5 Ditt Step 2 Day 12 Dermatology Immunology Rheuma

Front 1

What are the indications for a carotid endarterectomy?

Back 1

More than 70% stenosis & symptomatic
Asymptomatic with 80-90% stenosis AND life expectancy >5yrs

Front 2

What is the most common leukemia in kids?

Back 2

ALL

Front 3

What is the most common leukemia in adults (in the US)?

Back 3

CLL

Front 4

Philadelphia Chr is almost always seen in this type of leukemia:

Back 4

CML

Front 5

Which type of leukemia:
Smudge cells on peripheral smear

Back 5

CLL

Front 6

Which type of leukemia:
Peripheral blasts are PAS(+) and Tdt(+)

Back 6

ALL

Front 7

Which type of leukemia:
Peripheral blasts are PAS(-), myeloperoxidase(+) and have Auer rods

Back 7

AML

Front 8

Which type of leukemia:
Pancytopenia in a Down Syndrome pt

Back 8

ALL

Front 9

What is the next step in management of testicular torsion confirmed with U/S?

Back 9

Manual detorsion & bilateral testicular orchioplexy

Front 10

What are the causes of hypovolemic hyponatremia?

Back 10

Thiazide diuretics
Addison’s disease
Fluid loss + H2O replacement

Front 11

Fever + rash + ↑ Cr + eosinophilia → what is the dx?

Back 11

Acute Interstitial nephritis (AIN)

Front 12

What distinguishes primary biliary cirrhosis from primary sclerosing cholangitis?

Back 12

Front 13

What type of current or past Hepatitis B exposure is present in each of the following scenarios?

Back 13

Front 14

What is the differential dx of ground-glass infiltrates on CXR?

Back 14

Interstitial pneumonia
PCP
Pulmonary edema (ie CHF, ARDs)
Pulmonary hemorrhage
Hypersensitivity pneumonitis

Front 15

What is the treatment for Whipple disease?

Back 15

TMP-SMX (Bactrim) for 1 yr

Front 16

What medication is used to close a PDA?

Back 16

Indomethacin

Front 17

What complications can arise from electrical burns?

Back 17

Cardiac dysrhythmias
Compartment syndrome
Bony injuries
Myoglobinuria → renal failure
Neurologic disturbances

Front 18

What eye abnormality is seen with a lesion to the oculomoter nerve (CN 3)?

Back 18

Fixed, dilated pupil with Down & out gaze

Front 19

What are the differing presentations of Alzheimer’s dementia, Pick’s disease, and Lewy body dementia?

Back 19

Front 20

What's the derm term for:

Flat spot <1cm (non-palpable, just visible)

Back 20

Macule

examples: Freckles, tattoos

Front 21

What's the derm term for:
Flat spot > 1cm

Back 21

Patch

examples: port-wine stain

Front 22

What's the derm term for:

Solid, elevated lesion < 1cm (palpable)

Back 22

Papule

mneumonic: "Palpable Papules"
examples: Wart, acne,
lichen planus

Front 23

What's the derm term for:

Same as papule but >1cm and flat-topped

Back 23

Plaque

example: psoriasis

Front 24

What's the derm term for:

Palpable, solid lesion > 1cm & not flat-topped

Back 24

nodule

ex: Small lipoma, erythema nodosum

Front 25

What's the derm term for:

Elevated, circumscribed lesion <5mm containing clear fluid (small blister)

Back 25

Vesicle

ex: Chickenpox,
genital herpes

Front 26

What's the derm term for:

Same as vesicle but >5mm (large blister)

Back 26

bulla

ex: Contact dermatitis
Pemphigus

Front 27

What's the derm term for:

Itchy, transiently edematous area

Back 27

wheal

ex: allergic reaction

Front 28

Describe the proper treatment for skin abscesses

Back 28

Front 29

What are some of the distinguishing characteristics of necrotizing fasciitis?

Back 29

Unexplained, excruciating pain in the absence of or beyond areas of cellulitis
Erythema with blister and bullae formation & possible crepitus
DM patient with foot cellulitis and signs of systemic toxicity
Perineal cellulitis with abrupt onset & rapid spread (Fournier’s gangrene)

Front 30

What is the general treatment for necrotizing fasciitis?

Back 30

Immediate, extensive surgical debridement
Antibiotics:
General empiric polymicrobial coverage → imipenem (or meropenem) +/- vancomycin
If streptococci → Penicillin G +/- Clindamycin
If Clostridia → Penicillin G + Clindamycin

Treatment for shock if it arises (IVF, dopamine)

Front 31

What are the distinguishing characteristics of gangrene?

Back 31

Front 32

What is the treatment for a limb with dry gangrene?

Back 32

Autoamputation over time
Angiography to evaluate the extent & location of peripheral artery disease → distal bypass of stenotic areas → if circulation improves & healing is adequate, then amputation of the affected region

Front 33

What is the treatment for wet gangrene infection?

Back 33

Emergency debridement or guillotine amputation of the infected portion of the foot then revision to a below or above the knee amputation 72 hours later
(antibiotics are indicated if cellulitis or gas gangrene is present)

Front 34

A 66 yo M with long-standing poorly controlled DM arrives at the ER c/o a horrid smell coming from his left foot. He denies pain, but admits to having lost the feeling in his feet a long time ago from the diabetes. On exam there is an open wound btw the 1st and 2nd toe on the left foot. Pus drains from the wound and some crepitus is felt in the area. The odor is atrocious. The pt is tachycardic and feverish. What tx does he need?

Back 34

Dx: Wet gangrene
Tx: emergency surgical exploration & debridement; possible amputation

Front 35

A 44 yo AA woman is in the office for evaluation of an area of inflammation in her left axilla. She said that initially the area was simply itchy but has now become painful. On exam the area has about 6 papules and nodules that are erythematous, indurated and warm. The skin is fluctuant, and drainage is noted at some of the lesions. How will this patient need to be treated?

Back 35

Dx: Hidradenitis
Tx: Incision & Drainage (I&D) + Antibiotics
Note: Hydradenitis Suppurativa treatment:
Tetracyclines
Macrolides
Intralesional steroids
OCPs
Spironolactone
Isotretinoin

Front 36

A patient is admitted to the ICU for fluid resuscitation and monitoring following trauma with significant blood loss. A central line that was inserted into the right groin emergently in the ER has been in place for a few days, and now the surrounding skin is red and warm. Also, the pt’s temp is rising, and the WBC ct is elevated. What is the likely cause?

Back 36

Central line infection

Front 37

A 7 yo boy is brought to the county clinic with a rash. The mother denies that the child has acted ill. The exam is unremarkable besides perioral honey-crusted lesions & regional lymphadenopathy. What can be used to tx this pt?

Back 37

Dx: uncomplicated impetigo
Tx: washing the area, removing the crusts, topical antibiotics +/- systemic antibiotics

Front 38

A 57 yo diabetic female has a severe infection in her right foot. An open purulent wound is draining from the top of her right foot and redness extends from the toes to just above the ankle. However, she has exquisite tenderness that extends beyond the redness to midway up the leg. CT scan of the extremity shows many small air collections in the fascia overlying the muscles what treatment is needed?

Back 38

Dx: Necrotizing fasciitis
Tx; extensive surgical debridement, possible amputation
Broad spectrum antibiotics with gram (+) and Gram (-) coverage & anaerobic coverage
Wound culture prior to antibiotics administration

Front 39

What tx options are available for patients with acne vulgaris?

Back 39

Front 40

What are the treatment options for rosacea?

Back 40

Front 41

What treatments are available for children with chicken pox?

Back 41

Front 42

What is the treatment for an uncomplicated varicella zoster outbreak in an elderly patient?

Back 42

Front 43

Which acne medication is known for causing photosensitivity?

Back 43

Tetracyclines

Front 44

What should you know about oral isotretinoin (Accutane) in the treatment of acne?

Back 44

Usually, try 2-3 other therapies prior to using this therapy
Check β-hCG, CBC, lipids, LFTs regularly
(25% develop ↑ triglycerides: >800 = risk of pancreatitis)
For dry skin – moisturizing soap, lotions, Chapstick, polysporin to nares PRN, eye drops PRN
Screen for depression & suicidal ideation each visit
Never use with tetracycline → combined risk of pseudotumor cerebri
OCPs should be prescribed to women pts due to high risk of of teratogenic side effects

Front 45

HYQ: What is the classic presentation of rosacea?

Back 45

Middle-aged patient
Facial erythema w/ telangiectasias starting at nose & cheeks
Recurrent facial flushing provoked by various stimuli: hot or spicy foods, alcohol, temp extremes, emotional reactions
Inflammatory papules, pustules, cysts and/or nodules similar in appearance to acne but without comedones
Ocular blepharitis, conjunctivitis, and/or keratitis
Rhinophyma (sebaceous gland hyperplasia of the nose)

Front 46

What are the clinical features of varicella chicken pox?

Back 46

Prodrome of malaise, fever, pharyngitis, headache, and myalgia for 24 hours prior to rash onset
Pruritic evolving rash: red macules → teardrop vesicles → rupture & crusting over
Vesicular rash starts on face & trunk then spreads to extremities
Rash appears in successive crops of vesicles over 2-4 days
Most all lesions are fully crusted by 6 days
Skin bacterial superinfections may occur (group A strep pyogenes)
Adults may also develop pneumonia and/or encephalitis

Front 47

What medications are used in the treatment of postherpetic neuralgia?

Back 47

Gapapentin, Pregabalin, Lidocaine patches, Capsaicin cream

Front 48

A 15 yo girl is brought to the dermatologist for tx of her acne. What is the causative organism in acne?

Back 48

Propionibacterium acnes

Front 49

An elderly woman presents with a rash on her right flank. She says that the rash appeared a few days ago and followed a recent cataract surgery. The rash is causing her terrible pain. On exam the rash extends from the spine past the mid-axillary line in a dermatomal distribution. The rash is composed of grouped erythematous vesicles. What can be used to treat this patient?

Back 49

Dx: Herpes Zoster
Tx: acyclovir, valacyclovir, famciclovir
Acetominophen (tylenol) or opioid analgesia

Front 50

A 41 yo woman with rosacea is seen in the clinic. It is a mild case, for which avoidance of the triggers of facial flushing would be an initial therapy. What are some examples of things to avoid?

Back 50

Hot/spicy drinks or food, Alcohol, Caffeine
Extremes of temperature, Exercise, Wind
Skin products that irritate
Extreme emotions

Front 51

A friend of yours has significant allergies this season for which his doctor has given him the following treatment, “a shot, and pills that I take decreasing doses each day for about a week.” Your friend is concerned b/c he has noticed that his face suddenly has “as many zits as I did when I was 17.” What medication was likely in the shot & the pills he is taking?

Back 51

Dx: acne triggered by steroids

Front 52

A 25 yo man is in the office for cold sores. On exam he has a collection of 3 small vesicles at the vermillion border. He says that they are painful. This is the second time he has had these. He says he knew he was about to get them b/c he could feel a tingly sensation at that location for a few days before the lesions appeared. What studies might be helpful to diagnose this disease?

Back 52

Dx: HSV 1
Test: Tzanck smear

Front 53

Which HPV types cause skin warts? Genital warts?

Back 53

Skin warts: Type 1 – 4
Genital warts: Type 6, 11

Front 54

What are the different treatment options for condyloma acuminata (genital warts)?

Back 54

Spontaneous regression of small asymptomatic warts within 3 months occurs about 25% of the time
Podophyllotoxin (Self-administered) – for vulvar lesions in nonpregnant women
Podophyllin – for vulvar lesions in nonpregnant women
Trichloroacetic acid (TCA): often 1st line therapy
Imiquimod: (self administered) – for vulvar lesions in nonpregnant women, induces interferon mediated antiviral response
Cryoablation with liquid nitrogen

Front 55

What are the characteristic features of tinea versicolor?

Back 55

Pale, velvety pink (“salmon-colored”), light-brown, or whitish hypopigmented macules
Usually limited to the upper trunk & extremities
Lesions do not tan
Lesions do not appear scaly, but scale when scraped
Miscroscopic exam reveals both hyphae & spores (“spaghetti & meatballs”) in 10% KOH prep

Front 56

What are the treatments for tinea versicolor?

Back 56

Topical OTC antifungal for 2 weeks
Terbinafine (Lamisil) Clotrimazole (Lotrimin)
Selenium sulfide (foam, solution, shampoo) qd-BID daily to affected areas for 1 week → then q1-3 weeks for prophylaxis
Ketoconazole 2% shampoo daily for 3 days
Oral antifungal for extensive disease: ketoconazole, fluconazole, itraconazole

Front 57

What is the treatment for onychomycosis?

Back 57

Front 58

What is the tx for pediculosis capitis and pediculosis pubis?

Back 58

Front 59

An obese, 42 yo diabetic woman c/o a pruritic rash underneath her breasts. Exam reveals an erythematous patchy rash underneath large, pendulous breasts. What diagnostic study would be helpful, and what would be seen?

Back 59

Dx: Intertrigo (candida)
Study: KOH prep – see pseudohyphae

Front 60

A 30yo patient with a pruritic scaly lesion is evaluated. A KOH prep of the lesion shows hyphae. What oral agents are available to treat this condition in the case that it is refractory to topical treatment?

Back 60

Dx: Dermatophyte/ tinea
Tx: one of the “azoles” (ketoconazole, fluconazole, itraconazole)

Front 61

A 13yo girl is brought to the county clinic with a rash on her wrists and hands, which becomes intensely pruritic when she bathes. On exam, the rash consists of narrow burrows and erythematous papules. What medication options are available for this rash?

Back 61

Dx: Scabies
Tx: Primethrin Cream, Oral Ivermectin, Diphenhydramine
Minimize contact, good hygiene, wash all lines & clothes in hot water

Front 62

A 22yo Asian patient comes to your office. She is concerned b/c she noticed small areas of hypopigmentation on her back. She says these areas are more noticeable in the summer. What is the organism that is likely causing her skin condition?

Back 62

Dx: Tinea versicolor
Organism: Malassesia furfur

Front 63

When treating pediculosis with malathion, what symptoms might suggest malathion toxicity?

