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Exam 4 Flashcards

1
Q

Signs of tinea pedis (athlete’s foot)

A

*Any area of the foot, but likely to occur in a fissured area or between toes, particularly between 3rd and 4th interdigital spaces

*Lesions vesiculopustular with fine scale

*Itching common

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2
Q

What is inframammary candidiasis and what is the treatment?

A

*Intertriginous candidiasis is a skin-fold infection caused by the yeast, candida.

*Inframammary candidiasis-located in the skin fold of the breast tissue; bright red rash under breasts and upper torso

*Treatment: Topical antifungal treatments are first-line (clotrimazole) and decrease favorable environmental conditions such as moisture, warmth, and poor air circulation

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3
Q

What tests are important to perform for recurrent yeast/candidiasis?

A

*STI screen (vag/genital culture for gonorrhea and chlamydia)

*Wet prep/KOH, gram stain vag culture for candida

*risk factors: antibiotics, birth control, DM, pregnancy, immunodeficiency

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4
Q

Acne vulgaris treatment (least to most teratogenic)

A

*least cleocin
*most retin a
*monocyclin middle

Mild-topical benzoyl peroxide (least teratogenic) and topical retinoids

*Mild to moderate-topical antibiotics with or without retinoids (avoid retinoids during pregnancy)

*Moderate to severe-systemic antibiotics

*Severe-Accutane (most teratogenic)

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5
Q

Benzoyl peroxide and properties

A

*Topical antibiotic for mild acne vulgaris; OTC
*antibacterial activity against P. acnes, predominant organism in sebaceous follicles and comedones of acne vulgaris
*Properties: colourless solid with crystalline structure; faint odor resembles smell of benzaldehyde
*Has a drying effect, removes excess sebum

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6
Q

A ________ is a type of cutaneous wart that is often painful.

A

plantar wart

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7
Q

What is a carbuncle? How will it present?

A

*lg multiloculated abscess made up of multiple furuncles in a contagious area

*appear as lg, red painful lumps on skin with multiple follicular openings; may have fever and chills

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8
Q

How can you tell the difference between a carbuncle, folliculitis, and a furuncle? Which one is more of a “boil” with mucopurulent drainage?

A

*Carbuncle
-evolves from folliculitis
-lg multiloculated abscess made up of multiple furuncles in a contagious area
-less common than furuncles
-appear as lg, red painful lumps on skin with multiple follicular openings; may have
fever and chills

*Folliculitis
-superficial to deep infection of hair follicles
-inflammation of hair follicle appearing as eruption of pustules/papules centered on hair follicles
-itching is a defining characteristic

*Furuncle
-Boil; evolves from folliculitis
-deep bacterial infection of a hair follicle with abscess formation typically caused by gram-positive Staph
-tender, bright red color; located on scalp, neck, axilla, buttocks, groin, thighs
-treat with warm compresses, drains pus and resolves spontaneously

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9
Q

What is hidradenitis suppurativa? (presented in pt scenario)

A

*Also known as acne inversa; appears after puberty, not contagious

*Chronic skin disease characterized by recurrent boil-like lumps (nodules) under the skin

*Nodules become inflamed and painful and tend to rupture causing abscesses that drain fluid and pus cause an odor

*Healed abscesses produce significant scarring of skin

*S/S: nodules in armpits, groin, anus, buttocks, under breasts, nape of neck, waist, inner thighs; chronic pain

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10
Q

How are scabies transmitted?

A

*skin to skin contact and acquired by sleeping with or in bedding of individual or other close contact

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11
Q

What medication treats scabies?

A

*First line: Permethrin (Elimite) 5% cream single application, may repeat in 1 week.

*Alternative: oral Ivermectin as single PO dose (rpt 2 wks prn)

*Triamcinolone 0.1% cream for dermatitis and Benadryl for itching

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12
Q

Differential diagnosis for eczema (atopic dermatitis)?

A

*Contact dermatitis
*Seborrheic dermatitis
*Scabies
*Psoriasis
*Dermatophytosis

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13
Q

What are the subjective findings of atopic dermatitis?

A

*itching, pain, irritation
*associated bleeding or oozing skin
*sudden/gradual onset
* recent use of antibiotics, oral drugs, topical medication; assess use of soaps, creams or lotions
* exposure to insects or travel abroad
* preceding s/s (fever, sore throat)

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14
Q

How is contact dermatitis typically diagnosed?

A

*History: Abrupt or insidious, burning (irritant contact dermatitis), itching (allergic contact dermatitis), occupational exposures, recreational habits, personal hx of allergies, treatments attempted

*Physical: examine skin, lesions, and location of inflammation/distribution

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15
Q

What are the signs of pityriasis rosea? How does it present? What does it look like?

