suicide Risk Assessment: [ iSAD PERSONS ]*
73
Describe the difference between Factitious Disorder and Malingering
**F** = purporting unreal Sx or injury for **F**un \ fufill "sick role" (but NO obvious external reward)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**M** = purporting unreal Sx or injury for **M**oney/External Reward
74
Antipsychotics (\_\_\_ generation) can be used to treat the depressive phase of [Bipolar Depression]
Which 2 are the best to be used?
"Treat Bipolar pts b4 they go **BALLD**, [***Quiet* or *Lurky***!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
2nd gen;
**Quetiapine***BPD_dysthymia*
or
**Lurasidone***BPD dysthymia*
2nd generation Antipsychotics for Bipolar *Depression* =
Quetiapine and Lurasidone
| "*[BPD Depression] is **Quiet** or **Lurky**""
75
[Pyogenic granuloma telangiectaticum]
[dome shaped papule with recurrent bleeding] caused by capillary proliferation after trauma during pregnancy
76
What are the 2 **non**stimulant medication options for ADHD?
ATOmoxetine
[alpha 2 R agonist]
77
# Diagnosis?
What conditions is this diagnosis associated with? (3)
[Acrochordon skin tag] ⼀*benign pedunculated outgrowth of normal skin*
78
describe meLasma
management? (4)
[Minimize sun exposure]
[Broad spectrum Sunscreen]
[skin-lightening agents]
[Topical retinoid creams (ctd in pregnancy)]
79
MOD for Lentigo
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
demographic?
intraepidermal melanocyte hyperplasia that --\> **UN**EVEN pigmentation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
elderly
80
Physicians should screen for ⬜ in veterans reporting insomnia, substance use and interpersonal conflict longer than ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What is the diagnostic criteria -2
PTSD
\> 1 month
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[LIFE THREATENING TRAUMA]
+
**P.A.I.N.** sx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
***P***ysch_ed_ (arounsal ∆ /sleep* ∆/*hypervigilance/concentration ⬇︎)*
***A**voidance (avoids distressing thoughts/feelings/external reminds of the event)*
***I**ntrustion (nightmares/flashbacks)*
***N**egative mood (guilt/ anhedonia/detachment/anger/self-esteem ⬇︎)*
81
For all patients at risk for suicide, what item if present in the home **must** physicians absolutely address for removal ?
FIREARM
* * *
## Footnote
*Guns are a/w high suicide completion rate if used in suicide attempt and removal is a protective factor*
82
Which Second Generation Antipsychotics are most associated with
Prolonged QTc -5
ZIPRASIDONE \>\> **CORQ**
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*CORQ = Clozapine/Olanzapine-Risperidone/Quetiapine*
83
Which Second Generation Antipsychotics are most associated with
ExtraPyramidal Side effects ( ***TADD*** ) -2
Risperidone \>\> Lurasidone
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*CORQ = Clozapine/Olanzapine-Risperidone/Quetiapine*
84
[Nevus Flammeus Port-Wine Stain] are [⬜ common | NOT common] and may be a/w with what syndrome? Explain
**NOT** common ; sturge weber = possible leptomeningeal vascular malformations = obtain brain MRI for evaluation
| *NFPWS respect midline and do NOT regress*
85
When does Delirium Tremens : Onset? Peak? Resolve?
*same as EtOH 🅆ithdrawal (but i/⊕D&T!])*
*After last EtOH⼀MonAM [EtOH 🅆ithdrawal_"PAST NITE"]:*
*🍺[ONSETS **0.5** Days]⼀MonPM,*
*🍺🍺[PEAKS Day**2**]⼀TUE,*
*🍺🍺🍺[ENDS by Day**5**]⼀FRI*
86
describe Bullous Pemphigoid (3)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how is it diagnosed? (2)
1. [Anti-HemiDesmosome IgG +/-C3] (*a/w [Dementia/Parkinson/Depression])* collect along basement membrane
2. [pts\>60 yo]
3. [pruritic prodrome ➜ **TENSE BULLAE**]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx = Skin Biopsy
*demonstrating*:
*1.Supepidermal cleavage*
*2.Linear [IgG and/or C3]along basement membrane*
87
Pt just began an antidepressant
How long should they give for a trial?
≥6 weeks
88
How do you assess if a patient has Decision Making Capacity? (4)
*"a DMC* patient can "**CURE**" themself"
*patient can ...*
**C**ommunicate choice
**U**nderstands info about choice & condition
**R**ecognizes CONSEQUENCES of choice
**E**xplains rationale for choice
*DMC = Decision Making Capacity*
| *choice = preferred [tx (or no tx)]*
## Footnote
**R**ecognizes any/all CONSEQUENCES of their [tx (or no tx) of choice]
**E**xplains rationale for their [tx (or no tx) of choice]
given regarding their condition and the their selected [tx (or no tx) of choice]
89
[Drug-induced parkinsonism] is an EPS component caused by ⬜ blockers.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[⬜ and ⬜] are the tx of choice for immediate relief from both [(D2🟥)Dystonia] and/or [(D2🟥)Drug-induced parkinsonism]}
*EPS = **TADD** sx*
D2 R blockers;
[Diphenhydramine IV (***DD***)]
[Benztropine IV (***DD***)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Obviously⬇︎ (not d/c) D2🟥 as well*
*EPS = **TADD** sx*
90
*pregnant patient*
Diagnosis?
Tx?
MOD?
pemphigoid gestationis ;
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
topical Triamcinolone
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* Autoimmune* [Pregnancy Induced abd pruritus **without rash**)] ➜ gzd urticarial papular RASH starting umbilicus and trunk ➜ eventually tense bullae*
91
schizophrenia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how is it diagnosed -4
• must meet all **ABCD**
A= [**A**ctive (*GOE2 DNDDH Sx*) x GOE1mo]
B= [**B**ad social occupational dysfunction]
C= [**C**hronicity x GOE6mo]
D= [**D**x from other cause RULED OUT FIRST]
92
s/s of Opioid Withdrawal -7
*the* **MAILMAN** *went through opioid withdrawal!*
**M**yDriasis
**A**bd cramps
**I**rritability
**L**acrimation
**M**yalgia
**A**rthralgias
**N**V
93
What is [Cholinergic Inducible Urticaria] ?
rapid-onset type of [Inducible Urticaria] induced by rise in body temperature (hot shower/exercise) ⼀that resolves 1-2h after stimulus. Tx = H1 blocker
94
diagnosis?
Psoriasis
## Footnote
*affects extensor surfaces*
95
Treatment?
Salicylic Acid
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Cutaneous Warts*
96
diagnosis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Treatment?
bullous pemphigoid
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[high potency topical CTS]
97
▶This skin rash can be induced by which 3 things?
▶Diagnosis?
