Leik’s Exam Tips + My Extra
Good Stuff
Leik’s Exam Tips + My Extra Good Stuff
Medication
1) Aspirin irreversibly suppresses platelet function for up to 7 days (due to
irreversible acetylation).
2) Discontinue ASA if patient complains of tinnitus (possible aspirin toxicity).
3) For chronic use, the recommended dose is 81 mg/day (some exceptions exist).
4) Aspirin given post-MI or after a stroke/TIA is considered tertiary prevention.
5) Avoid using in children with viral infections who are less than 16 years of age
(Reye’s syndrome).
1) Memorize the FDA category and dose of finasteride (Proscar 5 mg PO once a day).
Finasteride is also a teratogen. Cat X medication
2) Accutane is a potent teratogen. Reproductive-aged females must use 2 reliable forms of
birth control and must have a negative pregnancy test 1 month before, during, and 1
month after Accutane.
3) High-dose vitamin A is teratogenic in animal studies—avoid “mega-doses” of vitamins
in pregnancy.
4) Avoid mixing warfarin with sulfa drugs—can increase INR and bleeding risk.
HEENT
■ Treatment for otitis externa is Cortisporin Otic drops.
■ Otitis externa’s common bacterial pathogen is Pseudomonas.
■ Ruptured spleen is a catastrophic event. Avoid contact sports (i.e., 4 weeks) until
ultrasound documents resolution.
■ Betimol (timolol) which is an eye drop used for glaucoma, has the same contraindications
as oral beta blockers.
■ Cholesteatoma, periorbital sinusitis complication which can cause hearing loss in the affected
ear and is a “cauliflower like growth” accompanied by foul smelling discharge. Patient will
have history of chronic otitis media. TM not visible due to tumor. Refer to ENT.
■ Do not use amoxicillin if used in the past 3 months. Advance to second-line antibiotics
such as Augmentin which is a beta lactam or Ceftin.
■ Penicillin-allergic patients, use macrolides, sulfas (avoid cephalosporins, especially if
had Class I reaction or anaphylaxis from penicillins).
■ Learn to recognize a description of eye findings such as pinguecula, pterygium, chalazion.
, Leik’s Exam Tips + My Extra
Good Stuff
Pinguecula: yellow, triangular thickening of the bulbar conjunctiva (skin covering eyeball).
Caused by UV light damage to collagen.
Pterygium: yellow, triangular (wedge-shaped) thickening of the conjunctiva that extends to the
cornea on the nasal or temporal cornea. UV damage, chronic sun exposure – benign – can be red
and inflamed at times.
Chalazion: chronic inflammation of the Meibomian gland of the eyelids (classic case: complains
of gradual onset of a small superficial nodule that is discrete and moveable on the upper eyelid
that feel like a bead, painless, can slowly enlarge over time.)
■ Rinne test result of BC greater than AC with conductive hearing loss (i.e., cerumenosis,
AOM). NORMAL IS AC>BC which means the patient hears longer in front of the ear rather than
over the mastoid.
■ Weber test result is lateralization to the “bad” or affected ear with conductive hearing
loss. NORMAL IS NO LATERALIZATION.
■ Weber or Rinne are testing the acoustic or CN 8.
■ Lateralization on the Weber exam is an abnormal finding.
■ Normal finding in Rinne test is air conduction that lasts longer than bone conduction
(AC greater than BC).
■ Remember what 20/40 vision means: patient can see at 20 feet what a person with
normal vision can see at 40 feet.
■ Carbamide peroxide (similar to hydrogen peroxide) is one of the most common
OTC treatments
for cerumenosis.
Xerostomia: Dry mouth
Xerophthalmia: Dry eyes
Papilledema: swollen optic disc due to IOP often due to bleeding or brain tumor.
HTN retinopathy: copper and silver wire arterioles
DM retinopathy: Cotton wool spots
Koplik’s spots: red papules w blue-white centers inside cheeks by lower molars seen in measles.
Dermatology
Differentiate between contact dermatitis and atopic dermatitis. The best clue is the unilateral
location and the shape of the lesions in contact dermatitis.
