SM NP review skin, eyes, neuro, cardio Flashcards
What is the difference in location from aphthous stomatitis and herpes?
herpes- painful vesicles outside of mouth
apthous stomatitis- inside the mouth
What is chronic ulcerative stomatitis (CUS)
autoimmune with the same lesion but larger in size but more of them with no relief. takes months to go away. treat with Plaqunil and steroids
What is the main difference in treatment between bullous and non bullous impetigo
Bullous (0 honey crust)- oral meds; Keflex
Non bullous- mupirocin ointment
What condition is known for starting with a Herald patch and a Christmas tree pattern?
Pityriasis rosea
How would a patient with a brown recluse spider bite present
Tender, deep, purple with white halo around it
What key words are used to describe the presentation of a patient with Rocky mountain fever? What is the treatment
North Carolina, tick bite, rash on soles/ palms
Doxycycline- even when pregnant
How can we distinguish a Lyme Disease rash
bull’s eye lesion
What is the medical term for Lyme Disease
Erythema migrans
How do we treat Lyme disease?
Doxycycline
If pregnant, amoxicillin
What is another name for Measles?
Rubeola
What are the 3 C’s associated with measles (rubeola)
Cough
Congestion
Conjunctivitis
When can babies get the MMR vaccines?
12 months
What develops in the mouth with measles?
Koplik spots
What is the most common symptom of mumps?
Parotitis- swelling of the glands between jaw and ear
Sialotitiasis- salivary gland stone- mass under chin while eating
Characteristics of actitic keratosis
dry, scaly lesions on sun exposed skin
What are characteristics of squamous cell carcinoma
slow growing, scaly, ulceration, more red, bleeds easily
What are cafe au lait spots and how are they treated?
Benign but more than 8 think neurofirbomatosis
What the mnemonic for malignant melanoma
A- Asymmetry
B- Board irregular
C- Color variation
D- Diameter > 6
E- evolution
What lesion is “pasted on” and does not need to be removed?
Seborrheic keratosis
What are key words to describe basal cell carcinoma?
telangiectasias (dilated small blood vessels), visible, shiny, waxy, pearly
** most common type of skin cancer **
How would you describe eczema?
flexor surface of body, itch that rashes
What is another term for eczema? 3 A’s?
Atopic dermatitis
Asthma Allergies
How can we recognize plaque psoiasis?
thick, silvery, scales
Auspitz Sign
plaques are scratched and pinpoint bleeding occurs
Koebner’s phenomenon
trauma to skin leads to plaque formation
How would we describe contact dermatitis? Treatment?
linear distribution; topical steroids’; avoid irritant
How would we describe shingles?
on a dermatone, vesicular, burning/tinglings before the rash appears
If the skin is still intact but non-blanchable, what stage of pressure ulcer is that
stage 1, foam dressing
What are the stereotypical signs of Scabies and treatment?
intensely pruritic between fingers and toes, contagious
permethrin cream
wash everything in hot water
How would we describe chicken poxs and when can these kids get the vaccine and go back to school?
various stages of healing
12 months
when all the lesions are crusted over
What symptoms will someone with head lice have and how do we treat it?
incessant puritis of scalp
permethrin for live bugs nits need to be combed out and bedding washed
How would you describe molluscum contagiosum?
indent in middle of lesion, umbilicate, dimple, flesh color, contagious, suspicious in the groin area of children
What are the key words for Anthrax?
cattle farmer, painless, ulcerated
What is the treatment for Anthrax?
1 cipro
#2 tetracyclines
What are the two risk factors for reoccurring hidradenitis suppurativa?
obesity and smoking
What is folliculitis?
skin infection of hair follicles and surrounding tissues
How do we treat folliculitis?
warm compresses, mupirocin, PCN, Keflex
What is the key distinguishing factor for rosacea and treatment
across nasal folds
metronidazole cream
How is the Lupus rash described?
malor rash, butterfly rash, spares nasal folds
What symptoms are consistent with Sjogren’s syndrome?
Very dry eyes
very dry mouth
How would we describe erysipleas? Treatment?
more superficial cellulitis
sharply defined or well demarcated boarders
superficial and reddened
PCN or Keflex
What are the characteristics of cellulitis
angry, swollen
What is the treatment of purulent cellulitis?
Mneumonic?
B: Bactrim
C: Clindamycin
D: Doxycycline
What is the treatment of non-purulent cellulitis?
Keflex, PCN
What is the three step treatment for acne?
- topical: benzoyl peroxide
- topical antibiotic
- Oral antibiotic: doxycycline
What is the three step treatment for acne?
