Maryville NURS 623 Exam

1. Mode of transmission for parasitic skin infections

Close direct skin contact.
2. Clinical presentation for Scabies
Intense itching, worse at night. Burrows noted between webs of fingers.
3. Commonly prescribed medications for Scabies
Permethrin Cream 5% (Elimite) is the first-line treatment. Safe in 2 months and older. Apply to
all areas from neck down and leave on for 8-12 hours. Repeat application in 1 week. May
repeat a third time in another week. Follow up in 1 week.
Antihistamines and topical steroids if the pruritis is bad.
4. What should you include in the patient education to prevent spreading of the various parasitic
skin problems?
Avoid close contact. Wash all bedding, clothing, cloth items, and stuffed animals in hot water.
All close contacts family members, people you live with and sexual partners need to be
treated as well.
5. Which bacterial skin infection is considered highly contagious?
Impetigo
6. What is the "classic" presentation of impetigo?
Honey crusted lesions
7. What is the management of a minor case of folliculitis (non-pharmacologic)?
Gentle cleansing by washing the skin twice a day with antibacterial soap.
8. What are the commonly prescribed medications for folliculitis?
Mupirocin (Bactroban) 2% ointment or cream, TID, 5-14 days, for secondarily infected skin
lesions.
Mupirocin (Bactroban) twice daily for 5 days in the nose for people with recurrent folliculitis
to clear the colonization of S. Aureus.
9. Furuncles
Initially appear small (0.5-1 cm), red, tender, indurated nodule. As it grows it develops a
central yellow plug. They eventually rupture spontaneously. Fluctuant or larger furuncles
should be treated with I&D and covered with a simple dry sterile dressing. Patients should be
instructed to use warm compresses twice daily to encourage drainage of pus.
10. Carbuncles
Initially appear as multiple furuncles and develops into a large, erythematous lump and must
be drained before healing will take place and this typically occurs spontaneously within 2
 weeks. Carbuncles frequently require I&D and need systemic antibiotics and a referral.
Antibiotics include: TMP-SMX (MRSA converage), dicloxacillin, cephalexin, or doxycycline.
A gram stain is recommended to check for MRSA strains.
11. What are the considerations when determining treatment for cellulitis?
Severe infections, infections around the eyes, or systemic involvement (fever & chills),
immunocompromised should be sent to the ED for inpatient IV treatment.
Mild cases can be treated with PO antibiotics that should show improvement within 48-72
hours. Penicillin VK, dicloxacillin, clindamycin, or cephalexin for 5 days.
Infected human & animal bites need to be treated with amoxicillin-clavulanic acid
(Augmentin) for 2 weeks. Prophylaxis treatment for human & animal bites (within 6 hours)
amoxicillin-clavulanic acid (Augmentin) for 3-5 days.
12. HSV
grouped vesicles on an erythematous base, followed by ulcers or erosions that crust over
with honey color. Lesions typically heal in 7-10 days. Mouth, face, or genitals.
13. Diagnostic tests for HSV
Viral Culture Gold Standard & PCR tests are standard for diagnosis. Vesicle fluid can be
cultured with 72 hours of outbreak. Tzanck smear. HIV testing is advisable in HSV-2 patients.
Herpetic keratoconjunctivitis
requires immediate referral to an ophthalmologist.
14. HSV-2 Genital lesion treatment
Treated with oral antivirals Valacyclovir or famciclovir. Warm compresses and oatmeal sitz
baths can help promote comfort and healing. Urinate into a warm bath. Increase fluid intake
and rest.
15. HSV-1 oral lesion treatment
Acetaminophen to control pain. Ice or lip ointments like Blistex. OTC docosanol (abreva) 10%
cream applied 5 times a day. For more extensive lesions, penciclovir (Denavir) 1% cream
applied every 2 hours while awake. Extensive oral lesions may require lidocaine, and
acyclovier oral suspension 200mg/5mL, rinse mouth with 1 teaspoon and swallow five times a
day.
