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
What is the physical examination of cellulitis?
Vital signs Examine skin and degree of erythema Examine lymph nodes Any sign of purulent lesions? Infection?
What is/are the causative agent of toothache?
Diverse flora including gram-positive anaerobes & bacteriods are the most common organisms
What are the differential diagnosis of furuncles/carbuncles?
Acne pustules Epidermal cyst Folliculitis
What are the differential diagnosis of pediculosis?
Scabies Neurotic excoriation
What is hordeolum?
A painful acute bacterial infection of a hair follicle on the eyelid. Classic Case Complains of an itchy eyelid and an acute onset of a pustule on either upper or lower eyelid that eventually becomes painful.
What is the physical examination of seborrheic keratosis?
Examine entire skin surfaces (teach self-skin exam at this time as well) Determine patient skin type and sun sensitivity & provide education about sun protection
What are the risk factors for impetigo?
Children 2-5yrs old, young adults living in crowded conditions, poor hygiene, neglected minor trauma It occurs equally in males and females
What are the risk factors for pediculosis?
Head lice- in elementary school children. Pubic lice- common in adolescents and young adults-transmission by sexual contact
What is the diagnostic test for rhinitis?
Diagnosis is clinical, no tests are required. Skin testing is good standard for determining specific IgE antibody.
What is the diagnostic test for otitis externa?
None. C&S swab for ear drainage if resistance to initial management.
What is the diagnostic test for otitis media?
Usually no diagnostics ordered Tympanocentesis for C&S is gold standard for diagnosing of AOM
What is the diagnostic test for hordeolum?
None indicated
What is the physical examination of rosacea?
Vital signs Examine facial skin for characteristic distribution (central facial area) Examine eyelids for erythema (Uphold)
What is the health history of cervical adenitis?
Onset & duration of node enlargement If node is increasing in size Any pain when eating Any constitutional symptoms Any allergies
What are the risk factors for cervical adenitis?
Children immunocompromised disease states (HIV, cancer, transplant patients)
What is the health history of seborrheic keratosis?
Inquire about presence of new or change in existing lesions Ask about personal & family hx of skin tumours, both nonmalignant & malignant Ask about sun exposure & use of sun protective strategies
What are the 6 Ps of lichen planus?
§ Purple Pruritic Polygonal (noncircular, straight edges) Peripheral Papules Penis (i.e. mucosa)
What are the clincal manifestaton of cataracts?
decreased vision, glare, distortion, altered color perception
What are the red flags of orbital cellulitis?
• Diplopia (double vision), proptosis (bulging of the eye), vision loss, and fever suggest orbital involvement. • Severe septic appearance, mental status changes, contralateral cranial nerve palsy, or bilateral orbital cellulitis may indicate CNS involvement. • MRSA orbital cellulitis may present without associated upper respiratory infection.
What is the diagnostic test for seborrheic keratosis?
· None required when lesions are characteristic
What is rhinosinusitis (RS)
Acute, subacute, or chronic inflammation of the mucous membranes that line the paranasal sinuses & concomitant inflammation of nasal mucosa
What are the risk factors for seborrheic dermatitis?
Hereditary diathesis: so-called seborrheic state, with marked seborrheic and marginal blepharitis Psoriasis: “pre-psoriasis state”
What are the differential diagnosis of diabetic retinopathy?
Other causes of retinopathy (e.g., radiation, HTN)
What are the differential diagnosis of hordeolum?
Chalazion Blepharitis Squamous cell carcinoma Seborrheic keratosis (from Uphold)
What are the risk factors for molluscum cotagiosum?
Immunosuppression in HIV positive patients
What are the red flags for impetigo?
Dusky erythema: impending necrosis esp. of lesions w/ stellate or sharp borders Purple or violaceous nodules: leukemia, lymphoma, malignant vascular tumors, melanoma Black lesions: cutaneous necrosis, melanoma
What are the risk factors for contact dermatitis?
ICD: Abrasives, cleaning agents, oxidizing/reducing agents, urine, stool, excessive exposure to water Occupational exposure: healthcare, child care, cosmetology, janitorial, farming, construction Predisposing factors: atopy, fair skin, low temp/climate ACD: Natural: Poison ivy, poison oak, poison sumac (most common) Man-made: metals (e.g. nickel), fragrances, dyes in clothing/hair products, latex gloves, topical med ingredients (adhesives, preservatives)
What are the differential diagnosis of glaucoma?
