Screening, Optho, Derm, ID Flashcards
HPV Ages
Men 9-21, women 9-26
Hyperlipidemia screening? How often
Men, 35, every 5 years
Colonoscopy screening? Alternative?
Relatives?
After UC?
Alternative - annual fecal blood
Colonoscopy - 50 - 75
1st relative - 40 y.o
UC - 8 yr after diagnosis - 1-2 years after
Mammography screening?
(40) 50-75
Every 2 years
AAA screening?
65-76 in smokers
Dexa screening?
65 y.o
Pneumococcus in normal?
Medium risk?
High risk? HIV/CKD/SS/Splenectomy?
After 5y.o, give PCV 13, followed by 23 in 1 years.
In “medium risk” such as COPDers etc, give one 23 solo, then reset and give 13 -> 23 at 65.
In HIV/CKD/SS/Splenectomy - give 13->23 after 8wk. In HIV, repeat and give every 5 years. Not sure about other hgih risk
Bladder screening? Pancreas screening?
Dont screen for either bladder or pancreas
Lung CA screening? Age? How?
30+ pack year. Low dose CT from 55-80
CEA screening
50,60. male. 70% for asx/sx female
DM screening?
Multiple bp over 135/80; multiple risk factors (obese etc)
Start Statin in diabetic patients 40-75
Initial HTN dx,. What should tests to run?
UA, BMP, Protein/Cr, Lipids, EKG
Best nonpharm ways to control HTN?
Weight Loss, Dash, Execise, Sodium restrick, ETOH - in that order. Smoking not on the list
Is verbal consent enoguh to release info?
Yes - per HIPPA
Best way to screen for MEN2?
Genetic screening better than calctonin or metanephrines. Still get metanephrines first if you are concerned about pheo… then screen later.
HIV screening
HIP p24 antigen and Antibody test.
HIV RNA if negative results and high suspicion
HyperK treatment?
Ca Gluconate > Insulin , albuterol.
Hyper Ca tx? Short term? Long term?
IV hydration, calcitonin.
Long term - bisphosphnates
NO DIURETICS (unless extreme?)
Tumor lysis findings?
HyperP, Hyper K, HyperUricemia. HypoCa (Excess P binds Ca)
Hyper Na tx in hypovolemic?’
Mildly dehydrated
Very dehydrated?
Mild: 1/2NS+D5
Very dehydrated: Hydrate w/ NS.
Usually I would go with this. Also for any sort of resuscitation, always NS
When euvolemic - can switch to 1/2 NS
Acute Angle glaucoma presentation?
Triggers?
Dx?
Tx?
What not to give?
Sudden onset w/ pain, blurry vision.
Triggers - Decongestants
Dx - IOP w/ slit lamp (tonometry/gonioscopy)
Tx - Mannitol, acetazolamide, Pilocarpine, Timolol
DO NOT GIVE ATROPINE
Open angle glaucoma - presentation?
tx?
DEC peripheral vision. Cupping of disk.
Tx Timolol
Optic neuritis presentation?
What is affected?
Rapid color change - Central scotoma.
Afferent defect often
Macular degeneration?
Findings?
Dx?
DEC visual acuity
Dx - Straight lines -> wavy
Central Retinal Artery Occlusion.
Presentation?
What else has this presentation?
Difference?
Tx?
Sudden onset - curtain falling down
Retinal detachment also has this presentation.
Difference: on optho exam you will see PALLOR (due to ischemia) and accentuated red fovea. No retinal tears.
Tx - High flow O2, ocular massage
Retinal Detachement
Presentation?
What has similar presentation?
Why are these different?
Tx?
Sudden onset curtain coming down, vision loss.FLOATERS
Similar to centrla retinal artery occlusion, but do not see pallor and red fovea.
Instead, see elevated, grey retina.
Tx ?!
Virteous Hemorrhage
Presentation?
Optho finding?
Loss of fundal detail.
dark red glow. Floaters.
Preseptal cellulitis vs Orbital cellulitis? Presentation?
Risk factors for orbital cellulitils, and risk factors for the risk factor?
Preseptal - no change in vision.
Orbital Cellulitis - vision change, opthalmoplgia.
Viral sinusitis -> Bacterial rhinosinusitis -> Orbital sinusitis.
Dacrocystitis
WHt is it? Presentation? Tx?
Dacrocystitis - lacrimal infection - medial canthal pressure elicits purulent draininage - Discharge w/ pressure.
Tx - Staph A
Stye (Hordeolum) VS Chalazion
Recurrent chalazion?
Stye (hordeolum) - small, painless, external eye
Chalazion - Chronic, painless, usu internal
- must biopsy if recurrent - risk of sebaceous CA or BCCA
Choroidal rupture clinical scenario? prsentation?
