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IPAP > IMC/FM/EMED Psych/Heme/Derm > Flashcards

IMC/FM/EMED Psych/Heme/Derm Flashcards

1
Q

Define GAD

How is this Tx

What herbals can be used but w/ ? toxicity Sxs

A

Persistent and excessive worry to multiple events x 6mon/>

CBT
SSRI: Paroxetine, Escitalopram
SNRI: Venlafaxine

Kava plant
Liver failure, hepatitis, cirrhosis

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2
Q

What med is used as an adjunct to SSRIs for Tx of GAD

What is the wait time for benefits to be seen

What is used as interim while SSRIs levels are increasing and haven’t kicked in yet

A

Buspirone

2wks

Benzos

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3
Q

Define Panic D/o

What criteria must be met for this to be Dx as Panic D/o

How is this d/o Tx

A

Periodic intense fear/discomfort develops and peaks w/in 10min w/ 4/> Sxs

One month or more of worry/avoidant behavior

1st: SSRI- Paroxetine, Sertraline, Fluoxetine
Acute attacks: Benzos
Severe: anti-seizure meds

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4
Q

What are the 5 steps of CBT Tx for Panic D/os

Define OCD

This is defined as a ? d/o which seperates it from ?

A

1: education/Sxs
2: tracking diary
3: breathing/relaxation techniques
4: changing beliefs IRT attack severity
5: exposure therapy

Repetitive, obsessive thoughts/compulsions that are disabling/causing anxiety

Ego-dystonic: aware of unhealthy behavior, trouble changing it;
OCPD

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5
Q

What are the two components of OCD

What is the primary goal for the Pt w/ this condition

What other associated condition is seen w/ this

A

Obsession, Compulsion

Not to lose control

Tourette’s

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6
Q

What is used for first line OCD Tx

What adjustment does SSRIs need if used for Tx

What is TCA is used first line if SSRIs are not used

Augmentation therapy can be done w/ ?

A

CBT: exposure/response prevention

Higher dose than for depression

Clomipramine

Antipsychotics

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7
Q

Define PTSD

In order for Dx to be given, ? criteria must be met

What are the four essential features for this d/o

A

Traumatic event causing acute stress reactions

Sxs >1mon

Intrusive memories
Uncontrolled thoughts
Sleep issues
Anxiety

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8
Q

What is first line therapy for PTSD Tx

What med is used for nightmares

The use of ? benzos, particularly ?, should not be used for more than ?

A

SSRIs w/ CBT

Prazosin

Alprazolam;
>2wks after event

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9
Q

Define Acute Stress D/o

How long are Sxs present for Dx

How is this D/o Tx

A

Exposure to/situation of threatened death/inury/sexual violence

3d-1mon

CBT
SSRI
Propranolol
Benzos

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10
Q

Define Adjustment D/o

How long are Sxs needed for Dx

How is this Tx w/ meds

How is this Tx non-pharm

A

Out of proportion reaction to stressor that impairs daily function

W/in 3mon of stressor, ending w/in 6mon after stressor resolution

Benzo
Zolpidem
SSRIs

Psychotherapy- counseling/stress management

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11
Q

What happens if Adjustment D/o lasts longer than 6months

How long are Sxs needed for Dx of depression

What 3 DDxs need to be r/o

A

Re-Dx: depression

5/> SIGECAPS 2/> wks and,
Depressed or anhedonia

Hypothyroid
Addisons
Cushings

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12
Q

What are the 3 hypothesis for the etiology of depression

? combo deficiency can cause major depression

? is a major cause of depression

A

Monoamine,
Neurotrophic,
Neuroendocrine

Dec BDNF and dec monoamine

Unemployment

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13
Q

What are the 3 monoamines

What are the 5 types of depression and how is each one characterized

A

5-HT
Dopamine
NorEpi

Psychotic- paranoia/delusions

Major w/ atypicals- fatigue, hypersomina, excessive eating

Melancholic- seasonal w/ fall/winter; lethargy, carb craving

Post-Partum- 2wks-6mon of pregnancy

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14
Q

What risk score is used for Post-Partum Depression severity

How is Major Depression Tx

Define Dysthymia

A

Beck Depression Inventory- 21 questions

First: SSRI w/ f/u q204wks then monthly
TCA
MAOI

Persistent depressive d/o >2yrs w/ no hypo/manic episodes

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15
Q

How is Persistent Depressive D/o Tx

Define Bipolar Type 1

What is first line Tx

A

SSRI
Psychotherapy
Exercise

Manic w/ or w/out depressive episodes while destroying life, savings, relationships

Lithium

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16
Q

What meds are used for acute mania episodes

What meds are used for mania maintenance

What med is added if agitation is present

What class needs to be avoided in Bipolar type 1

A 
Lithium
Valproate
Olanzapine
Aripiprazole
Carbamazepine

Gabapentin
Olanzapine
Aripiprazole
Lamotrigine

Haloperidol
Risperidone

SSRIs

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17
Q

Define Bipolar Type 2

There must me one ? and one ? w/out a ?