Conjunctivitis Acute uveitis Age-related macular degeneration (From Uphold)
What is the health history of pediculosis?
Determine of nits or lice have been visualized Determine if generalized or localized. itching is present- especially nocturnal
What is the diagnostic test for folliculitis?
Potassium hydroxide examination to exclude a dermatophyte infection is indicated if there is scale surrounding the lesions making diagnosis uncertain
What is/are the causative agent for warts?
Human papillomavirus (HPV)
What is the diagnostic test for stomatitis aphthous?
None indicated. May order B12, folate, iron levels if nutritional deficiencies suspected
What is the diagnostic test for rosacea?
None
What is a complication of blindness?
Blindness due to ischemic damage to retina (CN 2).
What is the treatment plan for cataracts?
• No medical management. Management is surgical; refer to ophthalmalogist
What are the two types of tinnitus?
Subjective tinnitus: (most common) perceived only by the patient; can be continuous, intermittent, or pulsatile Objective tinnitus: audible to the examiner; usually pulsatile; ≪1% cases
Describe acute otitis media.
Rapid onset of S&S of inflammation in middle ear
What are the differential diagnosis of atopic dermatitis?
Seborrheic Dermatitis Contact Dermatitis Scabies Psoriasis Cutaneous Lymphoma
What is the most causative organism of blepharitis?
S. aureus
What is the diagnostic test for toothache?
Should be done by dentist
What are the risk factors for rhinosinusitis (RS)
URTI Allergic rhinitis Foreign body Trauma Neoplasm
What is the causative agent for folliculitis?
Staphylococcal infection
What is mononucleosis?
Acute viral syndrome with class triad of fever, pharyngitis, and adenopathy (enlargement of lymph nodes)
What is the diagnostic test for herpes simplex infection?
cell culture and polymerase chain reaction (PCR) are preferred
What is/are the causative organism of mononucleosis?
Epstein-Barr Virus (EBV) is the causative agent
What is the causative agent for cellulitis?
Staph aureus and Strep pyogenes
What is the diagnostic test for candidiasis?
When lesions are typical, no tests indicate. If unsure about source of infection (i.e. bacterial, viral or fungal), skin scraping and staining the cells with potassium hydroxide (KOH) indicated
What is the health history for orbial cellulitis?
• Complaints of acute onset red, swollen, tender eye or eyelid and pain with eye mov’t • History of surgery, trauma, sinus or upper respiratory infection, dental infection • Malaise, fever, stiff neck, mental status changes • Specific signs of orbital cellulitis include: (proptosis, double vision, ophthalmoplegia, vision loss (or decreased field of vision), pain with eye movement, decreased color vision)
What are the risk factors for cataracts?
natural age related (90% of cases), congenitial, traumatic (e.g. UVR exposure), secondary to sytemic disease (DM), corticosteroid treat, eye disorders (uveitis), alcohol, smoking
What is the health history of rhinosinusitis (RS)
Nature and duration of symptoms History of nasal congestion Fever and systemic symptoms Smoking Past episodes & treatment
What are the differential diagnosis of tinea infections?
Seborrhetic dermatitis Psoriasis Alopecia Atopic dermatitis Contact dermatitis
What is blepharitis?
Chronic bilateral inflammatory condition involving the lashes and lid margins
What is a complication of a toothache?
Periapical abscess in the periodontal tissue
What is the treatment plan for primary angle closure glaucoma?
Refer to ER
What are the differential diagnosis of iritis?
Acute angle-closure glaucoma Conjunctivitis Keratitis Scleritis
What are the differential diagnosis of molluscum cotagiosum?
Basal cell carcinoma Verruca vulgaris (warts) Keratoacanthoma
What are risk factors for Blepharitis?
Dermatologic disorders (e.g. seborrheic dermatitis, atopic dermatitis, and rosacea) are also often associated with blepharitis
What are the risk factors for epistaxis?
Commonly seen in children, >50
What are the differential diagnosis of pharyngitis?
Somatitis Rhinitis Epiglottitis Thyroiditis
What is the health history of scabies?
ask if itching is present and if its worse at night close contact with people with similar symptoms inquire if patient has tried treatments and their effectiveness
What are the differential diagnosis of impetigo?
