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MVU Adult 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Types of alopecia

A

Scarring and Nonscarring

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2
Q

Medications for treating alopecia

A

Finasteride (Propecia), Minoxidil (Rogaine)

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3
Q

Finasteride (Propecia) considerations

A

Use in men only because causes birth defects in women; check liver functions. SE includes ED

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4
Q

Side effects of Minoxidil (Rogaine)

A

pruritis, dryness, scaling, hypertrichosis (excessive body hair)

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5
Q

Describe vitiligo

A

Loss of color in patchy areas of body; white macules/patches of sun-exposed skin often caused by autoimmune diseases

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6
Q

Describe Chloasma

A

“mask of pregnancy”;a pigmentation disorder of the skin characterized by darker skin patches that primarily affect the face and other sun-exposed areas.; caused by increased estrogen, progesterone

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7
Q

Dx for chloasma

A

PMH/HPI, Wood’s lamp to visualize excess melanin in epidermis

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8
Q

Describe melasma

A

Darker patches to any area regardless of pregnancy; causes by sun exposure and hormone changes

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9
Q

Dx for melasma

A

PMH, hormone levels

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10
Q

What drugs can cause drug-induced skin pigmentation changes?

A

amiodarone, chlorpromazine, antimalarials

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11
Q

Describe the skin pigmentation changes in addison’s disease

A

Increased pigmentation on skin creases, skin folds, palmar creases, pressure points

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12
Q

What systemic diseases can cause pruritis?

A

CKD, hyperbilirubinemia

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13
Q

HPI for rash

A

Onset, spread, change, associated symptoms (pruritis, pain), Food or medications, Atopic hx, infectious disease exposure, systemic symptoms

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14
Q

Define urticaria

A

An IgE reaction causing hives or wheals associated with severe itching; ANGIOEDEMA is considered a type of urticaria

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15
Q

Management of urticaria

A

-Isolate, treat cause
-Avoid ASA, ACE inhibitors, NSAIDs
-Avoid allergens

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16
Q

Medication for management of urticaria

A

Antihistamines: hydroxyzine, diphenhydramine, loratadine, cetirizine

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17
Q

Vesicle vs Bulla

A

Vesicle- < 0.5 cm in diameter
Bulla- > 0.5 cm in diameter

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18
Q

Describe scabies

A

highly contagious mite infestation causing intractable pruritis that is worse at night between fingers, periumbilic, ankles, axilla, pelvis

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19
Q

Objective finding for scabies

A

1-2mm red papules with crusting/scaling from scratching’ intraepidermal burrow

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20
Q

Diagnostics for scabies

A

Burrow ink test with microscope identification

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21
Q

Symptom management for scabies

A

Antihistamines and topical steroids to help with pruritis

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22
Q

1st line treatment for scabies

A

permethrin

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23
Q

Tx for persistent severe pruritis with scabies

A

Ivermectin x1 followed by another in 1-2 weeks

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24
Q

ABX for secondary scabies infection d/t waiting for treatment

A

Cephalexin or Dicloxacillin x 7-10 days

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25
Q

Education for scabies

A

-F/U 1 week
-Trim nails
-Wash bed sheets and linens in hot water
-Itching may continue for a week after successful treatment
-May have to repeat treatment

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26
Q

Describe pediculosis

A

lice, spread by close personal contact and causing intense itching and 2-3mm red, erythematous macules or papules

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27
Q

Follow-up for pediculosis

A

-Reevaluate after 1 week, retreat if necessary
-Screen all close contacts for lice

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28
Q

Tx for lice

A

permethrin lotion 1% or 5% cream, nix cream, shampoos (pyrethrin), benzyl alcohol, ivermectin, lindane is second-line

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29
Q

Application of permethrin or other topical agents for pediculosis

A

-Use nit-remover products before application
-Apply to towel-dried, affected area; leave on for 10 minutes and then wash off.

