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203 Cards in this Set
- Front
- Back
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Five A's
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Ask
Advise Assess Assist Arrange |
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Ask
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Screen at each visit
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Advise
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Strongly advise patients to quit.
Cardiac benefits are immediate |
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Assess
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determine willingness to make a quite attempt
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Assist
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Aid the patient in quitting
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Assist- Quit Plan
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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 |
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Assist- Advice
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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. |
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Arrange
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Follow up contact, 1 wk of quit date, 1 month,
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What are the contraindications to Buproprion use?
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Hx of seizures
eating disorder head injury |
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How should you begin Bupropion Rx for smoking cessation?
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1-2 wks before quit date
150 mgs qday for 3 days. bid for 6 months |
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What are the side effects of buproprion?
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Insomnia
Dry Mouth |
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How should you begin Nicotine Patch Rx for smoking cessation?
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21 mgs for 4 wks
14 mgs for 2 wks 7 mgs for 2 wks |
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What are the SEs of the Nicotine Patch?
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Skin dermatitis
insomnia |
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How do you use nicotine gum?
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for cravings. 1-2 chews and let it hang in your mouth.
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what are the SEs of nicotine gum?
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sores
dyspepsia |
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What is the mechanism of action of a statin?
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HMGCoA inhibitor
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What does a statin do to:
LDL HDL TG |
LDL- really down (20-60%)
HDL- little up (5-10%) TG- little down (10-33%) |
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What are the SEs of Statins?
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myalgias
liver toxicity |
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What is the mechanism of Niacin?
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1. decreases LDL and VLDL production
2. inhibits lipolysis 3. increases lpl activity |
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What does Niacin do to:
LDL HDL TG |
LDL- little down 10-25%
HDL- really up 20-35% TG- middle down (25-30%) |
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What are the SEs to Niacin?
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Flushing
Itching Myalgias Liver toxicity Glucose Intolerance Gout |
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What is the mechanism of Fibrate?
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1. Inhibits peripheral lipolysis
2. decreases liver FFA extraction 3. Increases clearance. inhibs synth of apoB |
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What does Fibrate do to:
LDL HDL TG |
LDL- little down (<20%)
HDL- middle up (15-30%) TG- Really down (35-50%) |
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What are the SEs of Fibrates?
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Myopathy
Gallstones dyspepsia |
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What is the mechanism of Bile Acid Resins?
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binds bile acid resins
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What do Bile Acid Resins do to:
LDL HDL TG |
LDL- down (15-30%)
HDL- little up TG- little up |
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What are the SEs of Bile Acid Resins?
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Constipation
Decreased absorption of other medications |
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What is the mechanism of action of Zetia?
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prevents chol absorption on the chol border
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What does Zetia do to:
LDL HDL TG |
LDL- medium down (17%)
HDL- none TG- none |
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What are the SEs of Zetia
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liver toxicity
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When should you order a fasting lipid profile?
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all people >20 every 5 years
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When should you recheck someone with chol <200?
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5 yrs
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When should you recheck someone with chol 200-239 between 0-1 cardiac risk factors?
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annually
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When should you recheck someone with chol 200-239 w/ 2 or more risk factors?
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Treat based on LDL levels
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How do you calculate LDL?
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Total-HDL-TG/5
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What is Pre-HTN and how do you Rx?
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120-139/80-89
Rx is lifestyle changes |
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What is Stage 1 HTN and how do you Rx?
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140-159/90-99
lifestyle + 1 drug |
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What is Stage 2 HTN and how do you Rx?
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>160/>100
lifestile + 2 drugs |
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what is an emergency diastolic level?
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>120-130
hospitalize |
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When do you use an ACE inhibitor?
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CAD- Decreases Mortality
Diabetes- preserve renal fx CHF- prolong survival LV dysfunction- prolong survival hyperlipidemia |
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what demographics are ACE ihibs best?
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not in AA unless w/ thiazide
Better than CCB for preventing renal failure - no pregs |
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What are the se's of ACE inhibs?
