Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/203

Click to flip

203 Cards in this Set

  • Front
  • Back
Five A's
Ask
Advise
Assess
Assist
Arrange
Ask
Screen at each visit
Advise
Strongly advise patients to quit.
Cardiac benefits are immediate
Assess
determine willingness to make a quite attempt
Assist
Aid the patient in quitting
Assist- Quit Plan
Set a quit date (w/in 2 wks)
Prepare
- Tell friends, family, co-workers, request assistance and support
- prepare the environment
- Review previous quit attempts
- anticipate challenges

Nicotine Replacement
Assist- Advice
Nature of w/drawal
- wt gain, 1-3 wks of irritability, insomnia, coughing, constipation, mild headache, anxiety
- addictive- abstinence is essential
- internal states/activities
- Identify and practice coping skills.
Arrange
Follow up contact, 1 wk of quit date, 1 month,
What are the contraindications to Buproprion use?
Hx of seizures
eating disorder
head injury
How should you begin Bupropion Rx for smoking cessation?
1-2 wks before quit date
150 mgs qday for 3 days. bid for 6 months
What are the side effects of buproprion?
Insomnia
Dry Mouth
How should you begin Nicotine Patch Rx for smoking cessation?
21 mgs for 4 wks
14 mgs for 2 wks
7 mgs for 2 wks
What are the SEs of the Nicotine Patch?
Skin dermatitis
insomnia
How do you use nicotine gum?
for cravings. 1-2 chews and let it hang in your mouth.
what are the SEs of nicotine gum?
sores
dyspepsia
What is the mechanism of action of a statin?
HMGCoA inhibitor
What does a statin do to:
LDL
HDL
TG
LDL- really down (20-60%)
HDL- little up (5-10%)
TG- little down (10-33%)
What are the SEs of Statins?
myalgias
liver toxicity
What is the mechanism of Niacin?
1. decreases LDL and VLDL production
2. inhibits lipolysis
3. increases lpl activity
What does Niacin do to:
LDL
HDL
TG
LDL- little down 10-25%
HDL- really up 20-35%
TG- middle down (25-30%)
What are the SEs to Niacin?
Flushing
Itching
Myalgias
Liver toxicity
Glucose Intolerance
Gout
What is the mechanism of Fibrate?
1. Inhibits peripheral lipolysis
2. decreases liver FFA extraction
3. Increases clearance. inhibs synth of apoB
What does Fibrate do to:
LDL
HDL
TG
LDL- little down (<20%)
HDL- middle up (15-30%)
TG- Really down (35-50%)
What are the SEs of Fibrates?
Myopathy
Gallstones
dyspepsia
What is the mechanism of Bile Acid Resins?
binds bile acid resins
What do Bile Acid Resins do to:
LDL
HDL
TG
LDL- down (15-30%)
HDL- little up
TG- little up
What are the SEs of Bile Acid Resins?
Constipation
Decreased absorption of other medications
What is the mechanism of action of Zetia?
prevents chol absorption on the chol border
What does Zetia do to:
LDL
HDL
TG
LDL- medium down (17%)
HDL- none
TG- none
What are the SEs of Zetia
liver toxicity
When should you order a fasting lipid profile?
all people >20 every 5 years
When should you recheck someone with chol <200?
5 yrs
When should you recheck someone with chol 200-239 between 0-1 cardiac risk factors?
annually
When should you recheck someone with chol 200-239 w/ 2 or more risk factors?
Treat based on LDL levels
How do you calculate LDL?
Total-HDL-TG/5
What is Pre-HTN and how do you Rx?
120-139/80-89
Rx is lifestyle changes
What is Stage 1 HTN and how do you Rx?
140-159/90-99
lifestyle + 1 drug
What is Stage 2 HTN and how do you Rx?
>160/>100
lifestile + 2 drugs
what is an emergency diastolic level?
>120-130
hospitalize
When do you use an ACE inhibitor?
CAD- Decreases Mortality
Diabetes- preserve renal fx
CHF- prolong survival
LV dysfunction- prolong survival
hyperlipidemia
what demographics are ACE ihibs best?
not in AA unless w/ thiazide
Better than CCB for preventing renal failure
- no pregs
What are the se's of ACE inhibs?
COUGH
hypotension
angioedema
hepatotoxicity
loss of taste
when are ARBs used?
when ACE isn't tolerated
What are the SEs of ARBs?
rare angioedema
rare hepatotox
What are the indications for B-Blocker use?
Hx of MI
angina
migraine
some CHF
elderly w/ isolated systolic HTN if used w/ diuretic
Which B-blockers are cardioselective?
Atenolol
betaxolol
metoprolol
acebutolol
What are the SEs of cardioselective B-Blockers?
Bradycardia
Impotence
Worsening CHF
bronchospasm
Masks hypoglycemia
increases TG
Decreases HDL
Sudden d/c--> MI
what are the sympathomimmetic B-Blockers?
acebutolol
carteolol
Penbutolol
Pindolol
When are thiazides used?
HTN
elderly w/ systolic htn
What are the SEs of thiazides?
pancreatitis, impotence, gout
High- Uric Acid, gcose, Ca, chol, TG
Low- K, Na, Mg
When are loop diuretics used?
in those w/ kidney problems
Creatinine <30-50
What are the SEs of Loops?
metabolic alkalosis
What is malignant HTN?
Severly elevated HTN with end organ damage
- neurologic, papilledema
- chest pain, ecg changes, CHF
- Renal failure, active urinary sediment
How do you Rx malignant HTN?
reduce MAP by 1/3rd.
IV nitrus
nitroprusside
labetolol (hydralazine in pregs)
What are the acute Rx for migraines?
Triptans
Ergots
NSAIDS
antiemetic
caffeine
what are the prophylaxis Rx for migraines
TCAs
Topomax
depakote
B-blockers
What is the HPI of Cluster Headaches?
7 to 1 m to w
less than migraine
precipitated by nitrates, alcohol or stress
unrelenting unilateral pain, occuring cluster
What is the acute Rx of Cluster Headaches?
100% o2
intranasal lidocaine
DHE
What is the prophylaxis Rx of Cluster Headaches?
Verapamil
Lithium carbonate
Ergotamine 2hrs before
Steroid taper
What dietary changes should someone make to reduce weight
reduce 500-1000 kcal
<30% from fat
>15% of calories from protein
What dietary changes should someone make to lower cholesterol?
reduce saturated fat and cholesterol
saturated fat <7% of total calories
dietary chol <200mg/cal
total fat <25-35 calories

