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Clinical Medicine I > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Leukoplakia

A

adherent white patches/plaques on oral mucosa or tongue
not painful
can present as erythroplakia (red) or leukoerythroplakia (speckled)

*tobacco and alcohol use

Treatment: refer to ENT for biopsy and monitor closely

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2
Q

Squamous Cell Carcinoma (SCC)

A

ulcers or masses that do not heal
*exophytic (protruding outward) lesions on tongue and lip that are often painful

*tobacco and alcohol use

Treatment: refer to ENT for surgical resection or radiation/chemo –> poor prognosis

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3
Q

Melanoma

A

*if pigmented oral lesion, MUST consider melanoma in DDx
ABCD’s
often 5th - 7th decade and often missed

Treatment: excision with clear margins, radiation

note - amalgam tattoo DDx look for dental filling nearby

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4
Q

Mucoceles

A

pinkish/blue soft papules/nodules filled with gelatinous fluid
variable size
may rupture spontaneously

Treatment: generally asymptomatic and resolve on their own via reabsorption or rupture
cryotherapy or excision if necessary

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5
Q

Herpes Simplex Virus (HSV)

A

etiology: HSV-1 via direct contact
sunlight, trauma, stress
painful grouped vesicles on an erythematous base on buccal mucosa

recurrent infection generally on skin surface, not mucosa
burning/pain/tingling prodrome

Treatment: antiviral at onset of prodrome (acyclovir, valacyclovir, famciclovir)
supportive care (fluids, analgesics, miracle mouthwash)

note - herpes zoster is unilateral/dermatomal on palate

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6
Q

Coxsackie Virus (hand, foot, mouth)

A

painful oral lesions, but tends to spare gingiva and lips (unlike HSV)
palmar/plantar lesions - pale, oval-shaped papules with rim of erythema

Treatment: supportive (hydration and analgesics)
lesions resolve 5-6 days

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7
Q

Oropharyngeal Candidiasis (Thrush)

A

etiology: Candida albicans (yeast)
opportunistic infection

mouth pain/sore throat
creamy white patches/plaques with underlying erythematous mucosa
“THRUSH WILL BRUSH”
KOH prep

Treatment: topical (nystatin suspension or troche, clotrimazole troche)
patient education (clean dentures and rinse mouth after using inhaler)
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8
Q

Erythema Multiforme Major

A

acute, immune-mediated condition (HLA gene)
etiology: commonly HSV

target-like lesions on skin
mucosal erythema
painful, burning erosions or bullae
70% oral

Treatment: self-limiting (2 weeks)
symptomatic relief (topical corticosteroid or oral antihistamine)
*refer if ocular involvement

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9
Q

Stevens-Johnson Syndrome (SJS)

A

etiology: med induced (sulfa, NSAIDs, etc.)

prodrome of flu-like sxs 1-3 days
tender, erythematous pruritic macules, vesicles
edema of lips
SKIN SLOUGHING
conjunctivitis

Treatment: discontinue medication, corticosteroids (ie. Prednisone)
*Bacteremia is highest risk of death

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10
Q

Pemphigus

A

vulgaris is most common form
life-threatening blistering disorder
etiology: autoimmune, idiopathic, or drug-induced

FLACCID bullae that will spread when pressed
*Nikolsky sign - gentle application of pressure in uninvolved layer = sloughing –> early acantholysis

Treatment: systemic corticosteroids, immunosuppressive agents, antibiotics for secondary infection

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11
Q

Pemphigoid

A

chronic autoimmune blistering disorder (less severe than pemphigus)

prodrome of pruritic eczematous, urticaria-like lesions
TENSE bullae (deeper in dermis)

Treatment: topical or systemic corticosteroids

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12
Q

Aphthous Ulcers

A

“canker sores”
recurrent aphthous stomatitis most common cause of mouth ulcers

shallow, round/oval, painful with grayish base on buccal and labial mucosa (single or multiple)

Treatment: typically heals in 10-14 days
symptomatic relief with topical steroid (ie. triamcinolone)

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13
Q

Behcet’s Syndrome

A

recurrent oral and genital ulcers (3+/yr)
painful, shallow or deep with central yellow necrotic base
often multiple

Treatment: refer to rheumatology

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14
Q

Oral Lichen Planus

A

etiology: chronic inflammatory disorder
reticular - *Wickham’s striae (lacy, thin white plaques)
erythematous and erosive = painful

Treatment: pain relief, topical corticosteroids, refer to ENT

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15
Q

Black Hairy Tongue (Lingua villosa nigra)

A

BENIGN associated with antibiotics, candida infection or poor oral hygiene

elongated filiform papillae
yellow-white to brown dorsal tongue surface

Treatment: BRUSH

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16
Q

etiology: unknown
erythematous patches on dorsal tongue with circumferential white borders

