Miscellaneous Flashcards by Ronak Chhaya

T/F: Increased social isolation in elderly when hearing and vision loss present

true

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Recurrent vertigo, tinnitus and sensorineural hearing loss

Meniere disease. Can experience ear fullness/pain in the affected ear

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Common age-related hearing loss. Progressive, symmetrical and high-frequency

Presbycusis. Can be accompanied by bilateral tinnitus, vertigo, disequilibrium. Difficulty hearing in the presence of competing backgrounds but do well one-on-one.

Tx: hearing aids, implants

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acute onset eye redness and tearing in young female without many disorders. foreign-body sensation. no pain, visual impairment or photophobia

Episcleritis. Usually self-limited, tx with topical lubricants

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subacute eye diffuse redness and severe pain with movement/photophobia and patient with rheumatologic disease

Scleritis is SCARY (vs episcleritis is easy). Diffuse erythema and edema with dark red sclera. Eval for rheum dz and need systemic steroids and immunosuppressants

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painless acute vision loss in 1 eye, complete or relative afferent pupillary defect, cherry red spot in macula

central retinal artery occlusion. Urgent optho consult, ocular massage to lower intraocular pressure, long term atherosclerosis risk factor mod. rare, seen in vasculopaths

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vision loss, severe eye pain, HA, n/v. Light halos, conjunctival redness, poorly reactive and dilated pupil

acute angle-closure glaucoma

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T/F: Perforated/ruptured tympanic membrane in AOM resolves completely with oral and topical abx

TRUE

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acute rhinosinusitis

usually viral and tx with supportive care. clues for bacterial needing abx = sxs >10 days, severe sxs >3 days, worsening sxs >5 days after initially improving viral URI

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Painful vs painless parotid gland enlargement

Painless: lymphoma

Painful: infection (sialedenitis, fever present) or parotid stone obstruction (sialolithiasis; recurrent)

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How to interpret Weber and Rinne test

Sensorineural hearing loss (presbycusis, meniere, idiopathic):

Weber: lateralization to unaffected ear
Rinne: air conduction > bone conduction (better heard in front of the ear compared to placed on the mastoid)

Conductive:
(otitis, cerumen, TM perf)

Weber: lateralizes to affected ear
Rinne: bone conduction > air conduction

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t/f: consider audiometry and MRI in acute idiopathic sensorineural hearing loss

true

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mgmt of meniere disease (tinnitus, vertigo, sensorineural hearing loss)

sodium restriction +/- diuretics

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ear fullness, decreased hearing and popping sounds after URI

eustachian tube dysfunction. need decongestants

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new onset of floaters, flashing lights or vision loss

retinal detachment. if vision loss: see retinal specialist w/in 24 hours. if just floaters/flashes without vision loss, can see opthy more electively

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t/f: central retinal a occlusion usually preceded by amaurosis fugax

true

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Lichen planus 4 P’s and associated dz

Pruritic, purple, polygonal papules or plaques. associated with hep C. Topical steroids.

tx after poison ivy exposure

wash skin with soap and water within 2 hours of exposure
topical mid to high potency cortisteroids since its a delayed hypersensitivity rxn. continue tx for 2-3 weeks because of rebound dermatitis

skin blisters and changes in pigmentation in sun-exposued areas in IVDU

porphyria cutanea tarda. may see elevated liver enzymes, urine overload, elevated plasma/urine porphyrin levels. Tx: phlebotomy, HCV tx

Which common skin condition (sebacous glands) occurs in all age groups but especially in Parkinson and HIV?

Seborrheic dermatitis. scalp (dandruff), face, chest etc. pruritic, greasy scales. tx with low-potency corticosteroids, antifungal creams

dystrophic nails and funal appearing toes

confirm dx with KOH scrapings

if hyphae/fungus…ora terbinafine 12 weeks

Tx of urticaria

Its chronic if >6 weeks.

Either way. start with 2nd gen antihistamine (loratidine). increase dose, if doesn’t work then first gen (benadryl, hydroxyzine) at night, etc

30-60 year old with erythema and telangiectasias over cheeks, nose and chin. may have papules, pustules, flushing

rosacea. topical metronidazole or oral abx (doxycycline/minocycline/erythromycin)

T/F: Molluscum contagiosum is caused by poxvirus, has umbilication and should probably have HIV testing

true

Mild to moderate plaque psoriasis (most common) tx

topical steroids and emollients. Combo therapy with topical steroids + vitamin D is most effective. If facial or intertigonous: topical tacolimus or pimecrolimus Moderate to severe: phototherapy + methotrexate

T/F: Common warts due to HPV are common in individuals who handle meat, poultry and fish, and those with atopic dermatitis. as well as HIV

true. tx with OTC salicylic acid or liquid nitrogen, many will self resolve over 2 years

tx for discoid lupus

sunscreen protective clothing topical corticosteroids or calcineurin inhibitor (tacrolimus)

pruritic lesions that can ulcerate and seen on flexor surfaces of extremities, especially wrists

lichen planus

antimalarials differentiate btwn discoid lupus and?

they make discoid lupus better but worsen psoriasis. DLE may have negative or low titer ANA, can also have no other SLE findings . its very photosensitive . extends to follicles an dcauses permanent scarring alopecia

T/F: Venous lakes are benign lesions commonly seen on lips and ears of elderly patients

true, disappear when compressed. can bleed sometimes. are gray/blue/purple

what is vitiligo associated with

Thyroid disease and type 1 diabetes

warty growths with stuck on appearance

Seborrheic keratoses (SK)

T/F: Necrobiosis lipoidica is a skin condition frequently seen in diabetics, pretibial areas with annular lesions

true wtf

meds for EtOH abuse help

- Naltrexone (prevent relapse and dependence, and in patients actively drinking - Acamprosate (enhances abstinence, CI in CKD) * Use sx triggered regimen to treat withdrawal, i.e. sx-triggered benzos * thiamine before glucose * avoid antipsychotics (lowers seizure threshold) * disulfiram is second-line

meds for tobacco cessation

Nicotine gum/patches etc: avoid in recent MI, arrythmia, unstable angina Buproprion: avoid in seizure or eating disorder Varenicline: Increases smoking cessation double than buproprion

thickness for endometrial biopsy in postmenopausal AUB

>4mm

T/F: Medroxyprogesterone acetate used for second half o fmenstrual cycle will restore cyclic withdrawal bleeding and thus preserve fertility in anovulatory AUB

true

HIV mother HIV >1000

if >1000, intrapartum zidovudine, need a c/section, postparum ART prophylaxis for the infant if <1000, vaginal and no meds

Suspect IgG4-related disorder in middle age man with:

- autoimmune pancreatitis - lymphadenopathy - bilateral salivary/lacrimal gland enlargement - eosinophilia Tx: steroids (can add mycophenolate, azathioprine or rituximab if refractory)

low immunoglobulins and poor response to vaccination

CVID

T/F: Myeloperoxidase deficiency can present with recurrent candida infections

true