“**AND** *phototoxic!*"
[**A**bx / **N**SAIDs / **D**iuretics] with sunexposure
* * *
Phototoxic dermatitis
*[erythema(+/- bullae or vesicles)] over sunexposed areas (dorsal hand, forearm, upper chest, face)*
98
Diagnostic criteria for Bipolar II ? - 3
1. Major Depressive Episodes +
2. **hypO**manic episode +
3. **NOT** functionally impaired
99
SQC is the most common Cancer of the lower lip
What would microscopy show for SQC? (2)
Squamous cells with **KERATIN PEARLS**
100
What are the risk factors for [Hidradenitis Suppurativa Acne Inversa]? - 5
1. DM
2. Obesity
3. Smoking
4. Mechanical stress (friction, pressure)
5. Fam hx
## Footnote
Painful intertriginous nodules that can --\> abscess and scarring
101
clinical presentation of [HAWCA]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx? -4
| HAWCA = HPV Anogenital Warts Condylomata Acuminata
[multiform *(**cauliflower**|verrucous|smooth|dome|flat)*] anogenital wart lesions
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
"*Treat **HAWCA** with **picA***"
-**p**odophyllotoxin
-**i**miquimod
-**c**ryotherapy
-⭐**A**CID (TriChloroAcetic ACID) ⭐
102
What is the CAM score and describe its criteria
CAM “[**aiD|L**]” score = **Diagnosis Delirium** and differentiates it from Dementia/Depression
Delirium dx = [**aiD|L**]*Requires a and i, but only either D or L*
**a**cute confusion
**i**nattentive (can not spell "world" backwards & forward)
**D**isorganized thinking (rambling/illogical)
**L**OC fluctuates (intermittently not alert?)
103
treatment?
AmoxicillinPO
## Footnote
* * *
*[Scarlet fever GASP sandpaper rash]*
104
etx for pemphiGus vulGaris
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp?-2
[Desmo**G**lein3 (which adhere epidermal cell _lateral keratinocyte anchors_ to one another)] are attacked by [*anti*Desmo**G**lein3 IgG autoantibodies] →pemphi**G**us vul**G**aris
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. [Flaccid Bullae **with Nikolsky**] PLUS
2. Mucosal Erosions
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
***Nikolsky** sign = light rubbing of skin separates epidermis*
105
describe MeLasma
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What are the 3 major risk factors?
acquired irregular hyperpigmentation of [sun-exposed face] that occurs when **UVA and UVB radiation** triggers melanocyte proliferation of [sun-exposed face]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
1. [Female (worse with pregnancy and/or OCP)]
2. dark skin
3. cosmetic usage
106
What type of cellular reaction is responsible for [Allergic Contact Dermatitis]?
## Footnote
*erythematous papules and vesicles*
[Type 4 Delayed T-cell mediated]
hypersensitivity
107
Tinea Corporis ringworm
## Footnote
**annular plaque with raised borders and central clearing** *(also well demarcated & scaly)*
108
# Diagnosis?
Clinical Presentation
Sporothrix schenckii *nodular lymphangitis*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
contact with **decaying plant matter** ➜ tame (*painLESS*) distal nodule at inoculation site ➜ ulcerates ➜ several similar lesions form proximally along lymphatic channel over weeks = nodular lymphangitis
109
Describe 2nd degree burn -2
[*PAINFUL* blisters*(fluid accumulation between skin layers)*]
with
[white fibrinous exudate]
110
# a. Describe this diagnosis
b. Describe the treatment (5)
a. **Ichthyosis Vulgaris** = chronic inherited DO characterized as
* diffuse dermal scaling resembling fish or reptile scales, MUCH WORST than eczema*.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
b. *Remove scales via*
▶[keratolytic topicals (*urea, [alpha-hydroxy lactic acid], salicylic acid, retinoids*)]
-▶long baths
111
# *⚠️DSM5: Panic DO is now _only a specifier_ for other conditions*
*If they meet its clinical criteria, other Conditions can be modulated by adding "[_Panic Attack Specifier_]" to final dx*
## Footnote
Clinically define "Panic Attack"? -2
❗️ "***PAK**(🔎Panic AttacK)*" =[ ≥ 4 **P**anic sx -*image*] + [abrupt rapidly intense fear in min]❗️
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⚡{[*≥4* **P**sx+ abrupt fear] = **PAK** --(if)--> *Recurrent + Unexpected + Anticipatory* = **[PANIC ATTACK SPECIFIER]**}⚡
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⚠️*DSM5 no longer considers Panic DO its own DO but now solely a Specifier for other conditions*
112
# *⚠️DSM5: Panic DO is now _only a specifier_ for other conditions*
*If they meet its clinical criteria, other Conditions can be modulated by adding "[_Panic Attack Specifier_]" a final dx*
## Footnote
What is the clinical criteria for the addition of ***"[_Panic Attack Specifier_]"*** to a final dx ? - 3
📖add "***[PANIC ATTACK SPECIFIER]*** to Final Dx if pt (in the _absence_ of drug etx|alt dx ) has :
1.PAK *Recurrently*
2.PAK *Unexpectedly*
3.{≥1 PAK followed by ≥1mo of [PAK*Anticipatory* Anxiety +/- Avoidance Behavior]}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
| *🔎{PAK (Panic AttacK) = [≥4 Panic sx + intense fear]}*
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⚡{[*≥4* **P**sx+ abrupt fear] = **PAK** --(if)--> *Recurrent + Unexpected + Anticipatory* = **[PANIC ATTACK SPECIFIER]**}⚡
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⚠️*DSM5 no longer considers Panic DO its own DO but now solely a Specifier for other conditions*
113
# There are 4 options to screen for Alcohol Use Disorder
Describe the **CAGE** method
[0 = negative / 1 = obtain further eval / **≥2 = POSITIVE**]
1. ever tried to **C**ut back on drinking?
2. **A**ngry when someone criticizes ur drinking?
3. **G**uilty about how much you drink?
4. need **E**ye opener in morning to prevent withdrawal/calm nerves?
114
# patient has hx of Crohn's disease
diagnosis?
Pyoderma Gangrenosum
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*rare neutrophilic dermatitis starting as tender papule that degrades into bluish/violaceous ulcer - a/w IBD*
115
Burns management -3
A. [*3rd degree burn: DEC subeschar infection with Surgical resection and grafting*]
B. [Debridement ➜ Dressing]BID
C. [TOP Silver Sulfadiazine]
116
Malar Butterfly Rash
117
*Patients with OCD can experience Obsessions, Compulsions or both*
Tx for OCD -3
[*high dose* SSRI]
+
[CBT (Exposure & Response prevention)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
+/- {[TCA clomiporamine] *with antipsychotic augment*}
118
treatment?
topical Nystatin
*(treats Candida skin infections)*
* * *
| *Intertrigo*
119
Tardive Dyskinesia is an EPS component caused by ⬜ blockers.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the antidote for Tardive Dyskinesia?
*EPS = TADD sx*
[D2 R blockers]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
switch current antipsychotic to **Clozapine**
*Obviously ⬇︎ (not d/c) D2 blocker as well*
120
What is the difference between [Alopecia areata] and [Alopecia androgenetic MPB]?
