AANP EXAM NOTES 6 Flashcards
Transient ischemic attack (TIA) is an episode of dysfuntion of what system?
Neurologic
A PT who had a TIA is at high/low risk for severe stroke in the future
HIGH
TX for TIA?
Refer to ED, Schedule CT/MRI within 24 hrs
TIA ABCD2 Score is a tool to help predict who is at high risk for subsequent stroke after a TIA within next 7 days. What is next step if PT has ABCD2 score of 3 or greater?
Refer to ED for hospitalization
What does ABCD represent for a PT with a possible TIA?
Age (greater than 65)
BP (140/90 or higher)
Clinical features of TIA (unilateral weakness)
Duration (> 60 mins)
Diabetes
72-year-old patient with a hx of coronary artery disease and hypertension reports an episode of slurred speech and right sided facial droop that started yesterday while at home. It lasted for about an hour. She denies pain or headache. What is likely cause?
TIA
An 80-year-old pt. comes with c/o ataxic gait, new onset headache & slurred speech that began 2 hours ago. What is likely Etiology?
Stroke/TIA
Name 2 risk factors of CVA (stroke)
A fib, prolonged immobilization.
Name 1 risk factor for Homorrhagic CVA
- Poorly controlled HTN
Name 3 s/s the describes how hemorrhagic CVA presents
- abrupt onset severe HA
- N&V
- Photophobia
- Nuchal rigidity
Intracerebral/ Sub arachnoid hemorrhage presents with sudden onset of severe “thunderclap”/ “the worst HA of my life” or “sentinel HA. T/F
TRUE
CVA has high prevalence in blacks, hispanics, american indians, and women of what age?
25-34
PTs preparing to undergo heart catheterization should/should not stop Losartan
Should not stop Losartan
Naproxen should be stopped for 24 hours prior to heart cath due to the impact on renal prostaglandin production. T/F
TRUE
The TIMI score evaluates patients for what 2 condx?
angina & possible MI
Splinter hemorrhages on nail, new onset murmur fever, chills, tender violet-colored (red to purple) nodules on fingers & toes are some symptoms presented by what bacterial condition?
bacterial endocarditis
Osler Nodes are what color?
purple/pink
What part of body do you find Osler Nodes?
These nodules are found on distal fingers/ toes
Lesions that are irregular, non-tender, erythematous macules/papules on the hands and soles are called?
Janeway lesions
What condx includes a color change in hands from white, blue, and red in a symmetric pattern.
Raynaud’s Phenomenon
What is TX for Raynaud’s Phenomenon
CCB (nifedipine, amlodipine)
Insulin resistance syndrome is AKA
Metabolic Syndrome, Syndrome X
What labs would you order for Metabolic Syndrome?
Labs: Fasting (9 to 12 hrs) lipid profile (esp. triglycerides & HDL), Fasting blood glucose
What type of HTN Medication should be avoided when treating a PT with Metabolic syndrome?
A butterfly rash is associated with what dz?
lupus
When may children with chickenpox return to school?
After lesions have crusted.
What OTC medication should be avoided in children with chickenpox? why?
ASPRIN - May cause Reye’s syndrome
What condx presents with Lip/ oral cavity symptoms that may present as painful vesicles on the soft palate & mouth
Herpangina
What condx presents with honey colored crusts, fragile bullae (that easily ruptures), pruritic.
Impetigo
What labs are drawn for PT with Impetigo?
C&S of crusts/wound
What is the TX for PT with severe case of Impetigo but NKDA?
Cephalexin (Keflex) QID, dicloxacillin QID x 10 days.
What is the TX for PT with severe case of Impetigo who has penicillin allergy?
Azithromycin 250mg x 5 days (Macrolide), Clindamycin x 10 days.
What is the TX for PT with Impetigo with few lesions and no bullae (NDKA)?
Topical 2% mupirocin ointment (Bactroban)
What acute bacterial infection is caused by Staph/Strep that ruptures easily and becomes superficial, bright red, weeping with honey crusted exudate on face, arms or legs.