A

*Skin rash that begins as one circular or oval spot on chest, abdomen, or back (herald patch); can be up to 4 in (10 cm) across

*Herald patch followed by distinctive pattern of similar but smaller lesions that sweep out from the middle of body in shape that resembles pine-tree branches

*Can cause itching; not contagious

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16
Q

How is vitiligo identified?

A

*Total loss of color in patchy areas; extremely white macules or patches typically located on exposed areas such as the face or hands

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17
Q

How is actinic keratosis identified? This condition is a precursor to what disease?

A

*Scaly, dry, rough lesions found on sun-exposed areas

*Can be found on tops of hands, face, back and tops of ears, forearm-may be able to feel them and not see them

*precursor to squamous cell carcinoma

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18
Q

What is the greatest risk factor for melanoma?

A

*Intense sun exposure

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19
Q

What is the most common type of skin cancer?

A

*Basal cell carcinoma found in humans

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20
Q

Define a confluent lesion.

A

*Lesions that have run or grown together (combined) and are no longer discrete (unique)
*begin as 1-3 mm macules that gradually become confluent assuming a reticulated lacelike pattern

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21
Q

Define umbilicated lesions.

A

*Lesions that are depressed in the middle like a naval (ex. Molluscum contagiosum)

22
Q

Types of primary lesions (macules, papules, plaques, vesicles)

A
23
Q

Types of secondary lesions characteristics (erosions, ulcers, fissures)

A
24
Q

Lesion distribution among a dermatome is a characteristic of what type of lesion?

A

*herpes zoster (shingles)

25
Q

What types of lesions are typically found on men who have sex with men? (i.e. Kaposi sarcoma) What labs would you order to diagnose Kaposi sarcoma?

A

*Kaposi sarcoma is found in men who have sex with men, but who have no evidence of HIV infection or immunodeficiency

*Labs: examine cells from punch biopsy, CD4 lymphocyte counts and plasma HIV viral-load studies for patients with HIV infection

26
Q

Skin cancer mnemonic

A

ABCDE-asymmetry, border, color, diameter, evolving

27
Q

What are the common risk factors for carpal tunnel syndrome?

A

*Women 3x more likely
*age 40-60 yrs
*pregnancy due to fluid retention and the softening of ligaments
*occupational hazard; hobbies or occupations that require repetitive wrist or hand movement (desk workers, hairstylist)
*history of wrist trauma
*degenerative joint disease, ganglion cyst, fibromyalgia
*genetics

28
Q

Describe Phalen maneuver.

A

*Have the patient place the wrists in complete unforced flexion for at least 30 seconds. If the median nerve is entrapped at the wrist, the maneuver reproduces the symptoms of carpal tunnel syndrome.

29
Q

What are positive Tinel and Phalen signs associated with?

A

*Carpal tunnel
*Negative tests do not rule out carpal tunnel

30
Q

How do you diagnose fibromyalgia?

A

*Common s/s: diffuse musculoskeletal pain, sleep disturbances, persistent fatigue

*No specific test

*Consider CBC, ESR, measurement of muscle enzymes, TSH, and Rheumatoid factor to rule out other diagnoses

31
Q

What education would you provide to a patient with fibromyalgia?

A

*Chronic disorder
*symptoms are manageable with meds, exercise and activity
*healthy lifestyle/diet
*massage therapy, acupuncture
*get adequate sleep
*manage stressors

32
Q

What is an important reminder for a patient taking an NSAID (i.e. Motrin)?

A

*Take with food due to risk for GI upset

33
Q

What are the clinical findings of osteoarthritis?

A

*Insidious, gradual onset of joint pain (unilateral) that worsens with weight-bearing activity and improves with rest
*Morning stiffness or stiffness after prolonged immobility
*Crepitus on motion
*Joint deformity (hand, neck, lower back, knees, and hips)
*Erythema and swelling

34
Q

What is osteoarthritis associated with? What does it inhibit or restrict?

A

*Joint trauma
*Aging
*Obesity
*Occupational overuse
*Weak muscles around joints
*Congenital musculoskeletal disorders
*Metabolic and endocrine disorders

*Pain increased with joint use and decreased with rest

35
Q

What is rheumatoid arthritis associated with? Where are RA symptoms most seen (i.e. isolated to certain areas like joints, systemic)?