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COUGH
hypotension angioedema hepatotoxicity loss of taste |
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when are ARBs used?
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when ACE isn't tolerated
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What are the SEs of ARBs?
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rare angioedema
rare hepatotox |
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What are the indications for B-Blocker use?
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Hx of MI
angina migraine some CHF elderly w/ isolated systolic HTN if used w/ diuretic |
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Which B-blockers are cardioselective?
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Atenolol
betaxolol metoprolol acebutolol |
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What are the SEs of cardioselective B-Blockers?
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Bradycardia
Impotence Worsening CHF bronchospasm Masks hypoglycemia increases TG Decreases HDL Sudden d/c--> MI |
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what are the sympathomimmetic B-Blockers?
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acebutolol
carteolol Penbutolol Pindolol |
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When are thiazides used?
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HTN
elderly w/ systolic htn |
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What are the SEs of thiazides?
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pancreatitis, impotence, gout
High- Uric Acid, gcose, Ca, chol, TG Low- K, Na, Mg |
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When are loop diuretics used?
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in those w/ kidney problems
Creatinine <30-50 |
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What are the SEs of Loops?
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metabolic alkalosis
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What is malignant HTN?
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Severly elevated HTN with end organ damage
- neurologic, papilledema - chest pain, ecg changes, CHF - Renal failure, active urinary sediment |
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How do you Rx malignant HTN?
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reduce MAP by 1/3rd.
IV nitrus nitroprusside labetolol (hydralazine in pregs) |
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What are the acute Rx for migraines?
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Triptans
Ergots NSAIDS antiemetic caffeine |
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what are the prophylaxis Rx for migraines
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TCAs
Topomax depakote B-blockers |
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What is the HPI of Cluster Headaches?
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7 to 1 m to w
less than migraine precipitated by nitrates, alcohol or stress unrelenting unilateral pain, occuring cluster |
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What is the acute Rx of Cluster Headaches?
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100% o2
intranasal lidocaine DHE |
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What is the prophylaxis Rx of Cluster Headaches?
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Verapamil
Lithium carbonate Ergotamine 2hrs before Steroid taper |
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What dietary changes should someone make to reduce weight
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reduce 500-1000 kcal
<30% from fat >15% of calories from protein |
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What dietary changes should someone make to lower cholesterol?
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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 |
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What dietary changes should be made to lower HTN?
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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 |
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What lower back pain is characterized by morning pain releived by activity?
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ankylosing spondylitis or inflammation
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What lower back pain is characterized by pain worse with standing, walking; relief with bending or sitting.
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spinal stenosis
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What back pain is worse with sitting, driving or lifting?
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disk
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What is the HPI of sciatica?
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sharp burning pain
Radiates down posterior or lateral aspect of leg to ankle or foot Worse with cough, valsalva Paresthesias Numbness weakness |
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What are the signs of sciatica found on PEX?
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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 |
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What is in the HPI of someone with a lumbosacral strain?
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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 |
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What are the PEX findings for a lumbosaral sprain
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Local swelling
Markedly TTP |
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How do you Rx a lumbosacral strain?
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ordinary activities
local application of heat or warm baths mild NSAIDs |
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When do you order films for someone with low back pain?
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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. |
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How do you Diagnose DM?
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random plasma >200 and symps
two fastings gcose >126 post-prandial >200 or after 75g of GTT |
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How does sulfonylureas result in lower gcose?
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increases postprandial insulin from beta cells
decrease insulin resistance |
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What are the SEs of sulfonylureas?
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hypoglycemia.
1st generations (amides) displace other meds from plasma proteins. Work better in those not obease |
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How do biguanides lower sugars?
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sensitize skeletal muscle to insulin
inhibit hepatic gluconeogenesis |
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What are the SEs of the biguanides?
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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 |
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How do thiazolidinediones lower sugars?