Contact dermatitis: reaction due to contact with irritating external substance; can be single
lesion or generalized rash within several minute or hours after contact. Classic Case: acute onset
of one to multiple bright red and pruritic lesions that evolve into bullous or vesicular lesions;
, Leik’s Exam Tips + My Extra
Good Stuff
easily ruptures, leaving bright red moist areas that are painful. When rash dries, it becomes
crusted; very pruritic and get lichenfied from chronic itching. Asymmetric distribution, or
localized area like around the finger where a ring would be.
Atopic dermatitis (eczema): chronic, inherited disorder extremely pruritic rashes on
hands, flexural folds which are AC and popliteal spaces, and neck. Exacerbated by stress
and cold. Infants up to 2 years will often have on cheeks, trunk, knees and elbows.
■ Rashes that are very pruritic at night and located on the interdigital webs and/or penis
are scabies until proven otherwise. Treat entire family. Wash linens/clothes in hot water.
■ Preferred antibiotic is Augmentin for human, dog, and cat bites.
■ Do not confuse actinic keratosis (precursor to squamous cell cancer) with seborrheic
keratoses (benign).
Actinic Keratosis: Older to elderly – numerous dry, round and red lesions with rough texture
that do not heal. Slow growing, most common in sun exposed areas such as cheeks, neck, face,
arms and back. Light colored skin highest risk. Precursor to squamous cell cancer.
Seborrheic Keratosis: soft, round, wart like fleshy growths in the truck, mostly on the back.
Lesions can vary in color from light tan to black. Asymptomatic and benign.
■ Diagnose hidradenitis suppurativa, psoriasis, RMSF, meningococcemia, erythema
migrans (Lyme disease), contact dermatitis, rosacea.
Hidradenitis suppurativa: usually staph aureus. patient complains of acute onset painful, large,
dark red nodules and papules under one or both axillae that become abscessed. Ruptured lesions
drain purulent green colored discharge. Pain resolves with draining and healing of abscess.
C&S of discharge. Treat with Augmentin or dicloxacillin, mupirocin ointment to nares and
fingernails, antibacterial soap and avoid deodorants during acute phase.
Psoriasis: Auspitz sign or Koebner phenomenon: New psoriatic plaques form over areas of skin
trauma.
RMSF: petechiae starting on both hands and feet, rapidly progressing to trunk until it becomes
generalized. Appears on third day after abrupt onset of fever (103-105 degrees) with severe
headache, myalgia, conjunctival injection, n/v, and arthralgia. Can be fatal. Mortality rate 3-9%.
Usually during spring and early summer. DO NOT DELAY TREATMENT OR WAIT FOR LAB
RESULTS. Treat with Doxycycline.
Meningococcemia: Sudden onset sore throat, cough, fever, headache, stiff neck, photophobia,
changes in LOC. Appearance could be toxic, can have petechial hemorrhage to axillae, flanks,
wrists, and ankles. High risk is college students residing in dorms. Spread by aerosol droplets.
DO NOT DELAY TREATMENT IF HIGH INDEX OF SUSPICION REFER TO ED STAT. Treat
with Rocephin plus Vanc. Treat any close contacts with Rifampin x 2 days.
Erythema migrans (Lyme Dz): Classic bulls eye lesion appearing 7-14 days after tick
bite accompanied by flu like symptoms. Treat w doxycycline.
Rosacea: chronic and relapsing inflammatory disorder. No cure. Classic Case: light skinned
adult to older patient with Celtic background. Chronic and small acne like papules around nose,
mouth and chin. Blushes easily. Treat with metronidazole get
, Leik’s Exam Tips + My Extra
Good Stuff
■ Instead of silvery scales, may see “covered with fine scales” with psoriasis.
Psoriasis will have Auspitz sign which is pinpoint areas of bleeding when plaque is removed.
■ Psoralens (tar-derived topicals) used to treat psoriasis, antimetabolite (methotrexate) for
severe cases.
■ How to treat mild and moderate acne. Mild acne is treated only with topicals. Moderate
is treated with both topical and oral tetracycline.
