Module 2 & 3 Flashcards
What are the risk factors for seborrheic keratosis?
Age >50, but can also appear in young adulthoodGenetic predisposition but precise inheritance pattern is unknownUV radiation exposure HPV infection
What is the diagnostic test for mononucleosis?
None usually indicated. Can order CBC w/ diff but nonspecific
What are the risk factors for actinic keratosis?
Increased age light skin/eyes/hair immunosuppression states Hx of skin cancer persistence of the AK
What are the diagnostic itests for orbital cellulitis?
• Blood C&S x2 • Orbital CT
What is the health history of folliculitis?
Ask about location, appearance of lesions, onset, and duration Associated symptoms - ? (there should be none) Ask about occupational and recreational exposures that might be relevant – work as machinist, fry-cook in fast-food restaurant, hot tub or whirlpool use, and application cosmetics or products containing oil. Ask about previous episodes of skin infections and recent or present antibiotic use
What is pharyngitis?
Inflammation of the pharynx and surround lymph tissue (tonsils). Commonly called “strep throat”
What are the risk factors for pityriasis rosea?
Sometimes follows URI (ex. Influenza)
What are the risk factors for warts?
HIV/AIDS Immunosuppressive drugs Pregnancy Previous wart infection
What is the physical examination of glaucoma?
Examine external eye Visual acuity Measure intraocular pressure Test peripheral vision using confrontation
What is the diagnostic test for iritis?
No specific test, diagnosis on based on history and physical exam.
What are the risk factors for herpes zoster?
Increasing age immunosuppression
What are the differential diagnosis of folliculitis?
Acne pustules Epidermal cyst Dermatophyte infection Skin abscess
What is the health history of herpes simplex infection?
Location, onset, duration, and appearance of lesion(s) Pain, burning, paresthesia prior to eruption? Associated symptoms: fever, myalgia, malaise? Previous occurrence of similar lesions? Sexual hx: 5 P’s (partners, pregnancy prevention, protection from STIs, practices, past hx of STI’s) – see page 760 of Uphold & Graham for detailed sexual hx
What are the risk factors for hordeolum?
Common in children & adolescences Poor eyelid hygiene Previous hordeolum Contact lens wearers Application of makeup Predisposing blepharitis
What are the risk factors for acne vulgaris?
Pre-pubertal period (age 12-24) Medications-corticosteroids, anabolic steroids, lithium Males (more severe disease and less likely to seek treatment) Hyper responsiveness to androgens
What are the risk factors for psoriasis?
Family history Local trauma Local irritation (exacerbation HIV Seasonal changes in the weather
What are the risk factors for rhinitis?
history of atopy SES Tobacco smoke Other allergies such as asthma Pets in house
What is the health history of otitis externa?
Location & onset of pain/discomfort & time of onset Any itching, bleeding/purulent exudate? Hearing loss Location & frequency of swimming
What is the health history for chalazion?
onset, duration of symptoms Is visual acuity affected? Do you wear contact lens? Any history of other eye problems?
What is the diagnostic test for epistaxis?
Extensive workup only for recurrent or severe cases
What is the physical examination of foreign body of the ears?
Perform thorough examination of ear Inspect auditory canal & tympanic membrane Inspect all orifices of the head for foreign bodies as multiple insertions are common
What is the health history of cellulitis?
Onset and durations of symptoms Any systemic symptoms? Mechanism of injury If tetanus is up to date Medical and medication history
What is the physical examination of lichen planus?
VS General appearance Examine appearance of skin, oral, mucous membranes, scalp, and nails for other lesions
What is otitis media?
Inflammation of the middle ear; usually accompanied by fluid collection
What is urticaria?
A cutaneous lesion involving edema of the epidermis and/or dermis presenting with acute onset and pruritis, returning to normal skin appearance within 24 hours
What are the differential diagnosis for orbital cellulitis?
• Orbital foreign body • Cavernous sinus thrombosis • Orbital tumor • Trauma insect • Bite
What are causes foreign body of the eyes?
Foreign body of the conjunctiva occurs when particles, usually dirt or sand, become entrapped under the upper lid or in the cul-de-sacs, generally no trauma involved Foreign body of the cornea due to substances stuck in epithelium, usually from trauma
What is the physical examination of urticaria?
Vital signs General state of health Full inspection of skin
What is the health history of otitis media?
Onset & duration of symptoms Always assess for pain Ask about hearing loss, tinnitus, & dizziness, drainage from ear, Associated symptoms such as nasal congestion, HA, sore throat, cough Document # & dates of previous episodes –include success & failures of tx Recent URTI preceded fever & ear pain
What are the risk factors for pharyngitis?
