NURS 623 Exam 100% with correct answers

NURS 623 Exam 100% Mode of transmission for parasitic skin infections - correct answer Close direct skin contact. Clinical presentation for Scabies - correct answer Intense itching, worse at night. Burrows noted between webs of fingers. Commonly prescribed medications for Scabies - correct answer 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. What should you include in the patient education to prevent spreading of the various parasitic skin problems? - correct answer 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. Which bacterial skin infection is considered highly contagious? - correct answer Impetigo What is the "classic" presentation of impetigo? - correct answer Honey crusted lesions What is the management of a minor case of folliculitis (non-pharmacologic)? - correct answer Gentle cleansing by washing the skin twice a day with antibacterial soap. What are the commonly prescribed medications for folliculitis? - correct answer 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. Furuncles - correct answer 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. Carbuncles - correct answer 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. What are the considerations when determining treatment for cellulitis? - correct answer 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. HSV - correct answer 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. Diagnostic tests for HSV - correct answer 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 - correct answer requires immediate referral to an ophthalmologist. HSV-2 Genital lesion treatment - correct answer 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. HSV-1 oral lesion treatment - correct answer 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. HSV Patient education - correct answer 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. Which dermatitis is an inherited skin reaction that begins in infancy - correct answer Atopic dermatitis What is the "atopic triad?" - correct answer Atopic eczema, asthma, and allergies What dermatitis is associated with the expression "the itch that rashes?" - correct answer Atopic dermatitis What is the objective finding with atopic dermatitis? - correct answer 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. What is the primary aim in management of atopic dermatitis? - correct answer Control signs and symptoms because there is no cure. What is the non-pharmacologic and pharmacologic management for atopic dermatitis? - correct answer 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. What is the cardinal symptom of contact dermatitis? - correct answer Pruritic erythematous rash contact dermatitis - correct answer Rough, red patches, weeping lesions with tiny vesicles. What is the non-pharmacologic and pharmacologic management for contact dermatitis? - correct answer 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. seborrheic dermatitis - correct answer 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 Seborrheic dermatitis treatment - correct answer 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. Is seborrheic dermatitis contagious? - correct answer No Psoriasis - correct answer 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. What is the Auspitz's sign? - correct answer Multiple small sites of bleeding are noted when the psoriasis scales are traumatically removed. What is the goal of management for psoriasis? - correct answer 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. What is the first line pharmacotherapeutics for psoriasis if 20% of the body is involved? - correct answer Topical agents are the first line therapy. Emollients twice daily. When should you refer a patient with psoriasis to a dermatologist or psoriasis specialty clinic? - correct answer 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. What should be included in the patient education of psoriasis? - correct answer 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. What is the clinical presentation of acne vulgaris? - correct answer 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. What is different in the presentation of rosacea versus acne? - correct answer 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. What are the commonly prescribed medications for acne and rosacea? - correct answer 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. When would you choose a topical medication versus systemic antibiotics in the treatment of acne vulgaris? - correct answer Mild cases can use topical. Moderate to severe with lots of inflammation may need systemic antibiotics. What are the concerns with prescribing tretinoin (Retin-A)? - correct answer 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%. What is the clinical presentation of seborrheic keratosis? - correct answer 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. Management of seborrheic keratosis - correct answer 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. acne vulgaris patient teaching - correct answer 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. Roscea Patient teaching - correct answer 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. What is the clinical presentation and management of actinic keratosis? - correct answer 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. Risk factors for malignant melanoma - correct answer 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. What is the clinical presentation of malignant melanoma? - correct answer 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. Patient education for prevention of melanoma - correct answer 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 ABCDE of malignant melanoma - correct answer 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? basal cell carcinoma - correct answer 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. squamous cell carcinoma - correct answer SCC firm papule with scaly (keratotic) rough surface with irregular borders and they bleed very easily. Diagnosis and management of BCC & SCC - correct answer Diagnosis: Referral to Dermatologist for a biopsy. Management: Dermatologist Excision. Full skin assessment every 6-12 months. microcytic anemia - correct answer iron deficiency anemia Anemia of Chronic Disease Thalassemia What if any, additional diagnostic test do you need to determine the cause of a microcytic anemia? - correct answer 