Back 63

Cholinergic symptoms: lacrimation, salivation, diarrhea, muscle excitation

Front 64

When should antibiotics be used in the tx of skin abscesses?

Back 64

If abscess is > 5 cm
If patient is at high risk due to DM, Steroids, immunocompromised

Front 65

What medication is preferred in the tx of scabies?

Back 65

Permethrin

Front 66

What are the characteristic features of necrotizing fasciitis?

Back 66

Unexplained excruciating pain in absence of cellulitis or beyond areas of cellulitis
Erythema with blistering or bullae
Crepitus in the cellulitis
Cellulitis of the perineum
DM pt with foot cellulitis and signs of systemic toxicity

Front 67

What is the treatment for dry gangrene? Wet gangrene?

Back 67

Dry: autoamputation or tx of vascular disease then amputation
Wet: debridement with possible amputation

Front 68

What medication options are available for the treatment of acne vulgaris?

Back 68

1st line: topical retinoid
2nd line: benzoyl peroxide
topical or oral antibiotics
spironolactone
OCPs
Isoretinoin (Accutane)

Front 69

What is the time-frame in the treatment of varicella?

Back 69

Need to start tx within first 72 hours

Front 70

What side-effects can arise from the use of oral isotretinoin (Accutane)

Back 70

Teratogenic
Drying of skin & mucous
Hepatotoxicity
↑ triglycerides
depression, suicidal ideation
pseudotumor cerebri if given with tetracycline

Front 71

HYQ: What is the treatment of molluscum contagiosium?

Back 71

Self-resolve
Laser or cryotherpay
Imiquimod – gets the body to kill the virus itself

Front 72

What is the treatment for tinea capitis?

Back 72

Oral Griseofulvin, Oral Itraconazole, Oral Terbinafine

Front 73

What is the treatment for rosacea?

Back 73

Topical sulfacetamide
Topical metronidazole
Laser therapy for rhinophyma
Systemic tx: tetracycline, doxycycline, minocycline, isoretinoin

Front 74

What are the characteristic features of erythema multiforme?

Back 74

Skin lesions with a target appearance (dull red center, a pale zone, and a darker outer ring)
Lesions can take many different shapes (multiforme)
Lesions develop over 10+ days: macule → vesicles/bullae in the center of the papule
Common sites: hands/forearms, soles/feets, face, elbows & knees, penis & vulva
Severe form (EM Major) always involves the mucus membranes → can become SJS/TEN

Front 75

What is the treatment for erythema multiforme?

Back 75

Stop any inciting medication
Symptomatic tx with antipruritics
If severe → systemic glucocorticoids (although no proven effectiveness)
If patient also has h/o HSV → antiviral such as acyclovir or valacyclovir

Front 76

What is the distinction bwn Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Back 76

SJS is the less severe form of TEN
SJS: skin sloughing (epidermal detachment) is limited to less than 10% of body surface area
TEN: at least 30% of the skin is detaching
there is overlap btw the two at 10-30% skin involvement

Front 77

What is the treatment for infantile seborrheic dermatitis (aka cradle crap)?

Back 77

Selenium sulfide (Selsun Blue) shampoo 2x/wk until resolved
Massaging olive oil into the scalp and leaving for 15 min can help remove scales when washing
+/- hydrocortisone 1% cream BID to affected area

Front 78

How does seborrheic dermatitis manifest in adults?

Back 78

Erythema, scaling, and white flaking in areas of sebaceous glands including eyebrows, nasolabial folds, face, external ear, scalp, upper trunk, and body folds (axilla, groin)

Front 79

What diseases are a/w an ↑ incidence of seborrheic dermatitis?

Back 79

Parkinson’s, HIV, Psoriasis, immunocompromised pts (ie transplant pts)
Exacerbations are common in emotional stress & hositalizations
Severe intractable SD may point to HIV infection

Front 80

What are the available tx for atopic dermatitis (aka eczema)?

Back 80

Front 81

What are the possible side effects of the calcineurin inhibitors (Elidel cream or Protopic ointment) in the treatment of atopic dermatitis?

Back 81

Do not cause systemic effects or skin atrophy like topical steroids. Safe on face/ eyelids
Try to avoid in children younger than 2 years due to higher rates of URIs. However most dermatologists have no problems using these in those under 2 years b/c the alternative of using topical steroids would probably have more side effects
Preliminary studies suggest possible slight ↑ in risk of lymphoma. Therefore keep duration as short as possible

Front 82

A 34 yo M is started on phenytoin to control his seizures. Shortly thereafter, he begins to have malaise, fever, headache, and a rash. On PE his skin is very red & sloughing off in some areas. How should this patient be treated?

Back 82

Dx: Stevens Johnson Syndrome
Tx: D/c Phenytoin, give IVF & corticosteroids, analgesics
Admit to burn unit, IVIG may be needed

Front 83

An infant is brought to the physician with an area of greasy scaling over part of her scalp. What recommendations can be given for this?

Back 83

Dx: Seborrheic Dermatitis
Tx: Selenium Shampoo, Tar, ketoconazole, OTC topical hydrocortisone

Front 84

A 40yo patient has erythematous plaques covered with silver scales on his knees and elbows. He also c/o arthralgia. What do you expect to find on a skin biopsy?

Back 84

Dx: Psoriasis
Labs: ↑ ESR & negative RF
Biopsy: thickened epidermis with nucleated cells in stratum corneum, absent stratum granulosum

Front 85

A 27yo F c/o fatigue & muscle aches. She notes a recent recurrence of her cold sores. PE reveals a large plaque with a red center and perimeter but a paler inner region. What is the diagnosis, and the cause of the disease in this case? What can be given to treat her?

Back 85

Dx: Erythema multiforme due to HSV
Tx: Acyclovir, Valacyclovir, Analgesics, corticosteroids

Front 86

What drugs are used in the treatment of Psoriasis?

Back 86

Front 87

What is the treatment for pityriasis rosea?

Back 87

This is a self-limiting disease of 4-6 weeks, and no treatment is necessary. Sunlight is helpful
If significant itching, may use a moderate potency topical steroids
If extensive disease or severe itching → phototherapy
Possibly beneficial but unproven:
Erythromycin 250mg 4x/day x 14days
Acyclovir 800mg 5x/day x 7 days

Front 88

What are the characteristic features of lichen planus?

Back 88

Skin involvement: pruritic, purple, polygonal papules and plaques that are shiny and flat and commonly occur on the flexor surface of the extremities (ie wrist)
Wickham’s striae: is a white, lacelike pattern on the surface of the papules/plaques
Mucus membrane involvement: Wickham’s striae in the lateral buccal mucosa nd possible erosive lesions that may become infected with Candida
Genital involvement: usually limited to violaceous papules on the glans penis in men and vulva of women

Front 89

What infections are a/w an ↑ likelihood of lichen planus?

Back 89

Young patients: HIV
Older patients: Hepatitis C

Front 90

What is the treatment of Lichen Planus?

Back 90

Corticosteroids of medium to high-potency – topical or intralesional (oral if topical unsuccessful)
Acitretin (or oral retinoid)

Front 91

What are the different stages of decubitus ulcers?

Back 91

Front 92

What is the tx for the diff stages of sacral decubitus ulcers?

Back 92

Front 93

HY: What is the characteristic appearance of stasis dermatitis?

Back 93

Eczematous dermatitis with inflammatory papules, scaly and crusted erosions, ↑ pigmentation, stippling with recent and old hemorrhages and possible ulceration

Front 94

HY: What is the treatment for stasis dermatitis?

Back 94

Compressive dressings or stocking with at leas 20-30 mmHg of pressure (usually 30-40mmHg)
Elevation of the legs above the heart whenever possible but for at least 30 min 3-4 times a day
Topical steroids
Consider horse chestnut seed extract – 300mg (50mg of aescin) BID esp if unwilling to wear compressive stockings
Aspirin 300-325mg/day (may accelerate the healing of venous ulcers)
(Treatment of ulceration from chronic venous insufficiency is not addressed here)

Front 95

A 70 yo pt has dry, scaly skin of the lower legs. It is also of a darker color than the rest of his skin. What is the pathophysiology of this disease?

Back 95

Dx: Stasis Dermatitis

Front 96

Target lesion

Back 96

Erythema multiforme

Front 97

Punctate bleeding when silvery scale is removed

Back 97

Psoriasis

Front 98

Christmas tree pattern rash

Back 98

Pityriasis Rosea

Front 99

Pruritic, dry rash of flexor surfaces

Back 99

Eczema/ Atopic Dermatitis

Front 100

Red plaques with silvery scale

Back 100

Psoriasis

Front 101

Greasy, yellow scales on scalp

Back 101

Seborrheic Dermatitis

Front 102

Pruritic, purple, polygonal papules and plaques

Back 102

Lichen Planus

Front 103

Tender erythematous pretibial nodules

Back 103

Erythema nodosum

Front 104

What are the 2 most important ways to both prevent and treat decubitus ulcers?

Back 104

Maintain adequate nutrition
Relieve pressure by frequent positioning
Use appropriate mattress & pillows

Front 105

A 26yo computer programmer c/o an itchy rash on his back, It started out as a single erythematous oval with a thin white scale over it. The rash then progressed and now forms a series of streaks in a roughly triangular shape on his back. The man is averse to taking medications. How can he be treated with this preference in mind?

Back 105

Dx: Pityriasis Rosea
Self-limited disease, sunlight may help
Meds: topical corticosteroids, acyclovir, erythromycin

Front 106

A 40yo woman arrives at the ER malnourished and c/o abdominal pain. She has a fever, tachycardia, and dehydration. Her skin is leathery from chronic sun exposure, but you especially notice nodules appearing on her anterior leg. The skin overlying these is reddish-purple and tender to palpation. The patient denies trauma to the area. Abdominal CT scan with constrast reveals obstruction with a string sign and skip lesions. What are the diagnoses for this patient?

Back 106

Dx: Erythema nodosum & IBD (Crohn’s Disease)

Front 107

A patient presents with erythema multiforme. What meds are the most common offenders?

Back 107

Penicillins, Sulfonamides
NSAIDs
Anticonvulsants
OCPs

Front 108

What are the distinctions btw erythema multiforme, Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrosis (TEN)?

Back 108

EM: milder disease, most likely without mucous membrane involvement, no sloughing of skin
SJS: sloughing of skin < 10%, mucous membranes involved
TEN: worst form, >30% of skin sloughing

Front 109

What is the classic presentation of pityriasis rosea?

Back 109

Herald patch, followed by Christmas tree pattern rash several days later

Front 110

What is the treatment for pityriasis rosea?

Back 110

Self-limited, no tx needed

Front 111

What are the clinical features of pityriasis versicolor?

Back 111

Hypopigmented lesions with a transparent scale
KOH prep: spaghetti & meatball appearance

Front 112

What is the treatment for pityriasis versicolor?

Back 112

Topical antifungal for 2 weeks
Ketoconazole
Selenium sulfide

Front 113

What is the classic presentation of erythema nodosum?

Back 113

Pretibial nodules (painful, erythematous)

Front 114

What is the classic presentation of lichen planus?

Back 114

Pruritic, Purple, Polygonal papules & plaques, Flexor surfaces & extremities

Front 115

What is the treatment for seborrheic dermatitis?

Back 115

Selenium sulfide, coal tar shampoo, ketoconazole shampoo
Steroids

Front 116

What are the treatment options for psoriasis?

Back 116

Topical steroids
Calcipotriene
Tazarotene
Coal tar
Anthralin
Salicyclic acid
UV therapy
Soriatane
Intralesional steroids
Anti-TNF agents

Front 117

What are the distinctive features of pemphigus vulgaris & bullous pemphigoid?

Back 117

Front 118

What are the distinctive features of pemphigus vulgaris & bullous pemphigoid?

Back 118

Front 119

What is the treatment and prognosis for pemphigus vulgaris?

Back 119

Steroids – high dose systemic (1 mg/kg/day)
Azathioprine or cyclophosphamide can be used as a steroid-reducing adjuvant
Treat wounds as burns
Antibiotics if infection is present
Dermatologist referral & possible life-long suppressive therapy
Prog: fatal if untreated, mortality of 5% even with treatment

Front 120

What is the treatment for bullous pemphigoid?

Back 120

steroids

Front 121

What is the classic presentation of porphyria cutanea tarda?

Back 121

Chronic blistering lesions on sun-exposed areas of skin (usually dorsum of hands, face, forearms, legs)
Facial hypertrichosis and hyperpigmentation
Pseudoscleroderma with cutaneous thickening, scarring and calcification
Elevated LFTs (AST, ALT, GGT)
Hepatitis C infection is common
Elevated “total plasma porphyrin”

Front 122

What is the treatment for porphyria cutanea tarda?

Back 122

Phlebotomy
Low-dose chloroquine or hydroxychloroquine
Avoidance of alcohol, estrogens, iron supplements
Sunscreen use

Front 123

Most common type of melanoma

Back 123

Superficial spreading melanoma

Front 124

Non-pigmented melanoma

Back 124

Amelanotic melanoma

Front 125

Dark papule on the legs or trunk that bleeds with minor trauma

Back 125

Nodular melanoma

Front 126

which type of melanoma occurs on palms, soles, or beneath the nail bed in pts with dark skin

Back 126

Acral lentiginous melanoma

Front 127

Dark lesion larger than 6mm with irregular, asymmetric borders

Back 127

Superficial spreading melanoma

Front 128

What do the antibodies target in bullous pemphigoid & pemphigus vulgaris?

Back 128

PV: epidermis, anti-desmosome
BP: basement membrane, dermal-epidermal junction, anti-hemidesmosome

Front 129

Which type of melanoma:

Grows only vertically

Back 129

Nodular

Front 130

Which type of melanoma:
Found on palms, soles and nail beds

Back 130

Acral Lentiginous

Front 131

Which type of melanoma:
Most common type

Back 131

Superficial spreading

Front 132

Which type of melanoma:
A longstanding precancerous lesion before dermal invasion

Back 132

Lentigo Maligna

Front 133

Which type of melanoma:
Lateral growth occurs before vertical invasion

Back 133

Superficial spreading

Front 134

What type of biopsy is appropriate for a pigmented skin lesion? A pale firm pearly heaped up area of epidermis? An erythematous, scaly lesion?

