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46 Cards in this Set
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- Back
Primary vs Secondary Skin Lesion: Definition
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Primary: Uncomplicated lzn representing initial pathologic change, uninfluenced by secondary alterations such as infection, trauma, or therapy
Secondary: lesion in which a change has occurred as consequence of progression of disease |
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List and define categories of skin lesions (macule, vesicle, etc)
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Macule: flat, <1cm
Patch: Macule >1cm Papule: solid, raised lesion, <1cm Plaque: papule >1cm Vesicle: lesion <1cm filled with clear fluid Bulla; Fluid-filled lesion >1cm in diameter |
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Where does psoriasis appear?
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Extensor surfaces
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Where does atopic eczema appear?
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Flexor surfaces
Behind ears |
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What does it mean when a lesion is an iris lesion?
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Annular lesion with a second ring "bull's eye"
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Annual skin cancer screening if a category ___ recommendation.
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Category I
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What lesion diameter is a risk for malignancy?
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6mm+
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What DRE findings raise suspicion for malignancy?
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Prostate firm, nodular, asymmetric, or indurated
(BPH = symmetrically firm and enlarged) |
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What is the most common form of skin cancer?
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Basal Cell Carcinom
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Basal Cell Carcinoma vs Squamous Cell Carcinoma:
Appearance |
Basal: plaque-like with waxy, translucent appearance, often with ulceration and telangiectasia. No itching or change in skin color.
SCC: Scaly, pink macular to papular area with erythematous RAISED BASE. Sometimes scale or ulcerated. Borders often irregular and bleed easily. UNLIKE BASAL CELL, heaped-up edges of lesions are FLESHY rather than CLEAR in appearance. |
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When is shave biopsy indicated?
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When lesion is elevated above surface of skin
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Under what circumstances should PSA be obtained in setting of BPH?
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If life expectancy > 10 years
If PSA level will influence BPH treatment (e.g., patient considering treatment with 5-alpha reductase inhibitor) |
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What is the most widely used treatment for cutaneous squamous cell carcinoma?
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Surgical Incision
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When is Mohs microscopic surgery indicated?
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Patients with any non-melanoma skin cancer greater than 2 cms, lesions with indistinct margins, and those close to important structures (eyes, nose, mouth)
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When is topical 5-FU indicated?
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SUperficial SCCs and SCC in situ
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What is the downfall to cryotherapy?
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Does not permit histologic confirmation of adequacy of treatment margins.
Useful for small, well-defined, low-risk, invasive SCCs and Bowen's dz. |
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BPH:
Medical Management |
Medical: alpha-antagonists (tamsuolosin, terazosin) decrease syx of LUTS
5-alpha-reductase inhibitors (finasteride) more effective in men w/larger prostates If severe enough, combine above classes Sx: If bladder outlet obstruction creating risk for UTI or lower UTI, consider surgery |
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Tinea capitis:
Treatment |
ORAL THERAPY (topical tx unable to penetrate hair shaft)
Griseofulvin |
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Tinea unguium:
Treatment |
Terbinafine 250 mg qd x 12 weeks for toenails, 6 weeks for fingernails
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How does the composition of a cream differ from an ointment? Lotion?
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Cream: organic chemicals (oils) and water; can be used in any area, drying effect with continuous use
Ointments: Limited organic compounds consisting of grease (petroleum jelly), with little or no water; desirable for dryer skin. Greater penetration than cream and thus enhanced potency Lotions/gels: Contain EtOH; most useful in scalp because penetreate easily, leave little residue. Drying effect. |
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What are the strongest steroid creams?
Weakest? |
Strongest: Betamethasone, Halobetasol
Weakest: Hydrocortisone |
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What are the side effects of steroid creams?
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Skin atrophy (most common)
Hypopigmentation (more apparent with darker skin tones) HPA suppression... |
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Where are fractures likely to occur in those with osteoporosis?
Which fractures carries the greatest mortality? |
Vertebrae
Hip Distal radius Proximal humerus Hip fracture has mortality rate of 20-25% |
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What are the risk factors of osteoporosis?
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Previous fragility fracture (low impact)
Smoking Heavy EtOH Corticosteroid use Caucasian race Lower body weight |
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What is the FRAX tool?
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Tool developed by WHO to calculate risk of fractures; adjusts for gender, ethnicity, and locale
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How would you interpret the T scores provided on a DEXA scan?
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0 to -1: Normal
-1 to -2.5: Decreased bone density, or osteopenia Less than -2.5: Osteoporosis Note T = standard deviation of average peak bone mass density in a young healthy person |
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What are the USPSTF guidelines for breast cancer screening?
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Mammogram every 2 years for 50-74
If wish to initiate prior to 50, should be individualized decision |
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What are the ACOD guidelines for Pap smears?
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Every 2 years from 21-30
Every 3 years from 30-64 |
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Is CA-125 level indicated as a screening tool for ovarian cancer?
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No
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What are the risk factors for endometrial cancer?