Increase soluble fiber to 10-25mg

plant stanols, sterols 2g/day
What dietary changes should be made to lower HTN?
DASH
<2g per Na
7-8 grains
4-5 veggies, fruits
2-3 lowfat dairy
<2 servings of meat
2-3 servings fats/oils
5 sweets per wk
2-3 nuts/seeds
What lower back pain is characterized by morning pain releived by activity?
ankylosing spondylitis or inflammation
What lower back pain is characterized by pain worse with standing, walking; relief with bending or sitting.
spinal stenosis
What back pain is worse with sitting, driving or lifting?
disk
What is the HPI of sciatica?
sharp burning pain
Radiates down posterior or lateral aspect of leg to ankle or foot
Worse with cough, valsalva
Paresthesias
Numbness
weakness
What are the signs of sciatica found on PEX?
Pain/numbness/paresthesia of butt, posterior thigh, calf, lateral ankle and foot, lateral toes
calf atrophy
decreased ankle/knee jerk
Plantar flexion wekaness
Extensor weakness of great toe
Paraspinal muscle spasm
+SLR
What is in the HPI of someone with a lumbosacral strain?
Specific episode of bending, twitsting or lifting
something giving way in the lower back
pain onset is immediate
radiation across low back to butt, posterior upper thigh, none to leg
What are the PEX findings for a lumbosaral sprain
Local swelling
Markedly TTP
How do you Rx a lumbosacral strain?
ordinary activities
local application of heat or warm baths
mild NSAIDs
When do you order films for someone with low back pain?
maligs- focal persistent bone pain unrelieved by bed rest w/ Hx of malig
Compression fx- prolonged steroids, postmenopausal women, severe trauma, focal tenderness
Ankylosing spondylitis- young male, limited spinal motion, sacroiliac pain, morning pain, and spinal stiffness, relieved by activity
Chronic osteomyelitis- fever, high ESR, focal tenderness over affected vertebrae
Trauma
Major neuro deficits
back pain high in lumbar or thoracic region.
How do you Diagnose DM?
random plasma >200 and symps
two fastings gcose >126
post-prandial >200 or after 75g of GTT
How does sulfonylureas result in lower gcose?
increases postprandial insulin from beta cells
decrease insulin resistance
What are the SEs of sulfonylureas?
hypoglycemia.
1st generations (amides) displace other meds from plasma proteins. Work better in those not obease
How do biguanides lower sugars?
sensitize skeletal muscle to insulin
inhibit hepatic gluconeogenesis
What are the SEs of the biguanides?
GI side effects (bloating, diarrhea, cramping)
Don't use if creatinine > 1.5
don't give w/in 24 hrs of IV contrast
don't use in CHF
can cause lactic acidosis
locwers lipids, weight loss
How do thiazolidinediones lower sugars?
decreases insulin resistance
adjunct to insulin
What are the SEs of thiazolidinediones?
hepatotoxicity
How do alpha-glucosidase inhibitors keep sugars down?
inhibs mono and oligo saccharide hydrolisis in the small intestine
decreaseing carb absorption
What are the SEs of alpha-gluco ihibs?
N/V/D
ab pain
potentiates hypoglycemia
What does reapglinide do to decrease sugars?
increases sensitivity
stims insulin release
What are the SEs to repaglinide?
Hypoglycemia
pancreatitis
stevens-johnson syndrome
HUS
hepatic dysfunction
Lispro:
Onset
Peak
Duration
Onset- 15 min
Peak- 30-90
Duration- 2-4 hrs.
Regular Insulin:
Onset
Peak
Duration
Onset- 30-60 min
Peak- 2-4 hr
Duration- 6-8 hr
NPH, Lente:
Onset
Peak
Duration
Onset- 1-3 hrs
Peak- 6-12 hrs
Duration- 18-26 Hrs
