Diana's Flashcards > cpm midterm > Flashcards

cpm midterm Flashcards

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1
Q

what does empathy stand for?

A

Eye contant
Muscles of facial expression
Posture
Affect
Tone of voice
Hearing the whole px
Your response

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2
Q

psoriasis has absence of what layer?

A

granular layer

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3
Q

BCC appearance

A

pearly papule with rolled borders
pink shiny bumps

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4
Q

squamous cell carcinoma appearance

A

crested pink nodule

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5
Q

what does ABCDE stand for?

A

Asymmetric
Border
Color
Diameter
Color
Evolution

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6
Q

skin cancers in skin of color often present…

A

atypically in NON-SUN EXPOSED sites like hands, feet, nails, lower legs, and genital areas

it will be more advanced stage with a worse prognosis

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7
Q

what is the sunscreen recs?

A

SPF 30+ every 2 hrs

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8
Q

chemical sunscreen does not…

A

cause cancer

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9
Q

humans are born with as many…

A

hair follicles they will ever have

fastest growing cells in the body

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10
Q

explain psoriasis

A

symmetric, well defined red papuples and plaques with prominent white scales

common in scalp, knees, elbows, pre-sacrum, hands, feet, and genitalia

CHECK FOR STREP IN KIDS

tx = topical steroids
DO NOT USE PREDNISONE

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11
Q

explain atopic dermatitis

A

acute = itchy, scaly red/pink papules and plaques involving FLEXURAL surfaces

chronic = lichenified plaques, hyper- and hypopig

common in antecubital fossae, popliteral fossae, face, neck, extremities

ASSOCIATED W/ ALLERGIC RHNITIS and ASTHMA (ATOPIC TRIAD)

tx = topical steroids
DO NOT USE PREDNISONE

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12
Q

what is the atopic triad?

A

atopic dermatitis, rhinitis and asthma

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13
Q

what are wheals?

A

elevated, blanched lesions resulting from tissue fluid dispersed in dermis

ex: hives

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14
Q

what are the 5 key elements?

A

primary lesion
secondary lesion
color
distribution
configuration

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15
Q

what are the diff diseases associated with colors of the skin?

A

pink = pityriasis rosea
violet = lichen planus
orange = juvenile xanthogranuloma
blue = amiodarone skin pig
green = pseudomonas
yellow = xanthomas
black = eschar
brown = cafe au lait spots

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16
Q

what are the diff diseases associated with the distributions of the skin?

A

flexural = eczema
extensor = psoriasis
dermatomal = herpes zoster
gen = morbilliform drug eruption
localized = contact dermatitis
sun exposed = lupus, dermatomyositis
acral = psoriasis, eczema, tinea
intertriginous = tinea, candida, psoriasis

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17
Q

what are beau’s lines?

A

transverse depressions in nail plate

site of injury = PROXIMAL matrix, temporary stoppage of growth

associated with chemotherapy or systemic illness

in children = HAND-FOOT-MOUTH disease

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18
Q

what is onycholysis?

A

site of injury = DISTAL nail plate detachment

associated with psoriasis, onychomycosis, drugs (TCN, fluoroquinolones, chloramphenical, psoralens, UV)

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19
Q

what is pitting in the nail?

A

site of injury = matrix (PROXIMAL)

associated with psoriasis (scattered) and alopecia areata (symm and grid-like)

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20
Q

what is trachyonychia (20 nail dystrophy)?

A

rough, SANDPAPER like nail plates

site of injury = matrix

associated with lichen planus

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21
Q

what is Terry nails?

A

3/4 nails
leukonychia

associated with LIVER CIRRHOSIS

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22
Q

what is Lindsay’s nails?

A

half and half nails

associated with CHRONIC RENAL DISEASE

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23
Q

what is koilonychia?

A

spoon nails

site of injury = matrix

associated with iron deficiency –> PLUMMER VINSON SYNDROME

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24
Q

what are splinter hemorrhages?

