Test 4 Flashcards
Actinic Keratosis can progress to
squamous cell carcinoma
Risk factors for actinic keratosis
age greater than 40, UV light exposure, skin that burns easily, immunosuppresion
often more easily felt than seen
actinic keratosis
first line trx for actinic keratosis
cryotherapy
meds for actinic keratosis
fluorouracil
risk factors for basal cell caricinoma
age greater than 55, UV radiation, light complexion, blond, light eyes, family hx of cancer
Most basal cell carcinoma occur on
face, neck, trunk, lower limbs
pinkish, pearly papule, plaque, or nodule often with telangiectatic vessels, ulceration
basal cell carcinoma
presents as a translucent papule with “floating pigment”, more commonly seen in darker skin types.
Pigmented basal cell carcinoma
first choice trx for basal cell carcinoma
surgery
monitoring for BCC
monthly for 3 months, twice yearly x 5 years, then yearly after
Malignant epithelial tumor arising from epidermal keratinocytes.
squamous cell carcinoma
squamous cell carcinomas can arise from
actinic keratosis or HPV infection
metastasis of squamous cell carcinoma are more likely to occur in
thicker tumors > 6 mm deep, lesions on ears, border of lip, or mucous membranes
risk factors for squamous cell carcinoma
older men, sun exposure, multiple AKs, personal or family hx of skin cancer, Northern European descent
squamous cell carcinoma characteristics
slow growing, asymptomatic, smooth surface; red/brown/pearly
squamous cell carincoma can be mistaken for
warts
invasive SCC penetrates through
the dermis
a microscopically controlled method of removing skin cancers that allows for controlled excision and maximum preservation of normal tissue. It has the highest cure rate.
Mohs surgery
keratinizing (scaly) lesions in squamous cell carcinoma are
least likely to metastasize
SCCs that develop from AKs are generally
nonaggressive
greatest risk factor for melanoma
high number of nevi
HARMM risk for malignant melanoma
history of prior melanoma, age greater than 50, absence of a regular dermatologist, changing mole, male gender
ABCDE of melanomas
asymmetry, border irregularity, color variation, diameter greater than 6 mm, elevation above skin surface.
Common location of melanomas on whites
back and lower leg
common location of melanomas on blacks
hands, feet, nails
Lab that may be helpful in monitoring progression of metastatic disease
LDH
full surgical excision is more curative in melanoma stages
I-III
how often skin exams are done in patients with melanoma
every 3-6 months
meds for acne that are contraindicated during pregnancy
isotretinoin, tetracycline, doxycycline, minocycline
Do not use tetracyclines in children
less than 8 years old
stimulate sebum production and proliferation of keratinocytes in hair follicles
androgens
anaerobe that colonizes and proliferates in the plugged follicle causing inflammation
P. acnes
Closed comedones
whiteheads
open comedones
blackheads
trx for moderate inflammatory acne
systemic atbx + benzoyl peroxide
trx for comedones
salicylic acid
education for trx meds for acne
acne may worsen first 2 weeks of trx and full results take 8-12 weeks
recurrent episodes of facial flushing, erythema, papules, pustules, and telangiectasia in a symmetrical, facial distribution.
rosacea
risk factors for rosacea
30-50 females, thyroid disturbance
triggers for rosacea
stress, exposure to hot/cold, spicy foods, alcohol
predominant s/s of rosacea
facial warmth and redness
Men predominately have rosacea on
nose
common in 50% of patients with rosacea
ocular problems (blepharitis, dryness/irritation)
topical treatment for rosacea
metronidazole twice daily, erthyromycin/clindamycin
medication for rosacea
doxycycline
avoid tetracyclines with
antacids, dairy products, or iron.
s/s of acute dermatitis
papules, vesicles with crusting and oozing
s/s of chronic dermatitis
erythematous base, thickening with lichenifcation
trx for dermatitis
topical or oral corticosteroids, antihistamines
Hand Foot & Mouth disease is most common in children less than
5 years old
s/s of Hand foot mouth disease
low grade fever, abd pain
Hand foot mouth disease is caused by
coxsackie A16
In hand foot and mouth disease, do not use this for treatment
topical lidocaine
prodrome phase of chicken pox
fever, malaise, anorexia, HA
rash in chicken pox
lesions on trunk turn into vesicles, then scab in 6-10 hours
varicella vaccine
12-15 months then 4-6 years
can be given to children with chickenpox ages 2-16 years
acyclovir
cause of fifth’s disease
parovirus b19
fifth’s disease is common in
children 4-12 years old
children with fifth’s disease can return to school when
rash appears and they have been afebrile for 24 hours
rash in fifth’s disease
slapped cheek, then lacy red rash on body. Last phase itches
Koplik spots appear in
rubeola (measles)
3 C’s of rubeola
croup, conjunctivitis, and coryza
rubeola rash
begins on face, then spreads to body and extremities; lasts 3-4 days
vaccine for measles
12-15 months then 4-6 years
common symptom of rubelle in adults
arthalgia and arthritis
roseola signs and symptoms
first a fever for 3-5 days, then maculopapular rash on trunk and extremities that does not itch.
