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51 Cards in this Set
- Front
- Back
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Who should be offered routine HIV screening?
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All sexually active persons over 13yo should be offered at least once. Annual testing for those with high risks
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What is the order of testing for HIV?
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Elisa first, then Western Blot
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When does seroconversion occur in an HIV infected person?
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2-12 weeks after infection
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What are the typical symptoms of acute HIV syndrome?
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Like mono or the flu - fever, fatigue, myalgias, rash, lymphadenopathy
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At what CD4 levels is oral thrush seen in HIV patients?
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<350
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What are the most common opportunistic infections in AIDS?
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Pneumocystis pneumonia
Esophageal candidiasis Cryptococcal meningitis Toxoplasma encephalitis |
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What are the most common opportunistic malignancies in AIDS patients?
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B cell lymphoma
Hodgkin disease Lymphoma of CNS Kaposi very uncommon now |
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What lab tests are indicated in a patient newly diagnosed with HIV?
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CD4 and viral load
HIV genotype |
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Once an HIV patient has stablized on their HAART, how often should CD4 be checked?
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Every 6 months
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Which vaccine should every new HIV patient receive on diagnosis?
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pneumococcal
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Should HIV positive women be discouraged from having babies?
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No, since pregnancy does not affect the course of the disease and vertical transmission can be prevented effectively with treatment.
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What is the difference between atopic dermatitis and eczema?
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Eczema means skin inflammation from any cause, whereas AD is associated with other Type-1 reactions
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What elements of history suggest Atopic Dermatitis as the cause of rash?
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Early childhood onset
Dry skin Pruritus History of asthma, allergy Relapsing, remitting course |
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What is the typical morphology of atopic dermatitis rashes?
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Discrete but vague borders
Erythematous Scaly Dry |
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What are the typical sites for Atopic dermatitis rashes in the adult?
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Face, especially eyelids
Antecubital, popliteal fossa Extensor surfaces Hands, feet |
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How are the rashes of seborrheic dermatitis different from those of atopic dermatitis?
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Seborrheic dermatitis rashes are larger, whiter, greasier than the fine dry scales of atopic dermatitis
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How is the morphology of rash in psoriasis different from atopic dermatitis?
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Psoriasis plaques are more raised and have a thicker scale than AD.
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What should be on the differential diagnosis when diagnosing atopic dermatitis?
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Seborrheic dermatitis
Psoriasis Contact dermatitis Tinea capitis/corporis Scabies |
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What nonpharmacologic measures should be used to manage patients with atopic dermatitis?
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Daily moisturizing with emollients, especially after bathing
Control allergens |
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What is the risk of using higher potency steroid ointments for atopic dermatitis?
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More side effects:
Skin atrophy Acne like eruptions Stretch marks Suppression of central hormone axis |
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Topical steroids are graded class 1-7. Which is the most potent?
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Class 1 is superpotent
Class 7 is least potent |
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What is considered the cornerstone of treatment for atopic dermatitis?
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Topical corticosteroids, typically used in ointment form
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What are other pharmacologic treatment options for atopic dermatitis besides topical steroids?
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Antihistamines
Topical calcineurin inhibitors Oral steroids Antibiotics with anti-inflamm. properties |
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When should calcineurin inhibitors be used for atopic dermatitis patients?
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Tacrolimus and pimecrolimus:
Useful for steroid resistent AD, on areas of thin skin |
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What are the common complications of atopic dermatitis?
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Bacterial superinfection
Bullous impetigo |
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Who should have bone density screening tests?
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All women >65 and women and men under 65 with risk factors
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What is the screening tool of choice for patients at risk for osteoporosis?
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DXA - dual energy xray absorptiometry
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What type of exercise is most beneficial for building bone health?
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Impact/weight bearing aerobic exercise
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What ranges of T-scores define osteopenia v. osteoporosis?
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Osteopenia - T -1.0 - -2.5
Osteoporosis - T < -2.5 |
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What is the mechanism of raloxifene?
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selective estrogen receptor modulator - selectively suppresses osteoclast activity in the bone
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What additional tests are essential after diagnosing osteoporosis?
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CBC, Ca, P, BMP, TSH, liver enzymes, alk phos, testosterone (in men), urinary Ca
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What lifestyle modifications are helpful for patients with osteoporosis?
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Quit smoking, decrease EtOH
Weight bearing exercise Fall prevention Ca and vitD supplements |
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Patient's with which comorbid conditions should be cautioned about taking oral bisphosphonates?
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GERD and PUD or other gastric/esophageal pathologies since bisphosphonates can irritate the esophagus
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When is raloxifene a good option for patient's with osteoporosis?
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When there is a high risk for breast cancer and low risk for CV events like stroke and DVT.
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What should a clinician do if a patient's DXA scan shows worsening mineralization after oral bisphosphonate therapy?
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Consider med adherence, adequate Ca and vit D intake, comorbidities like hyperthyroid.
Switch to injectable form of bisphosphonate or change drug classes |
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What two tests are important when determining whether or not to start a patient on oral bisphosphonates for osteopenia/osteoporosis?
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DXA scan results
FRAX probability score predicting 10 year fracture probability |
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Does a DXA scan use more or less radiation than a chest X-ray?
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1/10 radiation of a CXR
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Where geographically is psoriasis most common?
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Colder climates (higher latitudes)
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How is "guttate psoriasis" defined morphologically?
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Small "droplet" lesions of short duration - palms and soles spared
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Where do you find the lesions of "inverse psoriasis"?
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In the intertriginous areas - armpits, under breasts, between buttocks
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What areas of the skin are commonly affected in plaque psoriasis?
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Extensor surfaces, elbows, knees, lumbosacral area, scalp, buttocks
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What is onycholysis?
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White discoloration of the nail that occurs when air enters the space between the nail plate and nail bed - occurs in psoriasis
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What is the ideal way to diagnose psoriatic arthritis?
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Not synovial studies
Clinically and radiographically |
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What is the cornerstone of treatment for mild-moderate psoriasis?
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Topical corticosteroids
Topical vitamin D analogues, retinoids or calcineurin inhibitors are also standard treatments. |
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How is psoriasis severity classified?
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By %BSA
<3% - minimal 3-10% - moderate >10% - severe (or sensitive areas) |
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What medication options should patients with more severe psoriasis be started on?
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Methotrexate or biological agents (enanercept, infliximab etc)
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When should systemic steroids be used for psoriasis?
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They shouldn't be
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What are the side effects of topical steroids?
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Skin atrophy, telangiectasias, acne,
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What percentage of inpatients will experience delirium?
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30%
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What is on the differential diagnosis of delirium (not causes)?
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dementia, depression, acute psychiatric syndromes
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What tests might be ordered to search for a cause of delirium?
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CBC - anemia, infection
BMP - e- abnorm, hypoglyc., dehyd UA - UTI CXR - pneumonia |