What meds are used for depressive episodes

What two classes are least used

A

Periods of depression, distraction and dec need for sleep, flight of ideas and bullying

Hypomanic
Major depressive w/out manic episodes

SSRIs
Quetiapine
Olanzapine+Fluoxetine

MAOIS
TCAs

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18
Q

What 3 characteristics define ADHD

What are the first line meds used for management

What meds are used 2nd line

A

Hyperactivity
Impulsive
Inattentive
Before 12y/o and in more than one setting for >6mon

Methylphenidate
Dexmethylphenidate
Dextro/Amphetamine
Atomoxetine

Guanfacine
Clonidine
Imipramine
Buproprion
Venlafaxine
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19
Q

Define Autism

What meds are used for aggression, hyperactivity or mood

What is used for stereotyped/repetitive behavior

A

D/o w/ developmental delay in social, language and cognition

Risperidone
Aripaprazole
Carbamazepine
Haloperidol

SSRIs

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20
Q

? is one of the most heritable psych d/os

What is the tetrad of narcolepsy

How is it Dx

A

ADHD

Daytime sleepiness
Hallucination
Cataplexy
Paralysis

Polysomnography

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21
Q

What are the two types of hallucinations seen in narcolepsy

What causes the sleep paralysis in this d/o

How is it Tx

A

Hypnagogic- before sleep
Hypnopompic- before waking

Hypocretin deficiency in lateral hypothalamus

Modafinil
Methylphenidate
Planned naps

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22
Q

Define Parasomina

What d/o is present

What other Neuro dx may be present

A

Non-REM sleep arousal d/o (sleep walking/terrors)

Nightmare d/o in last 1/3 of REM

Restless leg syndrome 3x/wk x 3mon

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23
Q

Criteria for Narcolepsy Dx

When does sleep walking occur

When does nightmare d/o occur

When does sleep terror occur

When does REM behavior d/o occur

A

Sleep/napping/urge 3x/wk x 3mon

First half of night

Last 1/3

First 1/3

Second half of night

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24
Q

Addiction meds:

Disulfiram

Naltrexone

Acamprosate

Topiramate

Gabapentin

A

D: Inhibits acetaldehyde dehydrogenase; don’t use in active drinkers

N: dec desire; c/i w/ opioid use

A: changes brain chemistry to reduce anxiety, irritability and restlessness w/ early sobriety

T: dec desire

G: dec desire

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25
Q

MOA for PCP

This is similar to ? other drug

Tx

A

NMDA antagonist

Ketamine

Heloperidol
Benzo

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26
Q

MOA for LSD

Tx

Why is there usually no withdrawal

A

5-HT receptor action= seeing sound as color

Haloperidol
Benzo

No dopamine affect; flashbacks years later

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27
Q

Opioid MOA

Intoxication Tx

Withdrawal Tx

A

Mu receptor agonist for mood/pain/reward

Naloxone

Clonidine- a2 agonist to dec NorEpi and symp output to dec autonomic Sxs
Methadone

Buprenorphine+Naloxone

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28
Q

What is used for opioid addiction Tx

MOA of Benzos

How is intoxication Tx

How are withdrawls Tx

A

Methadone
Suboxone: Buprenorphine+Naloxone

GABA agonist

Flumazenil- competitive GABA antagonist

Clonazepam- long acting benzo

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29
Q

How are barbituates different from benzos

How is intoxication Tx

How is withdrawl Tx

A

No depression ceiling

Bemegride

Long acting benzo w/taper

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30
Q

Cocaine MOA

How is intoxication Tx

How is withdrawl Tx

A

Blocks amine re-uptake (dopamine, NorEpi, 5-HT)

Haloperidol
Benzo
Labetalol
Vit C- inc secretion

Buproprion
Bromocriptine
SSRI for depression

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31
Q

Amphetamine MOA

How are ODs Tx

A

Stimulates amine uptake

Haloperidol
Benzo
Vit C
Propranolol

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32
Q

MDMA MOA

How are intoxications identified

Leading preventable cause of death in USA

A

5HT > dopamine

Hyperthermia
HypoNa

Cigarette smoking

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33
Q

Tobacco cessation Tx

Caffeine withdrawal can occur if more than ? is ingested

? is the hallmark of withdrawal

A

Bupropion
Varenicline
Nicotine patch/gum

> 250mg

HA

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34
Q

Conversion d/o is AKA ?