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30
Q

Patient education for pediculosis

A

-Do not share hats, combs, scarves, headsets, towels, or bedding
-Combs and brushes should be washed in hot, soapy water and allowed to air dry
-Bedclothes and clothing should be washed in hot soapy water and dried in a hot dryer
-Screen children once a week for head lice

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31
Q

Describe candidiasis

A

A fungal infection that can affect the mouth, vagina, tip of penis, fingertip (paronychia), or under nail bed

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32
Q

Clinical presentation of different kinds of candidiasis

A

Oral-Severe sore throat, dysphagia; white patches on tongue easily scraped with a tongue blade
Vaginal- burning, itching, irritation on vulva and vagina; erythema with white curdlike patches
Balanitis- reddish rash and itching on glans of penis
Intertriginous candidiasis- red itchy rash that is occasionally “weepy”
Paronychia- painful fingertip that is red, hot, swollen
Subungual- yellow fingernails for several weeks or months; no pain or itching

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33
Q

How are fungal infections usually diagnosed?

A

by their classic appearance; candidal/fungal cultures can be obtained for resistant cases; for vaginal candidiasis- a saline wetmount, pH paper, or potassium hydroxide test

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34
Q

Prescription medications for candidiasis

A

-Topical antifungals (nystatin, clotrimazole) applied BID for 2-4 weeks
-First line for oral candidiasis: clotrimazole troches 10 mg five times a day

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35
Q

Management of paronychia

A

warm compress, possible I/D, systemic antifungals

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36
Q

Topical medications for Tx of candidiasis

A

Nystatin, clotrimazole, miconazole

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37
Q

Describe dermatophytosis

A

-Also known as tinea- superficial infection caused by fungus typically spread by contact with persons, animals, or soil
-Capitis-scalp
-Cruris- groin
-Manuum- hands
-Corporis- body

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38
Q

Clinical presentation of tinea capitis

A

painless patchy alopecia; no erythema, “black dot” from broken hair stubbles

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39
Q

Clinical presentation of tinea corporis

A

“ringworm”: ringlike lesions with bright red elevated border covered with scales

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40
Q

Clinical presentation of tinea cruris

A

extremely pruritic, lichenification from chronic scratching

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41
Q

Considerations when prescribing systemic antifungals

A

-Obtain baseline liver function progile and repeat again in 4 weeks and periodically thereafter during course of treatment
-For Griseofulvin check CBC at baseline and 4 weeks

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42
Q

Management of dermatophytosis (tinea)

A

If on scalp & nails: systemic antifungals (Monitor CBC, LFTs)
Topical antifungals ending in ‘-azole’ (miconazole/clotrimazole/ketoconazole)

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43
Q

What is onychomycosis?

A

A benign infection of toenail or fingernail caused by a dermatophyte fungus; causes thickened, dystrophic nails with cloudy to black discoloration

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44
Q

Treatment for onychomycosis

A

Systemic antifungals: Itraconazole or terbinafine

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45
Q

What is impitigo?

A

A highly contagious bacterial infection caused by staph aureus

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46
Q

S&S of impetigo

A

classic presentation: pruritis from lesions; red, crusty rash that is spreading; rash is located on face or extremities; easily ruptured vesicle with “honey-colored” crust

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47
Q

Topical Tx for impetigo

A

mupirocin BID x 5 days, chlorhexidine 2-3x/day

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48
Q

Systemic Tx for impetigo

A

-Dicloxacillin or cephalexin x 7 days

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49
Q

What to prescribe if suspecting MRSA infection with impetigo?

A

Systemic ABX: Doxycycline, clindamycin, bactrim

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50
Q

Pt education for impetigo

A

-F/U 14 days
-Handwashing, short nails
-Avoid school/daycare for 24 hours after ABX start
-Wash lesions with antibacterial soap before applying topicals

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51
Q

Non-pharmacological management of folliculitis

A

-Gentle cleansing by washing the skin twice a day with antibacterial soap (Dial)

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52
Q

Tx for folliculitis

A

Topical mupirocin (bactroban), retapamulin, clindamycin, erythromycin, keoconazole for 5-7 days

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53
Q

What is a furuncle?

