Exam 1 Flashcards
1
Q
Types of alopecia
A
Scarring and Nonscarring
2
Q
Medications for treating alopecia
A
Finasteride (Propecia), Minoxidil (Rogaine)
3
Q
Finasteride (Propecia) considerations
A
Use in men only because causes birth defects in women; check liver functions. SE includes ED
4
Q
Side effects of Minoxidil (Rogaine)
A
pruritis, dryness, scaling, hypertrichosis (excessive body hair)
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
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
7
Q
Dx for chloasma
A
PMH/HPI, Wood’s lamp to visualize excess melanin in epidermis
8
Q
Describe melasma
A
Darker patches to any area regardless of pregnancy; causes by sun exposure and hormone changes
9
Q
Dx for melasma
A
PMH, hormone levels
10
Q
What drugs can cause drug-induced skin pigmentation changes?
A
amiodarone, chlorpromazine, antimalarials
11
Q
Describe the skin pigmentation changes in addison’s disease
A
Increased pigmentation on skin creases, skin folds, palmar creases, pressure points
12
Q
What systemic diseases can cause pruritis?
A
CKD, hyperbilirubinemia
13
Q
HPI for rash
A
Onset, spread, change, associated symptoms (pruritis, pain), Food or medications, Atopic hx, infectious disease exposure, systemic symptoms
14
Q
Define urticaria
A
An IgE reaction causing hives or wheals associated with severe itching; ANGIOEDEMA is considered a type of urticaria
15
Q
Management of urticaria
A
-Isolate, treat cause
-Avoid ASA, ACE inhibitors, NSAIDs
-Avoid allergens
16
Q
Medication for management of urticaria
A
Antihistamines: hydroxyzine, diphenhydramine, loratadine, cetirizine
17
Q
Vesicle vs Bulla
A
Vesicle- < 0.5 cm in diameter
Bulla- > 0.5 cm in diameter
18
Q
Describe scabies
A
highly contagious mite infestation causing intractable pruritis that is worse at night between fingers, periumbilic, ankles, axilla, pelvis
19
Q
Objective finding for scabies
A
1-2mm red papules with crusting/scaling from scratching’ intraepidermal burrow
20
Q
Diagnostics for scabies
A
Burrow ink test with microscope identification
21
Q
Symptom management for scabies
A
Antihistamines and topical steroids to help with pruritis
22
Q
1st line treatment for scabies
A
permethrin
23
Q
Tx for persistent severe pruritis with scabies
A
Ivermectin x1 followed by another in 1-2 weeks
24
Q
ABX for secondary scabies infection d/t waiting for treatment
A
Cephalexin or Dicloxacillin x 7-10 days
25
Education for scabies
-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
26
Describe pediculosis
lice, spread by close personal contact and causing intense itching and 2-3mm red, erythematous macules or papules
27
Follow-up for pediculosis
-Reevaluate after 1 week, retreat if necessary
-Screen all close contacts for lice
28
Tx for lice
permethrin lotion 1% or 5% cream, nix cream, shampoos (pyrethrin), benzyl alcohol, ivermectin, lindane is second-line
29
Application of permethrin or other topical agents for pediculosis
-Use nit-remover products before application
-Apply to towel-dried, affected area; leave on for 10 minutes and then wash off.
30
Patient education for pediculosis
-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
31
Describe candidiasis
A fungal infection that can affect the mouth, vagina, tip of penis, fingertip (paronychia), or under nail bed
32
Clinical presentation of different kinds of candidiasis
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
33
How are fungal infections usually diagnosed?
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
34
Prescription medications for candidiasis
-Topical antifungals (nystatin, clotrimazole) applied BID for 2-4 weeks
-First line for oral candidiasis: clotrimazole troches 10 mg five times a day
35
Management of paronychia
warm compress, possible I/D, systemic antifungals
36
Topical medications for Tx of candidiasis
Nystatin, clotrimazole, miconazole
37
Describe dermatophytosis
-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
38
Clinical presentation of tinea capitis
painless patchy alopecia; no erythema, "black dot" from broken hair stubbles
39
Clinical presentation of tinea corporis
"ringworm": ringlike lesions with bright red elevated border covered with scales
40
Clinical presentation of tinea cruris
extremely pruritic, lichenification from chronic scratching
41
Considerations when prescribing systemic antifungals
-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
42
Management of dermatophytosis (tinea)
If on scalp & nails: systemic antifungals (Monitor CBC, LFTs)
Topical antifungals ending in '-azole' (miconazole/clotrimazole/ketoconazole)
43
What is onychomycosis?
