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36 Cards in this Set
- Front
- Back
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What is monosymptomatic hypochondriacal disorder?
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-fixed belief that there is a serious problem with a part of body -otherwise normaly functioning
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Delusions of parisitosis- what are some of the possible organic causes?
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-cocaine and amphetamine abuse -dementia -malignancy -cerebrovascular disease -multiple sclerosis -vitamin B-12 deficiency
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Delusions of parisitosis- what are some of the possible psychiatric causes?
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-Schizophrenia -monosymptomatic hypochondriacal psychosis -psychotic depression -dementia -depression with somatization
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Delusions of parisitosis- strategy to work up the patient
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-first exclude a true infestation (scabies etc) -then exclude an organic cause
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Delusions of parisitosis- Management options/suggestions
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-be carefull about initially suggesting psychiatric help -offer medication to "alter the perception of this bothersome sensation"
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Delusions of parisitosis- side effects of pimozide-
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-stiffness -restlessness -QT prolongation -extra pyramidal signs
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Neurotic Excoriations- definition
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-compulsion to pick at one's self -admission that action induce the lesions but cannot control behavior
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Neurotic Excoriations- physical exam
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-linear or geometric ulcers on the left side if the person is right handed -otherwise normally functioning individual
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Neurotic Excoriations- associated psychopathologies
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-depression -obsessive compulsive disorder -anxiety
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Neurotic Excoriations- treatment
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-doxepin (because of antidepressant and antipruritic effects) can slowly increase dose to greater than 100mg (if tolerated) -if coexestant OCP, may tri fluoxetine or sertraline -diversion strategies during "scratching episodes"
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Factitious Dermatitis- definition
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-self-inflicted skin lesions made consciously with a secondary gain intention
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Trichotillomania- Age and sex ratios
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-children 7X more common than adults -girls 2.5X more common than boys
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Trichotillomania- key differences from alopecial areata on physical exam
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-varying lengths of broken hairs present -absence of nail pitting -microscopic appearance of twisted or broken hairs (not the tapered fracture of A.A.)
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Trichotillomania- DDX for underlying psychopathology
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-OCD (most common) -depression -anxiety
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Trichotillomania- -treatment in kids -treatment in adults
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-KIDS
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What is the name for the uncontrollable desire to rub or pinch one's self to form bruised areas on the skin
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- Dermatothlasia
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What is the name for the uncontrollable neurosis in which a person is conviced that their sweat is so repugnant that it keeps others away
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- bromidrosiphobia
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bromidrosiphobia can be an early symptom of what disease?
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-schizophrenia
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Body Dysmorphic Disorder- RX
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-SSRI -in serious cases antipsychotics
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Burning mouth syndrome? -exam -demographic -possible etiologic agent -best treatment
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-no objective findings -post menopausal women -B12, Iron, or folate deficency. Hypoestrogen, psych -mood altering drugs
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treatment of burning lips syndrome
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-alpha- lipoic acid LIPoic acid
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Vulvodynia definition
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-burning and pain of th evulva without medial findings -lasting 3 months or longer
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Vulvodynia the two types and a brief description
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-vulvar vestibulitis- pain not constant-- ocurs on touch or attempted entry -dysethetic vulvodynia -- vulvar symptoms not only in the vestibule and may occur without touch or pressure
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vulvodynia - who gets it
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-no kids, late 30s female
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vulvodynia - how do you make the diagnosis?
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-eliminate other causes (careful exam, cx, bx)
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vulvodynia - other key items on the ddx and their features
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-contact derm is itchy, red, and spreads away from the vulva -Pudendal neuralgia usuall extends away from the vulva.
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vulvodynia - treatment
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-topical anesthetics, lubricants -topical tacrolimus (stop steroids) -TCA, neuroleptics (gabapentin)
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Notalgia Paresthetica- -description of symptoms
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-unilateral infrascapular pruritus, burning pain, hyperalgesia and tenderness
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Notalgia Paresthetica- -morphology
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-pigmented patch localized to the area of pruritus (PIPA)
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Notalgia Paresthetica- -etiology
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-degenerative changes in the corresponding vertebrae are seen
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Notalgia Paresthetica- -treatment
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-topical capsaicin -topical lidocaine -fixing the vertebral problem -paravertebral block, ultrasound, physiotherapy
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Brachioradial pruritus -buzzword
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-relief of symptoms using "ice pack"
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Brachioradial pruritus -etiology
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-cervical spine pathology is frequenty found on radiographic evaluation
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Brachioradial pruritus -possible causes
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-spinal injury -repetitive microtrauma -tumor -cervical rib
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Brachioradial pruritus -exacerbating factors
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-presentation in the spring secondary to UV light exacerbation
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Brachioradial pruritus -treatments
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-gabapentin -carbamazine -topical capsaicin -cervical spine manipulation/traction/surgery -NSAIDS
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