16. HSV Patient education
Begin antiviral at the first sign of tingling or burning.
No sharing of towels, silverware, or glasses. Wash hands frequently.
Avoid sex until lesions are healed, Use condoms every time to avoid viral spread.
17. Which dermatitis is an inherited skin reaction that begins in infancy
Atopic dermatitis
18. What is the "atopic triad?"
 Atopic eczema, asthma, and allergies
19. What dermatitis is associated with the expression "the itch that rashes?"
Atopic dermatitis
20. What is the objective finding with atopic dermatitis?
Begins in infancy on cheeks, face, and upper extremities. Erythema is often seen before
pruritis. Flexural eczema seen between 4-10 antecubital fossa, popliteal fossa, and neck.
Adults: face, neck, upper chest, genital area and hands. Excoriated maculopapular lesions.
Oozing and crusting.
21. What is the primary aim in management of atopic dermatitis?
Control signs and symptoms because there is no cure.
22. What is the non-pharmacologic and pharmacologic management for atopic dermatitis?
Mild emollients like Ceraphil as a substitute for soap. Soak and smear method, soak in tepid
bath and smear body with moisturizing cream, or petroleum jelly. Use a humidifier.
Wet soaks or compresses with cool tap water or Burow's solution for wet inflamed sores for
20-30 minutes, 4-6 times day. Topical corticosteroids should be placed on inflamed areas
immediately following the soak.
Doxepin (sinequan) can be used to help with the itch. TCA.
Singular 10mg daily
Prednisone 60mg, daily, for 7 days.
Immunomodulators Protopic, see relief in 3 days and have increased quality of life. 2nd line
treatment.
Bleach baths 1-2 a week for patients colonized with S. Aureus and at risk for secondary
bacterial skin infections.
Exacerbations are common in the fall.
23. What is the cardinal symptom of contact dermatitis?
Pruritic erythematous rash
24. contact dermatitis
Rough, red patches, weeping lesions with tiny vesicles.
25. What is the non-pharmacologic and pharmacologic management for contact dermatitis?
Moist compresses, Borow's Solution, or calamine lotion applied several times a day.
Topical corticosteroids and oral steroids for severe cases.
Avoid triggers and avoid scratching to stop the spread.
Follow up in 1 week. Severe cases may be referred to dermatologist or allergist.
26. seborrheic dermatitis
Skin condition caused by an inflammation of the sebaceous glands. It is often characterized
by redness, dry or oily scaling, crusting, and/or itchiness. Pink, edematous skin covered with
 yellow, brown scales and crusts that appear greasy. Typically at the hairline on the forehead,
eyebrows, and nasal folds. This is a chronic with remissions and exacerbations
27. Seborrheic dermatitis treatment
OTC dandruff shampoo left on for 5-7 minutes
Resistant: 2.5% selenium sulfide shampoo, ketoconazole (Nizoral) shampoo used every
other day. Maintenance is 1-2 times a week.
Hydrocortisone for inflammation 0.5%-1.0% for the face and betamethasone valerate
0.1% for the scalp after cleansing.
Exudative lesions use Burows solution 30 minute compresses TID.
28. Is seborrheic dermatitis contagious?
No
29. Psoriasis
chronic, recurrent dermatosis marked by itchy, scaly, red plaques covered by silvery
gray scales. Typically found over the extensor areas of the body to include elbows,
knees, and scalp.
30. What is the Auspitz's sign?
Multiple small sites of bleeding are noted when the psoriasis scales are traumatically
removed.
31. What is the goal of management for psoriasis?
Control the disease so that the patient no longer feels physically or psychologically hindered
by the skin lesions. Decreasing epidermal proliferation and underlying dermal inflammation
through the use of topical corticosteroids.
32. What is the first line pharmacotherapeutics for psoriasis if < 20% of the body is involved?
Topical agents are the first line therapy. Emollients twice daily.