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. What is the clinical presentation of microcytic anemia? - correct answer Tachycardia, SOB, fatigue, DOE, palpations, lightheadedness, poor concentration, anorexia, dizziness, PICA. Sallow-colored skin, pale mucous membranes, tachycardia, and tachypnea at rest. treatment for iron deficiency anemia - correct answer 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. Anemia of Chronic Disease treatment - correct answer 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. Anemia from Thalassemia - correct answer referral to hematologist. Foods that would be recommended in the treatment of iron deficiency anemia - correct answer Green leafy vegetables, legumes, animal protein What are potential causes of normocytic MCV 81-99 anemia? - correct answer Anemia of chronic disease, hemolysis, or volume overload. When do you follow up with patients who have normocytic anemia? - correct answer Follow up every 6 months. If peripheral smear is positive for morphology referral to hematologist is indicated. What are the anemias associated with the classification of macrocytic anemia? - correct answer Vitamin B12 Deficiency Folate Deficiency Antimetabolite medication: methotrexate The most common is the hereditary autoimmune disorder called pernicious anemia What is the clinical presentation of patients with macrocytic anemia? - correct answer 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. Treatment for Vitamin B 12 deficiency - correct answer - Oral Cobalamin 1000mcg/d (6-12 weeks) Monthly CBC & Vit B 12 levels Treatment for Vitamin B 12 deficiency from Pernicious and malabsorption: - correct answer • 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. Folate deficiency anemia treatment - correct answer Folic acid, 1mg/day. Folic acid is found in citrus fruits, dark green leafy vegetables and animal proteins. What is the cardinal sign of a sickle cell crisis? - correct answer 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. the seven-step approach to anaphylaxis - correct answer 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 What is rheumatoid arthritis (RA)? - correct answer A chronic progressive systemic inflammatory disease that primarily affects the synovial joints. A connective tissue disease. CML (chronic myelogenous leukemia) - correct answer - Clonal, neoplastic expansion of multipotent myeloid stem cell [myeloproliferative disease) -NEB cells Etiology - Philadelphia chromosome - reciprocal translocation of long arms of 9 & 22 Acute Lymphocytic Leukemia (ALL) - correct answer the most common form of leukemia in adults over 70 years of age; characterized by overproduction of lymphocytes What is the virus that causes the majority of infectious mononucleosis cases? - correct answer EBV Clinical presentation of RA - correct answer 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 What is the preferred initial test for the diagnosis of RA? - correct answer Serum qualitative and quantitative RF titer, ESR, CRP, & CBC What is the initial management of RA? - correct answer 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. chronic fatigue syndrome (CFS) - correct answer 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. Fibromyalgia - correct answer 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. Sjogren's syndrome - correct answer 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. Sjogren's syndrome patient education for symptom management - correct answer 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. systemic lupus erythematosus (SLE) - correct answer 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 clinical presentation for infectious mononucleosis - correct answer • 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. Mono diagnosis, treatment and patient education - correct answer • 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 What is the cause of Lyme's disease? - correct answer Borrelia burgdorferi (tick bite) Differentiate between early and late signs associated with Lyme's disease. - correct answer • 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 Lyme disease treatment - correct answer 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) What are the guidelines for initiating antibiotic therapy for Lyme's disease? - correct answer Within 72 hours of attachment and EM noted. What are the risk factors for HIV infection? - correct answer 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. What physical findings should prompt consideration of HIV testing? - correct answer 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 What is the significance of the HIV viral load? - correct answer 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. What is the recommended initial screening for HIV? - correct answer HIV ½ Antigen/Antibody test Describe the risk groups you would start HIV pre-exposure prophylaxis (PrEP). - correct answer 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. What are the initial and monitoring tests you order prior to PrEP? - correct answer • 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 Describe risk factors of individuals who should be started on post-exposure prophylaxis (PEP). - correct answer • 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 tinea capitis - correct answer A fungal infection of the scalp characterized by red papules, or spots, at the opening of the hair follicles. tinea pedis - correct answer fungal infection of the foot; athlete's foot Tinea versicolor - correct answer 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. Tinea versicolor treatment - correct answer 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. Tinea pedis treatment - correct answer 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 tinea capitis treatment - correct answer 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. Tinea cruris (jock itch) - correct answer 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. What is the most common cause of relative polycythemia? - correct answer Dehydration Acute: vomiting, fever, burns, crush injuries, decreased oral intake in elderly etc Chronic- Diuretic use like furosemide What is the clinical presentation with polycythemia? (absolute/relative) - correct answer 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% patient education for polycythemia - correct answer 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.