Supplemental topics Flashcards
Cranial nerves
Oh oh oh to touch and feel a great vein ah heaven
1. olfacactory
2. optic
3. oculomotor - eye movements
4. trochlear - eye movements
5. Trigeminal - mouth
6. Abducens - lateral eye movement
7. Facial - facial movements, tears, saliva, taste
8. acoustic
9. glosso-pharengeal - taste
10. vagus - slows HR, stimulated digestive organs
11. spinal accessory - swallowing, shrugging
12. hypoglossal - tongue movements
Brown recluse spider bite
- central blistering with surrounding gray-to-purple discoloration at bite site surrounded by ring of blanched skin surrounded by large area of redness (red, white and blue sign)
treatment
* local dibriedment, elevation, loose immobilization
* at time of bite: Ice to limit venom spread
* Dapsone ABX prescribed but scant evidence of effectiveness
Onychomycosis
- fungal infection involving the nailplate, matrix, and/or bed
- most commonly by dermophytes (candida infection is rare)
- usually asymptomatic at early stages, progresses to cause paresthesia, pain, discomfort, and loss of dexterity
- nail shows subungual hyperkeratosis with yellow streaks, separation from the nail bed
Dx
* suspision by H and P
* KOH prep to visualize hyphe - recomended for dx for treatment
Treatment
* topical for mild cases <1/2 nail plate involved
* Oral: terbinafine 6wks, itraconazole 3 months; toenail - will require 3 months. treatment required until completly healty nail has re-grown
Bells Palsy (idopathic facial paralysis)
Pathology
* acute paralysis of CN VII, in the absence of brain dysfunction
* cuase unknown, might involve inflammation of CN due to viral infection
Presentation
* sudden onset of unilateral paralysis
* decreased lacrimation, of affected eye with inability to close lid
Dx
* clincal dx based on H and P, no other neuro abnormaliy
* tests to exclude other conditions, considered case-by-case (lyme disease serology, electromyography, imaging if no improvement over time)
Tx
* promt initiation of systemic corticosteroids for new onset
* appropriate aye care
* most recover completely within 3 months
* facial PT may be needed with incomplete recovery
* surgical intervention if facial nerve permanintly impaired.
Viracella
At risk population
* nonimmune or unimmunized older child or young adult
* infants vulnerable - vaccine given at 1 year
Transmission
* person to person by direct contact, inhalation of aerosols from vesicular fluid or aresolized respiratory tract secretions
Presentation
* mild to mod systemically ill with myalgia, fever, often misirable with itch
* 2-3 mm vessicles that start on trunk then appear on limbs 2-3 days later
* non clustered lesions at a variety of stages, including crusts
Tx
* antivirals in early illness 24-48 hrs of erruption can be used in higher-risk situations. helps minimize duration and severity
* avoid aspirin due to reyes syndrome, and NSIADs due to necrotizing fasciitis risk
Prevent
* immunization - 80% lifetime immunity with 1 dose
Zoster (Shingles)
At risk Population
* >50 years but possible at any age with Hx of varicella
* nearly everyone in US >40years
Transmission
* virecella spread, but shingles not transmissable person to person
Presentation
* usually not systemically ill but miserable with pain and itch
* vesicles in a unilateral dermatonal pattern, slowely resolving with crusting
* complications include postherpatic neuralgia, opthalmic involvement, and superimposed bacterial infection
Tx
* antiviral - highdose acyclovir within 72 hrs - minimizes duration and severity
* provide analgesia and control itch with sytemic tx and topically
Prevention
* zoster vaccine
Seborrhea
- onset usually puberty with peak at 40
- primarily affects sebum-rich areas
- patchy scaling, thick adherant crusts over red, inflammed skin
- hypopigmentation and oozing can occur
- dx: clincally based on Hx of waxing and waningseverity and distrubution of lesions
Treatment
* topical antifungal - Ketoconazole
* low potency topical coorticosteroids
* Topical immune modulators - tacrolimus, sulfonomide
* severe cases - systemic fluconazole
Psoriasis
- peak age 16-22 and 57-60
- most common on extensor surfaces (elbows, knees), can also appear on scalp, trunk, and limbs
