Term Archives

  1. Systemic sclerosis - Scleroderma (ReelDx)

  2. Polymyositis (ReelDx)

  3. Urticaria (ReelDx)

    Urticaria (hives): Pt will present with blanchable, edematous pink papules, wheals or plaques.
    • (+) Darier's sign: localized urticaria appearing where the skin is rubbed (histamine release)
    • Angioedema: painless, deeper form of urticaria affecting the lips, tongue, eyelids hand and genital
    • If anaphylaxis: Epinephrine: 0.3–0.5 mg; use 1:1,000 dilution for IM route and 1:10,000 for IV route (peds: epinephrine 0.01 mg/kg SC/IV)
  4. Burns (ReelDx)

    Body percentage:
    • Rule of 9’s: Head 9%, Each arm 9%, Chest 9%, Abdomen 9%, Each anterior leg 9%, Each posterior leg 9%, Upper back 9%, Lower back 9%, Genitals 1%
    • Palmar method: Patient’s palm equates to 1%
    Degree involvement:
  5. Acanthosis nigricans (ReelDx)

    Acanthosis nigricans: Thick velvety hyperpigmentation and accentuated skin lines at skin folds - around the neck, armpits, and groin. Associated with insulin resistance -control blood sugars, weight loss, smoking cessation, Metformin.
  6. Dermatophyte Infections (ReelDx)

    KOH - long, branching fungal hyphae with septations
    • Tinea Barbae: papules pustules, around hair follicles
    • Tinea Pedis: Athlete's Foot: pruritic scaly eruptions between toes. Trichophyton rubrum is the most common dermatophyte causing athlete’s foot  Mgmt: Topical antifungals
    • Tinea Cruris: “Jock Itch” diffusely red rash in the groin or on the scrotum.
    • Tinea capitis: Most common fungal infection in the pediatric population. Occurs mainly in prepubescent children (between ages 3 and 7 years). Asymptomatic carriers are common and contribute to spread
    • Tinea corporis: (ringworm): usually seen in younger children or in young adolescents with close physical contact with others (i.e. wrestlers)
    • Tinea versicolor: is caused by Malassezia furfur, a yeast found on the skin of humans. Lesions consist of hypo or hyperpigmented macules that do not tan
  7. Candidiasis (ReelDx)

    Beefy red sharp bordered rash with pinpoint satellite pustules at the edge of erythemaPotassium hydroxide wet mount of skin scrapings - budding yeast, hyphae, and pseudohyphaeFavors skinfolds/creases (axillae, groin, below breasts, and, in infants, diaper area)
  8. Impetigo (ReelDx)

    Impetigo: nonbullous, golden honey colored crusts around nose and mouth, concurrent bullous, thin-walled vesicles. Staphylococcus aureus is most common
  9. Cellulitis (ReelDx)

    Cellulitis: An acute bacterial skin and skin structure infection of the dermis and subcutaneous tissue; characterized by pain, erythema, warmth, and swelling, margins are flat and not well demarcated. Caused by Staphylococcus and Streptococcus in adults. H. influenzae or strep pneumonia in children
  10. Verrucae

    Warts: all warts are caused by the Human Papillomavirus (HPV)

    • Verruca vulgaris (common warts): skin colored papillomatous papules. Hands
    • Verruca plana (flat warts): face, arms, legs
    • Verrucae plantaris (plantar warts): bottom of the foot. Rough surface. Dark spot (thrombosed capillaries)
    • Condyloma acuminatum (venereal warts): flesh-colored, cauliflower appearance genital warts caused by HPV types 6 and 11
  11. Varicella-zoster virus infections (ReelDx)

    • Chickenpox: Vesicular lesions in different stages of development. Dewdrop on rose petal
    • Shingles: Pain precedes rash groups of vesicles in a unilateral dermatomal pattern - Tzanck prep is positive for multinucleated giant cells. Hutchinson’s sign - lesion on the nose. Concern for eye involvement
  12. Molluscum contagiosum (ReelDx)

    Molluscum contagiosum: caused by the poxviruspearly papules with central umbilication
  13. Herpes simplex (ReelDx)