■ Accutane in females: Use two forms of reliable birth control.
■ “Herald patch” or a “Christmas tree” pattern is found in pityriasis rosea.
■ PHN (post-herpetic neuralgia) prophylaxis: Tricyclic antidepressants (TCA),
amitriptyline (Elavil).
■ A clue in a case scenario on cellulitis may involve a patient walking barefoot. Classic Case:
Most common location is legs or feet. Acute onset diffused pink to red skin on the trauma site
with poorly demarcated margin that grows larger. Lesion feels hot and may have an abscess
or purulent green drainage. Tinea pedis increases risk of LE cellulitis.
■ Recognize erysipelas versus other types of cellulitis.
Erysipelas is a subtype of cellulitis involving the upper dermis and superficial lymphatics usually
caused by Group A strep. Classic Case: Sudden onset of ONE large hot and indurated red lesion
that has clear demarcated margins. Usually on lower legs (shins) or cheeks. Accompanied by
fever or chills.
■ Treatment for rosacea is topical metronidazole gel.
■ Recognize herpetic whitlow. Viral skin infection of the finger(s) caused by type 1 or 2 HSV
from direct contact with cold sore or genital herpes lesion. Classic Case: complaint of acute
onset of extremely painful red bumps and small blisters on the sides of the finger, cuticle area,
or terminal phalanx of one or more fingers; may be recurrent. Ask about coexisting symptoms
or oral or genital herpes. Analgesics or NSAIDs for pain prn or Acyclovir for severe infections.
Xerosis: extremely dry skin
Cardiac
There are usually 2 or 3 questions regarding murmurs on the exam.
■ Learn to use the mnemonics “MR. ASH” and “MS. ART.” Or MR Peyton Manning as
MVP and ARMS
All diastolic murmurs are ABNORMAL.
■ Memorize the locations of the mitral area as well as the aortic area.
■ Regarding mitral murmurs, the word mitral will not be used because it is an obvious clue.
■ All murmurs with “mitral” in their names are only described as located:
Good Stuff
Leik’s Exam Tips + My Extra Good Stuff
Medication
1) Aspirin irreversibly suppresses platelet function for up to 7 days (due to
irreversible acetylation).
2) Discontinue ASA if patient complains of tinnitus (possible aspirin toxicity).
3) For chronic use, the recommended dose is 81 mg/day (some exceptions exist).
4) Aspirin given post-MI or after a stroke/TIA is considered tertiary prevention.
5) Avoid using in children with viral infections who are less than 16 years of age
(Reye’s syndrome).
1) Memorize the FDA category and dose of finasteride (Proscar 5 mg PO once a day).
Finasteride is also a teratogen. Cat X medication
2) Accutane is a potent teratogen. Reproductive-aged females must use 2 reliable forms of
birth control and must have a negative pregnancy test 1 month before, during, and 1
month after Accutane.
3) High-dose vitamin A is teratogenic in animal studies—avoid “mega-doses” of vitamins
in pregnancy.
4) Avoid mixing warfarin with sulfa drugs—can increase INR and bleeding risk.
HEENT
■ Treatment for otitis externa is Cortisporin Otic drops.
■ Otitis externa’s common bacterial pathogen is Pseudomonas.
■ Ruptured spleen is a catastrophic event. Avoid contact sports (i.e., 4 weeks) until
ultrasound documents resolution.
■ Betimol (timolol) which is an eye drop used for glaucoma, has the same contraindications
as oral beta blockers.
■ Cholesteatoma, periorbital sinusitis complication which can cause hearing loss in the affected
ear and is a “cauliflower like growth” accompanied by foul smelling discharge. Patient will
have history of chronic otitis media. TM not visible due to tumor. Refer to ENT.
■ Do not use amoxicillin if used in the past 3 months. Advance to second-line antibiotics
such as Augmentin which is a beta lactam or Ceftin.
■ Penicillin-allergic patients, use macrolides, sulfas (avoid cephalosporins, especially if
had Class I reaction or anaphylaxis from penicillins).
