IMC/FM/EMED Psych/Heme/Derm Flashcards
Define GAD
How is this Tx
What herbals can be used but w/ ? toxicity Sxs
Persistent and excessive worry to multiple events x 6mon/>
CBT
SSRI: Paroxetine, Escitalopram
SNRI: Venlafaxine
Kava plant
Liver failure, hepatitis, cirrhosis
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
Buspirone
2wks
Benzos
Define Panic D/o
What criteria must be met for this to be Dx as Panic D/o
How is this d/o Tx
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
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 ?
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
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
Obsession, Compulsion
Not to lose control
Tourette’s
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/ ?
CBT: exposure/response prevention
Higher dose than for depression
Clomipramine
Antipsychotics
Define PTSD
In order for Dx to be given, ? criteria must be met
What are the four essential features for this d/o
Traumatic event causing acute stress reactions
Sxs >1mon
Intrusive memories
Uncontrolled thoughts
Sleep issues
Anxiety
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 ?
SSRIs w/ CBT
Prazosin
Alprazolam;
>2wks after event
Define Acute Stress D/o
How long are Sxs present for Dx
How is this D/o Tx
Exposure to/situation of threatened death/inury/sexual violence
3d-1mon
CBT
SSRI
Propranolol
Benzos
Define Adjustment D/o
How long are Sxs needed for Dx
How is this Tx w/ meds
How is this Tx non-pharm
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
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
Re-Dx: depression
5/> SIGECAPS 2/> wks and,
Depressed or anhedonia
Hypothyroid
Addisons
Cushings
What are the 3 hypothesis for the etiology of depression
? combo deficiency can cause major depression
? is a major cause of depression
Monoamine,
Neurotrophic,
Neuroendocrine
Dec BDNF and dec monoamine
Unemployment
What are the 3 monoamines
What are the 5 types of depression and how is each one characterized
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
What risk score is used for Post-Partum Depression severity
How is Major Depression Tx
Define Dysthymia
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
How is Persistent Depressive D/o Tx
Define Bipolar Type 1
What is first line Tx
SSRI
Psychotherapy
Exercise
Manic w/ or w/out depressive episodes while destroying life, savings, relationships
Lithium
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
Lithium Valproate Olanzapine Aripiprazole Carbamazepine
Gabapentin
Olanzapine
Aripiprazole
Lamotrigine
Haloperidol
Risperidone
SSRIs
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
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
What 3 characteristics define ADHD
What are the first line meds used for management
What meds are used 2nd line
Hyperactivity
Impulsive
Inattentive
Before 12y/o and in more than one setting for >6mon
Methylphenidate
Dexmethylphenidate
Dextro/Amphetamine
Atomoxetine
Guanfacine Clonidine Imipramine Buproprion Venlafaxine
Define Autism
What meds are used for aggression, hyperactivity or mood
What is used for stereotyped/repetitive behavior
D/o w/ developmental delay in social, language and cognition
Risperidone
Aripaprazole
Carbamazepine
Haloperidol
SSRIs
? is one of the most heritable psych d/os
What is the tetrad of narcolepsy
How is it Dx
ADHD
Daytime sleepiness
Hallucination
Cataplexy
Paralysis
Polysomnography
What are the two types of hallucinations seen in narcolepsy
What causes the sleep paralysis in this d/o
How is it Tx
Hypnagogic- before sleep
Hypnopompic- before waking
Hypocretin deficiency in lateral hypothalamus
Modafinil
Methylphenidate
Planned naps
Define Parasomina
What d/o is present
What other Neuro dx may be present
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
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
Sleep/napping/urge 3x/wk x 3mon
First half of night
Last 1/3
First 1/3