## Footnote
*MPB = Male Pattern Baldness*
aAMPB starts **frontal** or **temporal**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*tinea capitis = scaly inflammaed hair loss of the scalp*
121
What rash is Rheumatic Fever associated with?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
describe the rash
122
This condition is associated with which infectious disease ?
[Hep **C** ⼀advanced liver disease]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
*Lichen Planus*
123
# Diagnosis?
How is this diagnosis confirmed?
Sporothrix schenckii *nodular lymphangitis*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
124
Diagnostic criteria for Bipolar I ? - 3
1. Major Depressive Episodes +
2. **Manic** episode +
3. Functionally impairing
125
In skin SQC, what is Photodynamic therapy used to treat? (2)
[Actinic⼀Solar Keratosis] and [Bowen SQC in situ]
## Footnote
*ASK = {[(AK):SANDPAPER papules|plaque lesions] on [(SK):Solar damaged skin]*} ...[possibly→SQC]*
126
Contact Dermatitis or Urticaria?
Urticaria
## Footnote
Causes = infection, NSAIDs, IgE, radiocontrast
*well circumscribed raised erythematous plaques with central pallor*
127
This condition is often triggered by ⬜ (4). Diagnosis?
* * *
Management? (2)
**_[allergic contact dermatitis] =_** *_faint vesicular erythema s/p exposure_*
1. [**urushiol*****poison Oak/poison Ivy*****]**
2. **topabx**
3. fragrances
4. *RPL* processing agents
* * *
d/c offending agent , [topCTS ⼀if itching/discomfort intolerable]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*RPL: Rubber/Plastics/Leather*
128
[High Risk SQC (on face/ears/sensitive areas)] is treated using ⬜. Why is this tx used?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*low risk SQC = \< 2 cm lesions on trunk or extremities (excluding hands/feet)*
[HRS] = [Mohs micrographic surgery] ; has higher cure rate than standard exicision and is great for cosmetic or functional areas
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[LRS] = curettage + electrodesiccation (mechanically + electrically destroys CA)*
129
Tx? -2
1. topMupirocin abx = local
2. POCephalexin abx = extensive
**IMPETIGO**
130
[⬜ and ⬜] are the tx options for [SEVERE (*nonfacial*) plaque psoriasis]
131
What is the step wise approach to treating Acne Vulgaris (5)
"**L**osers **T**reating **B**ad **A**cne **I**s *vulgar"*
1st: **L**ifestyle ∆ (avoid chocolate, water-based makeup)
2nd: [**T**opical Retinoids with salicylic acid] = [Noninflammatory *Comedonal* Acne]
3rd: add **B**enzoyl peroxidePGX = Inflammatory Acne
4th: add **A**ntibiotics (Topical before Oral) - erythromycin, clindamycin = Inflammatory Acne
5th: add [**I**sotretinoin PO]PGX = Nodulocystic Acne
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*PGX = PREGNANCY CONTRAINDICATED/TERATOGENIC*
132
MOD for this condition? | Management? (2)
Psuedofolliculitis barbae
**Close Shaves** of ["nappy" tightly curled hair] below skin surface➜ allows penetration of the resultant [angled tip hair shaft] into interfollicular skin ➜ [**small painful papules in beard**]
*and possibly ➜ [hyperpigmentation / 2º bacterial infection / keloid]*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
D/C SHAVING (or use clippers that leave hair longer)
133
Diagnosis?
[Actinic⼀Solar Keratosis]
## Footnote
*ASK = {[(AK):SANDPAPER papules|plaque lesions] on [(SK):Solar damaged skin]*} ...[possibly→SQC]*
134
diagnosis? | tx?
[Atopic dermatitits Eczema Herpeticum]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Acyclovir IV]
## Footnote
*painful vesicles, erythematous base, punched out erosions ➜ hemorrhagic crust*
note: [Zoster Ophthalmicus] is **dermatomal**. [ADE herpeticum] is fully facial
135
Lithium is eliminated exclusively by the ⬜ and has a narrow therapeutic index (*serum level ⬜ = toxic)*
Which 2 BP medications can you give to a patient on Lithium?
Kidney ; ≥1.5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**[Amlodipine CCB]** \> [Furosemide (Loop Diuretics)]
*“**g**otta **NAC** for lithium"*
136
clinical features for this condition (4)
Seborrheic _Keratosis_
- [_benign_ epidermal tumor *([Leser Trelat explosive onset] may = Lung/GI CA*)]
- face/trunk/UE
- well demarcated pigmented lesions with verrucous surface and “stuck on” appearance
## Footnote
💊Tx:[**REASSURANCE**-← N-*(Sx/Cosmetic?)*--Y ➜ > Cryotherapy]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⼀*_benign_ and slow growing so tx not necessary unless symptomatic or cosmetically unpleasant*
137
Describe Wickham Striae - 4
1. White
2. Lacy pattern
3. buccal mucosa
4. a/w Lichen Planus
138
*pt p/w [single annular patch @ trunk] that develops into [crops of oval lesions, following cleavage lines, in an oblique direction]*
## Footnote
Treatment?
[self limited x 2 months]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[*Pityriasis rosea "Christmas Tree"*]
139
Identify
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When does this onset and regress?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Describe composition
**Capillary Hemangioma**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Birth - 6 mo and regresses by 7 yo.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Small Capillaries that BLANCHES on pressure
140
treatment? (3)
**mild** = [*TMC*topical antifungals(terbinafine | miconazole | clotrimazole)]1-4w
[**moderate**/failed topical] = [*FIT*PO antifungals(Fluconazole | itraconazole | Terbinafine)]1-4w
[**Severe**/with onychomycosis] = [*FIT*PO antifungals(Fluconazole | itraconazole | Terbinafine)]12w
* * *
| [Tinea Pedis *Athlete's Foot* (*superficial pruritic fungal 👣infxn)*]
141
Describe 1st degree burn
Superficial erythema only
142
# *PTSD dx requires sx \> 1 month*
[PTSD sx*life + P.A.I.N.*]
x
[3 days -1 month] duration = ⬜
[Acute Stress Disorder]
143
⬜ is the most common CA of the eyelid. It presents as ⬜ and prognosis includes ⬜
Basal Cell Carcinoma ; [pearly skin colored nodule with telangiectasia];
[local invasion*( → exenteration → blindness)* **but no distant metz**]
144
Dx? | What is this condition caused by?
Keratosis Pilaris | retained keratin plugs in the hair follicles
## Footnote
*small papules over rough texture mostly on POST upper arm*
145
treatment?