Define Conversion D/o

What non-emotional Sxs can they present w/

A

Functional Neurological Sx D/o

Blind/Paralyzed or Neuro Sxs not explained by medical eval

La Belle indifference- lack of concern for Sxs

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35
Q

When/where is Conversion D/o most commonly seen

How is it managed

Define Somatic Sx D/o

A

Young adult/adolescence in low intelligence/socioeconomic groups

Therapy w/ short term anxiolytics

Pre-occupation w/ having serious illness x 6/> months

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36
Q

How is Somitic Sx D/o managed

Hypochondriasis is AKA ?

How long does this need to be present for Dx

A

One assigned provider w/ monthly visits and no unnecessary Dx testing

Illness Anxiety D/o- obsession w/ idea of having serious but undiagnosed condition

> 6mon

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37
Q

How is Hypochondriasis managed

Define Anorexia Nervosa

How much weight loss is used for definition/Dx

A

Group therapy
Regular appts w/ provider
SSRI if anxiety/depression

Intense fear of obesity despite slenderness

25% of baseline

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38
Q

Other than the low weight, what other issue is feared in anorexia nervosa

What are the two types of anorexia

How is Anorexia Nervosa distinguished from Bulimia Nervosa

A

Prolonged QT syndrome

Restricting- restricted intake w/out binge/purge behavior
Binge/Purge

BMI <17 or
Body weight <85% of ideal

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39
Q

How is Anorexia Nervosa Tx

What is an indication to admit

Define Bulimia Nervosa

A

Restore nutritional state
Psychotherapy
SSRIs

<75% of expected body weight

Binge eating w/ or w/out purging via induced vomit 1/wk x 3mon

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40
Q

What type of acid-base d/o is seen in Bulimia Nervosa

What PE findings may be used in question stem

How is this condition managed

A

Metabolic Alk w/ urinary Cl <20mEq

Scarred knuckles
Swollen parotids
Dental erosion
Hypo K
Normal weight

Restore nutrition
1st: Fluoxetine 60mg
2nd: TCA/MAOI
Therapy

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41
Q

Define Binge Eating D/o

? is the MC Anemia

What are the two MCC

A

Recurrent binge eating 1/wk x 3mon w/out control

Fe Deficiency: Micro/Hypo

Dysfunctional uterine bleeding
GI Bleeding

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42
Q

How is Iron Deficiency Anemia Tx

What is the first sign of this Dx

What is the 2nd sign

What is the 3rd sign

A

Ferrous Sulfate 3mg/kg between meals w/ juice

Low serum ferritin (low stores)

Inc TIBC

Micro/Hypo changes in RBCs

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43
Q

What lab result suggests anemia d/t lead poisoning

How is it Tx

What would be seen on CBC results for Fe Deficiency Anemia

A

Basophilic stippling

EDTA

Low retic count
High RDW

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44
Q

What lab result is Dx of Fe Deficient Anemia

What H/H levels are Dx

What would be seen on a peripheral smear

A

Ferritin <15ng

Men: <13.5/<39%
Female: <12/<37%

Poikilocytes- pencil/cigar shaped cells

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45
Q

How long does Fe Deficient Anemia Tx take

How often are Pts f/u during Tx

Fe Deficient Anemia commonly coexists w/ ? other form of anemia

A

6wks: correct anemia
6mon: replete stores

q3mon x 1year

Anemia of chronic Dz

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46
Q

What lab results suggest Anemia of Chronic Dz

What are the two MCCs

How is this form of anemia Dx

A

Normo/Normo w/ increased ferritin

Chronic RF
CT d/os

Low serum EPO

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47
Q

How is Anemia of Chronic Dz Tx

How does B12 Deficiency Anemia present

How is it Dx

A

Recombinant EPO if Hgb <10gm
Fe supplements

Lost proprioception
Dec vibratory sensation

Macro/hyper segmented neutrophils
Inc MMA/homocysteine

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48
Q

What are the two macrocytic anemias

How is one differed from the other

What is the risk in pregnancy

A

Folate/B12 deficiency

Folate= No neuro Sxs, megaloblastic anemia

No folate- Neural tube defects

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49
Q

How is Folate Deficiency Anemia Dx

How is this form Tx

What are the two etiologies of hemolytic anemia

A

Serum Folate <3 w/ normal MMA

PO Foalte 400-1000ug/day

Intracorpuscular: hereditary spherocytosis
Extracorpuscular: Autoimmune
G6PD
Drugs (chemo)