A

site of injury = damage to nail bed caps

associated with external trauma (distal) and endocarditis (proximal) also OCPs

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25
what is yellow nail syndrome?
yellow color, absent cuticle site of injury = arrest in nail growht associated with lymphedema, pleural effusions, and bronchiecstasis
26
what are the follicular occlusion disorders?
acne vulgaris acne keloidalis nuchae hidradenitis supparativa dissecting cellulitis
27
what is acne vulgaris?
pilosebaceous follicular disorder 1. microcomedome formation with hyperkeratotic plugs 2. increased sebum production 3. PROPIONBACTERIUM ACNE 4. inflam in ppl of color --> discoloration can lasts 4-6 months
28
what is acne keloidalis nuchae?
follicular based papules and pustules that form keloidlike scars occipital scalp and posterior neck caused = men with CURLY HAIR, close shaving, etc wear colorless shirts/jackets, avoid VERY SHORT HAIRCUTS, avoid wearing hats laser hair removal, topical/intralesion steroids, oral antibiotics, surgical excision
29
35 y/o M with hairless and painful cysts on scalp?
dissecting cellulitis common in men of African descent and Hispanic males
30
35 y/o women with concerns about boils in the armpits?
hidradenitis supparativa common in axilla, inframammary, groin, vulvae, buttocks
31
what are the conditions of facial discoloration?
pityriasis alba vitiligo dermatosis papulosa nigra melasma
32
what is melasma?
facial hyperpig of forehead, cheeks, temples, nose, upper lip may occur after OCPs, pregnancy worsened by sun exposure in type V, VI skin visible light can worsen tx = broad spec sunscreen, topical hydroquinone, oral tranexamic acid, chemical peels, laser
33
what are the inflam disorders?
psoriasis lichen planus atopic dermatitis sarcoidosis
34
psoriasis leads to increased risk of...
described as flaky psoriatic arthritis, HTN, obesity, and CVD
35
what is important about atopic dermatitis in people with skin of color?
described as burning more likely to have a PAPULAR VARIANT cultural differences = washcloths, emollient formulations
36
what is important about lichen planus?
hypetrophic variant can develop into squamous cell carcinoma which is high risk for spread, esp to lymph nodes
37
what conditions use retinoids as a tx?
acne, psoriasis, lichen planus, dissecting cellulitis
38
what are the itchy, flaky rashes?
tinea versicolor tinea capitis seborrheic dermatitis
39
what are the hair loss disorders?
traction alopecia frontal fibrosing alopecia CCCA androgenic alopecia
40
androgenic alopecia is due to...
increasing androgenic receptor activity or dihydrotestosterone interaction in men, may be associated with CAD
41
traction alopecia shows...
frontal hairline preservation progresses to bald patches with retention of hair at marginal hair line --> FRINGE SIGN
42
frontal fibrosing alopecia shows...
gradual bandlike recession lone hairs
43
CCCA due to...
genetic inheritance --> AD PADI3 mut traumatic hairstyling progressive, lymphocyte predom, scarring inflam hair loss affecting frontal and vertex scalp
44
localized adenopathy usually due to...
LOCAL process in area that drains to LNs
45
generalized adenopathy usually due to...
SYSTEMIC disease
46
lesions of the hand will drain into...
epitrochlear LNs
47
if the inguinal LN is >... then it is pathologic
1.5 cm
48
cuts and wounds on the foot will drain into...
popliteal LNs
49
why do LNs enlarge?
- prolif of resident lymphocytes (lymphoid neoplams) - infiltration by metastatic malig cells (cancers in primary draining area or hematogenous spread from distant sites)
50
gen vs localized lymphadenopathy
gen = if LNs are enlarged in TWO OR MORE noncontiguous areas --> almost always indicates presence of sig systemic disease localized = if only one area is involved
51
cervical, axillary, inguinal and epitrochlear LNs greater than what are abnormal?
cervical + axillary = >1cm inguinal = >1.5 cm epitrochlear = >0.5 cm
52
what are the B symptoms in lymphoid neoplasm?
unexplained fever, unintentional weight loss, and drenching night sweats
53
what do enlarged LNs feel like on PE?
stony hard = CANCER very firm, RUBBERY = lymphoma softer = infections or inflam conditions suppurant may be fluctuant matting = benign and malig fixation = MALIG
54
what drains into the R supraclavicular node?
mediastinum, lungs, esophagus causes = lung, retroperitoneal, or GI cancer
55
what drains into the L supraclavicular node?
