Family Medicine Core Rotation - Acute Complaints_3 Flashcards
what is a spermatocele?
asymptomatic nodule generally found attached to the spermatic cord
for what is a scrotal ultrasound useful?
to evaluate enlarging masses or to determine if a mass is solid (neoplastic) or not (varicocele, hydrocele)
what is the use of CT scan in the work up of scrotal complaint?
to evaluate hernia
what is the use of urinalyses or urethral smears in the workup of scrotal complaints?
infectious causes like epididymitis or UTI
the true causes of acne are what?
multifactorial, but familal factors are involved
what are the key factors contributing to acne?
follicular keratinization • androgens • propionibacterium acnes
what is the change in the keratinization pattern of the pilosebaceous unit seen in acne?
keratin becomes more dense, blocking the secretion of sebum
the keratin plugs in acne are called what?
comedones
contributory factors to acne include what?
certain medications • emotional stress • occlusion and pressure on skin
what is an example of occlusion and pressure on skin causing acne?
leaning the hands on the face –> ance mechanica
acne is not caused by what commonly blamed things?
dirt • chocolate • greasy foods • presence or absence of any foods in the diet
when are laboratory examinations warranted in the diagnosis of acne?
when history and physical indicates the need to exclude hyperandrogenism and/or polycystic ovarian syndrome
in the vast majority of patients with acne, the hormone levels are what?
normal
what works best for mild acne?
combination therapy with topical anitbiotics, benzoyl peroxide gels, and topical retinoids
how long does acne treatment take to work?
2-5months
when should topical acne medications be applied?
topical retinoids should be applied in the evening and benzoyl peroxide and topical antibiotics should be applied during the day
the indications for oral isoretinoin include what?
nodular acne • severe acne • moderate recalcitrant acne • -patient must be resistant to other acne therapies including oral abx
what is the major contraindication for isoretinoin?
is teratogenic so pregnancy must be prevented during its use
what is the major drug interaction to watch out for when prescribing isoretinoin?
since both tetracycline and isoretinoin cause pseudotumor cerebri, they should never be taken together
can you use tylenol while on isoretinoin?
yes, despite rare cases of hepatotoxicity
how does isoretinoin affect the eye?
dry eyes is a side effect, so contacts may be difficult but they can still be worn
what are the psychiatric considerations for prescription of isoretinoin?
some reported cases of depression, but no screening protocol because rarely occurs
what is the relationship between topical glucocorticoids and isoretinoin?
topical glucocorticoids are safe for use during isoretinoin therapy and are sometimes used if eczematous rashes occur during treatment
what is the difference between acne and rosacea?
comedo formation, the hallmark of acne, is absent in rosacea
what is stage I rosacea?
there is persistent erythema, generally with telangiectasia formation
what is stage II rosacea?
stage I plus the addition of papules and tiny pustules
what is stage III rosacea?
the erythema is deep and persistent, the telangiectases are dense, and there may be a solid appearing edema of the central part of the face due to sebaceous hyperplasia and lymphedema (rhinophyma and metophyma)
what are some very effective first line therapies for rosacea?
minocycline or doxycycline
are topical steroids effective for rosacea?
no
what are some alternative treatments for rosacea?
topical metronidazole, and sodium sulfacetamide can work
keratoacanthoma is difficult to distinguish visually from which conditions?
basal cell cancers • nodular squamous cell cancers • molluscum
how can you tell keratoacanthoma from similar conditions?
history
keratoacanthoma are characterized by what history feature?
rapid growth, achieving a size of 2.5cm within a few weeks
how do you differentiate verruca from keratoacanthoma?
verruca do not generally have the depressed center or the pearly borders
how do you differentiate molluscum from keratoacanthoma?
molluscum do have a central dimple, but don’t have such a significant keratotic plug present
skin lesions of psoriasis can be confused with what?
eczema, fungal dermatitis, other lesions
what is the appropriate therapeutic management for localized psoriasis skin rashes?
topical corticosteroids
when do you give topical pimecrolimus for psoriasis?