Epidemics of group A β-hemolytic streptococcal disease occurrence Cold and flu seasons Age (esp. children/adolescents) Family history of rheumatic fever Close contact with infectious individuals
What is the physical examination of dermatophyte infections?
Examine skin to determine type and distribution of lesions Use of Wood’s light may aid in exam as some species cause tinea to fluoresce pale or brilliant green, however the most common fungus infecting the scalp T. torsurans does not fluoresce
What are the risk factors for stomatitis aphthous?
Positive family history Allergies to coffee, chocolate Stress and trauma Nutritional deficiencies Medications e.g. antihypertensives (Uphold)
What is the scope of practice related to referral/consult for toothache?
Refer to dentist
What is a pterygium?
A yellow triangular (wedge-shaped) thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea. Due to UV-damaged collagen from chronic sun exposure. Usually asymptomatic. Can be red/inflamed at times.
What is the physical examination of acne vulgaris?
Examine skin to determine form of acne Determine location of lesions Establish extent of disease Based on lesion count, type, & severity
What is the health history of contact dermatitis?
Ask about location of eruption, time and rate of onset associated symptoms: burning (ICD) or itching (ACD) occupation and recreational pursuits (youth/adults): if freq hand washing needed, specific chemical agents encountered at job Ask about exposure to topical meds and poisonous plants Peronal & family history of allergies Previous treatment
What is stomatitis aphthous?
Chronic inflammation of the oral mucosa tissue with ulcers often called canker sores?
What are the risk factors for mononucleosis?
College-age adults/adolescence living in group setting; infants & young children
What is the physical examination of cervical adenitis?
Vital signs General state of health Examine neck for masses Examine HEENT Palpate lymph nodes
What constitutes Recurrent Acute Otitis Media?
3 or more well documented & separate AOM episodes in preceding 6 months or 4 or more in 12 months with at least 1 episode in the last
What is the physical examination of diabetic retinopathy?
Visual acuity Inspection of status of the iris, lens, and fundus
What are the differential diagnosis for blepharitis?
• Chalazion • Hordeolum • Allergic Conjunctivitis • Keratitis
What is the physical examination of scabies?
examine skin for burrows/evidence of scratching pay special attention to hands, finger webs, wrists, axillary folds, belt line, navel, penis, area surrounding areolae
What is the health history of urticaria?
Onset and duration Presence of pruritis Any previous treatments and their outcome
What is the physical examination of epistaxis?
Assess vital signs Inspect external for deviated septum Patency of nasal passages Nasal mucosa Inspect skin if systemic illness are suspected
What are the differential diagnosis of dermatophyte infections?
Seborrheic dermatitis Contact dermatitis Atopic dermatitis Psoriasis
What is the physical examination of stomatitis aphthous?
Vital signs Assess nutritional status Complete HEENT Palpate lymph nodes Inspect skin for lesions
What are the diagnostic investigations for cataracts?
• Ophthalmologist will do additional testing • Cataract is best evaluated by slitlamp biomicroscopy
What is the physical examination of otitis externa?
Determine if febrile Inspect skin as many dermatological conditions can cause OE Carefully inspect external canal with otoscope Apply pressure to tragus, pull pinna up & back, noting degree of tenderness Observe tympanic membrane which is usually normal
What physical examinationn for conjunctivitis?
• Determine visual acuity and pupillary function • Examine eyelids for inflammation or tenderness • Examine sclera & conjunctiva for hyperemia & edema; check cornea for clarity • If eye discharge present, note amount & color • Palpate for tenderness and enlargement of preauricular nodes
What is the health history of lichen planus?
Onset, duration, appearance, and symptoms When and where did you first notice the inflammation (flexural surface and then more generalized) Treatments tried and result Patients hepatitis C status
What is the health history of foreign body of the ears
Inquire about onset, duration & character of symptoms History of placing objects in ear
What characteristic appearance of the optic nerve distinguishes glaucoma from other forms of acquired optic neuropathy?
Optic-nerve cupping on funduscope
What is the physical examination of seborrheic dermatitis?
§ VS Integumentary System Determine distribution based on typical locations by age group: Infants: commonly see scalp involvement “cradle cap” (including scalp margins and upper forehead), develops a few weeks after birth. Lesions are usually red-yellow plaques covered by scales. Can involve face and diaper area, flexural regions Adults: characteristic locations are where there are many sebaceous glands:
What are the differential diagnosis of otitis media?
otitis externa transient middle ear effusion e.g. from plane travel mastoiditis Furuncle
What is the physical examination of foreign body of the eyes?