HSV 2nd degree Burns Allergic Contact dermatitis Cutaneous Anthrax (rare) Scabies
What is the causative agent for herpes simplex infection?
HSV1 – oral infections HSV2 – genital infections HSV 1 can cause genital infection (increased prevalence of oral-genital sex)
What is seborrheic dermatitis?
A chronic, inflammatory skin disorders with a distinctive pattern of distribution for different age groups and a characteristic tendency to involve skin with sebaceous glands (face & scalp). Characterized by redness and scaling.
What is the physical examination of actinic keratosis?
· Examine entire skin surfaces (teach self-skin exam at this time as well) Determine patient skin type and sun sensitivity & provide education about sun protection
What is the diagnostic test for dermatophyte infections?
Skin scrapings, hair, and/or nail clippings analyzed with potassium hydroxide (KOH) prep to look for hyphae and mycelia (vegetative part of the fungus) Fungal culture to diagnose tinea capitis and onychomycosis
What is the diagnostic test for herpes zoster?
Usually clinically as rash is distinctive and presence of pain corroborates. If uncertain, direct fluorescent antigen assay (DFA) of cell material from skin
What is the diagnostic test for rhinosinusitis (RS)
None indicated for typical presentation & first episode of acute RS
Corneal Abrasion
Complains of acute onset of severe eye pain and keeps affected eye shut. Reports feeling of a foreign body sensation with increased tearing of affected eye. May be caused by contact lens. Contact lens abrasions at very high risk of bacterial infection (treated differently— refer ASAP).
What is the physical examination of corneal abrasion?
Examine eyelids of affected eye to see if trauma Visual acuity Inspect cornea Always look for presence of foreign body on upper lid Do corneal staining with fluorescein if trained
What is the health history of impetigo?
Location of lesions, onset, duration, & any associated symptoms. Lesions & surround skin may be tender but not painful Determine if any underlying dermatoses (atopic dermatitis) or hx of skin problems Ask if other contacts are affected; ask about tx tried & results
What are the risk factors for rosacea?
Acne may precede onset Associated with seborrheic dermatitis Fair skinned, light hair and eyes Family history
What physical examinationn for cataracts?
• Measure visual acuity • Check pupillary responses to light • Using ophthalmoscope, confirm lens opacity by a nondilated fundus examination • Assess visual fields by confrontation
What is the health history for conjunctivitis?
• Ask pt/parent to describe symptoms & inquire re: onset & duration to establish if the condition is acute, subacute, chronic, or recurrent • Ask about type & amount of discharge and whether the condition is unilateral or bilateral • Question re: presence of ocular pain, photophobia, or blurred vision (that fails to clear with a blink) • Ask if itching & other symptoms of allergy are present and if there has been recent contact with persons w/ similar symptoms • Person & family hx of hay fever, allergic rhinitis, and other allergic disorders • Obtain past medical and medication history • Specially ask about any history of eye trauma, recent URI, contact lens use, and use of any ocular medications both prescription and OTC
What is a furuncle?
Called “boils” are infection of the hair follicle and involves subcutaneous tissue forming a small abscess. Usually caused by S. aureus (MSSA or MRSA)
What are the differential diagnosis of foreign body of the ears?
Rhinitis Sinusitis Adenoiditis Nasal tumors Nasal polyps
What is the diagnostic test for scabies?
None
What is the health history of furuncles/carbuncles?
Location, appearance of lesion, onset, duration of lesion Ask about associated symptoms, which include pain, fever and chills Ask about insect, animal, or human bites or any trauma to the involved area Previous skin infection and recent use of antibiotics? if tetanus prophylaxis is up-to-date
What is rhinitis?
Inflammation of mucous membranes of the nose, usually accompanied by edema of mucousa & a nasal discharge. Rhinitis may be allergic or nonallergic
What is the diagnostic test for glaucoma?
Diagnosis based on color & contour of optic nerve. All pts with c/o of ocular pain, photophobia, visual blurring, or sudden loss of vision should be emergently referred to an ophthalmologist for evaluation (RED FLAG)
What is the physical examination of insect bites?
if hx suggests anaphylactic reaction treat immediately do not complete exam if no anaphylaxis à examine bite/sting for local reaction and remove stinger if present
What is a red flag for urticarial?
