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Pg1,2 screening vaccination
Study
PCV vaccines
PCV 13: less than 18; PCV 15: if older than 65 or immunocompromised and 19-64; if you got PCV 15 then you need to follow with PCV 23 after 1 year; PCV 20 for anyone over 65 or under 65 and immunocomp/asplenia/chronic renal failure/asthma/smoker (and no need for a subsequent vaccine)
HPV vaccination
All adolescents, regardless of sexual orientation, should receive HPV vaccination before the onset of sexual activity. It is a 2-dose regimen 6 months apart for patients 9-14 years old and a 3-dose 0, 2, and 6 months regimen for patients 15-26 years old.
PCV 13 indicated for
Pneumococcal Conjugate Vaccine 13 (PCV13) is indicated for patients up to 18 years of age.
Hib Vaccine recommendation
Recommended for children under 5 years and for patients with sickle cell disease, asplenia, or history of bone marrow transplantation, and for patients ages 5-18
Intimate Partner Violence (IPV) screening recommendation for all women of reproductive age
All women of reproductive age should be screened for IPV
When to start giving influenza vaccine
Influenza Vaccine is recommended for all individuals 6 months of age at the start of the flu season.
What are the screening recommendations for diabetes mellitus (DM)?
Screening for diabetes mellitus (DM) should be done on individuals 35-70 years of age who are overweight, with fasting blood glucose, HbA1c, or oral glucose tolerance test. Individuals 35 years of age with either overweight or obesity and at least one additional risk factor for T2DM (first-degree family history, certain race or ethnicity, hypertension).
Who should undergo a low-dose CT scan of the chest for lung cancer screening?
Low-dose CT scan of the chest is indicated for lung cancer screening in adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
Meningococcal ACWY Vaccine recommendation
Recommended for children at 11-12 and 16 years of age, as well as for individuals at risk for meningococcal infections
Dual-energy x-ray absorptiometry screening recommendation for osteoporosis
Women over the age of 65, or those under 65 at increased risk of osteoporosis, should undergo screening
Who gets shingles vaccine
The Shingles Vaccine is recommended for all immunocompetent individuals 50 years of age and for immunocompromised individuals 19 years. It is administered in two doses 2 to 6 months apart.
Cervical cancer screening recommendation for women over 30 years of age
Undergo pap smear every 5 years
At what age is the Shingles Vaccine recommended for immunocompromised individuals?
19 years and older
Osteoporosis risk fx
Individuals under 65 who are at increased risk of osteoporosis are female, of advanced age, excessively consume alcohol, smoke, and have a low BMI.
At what age is the 3-dose HPV regimen administered for patients?
15-26 years old
What are the guidelines for mammogram breast cancer screening in women?
Mammogram breast cancer screening: Every 1-2 years in women over age 40.
Mammogram Breast Cancer Screening recommendation for women over age 40 with no family history of breast cancer
Undergo mammogram screening every 1-2 years
At what age is the Shingles Vaccine recommended for all immunocompetent individuals?
50 years of age
At what age is the 2-dose regimen administered for patients before onset of sexual activity?
9-14 years old
Risk factors for IPV screening
Risk factors include the postpartum period, pregnancy, low SES, and a history of abuse
What are the screening recommendations for PSA in men?
Men PSA Screening: Shared decision making for men 55-69 years of age. Men 65-75 years of age who are current or former smokers should receive a one-time screening with ultrasonography for an abdominal aortic aneurysm (AAA).
Who gets Hib
Hib Vaccine is recommended for children under 5 years, patients with sickle cell disease, asplenia, or a history of bone marrow transplantation, and patients ages 5-18 with HIV.
What are the USPSTF guidelines for colorectal cancer screening in asymptomatic adults?
Screening in all asymptomatic adults between 45 and 75 years of age. 1 colonoscopy every 10 years for general population, every 5 years in patients with a first-degree relative with a history of colorectal cancer.
How many doses is the recombinant vaccine administered in for shingles?
Two doses
Urine culture screening recommendation for pregnant individuals
Recommended for screening of asymptomatic bacteriuria in pregnant individuals
Cervical cancer screening recommendation for women between 21 and 30 years of age
Undergo pap smear every 3 years
3,4 vaccine smoking cess HTN
Study
What is the recommended interval for hypertension screening in healthy people aged 18-39 years?
Every 3-5 years.