VIRCHOW's node thorax, ab via thoracic duct causes = lymphoma, thoracic or retroperitoneal cancer, bacterial of fungal infection
56
what are the diff LN biopsies?
open biopsy allows histo exam of intact tissue and provides info about presence of abnorm cells and abnorm node structure --> useful for dx of lymphomas core needle biopsy is low morbidity, inexpensive alt to open biopsy in pxs with suspected lymphoma in whom an intact node is not easily accessible FNA has VERY LOW YIELD IN LYMPHOMA and is not usually recommended if its suspected, may be sufficient to establish dx in NON LYMPHOID SOLID NEOPLASMS
57
what are the indications of LN biopsies?
- increase in size over baseline in 2 wks - no decrease in size in 4-6 wks - no regression to norm in 8-12 wks - development of new signs and symps - high suspicion for malig
58
what are the important pts regarding LNs?
acute viral illness can mimic lymphoma and sometimes LN path stim lymphoma and lead to false-pos dx of malig excisional biopsy is more informative than FNA in dxing LN path, FNA is helpful in dxing NON LYMPHOMA SOLID MALIG (can't distinguish which lymphoma)
59
obstruction in asthma is usually...
reversible
60
COPD consists of...
emphysema and chronic bronchitis irreversible damage
61
obstructive lung disease is diagnosed when...
FEV1/FVC <0.7 asthma = administration of bronchodilators during spirometry shows sig improvement in FEV1 COPD = no sig improvement in volumes when bronchodilators are administered
62
what is obstructive sleep apnea?
derangements that occur due to repetitive collapse of upper airway may cause sleep fragmentation, hypercapnia, hypoxemia, increased symp activity, swings in intrathoracic pressure - loud snoring - apneic spells - daytime somnolence risk factors = large neck circumference, OBESITY
63
what do you hear on PE for pneumonia?
dullness to percussion INCREASED TACTILE FREMITUS egophany tachypnea
64
what do you hear on PE for pneumothorax?
decreased to absent breath sounds on side of pneumothorax hyperresonance w/ percussion decreased wall movement
65
what is orthropnea?
dyspnea when lying flat, relieved when px is sitting up or sleeping in propped up on pillows often a symp of pulm edema common indicator of CHF, may also be present in mechanical impairment of diaphragm associated with obesity, or asthma triggered by esophageal reflux
66
what is paroxsymal nocturnal dyspnea?
acute dyspnea appearing suddenly at night, usually waking up the px from sleep caused by pulm congestion w/ or w/o pulm edema that results from L side HF following mobilization of fluid from dependent areas after lying down suggests CHF or asthma
67
prolonged expiration vs inspiration
prolonged expiration = asthma and COPD prolonged inspiration = pulm edema and ARDs
68
COPD is NOT a cause of...
clubbing
69
what does clubbing stand for?
Cyanotic heart disease Lung disease UC, Crohn's Biliary cirrhosis Birth defect Interstitial fibrosis Neoplasm GI malabsorption
70
what does emphysema sound like?
crepitus bubble wrap popping
71
what has increased tactile fremitus?
consolidation like pneumonia
72
what has decreased tactile fremitus?
pleural effusion pneumothorax tumor COPD bronchial obstruction
73
percussion tone indicators for lungs
resonance = normal hyperresonance = hyperinflation (emphysema) or pneumothorax tympanic = large pneumothorax dullness = diminished air exchange - consolidation, malig, effusion
74
stridor vs stertor
stridor = high pitched noise during INHALATION due to partial airway obstruction stertor = SNORING-LIKE noise while awake from nasopharyngeal or oropharyngeal obstruction
75
pulm edema sounds like...
wet crackles
76
pulm fibrosis sounds like...
dry or velcro crackles
77
what conditions do you hear wheezing in?
asthma, COPD, non-obstructing foreign body
78
what conditions do you hear rhonchi?
caused by continous oscillation of opposing LARGER airway walls and has musical quality - low pitched (unlike wheeze which is high) - implies airway narrowing - more common during expiration asthma, COPD, non-obstructing foreign body
79
what do you hear absent/decreased breath sounds in?
pneumothorax pleural effusion asthma
80
what do you hear bronchial breath sounds in?
consolidation (pneumonia)
81
what do you hear crackles in?
heart failure consolidation pulm fibrosis
82
normal breathing is called...
vesicular breathing
83
crackles and rales are...
synonymous
84
if you only listen to the pos lung, you will miss...
the R lobe
85
abt... of pxs diagnosed w/ shoulder impingement have a component of cervical radiculopathy