Triggers may result in anaphylaxiss
What is candidiasis?
Skin and mucous membrane infections caused by Candida albicans and a few other candida species (70-80% are from C. albicans)
What is the physical examination of folliculitis?
Inspect for lesions that are typically pustules of hair follicles with small erythematous halos on the surrounding skin. Pustules are very superficial and may be somewhat tender
What are the differential diagnosis of scabies?
atopic dermatitis contact dermatitis papular urticaria pediculosis impetigo
What are the risk factors for herpes simplex infection?
Lifestyle (sexual practice, stress, alcohol use) HIV Excess sun exposure Physical trauma Emotional stress URTI
What is diabetic retinopathy?
Noninflammatory retinal disorder characterized by retinal capillary closure and microaneurysms. Retinal ischemia leads to release of a vasoproliferative factor, stimulating neovascularization on retina, optic nerve, or iris.
What are warts?
Virus-induced proliferation of keratinocytes resulting in tumors of the skin and mucous membranes
What is the diagnostic test for cervical adenitis?
None needed. May do Rapid Strep antigen detection test or throat swab for C&S
What is the causative organism of hordeolum?
S. aureus
What are the differential diagnosis of otitis externa?
Furunculosis Otitis media Mastoiditis Foreign body
What are red flags of red eyes?
Eye pain, photophobia, yellow-green purulent eye discharge, severe foreign body sensation that prevents pt from maintaining eye in the open position, hx of eye trauma or change in visual acuity
What is the causative agent for impetigo?
Staphylococcus aureus or Streptococcus pyogenes or both
What diagnositc test can you use for herpes keratitis and corneal abrasion?
Corneal staining with florescein
What are the most common pathogens in acute rhinosinusitis (RS)
Viruses are more common than bacteria Streptococcus pneumoniae Haemophilus influenza Moxaxella catarrhalis Streptococcus pyogenes
What is the health history of herpes zoster?
Onset of eruption, appearance, distribution of lesions Pain, itching, tingling, burning in days prior? Immunosuppressed status? Current medications? Hallmarks
What is a corneal abrasion?
Corneal abrasion will report sudden onset of symptoms with foreign body sensation.
What is the health history of molluscum cotagiosum?
Contact with infected individual Onset, location, appearance, and symptoms HIV or immunocompromised?
What is chalazion?
A chronic inflammation of the meibomian gland (specialized sweat gland) of the eyelids. Classic Case: Complains of a gradual onset of a small superficial nodule that is discrete and movable on the upper eyelid that feels like a bead. Painless. Can slowly enlarge over time. Benign.
What is the diagnostic test for urticaria?
None. Consider allergy skin tests and RAST for inhaled allergens, insects, drugs, or foods; total IgE level
What is rosacea?
Common chronic inflammatory facial eruption primarily of the convex areas of the central face – cheeks, chin, nose, and forehead. Occurs in middle-age and older adults.
What is the health history of pharyngitis?
Onset & duration of symptoms Presence of cough Mouth lesions Skin changes and other associated symptoms Exposure to sick contacts
What is the health history of dermatophyte infections?
Onset, duration, distribution, appearance of lesions, and presence of symptoms Contact with others (or infected animals) with similar lesions and symptoms? Predisposing conditions such as sweaty feet, occlusive footwear Treatments used and outcomes?
What are the differential diagnosis of herpes zoster?
Varicella HSV Contact dermatitis
What is the diagnostic test for acne vulgaris?
Routine microbiologic testing not necessary. Can test androgen levels in patients who exhibit additional signs of excess androgen production
What is the causative agent for molluscum cotagiosum?
Mollusucum contagiosum virus
What are the differential diagnosis of corneal abrasion?
Corneal foreign body corneal laceration viral keratitis
What is the health history of stomatitis aphthous?
Onset & duration of symptoms Nutritional deficiencies Ask about stressors Ask about allergies Ask about recent mouth trauma (Uphold)
When should NP refer/consult for chalazion?
If nodule enlarges or does not resolve in a few weeks, biopsy to rule out squamous cell cancer. If large and affects vision, surgical removal is an option.
What is/are the causative agents for tinea infections?
Microsporum, Trichophyton, and Epidermophyton
What is folliculitis?