A

a deep follicle infection often caused by S. aureus; multiple furuncles in a contiguous area are called a carbuncle

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54
Q

Difference between carbuncle and furuncle

A

Furuncle- deep bacterial infection of a hair follicle with abscess formation
Carbuncle- large, multioculated abscess comprising multiple furuncles in a contiguous area

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55
Q

Treatment for furuncle verses carbuncle

A

Furuncle- treat with I&D
Carbuncle- systemic antibiotics such as dicloxacillin, cephalexin, bactrim, or doxycyline

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56
Q

Patient education for furuncles and carbuncles

A

-Do not pop, squeeze, or manipulate furuncles (esp those in upper lip or nasolabial folds) due to risk of cavernous sinus thrombosis

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57
Q

What is cellulitis?

A

a bacterial infection of skin involving dermis and SQ tissue common caused by Streptococcus or S. aureus

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58
Q

Rx factors for cellulitis

A

DM, HIV/AIDS, Drug/alcohol abuse, PVD, chronic steroid use

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59
Q

Considerations for determining treatment for cellulitis

A

-Severity of infection
-Site of infection
-Presence of underlying disease
-Virulence of the pathogen

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60
Q

Tx for uncomplicated cellulitis

A

PCN, clindamycin, cephalexin x5 days; if PCN allergy- clindamycin, azithromycin
If from bite- Augmentin for 2 weeks

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61
Q

Pharmacologic recommendations for management of skin and soft tissue infections in primary care

A

For mild infections: PCN VK, Cephalosporin, Dicloxacillin, Clindamycin PO
For moderate-severe: Emergency department for IV ABX or surgery referral

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62
Q

Pt education for cellulitis

A

-RTC if no improvement in 48 hours or worsening infection
-Elevate affected limb

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63
Q

Tx options for warts

A

First line treatments are 17% salicylic acid and cryotherapy with liquid nitrogen

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64
Q

Patient education for warts

A

-Limit shaving of the area until warts are eradicated
-Do not bite nails
-Avoid scratching or rubbing warts
-Wear protective foot covering in wet public areas

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65
Q

Common cause of warts

A

HPV

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66
Q

S&S of oral HSV

A

fever, sore throat, hypersalivation, painful vesicles/ulcers on tongue or in mouth, swollen lymph nodes

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67
Q

Diagnostic tests for HSV

A

Viral culture, DNA studies

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68
Q

Tx for HSV 1

A

ice, lip ointment, OTC topical Abreva, Penciclovir 1% if extensive, Tylenol, oral anesthetics such as xylocaine 2%

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69
Q

Tx for HSV2

A

PO antivirals: Valacyclovir, famcyclovir, warm compress, oatmeal sitz bath, rest, increase fluids

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70
Q

Patient information for HSV

A

-Fever, stress, sunlight, and menses can trigger recurrence of lesions
-Burning/tingling can be first sign of recurrence
-Begin antiviral therapy at first sign of infection
-RTC if symptoms persist past 10 days
-Use condoms, avoid sexual intercourse until wounds are healed
-Blow dryer on the cool setting can be used to dry genital lesions

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71
Q

What is atopic dermatitis?

A

an inherited skin reaction that usually begins in infancy; also called eczema

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72
Q

“Atopic triad”

A

asthma, allergic rhinitis, and eczema

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73
Q

“The itch that rashes”

A

Atopic dermatitis

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74
Q

Objective finding with atopic dermatitis

A

-Erythema
-Lesions are excoriated, maculopapular, and inflamed
-Symmetrical lesions that are crusting and excoriated
-Later: crusted, scaly, thickened, lichenified

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75
Q

What is the primary aim in management of atopic dermatitis?

A

control signs and symptoms because no cure exists: decrease pruritis, prevent infection

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76
Q

DDX for atopic dermatitis

A

scabies, psoriasis, tinea, allergic reactions

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77
Q

Non-pharmacological treatment for atopic dermatitis

A

HYDRATION!
-mild emollients (cetaphil)
-baths over showers with liberal application of moisturizer after
-avoid soaps with perfumes or coloring agents
-Ointments (vaseline)
-Humidifier

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78
Q

Pharmacological management for atopic dermatitis

A

-Burow’s solution to be applied as a compress for 20-30 minutes followed by OTC corticosteroids
-Tricyclic antidepressants such as doxepin (sinequan)- have potent antihistaminic activity
-Montelukast (singulair) 5-10 mg daily
-Apply topical corticosteroids after skin hydration

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79
Q

What is the cardinal symptom of contact dermatitis?