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50
Q

How is Autoimmune Hemolytic Anemia Dx

How is it Tx

All hemolytic anemias are going to have ? three lab results

A

Pos Coombs Test

High dose Pred

Inc LDH/indirect bili
Dec haptoglobin

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51
Q

How is Autoimmune Hemolytic Anemia Dx

How is Hereditary Spherocytosis Anemia Dx

How is G6PD Hemolytic Anemia Dx

How is Sicle Cell Anemia Dx

How is Thalassemia Hemolytic Anemia Dx

A

Pos direct Coombs test

Pos osmotic fragility test

Heinz bodies

Very high retic count w/ pain

Very low MCV w/ normal TIBC/Ferritin

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52
Q

What are the two main types of Autoimmune Hemolytic Anemias

What are the hallmarks of hemolytic anemia used for Dx

A

Warm Ab- Abs destroy RBCs at temps near body temp

Cold Ab- Abs are more destructive at temps below body temp

Inc retic count
Falling Hbg
Inc indirect bili
Inc LDH

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53
Q

What does a direct coombs test do for hemolytic anemia

What does an indirect coombs test for

How is Autoimmune Hemolytic Anemia Tx

A

Abs on RBCs

Abs to serum

Steroids
Blood transfusion
Splenectomy

54
Q

How is Hereditary Spherocytosis Tx

Define Aplastic Anemia

What is unique about this form of anemia

A

Splenectomy

Normo/Normo from loss of precursors resulting in anemia w/out reticulocytes

All three lines of blood are decreased (RBC WBC Platelet)

55
Q

When is a Dx of Aplastic Anemia suspected

What is the most accurate test for Dx and w/ ? lab results

How is this Tx

A

Young Pts w/ Pancytopenia: WBC <1500, platelets <50K

Marrow biopsy- hypocellular marrow w/ fatty infiltration

RBC transfusion
Leukoreduced platelet transfusion

56
Q

In PTs <50y/o, what is curative for Aplastic Anemia

What is done for Pts >50 that are ImmSupp/w/ comorbidities

What is used to reduce incidence of infections for these Pts

A

Marrow transfusion

Anti-thymocyte globulin
Cyclosporine
Pred

Hematopoietic growth factor- G-CSF Filgrastim

57
Q

How is Sickle Cell Anemia inherited

? lab result is used during crisis to monitor the event

How is this Dx

A

Homozygous of HgbS
Two parents w/ trait= 1/4 chance of HbSS child

Retic count

HgbS on electrophoresis

58
Q

What lab result aids in Dx Sickle Cell Anemia

? microbe is a common cause of infections in these Pts

What ABX are used for Tx

A

Howell Jolly Bodies- nuclear remnants that have not been phagocytosed

Salmonella

Vanc and Cipro

59
Q

Define Thalassemia

Since this presents similarly w/ Fe Deficiency, how is thalassemia different

What lab result is used to differ the Dx

A

Autosomal recessive d/o w/ abnormal Hbg formation

More micro/hypo than Fe deficiency

RBC count; thallassemia= normal/high

60
Q

Define B-Thalassemia

When does this form present

What are the three types

A

Dec produciton ob B-polypeptide chains

Sxs at 6mon old

Minor: heterozygotes
Major: homozygotes
Cooley: anemia w/ marrow hyperactivity

61
Q

What are the different types of A-Thalassemia

A

A-thalassemia-2: silent, clinically normal

A-thallasemia-1,: trait; ASx w/ mild/mod microcytic anemia

Hb-H: excess B-chains

Y-chains: Barts Hb

62
Q

How is A/B Thalassemia Dx

What would be seen on peripheral smears

What would be seen on x-ray for B-Thalassemia

A

Dec MCV
+ HgB Electrophoresis

A: Target/tear drop cells; Basophilic stippling
B: Target, Stippling, Nucleated RBCs

Skull bossing- hair on end appearance d/t extramedullary hematopoiesis

63
Q

How is Mild A-Thalassemia Tx

How is Moderate Tx

How is Severe Tx

A

None

Folate, avoid axidative stress

Transfusions
Deferoxamine- Fe chelating
Splenectomy
Marrow transplant- definitive

64
Q

How is B-Thalassemis Major Tx

Blood transfusions risk transmitting ? organisms

Frequent transfusions can cause ? three adverse condition

A

Transfusions
Deferoxamine- Fe chelating
Splenectomy
Marrow transplant- definitive

CMV
Hep B/C
HIV

Secondary hemochromatosis
HypoCa
HyperK

65
Q

? type of allergic reaction can occur from blood transfusions

Reactions d/t ABO incompatibility will present <24hrs later w/ ?