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decreases insulin resistance
adjunct to insulin |
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What are the SEs of thiazolidinediones?
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hepatotoxicity
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How do alpha-glucosidase inhibitors keep sugars down?
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inhibs mono and oligo saccharide hydrolisis in the small intestine
decreaseing carb absorption |
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What are the SEs of alpha-gluco ihibs?
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N/V/D
ab pain potentiates hypoglycemia |
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What does reapglinide do to decrease sugars?
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increases sensitivity
stims insulin release |
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What are the SEs to repaglinide?
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Hypoglycemia
pancreatitis stevens-johnson syndrome HUS hepatic dysfunction |
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Lispro:
Onset Peak Duration |
Onset- 15 min
Peak- 30-90 Duration- 2-4 hrs. |
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Regular Insulin:
Onset Peak Duration |
Onset- 30-60 min
Peak- 2-4 hr Duration- 6-8 hr |
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NPH, Lente:
Onset Peak Duration |
Onset- 1-3 hrs
Peak- 6-12 hrs Duration- 18-26 Hrs |
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Ultralente, PZI
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Onset- 4-8 hrs
Peak- 14-24 hr Duration- 28-36 hrs |
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Describe Diabetes foot care
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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 |
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What immunizations are needed for a diabetic?
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flu
pneumovax |
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What should prevent diabetic neuropathy?
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ACE inhibitor
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what steps should be taken for prevention of diabetic neuropathy?
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yearly eye exams
laser surgery. |
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How do you preven diabetic neuropathy?
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intensive glucose control
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What is the HPI for coronary ischemia?
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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 |
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WHat is found on physical exam for coronary ischemia?
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Abnl ECG
Loss of physiologic splitting S4 or S3 |
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What is the HPI of musculoskeletal CP?
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pinpointed by patient
worse with deep inspiration, cough, movement, plapation Few secs every day, sharp, dull or aching |
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What are the signs of PEX of musculoskeletal CP?
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Tender to palpation
localized swelling, erythema, warmth, tenderness Trauma evidence Rash |
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What is the HPI of GERD?
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Resembles angina
Dull sensation for hrs after acute sensation Worse when supine Dysphagia Relieved w/ nitrates, CCBs and cough |
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What is the somatization disorder
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Patients have 12 symptoms w/out explanation. Multisystemic symps begin before age 30
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What is the approach to care for the patient with somatization disorder?
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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 |
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What are 8 clues to somatization?
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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. |
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What is the HPI of acute sinusitis?
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Sinus pain/pressure, purulent nasal discharge, facial pain increases with bending over, fever, fatigue, constitutional symptoms. In maxillary, pain can be referred to teeth.
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What happens with decongestants and acute sinusitis?
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can cause double sickening.
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What are the most common bugs in acute sinusitis?
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S. Pneumo, H. Flu
Moraxella, anaerobes |
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What is the Rx for acute sinusitis?
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Decongestant
Amoxicillin TMP/SMX Doxy or azithro if allergic |
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Describe the HPI for chronic sinusitis.
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nasal congestion, purulent discharge. No headache, or pain.
Fever is uncommon. Symps for 2-3 months. |
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What are the most common bacteria in sinusitis?
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S. aureus
Anaerobes |
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What is the Rx for sinusitis?
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Augmentin (amoxicillin-clavulanate for 10 days.
may require drainage or sinus irrigation |
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What are the signs and symptoms of IBS?
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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.
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What are the manning criteria for IBS?
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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. |
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What is Rx for IBS?
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Reassurance
High fiber, low fat diet. Consider food diary. Anxiolytic (SSRI) Antispasmodic Antidiarrheal (loperamide for more sever cases trial of cholestyramine |
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Viral vs. strep pharyngitis
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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. |
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When do you use a rapid stress test?
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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. |
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What is a complicated UTI?
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fever, back pain, elderly, male, catheterized pt
- 10-14 days of fluroquinolone - Hospitalize pts w/ rigors, high fever, flank pain, nausea, vomiting. |
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What is the cost-effective approach to uncomplicated UTI?