Second half of night
Addiction meds:
Disulfiram
Naltrexone
Acamprosate
Topiramate
Gabapentin
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
MOA for PCP
This is similar to ? other drug
Tx
NMDA antagonist
Ketamine
Heloperidol
Benzo
MOA for LSD
Tx
Why is there usually no withdrawal
5-HT receptor action= seeing sound as color
Haloperidol
Benzo
No dopamine affect; flashbacks years later
Opioid MOA
Intoxication Tx
Withdrawal Tx
Mu receptor agonist for mood/pain/reward
Naloxone
Clonidine- a2 agonist to dec NorEpi and symp output to dec autonomic Sxs
Methadone
Buprenorphine+Naloxone
What is used for opioid addiction Tx
MOA of Benzos
How is intoxication Tx
How are withdrawls Tx
Methadone
Suboxone: Buprenorphine+Naloxone
GABA agonist
Flumazenil- competitive GABA antagonist
Clonazepam- long acting benzo
How are barbituates different from benzos
How is intoxication Tx
How is withdrawl Tx
No depression ceiling
Bemegride
Long acting benzo w/taper
Cocaine MOA
How is intoxication Tx
How is withdrawl Tx
Blocks amine re-uptake (dopamine, NorEpi, 5-HT)
Haloperidol
Benzo
Labetalol
Vit C- inc secretion
Buproprion
Bromocriptine
SSRI for depression
Amphetamine MOA
How are ODs Tx
Stimulates amine uptake
Haloperidol
Benzo
Vit C
Propranolol
MDMA MOA
How are intoxications identified
Leading preventable cause of death in USA
5HT > dopamine
Hyperthermia
HypoNa
Cigarette smoking
Tobacco cessation Tx
Caffeine withdrawal can occur if more than ? is ingested
? is the hallmark of withdrawal
Bupropion
Varenicline
Nicotine patch/gum
> 250mg
HA
Conversion d/o is AKA ?
Define Conversion D/o
What non-emotional Sxs can they present w/
Functional Neurological Sx D/o
Blind/Paralyzed or Neuro Sxs not explained by medical eval
La Belle indifference- lack of concern for Sxs
When/where is Conversion D/o most commonly seen
How is it managed
Define Somatic Sx D/o
Young adult/adolescence in low intelligence/socioeconomic groups
Therapy w/ short term anxiolytics
Pre-occupation w/ having serious illness x 6/> months
How is Somitic Sx D/o managed
Hypochondriasis is AKA ?
How long does this need to be present for Dx
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
How is Hypochondriasis managed
Define Anorexia Nervosa
How much weight loss is used for definition/Dx
Group therapy
Regular appts w/ provider
SSRI if anxiety/depression
Intense fear of obesity despite slenderness
25% of baseline
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
Prolonged QT syndrome
Restricting- restricted intake w/out binge/purge behavior
Binge/Purge
BMI <17 or
Body weight <85% of ideal
How is Anorexia Nervosa Tx
What is an indication to admit
Define Bulimia Nervosa
Restore nutritional state
Psychotherapy
SSRIs
<75% of expected body weight
Binge eating w/ or w/out purging via induced vomit 1/wk x 3mon
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
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
Define Binge Eating D/o
? is the MC Anemia
What are the two MCC
Recurrent binge eating 1/wk x 3mon w/out control
Fe Deficiency: Micro/Hypo
Dysfunctional uterine bleeding
GI Bleeding
How is Iron Deficiency Anemia Tx
What is the first sign of this Dx
What is the 2nd sign
What is the 3rd sign
Ferrous Sulfate 3mg/kg between meals w/ juice
Low serum ferritin (low stores)
Inc TIBC
Micro/Hypo changes in RBCs
What lab result suggests anemia d/t lead poisoning
How is it Tx
What would be seen on CBC results for Fe Deficiency Anemia
Basophilic stippling
EDTA
Low retic count
High RDW
What lab result is Dx of Fe Deficient Anemia
What H/H levels are Dx
What would be seen on a peripheral smear
Ferritin <15ng
Men: <13.5/<39%
Female: <12/<37%
Poikilocytes- pencil/cigar shaped cells
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
6wks: correct anemia
6mon: replete stores
q3mon x 1year
Anemia of chronic Dz
What lab results suggest Anemia of Chronic Dz
What are the two MCCs
How is this form of anemia Dx
Normo/Normo w/ increased ferritin
Chronic RF