    There are eight types of herpes viruses known to affect humans. They are called the Herpes Human Viruses (HHV). There are two types of Herpes Simplex viruses: HSV 1- Oral lesions, HSV 2 - Genital lesions
    • HSV 1 - Oral lesions (tongue, lips etc.)
    • HSV 2 - Genital lesions (vulva, vagina, cervix, glans, prepuce, and penile shaft)
    • HHV 3 - VZV (Varicella Zoster Virus commonly known as chickenpox or shingles)
    • HHV 4 - EBV (Ebstein Barr Virus is commonly known as infectious mononucleosis [mono or glandular fever])
    • HHV 5 - CMV (Cytomegolo Virus is the most common virus transmitted to a pregnant woman's unborn child)
    • HHV 6 - Roseolovirus is more commonly known as the 6th disease or Roseola Infantum
    • HHV 7 - Similar to HHV6 (not yet classified)
    • HHV 8 - A type of rhadinovirus known as the Kaposi's sarcoma-associated herpesvirus (KSHV)
  14. Paronychia (ReelDx)

    Paronychia: Superficial inflammation of the lateral and posterior folds of skin surrounding the fingernail or toenail. Caused by candida if chronic and staph aureus if acute
  15. Alopecia (ReelDx)

  16. Spider bites (ReelDx)

    • Brown Recluse spider bites (necrotic wound) tend to cause pain, erythema, ecchymosis, and bleb formation, sometimes with surrounding ulceration and necrosis
    • Black Widow spider bites (neurologic manifestations) generalized muscle pain, spasms, and rigidity. May not see much at the bite site.
  17. Scabies (ReelDx)

    Pruritic papules. S-shaped or linear burrows on the skin. Often located in web spaces of hands, wrists, waist with severe itching (worse at night), treated with topical permethrin, all clothing bedding, towels washed and dried using heat and have no contact with body for at least 72 hours
  18. Lice (ReelDx)

    Pruritic scalp, body or groin. Nits are observed as small white specs on hair shaft. Body (corporis); Pubic (pubis), launder potential fomites such as sheets in hot water (> 131 F or 55 C)
  19. Acne vulgaris (ReelDx)

    Characterized by areas of open comedones (blackheads) incomplete blockage, closed comedones (whiteheads) complete blockage, papules, pustules, nodules or cysts. may result in scarring.
  20. Erythema multiforme (EM) is an acute, self-limited skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections - most commonly herpes simplex virus (HSV), medications (sulfa drugs), and other various triggers.
    • Skin lesions predominantly involving the extremities (hands, feet, and mucosa). Target-like shape, raised, blanching, and lack of itchiness help characterize this rash.
  21. Psoriasis (ReelDx)

    The classic clinical appearance is a well-demarcated, erythematous plaque with silver scaling. Patients may also present with no rash and only joint symptoms - pain in both hands and nail changes such as pitting and onycholysis.
  22. Pityriasis rosea (ReelDx)

    Pityriasis rosea typically occurs in children and young adults. It is characterized by an initial herald patch, followed by the development of a diffuse papulosquamous rash. Pityriasis rosea is easier to identify when the general eruption appears with smaller secondary lesions that follow Langer’s lines (cleavage lines) in a Christmas tree-like pattern.
  23. Drug eruptions (ReelDx)

    An adverse cutaneous reaction in response to administration of a drug. Skin reactions are the most common adverse drug reactions. Severity can range from mild eruptions that resolve after the removal of the inciting agent to severe skin damage with multiorgan involvement.
  24. Dyshidrosis (ReelDx)

    Tapioca vesicles on the lateral aspects of fingers, the central palm, and plantar surfaces following stress or hot humid weather
  25. Tourette disorder (ReelDx)

    The defining feature which separates Tourette syndrome from other tic disorders is the presence of both motor and vocal tics.
    • Symptoms must have been present for > 1 year and age at onset must be < 18 years old.
    • Tic disorders are divided into 3 categories:
      • Tourette syndrome (Gilles de la Tourette syndrome): Both motor and vocal tics have been present for > 1 year.
      • Persistent (chronic) tic disorder: Single or multiple motor or vocal tics (but not both motor and vocal) have been present for > 1 yr.
      • Provisional tic disorder: Single or multiple motor and/or vocal tics have been present < 1 yr.
  26. Syncope (ReelDx)

    Sudden, brief loss of consciousness (LOC) with loss of postural tone followed by spontaneous revival.
    • The patient is motionless and limp and usually has cool extremities, a weak pulse, and shallow breathing. Sometimes brief involuntary muscle jerks occur, resembling a seizure.
    • Near-syncope is light-headedness and a sense of an impending faint without LOC. It is usually classified and discussed with syncope because the causes are the same.
  27. Seizure disorders (ReelDx)