Blurred vison after trauma
Pathophys behind a FRECKLE?
INC melanosomes, not cytes
BCC - Presentation?
75% of skin CA.
ULCERATED open sore, pearly, reddish, scar like
Actinic Keratosis - Presentation. What are you concerned for?
Sandpaper feeling.
Precursor to SCC
Seborrheic Keratosis - Presentation? Concern?
Stuck on.
Seen in Lesser Trelat sign (multiple, quick onset -> CA in gut)
Seborrheic dermatitis - presntation? Who do you see this in?
Inflam of sebaceous glands.
Seen in parkinson and HIV
Keratoacanthoma - Presentation? Concerns?
Cup shaped tumor w/ keratin debris
Low grade SCC!
Dermatofibroma =- POresentation?
Hyperpig - nontender. Central dimpling when pinched
Rosacea - presentation?
Telangiectasia - Rossy, flushing w/ emotions, heat
Dermatitis herpetafrmis? Association? Tx?
Celiac - Tx dapsone
Tx of acne? Tiers?
Comedal - retinoids
Inflam - retinoids, benzoyl, add abx.
Nodular cystic - unresponsive to the above. PO isotretinoids
Presentation of steroid acne?
Noncomedal. pustular
Histo of pemphigous vulgarious? bullous pemphigoid?
Vulgaris - IgG between epidermal cells. ((desmosomes)
Bullous - IgG to hemidesmosomes - C3 deposits.
At the dermal-epidermal border - aka the BM
Tx of Nail puncture leading to osteo
Tx for pseudomonas. Not tetani.
Staph A most common cause of osteo in adults AND kids. But in nail… concern for pseudo
Tx for human/dog bite?
Amox clauvulonic
Rabies bite? What to do?
Based off of the animal.
High risk - Rabives PPX
Low risk - dogs etc.
If you can quarantine and watch for 10 days, do so
If you cant quarantine and observe, PPX
Tx of Legionella?
Atrypical pneumo - tx w/ Macrolide (Azithro, Erythro), or Levofloxacin (Quinolone)
PPD + individual? Categories/Requirements?
Asx?
Sx?
15+mm in normal no risk pt/.
10 mm in high risk - lab worker etc
5m in HIv
Asx - 9 mo INH+B6. Or 2 months rifampin+pyrazidamine
RIPE if sx
PCP tx? What are classic physio findings?
TMP SMX PLUS STEROIDS
INC A-a gradient (emphysema, not chronic bronchitis)(
Contact Lense Keratitis Tx?
Pseudo, Serration and other GN GP.
Broad spectrum abx.
Prostatitis tx?
TMP SMX
Lyme tx?
In kid?
In preg?
Amox, Doxy, 3rd gen Ceph. All basicalyl equiv.
Dont give doxy in kids younger than 8
Syph Dx? Tx? In pt w/ allergy? Preg?
Dx - Microscopy in early stages. VDRL etc later.
Syph - Tx Penicillin.
Penicillin allergy ->doxy
In preg ladies - > desensitize to penicillin
Condyloma lata vs accumunata
Lata = syph
accmunata - warps hpv - more papillary and verruncous
Cat scratch tx?
Noncutaneous findings
Bacillary angiomatosis
Tx - Azitrhomycin or erythromycin.
Red friable lesions - may be seen in the liver in ICH. Hemorrhagic on biopsy.
Disseminated GC findings?
Dx?
Tenosynovitis, rash, purulent or NOT arthritis
Blood cultures may be negative
Nucleic acid amplify of mucosa is better
Blasto vs Histo? Hosts?
Tx
Blasto may affect normal ppl as well as ICH.
Histo is ICH mainly.
Hist has HSM, pancytopenia
Tx both with itraconazole
Sporothrix - Presentation? Painful or not painful?
Tx ?
Painless! Garener
Tx - Itrac/Terbinafine > KI
Aspergillosis - radiographic findings?
Halo sign - cavity with air cresents
Itrac. Resistant to fluconazole.
In dissemianted, canuse ampho and caspofungin
babesia - presentation
tx?
Babesia - fever, hemolytic
Atovaquone + azitrhomycin
Toxo - PPx? Tx?
Toxo
PPx - TMP SMX
Tx - Sulfadiazine + pyrimethamine
Trichenellosis?
From where?
Clinical/lab findings?
Tx?
From pigs. undercooked pork
Eos! Periorbital edema , myositis, splinter hemorrhages
Tx - Albendazole
Malaria ppx?
Mefloquone, doxy, atovaquone.
Entamoeba - from where?
Dx/Findings?
Tx
Entameoba - traveling etc.
Blood diarrhea, may see liver cyst - DO NOT BIOPSY.