■ Learn to recognize a description of eye findings such as pinguecula, pterygium, chalazion.
, Leik’s Exam Tips + My Extra
Good Stuff
Pinguecula: yellow, triangular thickening of the bulbar conjunctiva (skin covering eyeball).
Caused by UV light damage to collagen.
Pterygium: yellow, triangular (wedge-shaped) thickening of the conjunctiva that extends to the
cornea on the nasal or temporal cornea. UV damage, chronic sun exposure – benign – can be red
and inflamed at times.
Chalazion: chronic inflammation of the Meibomian gland of the eyelids (classic case: complains
of gradual onset of a small superficial nodule that is discrete and moveable on the upper eyelid
that feel like a bead, painless, can slowly enlarge over time.)
■ Rinne test result of BC greater than AC with conductive hearing loss (i.e., cerumenosis,
AOM). NORMAL IS AC>BC which means the patient hears longer in front of the ear rather than
over the mastoid.
■ Weber test result is lateralization to the “bad” or affected ear with conductive hearing
loss. NORMAL IS NO LATERALIZATION.
■ Weber or Rinne are testing the acoustic or CN 8.
■ Lateralization on the Weber exam is an abnormal finding.
■ Normal finding in Rinne test is air conduction that lasts longer than bone conduction
(AC greater than BC).
■ Remember what 20/40 vision means: patient can see at 20 feet what a person with
normal vision can see at 40 feet.
■ Carbamide peroxide (similar to hydrogen peroxide) is one of the most common
OTC treatments
for cerumenosis.
Xerostomia: Dry mouth
Xerophthalmia: Dry eyes
Papilledema: swollen optic disc due to IOP often due to bleeding or brain tumor.
HTN retinopathy: copper and silver wire arterioles
DM retinopathy: Cotton wool spots
Koplik’s spots: red papules w blue-white centers inside cheeks by lower molars seen in measles.
Dermatology
Differentiate between contact dermatitis and atopic dermatitis. The best clue is the unilateral
location and the shape of the lesions in contact dermatitis.
Contact dermatitis: reaction due to contact with irritating external substance; can be single
lesion or generalized rash within several minute or hours after contact. Classic Case: acute onset
of one to multiple bright red and pruritic lesions that evolve into bullous or vesicular lesions;
, Leik’s Exam Tips + My Extra
Good Stuff
easily ruptures, leaving bright red moist areas that are painful. When rash dries, it becomes
crusted; very pruritic and get lichenfied from chronic itching. Asymmetric distribution, or
localized area like around the finger where a ring would be.
Atopic dermatitis (eczema): chronic, inherited disorder extremely pruritic rashes on
hands, flexural folds which are AC and popliteal spaces, and neck. Exacerbated by stress
and cold. Infants up to 2 years will often have on cheeks, trunk, knees and elbows.
■ Rashes that are very pruritic at night and located on the interdigital webs and/or penis
are scabies until proven otherwise. Treat entire family. Wash linens/clothes in hot water.
■ Preferred antibiotic is Augmentin for human, dog, and cat bites.
■ Do not confuse actinic keratosis (precursor to squamous cell cancer) with seborrheic
keratoses (benign).
Actinic Keratosis: Older to elderly – numerous dry, round and red lesions with rough texture
that do not heal. Slow growing, most common in sun exposed areas such as cheeks, neck, face,
arms and back. Light colored skin highest risk. Precursor to squamous cell cancer.
Seborrheic Keratosis: soft, round, wart like fleshy growths in the truck, mostly on the back.
Lesions can vary in color from light tan to black. Asymptomatic and benign.
■ Diagnose hidradenitis suppurativa, psoriasis, RMSF, meningococcemia, erythema
migrans (Lyme disease), contact dermatitis, rosacea.
Hidradenitis suppurativa: usually staph aureus. patient complains of acute onset painful, large,
dark red nodules and papules under one or both axillae that become abscessed. Ruptured lesions
drain purulent green colored discharge. Pain resolves with draining and healing of abscess.