CT d/os
Low serum EPO
How is Anemia of Chronic Dz Tx
How does B12 Deficiency Anemia present
How is it Dx
Recombinant EPO if Hgb <10gm
Fe supplements
Lost proprioception
Dec vibratory sensation
Macro/hyper segmented neutrophils
Inc MMA/homocysteine
What are the two macrocytic anemias
How is one differed from the other
What is the risk in pregnancy
Folate/B12 deficiency
Folate= No neuro Sxs, megaloblastic anemia
No folate- Neural tube defects
How is Folate Deficiency Anemia Dx
How is this form Tx
What are the two etiologies of hemolytic anemia
Serum Folate <3 w/ normal MMA
PO Foalte 400-1000ug/day
Intracorpuscular: hereditary spherocytosis
Extracorpuscular: Autoimmune
G6PD
Drugs (chemo)
How is Autoimmune Hemolytic Anemia Dx
How is it Tx
All hemolytic anemias are going to have ? three lab results
Pos Coombs Test
High dose Pred
Inc LDH/indirect bili
Dec haptoglobin
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
Pos direct Coombs test
Pos osmotic fragility test
Heinz bodies
Very high retic count w/ pain
Very low MCV w/ normal TIBC/Ferritin
What are the two main types of Autoimmune Hemolytic Anemias
What are the hallmarks of hemolytic anemia used for Dx
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
What does a direct coombs test do for hemolytic anemia
What does an indirect coombs test for
How is Autoimmune Hemolytic Anemia Tx
Abs on RBCs
Abs to serum
Steroids
Blood transfusion
Splenectomy
How is Hereditary Spherocytosis Tx
Define Aplastic Anemia
What is unique about this form of anemia
Splenectomy
Normo/Normo from loss of precursors resulting in anemia w/out reticulocytes
All three lines of blood are decreased (RBC WBC Platelet)
When is a Dx of Aplastic Anemia suspected
What is the most accurate test for Dx and w/ ? lab results
How is this Tx
Young Pts w/ Pancytopenia: WBC <1500, platelets <50K
Marrow biopsy- hypocellular marrow w/ fatty infiltration
RBC transfusion
Leukoreduced platelet transfusion
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
Marrow transfusion
Anti-thymocyte globulin
Cyclosporine
Pred
Hematopoietic growth factor- G-CSF Filgrastim
How is Sickle Cell Anemia inherited
? lab result is used during crisis to monitor the event
How is this Dx
Homozygous of HgbS
Two parents w/ trait= 1/4 chance of HbSS child
Retic count
HgbS on electrophoresis
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
Howell Jolly Bodies- nuclear remnants that have not been phagocytosed
Salmonella
Vanc and Cipro
Define Thalassemia
Since this presents similarly w/ Fe Deficiency, how is thalassemia different
What lab result is used to differ the Dx
Autosomal recessive d/o w/ abnormal Hbg formation
More micro/hypo than Fe deficiency
RBC count; thallassemia= normal/high
Define B-Thalassemia
When does this form present
What are the three types
Dec produciton ob B-polypeptide chains
Sxs at 6mon old
Minor: heterozygotes
Major: homozygotes
Cooley: anemia w/ marrow hyperactivity
What are the different types of A-Thalassemia
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
How is A/B Thalassemia Dx
What would be seen on peripheral smears
What would be seen on x-ray for B-Thalassemia
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
How is Mild A-Thalassemia Tx
How is Moderate Tx
How is Severe Tx
None
Folate, avoid axidative stress
Transfusions
Deferoxamine- Fe chelating
Splenectomy
Marrow transplant- definitive
How is B-Thalassemis Major Tx
Blood transfusions risk transmitting ? organisms
Frequent transfusions can cause ? three adverse condition
Transfusions
Deferoxamine- Fe chelating
Splenectomy
Marrow transplant- definitive
CMV
Hep B/C
HIV
Secondary hemochromatosis
HypoCa
HyperK
? 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
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
Define TRALI
How does this present
Define TACO and when is it more commonly seen
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
How is TACO differentiated from TRALI