A benign infection of toenail or fingernail caused by a dermatophyte fungus; causes thickened, dystrophic nails with cloudy to black discoloration
44
Treatment for onychomycosis
Systemic antifungals: Itraconazole or terbinafine
45
What is impitigo?
A highly contagious bacterial infection caused by staph aureus
46
S&S of impetigo
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
47
Topical Tx for impetigo
mupirocin BID x 5 days, chlorhexidine 2-3x/day
48
Systemic Tx for impetigo
-Dicloxacillin or cephalexin x 7 days
49
What to prescribe if suspecting MRSA infection with impetigo?
Systemic ABX: Doxycycline, clindamycin, bactrim
50
Pt education for impetigo
-F/U 14 days
-Handwashing, short nails
-Avoid school/daycare for 24 hours after ABX start
-Wash lesions with antibacterial soap before applying topicals
51
Non-pharmacological management of folliculitis
-Gentle cleansing by washing the skin twice a day with antibacterial soap (Dial)
52
Tx for folliculitis
Topical mupirocin (bactroban), retapamulin, clindamycin, erythromycin, keoconazole for 5-7 days
53
What is a furuncle?
a deep follicle infection often caused by S. aureus; multiple furuncles in a contiguous area are called a carbuncle
54
Difference between carbuncle and furuncle
Furuncle- deep bacterial infection of a hair follicle with abscess formation
Carbuncle- large, multioculated abscess comprising multiple furuncles in a contiguous area
55
Treatment for furuncle verses carbuncle
Furuncle- treat with I&D
Carbuncle- systemic antibiotics such as dicloxacillin, cephalexin, bactrim, or doxycyline
56
Patient education for furuncles and carbuncles
-Do not pop, squeeze, or manipulate furuncles (esp those in upper lip or nasolabial folds) due to risk of cavernous sinus thrombosis
57
What is cellulitis?
a bacterial infection of skin involving dermis and SQ tissue common caused by Streptococcus or S. aureus
58
Rx factors for cellulitis
DM, HIV/AIDS, Drug/alcohol abuse, PVD, chronic steroid use
59
Considerations for determining treatment for cellulitis
-Severity of infection
-Site of infection
-Presence of underlying disease
-Virulence of the pathogen
60
Tx for uncomplicated cellulitis
PCN, clindamycin, cephalexin x5 days; if PCN allergy- clindamycin, azithromycin
If from bite- Augmentin for 2 weeks
61
Pharmacologic recommendations for management of skin and soft tissue infections in primary care
For mild infections: PCN VK, Cephalosporin, Dicloxacillin, Clindamycin PO
For moderate-severe: Emergency department for IV ABX or surgery referral
62
Pt education for cellulitis
-RTC if no improvement in 48 hours or worsening infection
-Elevate affected limb
63
Tx options for warts
First line treatments are 17% salicylic acid and cryotherapy with liquid nitrogen
64
Patient education for warts
-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
65
Common cause of warts
HPV
66
S&S of oral HSV
fever, sore throat, hypersalivation, painful vesicles/ulcers on tongue or in mouth, swollen lymph nodes
67
Diagnostic tests for HSV
Viral culture, DNA studies
68
Tx for HSV 1
ice, lip ointment, OTC topical Abreva, Penciclovir 1% if extensive, Tylenol, oral anesthetics such as xylocaine 2%
69
Tx for HSV2
PO antivirals: Valacyclovir, famcyclovir, warm compress, oatmeal sitz bath, rest, increase fluids
70
Patient information for HSV
-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
71
What is atopic dermatitis?
an inherited skin reaction that usually begins in infancy; also called eczema
72
"Atopic triad"
asthma, allergic rhinitis, and eczema
73
"The itch that rashes"
Atopic dermatitis
74
Objective finding with atopic dermatitis
-Erythema
-Lesions are excoriated, maculopapular, and inflamed
-Symmetrical lesions that are crusting and excoriated
-Later: crusted, scaly, thickened, lichenified
75
What is the primary aim in management of atopic dermatitis?
control signs and symptoms because no cure exists: decrease pruritis, prevent infection
76
DDX for atopic dermatitis
scabies, psoriasis, tinea, allergic reactions
77
Non-pharmacological treatment for atopic dermatitis
HYDRATION!