*excision (snip or shave)*
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*filiform cutaneous wart*
146
Patients with postpartum depression can be treated with ⬜ or ⬜ antidepressant and **can** **continue to breastfeed**
[**P**aroxetine | **S**ertraline]
| treat **P**ostpartum **S**adness w [**P**aroxetine | **S**ertraline]
## Footnote
*these have the lowest/undetectable levels in breast milk*
147
Wernicke-Korsakoff syndrome tx
[Thiamine B1]
148
how is this diagnosis confirmed? (2)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1st line tx?(2)
*(Onychomycosis = dx)*
KOH preparation or culture of nail scrapings
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Terbinafine| itraconazole
149
What does microscopy for [Apthous Ulcer Canker Sores] show?
Fibrin coated ulcerations with underlying mononuclear infiltrates
150
What's the single greatest indicator of a teenager being in an abusive or coercive sexual engagement
sexual partners who occupy **POSITIONS OF POWER OR AUTHORITY** over the teenager is s/f abuse/exploitation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
*MDs are obligated to notify CPS or law enforcement about abuse/exploitation*
151
Tx for skin suffering from photoaging
[Tretinoin (all-trans-retinoic acid)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*⬇︎ROUGH&WRINKLED photoaged skin, [Actinic⼀Solar Keratosis] and brown liver spots*
152
# Rosacea and [SLE Malar Rash] may sometime look similar
What are 2 major discerning features?
[**nasoLabial folds**]R ⊝ S and [**telangiectasia**]R ⊝ S
| *{note: rOsacea = Older / acne vulgaris = younger}*
## Footnote
1. {ROSACEA = [⊕telangiectasia*plus pustules, papules and tissue hyperplasia* ⊕nLF]}
2. {[SLE Malar Rash (Lupus)] = [⊝telangiectasia ⊝nasoLabialFold]}
153
Describe Lichen Planus (7)
p7
1. papules
2. plaques
3. "planar" flexural surfaces (**MOSTLY WRIST**, buccal and genitalia)
4. pruritic
5. polygonal
6. purple
7. pattern that's lacy in the buccal = wickham striae
154
⬜ are the 1st line tx for [mild/moderate (*nonfacial*) plaque psoriasis].
This 1st line tx is prescribed (in addition to ⬜ for maximizing treatment) , ⬜ per day for ⬜ weeks
▶[High Potency topical CTS*(fluocinonide, augmented betamethasone)*]
-( [Topical Vitamin D derivative = alternative])
▶occlusive barrier (plastic wrap/occlusion tape)
▶[\_\_*\_x*\_\_\_ BID x 4w]
155
In psychiatry, what is splitting? Which demographic is it commonly seen in?
Splitting people into either all good, or all bad; Borderline PD (***PESSP***)
156
What is a Marjolin Ulcer?
SQC **that comes from wound or burn** and has higher risk for metastasis
157
[⬜ and ⬜] are the tx options for [any (*Guttate*) plaque psoriasis]
158
Although this disease ( ⬜ ) typically occurs alone, it is also a/w with 2 conditions. What are they?
HIV*acute+severe_SD = r/o HIV!* | Parkinson's
| *Seborrheic DERMATITIS*
## Footnote
*{[**oily greasy scales & flakes** on pruritic erythematous plaques(sometimes) a/w HIV|Parkinson's]*[Top **CAC**]tx**}
159
# Delirium is defined by what 3 fundsmentals?
When is it appropriate to use antipsychotics to manage delirium?
😵[**aiD|L**]
{[**acute confusion*(may present as psychosis vs agitation) → 💊***] and [**inattention**] plus **D**isorganized Thinking and/or **L**OC flux]}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
😵 2/2 underlying med condition
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
😵reversible
*(may manifest with psychosis or agitation)-->if so give antipsychoticsLD if severe*
| Delirium= [**aiD|L**]*Requires a and i, plus D or L*
## Footnote
book;
160
s/s of Anorexia Nervosa (3)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for Anorexia Nervosa typically includes ⬜ and ⬜ but When should these patients be hospitalized?(4)
1. knuckle calluses *(indicates self-induced vomiting)*
2. [BMI \<15]
3. distorted body image
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx = [CBT + Nutritional Rehab] --(*BESO sx*)--\> HOSPITALIZATION
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*BESO*
**B**radycardia / [**E**lectrolyte ∆] / **S**yncope / [**O**rthostatic hypOtension]
161
*Skin SQC is the 2nd most common Skin CA*
What factors qualify Skin SQC has *HIGH* Risk? (3)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for [Skin SQClow risk]? (4)
LARGE / [poorly differentiated histo] / perineural invasion
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Surgical exicision] 🆚 cryotherapy 🆚 electrosurgery 🆚 radiation
162
Where all would you expect to find Psoriasis skin rash? (6)
- scalp
- neck
- back
- **extensor elbows**
- [nail plate pitting*--(if severe)--> onycholysis*]
- knees
| *well demarcated, erythematous, scaly plaques covered w silver scales*
163
This condition is known as ⬜. How is it characterized?
It is a/w ⬜ and can be triggered by what? -2
Porphyria Cutanea Tarda; (Nonpainful blisters with increased fragility of dorsal hand +/- facial hypertrichosis & hyperpigmentation)
; Hepatitis **C** ;
[ethanol or estrogen]
| *HCV skin rashes = PCT | Lichen Planus*
164
diagnosis? | describe mechanism of treatment
HAWCA
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Topical Imiquimod
(immunomodulatory that speeds up clearance of lesions)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*HAWCA = HPV Anogenital Warts Condylomata Acuminata*
165
Tx for Panic Disorder - 6
**CBT** (can be used alone)(breathing technique, exposure therapy) +/-
## Footnote
2. SSRI (1st line rx)
3. SNRIs
4. [Benzo or BBlocker for situational]
5. TCA
6. MAOi
* Similar to Social Phobic Anxiety Disorder tx*
166
How do Corticosteroids affect the skin?
CTS ➜ [Monomorphic papular ACNE]
167
*[Normal Grief Bereavement] overlaps [Major Depressive Disorder]*
Name 4 major qualities of NGB that distinguishes it from MDD
*In [Normal Grief Bereavement]:*
1. if Patient wishes to die it's **only to join the deceased**
2. visual/auditory hallucinations **of deceased person** is normal
3. [sadness (Triggered by reminders) ➜ PRESENTS IN "WAVES" and ⬇︎ Intensity over time]
4. **NO PERVASIVE SUICIDALITY**
168
Dx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?-2
[Tinea versicolor Malassezia]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[selenium sulfide] or ketoconazole
*salmon colored hypo or hyperpigmented macules that appears more readily after sun exposure since surrounding skin is tanned*
169
Diagnostic criteria for [Adjustment disorder with depressed mood] - 3
1. [≤ 4 SIGECAPSS] within 3 mo. of acute stressor*(EXCLUDING nGB)* that --\>
2. **FISD**
3. NOT 2/2 more specific disorder
| *Tx = CBT*
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*🔎FISD = Functional impairment\Significant Distress*
*🔎nGB = normal Grief Bereavement*
170
*Patient presents with Suicidal Ideation*
What 2 factors determine if this patient should receive inpatient tx or outpatient tx?