? is the MC type of transfusion reaction
How are transfusion reactions Tx
Inc pulmonary capillary wedge pressure
Febrile, Non-Hemolytic
Epi
IV fluids
Mechanical vent (TRALI)
Diuretics (TACO)
Define ITP
What are the two types
What other Dxs is this condition associated w/
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
How is ITP Dx
How is this Tx
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
How does TTP present
What lab results aid w/ Dx
Purpura + FAT RN: Fever Anemia Thrombocytopenia Renal failure Neuro Sxs
Schistocytes
- Coombs test
How does Hemolytic Uremic Syndrome present
What microbe causes this
What prodrome makes this Dx possible
Dec platelets
Anemia
RF
Ecoli O157:H7
Child w/ diarrhea and now RF/thrombocytopenia
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
TTP:
Dec platelet
Anemia
Schistocytes
HUS:
Renal Failure
Anemia
Dec platelet
Plasmapheresis
Adult w/ TTP: CCS
Eculizumab
Define Clotting Factors
Define Hemophilia A
Define Hemophilia B
Proteins respond in cascade to form fibrin strands to strengthen platelet plugs
Dec Factor 8
Dec Factor 9
? is the MC genetic bleeding d/o
? is deficient in this MC
How is this MC Tx
Autosomal dominant von Willebrand Dz
VW Factor and Factor 8
DDAVP- desmopressin
Define Hemophilia
What are the two types
How is VWDz differed from Hemophilias
X-linked recessive (affecting males)
A: Factor 8
B: Factor 9, Christmas Dz
Lack of hemarthrosis
Petechiae
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
Inc PTT
Corrected w/ mixing studies
Non-corrected PTT= Lupus anticoagulant
Factor inhibitor
Functional Assay for Factor 8/9
How is Hemophilia A/B Tx
Define Primary Polycythemia
What are the characteristic presentations
Factor 8/9 replacement
Malignancy of marrow overproducing RBCs
Pruritus after hot bath
Erythromelalgia- rubor of hand/feet
Define Secondary Polycythemia
What can cause this
How is Polycythemia Dx
Inc production of Epo
Altitude
COPD
4 Hs: Hypervolemia Histaminemia Hyperviscosity Hyperuricemia
? mutation is seen in Polycythemia Dx
How is a Dx confirmed
How is this condition Tx
Jak 2 tyrosine kinase
Marrow biopsy
Phlebotomy until Hct <42%
>60/prior thrombosis: hydroxyurea w/ ASA
Anagrelide- decreases platelet count
Define Essential Thrombocytosis
Define Reactive Thrombocytosis
How is this Dx
Primary: Platelet count >600K
Secondary: myeloproliferative d/o
Peripheral smear: hypogranular, abnormal platelets
Marrow biopsy- differs primary/reactive
What result is positive in half of Thrombocytosis results
How is this condition Tx
ALL presentation
JAK2 mutation
Anagrelide and ASA
Hydroxyurea- for severe cytosis
Child w/: Adenopathy Bone pain Bleeding Fever
? is the MC childhood malignancy
What is the good news about this MC
ALL
Highly responsive to Chemo
How does CLL present
This owns ? MC fact
What lab result is Dx
How is this Tx
Middle aged Pt w/: ASx Fatigue Adneopathy Splenomegaly
MC form of leukemia in adults
Smudge cells- mature lymphoctyes
Observe
WBCs >100K or Sxs: Chemo
How is ALL Dx
How is CLL Dx
How is ALL Tx
How is CLL Tx
> 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
How does AML present
How are Pts managed
How does CML present
How is this Tx
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
How is AML Dx
How is CML Dx
Myeloblasts w/ Auer rods and >20% blast cells
Philadelphia Chromosome: translocation of chrom 9 and 22
Inc WBCs
How is AML Tx
What is a lethal s/e of Tx and how is this adverse Tx
How is CML Tx
Chemo w/ marrow transplant
Tumor lysis syndrome d/t chemo initiation;
Allopurinol, RF management
Gleevec (Imatinib)
Hodgkins lymphoma presentation
This owns ? MC fact
Next step if Dx is suspected
Painless adenopathy
Reed Sternberg cells
Bimodal; 15-35, >60
MC type of lymhoma
CXR then node biopsy
? lab result is Dx for Hodgkins Lymphoma
? viral DNA has been found in half of Hodgkin cells
How is this condition managed
Reed Sternberg cells
EBV
Chemo/Radiation w/ good prognosis