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UTI Sx, no evidence of pyelo, vaginitis, STD-> U/A or dipstick
- if infection, 3 dyas of TMP/SMX. Cipro or nitrofurantoin |
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What are the common symps of conjunctivitis?
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discharge, conjuctival infection, normal vision, lids stuck together, no photophobia, no pain, some tearing.
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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 |
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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 |
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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 |
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How do you work-up a thyroid nodule?
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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 |
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What are the Signs and SYmps of Hyperthyroid?
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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. |
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What are the Signs and symps of hypothyroidism?
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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 |
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What are the etiologies of hyperthyroids?
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Graves
Toxic multinodular goiter (elderly) Toxic Adenoma Subacute granulomatous thyroiditis Subacute lymphocytic thyroiditis (silent postpartum) 2ry hyperthyroidism, ectopic hyperthyroidism Meds (amiodarone, lithium, excess iodide) |
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What symps does subacute granulomatous thyroiditis
(DeQuervain's) |
painful, tender goiter
fever, malaise, myalgia, hx of URI |
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What are the etiologies for hypothyroid?
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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 |
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How do you Dx hyperthyroid?
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down TSH
Up T4 Thyroglobulins (high thyroiditis, low exog) TSI- Graves Studies- thyroid US, scan, 24 hr uptake |
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How do you Dx Hypothyroid?
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High antithyroglobulin and antimicrosomal Abs.
up TSH, down free T4 central, decreased both. |
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How do you Rx hyperthyroid?
|
Methimazole or PTU (Methimazole better in pregs)
Radioactive iodine (no pregs/breastfeeding) Subtotal thyroidectomy Adjunct- iodides, B-blocker |
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how do you Rx Hypothyroid?
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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 |
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What is the difference between 1ry and 2ry osteoporosis?
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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. |
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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 |
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How is osteoporosis Diagnosed?
|
Fragility Fraction
Bone Mineral density measurement: DXA scan of proximal femur, lumbar, spine, forearm < 2.5 osteoporosis osteopenia |
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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 |
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what are the clinical signs of BV?
|
Odor after urination, intercourse, itching
- thin, grayish-white - Weeks-months No cervical discharge normal or erythematous vulva |
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What are lab signs of BV?
|
Clue cells
whiff test (fishy odor w/ KOH) high pH |
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What is the Rx for BV?
|
Metronidazole
500 BID (teratogenic) |
|
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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 |
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What are the lab findings for Candida?
|
Hyphae/pseudohyphae
normal pH |
|
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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 |
|
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What are the lab findings for trich?
|
flagellated protozoa
High to very high pH STD, also in swimming pools |
|
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How do you Rx?
|
2g metronidazole 1 dose
treat sex partner. |
|
|
When is the Hep B vaccine given?
|
Birth
2 mo 6 mo |
|
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When is the DTaP given?
|
2
4 6 1 yr 4 yr Td at 11 |
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WHen is the Hib vaccine given?
|
2
4 6 1 yr |
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When is the IPV vaccine given?
|
2
4 6 4 yr |
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When is prevnar given?
|
2
4 6 1 yr |
|
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When do you give the MMR vacine?
|
1 yr
4 yrs |
|
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When do you give the VZV vaccine?
|
1yr
|
|
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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 |
|
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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 |
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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. |
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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 |
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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. |
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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 |
|
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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% |
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What are some tactics pharmaceutical companies use to influence perscribing?
|
Prizes
COnferences Reps |
|
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What are the 3 joints of the shoulder?
|
glenohumeral
acromioclavicular- most troublesome |
|
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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 |
|
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Where are you most likely to get a dislocation?
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ant. glenohumeral
post- in seizure |
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What causes acromioclavicular injuries?
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fall onto tip
subluxation III higher dislocation |
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Glenohumeral instability?