33. When should you refer a patient with psoriasis to a dermatologist or psoriasis specialty clinic?
Newly diagnosed patients and patients with moderate to extensive skin involvement
(more than 20%). Patients with recalcitrant or with frequent flares. Patient with
inflammatory arthritis should be referred to Rheumatology.
34. What should be included in the patient education of psoriasis?
This is NOT contagious. It is important to avoid skin trauma, as this can create new lesions.
Controlled sun exposure will help, use high SPF sun screen. Strep infections need to be
treated promptly. Try to control or eliminate aggravating factors like stress and alcohol
intake.
35. What is the clinical presentation of acne vulgaris?
Comedomes are the primary lesion in acne, it also includes papules, nodules, and cysts on
the face, back, chest, and upper arms. Between 12-25, peaking at age 15.
36. What is different in the presentation of rosacea versus acne?
Comedones are never found in rosacea. Easy flushing with alcohol & heat and is centrally
located on cheeks, nose, & chin. Telangiectasias can been seen in rosacea. Occurring
between 30-60 years old.
37. What are the commonly prescribed medications for acne and rosacea?
Topical Acne treatment includes retinoids: Tretinion (Retin-A) cream, gel start with
0.025% for 2 weeks increase to 0.05%. Sun sensitivity always use sunblock
Adapalene (Differin) First line therapy- well tolerated, less sun sensitivity.
Rosacea: Metronidazole cream 0.75%- can take 6-7 weeks to see therapeutic effects.
Systemic treatment for flare-ups of Rosacea and severe acne with Minocycline
tapering dose 50mg at bedtime for 1 week. Gradually increase to 100mg at bedtime
after 4-6 weeks, taper dose down gradually every 6-8 weeks until back at 50mg (this
is for moderate to severe acne as well) and doxycycline 40mg.
38. When would you choose a topical medication versus systemic antibiotics in the treatment of
acne vulgaris?
Mild cases can use topical. Moderate to severe with lots of inflammation may need systemic
antibiotics.
39. What are the concerns with prescribing tretinoin (Retin-A)?
Teratogenic, not to be used during pregnancy or breastfeeding. Dry and irritating
effects. Initiate therapy at the lowest dose 0.025% for the first two weeks of treatment,
then increase to 0.05%.
40. What is the clinical presentation of seborrheic keratosis?
Most common noncancerous skin growth in older adults. A wart-appearing
growth typically on the trunk, but can be on hands and face, both in sun
exposed and sun protected areas. They are superficial epithelial growths that
originate from the horny layer and are epidermal tumors. Occur in both men
and women, but typically patient is an older white female. "Barnacle of again"
Appearance: raised, well-defined, scaly, hyperpigmented, brownish-gray, with
a warty "stuck on" appearance. Most often found on the trunk, face or arms.
41. Management of seborrheic keratosis
Most do not require treatment. Removal is warranted for lesions that are symptomatic,
unsightly to the patient, or become easily irritated. They are removed using liquid nitrogen
therapy. Cryosurgery, liquid nitrogen results are superior. You may also use curettage and
snip or shave excision. No follow-up necessary.
42. acne vulgaris patient teaching
Wash face gently at least twice daily with antibacterial soap (dial). Wait 30 minutes
after washing face to before applying topical acne medications in order to minimize
 skin irritation. Do not use topicals on sunburned or irritated skin, abrasion, cuts, or
eczema. The medication needs to be temporarily stopped while the skin heals. Avoid
contact to eyes, lips, angle of nose, and mucous membranes with applying. Avoid oily
makeup or oily hair conditioners. Avoid excessive handling of face and cradling
phones on the chin. Avoid excessive scrubbing of the face.