-mild emollients (cetaphil)
-baths over showers with liberal application of moisturizer after
-avoid soaps with perfumes or coloring agents
-Ointments (vaseline)
-Humidifier
78
Pharmacological management for atopic dermatitis
-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
79
What is the cardinal symptom of contact dermatitis?
a pruritic erythematous rash
80
Patient education for atopic dermatitis
-watch/avoid triggers, avoid allergens, keep living areas cool, reduce sweating
81
Non-pharmacological management for contact dermatitis
Identify cause and avoid
wash with soap and water or with isopropyl alcohol asap after exposure to known irritant (poison ivy/oak)
82
Pharmacological management for contact dermatitis
-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
Patient education for contact dermatitis
-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
Contact dermatitis S&S
pruritis, erythematous rash, rough reddened patches with weeping lesions and tiny vesicles
85
DDx for contact dermatitis
Herpes zoster, impetigo, seborrheic dermatitis
86
S&S of seborrheic dermatitis
pink, scaling rash on face & scalp, may be pruritic; scaly patches, surrounded by erythema with yellow, brown scales or crusts
87
DDx for seborrheic dermatitis
Impetigo, atopic dermatitis, psoriasis, scabies, tinea capitis
88
Management of seborrheic dermatitis
-OTC antidandruff shampoo
-If resistant: prescription shampoo with ketoconazole
-Topical hydrocortisone if significant erythema
89
Patient education for seborrheic dermatitis
-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
What important HPI question to ask with psoriasis?
Any recent strep throat or recent infections
91
Clinical presentation for psoriasis
itchy, red, inflamed and dry, scaly plaques; erythematous plaques surrounded by a thick, silvery scale resembling mica
92
What areas of the body are usually involved in psoriasis?
One or both elbows, knee, buttocks, or scalp
93
Auspitz's sign
multiple sites of bleeding that appear when a psoriatic micaceous scale is removed from the skin
94
DDx for psoriasis
seborrheic dermatitis, lichen planus, atopic dermatitis, candida, syphillis
95
Diagnostics for psoriasis/psoriatic arthritis
CBC, uric acid, throat culture, x-rays
96
Goal of therapy for psoriasis
control the disease so that the patient no longer feels physically or psychologically hindered by the skin lesions
97
Tx for psoriasis
-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
Why is it important to know the potency of topical corticoids?
super potent choices for exacerbation should not be used for more than 2 weeks; a weaker corticosteroid is used for maintenance therapy
99
Labs to monitor if prescribing methotrexate
CBC/platelets, renal, liver (weekly at first, then monthly)
100
When to refer psoriasis to dermatology?
newly diagnoses patients or patients who have moderate to extensive skin involvement or severe disease
101
Medications to avoid in psoriasis
tetracyclines, sulfa, phenothiazines due to risk of sunburn; avoid trauma to skin
102
What is acne vulgaris?
inflammatory condition of sebaceous gland & accompanying hair follicle; characterized by comedones and dry, irritated skin
103
S&S of severe Nodulocystic acne
lesions are nodules & cysts; always result in scar formation/keloids
104
What diagnosis should a female be evaluated for if diagnosed with severe acne?
PCOS
105
DDx for acne vulgaris
Rosacea, folliculitis, perioral dermatitis
106
Commonly prescribed medications for acne
First line- benzoyl peroxide
Tretinoin (Retin-A)- topical retinoid
Topical abx- clindamycin/erythromycin
107
When to consider topicals versus systemic treatments for acne vulgaris
-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
What are the concerns with prescribing tretinoin?
-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
S&S of rosacea
burning, itching, stinging sensation on face; rosy hue with inflammatory papules
110
Management of rosacea
topical metronidazole cream for 6-8 weeks
111
What is seborrheic keratosis?
a benign warty-appearing growth most common noncancerous growth in older adults
112
Where is seborrheic keratosis most likely to appear?
non-sun exposed skin
113
ABCDEs for skin malignancy: A
Asymmetry: one half does not match the other
114
ABCDEs for skin malignancy: B
Border: the edges are irregular, ragged, notched, or blurred
115
ABCDEs for skin malginancy: C
Color: the mole is not evenly colored. It may include shades of brown or black, or patches of pink, red, white, or blue
116
ABCDEs for skin malignancy: D
Diameter: the spot is larger than 6mm across
117
ABCDEs for skin malignancy: E
Evolving: the mole is changing in size, shape, or color
118
What is actinic keratosis?
the most common pre-cancerous lesion found in light skinned patients on sun-exposed areas
119
Clinical presentation of actinic keratosis
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
What is malignant melanoma?
malignancy arising from epidermal melanocytes; prognosis very poor if >4mm in depth
121
Clinical presentation of malignant melanoma
-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
Risk factors for malignant melanoma
-Increased age
-light colored eyes, red or blond hair
-congenital nevi greater than 20 mm
-blistering sunburn
-Excessive outdoor exposure
-Indoor tanning
123
Management of malignant melanoma
-Referral to dermatology
-Mohs surgery
-Chemotherapy
-Radiation (only palliative)
-Biologic therapy
124
S&S of BCC
spot/bump that is getting bigger or a sore that isn't healing; often on face, ears, cheeks, nose, neck
125
What is the most common type of skin cancer?
basal cell carcinoma
126
BCC vs SCC
BCC- shiny, pearly papule or nodule with umbilicated center; grows slowly
SCC: hyperkeratotic lesion with crusting and ulceration; more aggressive than BCC
127
DDX for easy bruising
-Chronic corticosteroid use
-Anticoagulant therapy
-Thrombocytopenia
-Hemolytic anemia
-Violence/trauma
-Hypersensitivity vasculitis
128
Expected MCV
82-90
129
Define microcytic anemia
RBCs are small in size
130
DDx for lymphadenopathy
acute infection, HIV, lymphoma, cancer
131
What is RDW?
red cell distribution
132
What is MCHC?
mean corpuscular HGB concentration
133
What is the lifespan of an RBC?
120 days
134
Where are RBCs formed?
bone marrow
135
What could a high reticulocyte number indicate?
hemolytic anemia
136
Name some microcytic anemias?
iron-deficiency, thalassemias, chronic disease anemias, sideroblastic anemia
137
What is the most common cause of microcytic anemia?
iron-deficiency
138
What could be the causes of iron-deficiency anemia?
-malabsorption (IBS, Crohn's, Hx blockers, resections)
139
Tx and follow up for iron-deficiency anemia?
-Increase dietary iron, supplemental iron, recheck RBC in 2-4 weeks
140
Foods high in iron
animal proteins, legumes, dark green leafy vegetables like spinach
141
S&S of microcytic anemias
tachycardia, palpitations, fatigue, SOB, dizziness, pallor, Brittle nails, pale mucous membranes
142
Causes of normocytic anemias
Acute blood loss, sepsis, mechanical shearing, aplastic anemia, chronic diseases; something is causing reduced RBC lifespan
143
Tx for normocytic anemia
-Recombinant erythropoietin, procrit
-Manage cause/symptoms
144
When to follow up with patients who have normocytic anemia
6 months - CBC and reticulocyte count
145
What is MCV?
mean corpuscular volume or size of RBCs
146
What are some types or causes of macrocytic anemia?
-Vitamin B12 deficiency/pernicious
-Folate deficiency
-Antimetabolite drugs
-liver disease, chronic alcholism, decreased thiamine
147
Tx for macrocytic anemia
-Identify and treat cause (PO or IM B12 supplements, or folic acid supplements)
148
Clinical presentation for someone with macrocytic anemia
-Glossitis, nausea, anorexia, diarrhea, neuropathies, malaise
-pale mucosa
-decreased DTRs
-Variable Babinski sign
149
Follow up for macrocytic anemia
-CBC, B12
-Folate levels every 2-3 months while on therapy
-Hematology
150
What foods are rich in B12?
dark leafy greens, meat, fish, dairy
151
What is sickle cell anemia?
-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
S&S of sickle cell anemia
Pain, anemia, nausea, anorexia, SOB, low-grade fever, point tenderness, pinpoint pupils, jaundice, leg ulcers
153
Cardinal sign of sickle cell crisis
pain that appears suddenly in back, chest, abdomen, or extremities and is excruciating
154
Management for sickle cell
-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
Follow up for sickle cell
-X3 months: CBC, glucose, electrolytes, UA, 12-lead annualy
-Hematology f/u every 6 months
156
Diagnostics for sickle cell
CBC, peripheral smear, CMP, WBC, bilirubin
157
What is polycythemia?
increase in erythrocyte number or concentration, increased blood viscosity
158
What is the most common cause of polycythemia?
dehydration
159
S&S of polycythemia?