roseola is cause by
Human herpes virus 6
s/s of eczema in children
erythema papules on antecubital and popliteal flexural surfaces
s/s of eczema in adults
lichenification of hands, feet, face, neck, and chest
Dennie sign is seen in
eczema (intraorbital fold)
these may be elevated in eczema
serum igE levels
side effect of use of high potency steroids
hypopigmentation
Malessezia (Plasmodium ovale) may be a contributing factor to
seborrheic dermatitis
risk factors for seborrheic dermatitis
Parkinson’s AIDS, stress
meds that can intensify seborrheic dermatitis
buspirone, gold, lithium, phenothiazine
seborrheic skin should be
washed more than usual
greasy scaling of scalp and diaper rash; resolves by 8-12 months
cradle cap
characteristics of seborrheic dermatitis
red, scaling, itching plaques that are bilateral and occur in hairy skin areas
risk factors for psoriasis
family hx, diabetes, obesity, HLD, strep infection, steroids, smoking
meds that can cause psoriasis
beta blockers, lithium, antimalarials
Auspitz sign is indicative of
Psoriasis
avoid live vaccines in those with
psoriasis
caused by Treponema pallidum
syphillis
secondary sypillis occurs
2-8 weeks after primary chancre
s/s of secondary sypillis
nonpruritic rash on palms or feet, fever, lymphadenopathy
diagnosis of syphillis
screening with VDRL/RPR positive within 7 days of exposure; treponemal test confirms diagnosis
those with syphillis are
positive for life
teaching for syphillis
avoid sex until trx is complete, test for HIV, test those exposed within 90 days
first line trx for syphillis
PCN G IM
caused by mast cell degranulation and subsequent histamine release.
urticaria
urticaria with angioedema reside in
72 hours
S/S of urticaria
pruritis and burning
acute urticaria
lasts less than 6 weeks, more in children, extrinsic factors a cause
chronic urticaria
lasts more than 6 weeks, most have no obvious external stimuli
the appearance of linear wheals at the site of friction, scratching, or any type of irritation.
dermatographism
lesions of urticaria
plaques with central pallor, lasts less than 24-48 hours
Inflammation of the lateral and posterior folds of skin surrounding the fingernail or toenail.
paronychia
acute paroncyhia usually caused by
Staph aureus
risk factors for acute paronchyia
ingrown nail, DM, nail biting, thumb-sucking
chronic paronchyia is caused by
candida albicans
risk factors for chronic paronchyia
frequent handwashing, DM
Green changes in nail may indicate
pseudomonas
trx for acute paronchyia
warm soaks, atbx cream, topical steroid
trx for chronic paronchyia
topical steroids
cat bites are more likely to
cause infection with osteomyelitis, septic arthritis
vaccine for those who got bit if last tetanus was more than 5 years ago
tetanus immunoglobulin and tetanus vaccine
trx for animal/human bites
augmentin, keep wound open
risk factors for pityriasis rosea
age 10-35
s/s of pityriasis rosea
herald patch on trunk, generalized rash 1-2 weeks later that are salmon oval plaques
trx for pityriasis rosea
oatmeal bath, calamine lotion, resolves in 1-14 weeks
inflammatory disorders leading to permanent hair loss and follicle destruction.
scarring alopecia
lack of inflammation, no destruction of follicle. Includes focal, patterned, and diffuse hair loss.
nonscarring alopecia
check these labs for nonadrenergic alopecia
TSH, CBC, and ferritin
adverse effects of propecia
decreased libido, gynecomastic, infertility
s/s of abdominal obstruction
abd pain, N/V, anorexia, obstipation, abd distention
imaging for abd obstruction
CT scan
imaging for peritonitis
abd ultrasound
alarm features for abd pain
age > 50, weight loss, vomiting, dysphagia, anemia, abd mass
highly suspicious for gastrointestinal malignancy in elderly
iron deficiency anemia
most common etiologies of acute lower abdominal pain in women include:
PID, ectopic pregnancy, endometritis
s/s of appendicitis
umbilical pain that migrates to RLQ, vomiting after pain, fever
pain in the right lower quadrant with palpation of the left side
Rovsing sign
pain on flexion and internal rotation of the right hip, which is seen when the inflamed appendix lies in the pelvis and causes irritation of the obturator internus muscle
obturator sign
pain on extension of the right hip, which is found in retrocecal appendicitis
iliopsoas sign
elicited by the examiner placing steady pressure with his or her hand in the right lower quadrant for 10 to 15 seconds and then suddenly releasing the pressure; a positive finding consists of increased pain with removal of pressure
rebound tenderness
Appendicitis is more frequent in
children 5-12 years old
should not be used in isolation to make or exclude the diagnosis of appendicitis.