43. Roscea Patient teaching
Avoid triggers (heat, cold, alcohol, spicey foods, emotional upset). Wear sunblock everyday at
least SPF 15. Stay cool on hot days and protect your skin from the wind by using a scarf. Use
caution with exercise, do shorter more frequent intervals, use a cool towel around the neck
and take frequent water breaks. Gentle cleansing with fragrance free facial cleansers.
44. What is the clinical presentation and management of actinic keratosis?
Solar keratosis, small (.2-5mm) papules, flesh colored or slightly pigmented, irritated
rough scaly rash, poorly circumscribed with tenderness, burning or tingling sensation.
These are found in areas that have been highly exposed to the sun.
Topical cream: fluorouracil (Fluoroplex, Carac) for 3 weeks. F/U in 2-3 wks
Liquid nitrogen, F/U 2 wks
dermatologist referral for surgical removal.
45. Risk factors for malignant melanoma
Age: Increased
Skin, Eye, Hair Color: Light, blue or green eyes, red or blonde hair.
Person Hx: Skin Ca, dysplastic nevi, congenital nevi greater than 20mm,
blistering sunburn before age 20, immunosuppression.
Family Hx: Melanoma
Environmental Hx: Excessive outdoor exposure to UV rays. Indoor tanning.
46. What is the clinical presentation of malignant melanoma?
Typically, there are no symptoms, pruritic, ulcerated, or bleeding mole. A person may come
in with a large mole that has changed. Typically on sun exposed areas of the body.
47. Patient education for prevention of melanoma
Prevention is key, by wearing sun block and protective clothing to stop from getting
sunburns. A person risk doubles if they have had more than 5 sunburns. Avoid prime
hours of the day 10-3. Do not use tanning beds. Early detection is key, remember
ABCDE
48. ABCDE of malignant melanoma
A" stands for asymmetrical. Does the mole or spot have an irregular shape
"B" stands for border. Is the border irregular or jagged?
"C" is for color. Is the color uneven?
 "D" is for diameter. Is the mole or spot larger than the size of pencil eraser 6mm?
"E" is for evolving. Has the mole or spot changed during the past few weeks or months?
49. basal cell carcinoma
BCC elevated papules with a pearly appearance that may have some crusting.
Telangiectatc blood vessels are seen on the border. A central ulceration is seen at
later stages.
50. squamous cell carcinoma
SCC firm papule with scaly (keratotic) rough surface with irregular borders and they bleed
very easily.
51. Diagnosis and management of BCC & SCC
Diagnosis: Referral to Dermatologist for a biopsy.
Management: Dermatologist Excision. Full skin assessment every 6-12 months.
52. microcytic anemia
iron deficiency anemia
Anemia of Chronic Disease
Thalassemia
53. What if any, additional diagnostic test do you need to determine the cause of a microcytic
anemia?
CBC, Iron deficiency: Ferritin (low), TIBC (high), transferrin saturation (low) Smear may show
anisocytosis, poikilocyosis, & hypochromasia.
ACD: low serum iron, low TIBC, serum transferrin is either elevated or normal.
Thalassemias: CBC & hemoglobin electrophoreses.
54. What is the clinical presentation of microcytic anemia?
Tachycardia, SOB, fatigue, DOE, palpations, lightheadedness, poor concentration, anorexia,
dizziness, PICA. Sallow-colored skin, pale mucous membranes, tachycardia, and tachypnea at
rest.
55. treatment for iron deficiency anemia
Treated with dietary intake, followed by oral iron supplements (ferrous sulfate 325mg , TID)
take with juice because vitamin C aids in absorption. Follow up in 2-4 weeks to recheck labs
values. IV iron is available for patients who do not respond to oral iron supplements.
56. Anemia of Chronic Disease treatment
Must be differentiated from other etiologies
-best treatment is correction of underlying disorder
-if severe, blood transfusions
-erythropoietin therapy
 Parental iron is given in these patients, SQ erythropoietin (CBC checked twice weekly
for 2-6 weeks) and seen by PCP every 30 days.