Ultralente, PZI
Onset- 4-8 hrs
Peak- 14-24 hr
Duration- 28-36 hrs
Describe Diabetes foot care
Wash feet in lukewarm water
inspect feet daily
apply moisturizer
break shoes in carefully and slowly
alternate shoes daily
clip tonails straight across
wear cotton socks
keep feet clean and dry
consult doctor
What immunizations are needed for a diabetic?
flu
pneumovax
What should prevent diabetic neuropathy?
ACE inhibitor
what steps should be taken for prevention of diabetic neuropathy?
yearly eye exams
laser surgery.
How do you preven diabetic neuropathy?
intensive glucose control
What is the HPI for coronary ischemia?
Sudden onset w/ exertion, stress, eating a large meal.
Relief in minutes with rest or nitrus
Usually squeezing, heaviness, or pressure
Radiates to jaw, neck, shoulder, arm, back, upper abdomen
diaphoresis, nausea
WHat is found on physical exam for coronary ischemia?
Abnl ECG
Loss of physiologic splitting
S4 or S3
What is the HPI of musculoskeletal CP?
pinpointed by patient
worse with deep inspiration, cough, movement, plapation
Few secs every day, sharp, dull or aching
What are the signs of PEX of musculoskeletal CP?
Tender to palpation
localized swelling, erythema, warmth, tenderness
Trauma evidence
Rash
What is the HPI of GERD?
Resembles angina
Dull sensation for hrs after acute sensation
Worse when supine
Dysphagia
Relieved w/ nitrates, CCBs and cough
What is the somatization disorder
Patients have 12 symptoms w/out explanation. Multisystemic symps begin before age 30
What is the approach to care for the patient with somatization disorder?
Physician agrees there is a problem
acknowledges patients plight
emphasize function not symptoms
Regularly schedule appointments
Reinforce non illness behaviors and communications
Limit diagnostic tests. Signs not symps
What are 8 clues to somatization?
Variable in duration
Floridly positive ROS
Description is vague
Non-verbal: poor eye contact, anxios/depressed, sighing
Non-organic variations in pattern.
Verbal descriptions are striking
Insistent fear of specific disease even after it is ruled out
Verbal complaints contrast with nonverbal presentation.
many prior surgeries or workups, different doctors.
What is the HPI of acute sinusitis?
Sinus pain/pressure, purulent nasal discharge, facial pain increases with bending over, fever, fatigue, constitutional symptoms. In maxillary, pain can be referred to teeth.
What happens with decongestants and acute sinusitis?
can cause double sickening.
What are the most common bugs in acute sinusitis?
S. Pneumo, H. Flu
Moraxella, anaerobes
What is the Rx for acute sinusitis?
Decongestant
Amoxicillin
TMP/SMX
Doxy or azithro if allergic
Describe the HPI for chronic sinusitis.
nasal congestion, purulent discharge. No headache, or pain.
Fever is uncommon.
Symps for 2-3 months.
What are the most common bacteria in sinusitis?
S. aureus
Anaerobes
What is the Rx for sinusitis?
Augmentin (amoxicillin-clavulanate for 10 days.
may require drainage or sinus irrigation
What are the signs and symptoms of IBS?
Chronic symptoms of diarrhea or constipation, alternation or one predominating. Achy LLQ or lower ab pain, anorectal discomfort/pain prior to bowel movement and relieved afterwards. Rare weight loss.
What are the manning criteria for IBS?
continuous recurrent symps for several months of ab discomfort relieved w/ defecation or associated with change in frequency or sonsistency of stool.