A

*Chronic, systemic inflammatory disease primarily affecting joints (multiple, bilateral)
*involvement of synovial joints

*Inflammatory response mechanisms
*Immune system responses
*Bone resorption mechanism
*Endogenous hormone response
*Neuronal response mechanics
*Genetic predisposition

36
Q

A patient has a sprain, what would you do to treat it and what is the least appropriate treatment?

A

*First 48 hrs: PRICE (protection, rest, ice, compression, elevation)
*NSAIDs
*Functional rehabilitation
*f/u in 7-10 days if swelling doesn’t improve
*refer to ortho if grade 3 or if no improvement in 2-3 wks for grade 1-2

  • to avoid harm in the first 72 hours after injury, avoid hot bath, sauna, alcohol, and heat packs
37
Q

A patient has low back pain that often interferes with their sleep (especially while sleeping on back), what are some recommendations?

A

*Find the right position, place pillow between knees and draw them closer to chest, pillow can be placed under legs or lower back
*Avoid sleeping on stomach or put pillow under hips/abdomen
*Get a good mattress
*Stretching before bed

38
Q

What symptoms are most indicative of acute lumbosacral strain?

A

*Subjective
-Lifting or straining may exacerbate
-Difficulty standing erect
-Change positions frequently for comfort
-Pain radiates into buttocks or posterior thigh
-Activity intolerance

*Objective
-Diffuse tenderness to lower back
-Reduced ROM especially flexion elicits pain
-Muscle spasm may be present
-Observe gait-may ambulate with a limp, posture normal to guarded
-Straight leg, reverse straight leg raise, prone rectus femoris test

39
Q

What workup is appropriate for new-onset low back pain?

A

*Does not warrant radiograph unless red flag assessed

*Labs: CBC, ESR, serum calcium, alkaline phosphatase, UA, and serum immunoelectrophoresis when inflammatory, neoplastic, diffuse bone disease, or renal disease is suspected

40
Q

What type of patient would an x-ray be most appropriate for?

A

*Pt with red flag symptoms (i.e. spinal fracture)

*Acute low back pain lasting more than 4 wks-6 wks

*Chronic low back pain

41
Q

When would a CT scan be appropriate for back pain?

A

*If no improvement after 4 weeks
* Herniated disc, tumors, and other lesions the extent of injuries structural anomaly, such as spina bifida
*triple AAA
* red flags: Caudia equina, bowel/bladder issues, severe progressive neurological deficits, serious underlying conditions such as osteomyelitis, thoracic pain, weakness, drug abuse, HIV, age <less than 20 or >55

42
Q

What are the risk factors for the development of low back pain? What do they include or not include?

A

*Occupational risk factors-hard labor and heavy exertion, extended period of sitting or vibration (truck drivers), boring or dissatisfying job professions
*Obese or tall persons
*Scoliosis, weak “core”
*Smoking, age, psychosocial factors (depression, anxiety, alcoholism)

43
Q

The straight leg raise test can assist with the diagnosis of what?

A

*Fundamental maneuver during the physical examination of a patient with low back pain.
*Can help diagnose lumbar disc herniation

44
Q

A patient complaining of back pain and is unable to walk on their heels or their toes, what would you suspect?

A

*sciatica

45
Q

What are common complaints of patients with sciatica?

A

*Pain around buttocks occurring suddenly or gradually
*Pain associated with numbness traveling down lateral or posterior leg
*Numbness
*Paresthesia

46
Q

What is the diagnostic test for lupus/SLE?

A

*Antinuclear antibody panel, CBC, CXR, kidney biopsy, urinalysis

47
Q

What are objective findings associated with systemic lupus (labs)? How would you diagnose the condition?

A

*To be diagnosed with Lupus, you must have 4 out of the 11 typical signs
*Tests used to diagnose SLE include: Antinuclear antibody panel, CBC, chest X-ray, kidney biopsy, urinalysis
*SLE may alter results of: antithyroglobulin antibody, antithyroid microsomal antibody, C3 and C4, Coomb’s test, ESR, kidney function tests, liver function tests, and Rheumatoid factor

48
Q

What are common physical findings of lupus?

A

*All: joint pain and swelling, some develop arthritis
*Heart friction rub or pleural friction rub may be heard, abnormal heart rhythms, chest pain w/ deep breath
*Brain and nervous system effects
*Abd pain, n/v
*Fatigue, fever, general discomfort
*Hair loss
*mouth sores, swollen lymph nodes
*sensitive to sunlight
*Butterfly skin rash

49
Q

How does lead exposure relate to gout?

A

*Lead exposure can result in low urate excretion leading to gout

50
Q

If a patient is treated with NSAIDs and limited activity and after 1-2 wks they are still not having relief, what imaging tests should be ordered?

A

*Xray, CT, or MRI

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