Define Febrile Non-Hemolytic Reaction and the prevention

A

Type 1 against plasma proteins

Hemoglobinuria
Flank pain
Red urine d/t KF

Abs to HLAs on donor WBCs or donor cytokines released;
Leukoreduced transfusion

66
Q

Define TRALI

How does this present

Define TACO and when is it more commonly seen

A

Transfusion Related Acute Lung Injury;
Donor Abs attack recipient WBCs and pulmonary endothelial cells

<6hrs later w/ Resp Distress, Hypoxemia, Peulm Edema

Transfucion Associated Circulatory Overload: CHF/CKD

67
Q

How is TACO differentiated from TRALI

? is the MC type of transfusion reaction

How are transfusion reactions Tx

A

Inc pulmonary capillary wedge pressure

Febrile, Non-Hemolytic

Epi
IV fluids
Mechanical vent (TRALI)
Diuretics (TACO)

68
Q

Define ITP

What are the two types

What other Dxs is this condition associated w/

A

Autoimmune Ab reaction to platelets causing splenic platelet destruction after an acute infection

Primary: no underlying condition
Secondary: underlying condition (HIV)

HIV HCV SLE CLL

69
Q

How is ITP Dx

How is this Tx

A

Primary: <100K w/out cause
Secondary: <100k w/ underlying cause
+ Direct Coombs test

Platelet >30K, no bleeds:
Observe

Platelet <30K:
CCS

CCS c/i or bleeding: IVIG

Splenectomy- second line for refractory ITP

70
Q

How does TTP present

What lab results aid w/ Dx

A 
Purpura + FAT RN:
Fever
Anemia
Thrombocytopenia
Renal failure
Neuro Sxs

Schistocytes
- Coombs test

71
Q

How does Hemolytic Uremic Syndrome present

What microbe causes this

What prodrome makes this Dx possible

A

Dec platelets
Anemia
RF

Ecoli O157:H7

Child w/ diarrhea and now RF/thrombocytopenia

72
Q

TTP is broken down into TTP and HUS, how are these two Dxs

What is the Tx of choice

How are Pts w/ HUS refractory to Tx of choice/CCS Tx

A

TTP:
Dec platelet
Anemia
Schistocytes

HUS:
Renal Failure
Anemia
Dec platelet

Plasmapheresis
Adult w/ TTP: CCS

Eculizumab

73
Q

Define Clotting Factors

Define Hemophilia A

Define Hemophilia B

A

Proteins respond in cascade to form fibrin strands to strengthen platelet plugs

Dec Factor 8

Dec Factor 9

74
Q

? is the MC genetic bleeding d/o

? is deficient in this MC

How is this MC Tx

A

Autosomal dominant von Willebrand Dz

VW Factor and Factor 8

DDAVP- desmopressin

75
Q

Define Hemophilia

What are the two types

How is VWDz differed from Hemophilias

A

X-linked recessive (affecting males)

A: Factor 8
B: Factor 9, Christmas Dz

Lack of hemarthrosis
Petechiae

76
Q

How are Hemophilias Dx

What DDx are considered if Dx tests are not positive for hemophilias

What is the most specific test for Hemophilia confirmation/severity

A

Inc PTT
Corrected w/ mixing studies

Non-corrected PTT= Lupus anticoagulant
Factor inhibitor

Functional Assay for Factor 8/9

77
Q

How is Hemophilia A/B Tx

Define Primary Polycythemia

What are the characteristic presentations

A

Factor 8/9 replacement

Malignancy of marrow overproducing RBCs

Pruritus after hot bath
Erythromelalgia- rubor of hand/feet

78
Q

Define Secondary Polycythemia

What can cause this

How is Polycythemia Dx

A

Inc production of Epo

Altitude
COPD

4 Hs:
Hypervolemia
Histaminemia
Hyperviscosity
Hyperuricemia
79
Q

? mutation is seen in Polycythemia Dx

How is a Dx confirmed

How is this condition Tx

A

Jak 2 tyrosine kinase

Marrow biopsy

Phlebotomy until Hct <42%
>60/prior thrombosis: hydroxyurea w/ ASA
Anagrelide- decreases platelet count