57. Anemia from Thalassemia
referral to hematologist.
58. Foods that would be recommended in the treatment of iron deficiency anemia
Green leafy vegetables, legumes, animal protein
59. What are potential causes of normocytic MCV 81-99 anemia?
Anemia of chronic disease, hemolysis, or volume overload.
60. When do you follow up with patients who have normocytic anemia?
Follow up every 6 months. If peripheral smear is positive for morphology referral to
hematologist is indicated.
61. What are the anemias associated with the classification of macrocytic anemia?
Vitamin B12 Deficiency
Folate Deficiency
Antimetabolite medication: methotrexate
The most common is the hereditary autoimmune disorder called pernicious anemia
62. What is the clinical presentation of patients with macrocytic anemia?
Stomatitis, glossitis, nausea, anorexia, diarrhea, peripheral neuropathies and malaise.
Neurologic signs are seen with Vitamin B12 deficiency and can include a positive Romberg's
sign and positive Babinski sign and decreased deep tendon reflex and hypersegmented
neutrophils will be seen in the peripheral smear. Both Homocysteine & Methylmalonic levels
are elevated in Vit B12 deficiency. Cobalamin 1,000 mcg/day, PO
If pernicious anemia or B12 from malabsorption: Vitamin B12, IM, 1,000 mcg, daily for 7 days,
followed by monthly for life.
Folate deficiency: Only homocysteine levels are elevated. Serum Folate less than 3ng/mL.
Supplement 1mg/day of Folic acid. Monitor every 2-3 months.
Patients who do not respond with a significant reticulocytosis after 1 week should be
evaluated for mixed anemia.
63. Treatment for Vitamin B 12 deficiency
- Oral Cobalamin 1000mcg/d (6-12 weeks) Monthly CBC & Vit B 12 levels
64. Treatment for Vitamin B 12 deficiency from Pernicious and malabsorption:
• 1000mcg Vitamin B12, IM, x 7 days, weekly for 1 month; followed by once per month for
life
• Serial CBCs and Vit B12 monthly
Referral to gastroenterologist and hematologist for pernicious anemia as they are at greater
risk for GI malignancy.
65. Folate deficiency anemia treatment
Folic acid, 1mg/day. Folic acid is found in citrus fruits, dark green leafy vegetables and animal
proteins.
66. What is the cardinal sign of a sickle cell crisis?
Vaso-occlusive phenomena and hemolysis are the clinical hallmarks of sickle cell disease
(SCD). episodes of acute pain are one of the most common types of vaso-occlusive events in
SCD and are responsible for a large number of patient encounters. The sites of pain can
include the back, chest, extremities, and abdomen. In young children, dactylitis (acute pain in
the hands or feet) may be the most common site of pain.
67. the seven-step approach to anaphylaxis
1. Administer epinephrine 1:1,000 dilution 0.3-0.5 mg IM in the upper lateral thigh in the
supine position with head lower than heart.
2. Repeat epi every 5-15 minutes as needed
3. Support bronchodilation by administering albuterol 3mL inhalation via nebulizer.
4. If patient is having laryngospasm, emergency intubation is required.
5. Start IV fluids using NS or LR to maintain systolic BP greater than 90mm Hg.
6. If patient is conscious without laryngospasm, administer Benadryl 25-50mg to relieve
cutaneous symptoms
7. Transfer patient to an acute-care emergency center. Add cortisol IV or PO to prevent late-
phase anaphylaxis reaction
68. What is rheumatoid arthritis (RA)?
A chronic progressive systemic inflammatory disease that primarily affects the synovial joints.
A connective tissue disease.