Bullous Impetigo
What medication is used to treat Bullous Impetigo
Mupirocin
What highly contagious virus presents small spots with White centers (Koplik’s spots), round spots on a red base of the buccal mucosa by the rear lower molars & appears 2-3 days before onset of symptoms?
Measles
Measles is AKA
Rubeola
What infectious dz of the skin is caused by poxvirus?
Molluscum contagiosum
What infection dz of the skin presents smooth papules that arfe dome shaped with central umbiligation (belly button white plug)?
Molluscum contagiosum
What condition presents with a Christmas Tree pattern rash (on cleavage lines); Herald patch lesion appears initially
Pityriasis rosacea
Roseola typically occurs in children of what age?
6 mos to 3 years
Roseola typically presents a fever lasting how long?
2-3 days
Interdigital webs are associated with what skin infestation?
scabies
What infectious dz presents with Sandpaper rash with sore throat (strep throat), fever.
Scarlet fever
Compared to PTs with strep throat, PTs with scarlet fever are at higher risk for developing postglomerular nephritis. T/F
TRUE
What is the 1st approved drug for smallpox?
TPOXX
Smallpox vaccine can lessen severity if given within ….. days post exposure.
3
What inflammatory condition is characterized by Multiple painful, reddened nodules on anterior surface of both legs seen in pt. with ulcerative colitis?
Erythema Nodosum
What is prescribed to treat nodulocystic acne?
Isotretinoin
If pt. with Nodulocystic acne has been Rx’d Isotretinoin & oral contraceptives but presents with sinus infection, who should be consulted?
call the dermatologist to report the BP and discuss the risk of stroke.
What condx presents an extravasation of blood under the skin that is not present with Scarlet Fever?
Petechiae
What is a Pruritic rash located on hands, flexural folds, and neck?
Eczema
What can cause Urticaria?
Medications (e.g., Penicillin allergy rash), viral/bacterial infections, insect bites, latex allergies)
Urticaria is AKA
Hives
What is the best clue to differentiate between contact and atopic dermatitis?
Unilateral location and shape
Dermatitis symptoms include a NON-Pruritic rash located on hands, flexural folds (antecubital, popliteal space), neck, cheeks, entire trunk, knees, & elbows. T/F
FALSE. Dermatitis symptoms include an EXTREMELY PRURITIC RASH on hands, flexural folds (antecubital, popliteal space), neck, cheeks, entire trunk, knees, & elbows.
What is 1st line tx for dermatitis?
Topical steroids and emollients (hydrocortisone)
Dermatitis may be treated with Hydrating baths (warm water) then applying skin lubricants (Eucerin, Keri Lotion, Crisco, Mineral oil) while skin is wet. T/F
TRUE
What inflammatory skin reaction may present with just red skin or red skin with painful/ burning or stinging blisters. The blisters may be located anywhere, may/may not have a belt like pattern (linear).
Contact dermatitis
Rashes caused by contact dermatitis may become crusted, very pruritic, & lichenified from chronic itching when they dry. T/F
True
Cutaneous Lichen planus may present with purple plaques of what shape?
Polygonal
Actinic Keratosis is a precancerous precursor to squamous cell carcinoma. T/F
TRUE
What is the gold standard test for Actinic Keratosis?
Biopsy
What is TX for actinic Keratosis?
Refer to dermatologist for surgery, cryotherapy, topical medications such as fluorouracil cream 5% or imiquimod.
What condx may present soft, painless, wartlike, fleshy growths in the trunk that are located mostly on the back. They can look like they are “pasted” on the skin.
Seborrheic Keratosis
The most appropriate tx for a steroid responsive condition includes: Gel, cream, ointment but NOT lotion. T/F
TRUE
Autoimmune dz (Grave’s dz, Hashimoto’s thyroiditis, RA, psoriasis, pernicious anemia) are risk factors for what chronic autoimmune skin disorder?