Back 134

Punch or excisional, don’t use shave for pigmented lesion!

Front 135

A hairy homeless man with blisters on the face & hands comes to the ER> Lab studies reveal elevated AST, ALT and GGT> What enzyme is deficient in this disease? What comorbid infection may also be present in this man?

Back 135

Dx: Porphyria cutanea tarda
Deficient enzyme: Hepatic uroporphyrinogen decarboxylase
Comorbid infection: Hepatitis C

Front 136

A 60 yo bald Caucasian man comes to the clinic with several reddish, sandpaper-like lesions on the top of his head each measuring less than 1 cm. How can these be treated?

Back 136

Dx: Actinic Keratosis
Tx: topical 5-Fluorouracil, Imiquimod, Cryotherapy

Front 137

A 65yo M presents with a pearly papule with telagniectasia on the tip of his nose. What is the likely dx?

Back 137

Dx: Basal Cell Carcinoma

Front 138

What are the treatment options for melasma?

Back 138

Hydroquinone (3% solution or 4% cream)
Azelaic acid 20% cream
Flucinolone 0.01% + hydroquinone 4% + tretinoin 0.05%
Prevention by minimizing sunlight exposure and by using an opaque sunblock (titanium dioxide or zinc oxide)

Front 139

What are the characteristic features of vitiligo?

Back 139

Sharply demarcated patches of complete depigmentation (due to loss of melanocytes)
Borders are hyperpigmented
More common at acral areas & around body orifices
Skin is of normal texture (which excludes morphea & lichen sclerosus)
Assoc with thyroid disease in 30% of pts (esp women)
Most common at ages 20-30

Front 140

What comorbidities are a/w vitiligo?

Back 140

Autoimmune disorders: Graves Disease, autoimmune thyroiditis, pernicious anemia, type 1 DM, primary adrenal insufficiency, hypopituitarism, alopecia areata, autoimmune hepatitis

Front 141

What is the treatment for vitiligo?

Back 141

Front 142

What treatment options are available for treating acanthosis nigricans?

Back 142

Treat the underlying disorder which may require weight loss, discontinuation of an offending agent (ie glucocorticoids, OCPs) or identification and removal of a malignancy
Lightening agents may be used which often include Retin-A (tretinoin) and topical steroids
Fish oil oral supplementation may also be used

Front 143

Purple-red on face that does not regress with age

Back 143

Port Wine Stain
(Sturge Weber)

Front 144

Infant with bright-red lesion that regresses over mos-yrs

Back 144

Strawberry Hemangioma

Front 145

Benign small red papule that appears on skin with age

Back 145

Cherry Hemangioma

Front 146

Bright red papule with radiating blanching vessels

Back 146

Spider angioma (Cirrhosis)

Front 147

Blue compressible mass that does not regress

Back 147

Cavernous Hemangioma

Front 148

Red-pink nodule on a child that is often confused with melanoma

Back 148

Spitz Nevis

Front 149

What is the treatment for uncomplicated infantile hemangioma? When are infantile hemangiomas worrisome?

Back 149

Since most uncomplicated infantile hamaniomas (aka strawberry hemangioma) gradually resolve within the first 2 years of life (or at least 10% resolution each year) observation is usually the best treatment
They are worrisome and require additional treatment (such as systemic steroids) if periorbital, in an airway, or associated with high-output heart failure

Front 150

What are the clinical features of alopecia areata?

Back 150

Asymptomatic, non-inflammatory, non-scarring areas of complete hair loss
May be precipitated by stress
Regrowth after 1st attack in 30% by 6 months, in 50% by 1 yr, in 80% by 5 years
10-30% will no re-grow hair, 5% progress to total hair loss
Obtain syphilis screen, CBC, BMP, ESR, TSH, ANA (to rule out pernicious anemia, chronic active hepatitis, thyroid disease, SLE, Addison’s)
R/o trichotillomania (pulling-out one’s hair) – look for broken hair shafts of different lengths, consider shaving a small patch and observe over a few weeks for growth

Front 151

What is the treatment for alopecia areata?

Back 151

Front 152

What is the treatment for androgenic alopecia?

Back 152

Front 153

What is the term for the malar hyperpigmentation that can occur during pregnancy?

Back 153

Melasma

Front 154

A 31yo woman has patches of hypopigmentation on her skin. Considering the associated comorbidities with this condition, what endocrine test might you order initially?

Back 154

Dx: Vitiligo
Labs: Check TSH
(Vitiligo is a/w thyroid disease in 30% of pts, esp women)

Front 155

Name the common plastic surgery procedure done for drooping eyelids

Back 155

Blepharoplasty

Front 156

What treatment is indicated for a newborn with an uncomplicated strawberry hemangioma on the face?

Back 156

Usually no tx – will regress with time

Front 157

A 30 yo woman comes to the medical clinic b/c she has noticed a few small areas of complete absence of hair on her scalp. What are some labs that would help narrow the diagnosis of the cause of this skin condition?

Back 157

Suspect: Alopecia Areata (an idiopathic condition)
Labs (to r/o secondary causes of hair loss): VDRL, RPR, CBC, Metabolic panel, ESR, TSH, ANA, LFTs (to rule out pernicious anemia, chronic active hepatitis, thyroid disease, SLE, Addison’s)
Don’t forget to ask about stress, nutrition

Front 158

What is the most imp prognostic indicator in cases of melanoma?

Back 158

Depth of lesion

Front 159

a/w obesity, diabetes, or malignancy (esp if over age 50)

Back 159

Acanthosis Nigricans

Front 160

Pigmented plaques that appear to be stuck onto the skin

Back 160

Seborrheic Keratosis

Front 161

Black velvety plaques on flexor surfaces and intertriginous areas

Back 161

Acanthosis Nigricans

Front 162

Rough lesions on sun exposed skin that are easier to feel than see

Back 162

Actinic Keratosis (AK)

Front 163

Circular rash with central clearing on the trunk or arms

Back 163

Tinea Corporis

Front 164

What is the classic appearance of basal cell cancer (BCC)?

Back 164

Pearly papule with Telangiectasias

Front 165

What is the classic appearance of squamous cell cancer (SCC)?

Back 165

Papule or ulcer with scaling or keratinization
Regular or disorderly appearance
Painful or painless

Front 166

What is the classic appearance of porphyria cutanea tarda?

Back 166

Chronic blistering lesion on sun exposed areas
Hypertrichosis & hyperpigmentation of the face

Front 167

HYQ: From the presentation, how might pemphigus vulgaris be distinguishable from bullous pemphigoid?

Back 167

PV: (+) Nikolsky sign, flaccid, sloughs easy with light pressure
BP: (-) Nikolsky sign, thick, tense, difficult to rupture

Front 168

What are the treatment options for actinic keratosis?

Back 168

Topical 5-fluorouracil
Cryotherapy
Imiquimod

Front 169

Purple-red on face that does not regress with age

Back 169

Port Wine Stain
(Sturge Weber)

Front 170

Infant with bright-red lesion that regresses over mos-yrs

Back 170

Strawberry Hemangioma

Front 171

Benign small red papule that appears on skin with age

Back 171

Cherry Hemangioma

Front 172

Bright red papule with radiating blanching vessels

Back 172

Spider angioma (Cirrhosis)

Front 173

Blue compressible mass that does not regress

Back 173

Cavernous Hemangioma

Front 174

Red-pink nodule on a child that is often confused with melanoma

Back 174

Spitz Nevis

Front 175

What treatments are available for androgenic alopecia?

Back 175

Finasteride, Minoxidil, Spironolactone

Front 176

What are the possible underlying causes of alopecia areata?

Back 176

Syphilis, pernicious anemia, Lupus, chronic active hepatits, thyroid disease, Addison’s

Front 177

Q001. Ankylosing Spondylitis - What is it; Risk factors

Back 177

A001. Chronic inflammatory disease of spine and pelvis; sacroilitis => fusion of affected joints; 20's - 30's; seronegative; HLA-B27; risk factors – male, family History

Front 178

Q002. Ankylosing Spondylitis - History/PE

Back 178

A002. History - hip and low back pain, worse with inactivity, worse in mornings, better with activity, thru day; PE - hip pain and stiffness; limited chest expansion; loss of lumbar lordosis; positive Schober test - decreased spine flexion; may have anterior uveitis,; 3rd degree heart block; aortic insufficiency => CHF

Front 179

Q003. Ankylosing Spondylitis - Dx

Back 179

A003. Dx based on clinical & XR; HLA-B27; ESR - may be elevated; RF & ANA - negative; spine and pelvic XR - "bamboo spine"

Front 180

Q004. Ankylosing Spondylitis - Tx

Back 180

A004. NSAIDs; exercise; physical therapy

Front 181

Q005. Reiter's - What is it

Back 181

A005. "Can't see, can't pee, can't climb a tree"; conjunctivitis; uveitis; urethritis; arthritis; may also have - keratoderma blennorrhagicum, circinate balanitis; after infection with – campylobacter, Shigella, salmonella, chlamydia, ureaplasma; seronegative; HLA-B27; young men

Front 182

Q006. Psoriatic Arthritis - What is it

Back 182

A006. Chronic inflammatory arthritis; psoriasis of skin; psoriatic nail lesions; DIP joints; sausage-shaped digits; "mushroom caps"; HLA-B27; seronegative

Front 183

Q007. Rheumatoid Arthritis - What is it

Back 183

A007. Chronic autoimmune diseases; peripheral joints - symmetrically inflamed; progressive destruction of articular tissue; erosion of - cartilage, bones, tendons; systemic Sxs; atlanto-axial subluxation; ruptured Baker's cyst; MC females 35-50; HLA-DR4; T cell activation - why HIV improves pre-existing

Front 184

Q008. Rheumatoid Arthritis - History/PE

Back 184

A008. Insidious onset of morning stiffness > 1 hr; painful, warm swelling of multiple symmetric joints > 6 wks; MC - wrist, MCP, PIP, any joint may be involved; axial rare except upper cervical spine; ulnar deviation; MCP joint hypertrophy, swan-neck, boutonniere; subq, painless Baker's cysts

Front 185

Q009. Rheumatoid Arthritis - Dx

Back 185

A009. RF (anti-Fc IgG Ab); ESR; synovial fluid aspiration - slightly turbid, decreased viscosity, WBC 3,000-50,000

Front 186

Q010. Rheumatoid Arthritis - Tx

Back 186

A010. NSAIDs; COX-2 inhib; severe – corticosteroids, methotrexate, hydroxychloroquine sulfate, gold, azathioprine; operative may be necessary.

Front 187

Q011. Felty's Triad - What is it

Back 187

A011. RA; splenomegaly; neutropenia

Front 188

Q012. Juvenile Rheumatoid Arthritis - What is it

Back 188

A012. Nonmigratory, nonsuppurative, mono- and poly-arthropathy; bony destruction; < 16 y/o; lasts > 6 wks; 95% - disease resolves by puberty

Front 189

Q013. Juvenile Rheumatoid Arthritis - History/PE

Back 189

A013. 3 patterns; all patterns may have – fever, nodules, erythematous rashes, pericarditis, fatigue; pauciarticular - MC form, < 4 joints, weight-bearing joints; ANA type - MC subtype, asymm involvement of lg. joint, iridocyclitis – insidious, if not treated => blind; RF type - poor prognosis, HLA-B27 - boys also have spondyloarthropathies,; polyarticular - > 5 joints, similar to adult RA, symmetric, may develop iridocyclitis; Still's disease (systemic) - least common, daily high spiking fever, evanescent salmon-colored rash, hepatosplenomegaly, serositis

Front 190

Q014. Juvenile Rheumatoid Arthritis - Dx

Back 190

A014. No diag tests; XR; RF - positive in 15%; ANA - may be positive; RBC decreased; elevated – ESR, WBC, platelets; normal ESR doesn't exclude Dx

Front 191

Q015. Juvenile Rheumatoid Arthritis - Tx

Back 191

A015. NSAIDs; corticosteroids; ROM and strength exercises; methotrexate; monitor iridocyclitis

Front 192

Q016. Scleroderma - What is it

Back 192

A016. Progressive systemic sclerosis; multisys disease; thickening of skin from; accumulation of connective tissue; MCC of death - pulmonary; CREST - better prognosis; MC - females 30-50

Front 193

Q017. Scleroderma - History/PE

Back 193

A017. All have thick skin & Raynaud's; Lung - pulmonary fibrosis => restrictive lung disease and cor pulmonale; GI - esophageal dismotility, achalasia, decreased motility of small intestines, dilation of large intestines, large diverticula; renal - malignant HTN => ARF; CREST - limited form

Front 194

Q018. CREST - What is it

Back 194

A018. Calcinosis; Raynaud's; esoph dysmotility; sclerodactyly; telangiectasias

Front 195

Q019. Scleroderma - Dx

Back 195

A019. RF; ANA; eosinophilia; anticentromere Ab - CREST; anti-Scl-70 - systemic

Front 196

Q020. Scleroderma - Tx

Back 196

A020. Systemic glucocorticoids; Ca2+ channel blockers - Raynaud's; ACE inhibitor - renal disease, HTN

Front 197

Q021. SLE - What is it

Back 197

A021. Multisys autoimmune; women - especially Black; Ab-mediated cellular attack; deposits of Ag-Ab complexes; lupus-like syndrome - drug-induced lupus, Hydralazine, penicillamine, Procainamide, INH, methyldopa; rash only, anti-histone Ab, resolves when drug discont.