[+**INTENT** with +**PLAN**?] = Inpatient Tx
[No Plan and No Intent] = Outpatient tx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
| **i[SAD PERSONS]**
171
What's the tx for Severely depressed patients who require **URGENT** treatment
Electroconvulsive Therapy
172
Name all the Body Surface Area % for Burns -8
**[HAA - BALL - P]**
Head = 9
Arm L = 9
Arm R = 9
Back = 18
Anterior = 18
Leg L = 18
Leg R = 18
perineum = 1
173
* Patients with OCD can experience Obsessions, Compulsions or both*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
a. define Obsessions
b. Give 4 examples
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
c. define Compulsions
Obsession = Recurrent **intrusive** anxiety-provoking urges or thoughts or images about..
*([killing/unwanted taboo urges], fear of arm, contamination, symmetry/bad luck)*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Compulsion = rituals/behavioral response used to combat the obsessions (\> 1h/day or causing significant distress)
174
EtOH **withdrawal** can progress to ⬜ (which is an acute medical emergency)
🅳ELIRIUM 🆃REMENS
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[((PAST NITE)EtOH Withdrawal
plus
{🅳elirium & 🆃emp/fever}] = DT
| {[**PAST NITE**=EtOH🅆*[⊕{D&T}=⊕🅳T]*}
## Footnote
*After last EtOH⼀MonAM [EtOH 🅆ithdrawal_"PAST NITE"]:*
*🍺[ONSETS 0.5 Days]⼀MonPM,*
*🍺🍺[PEAKS Day2 {+/- 🅳T_"D&T"}]⼀TUE,*
*🍺🍺🍺[ENDS by Day5]⼀FRI*
175
⬜ side effects are common when 1st starting an SSRI, but should improve over a recommended drug trial of ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
what should u do if side effects are intolerable or inadequate response?
GI ; 6 weeks
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
change antidepressant
176
treatment?
POdoxy
* * *
* Rosacea*
177
dx? | is this rash painful or painless?
Erysipelas ; pain**FUL**
178
What are the treatments for this condition? (3)
*Bullous pemphigoid*
## Footnote
1. [CTSHIGH POTENCY Topical]
2. [CTS PO]
3. doxycycline PO
179
Tx for EtOH withdrawal -6
***B**enzos **T**reat **D**runk **F**airly **M**ean **A**lcoholics*
1. [**B**enzo \> barbituate] EARLY
2. ([**T**hiamine B1 IV ➜ 3. **D**extrose IVF])
4. [**F**olic Acid B9] IV
5. **M**g Sulfate
6. **A**dmit
180
*Differentiate [Pemphigus vulgaris] from [Bullous pemphigoid] using:*
Blister characteristics (3 each)
P*apa* = SUPERFICIAL / FLACCID / NIK+
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
b*ravo* = deep / tense/ nik-
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Nik = Nikolsky sign*
181
How are Tattoos done?
Solid bore needles repeatedly puncture skin to install tattoo pigment in the dermis ➜ dermis macrophages take up pigment ➜ permanence
182
*Psych pts who've taken [D2 R Blockers] chronically may develop EPS*
Why would abrupt discontinue of [D2 R Blockers] --\> **worsening** of EPS sx?
Chornic blockade of D2 Receptors --\> ⬆︎D2 receptors and sensitivity. With abrupt [D2 R blocker] d/c, these receptors are over stimulated even with low dopamine levels --\> Exaggerated EPS
## Footnote
*EPS = TADD sx*
183
S/S of Amphetamine and Cocaine withdrawal - 4
Coke/Meth withdrawal hits **HARD**
1. **H**ungry
2. **A**ngry irritable
3. **R**est a lot w/unpleasant dreams
4. **D**epressed (can mimic MDD vs Bipolar)
*can last several days*
184
Name the factors of Schizophrenia a/w a **good** prognosis -6
185
*Delirium Tremens is a dangerous graduation from [EtOH Withdrawal] that may onset Day ⬜ of EtOH abstinence*
## Footnote
What addtl 2 sx indicate graduation to Delirium Tremens from EtOH Wtihdrawal?
[Day2 *(when EtOH_🅆ithdrawal PEAKS)*]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⊕[🅳eliriumConfusion **and** 🆃empFever]
with
[**PAST NITE**]
## Footnote
*After last EtOH⼀MonAM [EtOH🅆 ithdrawal_"PAST NITE"]:*
*🍺[onsets after 0.5 Days]⼀MonPM,*
*🍺🍺[PEAKS Day2 {+/- DT_"🅳&🆃"}]⼀TUE,*
*🍺🍺🍺[resolves by Day5]⼀FRI*
186
Electroconvulsive Therapy indications -6
1. unipolar depression (with psychosis or suicidality)
2. bipolar depression (with psychosis or suicidality)
3. bipolar mania
4. depression requiring rapid treatment
5. depression during pregnancy when rx contraindicated
6. catatonia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*ECT is safe for pregnancy!*
187
Tx for Bipolar I and II - 6
Treat Bipolar pts b4 they go **BALLD**!
## Footnote
**-B**enzos adjunct prn
**-A**ntiPsychotics (Only use 2nd gen for Depressive phase)
-**L**amotrigine (depression phase only)
**-L**ithium or Valproate \*\*
**-D**epakOte \*\*
188
Treatment? (5)
*Remove scales via*
▶[keratolytic topicals (*urea, [alpha-hydroxy lactic acid], salicylic acid, retinoids*)]
▶long baths
| *Ichthyosis Vulgaris*
## Footnote
diffuse dermal scaling resembling fish or reptile scales, MUCH WORST than eczema
189
How do you manage suspected melanoma skin lesion? (2)
**EX**cisional biopsy with [1-3 mm margin surrounding skin & fat]
190
When is it ok for Bipolar pts to discontinue their Rx therapy?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Explain
NEVER!!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
It is a **lifelong** illness requiring maintenance tx for years (and forever in severe bipolar pts)
191
Dx?
Varicella Zoster shingles
192
This condition ( ⬜ ) is common in ⬜
[Tinea Corporis *trichophyton*] ; [atheletes who participate in contact sports]
## Footnote
*pruritic but **nontender** rash with central clearing and raised borders*
193
Psoriasis is a ⬜. It is typically located ⬜ ; and although mostly asymptomatic, some pts may have ⬜
▶[common inflammatory skin DO characterized by erythematous, well defined silvery scale plaques]
▶[over scalp, back, knees, elbows, nail plates]
▶mild itching
194
Physicians should screen for ⬜ in veterans reporting insomnia, substance use and interpersonal conflict
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for this condition? -4
PTSD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Trauma Focused CBT]
[SSRI] or
[SNRI]
[Prazosin for nightmares]
195
[T or F]
Stimulant therapy for ADHD is associated with ⇪ risk for Substance Use Disorder
FALSE
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
*Stimulant rx for ADHD does **NOT** increase risk of developing Substance abuse*
196
▶Which abx is most associated with phototoxic drug eruptions?