How often is a tetanus booster required?
Every 10 years.
What do ACE Inhibitors block?
Conversion of Angiotensin I to Angiotensin II.
What are the most common side effects of ACE Inhibitors?
Dry cough, angioedema, and hyperkalemia.
What does Angiotensin Receptor Blocker (ARB) block?
AT1 receptor, decreasing the binding of Angiotensin II.
What are the first-line treatment options for patients with hypertension and no other comorbidities?
Thiazide diuretics, ACEs, ARBs, and calcium channel blockers.
Which type of diuretics is recommended as a first-line treatment for patients with hypertension and no other comorbidities?
Thiazide diuretics
What has been shown to reduce systolic blood pressure by about 11 mm Hg and also shown to reduce levels of LDL cholesterol?
DASH diet.
How often should hypertension diagnosis screening be performed in adults aged 40 years and those at increased risk?
Every 1 year
What patients should avoid using bupropion for smoking cessation?
Patients with predisposing conditions that increase the risk of seizures, such as seizure disorder, anorexia or bulimia nervosa, alcohol withdrawal, and abrupt discontinuation of benzodiazepines.
5,6 htn drugs, hld, statin
Study
What are the indications for statin therapy?
40-75 y/o AND with T2DM, 10-year ASCVD risk of 7.5% (or clinical risk fx of smoking or HTN o, OR an LDL of 190 mg/dL.
What are the common side effects of Calcium Channel Blockers?
Peripheral edema, headaches, dizziness, facial flushing, reflex tachycardia.
What # LDL for starting statin therrapy?
An LDL of 190 mg/dL
Where do Calcium Channel Blockers cause vasodilation predominantly?
In the precapillary vessels.
What is the indication for low-dose aspirin therapy?
Patients 40-59 with a 10-year ASCVD risk of 10 and a low risk of bleeding
What is the leading cause of death in men in the US?
Coronary heart disease.
What is the preferred first-line treatment for isolated hypertension in African American patients?
Thiazide diuretics, specifically clorthalidone.
What is the clinical presentation of statin-associated myopathy?
Generalized symmetric weakness of proximal muscles and elevated serum creatinine kinase activity
What are the most common side effects of Thiazide Diuretics?
Orthostatic hypotension, hypokalemia, hyponatremia, hypercalcemia, hyperglycemia, and hyperlipidemia.
What is the treatment for statin-associated myopathy?
Discontinue statin patient is currently on and begin treatment with low-dose pravastatin or fluvastatin
What are the first-line agents for high-intensity statin therapy?
Atorvastatin and Rosuvastatin.
What are the subsequent treatment options if treatment goals are not met with high-intensity statin therapy?
Ezetimibe, PCSK9 inhibitors (e.g. evolocumab or alirocumab), Bile acid sequestrants (e.g. colesevelam)
7,8 diabetes
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What are the risk factors for Type II Diabetes?
High-calorie diet, sedentary lifestyle, obesity, positive family history, race/ethnicity, dyslipidemia, metabolic syndrome
How does obesity increase the risk of Type II Diabetes?
Obesity increases the risk of T2DM by intensifying peripheral insulin resistance, inhibiting glucose uptake from the bloodstream, and impairing anabolic metabolism
What is the relationship between increased abdominal fat and insulin resistance in Type II Diabetes?
Increased abdominal and visceral fat is associated with increased lipolytic activity and increased levels of serum free fatty acids. Increased levels of fatty acids induce insulin resistance by decreasing peripheral insulin-mediated glucose uptake
What is the earliest diagnostic sign of diabetic nephropathy?
Microalbuminuria is the earliest diagnostic sign of diabetic nephropathy
What are the manifestations of diabetic nephropathy as it progresses?
Progression of glomerular damage leads to increased urinary loss of albumin, which can manifest as nephrotic syndrome. Laboratory values show elevated creatinine and BUN levels, arterial hypertension, and electrolyte abnormalities
What lab values are usually normal in the early stages of diabetic nephropathy?
Creatinine and BUN levels are usually normal in the early stages of diabetic nephropathy and only rise once glomerular filtration rate significantly deteriorates
What is the recommended treatment for diabetes that can cause weight loss and control hyperglycemia with less risk of medication-induced hypoglycemia?