inverse psoriasis (located on the perianal and genital regions) or on the face and ear canals, but is generally not used for lesions on the trunk or extremities
when do you give antibiotics for psoriasis?
there is no place for antibiotics in treatment, except in the case of guttate psoriasis, a form that follows streptococcal infection and appears as multiple teardrops that erupt abruptly
when are oral retinoids and methotrexate used for psoriasis?
to treat generalized psoriasis and help with nail involvement
what is pityriasis rosea?
a self limited papulosquamous eruption
what is the classic history for pityriasis rosea?
a single herald patch (an oval, slightly raised plaque with scale) followed in the next 1-2 weeks with a more generalized eruption
what is the course of pityriasis rosea?
spontaneous resolution in 6-12 weeks, recurrence is uncommon
what is the treatment for pityriasis rosea?
symptomatic- antihistamines or corticosteroids to relieve itch
when should the diagnosis of impetigo be considered?
in the face of well demarcated erythematous lesions that when disrupted, develop a secondary golden crust
most cases of impetigo are caused by what?
S aureus
impetigo responds well to what?
topical antibiotics like mupirocin
hot tub folliculitis is generally caused by what?
P aeruginosa or P cepacia
course of hot tub folliculitis?
self limited, reassurance is all that is necessary
when is abx tx required for hot tub folliculitis?
recalcitrant or symptomatic cases
what is the appropriate abx tx for hot tub folliculitis?
cipro 500mg bid
what is the management for chronic HSV infection?
topical or oral antiviral therapy
when are antiviral therapies more effective for HSV?
better for primary than recurrent infections
what is the dosing for antivirals for HSV?
pulse dosing at the first sign of outbreak may shorten or reduce severity
what are the treatment options for genital herpes?
episodic therapy • suppressive therapy
what is recommended for discordant couples for genital herpes tx?
daily suppressive therapy
what is the benefit of antiviral therapy for shingles?
decrease the time for lesion healing and shorten the overall duration of pain if initiated within 72 h- start tx regardless of onset in pt >50yo, immunosuppressed, or eye involvement
what decreases the likelihood of postherpetic neuralgia in shingles?
corticosteroids
what causes 5th disease?
parvovirus B19
what child rash is caused by enteroviruses?
hand foot and mouth disease
parainfluenza causes what in children?
croup
varicella causes what in children?
chicken pox
CMV causes what in children?
mono like symptoms
how do you treat tinea capitis?
systemic therapy with griseofulvin (or terbinafine, itraconazole, fluconazole, ketoconazole) + topical ketoconazole or selenium sulfide shampoo
how long do you give fluconazole for tinea capitis?
3-4 weeks
tinea corporis is most commonly caused by what?
trichophyton rubrum
tinea infections can also be cause by what?
T tonaurans (tinea capitis) • T mentagrophytes (tinea cruris) • M canis (inflammatory tinea)
what is the best choice treatment for warts?
topical liquid nitrogen
what treatment for warts should be avoided in pregnancy?
podophyllum resin
what is the treatment for anal warts?
imiquimod
when do you laser warts?
warts resistant to other treatment modalities
can you use bleomycin injection on finger warts?
no bc of terminal digital necrosis
what helps differentiate atopic dermatitis from other causes of rash?
rash may look like rough red plaques with some flaking that can affect the face, neck, upper trunk, behind the knees. flexural surfaces often involved. • severe pruritus
when does eczema present?
usually in childhood, rarely after 30
what is a diagnostic clue to molluscum contagiosum vs basal cell?
absence of telangiectasia in molluscum
how can you treat mollusum contagiosa?
cryotherapy • cautery • curettage
symptoms of conjunctivitis include what?
increased redness • irritation • tearing • discharge • photophobia • itching
does discharge character differentiate bacterial from viral conjunctivitis?
no
eye pain is suggestive of what?
serious: • acute angle closure glaucoma • uveitis • scleritis • keratitis • foreign body • corneal abrasion
of the symptoms of conjunctivitis, what is more specific for allergic conditions?
itching
what is the characteristic presentation of allergic conjunctivitis?
bilateral
what is the MC virus causing conjunctivitis?
adenovirus
how is adenovirus conjunctivitis transmitted?
ocular and respiratory secretions
what are the incubation and shedding period for adenovirus conjunctivitis?