Visual acuity Examine internal instructure of the eye including sclera, conjuctivativa, iris, pupil, cul-de-sac for foreign body
What is a red flag of herpes zoster?
Hutchinson’s sign = vesicles on the side or tip of nose; associated with serious ocular complications (trigeminal nerve involvement)
What is the scope of practice related to referral/consult for cervical adenitis?
Immediately refer patients with suspected malignancy Refer patients on abx therapy with lymph node enlargement persisting >2 weeks
What are the differential diagnosis for chalazion?
Basal cell carcinoma Sebaceous cell adenoma (less likely) Meibomian gland carcinoma Blepharitis Hordeolum
What is seborrheic keratosis?
Common benign epidermal tumors that represent proliferation of immature keratinocytes
What is the causative agent for furuncles/carbuncles?
S. aureus (MRSA)
What is epistaxis?
Nasal bleeding from any cause. 90% of bleeds are related to local irritation
What are the risk factors for scabies?
spread through skin to skin contact sexual promiscuity, crowding, poverty, nosociomial, immunocompromised young adult cases often sexually acquired
What is the diagnostic test for foreign body of the ears?
x-rays may be helpful if the object is radiopaque, calcified, batter otherwise no tests are needed
What causes corneal abrasion?
Mechanical trauma to the eye caused by a human fingernail, tree branches, but can also be the result of foreign bodies, contact lens wear, surgical trauma, chemical and burns.
What is orbital cellulitis?
• Acute, severe, vision-threatening infection of orbital contents posterior to orbital septum. It is a medical emergency as it can lead to optic nerve inflammation, cavernous sinus thrombosis, meningitis, brain abscess with possible vision loss, death
What are the risk factors for tinnitus?
Hearing loss High-level noise exposure Advanced age Use of ototoxic medications Otologic disease
What is Iritis?
Higher risk with autoimmune disorders (RA, lupus, ankylosing spondylitis), sarcoidosis, syphilis, others. Complains of red sore eyes. Appears like red eye but with increased tearing.
What are the differential diagnosis of mononucleosis?
Pharyngitis Hepatitis HIV Syphilis
What is the health history of acne vulgaris?
onset, type of lesions, and distribution, seasonal variation medical and medication In females: history of cyclic menstrual flares, use of oral contraceptives In males: use of anabolic steroids Types of cleansers and moisturizers used on face Any previous treatments and results-topical antibiotic resistance is increasingly relevant in tx of acne
What is the health history of corneal abrasion?
If injury is chemical, thermal, or mechanical, blunt or sharp trauma arrange for transport to ER/ophthalmologist first because of threat to vision Eye pain and/or vision problem are present? Ask if any eye protection was being worn when the injury occurred? If anyone witnessed the injury Ask if contact lenses are being worn (or were being worn at time of injury)
What is atopic dermatitis?
A chronic, relapsing form of pruritic skin inflammation often associated with other atopic disorders e.g. allergic rhinitis and asthma
What is the health history of hordeolum?
Onset & duration of symptoms Any ocular pain or changes in visual acuity Past episodes or previous treatments
What is the health history of atopic dermatitis?
Family history of atopy (allergic rhinitis, asthma, AD)—and age of onset Ask about itching (+rubbing in infants), appearance Distribution of lesions Routine skin care * Atopy refers to the genetic tendency to develop allergic diseases
What is the diagnostic test for corneal abrasion?
It is a clinical diagnosis But a corneal staining with fluorescein can be done if trained
What is the scope of practice related to referral/consult for tinnitus?
Refer to audiologist for comprehensive hearing evaluation and management
What is the diagnostic test for contact dermatitis?
None indicated
What causes stomatitis aphthous?
Etiology uncertain but heighed immunologic response to oral mucosal antigen may play a role. It’s common in pts with leukemia, neutropenia, & HIV.
What are the specific eye findings of diabetic retinopathy?
Microaneurysms due to neovascularization. Cotton wool exudates. Neovascularization (growth of fragile small arterioles in retina rupture easily, causing bleeding and scarring on the retina).
What is the scope of practice related to referral/consult for candidiasis?
· Severe lesions Paronychia (soft tissue infection around a fingernail): referral to paediatric dermatologist is recommended as this usually occurs in infant and children who suck their fingers, limiting the usefulness of topical creams
What is the diagnostic test for pityriasis rosea?
None indicated. Consider ruling out syphilis
What is lichen planus?
An idiopathic eruption with characteristic shiny, flat-topped (Latin: planus, “flat”) purple (violaceous) papules and plaques on the skin, often accompanied by characteristic mucous membrane lesions. Itching may be severe.