▶Name the other 3 drugs that cause phototoxic drug eruptions
Tetracyclines
| (**SAT F**or *photo*) = Sulfa|Amiodarone|TETRACYCLINES|5FU
## Footnote
especially in sun-exposed areas
197
Describe the process for receiving gifts from patients -2
You **CAN** receive gifts from patients as long as they are
## Footnote
- NOT excessive
- NOT intended to influence care
198
*Rash description:* scaly, erythematous, pruritic rash with a raised border and central clearing.
What is the diagnosis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how do you confirm this diagnosis?
[Tinea Corporis ringworm]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
KOH of skin scrapings
199
[Actinic⼀Solar Keratosis] is a precursor to ⬜ and should be biopsied if concerning
SQC
## Footnote
*ASK = {[(AK):SANDPAPER papules|plaque lesions] on [(SK):Solar damaged skin]*} ...[possibly→SQC]*
200
In [2nd and 3rd degree burns] what % body surface area causes hypOvolemic shock?
\> 25%
(Remember: Give IVF within FIRST 24 HOURS)
201
# Diagnosis?
Tx? (2)
[Strawberry infantile hemangioma] ; {[spontaneous regression by 8 yo]--(if persist)--\>[Propranolol]}
202
Why are the **Negative** symptoms of Schizophrenia treated differently?
and what are Negative Schizo sx treated with?
NEGATIVE Schizo Sx **respond poorly to Antipsychotics** so...
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
➜ Negative Schizo symptom tx = [social skills training]
203
Burn patient may present with laryngeal edema and respiratory failure _______ hours after injury
6-**24** hrs
204
Wernicke-Korsakoff syndrome sx -3
**CAN**
1. **C**onfusion
2. **A**taxia
3. **N**ystagmus Ophthalmoplegia
205
Pityriasis Rosea
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation
[single annular **Herald Patch** @ trunk] ➜ [Christmas tree oval lesions @ trunk]
206
What type of hypersensitivity is Nickel allergy?
4T
[Type 4 T-cell mediated Delayed hypersensitivity reaction]
207
What is the strongest single risk factor for suicide?
**P**revious suicide attempt
| **i[SAD PERSONS]**
208
*Acne Treatment for females with [premenstrual acne flares] is different*
What is it?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
MOA
[Combined OCP]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[combined OCP] ⬇︎ sebum production and are antiandrogenic
209
For patients who have been involuntarily hospitalized , how can you acknowledge their distress, be empathetic and explain rationale for the involuntary hospitalization ?
*“You've been dealing with depression on your own for a while; getting treatment in the hospital can help you feel better in a safe place.”*
210
What is the clinical criteria for **Mania**-2
1. ≥3 [**BIPOLAR**] sx PLUS
2. Elevated or irritable mood \> 7 days
211
Which antiHTN causes [photosensitive sun rash]?
HCTZ
## Footnote
*HCTZ are sulfonamides = causes [photosensitive sun rash] = d/c, suncreesn, avoid sun*
212
# Diagnosis?
Treatment?
Sporothrix schenckii *nodular lymphangitis*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
213
Lithium is eliminated exclusively by the ⬜ and has a narrow therapeutic index. (*serum level ⬜ = toxic)*
Which drugs DEC serum Lithium level? (2)
Kidney ; ≥1.5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Mannitol (osmotic diuretics)
2. Theophylline
*“**g**otta **NAC** for lithium"*
214
what's the treatment for this? (5)
*Remove scales via*
▶[keratolytic topicals (*urea, [alpha-hydroxy lactic acid], salicylic acid, retinoids*)]
-▶long baths
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* Ichthyosis Vulgaris*
* diffuse dermal scaling resembling fish or reptile scales, MUCH WORST than eczema*
215
[Drug-induced parkinsonism] is an EPS component caused by ⬜ blockers.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the antidote for EPS?-6
*EPS = TADD sx*
[D2 R blockers;
1. Clozapine (use for **T**ardive Dyskinesia in extreme cases)
2. Propranolol (use for **A**kathisia)
3. [Diphenhydramine IV (**DD**)]\*\*
4. [Benztropine IV (**DD**)]\*\*
5. Trihexyphenidyl (**DD**)
6. Lorazepam (**DD**)
* Obviously ⬇︎ (not d/c) D2 blocker as well*
* EPS = TADD sx*
216
Tx for acute Mania -3
**(m): A** \> [**L** = **V**]
## Footnote
(**m**)ania: [**A**ntipsychotics (1st or 2nd)] \> **L**ithium = **V**alproate
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[*Antipsychotics for Agitation] since Lithium & Valproate have slower onset*
217
Lithium is eliminated exclusively by the ⬜ and has a narrow therapeutic index (*serum level ⬜ = toxic)*
How do you manage Lithium toxicity ? (4)
Kidney ; ≥1.5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* “**g**otta **NAC** for lithium"*
a. IVF
b. [Lithium level]q2-4h
c. [Bowel irrigation]*(for asx acute OD)*
d. [**HemoDialysis** **(if any below)**:
1. *Lithium \> 4*
2. *Lithium \> 2.5 with sx or AKI*
3. *Lithium INC despite IVF*
218
etx? | Tx?-2
**Papular urticaria** = INSECT BITES➜ [1cm pruritic papules with pale halos] 2/2 [Type 4 delayed hypersensitivity rxn] ➜ spontaneous resolution in months
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[2nd gen H1 blockers (cetirizine/loratidine)] + [Topical CTS]
219
What's difference between initial ADHD tx in [preSchool 3-5 yo] vs [older \> 6 yo]?
initial ADHD tx:
[preSchool 3-5 yo] = [behavioral therapy 1st] --(if persist)--\> [pharmacotherapy 2nd]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[older \> 6 yo] = pharmacotherapy 1st]
220
[Hidradenitis Suppurativa Acne Inversa] management for:
mild
Moderate
SEVERE -2
[Topical Clindamycin]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*sinus tracts/scar formation*
**[PO Doxy]**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*EXTENSIVE SINUS TRACT/DIFFUSE*
**[surgical incision + infliximab (TNFα-inhibitors)]**
221
list the 4 main characteristics of Histrionic personality disorder
1. **sexually provocative** behavior
2. excessive but shallow emotions
3. influenced easily
4. attention seeking - considers relationships more intimate than they are
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*MUST set firm boundaries to protect doctor-patient dynamic*
222
*teen* Depression has different cp than Adult MDD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What are 3 discerning features?
1. irritability
2. somatic sx (tension HA)
3. socioeducational decline
**{*_ALL_ DEPRESSED teens MUST BE "iSADPERSONS" SUICIDE SCREENED}!***
223
# Patient presents with papule that developed into lesions progressing distal to proximal
What is this called?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What causes this?
*[Sporothrix Schenckii nodular lymphangitis]*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
decaying plant material*wound infxn*
224
Which Skin Cancers are associated with Sun exposure?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How is this prevented?