A

a pruritic erythematous rash

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80
Q

Patient education for atopic dermatitis

A

-watch/avoid triggers, avoid allergens, keep living areas cool, reduce sweating

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81
Q

Non-pharmacological management for contact dermatitis

A

Identify cause and avoid
wash with soap and water or with isopropyl alcohol asap after exposure to known irritant (poison ivy/oak)

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82
Q

Pharmacological management for contact dermatitis

A

-moist compress if localized/weeping and antipruritic lotions (Burow’s solution) several times daily
-Potent topical corticosteroids in cream form BID
-Oral systemic corticosteroids may be indicated in severe cases

83
Q

Patient education for contact dermatitis

A

-Identify and avoid triggers
-S&S of exacerbation and when to seek further care
-Use protective clothing and gloves
-Avoid scratching, trim your nails, thorough hand washing

84
Q

Contact dermatitis S&S

A

pruritis, erythematous rash, rough reddened patches with weeping lesions and tiny vesicles

85
Q

DDx for contact dermatitis

A

Herpes zoster, impetigo, seborrheic dermatitis

86
Q

S&S of seborrheic dermatitis

A

pink, scaling rash on face & scalp, may be pruritic; scaly patches, surrounded by erythema with yellow, brown scales or crusts

87
Q

DDx for seborrheic dermatitis

A

Impetigo, atopic dermatitis, psoriasis, scabies, tinea capitis

88
Q

Management of seborrheic dermatitis

A

-OTC antidandruff shampoo
-If resistant: prescription shampoo with ketoconazole
-Topical hydrocortisone if significant erythema

89
Q

Patient education for seborrheic dermatitis

A

-Non-contagious
-Chronic
-A list of OTC preparations should be given to the patient
-Daily shampoo if oily scalp
-For oily scalp: daily shampoo at first then decrease 2-3 times weekly

90
Q

What important HPI question to ask with psoriasis?

A

Any recent strep throat or recent infections

91
Q

Clinical presentation for psoriasis

A

itchy, red, inflamed and dry, scaly plaques; erythematous plaques surrounded by a thick, silvery scale resembling mica

92
Q

What areas of the body are usually involved in psoriasis?

A

One or both elbows, knee, buttocks, or scalp

93
Q

Auspitz’s sign

A

multiple sites of bleeding that appear when a psoriatic micaceous scale is removed from the skin

94
Q

DDx for psoriasis

A

seborrheic dermatitis, lichen planus, atopic dermatitis, candida, syphillis

95
Q

Diagnostics for psoriasis/psoriatic arthritis

A

CBC, uric acid, throat culture, x-rays

96
Q

Goal of therapy for psoriasis

A

control the disease so that the patient no longer feels physically or psychologically hindered by the skin lesions

97
Q

Tx for psoriasis

A

-first line: topical agents (corticosteroids, emollients)
-UV light treatment for stubborn, widespread lesions
-Exacerbations: topical steroids like temovate (super potent) for 2 weeks, Anthralin ointment
-Systemic for severe, incapacitating disease: methotrexate, otezla

98
Q

Why is it important to know the potency of topical corticoids?

A

super potent choices for exacerbation should not be used for more than 2 weeks; a weaker corticosteroid is used for maintenance therapy

99
Q

Labs to monitor if prescribing methotrexate

A

CBC/platelets, renal, liver (weekly at first, then monthly)

100
Q

When to refer psoriasis to dermatology?

A

newly diagnoses patients or patients who have moderate to extensive skin involvement or severe disease

101
Q

Medications to avoid in psoriasis

A

tetracyclines, sulfa, phenothiazines due to risk of sunburn; avoid trauma to skin

102
Q

What is acne vulgaris?