What is the diagnostic test for pharyngitis?
GAS should be suspected on clinical presentation A throat swab C&S or Rapid Antigen Detection Tests (RADT) for Group A beta-hemolytic streptococcus (GABHS) (rapid strept) - Avoid testing for GAS pharyngitis in children ≪3 years old as acute rheumatic flare is rare *If antigen test is negative, then children still require a culture; in adults a negative antigen test alone is reasonable
What are the differential diagnosis of pityriasis rosea?
Drug eruptions (captopril, barbiturates) Secondary syphilis Tinea corporis Small plaque parapsoriasis Erythema multiforme Eczema (often first dx of herald patch)
What is the scope of practice related to referral/consult for psoriasis
all pediatric patients and patients w/psoriasis >20% of BSA, severe extremity involvement (hands and feet), failed response to tx after 4-8 weeks
What are the differential diagnosis of actinic keratosis?
Benign melanocytic nevus (mole) Basal Cell Carcinoma Malignant Melanoma Squamous Cell Carcinoma* Seborrheic Keratosis
What is the diagnostic test for actinic keratosis?
· The diagnosis is usually made clinically, except where there is a suspicion of carcinoma
What are the risk factors for cellulitis?
Trauma, recent surgery, obesity, middle age, immunodeficiency, drug/substance abuse, cancer
What is glaucoma?
Primary open-angle glaucoma (POAG)-most common, is an optic neuropathy resulting in visual field loss frequently associated with increased intraocular pressure (IOP) Classic Case: Most commonly seen in elderly patients, especially those of African background or diabetics. Usually asymptomatic. Gradual changes in peripheral vision (lost first) and then central If fundoscopic exam shows cupping, IOP is too high. Refer to ophthalmologist.
What is the physical examination of pityriasis rosea?
VS-normal General appearance (see above) Particular tests/exams Diagnostic tools
What is the causative agent for pityriasis rosea?
Reactivation herpesvirus-7 (HHV-7) and HHV-6
What are the differential diagnosis of warts?
Callouses Lichen planus Seborrheic keratosis Herpes simplex virus
What are the differential diagnosis of seborrheic keratosis?
Benign melanocytic nevus (mole) Basal Cell Carcinoma Malignant Melanoma Squamous Cell Carcinoma
What are the risk factors for diabetic retinopathy?
Diabetes (duration usually >10 years) Poor glycemic control Pregnancy Renal disease Hypertension Smoking
What is the health history of mononucleosis?
Onset & duration of symptoms Trouble breathing or swallowing Recent history of exposure to others with mononucleosis Any headache, weakness & confusion (CNS complications of mononucleosis) (Uphold)
What is the scope of practice related to referral/consult for hordeolum?
Pts not responsive to warm compresses after 2-3 days should be referred to ophthalmologist
What is actinic keratosis (solar keratosis)
Common, usually multiple, premalignant lesions of sun-exposed areas of the skin. Many resolve spontaneously Common sites: areas of sun exposure (face, ears, scalp if bald, neck, sun exposed limbs)
What is the most frequent type of injury in pulpitis?
Dental caries
What is herpes zoster?
A painful vesicular rash caused by a reactivation pf the varicella zoster virus (VZV), a double stranded DNA herpes virus persisting latently in dorsal root ganglia
What is the physical examination of rhinitis?
Measure vitals Inspect nose for deviated septum Patency of nasal passages Nasal mucosa Inspect eyes for “allergic shiners”
What is the diagnostic test for tinnitus?
Tinnitus is a symptom; no objective test to confirm diagnosis. Refer to Audiology
What is acne vulgaris?
A chronic inflammatory dermatosis of the pilosebaceous unit that is more intense in areas where sebaceous glands are number-face, chest, and upper back
What is the physical examination of contact dermatitis?
Examine skin to locate inflammation/distribution of eruption Determine appearance of primary lesion
What are the risk factors for atopic dermatitis?
Inhalants e.g. dust mites & pollens Microbial agents e.g. S. aureus Foods Emotional stress
What are the differential diagnosis of herpes simplex infection?
Syphilis (must be r/o) Herpes Zoster Impetigo Folliculitis Psoriasis
What is the physical examination of mononucleosis?
General state of health Vital signs HEENT Auscultate heart Auscultate lungs
What are the differential diagnosis of acne vulgaris?
Rosacea Steroid rosacea Molluscum contagiosum Folliculitis
What physical examinationn must be done for blepharitis?