- topical: benzoyl peroxide
- topical antibiotic
- Oral antibiotic: doxycycline
What is important to teach with tetracyclines?
sunscreen/ avoid sun
What is geographical tongue?
from spicy or hot foods
benign
What is leukoplakia?
oral hairy leukoplakia, can’t scrape off, common in HIV, refer to dentist
How does 5ths disease present?
slapped cheek rash
fever, then rash, then lacy net like all across body
When is 5ths disease no longer contagious?
when the rash appears
Who should be extra cautious around those with 5ths disease?
pregnant women
tinea capitis
head/scalp
tinea barbae
beard
tinea cruris
near groin
tinea pedis
foot
tinea versicolor
all over
How do we treat fungal infections?
topical antifungals unless more severe or reccurent
What is onychomycosis with treatment
nail bed fungal infection
treat with ORAL fluconazole
What is enetrobiasis?
Pinworm
How would the patient describe enterobiasis? How do you diagnose?
genital intently itchy at night
scotch tape test early in the morning
How do we treat enterobiasis
Mebendaozole or albendazole
How do we treat dog/cat bites?
augmentin
What is the #1 thing we do when a patient has an eye complaint?
Visual acuity
What does it mean to have 20/40 vision?
They can see at 20 feet what a person with normal eyesight can see at 40 feet
When is the patient considered legally blind?
20/200
What is amblyopia
Lazy eye
What usually causes amblyopia?
Strabismus
What test do we perform to asses for color blindness?
Ishihara chart
Which cranial nerves are related to the eyes?
II, III, IV, VI
How would you describe retinal arteries?
Arteries are light and thinner that veins
No hemorrhages or cotton wool spots
Optic disc with sharp margins and no swelling
Present red reflex
What are some things we don’t want to see in an eye exam?
Papilledema
Arteries crossing over veins
What is papilledema and how is it treated
Optic disc swelling
Refer!
What would we see on a fundoscopic exam of a patient with hypertension?
papilledema, AV nicking, copper wire arteries, flame hemorrhages
What would we see on a fundoscopic exam of a patient with diabetes?
cotton wool spots
blot hemorrhages
microaneurysm
neovascularization
How will a patient describe their symptoms if they are experiencing acute angle-closure glaucoma?
sudden eye pain, blurry vision, firm to touch, increased IOP
If we suspected acute angle-closure glaucoma what should we do?
Refer to ED for risk of permanent vision loss
What is the stereotypical description of retinal detachment to distinguish it from other eye conditions?
curtain pulled over their eye or field of vision. sudden, painless, a lot of floaters, blurred vision/ flashes of light
What is arcus senilis?
gray halo around eyes
What is Xanthelasema?
Cholesterol deposits on the eyes
What do you do if a patient has arcus senilis or xanthelasma?
Run lipid profile
What is pterygium?
benign overgrowth of conjunctiva
eye redness
crosses cornea
What is Pinguecula?
will not go over cornea
What is hordeolum?
stye; infection; staph; drainage. Warm compresses/ antibiotics
What is a chalazion?
blockage of duct
warm compresses
What are the characteristics of allergic conjuctivitis?
serous, stringy ropey drainage
starts bilaterally
notes in cervical chain
What are the characteristics of viral conjunctivitis?
serous drainage
spreads from one eye to the other
lymph nodes = preauricular or submandibular
What are the characteristics of bacterial conjunctivitis?
purulent drainage
spreads from one eye to the other
no lymph nodes
What is the medical term for pink eye
adenoviral conjunctivitis
What is leukocoria?
white reflex
What is the description of cataracts?
leukocoria
no red reflex
older age
hard to drive at night
What is the description of macular degeneration?
central vision loss
age
larger print to read
What is presbyopia?
“my arms are too short”
hard to see things close up
starts around age 40
reading glasses
What condition is typically associated with corneal abrasions?
Bells Palsy
How do you diagnose a corneal abraison?
flurocein staining
How would a patient with iritis present?
sensitivity to light, inflammation and swelling of iris
What are the concerns with iritis? How do we treat it?
Permanent blindness/ refer to optho
What is a subconjunctival hemorrhage and how do we treat it?
broken blood vessels on the sclera
resolves itself; artificial tears
How would a patient present with a tumor headache?
dull, persistent headache always in the same spot
personality changes, nausea/vomiting, vision issues
order head CT
What kind of stroke does atrial fibrillation increase the risk of
ischemic stroke
What kind of stroke does hypertension increase the risk of
Hemorrhagic stroke
What is BEFAST?