Front 198

Q022. SLE - History/PE

Back 198

A022. DOPAMINE RASH; Discoid rash; Oral ulcers; Photosensitivity; Arthritis; Malar rash; Immunologic criteria; Neuro Sxs - lupus cerebritis, seizures; Elevated ESR; Renal disease; ANA positive; Serositis; Hematologic abnormalities; Sxs exacerbated - sun exposure, pregnancy

Front 199

Q023. SLE - Dx

Back 199

A023. Anemia; leukopenia; TCP; ANA; anti-dsDNA; anti-Sm Ab; active attacks - decreased C3 and C4; antihistone Ab - drug-induced; anti-Ro (SSA) - neonatal lupus, neonatal congenital heart block if pregnant, screen; antiphospholipid Ab – hypercoagulability, thromboembolic disease, recurrent spontan abortions, stillbirths; Tx - LMWH

Front 200

Q024. SLE - Tx

Back 200

A024. Arthritis - NSAIDs; major organ involvement - steroids; flare-ups - steroids; antimalarials - rash; nephritis – cytotoxics, cyclophosphamide, azathioprine

Front 201

Q025. SLE - Complications

Back 201

A025. Infections; progressive impairment of – brain, heart, lungs, kidney; increased risk - spontaneous abortion (antiphospholipid Ab); neonates - increased risk of congenital complete heart block (anti-Ro/SSA)

Front 202

Q026. Temporal Arteritis - What is it

Back 202

A026. Giant cell arteritis; women 2x's > men; > 50 y/o; subacute granulomatous inflamm; large vessels – aorta, external carotid - especially temporal, vertebral a; blindness - occlusion of central retinal; polymyalgia rheumatica - 50%

Front 203

Q027. Temporal Arteritis - History/PE

Back 203

A027. Headache; temporal tenderness; scalp pain; jaw claudication; fever; monocular blindness - transient or permanent; weight loss; malaise; myalgia; arthralgia

Front 204

Q028. Temporal Arteritis - Dx

Back 204

A028. ESR; ophthalmologic evaluation; Biopsy - temporal artery

Front 205

Q029. Temporal Arteritis - Tx

Back 205

A029. If suspect TA - start steroids before Biopsy; hi-dose prednisone - 1-2 mos. before taper; monitor eye exams

Front 206

Q030. Henoch-Schönlein Purpura - What is it

Back 206

A030. Immune-mediated vasculitis; IgA immune complexes; small arteries - GI tract; skin; joints; kidney; 2-11 y/o; degree of renal involvement; det. prognosis

Front 207

Q031. Henoch-Schönlein Purpura - History/PE

Back 207

A031. Palpable purpura - buttocks and legs; asymmetric, migratory; periarticular swelling; abdominal pain; preceding URI

Front 208

Q032. Henoch-Schönlein Purpura - Tx

Back 208

A032. Usually self-limited; Tx supportive; steroids - Sxs

Front 209

Q033. Henoch-Schönlein Purpura - Complications

Back 209

A033. GI bleeding; intussusception; glomerulonephritis

Front 210

Q034. Polymyalgia Rheumatica - What is it

Back 210

A034. Elderly females; close association with; temporal arteritis

Front 211

Q035. Polymyalgia Rheumatica - History/PE

Back 211

A035. Pain and stiffness – shoulder, pelvic girdle; especially severe in morning or after inactivity; minimal joint swelling; fever, malaise, weight loss; hard to - get out of chair, lift arms above head; muscles not weak; pain limits muscle effort

Front 212

Q036. Polymyalgia Rheumatica - Dx

Back 212

A036. Clinical; anemia; ESR high

Front 213

Q037. Polymyalgia Rheumatica - Tx

Back 213

A037. Low-dose prednisone

Front 214

Q038. Inflammatory Myopathies - What Are They

Back 214

A038. Inflammatory muscle diseases; progressive muscle weakness; polymyositis; dermatomyositis; inclusion body myositis

Front 215

Q039. Inflammatory Myopathies - History/PE

Back 215

A039. Difficulty with proximal muscles - lifting objects, combing hair, getting up from chair; difficulty with distal later - writing; dermatomyositis - heliotrope rash, Grottron's papules

Front 216

Q040. Inflammatory Myopathies - Dx

Back 216

A040. Most sensitive test - CK - elevated; aldolase - elevated; anti-jo-1 autoAb; EMG; muscle Biopsy - confirms

Front 217

Q041. Inflammatory Myopathies - Tx

Back 217

A041. Steroids - polymyositis; dermatomyositis; inclusion body myositis - resistant to immunosuppressives

Front 218

Q042. Fibromyalgia - What is it

Back 218

A042. Connective tissue d/o; myalgia; weakness; fatigue; no inflammation; associated with – depression, anxiety, IBS; MC women > 50

Front 219

Q043. Fibromyalgia - History/PE

Back 219

A043. Pain when palpate at least 11 of 18 tender points; palpate "trigger point"=> pain, body aches; fatigue; sleep disorders

Front 220

Q044. Fibromyalgia - Dx

Back 220

A044. Dx of exclusion; myofascial pain syndrome - < 11 tender points or nonfibromyalgia-associated tender points

Front 221

Q045. Fibromyalgia - Tx

Back 221

A045. Stretching; heat application; hydrotherapy; transcutan electrical; nerve stimulation; patient education; stress reduction; low-dose antidepressants

Front 222

Q046. Sjogren's - What is it

Back 222

A046. Chronic autoimmune disease; lymphocytes infiltrate exocrine glands; can become progressive => systemic => lymphoproliferative (malignant lymphome)

Front 223

Q047. Sjogren's - History/PE

Back 223

A047. Xerostomia; dry eyes; keratoconjunctivitis sicca; "sandy feeling under eyes"; dental caries; parotid enlargement

Front 224

Q048. Sjogren's - Dx

Back 224

A048. Schirmer's test - decreased tear production; rose bengal stain - corneal ulcers; anti-Ro (SSA) & anti-La (SSB); Biopsy - lymphocytes infiltrate salivary gland

Front 225

Q049. Sjogren's - Tx

Back 225

A049. None; symptomatic Tx - artificial tears

Front 226

Q050. What drugs can induce SLE?

Back 226

A050. Procainamide; Hydralazine; Isoniazid; Chlorpromazine; Methyldopa; Quinidine

Front 227

Q051. What are the features of SLE?

Back 227

A051. Fever, anorexia, malaise, weight loss; Butterfly rash; Nail fold infarcts; Splinter hemorrhages; Raynaud's Phenomenon

Front 228

Q052. What is the diagnostic criteria for SLE?

Back 228

A052. Requires 4 of 11 criteria:; Malar rash; Discoid rash; Photosensitivity; Oral ulcers; Arthritis; Serositis; Renal disorder; Seizures, psychosis; Hematologic; Immunologic; Positive ANA

Front 229

Q053. How do you treat SLE?

Back 229

A053. Refer to rheumatologist; NSAIDS; Antimalarial drugs; Steroids; Immunosuppressive drugs; Anticoagulation

Front 230

Q054. What is antiphospholipid antibody syndrome?

Back 230

A054. Recurrent venous or arterial occlusions; Recurrent fetal loss; Thrombocytopenia; Antiphospholipid antibodies; No other features of SLE

Front 231

Q055. What is scleroderma?

Back 231

A055. diffuse fibrosis of the skin and internal organs

Front 232

Q056. What are the two forms of scleroderma?

Back 232

A056. Limited - CREST; Diffuse - Renal failure, intersitial lung disease, cardiac disease

Front 233

Q057. What is CREST syndrome?

Back 233

A057. Calcinosis; Raynaud's syndrome; Esophageal dysmotility; Sclerodactyly; Telangiectasia

Front 234

Q058. What are the clinical findings of scleroderma?

Back 234

A058. Polyarthralgia, Raynaud's phenomenon; Thickened skin, with loss of normal folds; telangiectasia, pigmentation, depigmentation; Dysphagia; Restrictive lung disease; Pericarditis, heart block; Renal disease

Front 235

Q059. What labs do you see with scleroderma?

Back 235

A059. mild anemia; normal ESR; positive ANA; SCL-70; Anticentromere antibody (50% w/ CREST)

Front 236

Q060. How do you treat scleroderma?

Back 236

A060. Severe Raynaud's phenomenon - nifedipine, losartan; Esophageal reflux - H2 blockers, PPI, antacids; Bacterial overgrowth and pseudoobstruction - octreotide; Malabsorption d/t bacterial overgrowth - tetracycline

Front 237

Q061. True or False: Prednisone is commonly used in the treatment of scleroderma.

Back 237

A061. False

Front 238

Q062. What is Sjogren's Syndrome?

Back 238

A062. chronic dysfuction of exocrine glands

Front 239

Q063. What are the clinical findings of Sjogren's Syndrome?

Back 239

A063. keratoconjunctivitis; burning, itching, FB sensation in eye; Dry mouth; Loss of taste and smell; Parotid enlargement; Desiccation of nose, throat, larynx, vagina, skin; Dysphagia; Pancreatitis

Front 240

Q064. What labs do you see with Sjogren's syndrome?

Back 240

A064. Mild anemia; Leukopenia; Eosinophilia; Polyclonal hypergammaglobulinemia; Positive RF; ANA; Anti-SS-a and Anti-SS-b; Thyroid-associated autoimmunity; Schirmer test; Lip biopsy; Parotid gland biopsy

Front 241

Q065. What does a Schirmer test measure?

Back 241

A065. quantity of tears secreted

Front 242

Q066. How do you treat Sjogren's syndrome?

Back 242

A066. Supportive and symptomatic

Front 243

Q067. What drug can relieve xerostomia?

Back 243

A067. Pilocarpine

Front 244

Q068. People with Sjogren's are at risk for developing what?

Back 244

A068. lymphoma

Front 245

Q069. What is polymyalgia rheumatica?

Back 245

A069. pain and stiffness in neck, shoulder, and pelvic girdle

Front 246

Q070. What are the characteristics of polymyalgia rheumatica?

Back 246

A070. pain and stiffness in neck, shoulder, and pelvic girdle; symmetrical symptoms; more prolonged in the morning; low-grade fever, fatigue, weight loss

Front 247

Q071. Does PMR have muscle weakness?

Back 247

A071. No

Front 248

Q072. What labs do you see with polymyalgia rheumatica?

Back 248

A072. ESR and CRP elevated; Anemia and mild thrombocytosis

Front 249

Q073. How do you treat polymyalgia rheumatica?

Back 249

A073. Prednisone 10-20 mg/day for 6 months-2 years

Front 250

Q074. Know about Giant Cell Arteritis.

Back 250

A074. Symptoms; Treatment

Front 251

Q075. What is polyarteritis nodosa?

Back 251

A075. medium-sized necrotizing arteritis

Front 252

Q076. What can cause polyarteritis nodosa?

Back 252

A076. Idiopathic; Hep B or C; Drugs

Front 253

Q077. What drugs can cause polyarteritis nodosa?

Back 253

A077. PTU; Hydralazine; Allopurinol; Penicillamine; Sulfasalazine

Front 254

Q078. What are the signs and symptoms of polyarteritis nodosa?

Back 254

A078. fever, malaise, weight loss; pain in extremities; Foot drop; livedo reticularis; HTN

Front 255

Q079. What labs do you see in polyarteritis nodosa?

Back 255

A079. anemia; elevated ESR; Leukocytosis; Hep B or C

Front 256

Q080. How do you confirm a diagnosis of polyarteritis nodosa?

Back 256

A080. tissue biopsy

Front 257

Q081. How do you treat polyarteritis nodosa?

Back 257

A081. corticosteroids (up to 60mg/day); immunosuppressive agents (cyclophosphamide); refer to rheumatologist

Front 258

Q082. What is a complication of polyarteritis nodosa?

Back 258

A082. mesenteric vasculitis

Front 259

Q083. What is Reiter's syndrome?

Back 259

A083. Reactive arthritis

Front 260

Q084. What causes Reiter's syndrome?

Back 260

A084. dysentery - Shigella, Salmonella, Yersinia, Campylobacter; STD - Chlamydia

Front 261

Q085. What are the clinical findings of Reiter's syndrome?

Back 261

A085. Urethritis; Conjunctivitis; Mucocutaneous lesions; Aseptic arthritis; Fever, weight loss; Aortic regurgitation

Front 262

Q086. With Reiter's syndrome, what do you see on x-ray?

Back 262

A086. permanent or progressive joint disease (sacroiliac or peripheral joints)

Front 263

Q087. How do you treat Reiter's syndrome?

Back 263

A087. NSAIDS; antibiotics at time of infection; tetracycline; sulfasalazine; methotrexate; anti-TNF agents

Front 264

Q088. True or False: Once symptoms of Reiter's syndrome develop, antibiotics can reduce the severity of the disease.

Back 264

A088. False

Front 265

Q089. Sjogren's si/sx

Back 265

A089. triad - keratoconjuctivitis sicca, xerostomia, arthritis; also, pancreatitis, fibrinous pericarditis

Front 266

Q090. Sjogren's labs

Back 266

A090. + ANA, antiRo/antiLa abs, 70% RF +; a/w HLA-DR3

Front 267

Q091. Behcet's si/sx

Back 267

A091. 20 yo; oral/genital ulcers; uveitis, arthritis, other derm disease

Front 268

Q092. Dermatomyositis si/sx

Back 268

A092. young kids, old peeps; symmetric weakness of proximal muscles (can see dysphonia/dysphagia) look for trouble getting out of chair. skin involvement = heliotrope rash around eyes + periorbital edema

Front 269

Q093. Dermatomyositis labs

Back 269

A093. high ESR, high CPK, abnormal EMG, muscle biopsy --> inflammation + ANA

Front 270

Q094. Kawasaki's si/sx

Back 270

A094. <5 yo; truncal rash, fever >104x(>5d), conjunctival injection, cervical LAD, strawberry tongue, skin desquamation. -> coronary vessel vasculitis, aneurysms, MI

Front 271

Q095. Kawasaki Tx

Back 271

A095. NOT STEROIDS; aspirin + IVIG

Front 272

Q096. Polyarteritis nodosa si/sx

Back 272

A096. Associated with hepatitis B + cryoglobulinemia; fever, abdominal pain, weight loss, renal disorder, peripheral neuropathies.

Front 273

Q097. Polyarteritis nodosa labs

Back 273

A097. high ESR, leukocytosis, anemia, hematuria/proteinuria. Biopsy of medium-sized vessels --> vasculitis

Front 274

Q098. Scleroderma si/sx

Back 274

A098. C - calcinosis; R - raynaud's; E - esophageal dysmotility; S - sclerodactyly; T- telangectasia; heartburn, mask-like leathery facies.

Front 275

Q099. Scleroderma labs

Back 275

A099. Positive ANA; positive anticentromere Abs = CREST; positive antitopoisomerase = scleroderma

Front 276

Q100. What drugs can cause secondary SLE?

Back 276

A100. procainamide; hydralazine; dilantin (phenytoin); sulfanomide; INH

Front 277

Q101. What is the dx lab in secondary SLE?