• Determine visual acuity • Complete eye exam: focus on a) inspecting eyelid margins for crusting, scaling, erythema & erosions b) evaluate structural changes of eyelids c) examine sclera & conjunctiva for abnormalities
What is toothache?
Also called pulpitis. A suppurative process that results from decay of the tooth and inflammation and infection of the pulp. Suppurative - the formation of, conversion into, or process of discharging pus
What are the differential diagnosis of rhinosinusitis (RS)
URTI Allergic rhinitis Foreign body Trauma Neoplasm
What are the differential diagnosis of tinnitus?
Pulsatile tinnitus: carotid stenosis, aortic valve disease, AV malformation, high cardiac output state (anemia, hyperthyroidism) Nonpulsatile tinnitus: auditory hallucinations
What is the physical examination of tinnitus?
Inspects both external ears for position and alignment Palpate auricle, tragus and mastoid process for tenderness Check hearing using Weber and Rinne tests Palpate TMJ for tenderness and crepitus with movement Funduscopic exam for papilledema
What are the differential diagnosis of psoriasis?
Plaque (vulgaris) most common- Inverse psoriasis Contact dermatitis Atopic dermatitis
What is cellulitis?
Acute bacterial infection of the lower dermis and subcutaneous fat (full thickness).
What are the most common pathogens pharyngitis?
Viruses most common (esp. adenovirus) Bacterial (Group A B-hemolytic Streptococcus-GAS)
What is the physical examination of warts?
VS General appearance Examine lesions observing for characteristics appearance
What is the health history of rosacea?
Duration add location: Episodic reddening of the face (flushing) Pain? (may burn/sting, dry appearance, edema) What makes condition worse (hot liquids, spicy food, alcohol or exposure to sun/heat=vasodilators) ocular involvement
What are the differential diagnosis of urticaria?
Anaphylaxis Angioedema Urticarial pigmentosa Atopic dermatitis Contact dermatitis
What is a red flag of seborrheic keratosis?
Sign of Leser-Trélat - sudden eruptive appearance of numerous lesions may indicate internal malignancy
What is the scope of practice related to referral/consult for herpes zoster?
All children/teens; immunosuppressed adults (HIV, leukemia, etc) or receiving tx (chemo, radiation, immune suppressing drugs); or ophthalmic involvement (immediate) warrant referral to specialist Pain control expert for pts with postherpetic neuralgia
What is the physical examination of iritis?
Visual acuity Test pupillary reaction to light Inspect eyes & eyelids Palpate eye for tenderness & masses Examine iris, sclera & conjunctiva
What is the health history of seborrheic dermatitis?
Ask about lesion onset, duration, + location Complete medical hx: determine immunosuppression from illness or meds/tx Ask about previous attempted tx and results
What is the most common sites for cervical adenitis?
Submandibular and anterior cervical
What is the physical examination for chalazion?
visual acuity inspect eyelid for inflammation and masses palpate eyelid for masses and tenderness inspect sclera and conjunctiva for abnormalities
What is the physical examination of impetigo?
Determine if febrile Examine skin: focus on areas of typical involvement –face, arms, & legs Check for regional lymphadenopathy that may be present
What is the physical examination of rhinosinusitis (RS) (same as rhinitis)
Measure vitals Inspect nose for deviated septum Patency of nasal passages Inspect nasal mucosa Inspect eyes for “allergic shiners”
What is molluscum cotagiosum?
Discrete dome-shaped and pearly, white papules with central umbilication. Small 2-5mm but occasionally coalesce to form larger lesions up to 15mm; can express a thick, creamy core material from centre. Highly contagious.
What is the physical examination for orbial cellulitis?
• Assess visual acuity (with glasses if required) • Lid exam and palpation of the orbit • Pupillary reflex for afferent pupillary defect • Extraocular movements; assess for pain with eye movement—if present, concerning for orbital cellulitis. • Red desaturation: Patient views red object with one eye and compares to the other; reduced red color may indicate optic nerve involvement. • Confrontation visual field testing
What is the diagnostic test for diabetic retinopathy?
Fluorescein angiography
What are the differential diagnosis of candidiasis?
Oral: aphthous stomatitis leukoplakia Diaper: Linea IgA dermatosis irritant contact dermatitis Intertriginous areas: Miliaria psoriasis Male genitalia: Psoriasis tinea Nails: tinea
What are the risk factors for dermatophyte infections?
Moisture, warm, environment occlusive footwear immunosuppressive agents, immunodeficiency states communal bathing
What are the risk factors for glaucoma?
Increased IOP Myopia Diabetes African American Elderly Hypothyroidism Family history