Commonly occurring pyoderma that arises within the hair follicle
What is the physical examination of hordeolum?
Visual acuity Inspect eyes Palpate eye for masses Examine sclera & conjunctiva
What is corneal abrasion?
Partial or complete removal of a focal area of the epithelium on the cornea of the eye. Usually due to trauma (e.g, fingernails, paper, twigs), contact lens
What is the health history of foreign body of the eyes?
First treat if emergent e.g. foreign body as a result of explosion, blunt, or sharp trauma presence of eye pain and or any vision loss if any eye protection was being used at time of injury, any witnesses to injury if contact lenses are in use (or were in use at time of injury)
What is the physical examination of herpes zoster?
Examine lesions in different stages of development (lesions necessary to make dx) Location/appearance of lesions may be atypical in immunocompromised pts Ophthalmic involvement?
What is the physical examination of pediculosis?
VS General appearance Check for excoriation from scratching and a secondary bacterial infection Head lice- use a fine toothed “nit” comb and insert near the crown touching the scalp- comb down and examine after each stroke.
What is contact dermatitis?
Skin inflammation due to irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis)
When should you refer/consult for otitis media?
Children < 3 months old Chronic/persistent infection w/evidence of mastoid involvement Craniofacial abnormalities Children with predisposition for recurrent OM (Down syndrome) Children with hx of febrile seizure
What is the physical examination of foreign body of the ears?
Test both nares for patency Examine both nares with nasal speculum Inspect all orifices of the head as multiple insertions of foreign bodies are common
What are the differential diagnosis for conjunctivitis?
• Acute angle-closure glaucoma • Lacrimal Duct Obstruction • Blepharitis • Corneal Abrasion • Keratitis (in contact wearers)
What are red flags for insect bites?
signs of anaphylaxis with breathing difficulties
What is the scope of practice related to referral/consult
Prompt referral to an ophthalmologist should be made with suspicion of an ulcer, recurrence of abrasion, retained foreign body, viral keratitis, significant visual loss, or lack of improvement despite therapy.
What is the physical examination of herpes simplex infection?
Examine skin for characteristic location, distribution, and appearance of lesions Palpate lymph nodes
Should you examine the pharynx of a patient who is drooling, stridor or trouble breathing?
No. They may have epiglottitis.
What is the diagnostic test for impetigo?
None required as clinical features are so characteristic. If there high prevalence of CA-MRSA in the area, culture of lesion is indicated before abx
What is the diagnostic test for insect bites?
none indicated for bites or stings with no systemic sx
What is the health history of glaucoma?
Onset & duration of symptoms Are both eyes affected? Difficulties with peripheral vision? Presence of headaches, photophobia or blurring vision? Personal or family hx of eye disease Obtain medical and medication history
What are the differential diagnosis of seborrheic dermatitis?
Psoriasis Tinea capitis/faciale Acne rosacea Subacute Lupus Erythematosus Impetigo (R/O by smears for bacteria)
What are the differential diagnosis of rosacea?
Acne vulgaris Contact dermatitis Seborrheic dermatitis Folliculitis
What are the differential diagnosis of cellulitis?
Contact dermatitis DVT Superficial phlebitis, Vasculitis
What are the differential diagnosis of contact dermatitis?
Allergic CD vs Irritant CD Atopic Dermatitis (usually more chronic) Scabies (begins in finger-webs + wrists, nocturnal itching, symptomatic household contacts) Nummular Dermatitis (discrete coin-shaped, erythematous, scaling plaques)
What are the differential diagnosis of rhinitis?
URTI Asthma Foreign body Cystic fibrosis (in children) Sinusitis
What is involved in psoriasis assessment?
Assessment of psoriasis severity involves a number of dimensions – amount of body surface area affected, location of lesions, thickness of plaques, symptoms experienced, quality of life. None specific diagnostic tests.
What is the physical examination of otitis media?
Examine auricle and external auditory canal Examine TMs bilaterally for position, color, degree of translucency Inspecting conjunctivae & sclera Inspect pharynx Nasal patency Palpate sinuses
What are the risk factors for otitis externa?