B- Balance
E- Eyes
F- Face
A- Arms
S- Speech
T- Time
What is asphasia?
inability to understand or express speech
What is receptive asphsia?
Wernicke’s area; cannot understand what is being said to them
What is expressive asphsia?
Broca’s area; trouble expressing themselves or forming speech
What causes Wernicke- Korasakoff Syndrome?
chronic alcoholism
Vitamin B1 (thiamine) deficiency
How does a patient with a cluster head present?
one sided, tearing/ runny nose, occurs at the same time daily
How would you treat this patient?
100% oxygen
Calcium channel blockers
What are symptoms of temporal arteritis/ giant cell arteritis
1 sided, possible visual impairment, temporal pain/pulsing, increased ESR
What is the treatment of temporal arteritis?
long-term steriods
How do you make the definitive diagnosis of temporal arteritis?
temporal artery biopsy
Polymyalgia rheumatica is commonly associated with what other condition?
temporal arteritis
How would a patient with a hypertension headache present?
occipital headache, typically upon awakening
How would you treat a patient with hypertension headache?
anti-hypertensives or med adjustments
What is the most common time of day to see hypertension headache?
morning
How would a patient with migraine present?
difficulty with lights/noise, throbbing, pulsating, nausea/vomiting, aura
How would you treat a patient with a migraine
Abortive- triptans (avoid with CVD patients and pts on serotonin)
What is the typical migraine prophylaxis
avoid triggers, beta blockers
How would a patient with a tension headache present?
pain bilaterally
What neurotransmitter is responsible for Parkinson’s?
dopamine
What are the three main symptoms of Parkinson’s?
- bradykinesia (most debilitating)
- tremor
- rigidity
How is Parkinson’s treated?
Levadopa/Carbidopa
What is Brudzinski’s sign?
back of head
when you flex back of the head causes hip and knees to flex with it
What is Kernig’s sign?
think knee
Can’t extend knee past 90 degrees without pain
What disease are Brudzinski and Kernig’s sign associated with?
meningitis
What are the three A’s associated with Alzheimer’s Disease?
Apraxia (skilled movement)
Agnosia (Recognition)
Aphasia
What is the goal treatment of Alzheimer’s disease?
Slow progression
What assessment tools can we use to assess cognitive decline
Mini-mental status exam
CN1
olfactory- smell
S
CNII
optic- visual acuity
S
CNIII
oculomotor- eye movement
pupil dilation
M
CNIV
trochlear- vertical eye movement
M
CNV
trigeminal- facial expression and sensation
M & S
CNVI
Abducens- lateral movement of eyeballs
M
CNVII
Facial- taste and facial expression
M & S
CNVIII
Auditory- hearing and balance
S
CNIX
Glossopharyngeal- taste and swallowing
M & S
CNX
Vagus- sensation in throat and viseral muscles, vocal cords, peristalsis
M & S
CNX1
Accessory- head and shoulder movement
M
CNXII
Hypoglossal- tongue movement
M
What is the mnemonic for cranial nerves?
Oh, oh, oh to touch and feel a great vein- ah heaven
Some say marry money but my brother says big brains matter more than
What condition is associated with cranial nerve V?
trigeminal neuralgia
What are the symptoms of trigeminal neuralgia with treatment?
severe stabbing pain; Tegretol
What are we concerned about with unsuccessful treatment of trigeminal neuralgia?
increased suicide risk
What condition is associated with cranial nerve VII?
bell’s palsy
What is a normal finding for Rinne test?
AC>BC
What is a normal finding for Weber test?
Sound will be heard equally by both ears
What will we see in the Weber test for conductive hearing loss?
think something you can see
sound lateralizes to the bad ear
What will we see in the Weber test for sensorineural hearing loss?
Sound will lateralize to the good ear
How will a patient with Meniere’s Disease present?
Vertigo, tinnitus, ear pressure, nystagmus
What is our biggest concern with Meniere’s disease?
Permanent hearing loss
What is the ASCVD risk cutoff for hyperlipdemia?
greather than 7.5%
How often do you check lipids?
every 5 years unless risk factors are present
What is the go to treatment for hyperlipidemia before medicine?
Lifestyle modifications
What are the two strongest statins we can prescribe?
Atorvastatin (greater than 40 mg)
Rosuvastatin (greater than 20 mg)
What are the signs of Rhabdomyolysis?
new muscle pain
CK level x5
Kidney failure
What are the signs of acute drug induced hepatitis
Jaundice
LFTs
What juice do we not mix with statins?
grape fruit juice
Are statins safe in pregnancy
No
What should we prescribe if a patient has a triglyceride over 500? What are we preventing?