Back 277

A101. Positive antihistone Abs

Front 278

Q102. What are the dx labs in SLE?

Back 278

A102. Positive ANA screen; positive antiSm or anti-ds-DNA

Front 279

Q103. What are other lab findings in SLE?

Back 279

A103. false positive for VDRL or RPR for syphilis; PTT falsely elevated; (SLE actually thrombogenic)

Front 280

Q104. Takayasu's arteritis si/sx

Back 280

A104. East Asian women 15-30yo; "pulseless" in 1 or both arms. carotid involve --> neuro sign, stroke; CHF

Front 281

Q105. Wegener's granulomatosis si/sx

Back 281

A105. old peep; nose bleeds, nasal perforation, hemoptysis, dyspnea, hematuria, ARF

Front 282

Q106. What's the diff between Wegener's and Goodpasture?

Back 282

A106. Weg = old peep, +ANCA; Goodpasture = young peep, positive antiglomerular antibody

Front 283

Q107. Polymyalgia Rheumatica si/sx

Back 283

A107. Women >50yo; Pectoral and pelvic girdles, neck involvement; a/w temporal arteritis

Front 284

Q108. Polymyalgia Rheumatica labs

Back 284

A108. Really high ESR; normal muscle biopsy/EMG

Front 285

Q109. Rheumatoid factor

Back 285

A109. It is an antibody against the Fc portion of IgG = RF & IgG form immune complexes. which is itself an antibody, IgM or IgA type.

Front 286

Q110. RF or RhF positive in:; is often determined in patients suspected in any form of arthritis

Back 286

A110. High levels RF: generally > 20 IU/mL; rheumatoid arthritis: present in 80%; Sjögren's syndrome: present in 60%

Front 287

Q111. false (+) RF or RhF; Blood test performed in patients with suspected rheumatoid arthritis (RA)

Back 287

A111. Chronic hepatitis; Any chronic viral infection; Leukemia; Dermatomyositis; Infectious mononucleosis; Scleroderma; Systemic lupus erythematosus (SLE)

Front 288

Q112. Sjögren's syndrome; * antibodies to Ro(SSA) or La(SSB) antigens, or both; * > 40 years old at the time of diagnosis & Woman >> Man

Back 288

A112. an autoimmune disorder in which immune cells attack and destroy the exocrine glands that produce tears and saliva with Schirmer test(+); A lip biopsy can reveal lymphocytes clustered around salivary gland

Front 289

Q113. Spondyloarthropathies

Back 289

A113. Group of related INFLAMMATORY JOINT Ds associated with the MHC class I molecule HLA-B27

Front 290

Q114. Seronegative spondylarthropathy

Back 290

A114. Spondylarthropathy & (-)rheumatoid factor (RhF)

Front 291

Q115. Non-specific spondylarthropathy

Back 291

A115. Indicator of other rheumatological disease (in particular rheumatoid arthritis)

Front 292

Q116. Subgroups (with increased HLA-B27 frequency)

Back 292

A116. ankylosing spondylitis Caucasians (AS, 92%),; ankylosing spondylitis African-Americans (AS, 50%),; reactive arthritis (Reiter's syndrome) (RS, 60-80%),; enteropathic arthritis associated with inflammatory bowel disease (IBD, 60%),; Psoriatic arthritis (60%),; isolated acute anterior uveitis (AAU, iritis or iridocyclitis, 50%), and; undifferentiated SpA (USpA, 20-25%).

Front 293

Q117. Buergers

Back 293

A117. thromboangiitis obliterans;; idiopathic, segmental, thrombosing vasculitis of intermed/small peripheral arteries and veins; seen in heavy smokers (tx- stop smoking)

Front 294

Q118. Buerger's findings

Back 294

A118. intermittent claudication, superficial nodular phlebitis, cold sensitivity, pain

Front 295

Q119. Takayasu's arteritis

Back 295

A119. pulseless disease;; granulomatous thickening of aortic arch and/or proximal great vessels;; associated with elevated ESR; primarily affects Asian females < 40 y/o

Front 296

Q120. Takayasu's sxs

Back 296

A120. fever,; arthritis,; night sweats,; myalgia,; skin nodules,; ocular disturbances,; weak pulses in upper extremities

Front 297

Q121. Temporal arteritis (giant cell)

Back 297

A121. most common vasculitis that affects medium and small arteries, usually branches of carotid; focal, granulomatous; unilateral HA, jaw claudication, impaired vision (occlusion of opthalmic artery- blindness); half of patients have systemic involvement and polymyalgia rheumatica; elevated ESR

Front 298

Q122. Temporal arteritis treatment

Back 298

A122. steroids

Front 299

Q123. young male smoker

Back 299

A123. buergers

Front 300

Q124. young asian female with weak pulses in upper extremities

Back 300

A124. takayasus

Front 301

Q125. PAN

Back 301

A125. necrotizing immune complex inflammation of medium sized muscular arteries typically involving renal and visceral vessels; sxs: weight loss, malaise, fever, abdominal pain, melena, HA, myalgia, HTN, neuro dysfunction, cutaneous eruptions

Front 302

Q126. PAN association

Back 302

A126. hep B;; multiple aneurysms and constrictions on arteriogram; not associated with ANCA (P maybe)

Front 303

Q127. Tx of PAN

Back 303

A127. corticosteroids, cyclophosphamide (hemorrhagic cystitis)

Front 304

Q128. Wegener's granulomatosis

Back 304

A128. traid of focal necrotizing vasculitis,; necrotizing granulomas in the lung and upper airway and necrotizing GN

Front 305

Q129. Wegener's sxs

Back 305

A129. perforation of nasal septum,; chronic sinusitis,; otitis media,; mastoiditis,; cough,; dyspnea,; hemoptysis,; hematuria; looks like goodpastures but upper respiratory tract is also involved

Front 306

Q130. findings in wegeners

Back 306

A130. CANCA,; CXR- may reveal large nodular densities,; hematuria and red cell casts; tx: cyclophosphamide, corticosteroids

Front 307

Q131. Churg Strauss

Back 307

A131. granulamatous vasculitis with eosinophilia;; involves lung, heart, skin, kidneys, and nerves; often seen in atopic pts; tx: steroids

Front 308

Q132. Kawasaki's disease

Back 308

A132. acute, self limiting disease of infants and kids;; acute necrotizing vasculitis of small/medium sized vessels; fever, congested conjunctiva, changes in lips/oral mucosa,; LAD, may develop coronary aneurysms,; skin rash,; strawberry tongue; tx: high dose aspirin

Front 309

Q133. HSP

Back 309

A133. most common childhood vasculitis;; skin rash (palpable purpura) below legs,; arthralgia,; intestinal hemorrhage,; abdominal pain,; melena

Front 310

Q134. telangiectasia

Back 310

A134. AV malformation in small vessels;; looks like dilated capillary; hereditary hemorrhagic telangiectasia-AD inheritance; presents with nosebleeds and skin discolorations

Front 311

Q135. What is arthrocentesis?

Back 311

A135. Arthrocentesis is a needle aspirate of synovial fluid for microscopic analysis. The cell count is the most accurate way of telling immediately if there is an infection versus inflammation. Counts from 0 to 2,000 are normal; from 2,000 to 20,000 are from inflammatory disorders such as gout. Counts above 50,000 are from infections. Counts between 20,000 and 50,000 are indeterminate.

Front 312

Q136. Anti-Scl-70

Back 312

A136. Scleroderma

Front 313

Q137. Anti- Microsomal; (2)

Back 313

A137. 1. Hashimoto's; 2. Autoimmune Hepatitis

Front 314

Q138. Anti-b islet cell

Back 314

A138. IDDM; type I diabetes

Front 315

Q139. Anti-Acetylcholine receptor

Back 315

A139. Myasthenia gravis

Front 316

Q140. Anti-Adrenal

Back 316

A140. Addison's

Front 317

Q141. Anti-Basement membrane

Back 317

A141. Goodpasture's

Front 318

Q142. Anti-Centromere

Back 318

A142. CREST

Front 319

Q143. Anti-ds DNA

Back 319

A143. SLE [specific]

Front 320

Q144. Anti-Epithelial

Back 320

A144. Pemphigus vulgaris

Front 321

Q145. Anti-Gliadin

Back 321

A145. Celiac disease

Front 322

Q146. Anti-Histone

Back 322

A146. Drug induced lupus

Front 323

Q147. Anti-IgM

Back 323

A147. Rheumatoid arthritis

Front 324

Q148. Anti-Intrinsic Factor

Back 324

A148. Pernicious anemia

Front 325

Q149. Anti-Mitochondrial

Back 325

A149. Primary biliary cirrhosis

Front 326

Q150. Anti-Neutrophil

Back 326

A150. Vasculitis

Front 327

Q151. c-ANCA

Back 327

A151. Wegener's granulomatosis

Front 328

Q152. p-ANCA

Back 328

A152. Polyarteritis nodosa

Front 329

Q153. Anti-Nuclear

Back 329

A153. SLE

Front 330

Q154. Anti-Thyroglobulin

Back 330

A154. Hashimoto's

Front 331

Q155. Anti-Thyroid peroxidase

Back 331

A155. Hashimoto's

Front 332

Q156. Anti-TSH receptor; (2)

Back 332

A156. Graves' or Hashimoto's

Front 333

Q157. Anti-Jo-1

Back 333

A157. Polymyositis;; dermatomyositis

Front 334

Q158. Anti-parietal cell

Back 334

A158. Pernicious anemia

Front 335

Q159. Anti-platelets

Back 335

A159. ITP

Front 336

Q160. Anti-smith

Back 336

A160. SLE

Front 337

Q161. B27

Back 337

A161. PAIR; Psoriasis,; Ankylosing spondylitis,; Inflammatory bowel diseas,; Reiter's syndrome

Front 338

Q162. B8

Back 338

A162. Graves Disease, Celiac Sprue

Front 339

Q163. DR2

Back 339

A163. Mulitple sclerosis,; hay fever,; SLE,; Goodpastures

Front 340

Q164. DR3

Back 340

A164. DM Type 1

Front 341

Q165. DR4

Back 341

A165. Rheumatoid Arthritis, DM Type 1

Front 342

Q166. DR5

Back 342

A166. Pernicious anemia = B12 deficiency,; Hashimoto's thyroiditis

Front 343

Q167. DR7

Back 343

A167. Steroid-responsive nephrotic syndrome

Front 344

Q168. Compartment Syndrome - What is it

Back 344

A168. Increased pressure in a confined space; compromises nerve, muscle & soft tissue perfusion; MC - ant. compartment of lower leg & forearm; causes – fractures, crush injuries, burns, ischemic- reperfusion after an injury, casts

Front 345

Q169. Compartment Syndrome - History/PE

Back 345

A169. The 6 P's:; Paresthesias; Palpation - tense compartment; Pallor; Poikilothermia; Pulselessness; Paralysis; Pain - out of proportion with passive motion of fingers & toes; Volkmann's contracture

Front 346

Q170. Compartment Syndrome - Dx

Back 346

A170. Measure compartment pressure - > 30 mmHg not good; delta pressure - diastolic minus compartment; should be > 30 to be OK

Front 347

Q171. Compartment Syndrome - Tx

Back 347

A171. Surgical emergency; immediate fasciotomy of all compartments; do in < 6 hrs.

Front 348

Q172. Low Back Pain - What is it

Back 348

A172. Paraspinous; strains - muscle injury; sprain - ligament injury

Front 349

Q173. Low Back Pain - History/PE

Back 349

A173. If malignancy - pain worse at night; pain not relieved by rest; pain not relieved by changing positions; if point tenderness over vertebral body – osteomyelitis, fracture, malignancy; cauda equina syndrome - bladder or bowel dysfunction, saddle-area anesthesia, impotence, surgical emergency

Front 350

Q174. Low Back Pain - L4 Associated Deficits:; Motor; Reflex; Sensory

Back 350

A174. Motor - foot dorsiflexion, tibialis anterior; reflex - patellar; sensory - medial aspect of leg

Front 351

Q175. Low Back Pain - L5 Associated Deficits:; Motor; Reflex; Sensory

Back 351

A175. Motor - big toe dorsiflexion, extensor hallucis longus; reflex - none; sensory - medial forefoot & lateral aspect of leg

Front 352

Q176. Low Back Pain - S1 Associated Deficits:; Motor; Reflex; Sensory

Back 352

A176. Motor - foot eversion; peroneus longus/brevis; reflex - achilles; sensory - lateral foot

Front 353

Q177. Low Back Pain - Dx

Back 353

A177. Mainly clinical; XR; MRI; electrodiagnostic studies - nerve conduction velocity test

Front 354

Q178. Low Back Pain - Tx

Back 354

A178. Sprains & strains - NSAIDs; physical therapy; continue activities as tolerated; rest > 1-3 days unnecessary. 90% recover spontaneously in 6 weeks; surgery - if correctable spinal disease, cauda equina syndrome - surgical emergency: immediate decompression, laminectomy

Front 355

Q179. Herniated Disk - What is it

Back 355

A179. Nucleus pulposus herniates posteriorly => nerve root or cord compression; neck/back pain; sensory & motor deficits; causes - degenerative changes, trauma, neck/back strain, neck/back sprain; middle-aged & older men after strenuous activity; L4-L5 & L5-S1

Front 356

Q180. Herniated Disk - History/PE

Back 356

A180. Several months of aching pain => sudden onset of severe, electricity-like LBP; pain exacerbated by straining; sciatica: tingling - lower extremities, numbness, muscle weakness, atrophy, contractions, spasms, pain increased by - passive straight leg, crossed straight leg raises, large midline herniations => cauda equina syndrome

Front 357

Q181. Herniated Disk - Dx

Back 357

A181. MRI

Front 358

Q182. Herniated Disk - Tx

Back 358

A182. Most cases - bed rest; NSAIDs; physical therapy; localized heat; resolved in 2-3 weeks; if no neuro deficit - bed rest not advised, early mobilization; muscle relaxant, NSAIDs; diskectomy - if persistent or disabling Sxs

Front 359

Q183. Spinal Stenosis - What is it

Back 359

A183. Stenosis of cervical or lumbar spinal canal => compression of nerve roots; usually from degenerative joint disease; middle-aged or elderly