A

inflammatory condition of sebaceous gland & accompanying hair follicle; characterized by comedones and dry, irritated skin

103
Q

S&S of severe Nodulocystic acne

A

lesions are nodules & cysts; always result in scar formation/keloids

104
Q

What diagnosis should a female be evaluated for if diagnosed with severe acne?

A

PCOS

105
Q

DDx for acne vulgaris

A

Rosacea, folliculitis, perioral dermatitis

106
Q

Commonly prescribed medications for acne

A

First line- benzoyl peroxide
Tretinoin (Retin-A)- topical retinoid
Topical abx- clindamycin/erythromycin

107
Q

When to consider topicals versus systemic treatments for acne vulgaris

A

-Topical is first line, consider systemic ABX if patient has not responded to topicals in 2-3 months, has very severe nodulocystic acne, a lot of inflammation, or at risk for pigmentation changes and scarring

108
Q

What are the concerns with prescribing tretinoin?

A

-Tretinoin can cause thinning of the top layer of the epidermis during the first 4 weeks of treatment which causes dryness, irritation, increased photosensitivity; takes 6-8 weeks for improvement to be seen
-Completely dry face and apply cream 20-30 minutes after cleansing

109
Q

S&S of rosacea

A

burning, itching, stinging sensation on face; rosy hue with inflammatory papules

110
Q

Management of rosacea

A

topical metronidazole cream for 6-8 weeks

111
Q

What is seborrheic keratosis?

A

a benign warty-appearing growth most common noncancerous growth in older adults

112
Q

Where is seborrheic keratosis most likely to appear?

A

non-sun exposed skin

113
Q

ABCDEs for skin malignancy: A

A

Asymmetry: one half does not match the other

114
Q

ABCDEs for skin malignancy: B

A

Border: the edges are irregular, ragged, notched, or blurred

115
Q

ABCDEs for skin malginancy: C

A

Color: the mole is not evenly colored. It may include shades of brown or black, or patches of pink, red, white, or blue

116
Q

ABCDEs for skin malignancy: D

A

Diameter: the spot is larger than 6mm across

117
Q

ABCDEs for skin malignancy: E

A

Evolving: the mole is changing in size, shape, or color

118
Q

What is actinic keratosis?

A

the most common pre-cancerous lesion found in light skinned patients on sun-exposed areas

119
Q

Clinical presentation of actinic keratosis

A

irritated, rough or scaly rash that might be painful or itch with small papules that are flesh colored or slightly hyperpigmented; lesions are poorly circumscribed

120
Q

What is malignant melanoma?

A

malignancy arising from epidermal melanocytes; prognosis very poor if >4mm in depth

121
Q

Clinical presentation of malignant melanoma

A

-Patient with pruritic, ulcerated, or bleeding mole that has changed in appearance
-Back and neck are the most common sites in men
-calves are the most common site in women

122
Q

Risk factors for malignant melanoma

A

-Increased age
-light colored eyes, red or blond hair
-congenital nevi greater than 20 mm
-blistering sunburn
-Excessive outdoor exposure
-Indoor tanning

123
Q

Management of malignant melanoma

A

-Referral to dermatology
-Mohs surgery
-Chemotherapy
-Radiation (only palliative)
-Biologic therapy

124
Q

S&S of BCC

A

spot/bump that is getting bigger or a sore that isn’t healing; often on face, ears, cheeks, nose, neck

125
Q

What is the most common type of skin cancer?

A

basal cell carcinoma

126
Q

BCC vs SCC

A

BCC- shiny, pearly papule or nodule with umbilicated center; grows slowly
SCC: hyperkeratotic lesion with crusting and ulceration; more aggressive than BCC

127
Q

DDX for easy bruising

A

-Chronic corticosteroid use
-Anticoagulant therapy
-Thrombocytopenia
-Hemolytic anemia
-Violence/trauma
-Hypersensitivity vasculitis

128
Q

Expected MCV

A

82-90

129
Q

Define microcytic anemia

A

RBCs are small in size

130
Q

DDx for lymphadenopathy

A

acute infection, HIV, lymphoma, cancer

131
Q

What is RDW?

