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► Med Notes > Family Medicine Core Rotation - Acute Complaints_3 > Flashcards

Family Medicine Core Rotation - Acute Complaints_3 Flashcards

1
Q

what is a spermatocele?

A

asymptomatic nodule generally found attached to the spermatic cord

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2
Q

for what is a scrotal ultrasound useful?

A

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

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3
Q

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

A

to evaluate hernia

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4
Q

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

A

infectious causes like epididymitis or UTI

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5
Q

the true causes of acne are what?

A

multifactorial, but familal factors are involved

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6
Q

what are the key factors contributing to acne?

A

follicular keratinization • androgens • propionibacterium acnes

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7
Q

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

A

keratin becomes more dense, blocking the secretion of sebum

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8
Q

the keratin plugs in acne are called what?

A

comedones

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9
Q

contributory factors to acne include what?

A

certain medications • emotional stress • occlusion and pressure on skin

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10
Q

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

A

leaning the hands on the face –> ance mechanica

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11
Q

acne is not caused by what commonly blamed things?

A

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

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12
Q

when are laboratory examinations warranted in the diagnosis of acne?

A

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

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13
Q

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

A

normal

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14
Q

what works best for mild acne?

A

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

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15
Q

how long does acne treatment take to work?

A

2-5months

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16
Q

when should topical acne medications be applied?

A

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

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17
Q

the indications for oral isoretinoin include what?

A

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

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18
Q

what is the major contraindication for isoretinoin?

A

is teratogenic so pregnancy must be prevented during its use

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19
Q

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

A

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

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20
Q

can you use tylenol while on isoretinoin?

A

yes, despite rare cases of hepatotoxicity

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21
Q

how does isoretinoin affect the eye?

A

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

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22
Q

what are the psychiatric considerations for prescription of isoretinoin?

A

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

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23
Q

what is the relationship between topical glucocorticoids and isoretinoin?

A

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

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24
Q

what is the difference between acne and rosacea?

A

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

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25
Q

what is stage I rosacea?

A

there is persistent erythema, generally with telangiectasia formation

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26
Q

what is stage II rosacea?

A

stage I plus the addition of papules and tiny pustules

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27
Q

what is stage III rosacea?

A

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

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28
Q

what are some very effective first line therapies for rosacea?

A

minocycline or doxycycline

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29
Q

are topical steroids effective for rosacea?

A

no

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30
Q

what are some alternative treatments for rosacea?

A

topical metronidazole, and sodium sulfacetamide can work

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31
Q

keratoacanthoma is difficult to distinguish visually from which conditions?

A

basal cell cancers • nodular squamous cell cancers • molluscum

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32
Q

how can you tell keratoacanthoma from similar conditions?

A

history

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33
Q

keratoacanthoma are characterized by what history feature?

A

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

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34
Q

how do you differentiate verruca from keratoacanthoma?

A

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

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35
Q

how do you differentiate molluscum from keratoacanthoma?

A

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

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36
Q

skin lesions of psoriasis can be confused with what?

A

eczema, fungal dermatitis, other lesions

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37
Q

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

A

topical corticosteroids

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38
Q

when do you give topical pimecrolimus for psoriasis?

A

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

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39
Q

when do you give antibiotics for psoriasis?

A

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

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40
Q

when are oral retinoids and methotrexate used for psoriasis?

A

to treat generalized psoriasis and help with nail involvement

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41
Q

what is pityriasis rosea?

A

a self limited papulosquamous eruption

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42
Q

what is the classic history for pityriasis rosea?

A

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

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43
Q

what is the course of pityriasis rosea?

A

spontaneous resolution in 6-12 weeks, recurrence is uncommon

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44
Q

what is the treatment for pityriasis rosea?

A

symptomatic- antihistamines or corticosteroids to relieve itch

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45
Q

when should the diagnosis of impetigo be considered?

A

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

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46
Q

most cases of impetigo are caused by what?

A

S aureus

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47
Q

impetigo responds well to what?

A

topical antibiotics like mupirocin

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48
Q

hot tub folliculitis is generally caused by what?

A

P aeruginosa or P cepacia

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49
Q

course of hot tub folliculitis?

A

self limited, reassurance is all that is necessary

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50
Q

when is abx tx required for hot tub folliculitis?

A

recalcitrant or symptomatic cases

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51
Q

what is the appropriate abx tx for hot tub folliculitis?

A

cipro 500mg bid

52
Q

what is the management for chronic HSV infection?

A

topical or oral antiviral therapy

53
Q

when are antiviral therapies more effective for HSV?

A

better for primary than recurrent infections

54
Q

what is the dosing for antivirals for HSV?

A

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

55
Q

what are the treatment options for genital herpes?

A

episodic therapy • suppressive therapy

56
Q

what is recommended for discordant couples for genital herpes tx?

A

daily suppressive therapy

57
Q

what is the benefit of antiviral therapy for shingles?

A

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

58
Q

what decreases the likelihood of postherpetic neuralgia in shingles?

A

corticosteroids

59
Q

what causes 5th disease?

A

parvovirus B19

60
Q

what child rash is caused by enteroviruses?

A

hand foot and mouth disease

61
Q

parainfluenza causes what in children?