Glucagon-like peptide-1 (GLP-1) receptor agonists (incretin mimetic drugs) such as exenatide. Metformin is also recommended as it reduces liver production of glucose, increases insulin sensitivity, and induces weight loss
What class of drugs are recommended in patients with Type II Diabetes and Diabetic Kidney Disease (DKD) regardless of HbA1c as they slow the progression of renal disease?
Sodium-glucose cotransporter 2 (SGLT2) inhibitors such as canagliflozin and dapagliflozin (flozins)
What are the usual Creatinine and BUN levels in early stages of diabetic nephropathy?
Normal
What rises once glomerular filtration rate significantly deteriorates in diabetic nephropathy?
Creatinine
Name the treatment for diabetes that reduces liver production of glucose, increases insulin sensitivity, and induces weight loss.
Metformin
What class of drugs is recommended in patients with T2DM and DKD, regardless of HbA1c, as they slow progression of renal disease?
Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors)
What is the effect of GLP1 receptor agonists in the treatment of diabetes?
They can cause weight loss and control hyperglycemia
Which medication is contraindicated in patients with recurrent urinary tract infections due to its glycosuric effect?
SGLT2 inhibitors
9,10 sore throat, resp
Study
when is it likely viral tonsilopharyngitis
cough, no fever, coryza, conjunctivitis
When should you throat culture after a negative rapid strep?
When less than 3 or adolescent
What are features of bacterial tonsilitis?
exudates, fever, no cough, lymphadenitis
What does spirometry show in the diagnosis of asthma?
Obstructive lung pattern, decreased FEV1, decreased A FEV1FVC ratio that reverses with bronchodilation
Gold standard for diagnosing bacterial tonsillitis
Throat culture
What is the clinical presentation of asthma?
Episodic dyspnea, nonproductive coughing, and wheezing that worsens during exertion and at night
11,12 asthma bronch copd
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Chronic Obstructive Pulmonary Disease (COPD) Clinical Features
Dyspnea, productive cough, decreased FEV1, decreased FEV1/FVC ratio, increased total lung capacity. Airway obstruction is primarily caused by long-term smoking. Smoking cessation is the single most important measure to slow the decline in lung function. Other treatment includes inhaled corticosteroids and bronchodilators, with the greatest impact on survival in COPD.
What has the greatest impact on survival in COPD?
Long-term oxygen therapy and smoking cessation.
What does spirometry show in patients with chronic bronchitis?
obstructuve lung pattern = decreased FEV1; decreased FEV1/FVC ratio)
What is an example of an empirical antibiotic therapy used for community-acquired pneumonia?
An example is amoxicillin.
Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) Clinical Presentation
Worsening of dyspnea, increased frequency and severity of cough, increased volume and/or purulence of sputum. May have distant heart sounds due to pulmonary hyperinflation.
What therapy is recommended for acute exacerbation of COPD?
Short course of systemic corticosteroids, nebulization of a short-acting B2 adrenergic agonist with or without a short-acting muscarinic antagonist bronchodilator, and supplemental oxygen. Empiric antibiotic therapy is indicated if the patient has 3 cardinal symptoms or requires mechanical ventilation.
Acute Bronchitis Clinical Presentation
Productive cough, sometimes chest pain, typically resolves within 2-3 weeks. Most common condition for which antibiotics are unnecessarily prescribed.
What is the preferred inhaled corticosteroid for pregnant women with asthma?
Budesonide
What is the symptom frequency for severe persistent asthma?
Daily throughout the day, waking up every night
What is the treatment for acute bronchitis?
Supportive, adequate hydration, and symptomatic relief; NO ABX
What is the treatment for acute exacerbations in moderate persistent asthma?
Systemic glucocorticoids (oral methylprednisolone)
How is acute bronchitis typically resolved without any specific treatment?
Within 2-3 weeks
Chronic Bronchitis Treatment
Lifestyle modifications (counseling on smoking cessation) and pharmacology (inhaled corticosteroids such as budesonide, fluticasone, or beclomethasone, which should be used in combination with long-acting bronchodilators).
What is the recommended treatment for AECOPD?
Short course of systemic corticosteroids for 4-7 days, nebulization of a short-acting B2 adrenergic agonist (e.g., albuterol) with or without a short-acting muscarinic antagonist bronchodilator (e.g., ipratropium), and supplemental oxygen. Empiric antibiotic therapy is indicated if the patient has 3 cardinal symptoms or requires mechanical ventilation.