69. CML (chronic myelogenous leukemia)
- Clonal, neoplastic expansion of multipotent myeloid stem cell [myeloproliferative disease) -
NEB cells
Etiology - Philadelphia chromosome - reciprocal translocation of long arms of 9 & 22
70. Acute Lymphocytic Leukemia (ALL)
the most common form of leukemia in adults over 70 years of age; characterized by
overproduction of lymphocytes
71. What is the virus that causes the majority of infectious mononucleosis cases?
EBV
72. Clinical presentation of RA
Early in disease malaise, diffuse arthritis, weight loss, anorexia, and low grade fever are
common. The patient may report they wake in the night with joint pain & stiffness and it
eases as the day progresses and the joint swelling also decreases with activity. With disease
progression both small and large joints may cause diminished activity, worsening pain, and
 immobility.
**Key findings on exam are symmetric polyarthritis and morning stiffness, which typically lasts
longer than one hour. Affected joints are tender, painful to pressure, edematous, and
partially immobile
73. What is the preferred initial test for the diagnosis of RA?
Serum qualitative and quantitative RF titer, ESR, CRP, & CBC
74. What is the initial management of RA?
Physical and occupational therapy to promote function and prevent immobility. Heat and
cold application for analgesia. Low impact exercises like swimming. Prone positioning/resting.
Assistive devices. Splints. Meditation. Weight loss. NSAIDS- Aspirin
Follow up every 90 days with labs, CBC, ESR, CMP, Liver Panel
Methotrexate, sulfasalazine, & hydroxycholoroquine, to be given by rheumatologist.
75. chronic fatigue syndrome (CFS)
Sudden and may precede mononucleosis-like illness or by significant GI findings. It tends to
affect active highly functional adults. The patient may appear tired and pale. Cervical lymph
nodes may be shotty and nontender, the rest of the exam my be unremarkable.
76. Fibromyalgia
chronic condition with widespread aching and pain in the muscles and fibrous soft tissue
Must have 11 of 18 tender points to digital palpation- strong enough to blanch a nailbed.
Widespread pain noted for at least 3 months & have pain to palpation on exam.
77. Sjogren's syndrome
a chronic, multisystem autoimmune disease characterized by lacrimal and salivary gland
inflammation, with resultant dryness of the eyes and mouth and occasional glandular
enlargement. In addition, a variety of systemic (so-called "extraglandular") manifestations
may occur, including fatigue, musculoskeletal symptoms, rashes, and internal organ (eg,
pulmonary, renal, hepatic, and neurologic) disease. There is also increased risk of non-
Hodgkin B-cell lymphoma.
78. Sjogren's syndrome patient education for symptom management
Most people use artificial tears (eye drops) to treat dry eyes. Dry mouth: sucking on sugar-
free candy or lozenges or chewing sugar-free gum can stimulate the flow of saliva. Sipping
on water throughout the day is an easy and effective treatment of dry mouth for many
people. The water does not have to be swallowed. It can be rinsed around the mouth and
then spit out. Preventing cavities — People with Sjögren's syndrome are at increased risk for
dental cavities. You should brush and floss after eating meals and snacks. An electric
toothbrush is preferred. It is important for you to visit your dentist at least every six months
for a cleaning and evaluation. or dry lips, you can use petroleum jelly or lip balms or salves.
Dry skin usually improves with frequent and liberal use of a moisturizing cream or ointment.
79. systemic lupus erythematosus (SLE)
chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs
Constitutional symptoms, such as fever, fatigue, lymphadenopathy, or weight loss
●Photosensitive skin lesions, such as a malar rash
●Painless oral or nasal ulcers
●Hair loss that is patchy or frontal/peripheral
●Raynaud phenomenon
●Joint pain or swelling, which can be migratory or symmetrical
●Dyspnea or pleuritic chest pain suggestive of serositis
●Chest pain suggestive of pericarditis
●Lower-extremity edema
80. clinical presentation for infectious mononucleosis
• Primarily EBV transmitted through saliva typically seen in ages 10-35.
• Fever, pharyngitis, lymphadenopathy (posterior cervical and posterior auricular nodes),
malaise, fatigue, sweats. The syndrome is often heralded by malaise, headache, and low-
grade fever. Sore throat is often accompanied by pharyngeal inflammation and tonsillar
exudates.