80
Q

Define Essential Thrombocytosis

Define Reactive Thrombocytosis

How is this Dx

A

Primary: Platelet count >600K

Secondary: myeloproliferative d/o

Peripheral smear: hypogranular, abnormal platelets
Marrow biopsy- differs primary/reactive

81
Q

What result is positive in half of Thrombocytosis results

How is this condition Tx

ALL presentation

A

JAK2 mutation

Anagrelide and ASA
Hydroxyurea- for severe cytosis

Child w/:
Adenopathy
Bone pain
Bleeding
Fever
82
Q

? is the MC childhood malignancy

What is the good news about this MC

A

ALL

Highly responsive to Chemo

83
Q

How does CLL present

This owns ? MC fact

What lab result is Dx

How is this Tx

A 
Middle aged Pt w/:
ASx
Fatigue
Adneopathy
Splenomegaly

MC form of leukemia in adults

Smudge cells- mature lymphoctyes

Observe
WBCs >100K or Sxs: Chemo

84
Q

How is ALL Dx

How is CLL Dx

How is ALL Tx

How is CLL Tx

A

> 20% blasts in marrow

Peripheral smear w/ fragile B-cells that smudge during prep= smudge cells

Chemo
Relapse= stem cell transplant

Indolent: observe
Chronic: chemo

85
Q

How does AML present

How are Pts managed

How does CML present

How is this Tx

A

Adult w/ >20% Blasts and Auer rods

Chemo and
Marrow transplant

Adult >50y/o w/:
WBC >100K
Hyperuricemia
ASx until bastic crisis (acute leukemia)

Imatinib- makes condition chronic dz state

86
Q

How is AML Dx

How is CML Dx

A

Myeloblasts w/ Auer rods and >20% blast cells

Philadelphia Chromosome: translocation of chrom 9 and 22
Inc WBCs

87
Q

How is AML Tx

What is a lethal s/e of Tx and how is this adverse Tx

How is CML Tx

A

Chemo w/ marrow transplant

Tumor lysis syndrome d/t chemo initiation;
Allopurinol, RF management

Gleevec (Imatinib)

88
Q

Hodgkins lymphoma presentation

This owns ? MC fact

Next step if Dx is suspected

A

Painless adenopathy
Reed Sternberg cells
Bimodal; 15-35, >60

MC type of lymhoma

CXR then node biopsy

89
Q

? lab result is Dx for Hodgkins Lymphoma

? viral DNA has been found in half of Hodgkin cells

How is this condition managed

A

Reed Sternberg cells

EBV

Chemo/Radiation w/ good prognosis

90
Q

How does Non-Hodgkins present

Where would visible manifestations be more likely seen

How is this condition managed

A

HIV Pt w/ GI Sxs and painless adenopathy

Peripheral nodes

Rituximab
Chemo

91
Q

Define Burkitts Lymphoma

What unique fact about this prevelance

It is associated w/ ? viral Hx and more common in ? Pts

A

Fast growing Non-Hodgkins from B-cells

Geography:
Central Africa

EBV;
AIDS

92
Q

? Sxs doe Hodkgkins have

How can this be Tx

How is Non-Hodgkins Tx

A

B Sxs:
Fever
Weight loss
Night sweats

ABVD Chemo:
Adriamycin
Bleomycin
Vinblastine
Dacarbazine

Indolent/1-2 nodes: radiation
Intermittent/High grade: chemo, immunotherapy and stem cell transplant

93
Q

Define Multiple Myeloma

What is produced as a result of ths condition

? MC fact does it own

A

Cancer of monoclonal plasma cells

IgG > IgA

MC primary tumor of bone/marrow in Pts >50y/o

94
Q

What are the MC c/c in Pts w/ Multiple Myelomas

How is this Dx

What result is seen on UA

What is seen on smears

A

Low back/rib pain
Infection

Monoclonal spike (M-protien) on electrophoresis

Ig light chains: Bence Jones protein

RBC rouleaux formation

95
Q

What is seen on marrow biopsy results in MM

How is this Tx

What is used for immunomodulatory management

What is used as proteasome inhibitors

A

Fried egg appearance of plasma cells

Marrow transplant- curative and preferred in young Pts

Thalidomide
Lenalidomide

Bortezomib

96
Q

What are the two characteristics of acne

Since acne can present similar to rosacea, how is acne differentiated

How does neonatal acne present and how is it managed

A

Open comedomes: black heads
Closed comedomes: white heads

Rosacea has no comedomes

Newborn - 8wks, limited to face;
Topical ketoconazole 2%

97
Q

What are the 4 grades of acne

How are each grade Tx

A

1: comedonal
2: papular, little scarring
3: pustular, moderate scarring
4: nodulocystic, severe scars

1: topical retinoid
2: topical retinoid and benzoyl peroxide; add Clascoterone/Minocycline if no response
3: systemic ABX (Doxy, Mino, Sare) + grade 2 regiment
4: Isotretinoin

98
Q

Any case of acne that is more than mild is Tx w/ ? first line Tx regiment

What birth control options are available for Tx

What type of reaction is Erythema Multiform and is usually associated w/ ?