What can be used for long-term management of mild persistent asthma but does not help with acute asthma attacks?
Oral Leukotriene-receptor antagonist (montelukast)
What is the main risk factor for chronic bronchitis?
Smoking
Glucocorticoids ex oral methylprednisolone
Used in acute bronchitis to provide symptomatic relief and supportive care. Can increase the risk of congenital malformation, preeclampsia, neonatal adrenal insufficiency, and low birth weight when used in pregnant women.
What is the symptom frequency for moderate persistent asthma?
Daily
13,14 emphysema general msk
Study
What are the clinical features of Emphysema?
dyspnea, productive cough, expiratory wheezing
What does decreased DLco in emphysema reflect?
The reduction of gas exchange due to a loss of diffusion area and destruction of alveolar walls
What are the risk factors for Emphysema?
smoking, air pollution, inhalation of chemical fumes and dust. Nonsmokers and individuals 50 years of age who present with COPD and emphysema should be tested for alpha1antitrypsin deficiency.
What are the clinical features of a1Antitrypsin Deficiency?
Characterized by early-onset emphysema and liver involvement (hepatitis, cirrhosis, hepatocellular carcinoma). Spirometry shows obstructive lung pattern (decreased FEV1, decreased FEV1/FVC ratio). X-Ray would show basilar emphysema. Liver disease due to intrahepatic accumulation of AAT would also be expected. Treatment: IV AAT replacement therapy in patients with severe deficiency.
What is the treatment for Acute Bacterial Rhinosinusitis?
Give Penicillin beta lactamase inhibitor. (Develops following an acute viral rhinosinusitis, usually caused by Strep Pneumo or H. influenzae).
What are the clinical presentations of Secondary Bacterial Infection in Acute Bacterial Rhinosinusitis?
Fever, facial pain, nasal congestion, bilateral purulent nasal discharge, and maxillary sinus tenderness that has persisted for greater than 10 days without improvement.
What is Reactive Arthritis and how does it develop?
It develops 1-4 weeks after a chlamydial infection and causes joint pain. The condition typically manifests with acute polyarthritis, asymmetric and migratory in nature.
What should be evaluated in Synovial Fluid Analysis for Reactive Arthritis?
Evaluate for septic arthritis and gout. Intraarticular pathology including erythema, joint effusion, and local warmth should be assessed.
What may provide modest symptomatic relief in patients with lumbrosacral radiculopathy that persists for 6 months?
Epidural Glucocorticoid Injection.
Secondary Bacterial Infection Clinical Presentation
Fever, facial pain, nasal congestion, bilateral purulent nasal discharge, and maxillary sinus tenderness that has persisted for greater than 10 days without improvement
General Reactive Arthritis
Develops 14 weeks after a chlamydial infection and causes joint pain. Condition typically manifests with acute polyarthritis, asymmetric and migratory in nature.
Synovial Fluid Analysis
Evaluate for septic arthritis and gout. May indicate intraarticular pathology, erythema, joint effusion, local warmth.
What muscle relaxants can be used for acute musculoskeletal lower back pain?
Cyclobenzaprine or tizanidine can be used alternatively or in conjunction with NSAIDs.
How long does it take for almost all cases of musculoskeletal lower back pain to resolve on their own?
Within 6 weeks.
What is recommended for long-term treatment and recovery phase of musculoskeletal lower back pain?
Physical therapy.
When should further testing (e.g., MRI) be considered for patients with lower back pain?
In patients whose symptoms have not improved after 6 weeks.
15,16 ankle
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Ankle X-rays indication
Pain in malleolar region AND eitherr Tenderrness over DISTAL malleolas OR inability to walak 4 steps both after injury and in ED
What does a positive Thompson's Test imply?
lack of motion with calf squeeze, indicates achilles teendon rupture
Foot X-rays indication
An indication for obtaining foot x-rays if there is pain in the midfoot region AND EITHER tendreness over baase of the 5th metatarsal or navicular bonee OR inability to bear weight after a foot injury.
Spurling's Maneuver
A clinical test for cervical radiculopathy in which the neck is extended and rotated to one side, then downward pressure is applied to the head, reproducing pain or other symptoms if there is nerve compression.
17,18 knee
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What is the recommended treatment for Patellofemoral Pain Syndrome in the recovery phase?
Physical therapy is recommended.