- lesions are raised silvery scales with underlying red plaque with well defined margins
- Auspits sign - pin point bleeding when scale is removed
- clinically dx based on Hx, fam Hx, and physical
Treatment
* topical corticosteroids for mild limited skin area
* generalized - UVA light therapy, systemic retinoids, cyclosporin, methotrexate, PDE-4 inhibitor, biologics
Active TB
Risk factors
* HIV
* Hx positive PPD
* Hx of prior tx
* known or suspected exposure
* travel to or emigration from TB endemic area
* homelessness, shelter-dwelling, incarceration
Presentation
* Congested, productive cough with white, yello, blood tinged sputum
* hemoptysis - only 8% but rules in
* chest pain, fever, unexplained weight loss/anorexia
* night sweats
* fatigue
Dx
* mantoux tuberculin skin test or quantiferon gold
* acid-fast bacilli (AFB) smear or culture from sputum
* ELISpot assay for mycobacterial ribosomal RNA
* Chest XR/thoracic CT
* HIV test
Syphilis
- treponema pallidum (spirochete bacterium)
Primary stage
* chancre, firm, round, painless genital/anal ulcer with clean base and indurated margins, accompanied by localized lymphadenopathy
* 3 weeks duration, resolves without therapy
2ndary satge
* nonpuritic skin rash involving palms and soles, as well as mucous membrane lesions, usually without genital lesions
* systemic symptoms include fever diffuse lymphadenopathy, sorthroat, patchy hair loss, HA, weight loss, muscle aches, fatigue
* resolves without treatment
Latent satge
* presentation varies occurs after 1st and 2nd stage resolves
Tx
* 1st line - injectable penicillin
* PO doxycycline if beta-lactam allergy
Genital warts (condyloma acuminata)
- caused by HPV - most commonly 6, 11, infection with multiple HPV types common
- Verruca-form lesions can be subclincial or inrecognized
- prevention with guardasil 9 appoved for ages 9-45
Treatment
* topical podofilox, liquid nitrogen, cryoprobe
* imiquimod only indicated for external warts
* trichloroacetic acid acceptable in pregnancy
Pelvic inflammatory disease
- casued by n.gonorrhoeae, C. trachomatis, bacteroides, enterobacterales, streptococci
- presents with irrative voiding, fever, abd pain, CVA, vaginal discharge
- possible sequale include tubal scarring with subsequent risk of ectopic pregnancy and/or infertility
Treatment
* 1st line - Ceftriaxone 500mg IM + doxycycline 100mg PO and metronidazole 500mg x14days
TWIST for testicular torsion
- Testicular swelling 2 points
- hard testicle - 2 points
- absent cremasteric reflex - 1 point
- N/V -1 point
- High - riding testicle 1 point
5-7 points promt urology consult
1-4 points promt scrotal US
Obesity
Grade 1: overweight BMI 25-29.9
Grade 2: Obesity - BMI 30-39.9
Grade 3: morbid obesity - BMI >40
Management
* lifestyle mamgement for all BMI >25
* Pharmacotherapy for BMI >27 and comorbidity, or BMI >30
*phentermine plus extended-release topiramate and buproprion plus naltrexone used to supress cravings aind increase energy
* GLP-1 antagonists - semaglutide, liraglutide - decrease appetite and caloric intake
* orlisat - blocks pancreatic lipase action, decreasing triglyceride absorption
* Bariatric Surgery BMI >35 with comorbids, or BMI >40
Monkeypox virus
Transmission
* close personal contact, direct contact with skin lesions or body fluids
* touching objects or fabrics used by someone with monkeypox
* contact with resp. secretions
* presumed contagious from symptom onset until all skin lesions resolved, including loss of crusts and fresh layer os skin formed
S/S
* lesions firm, vvesicular, often progressing to pustular, somtimes umbilicated, painful/uncomfortable. Often starting in the genitals/perianal streading to other areas
* lesions often preceded by 1-4 day prodromal flu-like syndrom and lymphadenopathy
* rarely fatal lasting 2-4 weeks
Tx
* symptomatic care only
* antiviral agent can be considered for those at risk of severe disease- administered with infectious disease consult
Prevention
* avoid contacts with infection
* small pox vaccines can offer protection (live viral vaccine) given to highrisk individuals (mutiple sex partners in endemic area, lab workers in contact with virus, and healthcare-workers)
* vaccine for post-exposure prophylaxis - admin with in 4 days of exposure