Irregular pattern of disturbed defecation of at least 25% of the time, with altered frequency or consistency, straining, urgency, feeling of incomplete evac, mucus stool, distended feeling.
What is Rx for IBS?
Reassurance
High fiber, low fat diet. Consider food diary.
Anxiolytic (SSRI)
Antispasmodic
Antidiarrheal (loperamide for more sever cases
trial of cholestyramine
Viral vs. strep pharyngitis
Viral- cough, rhinorrhea, systemic symps; conjunctivitis, no strep PEX.

Strep- acute onset, dysphagia, history of recent exposure. Tonsillar exudates, tender cervical adenopathy, fever > 101. Pharyngeal erythema, no cough.
When do you use a rapid stress test?
Test with 1-2 suggestive symps.
Treat, no test- Hx of rheumatic fever, population w/ epidemic, 3 signs.
Don't treat, don't test- viral URI, no Hx or PEX of strep.
What is a complicated UTI?
fever, back pain, elderly, male, catheterized pt
- 10-14 days of fluroquinolone
- Hospitalize pts w/ rigors, high fever, flank pain, nausea, vomiting.
What is the cost-effective approach to uncomplicated UTI?
UTI Sx, no evidence of pyelo, vaginitis, STD-> U/A or dipstick
- if infection, 3 dyas of TMP/SMX. Cipro or nitrofurantoin
What are the common symps of conjunctivitis?
discharge, conjuctival infection, normal vision, lids stuck together, no photophobia, no pain, some tearing.
Define the following for Bacterial conjunctivitis:
Location
Symps
Discharge
Preauricular adenopathy
Associations
Agent
Rx
Location- Unilateral
Symps- +/- itch
Discharge- mucopurulent
Preauricular adenopathy- no except in chlamydia
Associations- none
Agent- Pneumococcus, Neisseria (scars cornea), Staph (chronic, ulcers)
Rx- Erythromycin ophthalmic ointment OR polyixin/trimethoprim drops
Define the following for viral conjunctivitis:
Location
Symps
Discharge
Preauricular adenopathy
Associations
Agent
Rx
Location- unilateral-> bilateral
Symps- foreign body sensation, tearing
Discharge- watery mucoid
Preauricular adenopathy- common
Associations- fever, pharyngitis
Agent- adenovirus
Rx- contagious 2 wks, clears up in 2-3 wks
Define the following for allergic conjunctivitis:
Location
Symps
Discharge
Preauricular adenopathy
Associations
Agent
Rx
Location- bilateral
Symps- itching +/- sensation
Discharge- clear
Preauricular adenopathy- none
Associations- seasonal allergies, atopic derm
Agent- none
Rx- cool compresses, decongestant-antihistamine
How do you work-up a thyroid nodule?
Labs- TSH/T4 for hyperfunctioning nodules (confirm with scintigraphy)
- thyroid ultrasound
- FNA
-- nodule is cystic or malig-> excise and give radiodine + T4 suppression
-- If cytology is indeterminate (microfollicular)-> scintigraphy
-- If macrofollicular (benign), follow w/ repeat FNA in 6-9 months
- Thyroid scintigraphy- if nodule is cold and cytology is indeterminate, excise
What are the Signs and SYmps of Hyperthyroid?
Nervous, irritable
heat intolerance, warm, moist skin
Hair loss, pruritus
Wt. Loss, increased appetite, increased bowel movements/diarrhea
Palpitations
Systolic HTN and tachycardia
DOE, fatigue, muscle weakness
Stare, lid lag, hyperreflexia.
What are the Signs and symps of hypothyroidism?
Fatigue, decreased exercise tolerance
Cold intolerance
Wt. gain, constipation
Hypercholesterolemia, anemia
Puffy facies, hoarseness
Bradycardia, delayed relaxation of DTRs, coarse hair and skin, alopecia, brittle nails, myxedema
What are the etiologies of hyperthyroids?
Graves
Toxic multinodular goiter (elderly)
Toxic Adenoma
Subacute granulomatous thyroiditis
Subacute lymphocytic thyroiditis (silent postpartum)
2ry hyperthyroidism, ectopic hyperthyroidism
Meds (amiodarone, lithium, excess iodide)
What symps does subacute granulomatous thyroiditis
(DeQuervain's)
painful, tender goiter
fever, malaise, myalgia, hx of URI
What are the etiologies for hypothyroid?
Hashimoto
Thyroidectomy, radiodine Rx, external neck irradiation
Iodide deficiency OR excess
Meds- Lithium, amiodarone, IFN-Alpha, cholestyramine and phenytoin
Infiltrative disease (TB, sarcoid, amyloid, cancer)
Congenital hypothyroid
Central hypothyroid
How do you Dx hyperthyroid?
down TSH
Up T4
Thyroglobulins (high thyroiditis, low exog)
TSI- Graves