How does Non-Hodgkins present
Where would visible manifestations be more likely seen
How is this condition managed
HIV Pt w/ GI Sxs and painless adenopathy
Peripheral nodes
Rituximab
Chemo
Define Burkitts Lymphoma
What unique fact about this prevelance
It is associated w/ ? viral Hx and more common in ? Pts
Fast growing Non-Hodgkins from B-cells
Geography:
Central Africa
EBV;
AIDS
? Sxs doe Hodkgkins have
How can this be Tx
How is Non-Hodgkins Tx
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
Define Multiple Myeloma
What is produced as a result of ths condition
? MC fact does it own
Cancer of monoclonal plasma cells
IgG > IgA
MC primary tumor of bone/marrow in Pts >50y/o
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
Low back/rib pain
Infection
Monoclonal spike (M-protien) on electrophoresis
Ig light chains: Bence Jones protein
RBC rouleaux formation
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
Fried egg appearance of plasma cells
Marrow transplant- curative and preferred in young Pts
Thalidomide
Lenalidomide
Bortezomib
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
Open comedomes: black heads
Closed comedomes: white heads
Rosacea has no comedomes
Newborn - 8wks, limited to face;
Topical ketoconazole 2%
What are the 4 grades of acne
How are each grade Tx
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
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/ ?
Topical retinoid
Topical antimicrobial
Ethinyl estradiol norgestimate
Estrostep
Yaz
Type 4;
HSV, Sulfa drugs
How does Erythema Multiforme present on PE
What are the two types of EM
How is EM differed from SJS
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
How is EM Tx
Define SJS
What is this commonly caused by
PO antihistamine
Topical CCS
Acyclovir if +HSV
Milder form of TEN w/ <10% of body surface area
Gout meds
Anticonvulsants
Sulfa drugs
How is SJS/TEN Dx
How is this Tx
What used to be a Tx of choice but is now d/c
Define TEN
Biopsy- necrotic epithelium
D/c offender
Consult derm/ophth
IVIG
Steroids- inc sepsis
> 30% body surface area affected
TEN can present mimicking SSS, how is it differed on exam
How is TEN Tx
Define Urticaria
Sparing of mucous membranes
Admit
Consult
Cyclosporine
Blanchable, pink papules/wheals that diappear <24hrs
What sign is associated w/ urticaria
What is a painless, deeper form or urticaria
What type of hypersensitivity reaction is this
Darier’s Sign- localized urticaria occurring where skin is rubbed d/t histamine release
Angioedema
Type 1, IgE
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
2ng Gen AntiHist:
Fexofenadine
Des/Loratadine
Cetirizine
First Gen:
Hydroxyzine
Diphenhydramine
Doxepin
Leukotriene antagonists
Define Acanthosis Nigricans
The presence of this indicated ? two issues
What are these Pts at risk for developing
Velvety, hyperpigmented plqaues
Hyperinsulinemia
Insulin resistance
Metabolic Syndrome
How is Acanthosis Nigricans Tx
What can be done for cosmetic Tx
How does BCC present
Weight loss
Metformin
Vit D analogs
Topical retinoids
Pearly rolled border, telangiectasis w/ central ulcer
How is BCC Dx
How is this Tx
What is Kaposi Sarcoma associated w/ and is a ? defining Ca
Shave/Punch biopsy
Sugical
Fluorouracil
Imiquimod
HHV-8;
AIDS
What is the hallmark of Kaposi Sarcoma used for Dx
What lab result will be seen in these Pts
How is it Tx
Biopsy showing vascular proliferation induced by angiogenic inflammation
CD4 <100
Radiation
HAART for all Pts w/ AIDS related cases
What are the ABCDEs of moles
Define Melanoma
What is the MC site of this in wo/men
Asymmetry Border irregularity Color variability Diameter Evolving
Tumor arising from malignant transformations in melanocytic system
M: back W: calves
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
Malignant melanoma
HARMM: Prior Hx of melanoma Age >50 Absent regular Derm evals Changing mole Male
Biopsy
How is malignant melanomas staged
Prognosis is associated w/ ?