Can serologic test
Tx w/ PO metronidazole, EVEN if there are liver abscess
Echinococcus? - from where?
Findings? How does this differ fromk entameoba?
tx
From dog/sheep
Liver absces - WITH EGG SHELL CALCIUM. These are not seen in entameoba (from the wild). AKA animals animals animals.
Tx - aspiration + albendazoel
Taenia soleum
From?
Tx?
undercooked pork
neurocysterercosis
Tx - Praziquantel + albendazole
soleum+praziq
HBV tx?
In whom?
HBV - tx in compensated
DNA >20k, ALTx2. INR less than 1.5? no depresion etc.
T
x - Tenofovir. .. Entecavir second.
HBV needle stick?
Vaccinated - nothing
Unsure/not vaccinated - Hb IG and Hep B (active and passive)
HCV - Tx?
Geno1?
Tx - Peginterfrom + Ribavarin
Geno1 + Telapovir (or boceprevir)
HCV predisposes you to what 4 things?
Porphyrea tarda, cryoglobulin, Membranous, Membranoproliferative T1
HIV Diarrhea - OOcysts?
OOcysts = Cryptosporidium
Microsporodium has spores, not oocysts
MAC - ppd findings?
presentation??
ppx WHEN in HIV ?
tx?
PPD negative
Diarrhea, pneumo
PPx
HIV vaccines - which can you give and when?
Do not give live.
Excespt MMR and Zoster (give the killed polio) Give these if CD4 is greater than 200.
Give HAV, HBV, Influenza, Tdap once, then Td every 10 yr
PCV13, then 23,
If less then hold.
CMV esophagitis histo presentation?
Tx
Linear ulcers w/ intranucelar and intracytoplasmis
tx gancyclovir
HSV esophagitis - histo presentation? tx?
Vesciular, volcano lesions. Intranuclear only.
Tx acyclovir
CMV retinitis vs HSV retinitis?
CMV - painless
HSV - pauinful
Herpetic whitlow tx?
None. self resolves.
HSV encephalitis?
Dx?
Tx?
Dx - PCR/.
Tx - acyclovir, even before the PCR comes back.
EBV - no sports for how long?
How doe sthis presentation differ from acute CMV infection?
No sports for 3 wk. Have autoimmune hemolytic anemia risk (mononucleosis) + splenomegaly, pharyngitis
CMV - splenomegaly . Got get as crazy LAD and no pharyngitis.
When to get Tdap, when to get Td?
Tdap once as adult, then Td every 10 years.
Get Tdap once again in liver failure/HIV etc, Then Td every 10 years.
Splenecotmy vaccine? when? which?
14 days before 14 days after.
Seq PCV13, 23 regardless of prior.
Also HiB, meningococcus.
Post splenectomy ppx in pediatrics adults
pediatric - PO penicillin daily for 3-5 years or until an adult.
INC risk of pneumococcal sepsis for 30+ year
may keep abx at home at sign of fever.
? Melanoma.
Do what?
if biopsy comes back.. as +, as BCC?
?Melanoma - > Excision biopsy.
If it comes back as melanoma -> 1cm margins + Sentinal LN
If comes back Basal Cell CA - no margins required.
benign = no margins.
TB tx and PPX
TB tx is RIPE for 6 mo. PPx is 9 mo INH+B6 or 2mo Rifampin + Pyrazidamide
Self breast exam?
Clinical breast exam?
SELF BREAST EXAM NOT RECOMMENDED – Clinical breast exam uncertain.
Clearly necrotic ulcer in DM pt
– don’t need to biopsy ulcer edges because necrotic = likely not malignancy.
Roseola
3d high fevers followed by maculopapular rash. Supportive care.
OCP associate ICN and DEC risk of CA
DEC endometrial and ovaria. INC breast and cervical.
Camper w/ rash that moves from arm/eg to TRUNK
Rocky Mountain - Rickettsia
When to do Head CT in someone with meningitismus?
CONFUSION (cannot perform neuroexam to find focal deficit)
Papilledema, Seizure, Focal deficit
If you cannot culture due to abx, what is the most SPECIFIC test?
Latex agglutination ANTIGENS. moreso than stain)
Someone with acute onset fever, confusion - what to do next?
Must Head CD because of CONFUSION - most likley encephalitis - herpes most common
cannot LP without CT because of CONFUSION
Mots common neuro deifict from UNTREATED BACTERIAL MENINGITIS
8th cranial nerve deficit/ Deafness
Most sensitive finding for otits media?
Immobility > bulging, redness, etc.
Sinusitis - most accureate dx test?
Bacterial Pharyngitis - best dx test?
Sinus biopsy or ASPIRATION. May not need to do and can just tx Amox Clauvulonic.