Studies- thyroid US, scan, 24 hr uptake
How do you Dx Hypothyroid?
High antithyroglobulin and antimicrosomal Abs.
up TSH, down free T4
central, decreased both.
How do you Rx hyperthyroid?
Methimazole or PTU (Methimazole better in pregs)
Radioactive iodine (no pregs/breastfeeding)
Subtotal thyroidectomy
Adjunct- iodides, B-blocker
how do you Rx Hypothyroid?
Synthroid.
Check Fn tests, and adjust every 6 wks.
Pregs, wt. gain, and meds can increase T4 need.
Elderly or pts w/ CHD- start at low dose (25 mcg) no MI
What is the difference between 1ry and 2ry osteoporosis?
Systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue w/ a consequent increase bone fragility and susceptibility to fx.
1ry- menopause or aging
2ry- low bone mass attributed to other factors beside menopause and aging.
What are the risk factors for developing osteoporosis?
Female,
white or asian
low bone mass or personal Hx of fracture after 50.
thin body
early menopause
increased age
genetics
cigarette smoking
EtOH
sedentary lifestyle
decreased Ca diet
decreased sunlight
Meds- steroids, AED, excess thyroid replacement, anticoag, antacids w/ aluminum, cholestyramine
Hyperthyroid, hyperPTH, Cushings
mult myeloma, lymphoma, leukemia, pernicious anemia
RA
GI- malabsorption, liver disease
How is osteoporosis Diagnosed?
Fragility Fraction
Bone Mineral density measurement: DXA scan of proximal femur, lumbar, spine, forearm
< 2.5 osteoporosis
osteopenia
How do you prevent and Rx osteoporosis?
- Calcium + D: 500mgs bid, tid; Ca best in less than 500 dose
- exercise- weight bearing and resistance
- No EtOH, no smoke
- Fall prevention
- Egen
- raloxifene
- bisphosphonates (1st line; alendronate, risedronate)
- Nasal calcitonin
- PTH
what are the clinical signs of BV?
Odor after urination, intercourse, itching
- thin, grayish-white
- Weeks-months
No cervical discharge
normal or erythematous vulva
What are lab signs of BV?
Clue cells
whiff test (fishy odor w/ KOH)
high pH
What is the Rx for BV?
Metronidazole
500 BID (teratogenic)
What are the clinical signs of candida?
discharge, itching, burning pain
Thick, white, "cottage-cheese
Days
Normal cervix
Edema, erythema of vuluva