C&S of discharge. Treat with Augmentin or dicloxacillin, mupirocin ointment to nares and
fingernails, antibacterial soap and avoid deodorants during acute phase.
Psoriasis: Auspitz sign or Koebner phenomenon: New psoriatic plaques form over areas of skin
trauma.
RMSF: petechiae starting on both hands and feet, rapidly progressing to trunk until it becomes
generalized. Appears on third day after abrupt onset of fever (103-105 degrees) with severe
headache, myalgia, conjunctival injection, n/v, and arthralgia. Can be fatal. Mortality rate 3-9%.
Usually during spring and early summer. DO NOT DELAY TREATMENT OR WAIT FOR LAB
RESULTS. Treat with Doxycycline.
Meningococcemia: Sudden onset sore throat, cough, fever, headache, stiff neck, photophobia,
changes in LOC. Appearance could be toxic, can have petechial hemorrhage to axillae, flanks,
wrists, and ankles. High risk is college students residing in dorms. Spread by aerosol droplets.
DO NOT DELAY TREATMENT IF HIGH INDEX OF SUSPICION REFER TO ED STAT. Treat
with Rocephin plus Vanc. Treat any close contacts with Rifampin x 2 days.
Erythema migrans (Lyme Dz): Classic bulls eye lesion appearing 7-14 days after tick
bite accompanied by flu like symptoms. Treat w doxycycline.
Rosacea: chronic and relapsing inflammatory disorder. No cure. Classic Case: light skinned
adult to older patient with Celtic background. Chronic and small acne like papules around nose,
mouth and chin. Blushes easily. Treat with metronidazole get
, Leik’s Exam Tips + My Extra
Good Stuff
■ Instead of silvery scales, may see “covered with fine scales” with psoriasis.
Psoriasis will have Auspitz sign which is pinpoint areas of bleeding when plaque is removed.
■ Psoralens (tar-derived topicals) used to treat psoriasis, antimetabolite (methotrexate) for
severe cases.
■ How to treat mild and moderate acne. Mild acne is treated only with topicals. Moderate
is treated with both topical and oral tetracycline.
■ Accutane in females: Use two forms of reliable birth control.
■ “Herald patch” or a “Christmas tree” pattern is found in pityriasis rosea.
■ PHN (post-herpetic neuralgia) prophylaxis: Tricyclic antidepressants (TCA),
amitriptyline (Elavil).
■ A clue in a case scenario on cellulitis may involve a patient walking barefoot. Classic Case:
Most common location is legs or feet. Acute onset diffused pink to red skin on the trauma site
with poorly demarcated margin that grows larger. Lesion feels hot and may have an abscess
or purulent green drainage. Tinea pedis increases risk of LE cellulitis.
■ Recognize erysipelas versus other types of cellulitis.
Erysipelas is a subtype of cellulitis involving the upper dermis and superficial lymphatics usually
caused by Group A strep. Classic Case: Sudden onset of ONE large hot and indurated red lesion
that has clear demarcated margins. Usually on lower legs (shins) or cheeks. Accompanied by
fever or chills.
■ Treatment for rosacea is topical metronidazole gel.
■ Recognize herpetic whitlow. Viral skin infection of the finger(s) caused by type 1 or 2 HSV
from direct contact with cold sore or genital herpes lesion. Classic Case: complaint of acute
onset of extremely painful red bumps and small blisters on the sides of the finger, cuticle area,
or terminal phalanx of one or more fingers; may be recurrent. Ask about coexisting symptoms
or oral or genital herpes. Analgesics or NSAIDs for pain prn or Acyclovir for severe infections.
Xerosis: extremely dry skin
Cardiac
There are usually 2 or 3 questions regarding murmurs on the exam.
■ Learn to use the mnemonics “MR. ASH” and “MS. ART.” Or MR Peyton Manning as
MVP and ARMS
All diastolic murmurs are ABNORMAL.
■ Memorize the locations of the mitral area as well as the aortic area.
■ Regarding mitral murmurs, the word mitral will not be used because it is an obvious clue.
■ All murmurs with “mitral” in their names are only described as located:
