Exam 1 Flashcards
Types of alopecia
Scarring and Nonscarring
Medications for treating alopecia
Finasteride (Propecia), Minoxidil (Rogaine)
Finasteride (Propecia) considerations
Use in men only because causes birth defects in women; check liver functions. SE includes ED
Side effects of Minoxidil (Rogaine)
pruritis, dryness, scaling, hypertrichosis (excessive body hair)
Describe vitiligo
Loss of color in patchy areas of body; white macules/patches of sun-exposed skin often caused by autoimmune diseases
Describe Chloasma
“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
Dx for chloasma
PMH/HPI, Wood’s lamp to visualize excess melanin in epidermis
Describe melasma
Darker patches to any area regardless of pregnancy; causes by sun exposure and hormone changes
Dx for melasma
PMH, hormone levels
What drugs can cause drug-induced skin pigmentation changes?
amiodarone, chlorpromazine, antimalarials
Describe the skin pigmentation changes in addison’s disease
Increased pigmentation on skin creases, skin folds, palmar creases, pressure points
What systemic diseases can cause pruritis?
CKD, hyperbilirubinemia
HPI for rash
Onset, spread, change, associated symptoms (pruritis, pain), Food or medications, Atopic hx, infectious disease exposure, systemic symptoms
Define urticaria
An IgE reaction causing hives or wheals associated with severe itching; ANGIOEDEMA is considered a type of urticaria
Management of urticaria
-Isolate, treat cause
-Avoid ASA, ACE inhibitors, NSAIDs
-Avoid allergens
Medication for management of urticaria
Antihistamines: hydroxyzine, diphenhydramine, loratadine, cetirizine
Vesicle vs Bulla
Vesicle- < 0.5 cm in diameter
Bulla- > 0.5 cm in diameter
Describe scabies
highly contagious mite infestation causing intractable pruritis that is worse at night between fingers, periumbilic, ankles, axilla, pelvis
Objective finding for scabies
1-2mm red papules with crusting/scaling from scratching’ intraepidermal burrow
Diagnostics for scabies
Burrow ink test with microscope identification
Symptom management for scabies
Antihistamines and topical steroids to help with pruritis
1st line treatment for scabies
permethrin
Tx for persistent severe pruritis with scabies
Ivermectin x1 followed by another in 1-2 weeks
ABX for secondary scabies infection d/t waiting for treatment
Cephalexin or Dicloxacillin x 7-10 days
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
Describe pediculosis
lice, spread by close personal contact and causing intense itching and 2-3mm red, erythematous macules or papules
Follow-up for pediculosis
-Reevaluate after 1 week, retreat if necessary
-Screen all close contacts for lice
Tx for lice
permethrin lotion 1% or 5% cream, nix cream, shampoos (pyrethrin), benzyl alcohol, ivermectin, lindane is second-line
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.
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
Describe candidiasis
A fungal infection that can affect the mouth, vagina, tip of penis, fingertip (paronychia), or under nail bed
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
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
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
Management of paronychia
warm compress, possible I/D, systemic antifungals
Topical medications for Tx of candidiasis
Nystatin, clotrimazole, miconazole
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
Clinical presentation of tinea capitis
painless patchy alopecia; no erythema, “black dot” from broken hair stubbles
Clinical presentation of tinea corporis
“ringworm”: ringlike lesions with bright red elevated border covered with scales
Clinical presentation of tinea cruris
extremely pruritic, lichenification from chronic scratching
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
Management of dermatophytosis (tinea)
If on scalp & nails: systemic antifungals (Monitor CBC, LFTs)
Topical antifungals ending in ‘-azole’ (miconazole/clotrimazole/ketoconazole)
What is onychomycosis?
A benign infection of toenail or fingernail caused by a dermatophyte fungus; causes thickened, dystrophic nails with cloudy to black discoloration
Treatment for onychomycosis
Systemic antifungals: Itraconazole or terbinafine
What is impitigo?
A highly contagious bacterial infection caused by staph aureus
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
Topical Tx for impetigo
mupirocin BID x 5 days, chlorhexidine 2-3x/day
Systemic Tx for impetigo
-Dicloxacillin or cephalexin x 7 days
What to prescribe if suspecting MRSA infection with impetigo?
Systemic ABX: Doxycycline, clindamycin, bactrim
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
Non-pharmacological management of folliculitis
-Gentle cleansing by washing the skin twice a day with antibacterial soap (Dial)
Tx for folliculitis
Topical mupirocin (bactroban), retapamulin, clindamycin, erythromycin, keoconazole for 5-7 days
What is a furuncle?
a deep follicle infection often caused by S. aureus; multiple furuncles in a contiguous area are called a carbuncle
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
Treatment for furuncle verses carbuncle
Furuncle- treat with I&D
Carbuncle- systemic antibiotics such as dicloxacillin, cephalexin, bactrim, or doxycyline
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
What is cellulitis?
a bacterial infection of skin involving dermis and SQ tissue common caused by Streptococcus or S. aureus
Rx factors for cellulitis
DM, HIV/AIDS, Drug/alcohol abuse, PVD, chronic steroid use
Considerations for determining treatment for cellulitis
-Severity of infection
-Site of infection
-Presence of underlying disease
-Virulence of the pathogen
Tx for uncomplicated cellulitis
PCN, clindamycin, cephalexin x5 days; if PCN allergy- clindamycin, azithromycin
If from bite- Augmentin for 2 weeks
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
Pt education for cellulitis
-RTC if no improvement in 48 hours or worsening infection
-Elevate affected limb
Tx options for warts
First line treatments are 17% salicylic acid and cryotherapy with liquid nitrogen
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
Common cause of warts
HPV
S&S of oral HSV
fever, sore throat, hypersalivation, painful vesicles/ulcers on tongue or in mouth, swollen lymph nodes
Diagnostic tests for HSV
Viral culture, DNA studies
Tx for HSV 1
ice, lip ointment, OTC topical Abreva, Penciclovir 1% if extensive, Tylenol, oral anesthetics such as xylocaine 2%
Tx for HSV2
PO antivirals: Valacyclovir, famcyclovir, warm compress, oatmeal sitz bath, rest, increase fluids
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
What is atopic dermatitis?
an inherited skin reaction that usually begins in infancy; also called eczema
“Atopic triad”
asthma, allergic rhinitis, and eczema
“The itch that rashes”
Atopic dermatitis
Objective finding with atopic dermatitis
-Erythema
-Lesions are excoriated, maculopapular, and inflamed
-Symmetrical lesions that are crusting and excoriated
-Later: crusted, scaly, thickened, lichenified
What is the primary aim in management of atopic dermatitis?
control signs and symptoms because no cure exists: decrease pruritis, prevent infection
DDX for atopic dermatitis
scabies, psoriasis, tinea, allergic reactions
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
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
What is the cardinal symptom of contact dermatitis?
a pruritic erythematous rash
Patient education for atopic dermatitis
-watch/avoid triggers, avoid allergens, keep living areas cool, reduce sweating
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)
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
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
Contact dermatitis S&S
pruritis, erythematous rash, rough reddened patches with weeping lesions and tiny vesicles
DDx for contact dermatitis
Herpes zoster, impetigo, seborrheic dermatitis
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
DDx for seborrheic dermatitis
Impetigo, atopic dermatitis, psoriasis, scabies, tinea capitis
Management of seborrheic dermatitis
-OTC antidandruff shampoo
-If resistant: prescription shampoo with ketoconazole
-Topical hydrocortisone if significant erythema
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
What important HPI question to ask with psoriasis?
Any recent strep throat or recent infections
Clinical presentation for psoriasis
itchy, red, inflamed and dry, scaly plaques; erythematous plaques surrounded by a thick, silvery scale resembling mica
What areas of the body are usually involved in psoriasis?
One or both elbows, knee, buttocks, or scalp
Auspitz’s sign
multiple sites of bleeding that appear when a psoriatic micaceous scale is removed from the skin
DDx for psoriasis
seborrheic dermatitis, lichen planus, atopic dermatitis, candida, syphillis
Diagnostics for psoriasis/psoriatic arthritis
CBC, uric acid, throat culture, x-rays
Goal of therapy for psoriasis
control the disease so that the patient no longer feels physically or psychologically hindered by the skin lesions
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
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
Labs to monitor if prescribing methotrexate
CBC/platelets, renal, liver (weekly at first, then monthly)
When to refer psoriasis to dermatology?
newly diagnoses patients or patients who have moderate to extensive skin involvement or severe disease
Medications to avoid in psoriasis
tetracyclines, sulfa, phenothiazines due to risk of sunburn; avoid trauma to skin
What is acne vulgaris?
inflammatory condition of sebaceous gland & accompanying hair follicle; characterized by comedones and dry, irritated skin
S&S of severe Nodulocystic acne
lesions are nodules & cysts; always result in scar formation/keloids
What diagnosis should a female be evaluated for if diagnosed with severe acne?
PCOS
DDx for acne vulgaris
Rosacea, folliculitis, perioral dermatitis
Commonly prescribed medications for acne
First line- benzoyl peroxide
Tretinoin (Retin-A)- topical retinoid
Topical abx- clindamycin/erythromycin
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
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
S&S of rosacea
burning, itching, stinging sensation on face; rosy hue with inflammatory papules
Management of rosacea
topical metronidazole cream for 6-8 weeks
What is seborrheic keratosis?
a benign warty-appearing growth most common noncancerous growth in older adults
Where is seborrheic keratosis most likely to appear?
non-sun exposed skin
ABCDEs for skin malignancy: A
Asymmetry: one half does not match the other
ABCDEs for skin malignancy: B
Border: the edges are irregular, ragged, notched, or blurred
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
ABCDEs for skin malignancy: D
Diameter: the spot is larger than 6mm across
ABCDEs for skin malignancy: E
Evolving: the mole is changing in size, shape, or color
What is actinic keratosis?
the most common pre-cancerous lesion found in light skinned patients on sun-exposed areas
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
What is malignant melanoma?
malignancy arising from epidermal melanocytes; prognosis very poor if >4mm in depth
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
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
Management of malignant melanoma
-Referral to dermatology
-Mohs surgery
-Chemotherapy
-Radiation (only palliative)
-Biologic therapy
S&S of BCC
spot/bump that is getting bigger or a sore that isn’t healing; often on face, ears, cheeks, nose, neck
What is the most common type of skin cancer?
basal cell carcinoma
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
DDX for easy bruising
-Chronic corticosteroid use
-Anticoagulant therapy
-Thrombocytopenia
-Hemolytic anemia
-Violence/trauma
-Hypersensitivity vasculitis
Expected MCV
82-90
Define microcytic anemia
RBCs are small in size
DDx for lymphadenopathy
acute infection, HIV, lymphoma, cancer
What is RDW?
red cell distribution
What is MCHC?
mean corpuscular HGB concentration
What is the lifespan of an RBC?
120 days
Where are RBCs formed?
bone marrow
What could a high reticulocyte number indicate?
hemolytic anemia
Name some microcytic anemias?
iron-deficiency, thalassemias, chronic disease anemias, sideroblastic anemia
What is the most common cause of microcytic anemia?
iron-deficiency
What could be the causes of iron-deficiency anemia?
-malabsorption (IBS, Crohn’s, Hx blockers, resections)
Tx and follow up for iron-deficiency anemia?
-Increase dietary iron, supplemental iron, recheck RBC in 2-4 weeks
Foods high in iron
animal proteins, legumes, dark green leafy vegetables like spinach
S&S of microcytic anemias
tachycardia, palpitations, fatigue, SOB, dizziness, pallor, Brittle nails, pale mucous membranes
Causes of normocytic anemias
Acute blood loss, sepsis, mechanical shearing, aplastic anemia, chronic diseases; something is causing reduced RBC lifespan
Tx for normocytic anemia
-Recombinant erythropoietin, procrit
-Manage cause/symptoms
When to follow up with patients who have normocytic anemia
6 months - CBC and reticulocyte count
What is MCV?
mean corpuscular volume or size of RBCs
What are some types or causes of macrocytic anemia?
-Vitamin B12 deficiency/pernicious
-Folate deficiency
-Antimetabolite drugs
-liver disease, chronic alcholism, decreased thiamine
Tx for macrocytic anemia
-Identify and treat cause (PO or IM B12 supplements, or folic acid supplements)
Clinical presentation for someone with macrocytic anemia
-Glossitis, nausea, anorexia, diarrhea, neuropathies, malaise
-pale mucosa
-decreased DTRs
-Variable Babinski sign
Follow up for macrocytic anemia
-CBC, B12
-Folate levels every 2-3 months while on therapy
-Hematology
What foods are rich in B12?
dark leafy greens, meat, fish, dairy
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
S&S of sickle cell anemia
Pain, anemia, nausea, anorexia, SOB, low-grade fever, point tenderness, pinpoint pupils, jaundice, leg ulcers
Cardinal sign of sickle cell crisis
pain that appears suddenly in back, chest, abdomen, or extremities and is excruciating
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
Follow up for sickle cell
-X3 months: CBC, glucose, electrolytes, UA, 12-lead annualy
-Hematology f/u every 6 months
Diagnostics for sickle cell
CBC, peripheral smear, CMP, WBC, bilirubin
What is polycythemia?
increase in erythrocyte number or concentration, increased blood viscosity
What is the most common cause of polycythemia?
dehydration
S&S of polycythemia?
Hx of pulmonary dx, headaches, blurred vision, weakness, fatigue, epistaxis, tinnitis, erythromelalgia (burning hands/feet), PUD, dark mucous membranes
Management of polycythemia
-rehydration/adjust dose of diuretics if necessary
-phlebotomy if Hct > 55-60% to prevent thrombosis
-treat underlying cause
-Antiplatelet agents- aspirin
Follow-up for absolute polycythemia
Weekly CBC, hematology, surgery referral if necessary
CBC findings for acute leukemias
-WBC very elevated > 300,000
-Low granulocytes <50,000
-Low PLT
-Low Hct < 30%
-Blastocytosis > 25%
CBC findings for chronic leukemias
-WBC elevated >100,000
-Lymphocytes > 90% in CLL
-left shift of myeloids with CML
Which leukemias are more common in adults?
AML, CML, CLL
General S&S of chronic leukemia
fatigue, night sweats, low-grade fevers, adventitious lung sounds, splenomegaly, hepatomegaly, lymphadenopathy
S&S of acute leukemia
bone/joint pain, fever, chills, palpitations, SOB, S&S of infection, tachycardia, pale, petechia, purpura, confusion
A type 1 allergic reaction is mediated by what?
IgE
Examples of a type 1 allergic reaction
allergic rhinitis, asthma, anaphylaxis
Example of a type 2 allergic reaction?
Neonatal Rh incompatability
Examples of a type 3 (antibody-allergen) allergic reaction
Drug reaction to phenytoin, phenobarbital, carbamazepine,
Example of type 4 (delayed-cellular hypersensitivity) allergic reaction
-T-cell dependent- TB skin test
Anaphylaxis managment (Seven-step approach)
- Epi 1:1000 0.3-0.5mg IM
- repeat every 5-15 minutes
- Albuterol for bronchodilation
- Intubation
- NS/LR if hypotension
- Benadryl/H2 blockers if conscious
- Transfer to emergency
What is rheumatoid arthritis?
a chronic, progressive, systemic inflammation affecting synovial joins
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
Preferred initial test for diagnosis of RA
measurement of peripherally circulating RF, an IgM class antibody
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
Role of exercise for fibromyalgia/CMS
increases quality of life
Initial management of RA
PT/OT, heat/cold compress, exercise, rest, splints, weight loss, OTC pain medications/NSAIDs
Follow up/referral for RA
-routine labs x3mo
-Referral to rheumatologist if initial managment fails
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
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
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
Management of Sjogren’s
saline drops, hard candies/gum, avoid caffeine or alcohol, special toothpastes or mouthwashes
-Medications: pilocarpine 5 mg PO TID, acetylcysteine
Diagnostics for SLE
-CBC/plt, BMP, albumin, ANA, urinalysis, screening test for antibodies
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
What virus is the most common cause of mononucleosis?
Epstein-Barr virus
Clinical presentation for infectious mononucleosis
-prolonged malaise & fatigue, fever, sore throat, tender cervical lymphadenopathy (specifically posterior), nuchal stiffness, enlarged tonsils, possible rash
Management of mononucleosis
Supportive care with NSAIDs or tylenol, hydration & nutrition, gargle warm salt water
Follow up for mononucleosis
-Risk for splenic rupture! follow-up regularly
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
What is the cause of lyme disease?
tick bite
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
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
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
What physical findings should prompt consideration of HIV testing?
-Persistent generalized lymphadenopathy
-Localized candida
-STIs
-Weight loss
-Cytopenias
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
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
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
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
PrEP medication
emtricitabine 200 mg/tenovir 300 mg (Truvada)
Who would not be a candidate for PrEP?
-Already HIV positive
-creatinine clearance lower than 60 mL/min
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
Auspitz’s sign
multiple sites of bleeding that appear when a psoriatic micaceous scale is removed from the skin