Hx of pulmonary dx, headaches, blurred vision, weakness, fatigue, epistaxis, tinnitis, erythromelalgia (burning hands/feet), PUD, dark mucous membranes
160
Management of polycythemia
-rehydration/adjust dose of diuretics if necessary
-phlebotomy if Hct > 55-60% to prevent thrombosis
-treat underlying cause
-Antiplatelet agents- aspirin
161
Follow-up for absolute polycythemia
Weekly CBC, hematology, surgery referral if necessary
162
CBC findings for acute leukemias
-WBC very elevated > 300,000
-Low granulocytes <50,000
-Low PLT
-Low Hct < 30%
-Blastocytosis > 25%
163
CBC findings for chronic leukemias
-WBC elevated >100,000
-Lymphocytes > 90% in CLL
-left shift of myeloids with CML
164
Which leukemias are more common in adults?
AML, CML, CLL
165
General S&S of chronic leukemia
fatigue, night sweats, low-grade fevers, adventitious lung sounds, splenomegaly, hepatomegaly, lymphadenopathy
166
S&S of acute leukemia
bone/joint pain, fever, chills, palpitations, SOB, S&S of infection, tachycardia, pale, petechia, purpura, confusion
167
A type 1 allergic reaction is mediated by what?
IgE
168
Examples of a type 1 allergic reaction
allergic rhinitis, asthma, anaphylaxis
169
Example of a type 2 allergic reaction?
Neonatal Rh incompatability
170
Examples of a type 3 (antibody-allergen) allergic reaction
Drug reaction to phenytoin, phenobarbital, carbamazepine,
171
Example of type 4 (delayed-cellular hypersensitivity) allergic reaction
-T-cell dependent- TB skin test
172
Anaphylaxis managment (Seven-step approach)
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
What is rheumatoid arthritis?
a chronic, progressive, systemic inflammation affecting synovial joins
174
S&S of RA
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
Preferred initial test for diagnosis of RA
measurement of peripherally circulating RF, an IgM class antibody
176
Difference between chronic pain syndrome (CFS) and fibromyalgia
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
Role of exercise for fibromyalgia/CMS
increases quality of life
178
Initial management of RA
PT/OT, heat/cold compress, exercise, rest, splints, weight loss, OTC pain medications/NSAIDs
179
Follow up/referral for RA
-routine labs x3mo
-Referral to rheumatologist if initial managment fails
180
What is Sjogren's syndrome?
A chronic inflammatory autoimmune disease caused by exocrine dysfunction, dryness to all areas where exocrine glans are associated with mucous membranes
181
S&S of Sjogren's syndrome
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
Diagnostics for SS
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
Management of Sjogren's
saline drops, hard candies/gum, avoid caffeine or alcohol, special toothpastes or mouthwashes
-Medications: pilocarpine 5 mg PO TID, acetylcysteine
184
Diagnostics for SLE
-CBC/plt, BMP, albumin, ANA, urinalysis, screening test for antibodies
185
S&S of systemic lupus erythematosus
-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
What virus is the most common cause of mononucleosis?
Epstein-Barr virus
187
Clinical presentation for infectious mononucleosis
-prolonged malaise & fatigue, fever, sore throat, tender cervical lymphadenopathy (specifically posterior), nuchal stiffness, enlarged tonsils, possible rash
188
Management of mononucleosis
Supportive care with NSAIDs or tylenol, hydration & nutrition, gargle warm salt water
189
Follow up for mononucleosis
-Risk for splenic rupture! follow-up regularly
190
Patient education with mononuclosis
-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
What is the cause of lyme disease?
tick bite
192
Early vs late signs of lyme diease
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
Guidelines for initiating antibiotic therapy for Lyme's disease
-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
Risk factors for developing HIV
-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
What physical findings should prompt consideration of HIV testing?
-Persistent generalized lymphadenopathy
-Localized candida
-STIs
-Weight loss
-Cytopenias
196
What is the significance of the HIV viral load?
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
What is the recommended initial screening for HIV?
-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
Risk groups for HIV that should be started on PrEP
-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
What are the initial and monitoring tests you order prior to PrEP?
-HIV testing
-HBV serology
-Hep C virus serology
-serum chemistry for estimation of renal function
200
PrEP medication
emtricitabine 200 mg/tenovir 300 mg (Truvada)
201
Who would not be a candidate for PrEP?
-Already HIV positive
-creatinine clearance lower than 60 mL/min
202
Risk factors for individuals who should be started on post-exposure prophylaxis
-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
Auspitz's sign
multiple sites of bleeding that appear when a psoriatic micaceous scale is removed from the skin