A

Topical retinoid
Topical antimicrobial

Ethinyl estradiol norgestimate
Estrostep
Yaz

Type 4;
HSV, Sulfa drugs

99
Q

How does Erythema Multiforme present on PE

What are the two types of EM

How is EM differed from SJS

A

Target shaped lesions on hands, feet, and mucosa that blanch, but don’t itch

Major: two mucosal sites and widespread skin
Minor: limited skin, one mucosal

EM: extremity/mouth
SJS: trunk

100
Q

How is EM Tx

Define SJS

What is this commonly caused by

A

PO antihistamine
Topical CCS
Acyclovir if +HSV

Milder form of TEN w/ <10% of body surface area

Gout meds
Anticonvulsants
Sulfa drugs

101
Q

How is SJS/TEN Dx

How is this Tx

What used to be a Tx of choice but is now d/c

Define TEN

A

Biopsy- necrotic epithelium

D/c offender
Consult derm/ophth
IVIG

Steroids- inc sepsis

> 30% body surface area affected

102
Q

TEN can present mimicking SSS, how is it differed on exam

How is TEN Tx

Define Urticaria

A

Sparing of mucous membranes

Admit
Consult
Cyclosporine

Blanchable, pink papules/wheals that diappear <24hrs

103
Q

What sign is associated w/ urticaria

What is a painless, deeper form or urticaria

What type of hypersensitivity reaction is this

A

Darier’s Sign- localized urticaria occurring where skin is rubbed d/t histamine release

Angioedema

Type 1, IgE

104
Q

How is urticaria Tx w/ non-sedating

What is used if Sxs disrupt sleep

What TCA can be used too

What med is safe for chronic, unresponsive cases

A

2ng Gen AntiHist:
Fexofenadine
Des/Loratadine
Cetirizine

First Gen:
Hydroxyzine
Diphenhydramine

Doxepin

Leukotriene antagonists

105
Q

Define Acanthosis Nigricans

The presence of this indicated ? two issues

What are these Pts at risk for developing

A

Velvety, hyperpigmented plqaues

Hyperinsulinemia
Insulin resistance

Metabolic Syndrome

106
Q

How is Acanthosis Nigricans Tx

What can be done for cosmetic Tx

How does BCC present

A

Weight loss
Metformin

Vit D analogs
Topical retinoids

Pearly rolled border, telangiectasis w/ central ulcer

107
Q

How is BCC Dx

How is this Tx

What is Kaposi Sarcoma associated w/ and is a ? defining Ca

A

Shave/Punch biopsy

Sugical
Fluorouracil
Imiquimod

HHV-8;
AIDS

108
Q

What is the hallmark of Kaposi Sarcoma used for Dx

What lab result will be seen in these Pts

How is it Tx

A

Biopsy showing vascular proliferation induced by angiogenic inflammation

CD4 <100

Radiation
HAART for all Pts w/ AIDS related cases

109
Q

What are the ABCDEs of moles

Define Melanoma

What is the MC site of this in wo/men

A 
Asymmetry
Border irregularity
Color variability
Diameter
Evolving

Tumor arising from malignant transformations in melanocytic system

M: back W: calves

110
Q

Malignant melanoma is the MC tumor responsible for mets to ?

What acronym is for the most important independent factors for increased likelihood of melanoma

How is this Dx

A

Malignant melanoma

HARMM:
Prior Hx of melanoma
Age >50
Absent regular Derm evals
Changing mole
Male

Biopsy

111
Q

How is malignant melanomas staged

Prognosis is associated w/ ?

How are these Tx

A

Clark Classification:

1: only in epidermis
2: papillary dermis
3: papilary reticular
4: reticular dermis
5: penetrates SQ fat

Depth of lesions

1-3: excision
4: chemo

112
Q

Define SCC

What do they look like on PE

These usually arise within preexisting ?