Associated w/ OCP, Pregs, diabetes, HIV, Abtic use, douche
What are the lab findings for Candida?
Hyphae/pseudohyphae
normal pH
what are the clinical signs of trich?
bad itching, discharge, dyparenunia
Frothy, foul smelling, green discharge
present in days
Strawberry cervix
Excoriations, edema, erythema of vulva
What are the lab findings for trich?
flagellated protozoa
High to very high pH

STD, also in swimming pools
How do you Rx?
2g metronidazole 1 dose

treat sex partner.
When is the Hep B vaccine given?
Birth
2 mo
6 mo
When is the DTaP given?
2
4
6
1 yr
4 yr
Td at 11
WHen is the Hib vaccine given?
2
4
6
1 yr
When is the IPV vaccine given?
2
4
6
4 yr
When is prevnar given?
2
4
6
1 yr
When do you give the MMR vacine?
1 yr
4 yrs
When do you give the VZV vaccine?
1yr
What are the indications for the flu vaccine in adults?
50+, yearly
Asthma
Chronic CV conditions
COPD
Diabetes
Renal dysfunction
Hemoglobinopathies
Immunosuppression
2nd or 3rd trimester of pregs in flu season
Health care workers
LTC, nursing care residents
contacts of high risk
When do you vaccinate adults with pneumovax?
yearly age 65+
Chronic CV conditions
COPD
Diabetes
Liver disease
Renal failure/nephrotic syndrome
Asplenia
Immunosuppresion

Nursing home
When do you vaccinate with hep B
Hemodialysis
Pts getting clotting factor

Health care
public safety workers
medical dental, nursing, lab techs

IV drug users
persons w/ >1 sex partner in past 6 months.
Persons w/ an STD
MSM
Household contacts of the infected
international travelers
inmates/workers at correctional facilities.
What are the guidelines for breast screenign?
Mammography every 1-2 yrs. beginning at 40
For women 50-70 yo- adds a month of life
40-50- adds 0-5 days
What are the screening guidelines for prostate cancer?
inconclusive data. PSA is more sensitve than DRE, but both will miss a lot of cancers. No benenfit with annual screening compared to bianuual
50-70 w/ avg risk or 45+ with high risk.
What are the screening guidelines for cervical cancer?
Every 1-3 yrs with 3 yrs of onset of sex, until age 65.
avg gain= 3 months
What are the screening guidelines for colon cancer?
start at 50. annual FOB + sigmoidoscopy every 5 years or colonoscopy every 10
if FHx start 10 yrs earlier than 1st degree relative.
Flex sig q 5 years decreases death by 60%
What are some tactics pharmaceutical companies use to influence perscribing?
Prizes
COnferences
Reps
What are the 3 joints of the shoulder?
glenohumeral
acromioclavicular- most troublesome
What are the 4 muscles of the rotator cuff?
Supraspinatus
Infraspinatus
subscapularis
Terres Minor
What serious issues can cause shoulder pain?
Pneumonia
PE
Cardiac
Diaphragm
Lung
What are the most common shoulder injuries with symps less than 2 wks?
Fracture
Dislocation
Sprain
Where is fracture most likely?
Proximal Humerus- old
Clavicle- Most common fracture in childhood
Scapula- high force trauma
Where are you most likely to get a dislocation?
ant. glenohumeral
post- in seizure
What causes acromioclavicular injuries?
fall onto tip
subluxation
III higher dislocation
Glenohumeral instability?
Ant- most common- shoulder slips out in throwing positoins
PEX- apprehension test
Sulcus sign
Rx- reduction and shoulder strengthening.
Inflammation of the shoulder?
Bursitis- deltoid
Tendonitis- Biceps and rotator cuff
Acute Rotator Cuff tear
For shoulder pain > 2 wks in a patient < 30?
Instability
- subluxation of GH joint
- subluxation or dislocation of AC joint

- Tear is very unlikely
what causes shoulder pain > 2 wks in a patient 30-50?
Instability
Impingement
Frozen shoulder
What is impingement syndrome?
impingement of acromion, coracoacromial ligament, AC joint, and coracoid process on the underlying bursa, biceps tendon, and rotator cuff

- Can cause rotator cuff tear.