What is the treatment for Patellofemoral Pain Syndrome during the acute phase?
Pain control and rest, analgesia, and avoidance of pain-inducing activities.
What is the clinical presentation of Iliotibial Band Syndrome?
Knee pain over the lateral femoral epicondyle and a positive Noble Test.
What are the causes of Patellofemoral Pain Syndrome?
Caused by multiple factors including overuse and malalignment of the knee joint.
What is the clinical presentation of Patellofemoral Pain Syndrome?
Retropatellar or peripatellar pain that worsens with activity or after prolonged sitting. Sometimes with an audible popping sound after prolonged sitting or when ascending or descending stairs. often worsens with extension
What is Noble Test B for Illiotibial Band Syndrome?
Patient lies in a lateral position with the injured knee facing upward. Knee is passively flexed while exerting constant pressure on the lateral femoral epicondyle with the thum
19,20 knee shoulder
Study
What does the empty can test (Jobe test) assess in the shoulder?
Supraspinatus muscle
What is the clinical presentation of medial collateral ligament injury?
Tenderness on the medial joint line of the knee, positive valgus stress test
How is the Hawkins-Kennedy Test performed?
The examiner places the patient's arm in 90-degree anteversion and flexes the elbow to 90 degrees.
What is the clinical presentation of lateral collateral ligament injury?
Positive varus stress test
What is the clinical presentation of posterior cruciate ligament injury?
Posterior drawer sign
What is the clinical presentation of anterior cruciate ligament injury?
Anterior drawer sign
What is a positive result in the Hawkins-Kennedy Test?
Internal rotation is a nonspecific indication of subaacromial impingement syndrome.
What muscle and/or tendon manifests with pain triggered by overhead motion?
Supraspinatus tendon and/or muscle
What is the procedure for performing the Hawkins-Kennedy test?
Examiner places the patient's arm in 90° anteversion and flexes the elbow to 90°
How should a patient with injury to the supraspinatus tendon and/or muscle manifest pain?
Pain triggered by overhead motion.
What does Neer's test assess in the shoulder? How is it done?
The presence and degree of a rotator cuff impingement. Elevate the patient's internally rotated and outstretched arm with the simulations stabilization of the scapula. Pain upon eliciting this maneuver indicates narrowed subacromial space and impingement, particularly of the supraspinatus muscle and tendon
21,22 shoulder
Study
Liftoff Test
4. A test used to assess the function of the subscapularis muscle by having the patient lift their hand off their back.
Drop Arm Test
5. A test for assessing rotator cuff integrity, where the patient is unable to hold up their arm at 90 degrees of abduction.
Lidocaine Injection Test
1. A diagnostic test for evaluating patients with undifferentiated shoulder pain. Pain relief from injection suggests subacromial impingement (rotator cuff tendinoapthy, subacromaill bursitis) syndrome as opposed to glenohumerol joint pathology
Conservative Treatment for Subacromial Impingement Syndrome
1. First-line treatment with analgesia and physical therapy, followed by subacromial glucocorticoid injections if conservative measures fail.
Advanced Imaging for Suspected Rotator Cuff Tear
2. MRI should be obtained to rule out rotator cuff tear if the patient fails to improve with physical therapy and analgesics.
Clinical Presentation of Adhesive Capsulitis
1. Progressive unilateral shoulder pain and stiffness, often with a history of shoulder injury.
Initial Treatment for Adhesive Capsulitis
2. Movement restriction, NSAIDs, and physical therapy for shoulder range-of-motion exercises.
Risk Factors for Adhesive Capsulitis
3. Patients with previous shoulder injuries and/or surgeries, diabetes mellitus, and other systemic diseases are at increased risk.
Cause of Elbow Lateral Epicondylitis (Tennis Elbow) -> txt
1. Repetitive wrist extension and forearm pronation/supination. -> txt with NSAIDS and rest anad PT (conservative)
Aftere positive drop arm test aand suspcion of rotator cuff tear
Musculoskeletal ultrasound and/or MRI should be performed to confirm diagnosis.
Distal Biceps Tendon Rupture
abnroomal biceps squeeze test. Surgical repair is recommended, especially in patients who are younger, active, and/or who require rapid restoration of elbow function (e.g., athletes, manual laborers). Early intervention is crucial and should be carried out within 2-3 weeks to avoid complications such as contracture, nerve injury, and functional limitation.