Culture of nasal discharge is ALWAYS WRONG ANSWER for sinusitis.
Rapid strep test. Tx Amox or penicillin.
Penicillin allergy pt - can you tx w/ cephalexin?
If penicillin allergy is rash?
Yes
Anaphylaxis - No
Initial best test for bloody diarrhea.
Blood and leukocytes
BUT if Lactoferrin is an answer,
LACTOFERRIN> LEUKOCYTES
Blood + Lactoferrin.
Scrombroid - presentation tx?
Eating fish - Rapid onset - WHEEZING
Caused by Histidine in fish, NOT bacteria
Tx antihistamines
Best sign of Active viral replication - Most benefit from antiviral, indicator of active viral replication?
Best sign that Hep C is not able to be transmitted to another?
e antigen
No surface antigen.
Syphilis tx - > Jarish Herxheimer reaction (fever and worse sx)
What to do?
Aspirin and antipyretics - it will pass. Continue to tx.
Uncomplciated cystitis in lady?
Nifurantoin for 3 days/
Not 7 (only if anatomical problem)
Difference in tx of cystitis vs proctitis in male?
Same drug
(Cipro, Bactrim)
BUT, proctitis is tx for much longer (2-6wk, as oppose to 7 days)
What is the other Bovis in Bowel organisms?
Clostridium septicum
Best initial tx of Infective Endocarditis?
Vanc + Gent
narrowing w/ culture
Viridians -> ceftriaxine
Enterococci - Amp gent.
What do you add if someone has Infective endocaritis with PROSTHETIC vlave w/ staph?
Add Rifampin + Whatever stapht x (prob vanc)
Best initial test for HIV? Confirmatory test?
ELISA test
Confirm - Western blot
Infants dx w/ PCR or viral culture, since maternal ab may be present.
Amp/Amox in sore throat causes rash
ebV
Milk Alkali syndrome - CAUSES - 3 SIGNS
Too much Ca and Alkali absorption – HyperCa, KIDNEY FAILURE, Met Alkalosis
Amyloidosis one way to screen?
abdominal fat pad
Bee sting anaphylaxis in respiratory distress - Epi or intubate?
Epi first. Few times you do something before intubating in respiratory distress (also racemic epi in croup)
JC virus imaging – MRI
patchy areas of white matter consistent with demyelination – Deected w/ PCR of CSF
Greatest risk factor for stroke?
HTN > smoking, DM etc
Basal cell CA – tx
Basal cell CA – txw/ electrodessication and curreettage or MOHS – which is why BCCA doesn’t need large margins.
Tx for CO poisoning?
100% O2 with nonrebreather
Prospective cohort
– cohort = group with or without risk factors. See how they develop disease incidence
Case Control
Disease case and nondisease controls, assess risk factor.
Smoking affect on BP?
Not significant. BP : Weigh tloss, DASH, Exercise, DEC Na, DEC ETOH. No smoking. Still encourage for other reasons.
Gait problem in alcoholic think what 3 things?
B12, Wernickes, Cerbellar dysfunction. Wernickes (ataxia, ophtalmoplegia, confusion); Cerebellar (gait, ataxia, dysdiadochokinesia, intention tremor)
Seborrheic dermatitis
affects head eyebrows, nasolabial folds – which Tinea capitis does not (onyly head)
PPSV23 vs PPSV13
23- T cell independent B cell response. PCV13 conjugate contains protein and T cell dependent B cell response with higher affinity ab and memory cells.
Subconjunctival hemorrhage algorithm
if asx, observe. Usu from simple trauma like coughing or rubbing eyes.
Burn victim with 5 p’s
First think escharotomy. If no sx improval after, fasciotomy.
HIV retinitis tx algoirthm?
– benign, cotton wool spots that remit spontaneously. As oppose to CMV, which although painless will have opacification and hemorrhages.
Frostbite tx
rapid rewarmwith warm water (better than slow rewarm).
CMV in ICH prsentation. Dont confuse with?
can develop pneumonitis (diffuse patchy infiltrates)a nd lower GI ulcers 9diarrhea, abd pain), myalgias, etc. So consider in addition to MAC
Varicella ppost exposture
give varicella vaccine. If ICH – give VZIG.
Hypothermia tx
– between 90-95deg, just passive warminign (blankets etc are fine, perhaps warm blankets if low). Warm fluids if only vitals unstable or severely cold.
SS osteo, which bug do you see more of?
Staph > Salmonella
Pemphigus vulgaris, first and second line?
Steroids, then azathioprine
Psoriasis tx
– emollients, topcical steroids, vitD/A derivatieves (calcipotriene, Tazarotene) UV LIGHT . Methotrexate
Elder abuse reporting?
, elder does not want reporting – still can report. Key word CAN.