lab tests
colic is definied as
crying for more than 3 hours a day on more than 3 days a week in a infant less than 3 months old.
etiology of colic is
unknown
possible etiologies of colic
over/underfeeding, cow milk/lactose intolerance, smoke exposure, temperament
Colic episodes have a
clear beginning and end
colic typically occurs in
the evening
colic typically resolves by
4 months of age
first line interventions of colic
feeding baby in vertical position with curved bottle; soothing techniques
second line intervention for coli
one week trial of hydrolysate infant formula
s/s of acute cholecystitis
prolonged, RUQ or epigastric pain that may radiate to back, fever, leukocytosis, and + Murphy’s sign
pain in acute cholecystitis is described as
steady and severe
pain in acute cholecystitis lasts for
more than 4-6 hours
Murphy’s sign for cholecystitis
Deep inspiration causes the gallbladder to press against examiner’s fingers, causing discomfort and patient catching his breath.
imaging for acute cholecystitis
US
pain in biliary colic
RUQ pain that reaches a crescendo then resolves completely,
different b/t biliary colic and cholecystitis
no peritoneal signs, fever, or abnormal labs in biliary colic
Left untreated, symptoms of cholecystitis may
go away in 7-10 days
defined as biliary pain resulting from a primary gallbladder motility disturbance in the absence of gallstones, sludge, microlithiasis, or microcrystal disease.
Functional gallbladder disorder
Rome III criteria for functional gallbladder disorder
located in epigastrum or RUQ;
Recurrent but occurs at variable intervals;
Lasts at least 30 min;
Builds up to a steady level;
severe enough to interrupt daily activities;
not relieved by BMs, postural changes, antacids
trx of functional gallbladder disorder
cholecystectomy
not required for GERD symtpoms
endoscopy
problem with H2 antagonists
they have diminished effect the longer they are taken, so its recommended to take PRN for those with less than 2 episodes a week
PPIs should be discontinued except for patients with
erosive esophagitis and Barrett’s
presence of hepatic steatosis when no other causes for secondary hepatic fat accumulation
nonalcoholic fatty liver disease
risk factors for nonalcoholic fatty liver disease
age 40-50, obese, dyslipidemia, HTN, hx of chole, diabetes
s/s of nonalcoholic fatty liver disease
usually asymptomatic; hepatomegaly on physical exam, high ALT/AST
diagnosis of nonalcoholic fatty liver disease requires:
hepatic steatosis on imaging; exclusion of alcohol or other causes of hepatic steatosis.
test all those with hepatic steatosis for
hep A, B, and C
the most common cause of death in those with nonalcoholic fatty liver disease
cardiovascular disease
trx for nonalcoholic fatty liver disease
weight loss, hep A&B shots
there is limited evidence that supports this is beneficial for patients with nonalcoholic fatty liver disease
vitamin E
s/s of pancreatitis
sudden onset of epigastric pain, N/V, anorexia
imaging for pancreatitis
CT
most useful lab for pancreatitis
serum lipase as it peaks in 24 hours and returns to normal in 8-14 days.
main causes of peptic ulcer disease
H. pylori, smoking, NSAIDs
there is no evidence that ___ have any advantages over ____ for patients with unhealed ulcers
COX2 inhibitors; NSAIDS
these should be stopped during healing of a gastric ulcer
both COX2 and NSAIDS; restart COX2 + PPI after healed
most peptic ulcers are
asymptomatic
The “classic” pain of duodenal ulcers occurs
2-5 hours after meals and between 11-2 am
The diagnosis of peptic ulcer disease is definitively established by
upper endo
All patients diagnosed with peptic ulcer disease should undergo
testing for H.pylori
Characterized by forceful, nonbilious, vomiting in young infants
pyloric stenosis
risk factors for pyloric stenosis
male, preterm, first-born, maternal smoking, macrolide atbx
pyloric stenosis mostly occurs at
3-5 weeks of age
s/s of pyloric stenosis
projective vomiting; “olive-like” mass in RUQ, strong appetitie
imaging for pyloric stenosis
abd ultrasound
the definitive management of pyloric stenosis.