Musculocutaneous Nerve Injury
Innervates the biceps brachii and can manifest with decreased flexion at the elbow. clinically loss of sensation of lateral arm. ---> conduction nerve study
23,24 pain opiod
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Why is Clonidine not recommended in pregnancy?
Due to its alpha adrenergic blockage effects, risks of hypotension, and fetal hypoperfusion
What is the treatment for opioid overdose?
Naloxone, a competitive opioid receptor antagonist with a rapid onset of action (2-3 minutes).
What is Methadone?
Methadone is a long-acting full opioid agonist that causes less euphoria than short-acting opioids, making it effective at controlling symptoms and minimizing craving in patients with opioid withdrawal. It also decreases the rate of relapse.
What is Buprenorphine-Naloxone?
Buprenorphine-Naloxone is a medication used for opioid dependence treatment. It is a combination of buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist, used to discourage misuse. used sublingually but when injected, naloxone takes effeeect.
What is the preferred medication for Opioid Use Disorder in pregnancy?
Buprenorphine
What are the clinical features of Basal Cell Carcinoma?
Slow-growing, nontender, pearly nodule with a rolled border and central ulceration. It is the most common malignant skin tumor and rarely metastasizes.
What is the recommended diagnosis for Basal Cell Carcinoma?
Undergo a full-thickness biopsy of the edge of the lesion to confirm the diagnosis.
What are the manifestations of opioid overdose?
Respiratory depression or distress, bradycardia, hypotension, lethargy or stupor, bilateral miosis (pinpoint pupils)
What is the medication effective at controlling symptoms and minimizing craving in patients with opioid withdrawal?
BuprenorphineNaloxone
What are the clinical presentations of opioid withdrawal?
GI symptoms (abdominal pain, nausea, vomiting, diarrhea), CNS stimulation (anxiety, sympathetic hyperactivity, mydriasis, tachycardia, hypertension), and flu-like symptoms (diaphoresis, piloerection).
Manifestation of nerve injury affecting the lateral aspect of the forearm
Loss of sensation in the lateral aspect of the forearm
What are the DSMV criteria for Opioid Use Disorder?
Opioid use that exceeds prescribed duration, unsuccessful attempts to reduce opioid use, and taking opioids to avoid withdrawal symptoms
What nerve injury affects the biceps brachii and is typically proximal and commonly results from brachial plexus injuries?
Conduction nerve study
What is the recommended analgesia for a patient with Opioid Use Disorder (OUD) experiencing severe acute pain?
Sufficient analgesia to alleviate severe acute pain, which may include a short-acting full opioid agonist if nonopioid analgesics and regional anesthesia methods are not suitable.
What are the effects of Clonidine in patients with opioid withdrawal?
Decreases rate of relapse
What should be considered when converting between opioids for pain management?
New opioid should be given at a lower dose (25-50% lower) and adjusted according to the patient's pain score
Describe the characteristics of Basal Cell Carcinoma.
Slow growing, non-tender pearly nodule with a rolled border and central ulceration
What are the manifestations of opioid overdose?
Respiratory depression or distress, bradycardia, hypotension, lethargy or stupor, and bilateral miosis (pinpoint pupils).
Is Basal Cell Carcinoma a common malignant skin tumor?
Yes, it is the most common malignant skin tumor
What pain management approach is recommended for individuals with Opioid Use Disorder?
Sufficient analgesia to alleviate severe acute pain, consideration of regional anesthesia or short-acting full opioid agonist if nonopioid analgesics are not effective
What is the recommended diagnostic procedure for Basal Cell Carcinoma?
Undergo full thickness biopsy of the edge of the lesion
Does Basal Cell Carcinoma metastasize?
it rarely metastasizes
What is the treatment for opioid overdose?
Naloxone, a competitive opioid receptor antagonist
25,26 derm
Study
What type of condition is Lichen Planus?
Lichen Planus is a Tcell mediated condition with altered immune response.
What are the characteristics of Seborrheic Dermatitis?
Pruritic rash affecting areas of high sebaceous activity (face, eyelids, scalp). Increased in HIV infection, underlying neurological conditions (Parkinson's, stroke), and intestinal malabsorption (Celiac Disease).
What are the treatment options for patients with central scale and rough surface?
actinic keratoosisisolated lesion of ac = cryotherapy5FU, imiquimod, or photodynamic therapy in patients with multiple lesions.