A

red cell distribution

132
Q

What is MCHC?

A

mean corpuscular HGB concentration

133
Q

What is the lifespan of an RBC?

A

120 days

134
Q

Where are RBCs formed?

A

bone marrow

135
Q

What could a high reticulocyte number indicate?

A

hemolytic anemia

136
Q

Name some microcytic anemias?

A

iron-deficiency, thalassemias, chronic disease anemias, sideroblastic anemia

137
Q

What is the most common cause of microcytic anemia?

A

iron-deficiency

138
Q

What could be the causes of iron-deficiency anemia?

A

-malabsorption (IBS, Crohn’s, Hx blockers, resections)

139
Q

Tx and follow up for iron-deficiency anemia?

A

-Increase dietary iron, supplemental iron, recheck RBC in 2-4 weeks

140
Q

Foods high in iron

A

animal proteins, legumes, dark green leafy vegetables like spinach

141
Q

S&S of microcytic anemias

A

tachycardia, palpitations, fatigue, SOB, dizziness, pallor, Brittle nails, pale mucous membranes

142
Q

Causes of normocytic anemias

A

Acute blood loss, sepsis, mechanical shearing, aplastic anemia, chronic diseases; something is causing reduced RBC lifespan

143
Q

Tx for normocytic anemia

A

-Recombinant erythropoietin, procrit
-Manage cause/symptoms

144
Q

When to follow up with patients who have normocytic anemia

A

6 months - CBC and reticulocyte count

145
Q

What is MCV?

A

mean corpuscular volume or size of RBCs

146
Q

What are some types or causes of macrocytic anemia?

A

-Vitamin B12 deficiency/pernicious
-Folate deficiency
-Antimetabolite drugs
-liver disease, chronic alcholism, decreased thiamine

147
Q

Tx for macrocytic anemia

A

-Identify and treat cause (PO or IM B12 supplements, or folic acid supplements)

148
Q

Clinical presentation for someone with macrocytic anemia

A

-Glossitis, nausea, anorexia, diarrhea, neuropathies, malaise
-pale mucosa
-decreased DTRs
-Variable Babinski sign

149
Q

Follow up for macrocytic anemia

A

-CBC, B12
-Folate levels every 2-3 months while on therapy
-Hematology

150
Q

What foods are rich in B12?

A

dark leafy greens, meat, fish, dairy

151
Q

What is sickle cell anemia?

A

-autosomal recessive disorder that affects people descended from West Africa
-characterized by abnormally shaped RBCs that cause small thrombi lodged in vascular beds causing pain and hemolysis

152
Q

S&S of sickle cell anemia

A

Pain, anemia, nausea, anorexia, SOB, low-grade fever, point tenderness, pinpoint pupils, jaundice, leg ulcers

153
Q

Cardinal sign of sickle cell crisis

A

pain that appears suddenly in back, chest, abdomen, or extremities and is excruciating

154
Q

Management for sickle cell

A

-Folic acid 1 mg/day
-B complex and Vitamin C rich foods (Kiwi, oranges)
-Hydroxyurea
-Rehydration to reverse crisis
-ABx if needed, opioid pain management

155
Q

Follow up for sickle cell

A

-X3 months: CBC, glucose, electrolytes, UA, 12-lead annualy
-Hematology f/u every 6 months

156
Q

Diagnostics for sickle cell

A

CBC, peripheral smear, CMP, WBC, bilirubin

157
Q

What is polycythemia?

A

increase in erythrocyte number or concentration, increased blood viscosity

158
Q

What is the most common cause of polycythemia?

A

dehydration

159
Q

S&S of polycythemia?