pyloromyotomy
s/s of hemorrhoids
painless; irritation/itching
trx for external hemorrhoids and low grade internal hemorrhoids
high fiber diet; avoid lingering at toilet
trx for grade II and III internal hemorrhoids that don’t respond to conservative measures
rubber band ligation
rubber band ligation should not be done for
external hemorrhoids
a tear in the anoderm distal to the dentate line, and is the result of the stretching of the anal mucosa beyond its normal capacity.
anal fissure
primary anal fissures are caused by
hard stool, prolonged diarrhea, vaginal delivery, anal sex
secondary anal fissures are caused by
IBD, malignancy, HIV
s/s of anal fissure
tearing pain with BMs, bleeding of bright red blood; appears as fresh laceration
The most common location for a primary anal fissure is the
posterior anal midline
raised edges exposing the white, horizontally oriented fibers of the internal anal sphincter muscle fibers at the base of the fissure
chronic anal fissure
most colorectal cancers arise from
adenomas
Crohns and ulcerative colitis have an increased risk for
colorectal cancer
con of flexible sigmoidoscopy
can only identify lesions in the distal 60 cm of the colon
discontinue screening for colon cancer when
life expectancy is less than 10 years
those who should have a screening colonoscopy at 40
first degree relative with colon cancer, or two first-degree relatives at any age
Erythematous, macerated plaques found in skin folds
intertrigo
referred pain felt in the epigastrium upon continuous firm pressure over McBurney’s point. It is indicative of appendicitis.
Aaron’s sign
Blumberg sign
rebound tenderness
bruising and swelling around umbilicus
Cullen sign
Cullen sign helps diagnose for
pancreatitis
long term PPI use has been associated with
osteoporosis and fractures
H2 blockers provide relief for
6-12 hours
Barrett’s esophagitis increases the risk for
adenocarcinoma
pyrosis
heartburn
IgM anti-HAV +
acute hepatitis infection
If IgM anti-HAV and IgG anti-HAV antibodies are negative
there is no infection
HBsAg+
viral infection for Hep B
HBsAb+
Immunity for hep B
route of transmission for Hep E
fecal-oral
ALT is greater than AST in
hepatitis
AST is greater than ALT in
alcohol, statin, and tylenol
route of transmission for hep D
parenteral
most cost effective testing for H.pylori is
serologic titers
trx for H.pylori
PPI and 2 atbx
The most common cause of anorectal abscesses and fistulas is bacterial infection of the
anal crypt gland
Chronic diarrhea is defined as diarrhea lasting more than ___________ during without improvement.
1 month
GI problem associated with trisomy 21
hirschprung disease
bloody, nocturnal diarrhea is suggestive of
inflammatory bowel disease.
Rome III criteria is used to diagnose
IBS
In gastroenteritis, nausea & vomiting
occurs before abd pain
s/s of giardia
abd cramping, diarrhea, greasy stools
Constipation must have at least two of the following criteria
straining, hard stools, incomplete emptying, sensation of blockage, fever than 3 stools a week.
initial trx of toddlers and children with constipation, pain, bleeding, initial trx should include
polyethylene glycol
Diarrhea that begin within 6 hours suggest ingestion of a preformed toxin of
Staph aureus
Diarrhea that begin at 8 to 16 hours suggest infection with
Clostridium
diarrhea that begin at more than 16 hours can result from
E. coli, virus
not cost effective for the majority of patients with acute diarrhea
sending stool for ova and parasites
An acute diarrheal illness is typically defined as a duration of
5 days of less
risk factors for diverticulitis
low fiber, high red meat and fats, obesity, NSAIDs, steroids
s/s of diverticulitis
LLQ pain, fever, leukocytosis
imaging for diverticulitis
CT
recommended after being treated for diverticulitis
colonoscopy 6 weeks of trx.
meds for diverticulitis
metrodinazole and cipro
most children with fecal incontinence have
constipation
steps in bowel retraining for fecal incontinence
disimpaction, laxative & behavioral trx, dietary changes, tapering off laxatives
ulcerative colitis is characterized by relapsing and remitting episodes of inflammation limited to the
mucosal layer of the colon
ulcerative colitis mostly involves the
rectum
crohn’s disease is characterized by inflammation of
transmural layers that skips
crohn’s disease mostly involves the
whole GI tract
s/s of IBS
less than 3 BMs a week or more than 3 BMs a day; cramping, passing mucus
alarm symptoms not associated with IBS
rectal bleeding, nocturnal pain, weight loss
this is not indicated for acute gastroenteritis
atbx