Treatment: reassurance

A

Geographic Tongue ( Benign migratory glossitis)

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17
Q

etiology: nutritional deficiency, dry mouth, oral candida
*atrophy of filiform pupillae
tongue appears smooth, glossy, erythematous

Treatment: address underlying condition

A

Atrophic Glossitis

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18
Q

heat/moisture, trauma, associated skin disease
bacterial (pseudomonas or staph) or fungal

ear pain (movement of tragus)
pruritic, erythematous, edematous
pseudomonas discharge = green
staph = yellow
fungal = fluffy white or black
decreased hearing

Treatment: fungal - Clotrimazole 1% soln
bacterial - cortisporin or ofloxacin otic soln if TM perf
pain control

A

Otitis Externa (“swimmer’s ear”)

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19
Q

DM and immunocompromised pts
*Pseudomonas infection

intense otalgia and otorrhea
red, granulated tissue of EAC
trismus, edema, LAD

Treatment: IV Ciprofloxacin

A

Malignant Otitis Externa

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20
Q

etiology: strep pneumoniae, H. influenzae, M. catarrhalis
peak incidence 6-18 months
usually precipitated by URI

+/- fever
otalgia - “tugging” on the ear
N/V and otorrhea
conjunctivitis (H. influenza)

opaque/reddened BULGING TM, decreased mobility
*check for conductive hearing loss

Treatment: antibiotics for all under 6mo
6-23mo if bilateral or severe sxs
older than 24mo if dx certain and illness severe
*otherwise, observation and follow-up

Amoxicillin (high dose) 80-90mg/kg/day divided Q12 x7-10d
*Augmentin if antibiotics in past 30d or conjunctivitis
*Cef drugs if PCN allergy - IV daily x3d
tympanostomy tubes for recurrent AOM

A

Acute Otitis Media (AOM)

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21
Q

etiology: recurrent OM, trauma or cholesteatoma (accumulation of epithelial cells in middle ear)
pseudomonas, MRSA

otorrhea >2wks and associated TM perf
conductive hearing loss

Treatment: refer to ENT

A

Chronic Otitis Media

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22
Q

postauricular pain
edema, fever
erythema
protrusion of pinna

Treatment: IV antibiotics, mastoidectomy if needed

A

Mastoiditis

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23
Q

etiology: viral URI, AOM, AR

ear fullness and decreased hearing
pt afebrile (not acutely ill) - no infection associated with fluid in the ear
neutral or retracted TM - TYPE B tympanogram
conductive hearing loss

Treatment: “watchful waiting”, intranasal steroids if underlying AR

A

Otitis Media with Effusion

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24
Q

inflammation or blockage resulting in negative middle ear pressure
ear fullness and hearing loss
retracted TM - TYPE C tympanogram

Treatment: steroid nasal spray
topical nasal decongestant (ie. Afrin) but limit to 3 days or rebound congestion

A

Eustachian Tube Dysfunction

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25
Q

discomfort or damage to ear due to pressure difference
ear fullness
pain
tinnitus
hemotympanum (bloody otorrhea) if TM perf

Treatment: supportive

A

Ear Barotrauma

26
Q

benign acute inflammation/infection of vestibular system
may follow AOM and/or precede URI

N/V
acute onset severe vertigo
horizontal nystagmus
+ head thrust (cannot maintain visual fixation)

Treatment: symptomatic (bed rest, hydration)
meclizine (Antivert) 25mg TID
benzodiazepines

A

Labyrinthitis

27
Q

etiology: inherited hyper-responsiveness to allergen exposure (IgE antibodies)

rhinorrhea
sneezing
itchy eyes and nose (allergic salute)
nasal congestion
pale, “blue” mucosa and clear discharge
Allergic Shiners - bluish, purple ring around eyes
Denie Morgans lines - skin folds under eyes

ImmunoCAP - IgE or scratch skin testing (wheal&flare)

Treatment: avoid allergens
topical intranasal corticosteroids (Flonase, Nasocort)
antihistamines (Benadryl 25-50mg BID or Claritin/Allegra)
decongestants (Sudafed)
immunotherapy (last resort)

A

Allergic Rhinitis (AR)

28
Q

Stress, sex, perfume, etc. induced
normal IgE and nasal mucosa
nasal congestion
rhinorrhea

Treatment: avoid triggers
topical steroids, antihistamines and anticholinergics

A

Vasomotor (non-allergic) Rhinitis

29
Q

nasal congestion/obstruction
non-tender soft grey tissue growths

Treatment: intranasal glucocorticoids
refer to ENT if obstructive

A

Nasal Polyps

30
Q

tachyphylaxis with overuse of topical decongestants (decreased response to successive doses of drug)
REBOUND CONGESTION
nasal mucosa is erythematous