Front 360

Q184. Spinal Stenosis - History/PE

Back 360

A184. Neck pain; back pain - radiates to butt & legs, leg numbness, leg weakness, "spaghetti legs", "walks like a drunken sailor"; leg cramping - at rest, standing, walking; sitting gives relief; leaning forward gives relief (flexing at hips decreased pain)

Front 361

Q185. Spinal Stenosis - Dx

Back 361

A185. XR; MRI or CT

Front 362

Q186. Spinal Stenosis - Tx

Back 362

A186. Mild to moderate - NSAIDs; abdominal muscle strengthening; advanced - epidural steroid injection; surgical laminectomy - short-term, will recur

Front 363

Q187. Developmental Dysplasia of Hip; What is it

Back 363

A187. Congenital hip dislocation => dislocated femoral heads due to - lax musculature; excessive uterine packing (breech) => poor development of acetabulum, hip; will progress if not corrected; MC - 1st born breech females

Front 364

Q188. Developmental Dysplasia of Hip; History/PE

Back 364

A188. Barlow's - hip adducted; Ortolani's - thighs abducted; Allis' (Galeazzi's) sign - knees unequal when hip & knees flexed, dislocated side is lower; asymmetrical skin folds; limited abduction of affected hip

Front 365

Q189. Developmental Dysplasia of Hip; Dx

Back 365

A189. Early detection; evaluate clinical; US - if after 10 weeks old; XR - unreliable until 4 mos. old, neonatal femoral head radiolucent

Front 366

Q190. Developmental Dysplasia of Hip; Tx

Back 366

A190. Start Tx early; < 6 mos. - Pavlik harness; 6-15 mos. - spica cast; 15-24 mos. - open reduction; if no Tx started by 24 mos. - significant defect

Front 367

Q191. Developmental Dysplasia of Hip; Complications

Back 367

A191. Complications - joint contractures; AVN of femoral head

Front 368

Q192. Limp - What is it

Back 368

A192. 1 of the MC musculoskeletal disorder of kids; MC cause - trauma

Front 369

Q193. Limp - History/PE

Back 369

A193. May be associated with pain or fever; ask about - history of trauma, recent infections, contact with TB- positive patients; young kids & toddlers - infected joint; adolescent & teens – JRA, slipped capital femoral epiphyses (SCFE), Legg-Calve-Perthes (LCP); disruption in normal gait – Trendelenburg, antalgic gait; infection – erythema, edema, limited ROM; trauma or tumor - point tenderness; always evaluate for – fever, signs of systemic infection, neuro involvement – reflexes, muscle atrophy, changes in sensation, bowel & bladder function

Front 370

Q194. Limp - Differential Dx

Back 370

A194. STARTSS HOTT; Septic joint; Tumor; Avascular necrosis (LCP); RA/JRA; TB; Sickle cell disease; SCFE; HSP; Osteomyelitis; Trauma; Toxic synovitis

Front 371

Q195. Limp - Dx

Back 371

A195. Thorough H&P; XR; CBC; ESR; CRP; bone scan; nerve conduction studies; joint aspirate & culture - if suspect septic joint

Front 372

Q196. Limp - Tx

Back 372

A196. Depends on cause

Front 373

Q197. Legg-Calve-Perthes - What is it

Back 373

A197. AVN of femoral head; UNK etiology; boys 4-10; can be bilateral

Front 374

Q198. Legg-Calve-Perthes - History/PE

Back 374

A198. Usually asymptomatic at first => painless limp or => pain, referred to knee; limited abduction; limited internal rotation; atrophy

Front 375

Q199. Legg-Calve-Perthes - Tx

Back 375

A199. Self-limited; observation; if disease extensive or ROM impaired – brace, hip abduction with Petrie cast, osteotomy; prognosis dependent on – age, ROM, extent of involvement, joint stability

Front 376

Q200. Slipped Capital; Femoral Epiphysis - What is it

Back 376

A200. Separation of proximal femoral epiphysis through growth plate => fem head displaced; medial & posterior to fem neck; can be bilateral; obese Black 11-13 y/o boys; if < 11 y/o, may be associated with endocrinopathies; may be due to imbalance between GH & sex hormones

Front 377

Q201. Slipped Capital; Femoral Epiphysis - History/PE

Back 377

A201. Thigh or knee pain; painful limp; acute or insidious; acute - restricted ROM, inability to bear weight. limited internal rotation; limited abduction; hip tenderness; flexion => obligatory external rotation

Front 378

Q202. Slipped Capital; Femoral Epiphysis - Dx

Back 378

A202. TSH; XR both hips – AP, frog-leg lat

Front 379

Q203. Slipped Capital; Femoral Epiphysis - Tx

Back 379

A203. Start promptly; no weight on limb until; surgical stabilized with screws; acute slip - gentle closed reduction

Front 380

Q204. Slipped Capital; Femoral Epiphysis - Complications

Back 380

A204. Chondrolysis; AVN of fem head; premature hip OA => hip arthroplasty

Front 381

Q205. Shoulder Dislocation - Mechanics

Back 381

A205. MC - anterior dislocation, axillary artery & nerve, hold arm in external. rotation; posterior dislocations, radial artery, seizures & electrocutions, hold arm in int. rotation

Front 382

Q206. Shoulder Dislocation - Tx

Back 382

A206. Closed reduction; followed by sling & swath; recurrent - surgery

Front 383

Q207. Hip Dislocation - Mechanics

Back 383

A207. MC - posterior dislocation, compress sciatic nerve., can cause AVN, posterior directed force on, internal rotated, flexed, adducted hip, "dashboard injury"; anterior dislocation - obturator nerve compromises.

Front 384

Q208. Hip Dislocation - Tx

Back 384

A208. Closed reduction followed by abduction; pillow/bracing; CT after reduction

Front 385

Q209. Colles' Fracture - Mechanics

Back 385

A209. MC wrist fracture; distal radius; fall onto outstretched hand => dorsally displaced/angle Fracture; common in elderly (osteoporosis), kids

Front 386

Q210. Colles' Fracture - Tx

Back 386

A210. Closed reduction; then long arm cast; intra-articular - open reduction

Front 387

Q211. Scaphoid (Carpal Navicular) Fracture; Mechanics

Back 387

A211. MC fractured carpal bone; can be 1-2 weeks for XR to show; assume if tenderness in anatomical snuff box; proximal 3rd scaphoid fractures can => AVN

Front 388

Q212. Scaphoid (Carpal Navicular) Fracture; Tx

Back 388

A212. Thumb spica cast; open reduction - displacement; nonunion common

Front 389

Q213. Boxer's Fracture - Mechanics

Back 389

A213. Fracture of 5th metacarpal neck; forward trauma of closed fist

Front 390

Q214. Boxer's Fracture - Tx

Back 390

A214. Closed reduction & ulnar gutter splint; excessive angulation - percutan pinning; skin broken - assume infection by human oral pathogens; "fight bite"; surgical irrigation; debridement; IV Antibiotics to cover Eikenella

Front 391

Q215. Humerus Fracture - Mechanics

Back 391

A215. Direct trauma; radial nerve. wrist drop; loss of thumb abduction

Front 392

Q216. Humerus Fracture - Tx

Back 392

A216. Hanging arm cast or coaptation splint & sling; functional bracing

Front 393

Q217. Nightstick Fracture - Mechanics

Back 393

A217. Ulna shaft fracture; from self-defense - arm against blunt object

Front 394

Q218. Nightstick Fracture - Tx

Back 394

A218. ORIF; open reduction & int. fixation

Front 395

Q219. Monteggia's Fracture - Mechanics

Back 395

A219. Diaphyseal Fracture; proximal ulnar; subluxation of radial head

Front 396

Q220. Monteggia's Fracture - Tx

Back 396

A220. ORIF - shaft fracture; closed reduction - radial head

Front 397

Q221. Galeazzi's Fracture - Mechanics

Back 397

A221. Diaphyseal Fracture; radius; dislocation of distal radioulnar joint; from direct blow to radius

Front 398

Q222. Galeazzi's Fracture - Tx

Back 398

A222. ORIF - radius; cast forearm in supination

Front 399

Q223. Hip Fracture - Mechanics

Back 399

A223. MC in osteoporotic women who fall; shortened, ext rotated leg; at risk for DVTs; displaced fem neck fractures - high risk of AVN, fracture nonunion

Front 400

Q224. Hip Fracture - Tx

Back 400

A224. ORIF; parallel pinning of femoral neck; anticoagulant; > 80 y/o - may need hip hemiarthroplasty

Front 401

Q225. Femur Fracture - Mechanics

Back 401

A225. Direct trauma (MVA); fat emboli; fever; scleral & axillary petechiae; confusion; dyspnea; hypoxia

Front 402

Q226. Femur Fracture - Tx

Back 402

A226. Intramedullary nailing; open fractures - thorough irrigation; debridement

Front 403

Q227. Tibial Fracture - Mechanics

Back 403

A227. Direct trauma; car bumper & pedestrian injury; compartment syndrome

Front 404

Q228. Tibial Fracture - Tx

Back 404

A228. Casting vs. intramedullary nailing

Front 405

Q229. Open Fracture - Mechanics

Back 405

A229. Orthopedic emergency; must go to OR in < 6 hrs. (risk of infection)

Front 406

Q230. Open Fracture - Tx

Back 406

A230. OR emergently to repair; Antibiotics

Front 407

Q231. Achilles Tendon Rupture - Mechanics

Back 407

A231. MC in unfit men in sports; hear sudden "pop"; sounds like rifle shot; limited plantar flexion; pos Thompson test - pressure on gastrocnemius; doesn't => ft plantar flexion

Front 408

Q232. Achilles Tendon Rupture - Tx

Back 408

A232. Long-leg cast for 6 wks

Front 409

Q233. ACL Injury - Mechanics

Back 409

A233. From forced hyperflexion; positive anterior drawer sign; Lachman's test; rule out meniscal or MCL injury

Front 410

Q234. ACL Injury - Tx

Back 410

A234. Surgery; graft from patellar or hamstring tendons

Front 411

Q235. PCL Injury - Mechanics

Back 411

A235. From forced hyperextension; positive posterior drawer test

Front 412

Q236. PCL Injury - Tx

Back 412

A236. Operative PCL repair - for highly competitive athlete

Front 413

Q237. Meniscal Tears - Mechanics

Back 413

A237. Clicking or locking; joint line tenderness; positive McMurray's test

Front 414

Q238. Meniscal Tears,; MCL/LCL Injuries - Tx

Back 414

A238. Conservative; unless associated with Sxs or ligament injuries

Front 415

Q239. Clavicular Fracture - What is it

Back 415

A239. MC fractured long bone in kids; birth-related (lg infants); brachial n. palsies; usually middle 3rd of clavicle; proximal end displaced superiorly; from pull of sternocleidomast

Front 416

Q240. Clavicular Fracture - Tx

Back 416

A240. Figure-of-8 sling vs. arm sling

Front 417

Q241. Greenstick Fracture - What is it

Back 417

A241. Incomplete fracture; cortex of one side of bone

Front 418

Q242. Greenstick Fracture - Tx

Back 418

A242. Reduction with casting; order films at 7-10 days

Front 419

Q243. Nursemaid's Elbow - What is it

Back 419

A243. Radial head subluxation; from being pulled or lifted by hand; kid will not bend elbow

Front 420

Q244. Nursemaid's Elbow - Tx

Back 420

A244. Manual reduction - gentle supination of elbow; at 90 degrees of flexion; no immobilization necessary.

Front 421

Q245. Torus Fracture - What is it

Back 421

A245. Buckling of cortex of long bone; secondary to trauma; usually distal radius or ulna

Front 422

Q246. Torus Fracture - Tx

Back 422

A246. Cast immobilization; 3-5 wks - dep. on age

Front 423

Q247. Supracondylar Humerus Fracture - What is it

Back 423

A247. 5-8 y/o; proximal to brachial a. risk of Volkmann's contracture

Front 424

Q248. Supracondylar Humerus Fracture - Tx

Back 424

A248. Cast immobilization; closed reduction; percutan pinning - if significant displaced

Front 425

Q249. Osgood-Schlatter Disease - What is it

Back 425

A249. Overuse apophysitis of tibial tubercle; localized pain; especially with quadriceps Ctx; active young boys

Front 426

Q250. Osgood-Schlatter Disease - Tx

Back 426

A250. Decreased activity 1-2 yrs; neoprene brace

Front 427

Q251. Salter-Harris Fractures - What are they

Back 427

A251. Fractures of growth plate of kids; classified by fracture location; I - physis; II - metaphysis & physis; III - epiphysis & physis; IV - epi-, meta- & physis; V - crush injury of physis

Front 428

Q252. Salter-Harris Fractures - Tx

Back 428

A252. I & II - nonoperatively; others & unstable fractures-operatively; prevents leg-length inequality

Front 429

Q253. Osteosarcoma - What is it

Back 429

A253. 2nd MC primary malignant; bone tumor; metaphyses - distal femur; proximal tibia; proximal humerus; can metas to lungs; men; 20s-30s; Paget's can precede development of secondary osteosarcoma

Front 430

Q254. Osteosarcoma - History/PE

Back 430

A254. Progressive pain => intractable pain; worse at night; constitutional Sxs; at site of tumor - erythema; enlargement

Front 431

Q255. Osteosarcoma - Dx

Back 431

A255. MRI; CT; XR - Codman's triangle, sunburst pattern

Front 432

Q256. Osteosarcoma - Tx

Back 432

A256. Limb-sparing surgical proc; pre- and postop chemo – methotrexate, doxorubicin, cisplatin, ifosfamide; amputation - may be necessary if big

Front 433

Q257. Paget's (Osteitis Deformans) - What is it

Back 433

A257. Osteoclasts accelerate bone turnover in local areas => hyper osteoblastic repair => abnorm structure that weakens bone; may be associated with paramyxovirus infection; mainly disease of elderly

Front 434

Q258. Paget's (Osteitis Deformans) - History/PE

Back 434

A258. Often asymptomatic; if Sx occur, develop insidiously; deep bone pain; bone softening => tibial bowing, kyphosis, freq fractures; increased in cranial diameter - (frontal bossing); deafness - CN8 compressed