    Partial seizures: focal location in the brain affected often temporal lobe, the most common type of seizure in the elderly
    • Simple Partial: Consciousness fully maintained. Abnormal movements or sensations.
      •  Treatment: Carbamazepine
    • Complex Partial: Impaired consciousness lasts over 30 seconds, automatisms (ie. Lip smacking)
      •  Treatment: Carbamazepine
    Generalized seizures: start midbrain or brainstem and spreads to both cortices.
    • Absence seizure (petit mal): Children. Blank stare.
      • Treatment: Valproic acid, ethosuximide (only for absence)
    • Tonic clonic/Generalized convulsive (Grand mal): Loss of consciousness, increased muscle tone (tonic), jerking muscles (clonic).
      •  Postictal phase- confusion after seizure.
      •  Treatment: Valproic acid, carbamazepine
    • Myoclonic: muscle jerking, but not the tonic phase, occurs in the morning
    • Tonic: extreme rigidity then immediate LOC, but not followed by a clonic phase
    • Atonic attack (drop attack): looks like syncope, sudden loss of muscle tone
    Additional types
    • Febrile Seizure: A convulsion associated with an elevated temperature greater than 38°, > 6 mos < 5 years, absence of central nervous system infection or inflammation
      • Febrile seizures that continue for more than five minutes should be treated with IV benzodiazepines (diazepam or lorazepam)
  28. Myasthenia gravis (ReelDx)

    Autoimmune attack of acetylcholine receptors at the neuromuscular junction results motor problems
    • Young women, older men. weakness in everyday activities like brushing hair, Proximal to distal weakness: eyes: ptosis usually first
    • Diagnose with Acetylcholine receptor antibodies, Tensilon test/edrophonium test- short acting anticholinesterase
  29. Autoimmune: Antibodies against myelin sheath: Often first finding: Retrobulbar optic neuritis. Other symptoms: numbness, tingling, balance disturbance, diplopia. MRI: Dawson fingers (white matter lesions). CSF: Elevated IgG, oligoclonal bands
    • Relapsing remitting MC 85% (symptoms come and go)
    • Secondary progressive (relapsing remitting progresses to steady decline)
    • Primary progressive (no remission, steady decline from onset)
    • Progressive relapsing (combination. Worse overtime with acute relapses. Most rare.)
  30. Concussion (ReelDx)

    Grade 1: No LOC, post traumatic amnesia and other symptoms resolve in < 30 minutes
    • Athlete may return to sports if asymptomatic for one week
    Grade 2: + LOC , 1 minute or post-traumatic amnesia and other symptoms last > 30 minutes but < 1 week
    • Athlete may return to sports in 2 weeks if asymptomatic at rest and exertion for at least 7 days
    Grade 3: + LOC > 1 minute or post-traumatic amnesia and other symptoms last > 1 week
    • Athlete may return to sports in 1 month if asymptomatic at rest and exertion for 7 days
    Repeat concussions: if associated with either loss of consciousness or symptoms for more than 15 minutes may NOT to return to play sports for that season
  31. Cerebral palsy (ReelDx)

    Prenatal injury perinatal hypoxia or ischemia, preterm baby
    • Hyperreflexia, rigidity, intellectual impairment, seizures
  32. Altered level of consciousness (ReelDx)

    1. Eye opening:
    • 4- spontaneous
    • 3- voice
    •  2-pain
    • 1-none
    2. Verbal:
    • 5-oriented
    • 4-confused
    • 3-inappropriate words
    • 2-incomprehensible
    • 1-none
    3. Motor:
    • 6-obeys commands
    • 5-localizes pain
    • 4-withdraws
    • 3-abnormal flexion (decorticate)
    • 2-abnormal extension (decerebrate)
    • 1-none
    Scoring
    • Maximum score is 15 which has the best prognosis
    • Minimum score is 3 which has the worst prognosis
    • Less than 9 is a coma
  33. Stroke (ReelDx)

  34. Intracranial hemorrhage (ReelDx)

    • Epidural Hematoma:  transient loss of consciousness from an injury, period of lucency, then neurologic deterioration. CT: lens-shaped, biconvex
    • Subdural Hematoma: elderly patient with a history of multiple falls who is now presenting with neurological symptom. May be chronic, taking days to weeks to develop symptoms. CT scan: Crescent shaped density in the brain
    • Subarachnoid hemorrhage: "explosive thunderclap" headache described as "the worst headache ever." Aneurysm or AVM rupture.
  35. Meningitis (ReelDx)

    Classic Triad: Fever, headache, stiff neck, petechiae (especially N. meningitidis)
    • Kernig's sign: knee extension causes pain in neck (Remember K = Kernig's and K = Knee)
    • Brudzinski's sign: leg raise when bend neck
    • CSF Finding: 
      • Bacterial: ↑ Protein ↓ Glucose (bacteria love to eat glucose)
        • there is a markedly increased opening pressure
      • Viral:  normal pressure, increased WBC (lymphocytes)
  36. Tension headache (ReelDx)