ALL 3!
(SQC / Basal Cell Carcinoma / Malignant Melanoma)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Daily liberal application of [SPF ≥ **30** sunscreen] before/during outdoors
(Tight clothing and sun avoidance are also important but impractical)
225
Clinical presentation for [illNess Anxiety disorder]
{[**≥6 mo ANXIETY**] over having a serious ILLNESS} despite {[**(N)EGATIVE** somatic sx ≥6 mo]]
| *...In somatic sym(P)tom DO = [**(P)OSITIVE** somatic sx (albeit benign)]*
226
Explain the blackbox warning regarding antidepressants and Bipolar Depression
ALL ANTIDEPRESSANTS carry **risk of inducing mania** (especially in bipolar patients)
and tx for this is **d/c antidepressant**
227
Treatment choices? (3)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the prognosis of this condition after treatment?
*treat SD with [topical **CAC**]*
1. topical **A**ntifungal (ketoconazole / selenium sulfide)
2. topical **C**TS
3. topical **C**alcineurin inhibitors (pimecrolimus)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SD is a chronic RELAPSING condition so intermittent **re-treatment may be necessary**!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Seborrheic DERMATITIS ;
## Footnote
*{[**oily greasy scales & flakes** on pruritic erythematous plaques(sometimes) a/w HIV|Parkinson's]*[Top **CAC**]tx**}
228
Symptoms of fatigue and depression in patients taking Lithium should prompt a workup for ⬜. Explain (2)
* * *
Treatment? (2)
[Lithium-induced hypOthyroidism];
## Footnote
▶lithium (usually in first 2 years of tx) interferes with synthesis and release of thyroid hormone → \*[hypOthyroidism +/- Goiter]
vs [Hyperthyroidism] (rare)
vs [autoimmune thyroiditis] (rare)
▶assess [Thyroid function TSH/free T4/Goiter] before prescribing Lithium , and then repeat q6month while on Lithium
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**-ADD LEVOTHYROXINE**
-cont Lithium (DO NOT NEED TO STOP LITHIUM)
229
Tx for Major Depression **with psychotic features** - 2
1. ECT \> antipsychotic ➕
2. Antidepressant
## Footnote
*Use ECT in elderly as it is more rapid acting*
230
Diagnostic criteria for [Persistent Depressive Dysthymia disorder] - 3
1. [Persistent with _NO_ relief x \> 2 mo]
of
2. [≥2/6 **si****GECA** Dysthymia]
for
3. ≥2y (or 1 year if peds)
## Footnote
*Major Depressive Episodes may also occur with this*
231
Describe 3rd degree burn -3
1. [loss of epidermis and *all*dermis]
2. ➜ **charred leather**
3. numb (no sensation)
| *{1E → [2sP → 2DP] → 3F → 4G}*
## Footnote
⚠️"*3F*" dermis = 1E+[2sP+2DP]
232
clinical features of Psoriatic Arthritis (5)
a. [⅓ of Plaque Psoriasis patients develop PA]
b. [Normally, PP → PA (**but 15% have 🔄)**]
c. RA-like Morning stiffness, better with activity
d. *but at **DIP*** and [axial skeleton*sacroiliitis/spondylitis*]
e. PP tx: {[Topical CTS|Calcipotriene ← <10%]***PP*** [ ≥10% *OR *with ⊕PA →MTX) }
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*PA: Psoriatic Arthritis | PP: Plaque Psoriasis*
233
why do burn patients develop DEC oxygen delivery to tissue?
tx? why does this work?
burn ➜[smoke inhalation injury] ➜ [INC carboxyhgb>25%] ➜ [DEC oxygen delivery] = 1 of 3 Cause of Death for Burns
| tx = 100% OXYGEN (DEC 1/2 life of carboxyhgb)
234
Alopecia areata
Tx (2)
[Intralesional CTS] 🆚 [Topical CTS]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*note: Alopecia areata is PERSISTENT and can reoccur even after successful initial tx*
235
dx?
filiform cutaneous wart
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*tx = excision (snip or shave)*
236
Delusional disorder dx (4)
1. [**isolated** Delusions]≥1 mo
2. [NO Mood Sx]
3. [NO Criteria A Schizo]
4. [NO Criteria B Schizo]
237
a. diagnosis?
b. treatment
a. Scabies
b. topical permethrin
* * *
* scaly erythematous linear plaques involving hands/wrist/groin*
238
Which Second Generation Antipsychotics are most associated with
Weight Gain/Metabolic Syndrome -4
**CORQ**
[**C**lozapine = **O**lanzapine] \> [**R**isperidone = **Q**uetiapine]
239
Autism usually presents by age ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What is the CP?-3
***EAAARRRLY** intervention for Autism is the KEY!*
Presents by age **2**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
*"the **IRS** gave him Autism, not vaccines!"*
1. [**I**nterpersonal deficiency*(⬇︎ *+/- impaired* language, ⬇︎eye contact, ⬇︎ plays alone, poor pickup of social cues/metaphors/humor/NONverbals)*]
2. [**R**epetitive Behavior(rocking, hand flipping, repetitive speech)]
3. [**S**trict & Fixated Interest (insist on same routines, 1-sided convos on fixated topics)*]
*Autism is +/- language or intellectual impairment*
*Also, consider Fragile X syndrome testing*
240
Lithium is eliminated exclusively by the ⬜ and has a narrow therapeutic index (*serum level ⬜ = toxic)*
What are the sx of Lithium toxicity ? (4)
Kidney ; ≥1.5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*“**g**otta **NAC** for lithium"*
[**g**I NVD]acutely → [**N**euromuscular excitability (tremor), **A**taxia, **C**onfusion]CHRONIC
241
Diagnosis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Demographic?
*Non Blanching Blue Grey Sacral patches*
[Mongolian Spot dermal melanocytosis] (fades during childhood)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Pretty much every race except white lol
* These should be NON-Tender*
* Often described on test as Non Blanching Blue Grey Sacral Patches*
242
diagnostic crtieria for Cannabis Withdrawal
[≥1 physical sx (abd pain, sweating, shakiness, fever, chills, HA)]
+
[≥2 post cessation sx (Irritability,anxiety,insomnia, ⬇︎appetite, restlessness, depression)]
243
# Pt p/w rash in the groin
dx? organism that causes it?
Tinea Cruris ; Trichophyton rubrum
244
[Hidradenitis Suppurativa Acne Inversa] etx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp?
chronic recurring inflammatory occlusion of the FolliculoPiloSebaceous units --\>
Painful intertriginous nodules that can --\> abscess and scarring
245
describe this lesion
[stuc**K** on brown benign epidermal tumors in the elderly]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Seborrheic **K**eratosis*
246
Using Antipsychotics in *elderly* dementia patients is relatively contraindicated; why is this?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When is it clinically indicated to use Antipsychotics for *elderly* dementia?