Where is Lichen Planus commonly found and which surfaces does it primarily affect?
Lichen Planus commonly involves hands and primarily affects flexor, not extensor surfaces.
When is Seborrheic Keratosis concerning?
Sudden appearance of multiple lesions, Leser-Trelat sign.
How is a Dysplastic Nevus assessed?
Assessed based on ABCDE criteria: Evolving lesion with asymmetric shape, irregular borders, inconsistent color, and diameter greater than 6 mm.
What are the characteristics of Solar Lentigo?
Flat, brown macules; a benign skin condition in older individuals with light skin; as a result of overproduction of melanin by existin
What is Solar Lentigo?
Solar Lentigo is a benign skin condition in older individuals with light skin.
What derm condition is increased in those with HIV, underlying neurologic conditions like Parkinsons/storke, and intestinal malabsorption like Celiac?
seborrheic dermatitis
When is Seborrheic Keratosis concerning?
Sudden appearance of multiple lesions, Leser-Trelat sign, or associations with malignancies such as lung or GI cancers.
What are the treatment options for Actinic Keratosis?
Cryotherapy for isolated lesions, 5FU, imiquimod, or photodynamic therapy for patients with multiple lesions.
What are the characteristics of Dermatofibroma?
Benign skin condition characterized by fibroblast proliferation, leading to the development of small (3-10 mm) skin-colored or brown fibrous nodules, most commonly on the lower extremities. Patients are asymptomatic and require no treatment. Surgical excision may be considered for cosmetic reasons, symptomatic lesions, or suspicion of malignancy.
What are the characteristics of a Strawberry Angioma?
Benign vascular lesion that bleeds with trauma, develops within the first 2 weeks of life, and regresses by 5-8 years.
What is histopathological confirmation of a lesion?
Surgical excision with safety margin, or Mohs surgery if on the face.
What are the yeasts that play a role in the pathogenesis of scalp conditions like Atopic Dermatitis and Eczema?
Malassezia furfur and globose yeasts
Where does Actinic Keratosis occur and who does it affect?
Occurs on sun-exposed skin (scalp, face, dorsal aspect of hands or arms) and affects light-skinned people over 50.
What are the characteristics of a Cherry Angioma?
Benign vascular lesion that bleeds with trauma, does not regress.
Describe the symptoms and characteristics of Lichen Planus.
Symmetric, well-demarcated, severely pruritic papules with a polygonal shape that commonly involve the hands. Primarily affects flexor surfaces.
27,28 derm
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What is Melasma characterized by?
Irregular patchy hyperpigmentation of the skin, triggered/exacerbated by exposure to sunlight.
What depigmenting agent can be used in severe Melasma?
Topical Hydroxyquinone
What causes Plantar Warts?
Caused by HPV, most often HPV1, result of direct skin contact with an infected person or contaminated surface.
What are the treatments for Plantar Warts?
Salicylic acid or fluorouracil cream, cyrotherapy with liquid nitrogen, surgical excision.
What characterizes a Pyogenic Granuloma?
Solitary lesion following physical trauma, bright red papule less than 1 cm in diameter profusely bleeding due to minor trauma.
How are Psoriasis plaques treated with topical medications and moisturizers?
First-line corticosteroids combined with topical Vitamin D derivatives (calcipotriene tar preparations), anthralin, or keratolytic tazarotene. For skin areas susceptible to corticosteroid-induced atrophy (intertiginous and facial areas), topical calcineurin inhibitors can be used. Patients with greater than 5% body surface area covered or decreased quality of life may receive UVB phototherapy or systemic treatment (methotrexate, retinoids, cyclosporine, and biological agents).
What is the first line of treatment for psoriasis plaques?
Topical corticosteroids combined with topical Vitamin D derivatives (calcipotriene tar preparations, anthralin, or keratolytic tazarotene)
What can be used for skin areas susceptible to corticosteroid-induced atrophy, intertiginous, and facial areas in psoriasis treatment?
Topical calcineurin inhibitors
What treatment is recommended for patients with greater than 5% body surface area covered or decreased quality of life due to psoriasis?
UVB phototherapy or systemic treatment (systemic meds: methotrexate, retinoids, cyclosporine, and biological agents)
What are topical steroids used to treat?
Various skin conditions, including psoriasis, eczema (atopic dermatitis), and lichen planus