Vitiligo
Cherry Angioma presents benign small, smooth round papules that are bright cherry red. They may bleed if ruptured. T/F
TRUE
What is an Inherited/ chronic skin disorder in which squamous epithelial cells undergo rapid mitotic division & abnormal maturation?
Psoriasis
Methotrexate absolute contraindications includes Chronic alcohol use, acute renal failure, & breastfeeding. T/F
TRUE
Symptoms of this condx may be a/w inflammatory bowel disease (IBD) or psoriatic arthritis.
Psoriasis
Superficial candidiasis in the vagina presents with vaginal irritation and a non-malodorous discharge of what color.
White-ish
What is the tx for superficial candidiases in the vagina?
Miconazole cream (Monistat)
What condx presents an acute skin infection of the deep dermis & underlying tissue?
Cellulitis
Cellulitis is caused by what bacteria?
Staph aureus (Gram + bacteria)
What is a virulent strain of cellulitis?
MRSA
PT in office with diffused pink colored skin that is poorly demarcated with advancing margins and warm to the touch. PT has temp, fever, chills, and c/o malaise. What is a possible diagnosis?
Cellulitis
MRSA is a strain of cellulitis that presents with/without abscess?
WITH
What antibiotics are used to TX MRSA?
Note: Vancomycin or daptomycin are the agents of choice for treatment of MRSA (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204005/)
Is orbital cellulitis more common in adults or younger children?
younger children
What type of cellulitis is more common in younger children
orbital cellulitis
What type of cellulitis involving upper dermis & superficial lymphatics is usually caused by group A Streptococcus?
Erysipelas
PTs with clenched fist injury is at high/low risk for infection to joints (knuckles), fascia, nerves, & bones (osteomyelitis) esp. if punched in mouth or bitten by a human.
HIGH
Pt presents to office after being in a fight. He was punched in mouth and bitten. What is next step?
Refer to ED for xray to r/o foreign body or fracture
Furuncles are AKA
BOILS
How are furuncles usually treated?
antibiotic ointment
PT presents with painful nodules, abscesses, & pustules in groin and axilla areas. A ruptured lesion is draining
purulent green colored discharge. What is DX?
HIDRADENITIS SUPPURATIVA
How is HIDRADENITIS SUPPURATIVA treated?
Antibiotics: Clindamycin, cholorhexidine (Hibiclens) 4% sol
Oral antibiotics: Tetracycline
PT presents with broken hair shafts that leave a dot like pattern on scalp. What is likely Dx?
Tinea Capitis
What antifungal medication considered to be the gold standard TX for tinea capitis?
Griseofulvin
Tinea pedis is AKA
Athlete’s foot
PT presents with itchy, scaly rash on foot. Microscopic exam shows hyphae (skin lesion that fluoresces under wood’s lamp). What is likely dx?
Tinea Pedis
What is common TX for athlete’s foot?
antifungal cream (clotrimazole (Lotrisone), econazole (Ecoza, Spectazole) or ciclopirox (Loprox, Penlac).
Tinea unguium, is a fungal infection of the …
fingernail
Tinea unguium, is treated with
Terbinafine (Lamisil)
PT presents with unguium. What should you require prior to initiation of Lamisil? Why?
LFT. Lamisil is an inhibitor of CYP 2D6 enzyme can lead to liver failure
Why does FDA recommend avoiding prescribing oral ketoconazole (Nizoral) for fungal skin & nail infections?
May cause serious harm (liver damage)
What fungal skin infection presents hypopigmented or hyperpigmented (reddish, brown hue) round to oval macular rash/ patch?
most lesions on upper shoulders/back
Tinea Versicolor
Where do most Tinea Versicolor lesions appear on the body?
upper shoulders/back
KOH test reveals “spaghetti & meatballs” hyphae & spore pattern on PT’s back. What is likely DX?
Tinea Versicolor