A

Hx of pulmonary dx, headaches, blurred vision, weakness, fatigue, epistaxis, tinnitis, erythromelalgia (burning hands/feet), PUD, dark mucous membranes

160
Q

Management of polycythemia

A

-rehydration/adjust dose of diuretics if necessary
-phlebotomy if Hct > 55-60% to prevent thrombosis
-treat underlying cause
-Antiplatelet agents- aspirin

161
Q

Follow-up for absolute polycythemia

A

Weekly CBC, hematology, surgery referral if necessary

162
Q

CBC findings for acute leukemias

A

-WBC very elevated > 300,000
-Low granulocytes <50,000
-Low PLT
-Low Hct < 30%
-Blastocytosis > 25%

163
Q

CBC findings for chronic leukemias

A

-WBC elevated >100,000
-Lymphocytes > 90% in CLL
-left shift of myeloids with CML

164
Q

Which leukemias are more common in adults?

A

AML, CML, CLL

165
Q

General S&S of chronic leukemia

A

fatigue, night sweats, low-grade fevers, adventitious lung sounds, splenomegaly, hepatomegaly, lymphadenopathy

166
Q

S&S of acute leukemia

A

bone/joint pain, fever, chills, palpitations, SOB, S&S of infection, tachycardia, pale, petechia, purpura, confusion

167
Q

A type 1 allergic reaction is mediated by what?

A

IgE

168
Q

Examples of a type 1 allergic reaction

A

allergic rhinitis, asthma, anaphylaxis

169
Q

Example of a type 2 allergic reaction?

A

Neonatal Rh incompatability

170
Q

Examples of a type 3 (antibody-allergen) allergic reaction

A

Drug reaction to phenytoin, phenobarbital, carbamazepine,

171
Q

Example of type 4 (delayed-cellular hypersensitivity) allergic reaction

A

-T-cell dependent- TB skin test

172
Q

Anaphylaxis managment (Seven-step approach)

A
  1. Epi 1:1000 0.3-0.5mg IM
  2. repeat every 5-15 minutes
  3. Albuterol for bronchodilation
  4. Intubation
  5. NS/LR if hypotension
  6. Benadryl/H2 blockers if conscious
  7. Transfer to emergency
173
Q

What is rheumatoid arthritis?

A

a chronic, progressive, systemic inflammation affecting synovial joins

174
Q

S&S of RA

A

malaise, diffuse arthritis, weight loss, low-grade fever, joint pain in the AM that subsides slowly throughout the day; prosimal interphalangeal and metacarpophalangeal joins swelling

175
Q

Preferred initial test for diagnosis of RA

A

measurement of peripherally circulating RF, an IgM class antibody

176
Q

Difference between chronic pain syndrome (CFS) and fibromyalgia

A

Fibromyalgia- widespread muscular pain that has been present for at least 3 months
CFS- sudden onset often preceded by mono-like illness or GI findings; patient appears tired with pale skin and possibly has lymphadenopathy

177
Q

Role of exercise for fibromyalgia/CMS

A

increases quality of life

178
Q

Initial management of RA

A

PT/OT, heat/cold compress, exercise, rest, splints, weight loss, OTC pain medications/NSAIDs

179
Q

Follow up/referral for RA

A

-routine labs x3mo
-Referral to rheumatologist if initial managment fails

180
Q

What is Sjogren’s syndrome?

A

A chronic inflammatory autoimmune disease caused by exocrine dysfunction, dryness to all areas where exocrine glans are associated with mucous membranes

181
Q

S&S of Sjogren’s syndrome

A

Dry, gritty eyes and dry mouth, loss of taste/smell, dental caries, dysphagia, rectal bleeding, RA symptoms, ill-appearing, skin rash, GERD, CNS manifestations of sclerosis

182
Q

Diagnostics for SS

A

Based off of clinical and laboratory findings:
-Inadequate tear production
-Corneal epithelial damage from dry eye
-Decreased saliva production
-Labial gland biopsy- lymphocytic infiltration
-Blood tests: Autoantibodies, CBC, RF, ANA, globulin

183
Q

Management of Sjogren’s

A

saline drops, hard candies/gum, avoid caffeine or alcohol, special toothpastes or mouthwashes
-Medications: pilocarpine 5 mg PO TID, acetylcysteine

184
Q

Diagnostics for SLE

A

-CBC/plt, BMP, albumin, ANA, urinalysis, screening test for antibodies

185
Q

S&S of systemic lupus erythematosus

A

-Malaise, fever, anorexia, weight loss, blurred vision, insomnia, depression, joint pain
-Butterfly rash, alopecia, splinter hemorrhages, lymphadenopathym, Raynaud’s, swollen joints, systolic heart murmur, abdominal pain

186
Q

What virus is the most common cause of mononucleosis?