Frequent exposure to moisture (swimming, humid) Aggressive cleaning of canal or trauma External devices (e.g. hearing aids, hear plugs Anatomical abnormalities (narrow canal, exostoses) Allergies or skin conditions (psoriasis, eczema, seborrhea
What is/are the causative organism for cervical adenitis?
Most common are Staph aureus & Strep pyogene. Viral infections are also common (adenovirus)
What is a cataract?
A decrease in the transparency of the crystalline lens to the degree that vision is impaired. Shows as silver gray pupillary light reflex.
What is a red flag for otitis externa?
Malignant or necrotizing Otitis Externa is a serious complication - an infection that extends into the deeper tissues adjacent to the canal; may include osteomyelitis and cellulitis; S&S: nocturnal pain, granulation tissue at body-cartilaginous junction, fever
What is the scope of practice related to referral/consult for iritis?
Severe or unresponsive uveitis needs referral for lit-lamp exam & therapy including periocular injection of corticosteroids;
What is iritis?
Red eye can be a sign of uveitis. The uvea consists collectively of the iris, the choroid of the eye, and the ciliary body. Inflammation of the iris, or iritis, is the most common type of uveitis.
What are the causes/risk factors for iritis?
Infection should be the primary consideration. Allergies and psychological factors (depression, stress) may serve as a trigger. Trauma is also a common cause in this population.
What is the health history of pityriasis rosea?
Onset of stages of rash: Initial single “herald patch” (oval, slightly raised plaque 2-5cm, salon-red scale at periphery) plaque lesion usually on trunk 1-2wks later generalized secondary eruption develops (fine, scaling papules and patches with marginal collarette), dull pink in a Christmas tree pattern on back Itchy? varied degree of pruritis Associated symptoms: tired, nausea, sore throat, headaches Sexually active?
What is psoriasis?
A chronic inflammatory immune-mediated skin disorder with multisystem involvement and prominent skin and joint manifestations. Characterized by: scaly, thick, silvery, elevated lesions, usually on the scalp, extensor surfaces (elbows/knees) caused by a high rate of mitosis in the basal layer.
What are the risk factors for otitis media?
Age (6-24months) Parental smoking Male gender Congenital disorders (cleft palate, trisomy 21) Bottle feeling, use of pacifier Day care centre attendance
What is the physical examination of furuncles/carbuncles?
Determine if febrile Examine the affected area for swelling, pain, & redness Determine if cellulitis is present
What is a red flag for pityriasis rosea?
If rash on palms/soles need to r/o syphilis
What is the diagnostic test for atopic dermatitis?
Clinical diagnosis but can consider skin biopsy, patch testing, skin prick tests
What is the causative organism for dermatophyte infections?
Trichophyton, Microsporum, Epidermophyton species
What are the differential diagnosis of epistaxis?
Trauma Foreign body Sinusitis Rhinitis Systemic disease (HTN)
What is the physical examination of atopic dermatitis?
VS Examine skin to determine distribution and extent of eruption Palpate lymph nodes?
What is the physical examination of pharyngitis?
Vital signs Inspect oral mucosa for lesions Inspect ears Inspect skin for color and temperature Palpate lymph node
What are the risk factors for foreign body of the ears?
Intentional placement of object into ear usually due to curiosity, boredom, or imitation of others Accidental entry of foreign body can occur during play; insects may fly into ear
What is cervical adenitis?
Acute bacterial infection of a cervical lymph node. Often arising after a prior bacterial infection of the head or neck area. Common in children. If the infection is not contained, the bacteria enter the lymph system and proliferate (lymphadenitis)
What are the warning signs for ophthalmologist referral?
• Limbal/ciliary injection esp. unilateral involvement • Pupil abnormalities (abnormal PERRLA) • Signs and symptoms of acute angle-closure glaucoma (red, painful eye with raised intraocular pressure, blurred vision, headache, vomiting or coloured rings around lights) • Recent trauma to eye including contact lens wear • Severe foreign body sensation that prevents pt from maintaining eye in the open position, • Hx of eye trauma or change in visual acuity
What is pediculosis?
Infestation with one of the three species of lice, which feed on human blood; Head lice are not a health hazard; body lice are found on persons with poor hygiene and are well recognized vectors of disease- live in clothing; can survive away from blood source for 10 days Pubic lice- highly contagious *Itching is the most common symptom
What is pityriasis rosea?