Fenofibrate; pancreatitis
Cullens sign
bruising around umbillical
Grey Tuners sign
Bruising to flank
What is your B/P goal for JNC-8?
less than 140/90
When should you start treatment for HTN according to JNC8?
older than 60 > 150/90
Lifestyle 1st x3 months
When should we start treatment for HTN according to AHA?
ASCVD risk of 10 or higher
130/80
What is our initial plan of any new HTN?
lifestyle changes
According JNC 8 we initiate BP meds sooner if the patient has these two comorbidities?
diabetes and CKD
What ages with blood pressures do we start meds?
greater than 60= 150/90
less than 60= 140/90
With ACE- inhibitors what labs do we want to monitor?
renal function and potassium (at risk for hyperkalemia)
What are the first line HTN medications for non-black patients?
ACE, thiazides, CCB
When do we change from ACE to ARB?
angioedema
What is bad for thiazides?
Triglycerides, uric acid, glucose
but good for osteoporosis
Are ACE good for the kidneys or bad?
Both; but they are renal protectant
What are the typical side effects of CCB?
GERD- relaxes lower esophageal sphincter
Ankle edema/ headache
What heart rhythm do we not give CCB
heart block
What is the first line med for HTN in black patients?
thiazides/ CCB
What are the three BP meds that are safe in pregnancy?
New Little Momma
Nifedipine
Labetalol
Methyldopa
What are some meds we should not give to pregnant women
ACE
ARBS
Statins
DMARDS
Which hypertensive medication should we use if our patient has hypertension and diabetes?
ACE/ ARBS (renal protectant)
What is the preferred medication in the elderly for isolated systolic hypertension?
CCBS/ thiazides
What occurs when there are variances in heart rate upon inspiration and expiration?
respiratory sinus arrhythmia
What is the common population for respiratory sinus arrhythmia?
young healthy athlete
What is pulsus paradoxus?
10 point drop in SBP upon inspiration, very serious, cardiac tamponade, status asthmaticus
What are common diagnostic labs/tests for CHF?
BNP, EKG, chest xray, echo (less than 40% is diagnostic)
When should patients be educated to follow up with you with heart failure?
weight gain 2kg in a day
What heart sound is common with heart failure?
S3
Where does the fluid go with right sided heart failure?
body
Where does the fluid go with left sided heart failure?
lungs
What meds should you avoid in heart failure due to swelling?
TZDs, CCBs, NSAIDS
What two medications are patients with Afib typically on?
anticoagulation, beta blockers
What is the goal INR for afib? Prostetic valve?
2-3
2.5-3.5
What is the antidote for warfarin?
vitamin K
What is Raynaud’s Phenomenon?
Decreased blood flow
What participates Raynauds?
exposure to cold or stress
How do we treat Raynaud’s?
CCB/ avoid triggers
What is the mnemonic for heart valves?
All People Take Money
Aortic
Pulmonic
Tricuspid
Mitral
When is hearing a split S2 not normal?
Inspiration and expiration
What is heard at s1?
closure of AV (mitral and tricuspid)
What is heart at S2?
closure of semilunar (aortic and pulmonic)
When do we hear an S4?
uncontrolled HTN, and LVH
At what grade murmur do we feel a palpable thrill?
Grade 4 or higher
What mnemonic do we use for systolic murmurs?
MR PASS MVP
Mitral
Regurgitation
Physiological
Aortic
Stenosis
Systolic
Mitral
Valve
Prolapse
What syndrome do we see with mitral valve prolapse?
Marfan Syndrome
Which murmur radiates to the armpit?
Mitral regurgitation
What murmur radiates to the neck?
Aortic stenosis
What is the mnemonic we use for diastolic murmurs?
MS ARD
Mitral
Stenosis
Aortic
Regurgitation
Diastolic
Diastolic =
Doom
Refer!
What signs/symptoms do we see in PAD?
purple/hyperpigmentation
shiny skin
decreased blood flow
intermittent claudification
What is our go to diagnostic test for PAD?
Ankle-brachial index
Less than 0.9= PAD
How do we calculate ankle brachial index?
SBP leg / SBP arm
What signs/symptoms might you see in chronic venous insufficiency?
reddish brown edematous
hyperpig
What can chronic venous insufficiency lead to due to that pooling of blood?
increased risk of DVT
Where do we refer patients with varicose veins?
vascular
What are signs/symptoms of DVT?
swelling, calf pain, erythema