• Splenomegaly is seen in 50 to 60 percent of patients, it begins to recede at 3 weeks.
81. Mono diagnosis, treatment and patient education
• heterophile antibody test (Monospot)
• EBV-specific serologic testing
• CBC w/diff (lymphocytosis) The total white blood cell count in patients with IM averages
12,000 to 18,000/microL, although it may be much higher.
The mainstay of treatment for individuals with IM is supportive care. Acetaminophen or
nonsteroidal anti-inflammatory drugs are recommended for the treatment of fever, throat
discomfort, and malaise. Provision of adequate fluids and nutrition is also important. It is
prudent to get adequate rest. Due to the rick of splenic rupture potential resumption of all
sport activities, except for strenuous contact sports, no earlier than 21 days after illness onset
82. What is the cause of Lyme's disease?
Borrelia burgdorferi (tick bite)
83. Differentiate between early and late signs associated with Lyme's disease.
• Early signs are a bullseye rash, last signs are joint pain Flu-like symptoms
• Rash (erythema migrans) EM is a rash that appears at the site of the tick bite, usually within
7 to 14 days after the bite. They typically expand slowly over the course of days or weeks,
often with central clearing, and may reach a diameter of more than 20 cm
Early disseminated Lyme disease usually occurs weeks to several months after the tick bite
and may be the first manifestation of Lyme disease. Lymphocytic meningitis,
Unilateral or bilateral cranial nerve palsies (especially of the facial nerve),
 Radiculopathy (Bannwarth syndrome), Peripheral neuropathy, Mononeuropathy multiple,
myopericarditis, conjunctivitis, keratitis, iridocyclitis, retinal vasculitis, choroiditis, optic
neuropathy, and uveitis

• Late signs: Untreated months to years after infection: multiple joint arthritis
• Generalize pain
• stiffness large joints (Knee)
• polyneuropathy
84. Lyme disease treatment
Treatment: EM present-Doxycycline 100mg oral bid 10 day or 14 days of Amoxicillin 500 mg
3 times daily for 14 days, or cefuroxime 500 mg twice daily for 14 days (this drug is best to
use if you are unsure of a skin infection versus Lyme as it has coverage for both or if allergic
to amoxicillin)
85. What are the guidelines for initiating antibiotic therapy for Lyme's disease?
Within 72 hours of attachment and EM noted.
86. What are the risk factors for HIV infection?
Anal intercourse, intercourse with an HIV positive partner, oral sex, exchange sex for drugs or
money, IV drug use with needle sharing, blood transfusions, body fluids, hepatitis or TB,
herpes simplex virus and syphilis.
87. What physical findings should prompt consideration of HIV testing?
Flu-like symptoms: 6 days to 6 weeks. Darkish, purple-colored spots on the skin: indicative of
Kaposi's sarcoma. Nonproductive cough, shortness of breath, and fever: present for several
days to weeks. Other constitutional symptoms: weight loss, night sweats, chronic fever,
and/or chronic diarrhea
Evaluating risk of HIV infections
88. What is the significance of the HIV viral load?
Viral load testing can establish the prognosis of a patient with HIV infection. Rising viral loads
indicate disease progression, while falling viral loads indicate a favorable prognostic trend. If
the medication regimen is working full viral suppression should be seen by 8-12 weeks.
89. What is the recommended initial screening for HIV?
HIV ½ Antigen/Antibody test
90. Describe the risk groups you would start HIV pre-exposure prophylaxis (PrEP).
For individuals who are at ongoing high risk for HIV infection, pre-exposure prophylaxis with
an antiretroviral-based regimen is an effective strategy to reduce the risk of infection.
Ongoing relationship with HIV infected partner.