Front 435

Q259. Paget's (Osteitis Deformans) - Dx

Back 435

A259. Alkaline phosphatase; increased urinary hydroxyproline; serum Ca2+ & phosphate- normal; XR - bony cortex very expanded, jigsaw/mosaic bone pattern, thick trabeculae

Front 436

Q260. Paget's (Osteitis Deformans) - Tx

Back 436

A260. NSAIDs; calcitonin; alendronate

Front 437

Q261. Paget's (Osteitis Deformans) - Complications

Back 437

A261. Fracture; hi-output cardiac failure; arthritis; deafness; secondary osteosarcoma; vertebral collapse => spinal cord compression

Front 438

Q262. Gout - What is it

Back 438

A262. Recurrent attacks - acute monoarticular arthritis; monosodium urate crystals; middle-aged, obese men, Pacific Islanders; hyperuricemia - secondary to uric acid underexcretion; other causes - Lesch-Nyhan, diuretics (furosemide, HCTZ), trauma, surgery, infections, steroid withdrawal, cyclosporine, malignancy, excessive red meat or red wine, hemoglobinopathies

Front 439

Q263. Pseudogout - What is it; Dx; Tx

Back 439

A263. MC - elderly or preexisting joint damage; if < 50 y/o - metabolic abnorm, hyperparathyroidism, hypophosphatasia, hypomagnesemia, hemochromatosis; knee - #1, also ankle, wrist, shoulder; Dx - fluid aspiration, Positive birefringent rhomboid crystals; XR - chondrocalcinosis; Tx - same as gout; low dose of colchicine - prevents recurrence

Front 440

Q264. Gout - History/PE

Back 440

A264. 1st episode - awakened from sleep; sudden onset of joint pain; podagra; usually 1st MTP joint, knee, ankle, DIP & PIP; joint – erythematous, swollen, tender; as becomes chronic - multiple joints involved; urate crystals deposited in connective tissue (tophi), kidneys

Front 441

Q265. Gout - Dx

Back 441

A265. Joint-fluid aspirate - needle-shaped, negative birefringent crystals; yeLLow when paraLLel to condenser; increased WBC; advanced - "rat bite" = punched-out erosions - of long- standing tophus, "overhanging margin"

Front 442

Q266. Gout - Tx

Back 442

A266. Acute - decrease inflammation; NSAIDs (indomethacin); IV colchicine or steroids - if elderly maintenance - decrease uric acid level:; probenecid if underexcrete, inhibits reabsorb of uric acid; allopurinol if overproduce or have RF or have kidney stones, can precipitate acute attack

Front 443

Q267. Osteoarthritis - What is it; Risk Factors

Back 443

A267. Degen joint disease; deterioration of articular cartilage of moveable, weight- bearing joints; MCC- idiopathic; secondary - any diseases that causes stress or trauma to joint; knee OA - MCC of chronic disability in elderly in West; risk factors – obesity, family History, history of joint trauma; especially intra-articular fractures, repetitive stress

Front 444

Q268. Osteoarthritis - History/PE

Back 444

A268. History - joint stiffness - insidious onset; pain - insidious onset; worse by activity & weight-bearing; relieved by rest; crepitus; decreased ROM; PE - weight-bearing joint involved; DIP - heberden nodes; PIP - bouchard nodes; MTP joint of 1st toe; cervical spine

Front 445

Q269. Osteoarthritis - Dx

Back 445

A269. Based on clinical & XR; XR - irregular joint space narrowing, osteophytes, subchondral sclerosis, subchondral bone cysts; ESR normal; synovial fluid aspiration - straw-colored fluid, normal viscosity, WBC < 3000

Front 446

Q270. Osteoarthritis - Tx

Back 446

A270. Weight reduction; physical therapy; NSAIDs; intra-articular corticosteroid injections; elective joint replacement - total hip/knee arthroplasty

Front 447

Q271. Duchenne Muscular Dystrophy - What is it; What is Becker's

Back 447

A271. XLR; defect of dystrophin - cytoskeletal protein; MC muscular dystrophy; most lethal; ages 2-6; Becker – milder, XLR, abnormal-sized dystrophin

Front 448

Q272. Duchenne Muscular Dystrophy - History/PE

Back 448

A272. History - axial and proximal before distal muscles; progressive clumsiness; fatigability; hard to stand or walk; hard to walk on toes; waddling gait; Gower's maneuver; PE - pseudohypertrophy of gastrocnemius; possible MR

Front 449

Q273. Duchenne Muscular Dystrophy - Dx

Back 449

A273. CK - always high; EMG; muscle Biopsy; DNA; diagnostic - immunostain for dystrophin

Front 450

Q274. Duchenne Muscular Dystrophy - Tx

Back 450

A274. No cure; Tx supportive; physical therapy; achilles tendon release; wheelchair by 13 y/o; death in 20s

Front 451

Q275. what is the defect in Bruton's agammaglobulinemia?

Back 451

A275. X-linked recessive defect in a tyrosine kinase gene associated with low levels of all classes of Igs

Front 452

Q276. this disorder occurs in boys and is associated with recurrent bacterial infections after 6 months of age, when levels of maternal IgG antibody decline

Back 452

A276. Brutons agammaglobulinemia (B cells)

Front 453

Q277. this immune deficiency presents with tetany owing to hypocalcemia and recurrent viral and fungal infections

Back 453

A277. DiGeorge syndrome/thymic aplasia (T cells)

Front 454

Q278. this immune deficiency is associated with congenital defects of heart and great vessels

Back 454

A278. DiGeorge syndrome

Front 455

Q279. what ist eh chromosomal abnormality associated with DiGeorge syndrome?

Back 455

A279. 22q11 deletion

Front 456

Q280. this is a defect in early stem cell differentiation and presents with recurrent viral, bacterial, fungal, and protozoal infections

Back 456

A280. SCID - B and T cell deficiency

Front 457

Q281. failure to synthesize MHC II antigens, defective IL-2 receptors, and adenosine deaminase deficiency can all lead to what immune deficiency?

Back 457

A281. SCID

Front 458

Q282. what does IL-12 receptor deficiency (decreased activation of T cells) present with?

Back 458

A282. disseminated mycobacterial infections

Front 459

Q283. defect in CD40 ligand on CD4 T helper cells leads to inability to class switch; presents early in life with severe pyogenic infections

Back 459

A283. hyper-IgM syndrome (decreased activation of B cells)

Front 460

Q284. this disorder is characterized by high levels of IgM and very low levels of IgG, IgA, and IgE

Back 460

A284. hyper-IgM syndrome

Front 461

Q285. this syndrome is characterized by an X-linked defect in the ability to mount an IgM response to capsular polysaccharides of bacteria

Back 461

A285. Wiskott-Aldrich syndrome (decreased activation of B cells)

Front 462

Q286. what is the triad of symptoms associated with Wiskott- Aldrich syndrome?

Back 462

A286. infections, thrombocytopenic purpura, eczema (WIPE)

Front 463

Q287. this syndrome is associated with elevated IgA levels, normal IgE levels, and low IgM levels

Back 463

A287. Wiskott-Aldrich syndrome

Front 464

Q288. this syndrome presents with recurrent 'cold' (noninflamed) staphylococcal abscesses, eczema, coarse facies, retained primary teeth, and high IgE levels

Back 464

A288. Job's syndrome (decreased activation of macrophages)

Front 465

Q289. this syndrome is characterized by failure of gamma- interferon production by helper T cells; neutrophils fail to respond to chemotactic stimuli

Back 465

A289. JOb's syndrome

Front 466

Q290. what is the defect in leukocyte adhesion deficiency syndrome?

Back 466

A290. defect in LFA-1 adhesion proteins on phagocytes

Front 467

Q291. this syndrome presents early with severe pyogenic and fungal infections and delayed separation of umbilicus

Back 467

A291. leukocyte adhesion deficiency syndrome

Front 468

Q292. how is Chediak-Higashi inherited?

Back 468

A292. autosomal recessive

Front 469

Q293. this disease is marked by a defect in microtubular function and lysosomal emptying of phagocytic cells

Back 469

A293. Chediak-Higashi disease

Front 470

Q294. this disease presents with recurrent pyogenic infections by staph and strep, partial albinism, and peripheral neuropathy

Back 470

A294. Chediak-Higashi disease

Front 471

Q295. defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity or similar enzymes

Back 471

A295. chronic granulomatous disease

Front 472

Q296. how is the diagnosis of chronic granulomatous disease confirmed?

Back 472

A296. negative nitroblue tetrazolium dye reduction test

Front 473

Q297. this disease presents with marked susceptibility to opportunistic infections with bacteria, especially S. aureus, E. coli, and Aspergillus

Back 473

A297. chronic granulomatous disease

Front 474

Q298. what is the defect in chronic mucocutaneous candidiasis present?

Back 474

A298. idiopathic dysfunction of T cells specifically against candida albicans

Front 475

Q299. what is the most comon selective immunoglobulin deficiency? how does it present?

Back 475

A299. selective IgA deficiency - presents with sinus and lung infections;; milk allergies and diarrhea are common

Front 476

Q300. ataxia-telangiectasia is an idiopathic dysfunction of what type of cells?

Back 476

A300. B cells

Front 477

Q301. defect in DNA repair enzymes with associated IgA deficiency; presents with cerebellar problems and spider angiomas

Back 477

A301. ataxia-telangiectasia

Front 478

Q302. deficiency of what leads to hereditary angioedema?

Back 478

A302. C1 esterase inhibitor

Front 479

Q303. deficiency of which complement protein leads to severe, recurrent, pyogenic sinus and RT infections?

Back 479

A303. C3

Front 480

Q304. deficiency of what complement proteins leads to Neisseria bacteremia?

Back 480

A304. C6-C8

Front 481

Q305. deficiency of what leads to paroxysmal nocturnal hemoglobinuria?

Back 481

A305. decay-accelerating factor

Front 482

Q306. patients with what deficiency have an increased susceptibility to recurrent bacterial infections, especially with encapsulated bacteria

Back 482

A306. C3 deficiency;; not detected until later in life

Front 483

Q307. what is the most important immunological protective mechanism against blood-borne encapsulated organisms?

Back 483

A307. IgG-mediated opsonization in the spleen

Front 484

Q308. Warthin-Finkeldy giant cell is pathognomonic for what?

Back 484

A308. measles or the live attenuated measles vaccine

Front 485

Q309. Lyme arthritis is associated with what HLA?

Back 485

A309. HLA-DR4

Front 486

Q310. patients with Wiskott-Aldrich syndrome have a 12% chance of developing what?

Back 486

A310. non-Hodgkin's lymphoma

Front 487

Q311. test of choice to determine presence of circulating anti-Rh antibody?

Back 487

A311. indirect Coombs test to measure IgG anti-Rh antibody

Front 488

Q312. low levels of all antibody classes

Back 488

A312. common variable immunodeficiency

Front 489

Q313. spleen is important for removing what type of organisms? list 3

Back 489

A313. strep pneumo,; H. flu,; Neisseria

Front 490

Q314. what is defective in leukocyte adhesion deficiency?

Back 490

A314. integrins - function both in adhesion of leukocytes to other cells and in the phagocytosis of complement-coated material

Front 491

Q315. HLA types associated with SLE?

Back 491

A315. HLA-DR2 and HLA-DR3

Front 492

Q316. most likely sequelae of rheumatic fever?

Back 492

A316. mitral valve disease

Front 493

Q317. antitopoisomerase antibodies?

Back 493

A317. scleroderma/systemic fibrosis - likely to develop diffuse systemic fibrosis & death from consequences of systemic disease such as pulmonary fibrosis or malignant hypertension

Front 494

Q318. what is responsible for strong binding between monocytes, T lymphocytes, macrophages, neutrophils, and dendritic cells, and injured epithelium?

Back 494

A318. LFA-1; interacts with ICAM-1

Front 495

Q319. an increased level of what cytokine would decrease the likelihood of a delayed-type hypersensitivity reaction?

Back 495

A319. IL-10

Front 496

Q320. what 2 molecules exert the most powerful chemotactic effect on neutrophils?

Back 496

A320. C5a and C8

Front 497

Q321. what are the best markers for identification of B cells?

Back 497

A321. CD19, CD20, CD21

Front 498

Q322. IgG subclass deficiency is associated with a deficiency with what other substrate?

Back 498

A322. IgA

Front 499

Q323. what is C-reactive protein a marker of?

Back 499

A323. non-specific inflammation - one of the most commonly measured acute-phase reactants

Front 500

"stuck-on" appearance

Back 500

seborrheic keratosis

Front 501

red plaques with silvery-white scales and sharp margins

Back 501

psoriasis

Front 502

the most common type of skin cancer; the lesion is a pearly-coated papule with a translucent surface and teleangiectasias

Back 502

basal cell carcinoma

Front 503

honey-crusted lesions

Back 503

impetigo

Front 504

febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity

Back 504

cellulitis

Front 505

positive Nikolskys sign

Back 505

pemphigus vulgaris

Front 506

negative Nikolskys sign

Back 506

bullous pephigoid

Front 507

a 55 year old obese patient presents with dirty, velvety patches on the back of the neck

Back 507

acanthosis nigricans --> check fasting blood sugar to rule out diabetes

Front 508

dermatomal distribution

Back 508

varicella zoster

Front 509

flat-topped papules

Back 509

lichen planus

Front 510

iris-like target lesions

Back 510

erythema multiforme

Front 511

a lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry

Back 511

contact dermatitis

Front 512

presents with a herald patch, Christmas-tree like pattern

Back 512

pityriasis rosea

Front 513

a 16 year old presents with an annular patch of alopecia with broken-off, stubby hairs

Back 513

alopecia areata (autoimmune process)

Front 514

pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti-and-meatballs" appearance

Back 514

pityriasis versicolor

Front 515

four characteristics of a nevus suggestive of melanoma

Back 515

asymmetry, border irregularity, color variation, large diameter

Front 516

premalignant lesion fro sun exposure that can lead to squamous cell carcinoma

Back 516

actinic keratosis

Front 517

"dew-drop on a rose petal"

Back 517

lesions of 1st degree varicella

Front 518

"cradle cap"

Back 518

seborrheic dermatitis; treat with antifungals

Front 519

associated with propionbacterium acnes and changes in androgen levels

Back 519

acne vulgaris

Front 520

a painful, recurrent, vesicular eruption of mucocutaneous surfaces

Back 520

herpes simplex

Front 521

inflammatoin and epithelial thinning of anogenital area, predominantly in postmenopausal women

Back 521

lichen sclerosis

Front 522

exophytic nodules on the skin with varying degrees of scaling ulceration; the second most common type of skin cancer

Back 522

squamous cell carcinoma

Front 523

what vitamin do you supplement for a measles infection?