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Any inc'd exposure to unopposed estrogen:
Unopposed estrogen therapy Tamoxifen Obesity Anovulatory cycles Estrogen-secreting neoplasms Early menarche (before 12) Late menopause (after 52) Nulliparity Other factors include: -HTN -DM -Hx breast or colon ca -Menstrual irregularities -Age |
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What cancer is smoking protective against?
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Endometrial
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What factors are protective against endometrial cancer?
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Smoking (decreases estrogen exposure)
Oral Contraceptive Use (increases progestin levels, thus providing protection) |
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What is the differential for abnormal uterine bleeding in a postmenopausal woman?
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Cervical polyps (common in postpartum and perimenopausal women; r/o via pelvic exam)
Endometrial hyperplasia (progresses to cancer in <5% pts) Endometrial cancer (90% pts with Endometrial Ca have abnl vaginal bleeding) Proliferative Endometrium: seen in high estrogen states Iatrogenic causes: anticoags, SSRIs, antipsychotics, steroids, hormones Genital Tract Pathology |
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What tests/labs should be ordered in a postmenopausal woman with abnormal vaginal bleeding?
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Transvaginal Ultrasound: most cost-effective test if low risk for endometrial cancer; highly sensitive for detection of endometrial cancer and abnlty
Endometrial biopsy: Gold standard for evaluation of pt with high risk for endometrial cancer. Widely done in outpt setting. CBC, LFTs: anemia, low PLT, liver abnlts Thyroid Function Tests: can interfere with HP/Gonadal axis FSH, LH; Elevated FSH confirms menopause (less inhibin around), elevated LH too |
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How can osteoporosis be prevented?
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Adults 50 and over should consume 800 IU vitamin D daily
Most adults should consume 1000mg calcium, if over 50, consume 1200 mg Life-long weight-bearing exercise and muscle strengthening (walking, jogging, Tai-Chi, stair climbing, dancing, tennis) Limit smoking and excess EtOH |
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What is the treatment of osteoporosis?
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Bisphosphanates: inhibit bone resorption and reduce bone turnover, increas ebone mineral density. Ex: ALENDRONATE
Parathyroid hormone: Forteo; only if high risk for fracture, given SQ, $$$ Estrogen Replacement Tx: short-term only Calcitonin: reduces vertebral fractures, but not hip or other fractures |
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What is the benefit of menopause hormone therapy? Concerns?
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Use for short-term relief of bothersome syx of menopause; improves vasomotor and atrophic symptoms, prevents osteoporosis
Concerns: If given for more than 3 years, risk of breast cancer; unopposed estrogen risks endometrial cancer; beginning after age 60 increases risk of CAD; inc'd risk of stroke after first 1-2 years of use Use lowest effective dose for shortest possible time |
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What is the best treatment for atrophic vaginitis?
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Topical estrogen; doesn't even require coverage with progesterone even in women with intact uterus
Available as cream or an E-ring (estrogen-impregnated ring inserted into vagina) |
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For the three types of headaches describe:
Number needed for diagnosis Character Associated Symptoms Length Aggravated by physical activity |
Migraine: 5 episodes, pulsating, n/v/photo/phonophobia, unilateral, aura possible
Lasts 4 to 72 hours Aggravated by phys act Tension: 10 episodes, photo/phonophobia, pressing headache, bilateral, occipital tenderness, 30 minutes to 7 days Not aggravated by phys act (only mild to mod pain) Cluster: 5 episodes, severe pain, rhinorrhea, lacrimation, facial sweating, miosis, eyelid edema, conjunctival injection, ptosis; orbital/periorbital/temporal Not agg'd by phys act |
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What are secondary headaches?
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HAs as a result of another underlying medical or psych diagnosis (ANX, depression)
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What are the criteria for diagnosis of analgesic rebound headaches?
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>15 HAs per month
Regular overuse of analgesic for > 3 months Dev't or worsening of HA during medication overuse |
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What life-threatening diagnoses must be considered with headache?
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Bacterial meningitis (esp if new rash, abnlt mentation, abnl neuro exam, stiff neck)
Intracranial hemorrhage (recent history of trauma, HTN, abnl neuro exam) Brain tumor--won't cause pain unuless affects dura mater (brain itself doesn't contain pain fibers)--weight loss, systemic syx, abnl thinking |
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What mental status changes can indicate increased intracranial pressure?
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Changes in appearance/attitude
Psychomotor behavior Speech/language Affect Attention Memory Insight/Judgment NOTE: LOOK FOR PAPILLEDEMA |
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What medications/substances can trigger headaches?
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Progesterone
Tobacco Caffeine EtOH Aspartame and phenylalanine (found in diet colas) |
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What two drug are specific to migraine headaches?
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Sumatriptan
Ergotamine (Ergot alkaloid) Do not use together!! |
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What prophylactic therapies are available for migraine headaches?
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Propranolol (good and cheap)
Timolol Amitriptyline (cheap, excellent drug) Neurostabilizers: Divalproex ($$$)--birth defects Topiramate ($$$)--birth defects |