Gay or bisexual man who has anal sex without condoms and is not in a monogamous
relationship, or who has had an STI in last 6 months
 Anyone who does not use condoms with partners of unknown status.
Anyone who has injected drugs in the last 6 months.
91. What are the initial and monitoring tests you order prior to PrEP?
• Creatinine clearance is important, less than 60mL/min cannot start treatment. Hepatitis and
liver enzymes. HIV Antibody/antigen, HBV, HCV, serum creatinine, Alanine transaminase
(ALT) and aminotransferase (AST)
• Sexual exposure: Screen for syphilis, chlamydia, gonorrhea, pregnancy
Emtricitabine200mg/tenofovir 300mg, Daily, Follow up every 3 months for HIV testing
92. Describe risk factors of individuals who should be started on post-exposure prophylaxis (PEP).
• An uninfected individual has a recent exposure that has a substantial risk of HIV infection.
• Percutaneous contact
• Exposure of mucosal surfaces
And must be started within 72 hours of exposure
93. tinea capitis
A fungal infection of the scalp characterized by red papules, or spots, at the opening of the
hair follicles.
tinea pedis
fungal infection of the foot; athlete's foot
94. Tinea versicolor
Also known as sun spots; a noncontagious fungal infection which is characterized by white or
varicolored patches on the skin and is often found on arms and legs.
95. Tinea versicolor treatment
selenium sulfide shampoo (Selsun Blue) lathered from neck down and left on for 10 minutes
for 7 days, followed by once a week for a month and then once a month for maintenance.
ketoconazole (Nizoral) shampoo can be used weekly for maintenance,
For more aggressive treatment:
Fluconazole 150-300 mg weekly, for 2-4 weeks is the safest choice for systemic treatment.
96. Tinea pedis treatment
Moisture control is key. drying foot powders; miconazole, tolnaftate are very helpful. Burow's
solution to dry out any weeping. Keep them open to air as much as possible. Change socks
1-2 times a day. Use antiperspirants on feet.
Terbinafine 1% cream (Lamsil AT) BID, for 1 week.
Miconazole 2% cream, BID, 4 weeks
Severe cases can be treated system Terbinafine (Lamisil) caution with Liver and kideyy DX
97. tinea capitis treatment
 Systemic therapy is required; topical is not sufficient.
Treatment of choice Griseofulvin V 250-500mg, BID, for 2-4 months.
Alternatively, consider terbinafine for 2 to 4 weeks in children older than 4 years is effective
against Trichophyton
Topical therapy with selenium sulfide shampoo (Selsun Blue) may help increase eradication
rates but alone is not sufficient therapy.
98. Tinea cruris (jock itch)
Topical antifungal therapy is effective for treating jock itch. Terbinafine 1% cream (Lamsil AT)
once daily for 1 week. Short-term treatment with mild corticosteroids, Hydrocortisone 1%
OTC to relieve itch and inflammation. Burrow's solution compression if weeping. OTC
antifungal powders help prevent recurrance.
99. What is the most common cause of relative polycythemia?
Dehydration
Acute: vomiting, fever, burns, crush injuries, decreased oral intake in elderly etc
Chronic- Diuretic use like furosemide
100. What is the clinical presentation with polycythemia? (absolute/relative)
Headache, blurred vision, fatigue, irritability, dizziness, tinnitus and most commonly
epistaxis due to mucosal engorgement.
Splenomegaly, peptic ulcer, new vessel growth on retinae, erythromelalgia (burning
pain in hands and feet), plethoric appearance, ruddy cyanosis fingers and toes
Absolute: cushingoid features are noted along with HTN
Women: Hematocrit greater than 48%
Men: Hematocrit greater than 52%
101. patient education for polycythemia
Patients on average live less than 15 years after their diagnosis due to the risk
of thrombosis. It is important to follow hydration and drug regimens.
Increasing activity can decrease the risk of clot formation. Stressing the
importance of adhering to lab draws and scheduled phlebotomies.