[AntipsychoticsBOTH GEN] actually ⇪ risk of all-cause mortality in *elderly* dementia patients!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
if *elderly* dementia starts exhibiting psychotic or dangerous sx ➜ AntipsychoticsLd
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
## Footnote
(*all-cause mortality = ❤️ /stroke/falls/etc)* (*MUST* *INFORM family of ⇪ Mortality risk*)
247
Describe Desmoid tumors
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how do you differentiate it from lipoma?
Desmoid tumor= slow but locally aggressive benign neoplasm with high recurrence rate (tx = radiation if asx // surgery if sx)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Lipoma will NOT reoccur
248
Describe Nummular Eczema
[round erythematous patches @ extremities]
249
**perianal** [Acrochordon skin tag] is associated with ⬜
Crohn's IBD
250
dx? | tx?-2
Allergic Contact Dermatitis 4D
| 4D= Type 4 Hypersensitivity Rxn
## Footnote
*pruritic excoriated lichenified plaques*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Topical *HP* CTS] (or Topical Tacrolimus for face)
*HP = High Potency (betamethasone/fluocinonide*)
251
*A pt has a **single** episode of major depression but responds well to antidepressant SSRI tx. He is now asking to stop the SSRI since he's now feeling "great"*
## Footnote
How do you manage pt pmhx MDD on SSRI, now at remission and requesting d/c SSRI? (3)
At Remission, if ____ cont Antidepressant tx for additional ____ then d/c
▶[single|mild] MDD = [+ 4-9mo]
▶[Multiple|Mod] MDD = [+ 1-3y]
▶[PERSISTENT|SEVERE] MDD = [+INDEFINITELY]
| *This is called continuation phase tx*
## Footnote
if _single_ MDD → Cont Antidepressant rx for _**additional 4-9 months**_ then d/c
252
Explain why Codeine is contraindicated in peds less than ⬜ years old
*"In peds, Codeine is ONLY for Teens & Preteens!"*
⚠️[N🚷 Codeine for **\< 12 y/o**]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[unpredictable *kids* metabolism < 12 yo] --*(could)*--> ⇪codeine conversion to active opioid metabolites ➜ fatal respiratory depression in kids \< 12 yo
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Morphine / Hydromorphone are OK*
253
How should you counsel on smoking cessation? (5)
5 A's (KCVSR)
*"**K**evin **C**an **V**oluntarily **S**top **R**ightnow"*
*A*s**K** patient about their tobacco usage every visit
*A*s**C**ertain readiness to quit
*A*d**V**ise to quit
*A***S**sist with Rx or cessation programs
*A***R**range quit date + follow up appointments
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*smoking cessation ⬇︎ [all cause mortality (including Lung CA, CV events and COPD)] within 5 years after you stop*
254
# There are 4 options to screen for Alcohol Use Disorder
How do you counsel patients with a positive screening for Alcohol Use Disorder? (3)
*treat AUD with **EFG***
1. **E**xpress Concern but emphasize pt autonomy and responsibility
2. **F**eedback: Provide personalized feedback on patient's substance use and their risk
3. **G**OALS: [**reduction (***AUD or pregnant?***)ABSTINENCE**]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[AUD: Alcohol Use Disorder = pt has Alcohol-related problems]*
255
*Diagnostic clinical criteria for Generalized Anxiety Disorder consist of a ≥ ⬜ month time period of ≥ ⬜ out of 6 major sx*
What are the 6 GAD major sx?
*wa***TCHERS**
*w*orry / *a*nxiety that --\>
1. **T**ension in muscles
2. **C**oncentration ⬇︎
3. **H**yperarousal /on edge
4. **E**nergy ⬇︎
5. **R**estless/ IRRITABLE
6. **S**leep ∆
| 6 ; 3
## Footnote
GAD Dx = ≥6 mo of [ ≥3 / 6 ("waTCHERS" sx)]
256
How do you diagnose lichen Planus?
Skin biopsy
257
Diagnosis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?-2
[Tinea Capitis Dermatophytosis]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. [Griseofulvin PO]
2. [Terbinafine PO]
258
Tattoos are removed with ___ and \_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What are the side effects of these procedures? -2
Laser Removal ; Dermabrasion
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Scars
2. Pigmentation ∆
259
Key features for Borderline personality disorder - 5
**PESSP**
1. **P**ervasive Instability
2. **E**mptiness & fears of abandonment --\> ⬆︎**suicide**
3. **S**elf-defeating behavior
4. **S**plitting is common (people are either good or bad)
5. **P**aranoid when stressed
*these pts usually have hx of child abuse, will react to stressors with rage and manipulative behavior and tx = **D**BT only*
260
Dx? Clinical Course?
[Erythema Toxicum Neonatorum] ; [benign asx erythematous papules/pustules in 1st 2 weeks of life ➜ resolve within 1 week]
261
Buproprion MOA (2)
1. NorEpinephrine reuptake inhibitor
2. Dopamine reuptake inhibitor
262
# Pt p/w rash after camping
Dx?
[*Poison Ivy* Allergic Contact Dermatitis] 4T
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*pruritic linear papules and clear fluid-filled vesicles on exposed areas - after camping*
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Between flexor and extensor, which is more involved with [Eczema Atopic Dermatitis]
Flexor
## Footnote
*If superimposed with HSV --\> Eczema Herpeticum which --\> hemorrhagic crusting*
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In psychiatry, what is splitting?
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Which demographic is commonly seen in
Splitting people into either all good, or all bad
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Borderline PD ( ***PESSP*** )
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*small papules over rough texture mostly on POST upper arm*
Dx? | Tx? (2)
Keratosis Pilaris |
[topical salicylic acid / topical urea] *= topical keratolytics (softens papules)*
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What makes up the ExtraPyramidal Symptoms? - 4
*EPS = TADD sx*
1. **T**ardive dyskinesia (tx=switch to clozapine)
2. **A**kathisia
3. **D**ystonia
4. **D**rug-induced Parkinsonism
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What are the 5 major components of [irritant contact dermatitis]"?
"*repeated irritant exposure makes* ICD **PESTY** "
1. **P**ruritus
2. [**E**rythema*(with UNCLEAR BORDERS)* *]
3. **S**caling
4. [**T**hin areas worse*(hand dorsum, finger webs, fingertips)*]
5. h**Y**perkeratosis & fissuring when chronic
## Footnote
*[common in pts with eczema atopic dermatitis and HCP],
ICD = 2/2 repeated exposure to irritants (detergents/solvents/oxidizing agents)*
💡*/ [Allergic Contact Dermatitis] = Demarcated Borders)
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# *Skin SQC is the 2nd most common Skin CA*
What factors qualify Skin SQC has *HIGH* Risk? (3)
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Tx for [Skin SQCHIGH RISK]?
LARGE / [poorly differentiated histo] / perineural invasion
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SURGICAL EXICISION
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# Identify
[Urticaria *Hives*]