A

Epstein-Barr virus

187
Q

Clinical presentation for infectious mononucleosis

A

-prolonged malaise & fatigue, fever, sore throat, tender cervical lymphadenopathy (specifically posterior), nuchal stiffness, enlarged tonsils, possible rash

188
Q

Management of mononucleosis

A

Supportive care with NSAIDs or tylenol, hydration & nutrition, gargle warm salt water

189
Q

Follow up for mononucleosis

A

-Risk for splenic rupture! follow-up regularly

190
Q

Patient education with mononuclosis

A

-Avoid contact sports for 4 weeks after onset of symptoms
-Limit physical contact to prevent spread
-Fever can be present for 10-14 days

191
Q

What is the cause of lyme disease?

A

tick bite

192
Q

Early vs late signs of lyme diease

A

Early: flu-like, fever, chills, myalgia, “bull’s eye” rash or erythema migrans, lymphadenopathy
Late: meningitis, arthritis, facial palsy, arrhythmias, nerve pain, memory loss, headaches, pain/stiffness, generalized pain

193
Q

Guidelines for initiating antibiotic therapy for Lyme’s disease

A

-Single dose of doxycycline 200 mg when these circumstances are met: tick identified has been attached for 36 hours or longer based on engorement, prophylaxis can be started within 72 hours of the time the tick was removed, local rate of infection is 20% or greater, and doxy is not contraindicated
-doxycycline 100 mg BID for 10-14 days for initial management

194
Q

Risk factors for developing HIV

A

-Men having sex with men, sex with HIV+ partner
-Injected drug user
-Viral hepatitis or tuberculosis
-Prostitutes
-More than one sexual partner since last HIV test

195
Q

What physical findings should prompt consideration of HIV testing?

A

-Persistent generalized lymphadenopathy
-Localized candida
-STIs
-Weight loss
-Cytopenias

196
Q

What is the significance of the HIV viral load?

A

Nucleic acid amplifaction testing or NAT; NAT can be used when 1) the HIV antibody assay is inconclusive, 2) screening blood donors, and 3)diagnosis of neonatal HIV infection 4) when acute HIV is suspected

197
Q

What is the recommended initial screening for HIV?

A

-Should be a part of routine care for individuals aged 15-65 years
-Patients with risk factors should be tested annually
-Screening using the HIV- 1/2 antigen/antibody combination immunoassay

198
Q

Risk groups for HIV that should be started on PrEP

A

-Relationship with an HIV infected partner
-Gay or bisexual man not in a monogomous relationship, STI past 6 months
-Heterosexual man or woman that does not use condoms during sex with partners of unknown HIV status
-Injectable drug user that shared injection equipment in the past 6 months

199
Q

What are the initial and monitoring tests you order prior to PrEP?

A

-HIV testing
-HBV serology
-Hep C virus serology
-serum chemistry for estimation of renal function

200
Q

PrEP medication

A

emtricitabine 200 mg/tenovir 300 mg (Truvada)

201
Q

Who would not be a candidate for PrEP?

A

-Already HIV positive
-creatinine clearance lower than 60 mL/min

202
Q

Risk factors for individuals who should be started on post-exposure prophylaxis

A

-HIV-uninfected individual has a recent exposure that carries a substantial risk of HIV infection
-Percutaneous contact or exposure of mucosal surfaces (vagina, eye, nonintact skin) with blood, semen, vaginal secretions, body fluid
-sexual assault or nonoccupational needle-stick

203
Q

Auspitz’s sign

A

multiple sites of bleeding that appear when a psoriatic micaceous scale is removed from the skin

MVU Adult 2 (4 decks)

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