A

croup

62
Q

varicella causes what in children?

A

chicken pox

63
Q

CMV causes what in children?

A

mono like symptoms

64
Q

how do you treat tinea capitis?

A

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

65
Q

how long do you give fluconazole for tinea capitis?

A

3-4 weeks

66
Q

tinea corporis is most commonly caused by what?

A

trichophyton rubrum

67
Q

tinea infections can also be cause by what?

A

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

68
Q

what is the best choice treatment for warts?

A

topical liquid nitrogen

69
Q

what treatment for warts should be avoided in pregnancy?

A

podophyllum resin

70
Q

what is the treatment for anal warts?

A

imiquimod

71
Q

when do you laser warts?

A

warts resistant to other treatment modalities

72
Q

can you use bleomycin injection on finger warts?

A

no bc of terminal digital necrosis

73
Q

what helps differentiate atopic dermatitis from other causes of rash?

A

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

74
Q

when does eczema present?

A

usually in childhood, rarely after 30

75
Q

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

A

absence of telangiectasia in molluscum

76
Q

how can you treat mollusum contagiosa?

A

cryotherapy • cautery • curettage

77
Q

symptoms of conjunctivitis include what?

A

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

78
Q

does discharge character differentiate bacterial from viral conjunctivitis?

A

no

79
Q

eye pain is suggestive of what?

A

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

80
Q

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

A

itching

81
Q

what is the characteristic presentation of allergic conjunctivitis?

A

bilateral

82
Q

what is the MC virus causing conjunctivitis?

A

adenovirus

83
Q

how is adenovirus conjunctivitis transmitted?

A

ocular and respiratory secretions

84
Q

what are the incubation and shedding period for adenovirus conjunctivitis?

A

8 day incubation • 10-12 day shedding

85
Q

what PE finding is characteristic of viral conjunctivitis?

A

palpable preauricular lymph node

86
Q

what percent of conjunctivitis is bacterial?

A

15%

87
Q

why are topical corticosteroids contraindicated in conjunctivitis?

A

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

88
Q

what do you give for herpetic conjunctivitis?

A

antiviral eye drops

89
Q

how do you diagnose herpetic conjunctivitis?

A

fluorescin staining • corneal dendrites

90
Q

bacterial conjunctivitis is most commonly caused by what?

A

Strep • Staph • MRSA

91
Q

what is scleritis?

A

unilateral diffuse injection of the deeper vessels

92
Q

what are the symptoms of scleritis?

A

deep boring eye pain and a surrounding headache

93
Q

scleritis is usually associated with what?

A

autoimmune disease like RA or wegeners

94
Q

diff. between episcleritis and scleritis?

A

episcleritis= mild irritation, no as intense as scleritis

95
Q

corneal abrasion is associated with what?

A

decreased vision • intense pain • tearing • trauma

96
Q

difference between glaucoma and scleritis?

A

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

97
Q

difference between iritis and scleritis?

A

in iritis pupil is small

98
Q

what are the features of bacterial sinusitis?

A

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

99
Q

MCC of recurrent sinusitis?

A

allergy

100
Q

MC pathogen in bacterial sinusitis?

A

S pneumoneae

101
Q

other causes of bacterial sinusitis?

A

h flu • moraxella • gAβh strep

102
Q

what is the drug of choice for bacterial sinusitis?

A

amoxicillin

103
Q

Tx for shoulder dislocation?

A

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

104
Q

what is the MCC lateral knee pain in an athelete?

A

iliotibial band syndrome

105
Q

who gets iliotibial band syndrome?

A

cyclists and runners

106
Q

patellofemoral pain syndrome presents how?

A

diffuse knee pain and positive patellar grind test

107
Q

what is the presentation of an ACL tear?

A

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

108
Q

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

A

patellofemoral pain syndrome (theater sign)

109
Q

what are ottowa ankle pain rules?

A

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

110
Q

what should be done in the majority of syncope cases?

A

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

111
Q

additonal testing for syncope?

A

holter • echo • ambulatory loop ecg • tilt table test

112
Q

what do you order for syncopal patient with a murmur?

A

echo

113
Q

holter and ambulator loop ecg for syncope help ID what?

A

arrhythmia

114
Q

who gets tilt table test?

A

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

115
Q

in a diabetic, silent ischemia is signaled by what?

A

dyspnea and diaphoresis

116
Q

what do you order for suspect silent ischemia in diabetic?

A

stress test

117
Q

abnormal tilt table suggests what?

A

vasovagal syncope

118
Q

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

A

myerson sign seen in parkinsons

119
Q

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

A

selegiline (MAOBI)

120
Q

tx for vaginal candidiasis?

A

oral fluconazole x1 or topical azole application

121
Q

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

A

treat partner

122
Q

what is a strong diagnostic clue for trichomonas vaginalis?

A

strawberry cervix

123
Q

clue to bacterial vaginosis?

A

clue cells

124
Q

tx for bacterial vaginosis?

A

topical or oral metronidazole or clindamycin

125
Q

pt with 1st episode of wheezing requires what?

A

cxr

126
Q

when to get cxr in asthma?

A

fever, ronchi, sputum to rule out pneumonia

► Med Notes (62 decks)

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