8 day incubation • 10-12 day shedding
what PE finding is characteristic of viral conjunctivitis?
palpable preauricular lymph node
what percent of conjunctivitis is bacterial?
15%
why are topical corticosteroids contraindicated in conjunctivitis?
increased duration of viral shedding, prolongation of the infectious period, • potential corneal ulceration and perforation
what do you give for herpetic conjunctivitis?
antiviral eye drops
how do you diagnose herpetic conjunctivitis?
fluorescin staining • corneal dendrites
bacterial conjunctivitis is most commonly caused by what?
Strep • Staph • MRSA
what is scleritis?
unilateral diffuse injection of the deeper vessels
what are the symptoms of scleritis?
deep boring eye pain and a surrounding headache
scleritis is usually associated with what?
autoimmune disease like RA or wegeners
diff. between episcleritis and scleritis?
episcleritis= mild irritation, no as intense as scleritis
corneal abrasion is associated with what?
decreased vision • intense pain • tearing • trauma
difference between glaucoma and scleritis?
glaucoma has pain, decreased vision, and redness, but the affected pupil is usually dilated
difference between iritis and scleritis?
in iritis pupil is small
what are the features of bacterial sinusitis?
purulent rhinorrhea • purulent secretions in the nasal cavity • tooth pain • biphasic history
MCC of recurrent sinusitis?
allergy
MC pathogen in bacterial sinusitis?
S pneumoneae
other causes of bacterial sinusitis?
h flu • moraxella • gAβh strep
what is the drug of choice for bacterial sinusitis?
amoxicillin
Tx for shoulder dislocation?
relocate • immobilize 7-10 days • ROM exercise • pain management
what is the MCC lateral knee pain in an athelete?
iliotibial band syndrome
who gets iliotibial band syndrome?
cyclists and runners
patellofemoral pain syndrome presents how?
diffuse knee pain and positive patellar grind test
what is the presentation of an ACL tear?
twisting injury • pop • immediate effusion • still weight bearing • sense of instability
what is the MC dx for pt with anterior knee pain in primary care?
patellofemoral pain syndrome (theater sign)
what are ottowa ankle pain rules?
get films if • 1. cant walk 4 steps immediately after injury • 2. tender over distal 6cm of tibia or fibula • 3. midfoot or navicular tenderness • 4. tenderness over proximal 5th metatarsal
what should be done in the majority of syncope cases?
hct • ck • glc • ECG • carotid massage • orthostatic BP • pulses
additonal testing for syncope?
holter • echo • ambulatory loop ecg • tilt table test
what do you order for syncopal patient with a murmur?
echo
holter and ambulator loop ecg for syncope help ID what?
arrhythmia
who gets tilt table test?
pt w/ unexplained recurrent syncope in whom cardiac causes have been ruled out
in a diabetic, silent ischemia is signaled by what?
dyspnea and diaphoresis
what do you order for suspect silent ischemia in diabetic?
stress test
abnormal tilt table suggests what?
vasovagal syncope
persistence of glabellar tap reflex is called what and seen in who?
myerson sign seen in parkinsons
what drug has been shown to modify disease progession in parkinsons?
selegiline (MAOBI)
tx for vaginal candidiasis?
oral fluconazole x1 or topical azole application
what do you do for a female with recurrent vaginal candidiasis?
treat partner
what is a strong diagnostic clue for trichomonas vaginalis?
strawberry cervix
clue to bacterial vaginosis?
clue cells
tx for bacterial vaginosis?
topical or oral metronidazole or clindamycin
pt with 1st episode of wheezing requires what?
cxr
when to get cxr in asthma?
fever, ronchi, sputum to rule out pneumonia