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Ant- most common- shoulder slips out in throwing positoins
PEX- apprehension test Sulcus sign Rx- reduction and shoulder strengthening. |
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Inflammation of the shoulder?
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Bursitis- deltoid
Tendonitis- Biceps and rotator cuff Acute Rotator Cuff tear |
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For shoulder pain > 2 wks in a patient < 30?
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Instability
- subluxation of GH joint - subluxation or dislocation of AC joint - Tear is very unlikely |
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what causes shoulder pain > 2 wks in a patient 30-50?
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Instability
Impingement Frozen shoulder |
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What is impingement syndrome?
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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 |
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what causes shoulder pain > 2 wks in a patient > 50?
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Complete tear
DJD Frozen shoulder |
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What are the symptoms of a rotator cuff tear?
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Night pain
weakness catching and grating |
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Where is arthritis of the shoulder seen?
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AC joint
Glenohumeral- Seen in pitchers, laborers, Pain in upper arm and around the shoulder. Nocturnal pain. Progressive Loss of Motion |
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What is a Frozen Shoulder?
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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 |
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What does location tell you about shoulder pain?
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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. |
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What can cause acute pain of the knee?
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Fractures
Meniscal- medial most common Ligamentous Extensor mechanism injuries- collapse Contusion |
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What are the symptoms of meniscal injuries?
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Locking
tender along joint line manipulating knee unlocks it. |
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What are the symps of Ligamentous injuries
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Acute pain
swelling instability- Gives out |
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What can cause chronic pain of the knee?
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Arthritis
Tumors Infection Bursitis Overuse syndrome Referred pain from hip |
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What injuries cause medial knee pain?
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Most common
OA Anserine bursitis MCL Medial meniscal tear |
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What injuries cause lateral knee pain?
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Iliotibial band frictions- pain over lateral femoral condyle especially with audible snap
Lateral compartment OA Injury to LCL or lateral meniscus |
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What cause Posterior knee pain?
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Medial meniscal tear
Baker's cyst Popliteal aneurysm distension of joint capsule from effusion associated with prior disorders. |
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What causes anterior knee pain?
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2nd most common
Quadriceps tendonitis or partial tear Bilateral patellofemoral syndrome. Prepatellar bursitis Inflammatory arthritis. |
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Bulla
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large vesicle > 1-1.5 cm
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Demarcated
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clearly defined limits
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erosion
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gradual breakdown, shallow ulceration
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excoriation
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scratch marks
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lichenification
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thickening from scratching
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macule
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non-palpable, <1.5 cm
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nodule
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large papule
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papule
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palpable
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plaque
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large macule
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purpuric
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red lesions, not blanchable
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vesicle
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fluid-filled papule
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xerosis
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abnl dryness
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psoriasis
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chronic
appears at 22 and 55 infetions, stress can trigger calcipotriene, topical steroids treat |
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Pityriasis rosea
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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 |
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contact dermatitis
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extreme pruritis
erythematous and edematous papules |
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atopic dermatitis
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most common form of eczema
papulovesicular, red, scaly, and crusted, increases susceptibility to viruses. chronic disease, starts in kids. hydration treats dryness and pruritis |
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seborrhic dermatitis
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skin w/ greasy, yellow-white scaling. inflammation is localized to the central face and scalp
early infancy, 40s, 70s Pityrosporum ovale glucocorticoids, topical shampoo |
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acne vulgaris
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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 |
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Rosacea
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papules and papulopustules
telangiectasias nose, medial cheeks, glabella, upper lip, and chin. sun exposed skin. distortion of facial features. clindamycin, metronidazole |
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Mole
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enlarge with body growth. blue, gray, red moles are a concern.
change in puberty and pregnancy |
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dysplastic melanocytic nevus
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> 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 |
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seborrhic keratosis
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flat, sharply bordered brown macules
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cherry angioma
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bright papule
trunk, face, neck don't blanch easily increase in number and size over time |
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acitinic keratosis
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rough, scaly spot w/ a pink base.
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