Treatment: discontinue med and intranasal glucocorticoid

A

Rhinitis Medicamentosa

31
Q

etiology: adults- rhinovirus, coronavirus
peds- parainfluenza virus

rhinitis/congestions
sore throat
hacking cough
mild headache and fatigue
\+/- fever
nasal mucosa edema and pharyngeal erythema
clear lungs

Treatment: supportive (analgesics, antihistamines)
1-2 wk duration, pt education

A

Common Cold

32
Q

etiology: influenza virus type A (most severe) and B

abrupt onset fever
prominent headache
general aches/pains and fatigue
coughing
PND (post nasal drainage)
hot, dry skin and flushing

Diagnostics: RAT (rapid antigen tests), viral culture

Treatment: antiviral (Tamiflu PO, Relenza inhalation)

A

Influenza

33
Q

etiology: group A strep or virus

cervical LAD
sore throat
fever
headache
*palatal petechiae
purulent exudate
tonsillar hypertrophy
Dx Group A Strep (3 of 4):
pharyngeal exudates
cervical LAD
fever
lack of cough/rhinorrhea

Non-group A treatment: supportive
HSV - acyclovir, famcyclovir
Gonnorhea - ceftriazone

Group A treatment: PCN-V 500mg po BID-TID x10d
*clindamycin if PCN allergy

A

Pharyngitis/Tonsillitis

34
Q

severity of sore throat out of proportion
stridor/resp. distress
peritonsillar abscess
trismus

Tonsillectomy if:
7+ episodes in 1 year
5+ episodes in each of past 2 years
3+ episodes in each of past 3 years

A

Emergent Acute Pharyngitis

35
Q

etiology: polymicrobial (group A step & staph)

severe sore throat - usually unilateral
muffled voice
drooling
trismus - spasm of internal pterygoid muscle)
fever
ipsilateral ear pain
neck swelling/pain with cervical LAD
deviation of uvula to opposite side

Treatment: drainage
antimicrobial - oral = amoxicillin or clindamycin x14d
parenteral (IV/IM/SubQ) - ampicillin or vancomycin

A

Peritonsillar Abscess

36
Q

etiology: viral, bacterial, or non-infectious (ie trauma)

hoarseness
rhinorrhea
nasal congestion
cough and sore throat
direct laryngoscopy = laryngeal erythema and edema

Treatment: underlying cause (resp. virus)
humidify
voice rest and hydration

A

Acute Laryngitis

37
Q

etiology: viral (rhinovirus, influenza)
bacterial (H. influenza)

fever >102
severe headache
periorbital edema
abnormal vision
facial pain
maxillary teeth discomfort

Treatment: viral - supportive days 1-9 (analgesics, decongestants, saline irrigation)
bacterial - Augmentin 500/125mg TID, doxycycline if PCN allergy

A

Acute Rhinosinusitis

38
Q 
4 cardinal symptoms:
mucopurulent white/yellow nasal drainage
nasal obstruction/congestions
facial pain, pressure or fullness
reduction or loss of smell (adults)
cough (children)
Treatment: nasal saline lavage
intranasal corticosteroids
oral antimicrobials
antihistamines
topical/systemic antifungals
A

Chronic Rhinosinusitis

39
Q

etiology: Epstein Barr Virus (EBV)

cervical/general LAD
fever/malaise
pharyngeal exudative
petechiae on soft palate
splenomegaly
drug-induced ampicillin rash

Diagnostics: CBC, LFTs, Monospot
+IgM/-IgG = acute infection

Treatment: supportive (NSAIDs, fluids and rest)
4wk sport restriction

A

Infectious Mononucleosis

40
Q

age-related or traumatic opacity of the lens

gradual, chronic, painless loss of vision
decreased visual acuity
yellowing of lens

Treatment: referral, intraocular lens implant (phacoemulsification)

A

Cataracts

41
Q

etiology: decreased aqueous outflow resulting in increased intraocular pressure

chronic, painless visual loss
*peripheral first, central late
increased cup/disc ratio

Treatment: refer
topical anti-ocular hypertensives

A

Primary Open Angle Glaucoma

42
Q

separation of retina from underlying choroid layer
*associated with myopia and DM

floaters
photopsias (light flashes)
acute loss of vision - “CURTAIN-LIKE”
raised, whitish retina

Treatment: refer, cryotherapy, vitrectomy

A

Retinal Detachment (RD)

43
Q 
common in the elderly
more commonly gradual blurred vision
metamorphopsia (wavy/distorted)
*central scotoma (blind spot)
Amsler Grid distortion
Dry = Drusens
Wet = neovacularization

Treatment: refer (vitamins, quit smoking, photocoagulation)

A

Macular Degeneration

44
Q

embolic - different location
acute TOTAL painless loss of vision
afferent pupillary defect
“cherry red spot”

Treatment: refer, non effective
poor prognosis

A

Central Retinal Artery Occlusion (CRAO)

45
Q

thrombotic
acute VARIABLE painless loss of vision
“blood and thunder” retinal appearance

Treatment: aspirin and observation

A

Central Retinal Vein Occlusion (CRVO)

46
Q

retinal vascular changes due to systemic HTN

asymptomatic
systemic HTN
characteristic fundus findings
AV nicking
cotton-wool spots

Treatment: systemic BP control
refer if severe

A

Hypertensive Retinopathy

47
Q 
#1 cause of blindness 
non-proliferative = cotton-wool spots, microaneurysms
proliferative = non + neovascularization
macular edema = hard exudates

Treatment: blood sugar control

A

Diabetic Retinopathy

48
Q

eyelid inflammation
CHRONIC itching, burning, scratching (worse in AM)
no vision decrease
erythema, scales, meibomian gland disease

Treatment: warm compress
antibiotics/steroids for severe cases

A

Blepharitis

49
Q

infection of periorbital tissue

ACUTE onset of pain, swelling
+/- vision decrease
warm, edema, erythema, tender

Treatment: systemic antibiotics

A

Cellulitis

50
Q

deficient aqueous tear production

CHRONIC itching, burning, scratching
“tired” eyes esp. in PM
vision fluctuation
punctate epithelial erosions

Treatment: artificial tears
topical cyclosporin

A

Dry Eye

51
Q 
Viral
ACUTE bilateral burning soreness
watery discharge
URI sxs and preauricular LAD
Treatment: vasoconstrictors and artificial tears
Bacterial
ACUTE unilateral irritation
mucopurulent discharge
adherent lids
Treatment: topical and/or systemic antibiotics
Allergic
CHRONIC (seasonal) bilateral
stringy/mucoid discharge
chemosis - fluid within conjunctiva causing swelling
Treatment: topical antihistamines
A

Conjunctivitis

52
Q

blood in conjunctiva
ACUTE asymptomatic
vision unaffected
diffuse red patch

Treatment: reassurance

A

Subconjunctival Hemorrhage

53
Q

inflammation of episcleral or scleral tissue
SUBACUTE onset of foreign body sensation/pain
vision usually unaffected
focal injection (deep, bluish hue around sclera)

Treatment: topical/systemic steroids
refer

A

Episcleritis/Scleritis

54
Q

corneal epithelial defect
ACUTE onset of pain, foreign body sensation and epiphora
+/- vision affected

irrigate
numb with topical anesthetic
fluorescein
use blue light to see if stain lights up

Treatment: topical lubricants and antibiotics, oral pain medicines
NO TOPICAL ANESTHETICS

A

Corneal Abrasion

55
Q

caustic chemical exposure
ACUTE pain/burning
decreased vision
red/pink.white

Treatment: IRRIGATE!!
topical lubricants or antibiotics
refer

A

Chemical Injury

56
Q

“speck in my eye”
ACUTE onset of foreign body sensation
vision usually unaffected

Treatment: irrigation, cotton-tipped applicator
lubricant/antibiotic drops
refer

A

Corneal Foreign Body

57
Q 
infection of the cornea
ACUTE onset of pain
mucous discharge
*contact lens abuse
vision usually decreased
white infiltrate
*hypopyon - WBC and mucous in anterior chamber

Treatment: intensive topical antibiotics
refer

A

Keratitis/Corneal Ulcer

58
Q

dendritic pattern on fluorescein stain

Treatment: topical antivirals
NO STEROIDS

A

Keratitis: HSV

59
Q 
inflammation of uveal tissue
ACUTE onset *photophobia
\+/- vision decrease
ciliary flush around iris
hypopyon

Treatment: topical steroids, dilation drops, refer

A

Iritis/Uveitis

60
Q 
blood in anterior chamber due to trauma of iris/uvea
ACUTE onset pain
photophobia
\+/- vision decrease
layered heme

Treatment: eyeshield/bedrest
refer

A

Hyphema

61
Q

PAINFUL ACUTE rise of intraocular pressure due to outflow obstruction (rare)

decreased vision
*halos around lights
nausea
\+/-pain
*ciliary flush
*steamy cornea
mid-dilated pupil
crescent shadow

Treatment: refer
topical anti-ocular hypertensives
oral/intravenous osmotic agents

A

Acute Angle Closure Glaucoma

Clinical Medicine I (4 decks)

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