Back 523

vitamin A

Front 524

normal skin at birth that gradually progresses to dry, scaley skin = ??

Back 524

ichthyosis vulgaris, aka lizard skin

Front 525

dry, rough skin over extensor surfaces + horny plates = ??

Back 525

ichthyosis

Front 526

what vitamin supplement should be give for measles?

Back 526

vitamin A

Front 527

normal birth at skin that gradually progresses to dry, scaley skin = ??

Back 527

ichythyosis vulgaris, aka lizard skin

Front 528

dry, rough skin over extensor surfaces + horny plates = ??

Back 528

ichthyosis

Front 529

virus that causes measles

Back 529

paramyxovirus

Front 530

name of red spots with bluish specks over buccal mucosa and what disease it is associated with?

Back 530

Koblik spots, measles

Front 531

cough + coryza + conjunctivitis = ??

Back 531

measles

Front 532

well-circumscribed areas of depigmentation over arms/legs

Back 532

vitiligo

Front 533

autoimmune disease that attacks melanocytes and is associated with other AI diseases?

Back 533

vitiligo

Front 534

most common metal causing contact dermatitis

Back 534

nickel

Front 535

how do you rule out melanoma?

Back 535

excisional biopsy

Front 536

if a melanoma is >1mm deep what else must you do besides excise it?

Back 536

sentinal lymph node study

Front 537

poison ivy is what type of hypersensitivity exposure and what causes it? does it require prior exposure?

Back 537

type IV hypersensitivity, cell-mediated which means you need prior exposure

Front 538

what causes molluscum contagiosum?

Back 538

pox virus

Front 539

best method for photo-protection (avoiding sun burn)

Back 539

sun avoidance

Front 540

numerous umbilicated vesicles over healing atopic dermatitis = ??

Back 540

eczema herpeticm

Front 541

name the SIRS criteria

Back 541

1. fever/hypothermia2. tachypnea3. tachycardia4. leukocytosis, leukopenia or bandemia

Front 542

what is the normal course for impetigo?

Back 542

erythmatous macule --> vesicle --> pustule --> honey-colored, crusted exudates

Front 543

what causes hereditary angioedema?

Back 543

C-1 inhibitor deficiency

Front 544

what virus causes rubella?

Back 544

RNA togovirus

Front 545

what is the chronology for rubella?

Back 545

1. exposure2. fever, malaise3. suboccipital adenitis4. maculopapular rash on face then trunk and extremities

Front 546

treatment for tinea corporis

Back 546

terbinafine

Front 547

most common viral infection of hand

Back 547

herpetic whitlow; common in healthcare workers

Front 548

most common cause of acquired angioedema

Back 548

ACEI use

Front 549

what dermatological disorder is commonly seen with Parkinsons?

Back 549

seborrheic dermatitis

Front 550

which types of hypersensitivity are anti-body mediated?

Back 550

types I, II, III

Front 551

name the different types of hypersensitivity?

Back 551

type I - anaphylactic, atopictype II - cytotoxictype III - immune complex, serum sickness, arthus reactiontype IV - delayed, cell-mediated

Front 552

polygonal + purples + pruritic + papules = ??

Back 552

lichen planus

Front 553

what type of hypersensitivity is psoraisis?

Back 553

T-cell mediated

Front 554

yellow, greasy, erythematous scaling patches/plaques = ??

Back 554

seborrheic dermatitis

Front 555

young person with severe seborrheic dermatitis --> what must you rule out?

Back 555

HIV

Front 556

what BSA defines Stevens-Johnsons and what is the treatment?

Back 556

<10% BSA, treat with analgesia and IVIG

Front 557

what skin disorder is commonly associated with other autoimmune disorders?

Back 557

vitiligo

Front 558

what is the most common cause of cellulitis and what is the treatment of choice?

Back 558

staph, treat with keflex

Front 559

what causes hot tub folliculitis?

Back 559

pseudomonas aeruginosa

Front 560

what is a kerion?

Back 560

inflammatory granulomatous reaction in children to tinea capitus

Front 561

bullseye rash

Back 561

Lyme disease

Front 562

treatment for lice

Back 562

permethrin shampoo

Front 563

dome-shaped with central umbilication

Back 563

molluscum contagiosum

Front 564

christmas-tree pattern with herald patch

Back 564

pityriasis rosea (HHV-6)

Front 565

what causes cervical CA?

Back 565

usually HPV 16, 18, 31, 33

Front 566

Shagreen patches with ashleaf spots

Back 566

tuberous sclerosis

Front 567

cafe-au-lait spots

Back 567

neurofibromatosis

Front 568

hemangioma/port-wine stain on face

Back 568

Sturge-Weber syndrome

Front 569

what are hemangiomas often indicative of?

Back 569

von Hippel-Lindau disease

Front 570

what is the sign of Leser-Trelat?

Back 570

multiple seborrheic keratoses erupting at once associated with underlying malignancy, often gastric cancer

Front 571

most common skin CA associated with sun exposure

Back 571

basal cell CA

Front 572

ABCD of melanoma

Back 572

Asymmetric shapeBorders irregularColor variationDiameter >6mm

Front 573

what are strawberry hemangiomas and what do they indicate?

Back 573

they are benign vascular tumors of children that usually regress on their own at 5-8 years old

Front 574

what rash on the body does not appear scaly but will scale with scraping?

Back 574

tinea versicolor

Front 575

rosey-hue with teleangiectasias over cheeks, nose, chin

Back 575

rosacea

Front 576

treatment for moderate to severe acne, predominantly nodulocystic and firm

Back 576

oral isotretinoin

Front 577

what nail problems is psoriasis associated with?

Back 577

onycholysis and nail pitting

Front 578

what is erysipelis? what bacteria commonly causes it?

Back 578

commonly seen in patients with impaired lymph drainage who develop a rash that looks like "orange peels"; caused by strep pyogenes

Front 579

what are strong risks for a mole that is maligant?

Back 579

changes in size/shape/color/borders

Front 580

what anesthestic is used for suturing vessel-rich areas?

Back 580

1% lido with 1:100,000-1:400:000 epi

Front 581

what rash do you need to look for with warfarin?

Back 581

look for warfarin-induced necrosis that can occur within 1 week of beginning warfarin therapy; well-demarcated erythematous lesion that progresses to necrosis

Front 582

what is bullous pemphigoid? what do you see on immunoflorescence?

Back 582

it is an autoimmune bullous disorder in patients over 60 that present with wide-spread blistering over flexor and perianal surfaces; immunoflorescence will show epidermal basement membrane antibodies

Front 583

what is the most important factor in determining the resectable margins with a melanoma?

Back 583

depth of the tumor

Front 584

what is the most effective means to prevent death from melanoma?

Back 584

early clinical detection

Front 585

what is the most preventable risk factor for developing melanoma?

Back 585

chronic sun exposure

Front 586

what condition presents as a macular scaling behind the ears, on the scalp, eyebrow, nasal-labial folds? who commonly gets it?

Back 586

serborrheic dermatitis; common with patients that have neurological disorders or HIV

Front 587

what presents with erythematous plaques with silvery-white scales on the extensor surfaces?

Back 587

psoriasis

Front 588

what solution should be given during the first 24 hours following a burn injury?

Back 588

lactated ringers

Front 589

what is pemphis vulgaris? what do you see on immunoflorescence?

Back 589

it is an autoimmune disease of the skin that presents with painful, fragile blisters of the oropharynx, chest, face and perianal regions; look for antibodies to adhesion desmoglein molecules

Front 590

this disease results from a deficiency of hepatic uroporphyinogen decarboxylase and presents with chronic blistering of sun exposed regions and skin hyperpigmentation? who is it associated with?

Back 590

porphyria cutanea tarda; seen with alcoholics and hepatitis

Front 591

this disease presents with vesicular lesions and crusting erythematous plaques over the genital region, chest, neck and axilla with an malodorous discharge

Back 591

familial benign pemphigus

Front 592

what is Groves disease?

Back 592

it is a transient acantholytic dermatosis in men >50; appears as small red papules on back/chest

Front 593

Where does atopic dermatitis present in infants?

Back 593

Face, scalp, extensor surfaces. Diaper area is spared

Front 594

What is the treatment for atopic dermatitis?

Back 594

Topical steroids- but not longer than 2-3 weeks

Front 595

How does seborrheic dermatitis present in an infant?

Back 595

Red diaper rash with yellow scale, erosions, and blisters. A thick crust may be seen on the scalp.

Front 596

What kind of people can develop severe seborrheic dermatitis?

Back 596

HIV and Parkinson's patients

Front 597

How do you treat seborrheic dermatitis?

Back 597

Selenium sulfide or zinc pyrithione shampoos for the scalp; Topical antifungals or steroids for other areas in adults

Front 598

When does a drug eruption occur?

Back 598

7-14 days after exposure

Front 599

What is erythema multiforme?

Back 599

Targetoid lesions that can be on the palms and soles and associated with systemic symptoms. Can lead to TEN or SJS

Front 600

What is erythema nodosum?

Back 600

Panniculitis that can be triggered by infection (STREP, histo, cocci, yersinia, TB), drug reactions (sulfonamides, OCPs, abx), and chronic inflammatory disease (IBD, sarcoidosis, Behcet's)

Front 601

How does erythema nodosum present?

Back 601

Painful, erythematous nodules on the lower legs. Patients may have a false positive VDRL

Front 602

What is bullous pemphigoid?

Back 602

Antibodies to the BMZ that presents as firm, tense, stable blisters with NO Nikolsky sign or mucosal involvement. Linear immunofluorescence pattern. Treated by steroids

Front 603

What is pemphigus vulgaris?

Back 603

Antibodies to desmoglein (keratinocyte adhesion), lace-like/fishnet immunofluorescence, flaccid bullae, POSITIVE Nikolsky sign, common mucosal involvement (starts in mouth), treated by high-dose steroids + IVIG

Front 604

What are triggers for pemphigus vulgaris?

Back 604

ACEIs, penacillamine, phenobarbital, penicillin

Front 605

What is erysipelas?

Back 605

Starts out as a small red patch on the cheek or extremities that turns into a painful shiny red plaque. patients often have a history of cutaneous ulcers, pharyngitis, or lymphedema

Front 606

What does scarlet fever look like?

Back 606

Sunburn with goosebumps

Front 607

What does the rash of Salmonella typhi look like?

Back 607

Small pink papules on the trunk (rose spots) in groups of 10-20 plus fever and GI involvement. Treat with Rocephin and possible cholecystectomy for chronic carrier state

Front 608

What is Ludwig's angina?

Back 608

Bilateral cellulitis of the submental, submaxillary, and sublingual spaces from an infected tooth

Front 609

How does necrotizing fasciitis present?

Back 609

Sudden onset of pain and swelling at the site of trauma or recent surgery. Erythema spreads quickly over the course of hours to days and the skin becomes dusky and purplish. There is undermining of the skin and subcutaneous layer, bullae, gas production

Front 610

How is necrotizing fasciitis treated?

Back 610

Early and aggressive surgical debridement followed by Pen G + Flagyl or Rocephin

Front 611

What monthly blood tests do patients on isotretinoin require?

Back 611

LFTs, TGs, cholesterol, and B-hCGs

Front 612

What is tinea versicolor?

Back 612

Small, scaly patches of varying color on the chest or back that are hypopigmented. Treat with ketoconazole or selenium sulfide

Front 613

How does gas gangrene present?

Back 613

Around a site of recent injury or surgery. Swelling around the injury with skin that turns pale and then dark red

Front 614

How can gas gangrene be treated?

Back 614

Hyperbaric oxygen, surgical debridement, abx

Front 615

What does lichen planus look like?

Back 615

Violaceous, flat-topped, polygonal papules with prominent Koebner's phenomena (lesions at the site of trauma) with a shiny surface with fine white lines (Wickham's striae). Tx with steroids

Front 616

How do you treat rosacea?

Back 616

Flagyl

Front 617

What needs to be ruled out when pityriasis rosea is suspected?

Back 617

Fungal infection (KOH stain)Syphilis (RPR)

Front 618

How is melanoma treated?

Back 618

Lesions confined to the skin are treated by excision with margins

Front 619

What is tinea capitis?

Back 619

Infection of the scalp; mainly affects children with scaly patches of hair loss and possible inflamed, boggy granuloma of the scalp. REQURES SYSTEMIC Antifungals

Front 620

What infection can cause erythema multiforme?

Back 620

Herpes

Front 621

What is heratoacanthoma?

Back 621

Rapidly growing (grows to full size in 1-2 months) flesh-colored lesion with a central crater that contains keratinous material, usually on the face. Spontaneously involutes but observe in those with a history of it

Front 622

What's the derm term for:Flat spot <1cm (non-palpable, just visible)

Back 622

Maculeexamples: Freckles, tattoos

Front 623

What are some of the distinguishing characteristics of necrotizing fasciitis?

Back 623

Unexplained, excruciating pain in the absence of or beyond areas of cellulitisErythema with blister and bullae formation & possible crepitusDM patient with foot cellulitis and signs of systemic toxicityPerineal cellulitis with abrupt onset & rapid spread (Fournier’s gangrene)

Front 624

What is the treatment for a limb with dry gangrene?

Back 624

Autoamputation over time Angiography to evaluate the extent & location of peripheral artery disease → distal bypass of stenotic areas → if circulation improves & healing is adequate, then amputation of the affected region

Front 625

What is the treatment for wet gangrene infection?

Back 625

Emergency debridement or guillotine amputation of the infected portion of the foot then revision to a below or above the knee amputation 72 hours later (antibiotics are indicated if cellulitis or gas gangrene is present)