Acute, self-limiting, rapidly evolving papulosquamous eruption oval erythematous lesions with inner fine central scale that does not extend to edge of lesion thought to be reactivation herpesvirus-7 (HHV-7) and HHV-6
What is the health history for blepharitis?
• Onset & duration of symptoms. Ask about eye discomfort, visual disturbances, photophobia, dry eyes & tearing. Also about presence of flaking & crusting at lid margins • Hx of contact use, prior eye disease, ocular medication use, hx of facial trauma or eye surgery • Previous & present skin problems • Ask about chronic exposure to irritants eg smoke, cosmetics, topical meds, and chemical
What test is done for pts suspected of otitis media with effusion?
Rinne & Weber (Weber test is positive to affected ear with effusion)
What is herpes keratitis?
Damage to corneal epithelium due to herpes virus infection secondary to shingles. Classic Case: Complains of acute onset of eye pain, photophobia, and blurred vision of the affected eye. Look for a herpetic rash on the side of the temple and on the tip of the nose (rule out shingles of the trigeminal nerve or CN 5).
What is the health history of candidiasis?
o Infants/children: location of lesions If nails involved, does the child suck their finger(s)? Adults: location of lesions, medications used, underlying chronic conditions symptoms associated with lesions
What is the diagnostic test for furuncles/carbuncles?
C&S swab of wound drainage (due to high risk of MRSA in the community)
What is otitis externa?
Diffuse inflammation of the external auditory canal, the most common form. Also called “swimmer’s ear”
What is impetigo?
Superficial bacterial skin infection caused by invasion of the epidermis
What is the diagnostic test for pediculosis?
Identification of lice and nits with naked eye or magnifying glass.
What is the physical examination of psoriasis?
Examine entire body surface Look for characteristic lesions esp. extensor surfaces Use a tongue blade to scrape over a lesion surface to elicit pinpoint bleeding (Auspitz sign) Examine nails
What is the physical examination of toothache?
Determine if febrile Inspect & gently percuss teeth Examine oral mucosa including gums, tongue Auscultate heart valves (risk of sepsis & complications increase w/ valvular disease) Palpate lymph nodes
What is the physical examination of candidiasis?
Examine skin, mucous membranes and nails for characteristic lesions: Lesions are beefy red, well-demarcated plaques, often with scaling edge and satellite lesions intertriginous areas (in between skin folds) may also show erosions and maceratio
What is the health history of toothache?
Pain’s OPQRST (onset, provocative, quality, radiating, severity, and timing) Occurrence of facial swelling Ask about heart murmur or defect Any medication taken for pain (Uphold)
What is the health history of tinnitus?
Subjective vs. objective Continuous vs. pulsatile (vascular in origin) Unilateral vs bilateral Associated symptoms: hearing loss, vertigo, aural fullness, otorrhea (drainage)
What is the health history of tinea infections?
Onset, duration, distribution, appearance of lesions, and symptoms. Contact with others or animals with similar lesions Predisposing conditions Treatments used and outcomes
What are risk factors for orbital cellulitis?
• Sinusitis* • Orbital trauma, retained orbital FB, ophthalmic surgery • Dental, periorbital, skin, or intracranial infection • Immunosuppression
What are the differential diagnosis of lichen planus?
If oral lesions: leukoplakia, oral candidiasis Psoriasis Pityriasis rosea Tinea corporis
What are the risk factors for folliculitis?
Mechanical irritation: Overweight individuals and tight, heavy clothing
What are the risk factors for candidiasis?
Pregnancy, infancy, oral contraceptive use, systemic antibiotics, corticosteroids use , chronic infections, immunocompromised states
What are the differential diagnosis of toothache?
Mumps Cellulitis Pericoronitis (painful wisdom teeth) Sinusitis (Uphold)
What are the differential diagnosis of foreign body of the ears
Otitis externa Otitis media
What are red flags for rosacea?
-ocular involvement 40-60% (Red eyes) -blepharoconjunctivitis, iritis and rosacea keratitis may develop (rare) can lead to corneal ulcers
What is the health history of actinic keratosis?
· Inquire about presence of new or change in existing lesions Ask about personal & family hx of skin tumours, both nonmalignant & malignant Ask about sun exposure & use of sun protective strategies
What is are tinea infections?
Dermatophyte fungi are the main causes of tinea, the clinical term for dermatophyte infection. It that infects and survives on dead keratin; spread by person-to-person contact
What is the health history of foreign body of the ears?
Onset & duration Previous episodes of nasal foreign body Type of foreign body; child will usually not confess to insertion of object
What is the diagnostic test for seborrheic dermatitis?
None indicated
What is the diagnostic test for warts?
None
What is scabies?
Common ectoparasitic infection
What is the health history of rhinitis?
Nature and duration of symptoms History of atopic dermatitis and/or food allergies History of nasal congestion Family history of allergic diseases History of environmental and occupational exposure
What is a carbuncle?
Lesions that result when s. aureus infection extends to involve several adjacent hair follicles, coalescing into a confluent mass with pus draining from multiple follicular opening.
What is the causative agent for scabies?
Sarcoptes scabiei var. hominis
What are the differential diagnosis of stomatitis aphthous?
Oral cancer Oral candidiasis Herpes Simplex Virus (HSV) Varicella Syphilis (Uphold)
What is tinnitus?
Tinnitus is a perceived sensation of sound in the absence of an external acoustic stimulus; often described as a ringing, hissing, buzzing, or whooshing
What is the health history of warts?
Location, onset, duration, appearance Treatments tried and results Any associated symptoms Question regarding pregnancy, oral contraceptives and immune status If genital warts: 5 Ps of STI (Partners, Prevention of pregnancy, Protection from STIs, Practices, and Past history of STIs)
What is the physical examination of tinea infections?
Examine skin to determine type and distribution of lesions Can use Wood’s light to aid inspection (Note: the most common fungus infecting the scalp – T. tonsurans, does not fluoresce)
What is the health history of epistaxis?
Onset & duration of symptoms Occupation exposure to irritating chemicals or dust Medication use, ask about cocaine use if appropriate Previous episodes & treatments Ask about trauma (injury, nose picking, forceful blowing) Other medical conditions (bleeding disorders, HTN, clotting problems)
What is the health history of insect bites?
question about type or sting or bite, time of occurrence, location if sting determine if allergic reactions are present hallmark à sharp pinprick sensation followed by burning pain
What is the treatment plan for herpes keratitis and corneal abrasion?
Refer herpes keratitis patient to ED or ophthalmologist STAT (Zovirax or Valtrex BID). Flush eye with normal saline to remove foreign body. If unable to remove, refer.If corneal abrasion, use topical ophthalmic antibiotic (erythromycin or Polytrim applied to affected eye × 3 to 5 days). Do not patch eye. Follow up in 24 hours. If not improved, refer. Consider eye pain prescription (hydrocodone with acetaminophen; prescribe enough for 48 hours of use). Avoid steroid ophthalmic drops for herpes keratitis. If corneal abrasion, rule out penetrating trauma, vision loss, soil/dirt. Check vision.
What is dermatophyte infections?
Infection of skin, hair, and nails caused by dermatophytes (fungi that live within the epidermal keratin or hair follicle and do not penetrate into deeper structures Digestion of keratin by dermatophytes results in scaly skin, broken hair, crumbling nails/onycholysis
What are the differential diagnosis of cervical adenitis?
Congenital cysts Cervical lymphadenopathy Furuncle Dermoid cyst Thyroid nodule (Uphold)
What is the health history of psoriasis?
Onset, duration, location of lesions Joint pain or stiffness in fingers/toes Family hx of psoriasis in 1st degree relatives Treatments in the past
What are the risk factors for corneal abrasion?
History of trauma Contact lenses wear Male gender Job (e.g. construction) Lack of eye protection
What is the health history of iritis?
Onset & duration of symptoms Any ocular pain, photophobia, or blurred vision Any itching & other symptoms of allergy Person & family hx of allergic rhinitis, and other allergic disorders Past medical and medication history Any history of eye trauma, recent URI, contact lens use Any use of any ocular medications both prescription and OTC
What is the physical examination of molluscum cotagiosum?
VS General appearance Integumentary exam – lesions are discrete, nontender, flesh-coloured, dome-shaped papules that show a central umbilication Intertriginous areas – hundreds may appear (axillae and intercrural areas) Inflammatory changes: result in suppuration, crusting, and eventual resolution of lesion (rarely means secondary infection)