    Bilateral, non-throbbing, band-like or "vice like" pain
    • A tension-type headache is typically described as bilateral, mild to moderate, dull pain, whereas a migraine is typically pulsating; unilateral; and associated with nausea, vomiting, and photophobia or phonophobia.
    • Treatment: NSAIDs, Excedrin, muscle relaxer
  37. Migraine (ReelDx)

    Unilateral (70%), throbbing, disabling pain, nausea, vomiting, photophobia
    • Classic: Aura and Common: No aura (80% of migraines)
    • Abortive: Triptans (do not use in ischemic heart disease), ergotamine (do not use in pregnant women)
  38. Withdrawal (ReelDx)

    • Marijuana:  Glassy, red eyes; loud talking and inappropriate laughter followed by sleepiness; a sweet burnt scent; loss of interest, motivation; weight gain or loss.
      • Withdrawalirritability, depression, insomnia, nausea, anorexia. Most symptoms peak at 48 hours and last for 5 - 7 days.
      • Symptomatic treatment only.
    • AlcoholDilated pupils; clumsiness; difficulty walking; slurred speech; sleepiness; poor judgment.
      • Withdrawal: trembling, irritability, anxiety, headache, tachycardia, insomnia.
      • Thiamine, magnesium, multivitamin, dextrose (particularly if chronic alcoholism).
      • Benzodiazepines (if withdrawal). Disulfiram (Antabuse) - inhibits acetaldehyde dehydrogenase, aversive conditioning. Naltrexone - decreases desire.
    • Cocaine, Crack, Meth, and Other Stimulants: Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; go long periods of time without eating or sleeping; weight loss; dry mouth and nose.
      • Withdrawal: severe depression and suicidality, hyperphagia, hypersomnolence, fatigue, malaise, severe psychological craving.
      • Treatment: bupropion, bromocriptine, SSRI's for depression. Antipsychotics (haloperidol), benzodiazepines, vitamin C (promotes excretion), antihypertensives, propranolol (BP + tachycardia control).
    • Opiates (morphine, heroin, methadone): Contracted pupils; needle marks; sleeping at unusual times; sweating; vomiting; coughing and sniffling; twitching; loss of appetite; no response of pupils to light.
      • Withdrawal: Anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection ("cold turkey"). Fever, rhinorrhea, nausea, stomach cramps, diarrhea ("flulike" symptoms)
      • methadone, suboxone (buprenorphine + naloxone) long-acting oral administration with fewer withdrawal symptoms than methadone.
    • Depressants (including barbiturates and tranquilizers): Contracted pupils; seems drunk as if from alcohol but without the associated odor of alcohol; difficulty concentrating; clumsiness; poor judgment; slurred speech; and sleepiness.
      • Withdrawal: anxiety, seizures, delirium, similar to alcohol, life-threatening cardiovascular collapse.
      • Treatment: long-acting benzodiazepines with taper.
    • Inhalants (Glues, aerosols, and vapors): Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; anxiety; irritability.
      • Withdrawal: not well characterized, no treatment.
    • Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
      • Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep.
      • Treatment: symptomatic treatment only.
  39. Depressive disorder (ReelDx)

    5 or more SIEGECAPS for ≥ 2 weeks nearly every day and at least one of the symptoms is depressed mood or anhedonia
    • SIGECAPS: SadnessInterest/anhedonia, Guilt, Energy, Concentration, Appetite, Psychomotor activity, Suicidal
    • Continue to increase dosage q3–4wk until symptoms in remission. Full medication effect is complete in 4–6 weeks. Augmentation with 2nd medication may be necessary.
    • See within 2–4 weeks of starting medication and q2wk until improvement, then monthly to monitor medication changes
  40. Obesity and Binge Eating Disorder (ReelDx)

    Definition of obesity
    • Adults BMI = 30 kg/ m2 or, alternatively, 20% higher than suggested ideal body weight
    • Children and adolescents BMI at the 95th percentile or higher
    Binge eating disorder
    • Recurrent binge eating > 2 days/wk for 6 mos
    • Inappropriate weight control
    • >3 of following:
      • Eating rapidly, until very full, large amounts  when not hungry, alone out of embarrassment
      • Feeling disgusted/depressed/guilty afterward
    Bariatric surgery:  A body mass index of greater than 40 kg/ m2 or a body mass index of 35 kg/ m2 with an obesity-related comorbidity (e.g., diabetes, hypertension) are indications of bariatric surgery and are able to adhere to postoperative care.
  41. Two types of anorexia nervosa are recognized:
    • Restricting type: Patients restrict food intake but do not regularly engage in binge eating or purging behavior; some patients exercise excessively.
    • Binge-eating/purging type: Patients regularly binge eat and then induce vomiting and/or misuse laxatives, diuretics, or enemas.
    • Anorexia nervosa can be distinguished from bulimia nervosa by BMI < 17 or body weight < 85% of ideal body weight.
  42. Attention-Deficit/hyperactivity Disorder (ReelDx)