1/4
86
...% of visits for shoulder pain have isolated cervical spine problem
5
87
what are the most common musculoskeletal conditions?
rotator cuff = tendonitis/tears calcific tendonitis bicipital tendonitis/rupture adhesive capsulitis acromioclavicular arthritis dislocation of shoulder
88
trapezial or periscapsular pain can be...
subdeltoid, localized superior should, or ant shoulder pain should alert examiner to possibility of C-spine path
89
how is a shoulder and cervical pain described?
burning or electrical = neuropathic until proven otherwise radiation to the distal elbow or medial scapula
90
ROM on C-spine exam can detect...
motion loss or pain w/ motion indicates NECK DISORDER
91
what is spurling's sign?
neck extension, rotation, and axial compression positive if reproduces RADICULAR PAIN 95% sensitive and specific --> good screening and confirmatory test
92
what are pts to remember about the spine PE?
most muscles are innervated by >1 n root weakness, usually not complete paralysis, w/ n root injury exceptions = DELTOID (C5) and EHL (L5) dermatomes overlap n root injury causes HYPERESTHESIA peripheral n distribution DO NOT overlap peripheral n. injury causes ANESTHESIA
93
n root vs peripheral n injury
n root = hyperesthesia peripheral n = anesthesia
94
trapezial or periscapular pain w/ or w/o...
radiation distal to elbow should alert examiner to possible cervical spine path
95
what does ROM shoulder exam indicate?
passive ROM usually preserved in cervical spine disorders loss of passive ROM can indicate ADHESIVE CAPSULITIS or GLENOHUMERAL ARTHROSIS
96
how do you detect ant and/or lateral shoulder pain replicated?
neer sign = passive forward elevation in internal rotation hawkins sign = passive internal rotation in adduction impingement signs - non specific testing for subacromial path = rotator cuff tendonitis, rotator cuff tears, subacromial bursitis jobe test = rotator cuff path
97
how do you detect pos shoulder pain replicated?
dynamic labral shear test = SLAP tear
98
what is the referred shoulder impingement test?
34 pxs presented with neck pain - located over super-medial scapula/base of neck - impingement signs with pain localized in neck - radio abnorms - improvement in subacromial injection
99
what is quadrilateral space syndrome?
entrapment of axillay n in space - triceps - teres major - teres minor - humerus atrophy and weakness of teres minor and deltoid
100
what is thoracic outlet syndrome?
compression of neurovasc supply of upper limb (brachial plexus) pain = neck --> shoulder --> chest neuro symps = along ulnar n distribution
101
subacromial bursa veil
shoulder injection is KEY inject laterally then repeat exam
102
olecranon bursitis aka...
pitcher's elbow
103
what are the red flags in hand and wrist?
- any injury that involves tendon, n, joint capsule or an underlying fracture - worried about infection of a joint or tendon - evidence of numbness, weakness, or atrophy - concern about injury to flexor tendon - fracture of carpal bone --> SCAPHOID high risk for nonunion/osteonecrosis
104
what are abnormal gaits due to?
myopathic disorders and neuropathic consequence of pain, weakness, or a diff in lengths of limbs
105
what is antalgic gait?
aka painful gait pain is most common cause of limp characteristic is SHORTENED STANCE phase on affected side when pain arises in hip joint, there is also lurch of trunk toward painful side during stance phase
106
knee jerk reflex
patellar tendon L4
107
ankle jerk reflex
achilles tendone S1
108
what are the red flags of the lumbar spine?
inability to urinate or defecate peri-anal numbness or saddle anesthesia pain that wakes the px up at night in the lumbar spine
109
what does the trendelenburg test assess?
hip abductor weakness hemipelvis on opp site of weakness is lower
110
what are the red flags of the hip exam?
- inability to bear weight w/ history of trauma - severely limited range ROM w/ prodrome or other confounding factors - hip pain in children
111
what are the red flags of the knee exam?
- inability to extend knee against or elevate leg off bed - large joint effusion w/ erythema - inability to bear weight - sig trauma
112
what are the Ottawa ankle rules?
- bony tenderness pos edge of fibula or tip of lat malleolus - bony tenderness pos edge of tibia/tip of medial malleolus - bony tenderness at base of 5th metatarsal - bony tenderness at navicular - inability to bear weight both immediately after injry and 4 steps during initial eval