A

Malignant epithelial tumor from epidermal keratinocytes

Enlarged hyperkeratonic macule w/ scales/crusted lumps

Actinic keratosis
Intraepidermal carcinoma

113
Q

How are BCC and SCC differed on exam

How is SCC Dx

How are they Tx

A

BCC: telangiectasia, central ulcer, rolled border
SCC: scaly papules

Biopsy

Excision w/ Mohs

114
Q

Two areas MC affected by pressure ulcers

How can these be avoided

What are the 4 stages

A

Sacrum
Hip

Reposition q2hrs

1- Non-blanching
2- pink ulcer, loss of dermal layer
3- dermal loss, SQ/fat visible
4: full thickness exposing bone/tendon w/ possible osteomyelitis

115
Q

How are pressure ulcers Tx

? is a common inflammatory dermatosis of the lower extremities

When and where are these seen

A

1: prevention, thin dressing
2: occlusive dressing
3-4: necrotic debridment

Stasis dermatitis

MC- medial ankle;
Chronic venous insufficiency w/ varicose veins

116
Q

AKs are synonyms for ?

These are precursors for ? Ca

How are they Tx

A

Solar Keratosis- pink/yellow lesions w/ sand paper texture

SCC

Cryo
5-Fu
Imiquimod

117
Q

Define SKs

What are these commonly referred to as?

How are they Tx if desired

A

MC benign skin tumor; dark plaques w/ waxy/stuck on appearance

Barnacles of old age

Cryo
Electro dissection/curettage

118
Q

What MCC cellulitis in adults

What MCC cellulitis in kids

How are these Dx and w/ ? education

A

Staph, Strep pyogenes

HFlu, Strep pneumo

Cultures;
F/u <48hrs

119
Q

How is cellulitis Tx

A

Mild:
Cephalexin
Cefuroxime
PCN allergy: Clinda

Purulent/MRSA:
TMP-SMX
Clinda
Doxy
IV Vanc or Linezolid
120
Q

How is cat bite induced cellulitis Tx

What is the MC microbe

How is cellulitis d/t puncture through shoe Tx

A

Augmentin
Doxy if PCN allergy

Pasteurell multocida

Cipro

121
Q

Erysipelas is always caused by ? microbe

How is this type of infection defined

How is it Dx

A

GAS: Strep pyogenes

Superficial cellulitis w/ dermal lymphatic involvement

Culture
Antistreptolysin titer

122
Q

How is Erysipelas Tx

A

Mild: Pen G
PCN-All: Erythro/Clinda

Mod:
TMP-MSX and Pen VK
Cephalexin

Severe:
Vanc and Daptomycin

123
Q

How does dermal candidiasis present on PE

What is seen on KOH preps

How is vaginal candidiasis Tx

A

Diffuse, beefy red erythema w/ sharp margins

Budding yeast, hyphae and pseudohyphae

Micon/Clotrim/Flucaon-azole

124
Q

How is oropharyngeal dandidiasis Tx

How is esophageal candidiasis Tx

How is diaper cadidiasis Tx

A

Clotrimazole
Nystatin

Flucon/Itracon-azole

Nystatin
Clotrim/Micon/Ketocon-azole

125
Q

How is symptomatic candidiasis during pregnancy Tx

What type of herpes is Varicella Zoster

How is Shingles Dx

A

Topical Clotrim/Micon-azole

HHV-3

PCR
Tzanck prep w/ multi-nucleated giant cells

126
Q

What PE finding w/ shingles is an Ophtho referral

How is Zoster Tx

How is this Tx during pregnancy

A

Hutchinson

Antivirals, Sxs <72hrs
Acyc/Famic-lovir

Acyclovir

127
Q

How is chicken pos (varicella) Tx

What needs to be avoided in Peds and why

When can Peds be vaccinated from chicken pox

A

<12y/o: none
>13: acyclovir

Salicylates;
Reyes syndrome

12-15mon and 4-6yrs

128
Q

When should Pts get Shingles vaccine

Warts are AKA ? and all caused by ?

A

50y/o; two doses 2-6mon apart

Verrucae;
HPV

129
Q

Verruca Vulgaris

Verruca Plana

Verruca Plantaris

A

Common warts from
HPV 1 2 4 7; grow on areas of trauma

Flat warts from HPV 3 10 26 29 41; grow on face, scratch marks

Plantar warts D/t HPV 2 4 on weight bearing surfaces of feet

130
Q

Condyloma Acuminatum

Filiform Wart

Epidermodysplasia verruciformis

A

Veneral warts d/t HPV 6 11

Frond-like narrow growths on face; variant of common wart

Hereditary d/o of chronic HPV infections

131
Q

Cardinal sign of warts is ? on PE

A

Absent skin lines
Pin-point black dots
Bleeds when shaved

IPAP (212 decks)

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