cumulative part fo 439B final Flashcards
papule
elevated round <1 cm
plaque
palpable, elevated, depressed, >1cm
macule
flat, non-pal <1cm
patch
flat, >1cm (interchange with plaque)
vesicle
fluid filled <1cm
bullae
fluid filled >1cm
postules
pus filled vesciles
urticaria
wheals/hives, elevated, red ,pruiritic lesions
nodule
firm, palpable, extend into dermis or sq tissue
scale
scaley
crust
crust
petechiae
pinpoint non-blanchable red purple spots
telangiectasia
spider veins
risk facotrs SCC
elderly and Caucasian cumulative UV exposure fair skin male >50 YO inflammatory skin DO exposure to carcinogens HPV infection immunosuppression (transplant pts)
Immunosupression transplant pts in SCC
65 fold increase risk
more aggressive and freq metastases than traditional SCC
actinic keratosis
chronic UV exposure
rough, scaly plaques
<1 % progress to SCC
topical or cryo
bowens disease
chronic sun exposure or viral infection like HPV 16 or 18
up to 25% can become invasive SCC into dermis
red brown plaque with crusted scale
tx sx chemo or cryo
SCC metastases
2-6%
SCC variants
keroacanthoma- can regress- resembles SCC
verrucous carcinoma- giant warts
marjolins ucler- AGGRESSIVE, scc developing from ulcer or wd
Mucosal SCC- more aggressive than usual scc 20-70% mets
BCC risk factors
elderly and caucasians austrilians hihg UVB exposure ionizing radiation (xray ) exposure exposure to carcinogenic chemicals genetic syndromes
s&S BCC
pearly nodule, head and neck with CENTRAL ucler
- can be pigmented, raised, shiny pearly borders
BCC tx
biopsy if suspicious-refer to derm curettage/electo <1cm, cure 95% cryosurgery- cure 90% topical chemo- 75% (superficial BCC only) radiation- 80% surgical excision ** gold** 95%c cure mohs micrographic surgery (for aggreesive BCC) cure 95% vemuragenib - local chemo
fragility fx
low trauma fall from standing height or lower that occurred during injury
Plaquenili
- photosensitivity renal issues- renal toxicity opthlamology at baseline skin changes n/v/ tinnitus -continue dose even with SE tx lupus
OA and RA on xray
RA has erosion of bone, OA shows osteophytes, malalignment, bone on bone (narrow space)
xray may NOT correlate with s&S
plantar fascilitis
painful DO involving plantar aspect of heel
acute or chronic
-point tenderness
tx rest, footwear, NSAIDS, ice, massage
mortons neuroma
irritation of interdigital nerve btwn the metetarsal heads and beneath the overlying tranvserve ligament
- point tenderness btwn 3 and 4th toes
- mudlers sign (click or palpation tender)
- women with high heeled shoes, walk on marble, burning pain
metatarsal stress fx
initally pain occurs with activity only
point tenderness
xray- stress fx rarely visible until 2-6 weeks
MRI support dx
TX: heel without immoblization as long as causative activity stopped
-wt bearing painful- crutch/pwb
4-8 wks resume
normal abi
1-1.4
abnormal abi
0.9 or less
non-compressible abi
> 1.4
severe ischemia abi
<0.5 intermittent claudication
vascular surgery Referral
abi <50, urgent referral for ABI 0.4 with gangrene
Tdap
1 dose of tdap for Td Booster then Td every 10 years
tdap if not as a kid for 11 YO >, prego ok
varicella vaccine
2 doses
not for prego
ok to hold off if past zoster/chicken pox
HPV female vaccine
3 doses up to 11- 26 YO
nont for prego
HPV male vaccine
3 doses up to 21 YO and up to 26YO with risk (immunocompromised)
not for prego
Zoster vaccine
only for 60>YO 1 dose
regarless prior hx zoster
not for immunocompromised or prego
MMR vaccine
1 or 2 doses up to 55 YO (if not as a kid)
prior to 1957 ok- no vaccine
not for prego
PNA vaccine
> 65 YO 1 dose
Meningococcal
1 or more doses any age
college up to 21 YO
HEP A vaccine
2 doses at any age
risks: MSM, liver DO, healthcare,
Hep B vaccine
4 doses at any age
risk:MSM, increased risk STD, ESRD
hiB
1 or 3 doses at any age
-adults with hematopoietic stem cell transplant - 6-12months after,
asplenia or sickle cell disease
vaccines recommend off of
age, prior vaccine, health conditions, lifestyle, occupation and travel
influenza vaccine
annually
prego ok
6m and older
inactivated vaccines ok for immunosuppressants
pna
meningococcal
influenza (inactive)
ABI
right ankle systolic pressure/right brachial systolic pressure and left ankle systolic pressure/left brachial sytolic pressure-
lower # drives interpretation/care
sausage digits
psoriatic arthirtis
ithcy rash on Forehead and chin with b/l knee pain, ANA titer 1:40
low probability of SLE
swollen PID
Bouchards Nodes
swollen DID
Herbedens nodes
24 YO AFF with SLE has + prego
anti-phospholipid syndrome- cause death
gout patho
under excrete of uric acid
superficial spreading melanoma
caucasian male 70% of melanomas
what aggravates acne
dilantin
ACL
lachman
Menisucus
Mcmurray
lock/catch
theaters sign
patellar syndrome
Thompson test
squeeze and illicit Achilles reflex
Squeeze test
syndresmosis test
atopic dermatitis
folds/elbows/knees
MCP jts
RA
antifungal
elevated boarder but central clearing- ok
prego __ gets better
RA
lupus it worsens so REFER
seborrhatic dermatitis
itchym nasal folds and eyebrows
osteoporosis drugs
give biphosphonates first before $$ meds