How are these Tx
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
Define SCC
What do they look like on PE
These usually arise within preexisting ?
Malignant epithelial tumor from epidermal keratinocytes
Enlarged hyperkeratonic macule w/ scales/crusted lumps
Actinic keratosis
Intraepidermal carcinoma
How are BCC and SCC differed on exam
How is SCC Dx
How are they Tx
BCC: telangiectasia, central ulcer, rolled border
SCC: scaly papules
Biopsy
Excision w/ Mohs
Two areas MC affected by pressure ulcers
How can these be avoided
What are the 4 stages
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
How are pressure ulcers Tx
? is a common inflammatory dermatosis of the lower extremities
When and where are these seen
1: prevention, thin dressing
2: occlusive dressing
3-4: necrotic debridment
Stasis dermatitis
MC- medial ankle;
Chronic venous insufficiency w/ varicose veins
AKs are synonyms for ?
These are precursors for ? Ca
How are they Tx
Solar Keratosis- pink/yellow lesions w/ sand paper texture
SCC
Cryo
5-Fu
Imiquimod
Define SKs
What are these commonly referred to as?
How are they Tx if desired
MC benign skin tumor; dark plaques w/ waxy/stuck on appearance
Barnacles of old age
Cryo
Electro dissection/curettage
What MCC cellulitis in adults
What MCC cellulitis in kids
How are these Dx and w/ ? education
Staph, Strep pyogenes
HFlu, Strep pneumo
Cultures;
F/u <48hrs
How is cellulitis Tx
Mild:
Cephalexin
Cefuroxime
PCN allergy: Clinda
Purulent/MRSA: TMP-SMX Clinda Doxy IV Vanc or Linezolid
How is cat bite induced cellulitis Tx
What is the MC microbe
How is cellulitis d/t puncture through shoe Tx
Augmentin
Doxy if PCN allergy
Pasteurell multocida
Cipro
Erysipelas is always caused by ? microbe
How is this type of infection defined
How is it Dx
GAS: Strep pyogenes
Superficial cellulitis w/ dermal lymphatic involvement
Culture
Antistreptolysin titer
How is Erysipelas Tx
Mild: Pen G
PCN-All: Erythro/Clinda
Mod:
TMP-MSX and Pen VK
Cephalexin
Severe:
Vanc and Daptomycin
How does dermal candidiasis present on PE
What is seen on KOH preps
How is vaginal candidiasis Tx
Diffuse, beefy red erythema w/ sharp margins
Budding yeast, hyphae and pseudohyphae
Micon/Clotrim/Flucaon-azole
How is oropharyngeal dandidiasis Tx
How is esophageal candidiasis Tx
How is diaper cadidiasis Tx
Clotrimazole
Nystatin
Flucon/Itracon-azole
Nystatin
Clotrim/Micon/Ketocon-azole
How is symptomatic candidiasis during pregnancy Tx
What type of herpes is Varicella Zoster
How is Shingles Dx
Topical Clotrim/Micon-azole
HHV-3
PCR
Tzanck prep w/ multi-nucleated giant cells
What PE finding w/ shingles is an Ophtho referral
How is Zoster Tx
How is this Tx during pregnancy
Hutchinson
Antivirals, Sxs <72hrs
Acyc/Famic-lovir
Acyclovir
How is chicken pos (varicella) Tx
What needs to be avoided in Peds and why
When can Peds be vaccinated from chicken pox
<12y/o: none
>13: acyclovir
Salicylates;
Reyes syndrome
12-15mon and 4-6yrs
When should Pts get Shingles vaccine
Warts are AKA ? and all caused by ?
50y/o; two doses 2-6mon apart
Verrucae;
HPV
Verruca Vulgaris
Verruca Plana
Verruca Plantaris
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
Condyloma Acuminatum
Filiform Wart
Epidermodysplasia verruciformis
Veneral warts d/t HPV 6 11
Frond-like narrow growths on face; variant of common wart
Hereditary d/o of chronic HPV infections
Cardinal sign of warts is ? on PE
Absent skin lines
Pin-point black dots
Bleeds when shaved