Gradual onset of ant and lateral shoulder pain. Night time pain.
no localized tenderness
Pain and crepitus in painful arc
Neers and Hawkins +
NSAIDS nad stretch exercises
what causes shoulder pain > 2 wks in a patient > 50?
Complete tear
DJD
Frozen shoulder
What are the symptoms of a rotator cuff tear?
Night pain
weakness
catching and grating
Where is arthritis of the shoulder seen?
AC joint
Glenohumeral- Seen in pitchers, laborers, Pain in upper arm and around the shoulder. Nocturnal pain. Progressive Loss of Motion
What is a Frozen Shoulder?
unknown cause. underlying inflamm condition. Rotator cuff tendonitis
Pain and progressive loss of motion w/o known trauma or injury
Females between 40-65
Diabetics

PEX- reduced active and passive ROM.
Tender about the rotator cuff
What does location tell you about shoulder pain?
Lateral delt
- most common
- impingement; rotator cuff tendonitis

Ant
- less common, ac joint, GH joint
Posterior
- Least common, cervical radiculopath- neck
- rare rotator cuff tendinitis.
What can cause acute pain of the knee?
Fractures
Meniscal- medial most common
Ligamentous
Extensor mechanism injuries- collapse
Contusion
What are the symptoms of meniscal injuries?
Locking
tender along joint line
manipulating knee unlocks it.
What are the symps of Ligamentous injuries
Acute pain
swelling
instability- Gives out
What can cause chronic pain of the knee?
Arthritis
Tumors
Infection
Bursitis
Overuse syndrome
Referred pain from hip
What injuries cause medial knee pain?
Most common
OA
Anserine bursitis
MCL
Medial meniscal tear
What injuries cause lateral knee pain?
Iliotibial band frictions- pain over lateral femoral condyle especially with audible snap
Lateral compartment OA
Injury to LCL or lateral meniscus
What cause Posterior knee pain?
Medial meniscal tear
Baker's cyst
Popliteal aneurysm
distension of joint capsule from effusion associated with prior disorders.
What causes anterior knee pain?
2nd most common
Quadriceps tendonitis or partial tear
Bilateral patellofemoral syndrome.
Prepatellar bursitis
Inflammatory arthritis.
Bulla
large vesicle > 1-1.5 cm
Demarcated
clearly defined limits
erosion
gradual breakdown, shallow ulceration
excoriation
scratch marks
lichenification
thickening from scratching
macule
non-palpable, <1.5 cm
nodule
large papule
papule
palpable
plaque
large macule
purpuric
red lesions, not blanchable
vesicle
fluid-filled papule
xerosis
abnl dryness
psoriasis
chronic
appears at 22 and 55
infetions, stress can trigger
calcipotriene, topical steroids treat
Pityriasis rosea
mother patch on the trunk
eruption of salmon colored lesion.
christmas tree pattern
localized to the trunk
pruritis
unknown cause
captopril, arsenic, gold, bismuth, are triggers
lasts 4-10 wks
bland emollients
no Rx needed
contact dermatitis
extreme pruritis
erythematous and edematous papules
atopic dermatitis
most common form of eczema
papulovesicular, red, scaly, and crusted, increases susceptibility to viruses.

chronic disease, starts in kids.
hydration treats dryness and pruritis
seborrhic dermatitis
skin w/ greasy, yellow-white scaling. inflammation is localized to the central face and scalp
early infancy, 40s, 70s
Pityrosporum ovale
glucocorticoids, topical shampoo
acne vulgaris
comedones- blackheadsd, non-inflamm
closed comedones- white heads, non-inflamm
inflamm- papules, pustules, nodules
propionbacterium acnes after plugging
androgen

Rx- topical vitamin A, benzoyl peroxide
topical erythromycin
Accutane
Rosacea
papules and papulopustules
telangiectasias
nose, medial cheeks, glabella, upper lip, and chin. sun exposed skin. distortion of facial features.

clindamycin, metronidazole
Mole
enlarge with body growth. blue, gray, red moles are a concern.
change in puberty and pregnancy
dysplastic melanocytic nevus
> 5 mm in diameter. Two or more shades of brown or pink. irregular or fuzzy border. smooth or pebbly on the surface.
can progress to melanoma
seborrhic keratosis
flat, sharply bordered brown macules
cherry angioma
bright papule
trunk, face, neck
don't blanch easily
increase in number and size over time
acitinic keratosis
rough, scaly spot w/ a pink base.