113
what are the red flags of the foot and ankle exam?
- ottawa ankle rules - thompson test that doesn't result in foot plantar flexion - hx or diabetes with foot changes, ulcers, or erythema
114
who are the victims at hight risk of domestic violence?
single 17-28 abuse alc or drugs pregnant partners are jealous or obsessive
115
...% of women who present to the ED for ANY REASON
22-35
116
...% of women who present to ED w/ TRAUMATIC INJURIES
19-30
117
...% of women who present to ambulatory clinics
14
118
...% of women who attempt suicide
25
119
...% of women who present to psych ED
25
120
...% of mothers of abused children
45-59
121
...% of women over 30 who have been raped
58
122
what are the pros and cons of radiography?
pros = inexpensive, readily available, first line for most MSK indications (trauma, tumor/mass, arthritis) cons = radiation, superimposed structures, not great for soft tissues
123
what are the pros and cons of US?
pros = inexpensive, fast, no radiation cons = shows/artifacts, not great for details, limited by body habitus and user skills
124
what are the pros and cons of CT?
pros = fast, multiple planes and vol rendered 3D imaging, excellent bone and soft tisse eval and multiple planes cons = radiation, expensive, body habitus may degrade quality
125
what are the pros and cons of MRI?
pros = great soft tissue eval, multiple planes, NO RADIATION*** cons = time, expensive/insurance, contraindications (implanted devices)
126
what is the ABCDE of the radiology?
Alignment Bone/bone marrow Cartilage Disc/joint space Everything else
127
what are ways to describe a fracture?
bowing, torus, greenstick = incomplete simple and comminuted = complete
128
what is the classification of fractures?
Straight across Above Lower/beLow Two or Thru ERasure of growth plate or cRush
129
where are elbow fractures most common?
RADIAL HEAD in adults SUPRACONDYLAR in children
130
what is a bucket handle fracture?
aka metaphyseal corner fracture highly specific for NONACCIDENTAL TRAUMA --> twisting, pulling, shaking
131
what is scaphoid fracture?
FOOSH = fall on outstretched hand --> snuffbox tenderness vascular supply is distal to proximal the more proximal the fracture, the higher the comp
132
what do you find on imaging for OA?
subchondral sclerosis, cysts
133
SLE is higher in...
AA women than caucasian women
134
RA in the US...
affects AA and european-americans equally
135
PMR and GCA are...
higher in ppl of N european descent
136
enthesopathy is also called...
spondyloarthritis
137
SLE has low...
C3 and 4
138
valgus vs varus
valgus for MEDIAL instability varus for lateral instability
139
what is McMurray test for?
meniscus injury
140
what are the clinical signs of hyperthyroidism?
hyperkinesis warm, smooth skin eye signs ophthalmopathy, dermatopathy goiter thyroid bruit tachycardia, wide pulse pressure afib tremor
141
what are the clinical signs of hypothyroidism?
hypothermia goiter slow relaxation of DTRs coarse, dry skin periorbital edema coarse hair hoarseness compression neuropathies
142
what are the conditions of secondary HTN?
pheochromocytoma primary hyperaldosteronism cushing syndrome acromegaly
143
what are the signs of hypercorticolism?
easy bruising facial plethora proximal muscle weakness striae unexplained vertebral osteoporosis
144
when do you eval pheochromocytoma?
classical spells --> HA, sweating, tachycardia, labile BP adrenal incidentaloma familial disease resistant HTN HTN at young age HTN crisis during surgery, anesthesia, diagnostic procedures
145
when do you screen for primary hyperaldosteronism?
hypokalemia severe HTN resistant to tx adrenal incidentaloma pxs <30 y/o w/ no risk factors for HTN
146
age related macular degen causes...
loss of center vision
147
what are the types of diabetic retinopathy?
non-prolif = COTTON WOOL SPOTS, dot hemorrhages, microaneurysms prolif = neovasc, treat w/ lasers and injections
148
what are the types of macular degen?
wet (exudate) = neovasc/hemorrhage dry (non-exudative) = DRUSEN and atrophy
149
what are the types of glaucoma?
loss of peripheral vision open angle = MOST COMMON, usually asymp, pressures >21, treated with eye drops, lasers, or surgery closed angle = <5%, acute pain and vision loss, pressures >30
150
what does optic neuritis cause?
central blind spot and visual field defects
151
what is pseudotumor cerebri?
benign intracranial HTN FORTY, FERTILE, FEMALE, FAT
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