    Hyperactivity, impulsivity, or inattentiveness manifesting before age 7
    • > 6 symptoms of inattention, hyperactivity-impulsivity, developmentally inappropriate and duration of symptoms > 6 months
    • Symptoms must occur in more than one setting (example school and home)
    • 1st line meds – caution: wt. loss & ↓ growth with stimulants!
      • methylphenidate (Ritalin, Concerta, Daytrana)
      • dexmethylphenidate (Focalin)
      • amphetamine/dextroamphetamine (Adderall, Dexedrine)
      • atomoxetine (Strattera) selective norepinephrine atomoxetine (Strattera) selective norepinephrine reuptake inhibitor (non-stimulant)
    • 2nd line/adjuncts
      • antidepressants (guanfacine, clonidine, imipramine, bupropion, venlafaxine)
      • Behavior modification, family, educational management
  43. Panic disorder (ReelDx)

    Panic disorder is characterized by recurrent, unexpected panic attacks with at least a month or more of worry or avoidant behavior. Panic disorder can occur with or without agoraphobia.  Symptoms develop abruptly and reach a peak within 10 minutes.
    • Palpitations, chest pain, sweating, SOB, etc. etc.
    • SSRIs: Paroxetine, Sertraline, Fluoxetine
      • Benzodiazepines: for acute attacks (watch for abuse)
      • CBT (relaxation, desensitization, examining behavior consequences)
  44. Lymphoma (ReelDx)

    Hodgkin's Lymphomapainless lymphadenopathy + bimodal age distribution (15-35) and (>60)
    • Fever, chills, and night sweats for > 1 month. Painless enlarged posterior cervical and supraclavicular lymph nodes Virchow’s nodeCXR - mediastinal adenopathy. Excisional biopsy of lymph node shows Reed-Sternberg cells
    Non-Hodgkin Lymphoma
    • Look for an immunocompromised (HIV) Patient with GI symptoms and painless peripheral lymphadenopathy
  45. Varicella (chicken pox): primary infections - clusters of vesicles on an erythematous base.
    • Dew drops on a rose petal in different stages.
    • Starts on the face and spreads down.
    • Acutely causes chickenpox - becomes latent in the dorsal root ganglion.
    • Symptomatic treatment may use acyclovir in special populations.
    Herpes zoster (shingles): varicella reactivation causing maculopapular rash along one dermatome.
    • Identified via tzanck smear with visualization of multinucleated giant cells.
    • Zoster Opthalmicus: shingles involving CCN V, dendritic lesions on slit lamp exam if keratoconjunctivitis is present.
    • Zoster Oticus (Ramsay-Hunt Syndrome): facial nerve (CN VIII) otalgia, lesions on the ear, auditory canal and TM, facial palsy auditory symptoms.
    • Treat shingles with acyclovir, valacyclovir, and famciclovir - given within 72 hours to prevent post-herpetic neuralgia.
    • Postherpetic Neuralgia: pain > 3 months, paresthesias or decreased sensation. Treat with gabapentin or TCA, topical lidocaine gel, and capsaicin.
    • Herpes zoster vaccine is a live, attenuated virus vaccine - vaccination is recommended for immunocompetent adults > 60 years of age.
  46. Influenza (ReelDx)

  47. Herpes simplex (ReelDx)

    • HSV 1 - Oral lesions commonly called cold sores (tongue, lips etc.)
    • HSV 2 - Genital lesions (vulva, vagina, cervix, glans, prepuce, and penile shaft)
    • HHV 3 - VZV (Varicella Zoster Virus commonly known as chickenpox or shingles)
    • HHV 4 - EBV (Ebstein Barr Virus is commonly known as infectious mononucleosis [mono or glandular fever])
    • HHV 5 - CMV (Cytomegolo Virus is the most common virus transmitted to a pregnant woman's unborn child)
    • HHV 6 - Roseolovirus is more commonly known as the 6th disease or Roseola Infantum
    • HHV 7 - Similar to HHV6 (not yet classified)
    • HHV 8 - A type of rhadinovirus known as the Kaposi's sarcoma-associated herpesvirus (KSHV)