Commonly Confused Topics - Sarah Michelle Questions and Complete Solutions Graded A+

  1. actinic keratosis vs. seborrheic keratosis - more concerning? Answer: Actinic Ker- atosis AK: form b/c of atypical growth of keratinocytes in the epidermal layer ACT=ACT fast with actinic keratosis b/c precursor to squamous cell carcinoma skin cancer; risk factor is SUN EXPOSURE (scalp, legs, arms, face) AK Tx: cryotherapy or 5FU aka fluorouracil (topical chemotherapy drug) 2. seborrheic keratosis Answer: seen in older population, benign, will not develop into cancer; appear as well-defined brown, tan, black growths that have a stuck on appearance 3. Erythema Migrans vs. Erythema Infectiosum - tickborne illness? Answer: Erythema Migrans! - rash associated with Lyme Disease Bulls Eye Lesion 4. Erythema Infectiosum (Fifth Disease) Answer: A viral disease characterized by a face that appears as "slapped cheeks," a fiery red rash on the cheeks. 5. Retinal Detachment vs. Acute Angle Closure Glaucoma - which painLESS?- Answer: Retinal Detachment - patients report blurry vision, flashes of light, and floaters; feel as though a curtain / something being pulled over field of vision 6. Acute Angle Closure Glaucoma Answer: due to increased intraocular pressure; PAINFUL with blurry vision and seeing halos; eye may feel firm to palpation upon assessment 7. Mononucleosis Answer: Mononucleosis: caused by Epstein Barr Virus, teens and young adults, transmitted through saliva s/s: prolonged severe fatigue, posterior cervical lymphadenopathy, sore throat, fever, SPLEEN enlargement (no contact sports - spleen rupture) Dx: mono spot blood test; get ultrasound to ensure spleen has returned to normal size 8. Strep Throat (Streptococcal Pharyngitis) Answer: -Caused by Group A streptococcus (GAS) Streptococcus pyogenes, Gram-positive cocci; grow in chains s/s Answer: anterior cervical lymphadenopathy, palatine petechiae, sore throat, fever, swollen tonsils Dx Answer: rapid strep test Tx Answer: Amoxicillin; can be treated by Penicillin-based drugs or Macrolide drugs for patients allergic to penicillin (e.g., erythromycin) 9. Mono/Strep Co-Infection Answer: if a patient has both strep and mono YOU WOULD prescribe antibiotics BUT NO AMOXICILLIN b/c morbilliform rash could develop (erythematous, maculopapular, measles-like); treat with macrolide like azithromycin or cephalosporin like cephalexin/keflex Note Answer: the only penicillin that won't cause the morbilloform rash is penicillin VK 10. TZDs vs. Thiazide Diuretics Answer: TZDs Answer: used for DM2; medication example is Pioglitazone (Actos) SE Answer: fluid retention, peripheral edema CI Answer: heart failure, liver issues, bladder cancer Thiazide Diuretics Answer: include medications like HCTZ or chlorthalidone (Thalitone); used in the tx of HTN and heart failure to treat edema Note Answer: chlorthalidone (Thalitone) is cardioprotective Remember Answer: TZDs cause fluid retention and Thiazide Diuretics remove fluid 11. Scabies vs. Pinworms (Enterobiasis) Answer: Scabies Answer: intense pruritis in webs of fingers, inner thighs, arm pits; worse at night; "linear burrows" hallmark feature Tx Answer: permetherin cream applied from neck to feet 8-14 hours after application; household members must be treated as well; wash all clothes and linens in hot water Pinworms (Enterobiasis) Answer: spread via fecal-oral route and intense pruritis is s/s specifically in the perianal area; search for worms 2-3 hours after infected individual has fallen asleep or scotch tape test in morning; needs 3 morning tests; pinworm eggs can be seen under microscope Tx Answer: mebendazole or albendazole "bend over" to get tape test 12. Somogyi effect vs. Dawn phenomenon Answer: Both cause hyperglycemia in the morning in Diabetics *Dawn Phenomenon* Answer: Release of Growth hormone, coritsol, catecholamines in the early morning --> hyperglycemia ; in normal patients, insulin would be released to control this hyperglycemia, but in diabetics, its not able to control the sugars *Somogyi Effect* Answer: Nocturnal hypoglycemia; a rebound hyperglycemia; educate pa- tients to eat snack, no vigorous exercise prior to bed, decrease insulin 13. Rocky Mountain Spotted Fever vs. Lyme Disease Answer: RMSF Answer: rash that works its way from hands/feet to trunk, rapid onset; distinctive rash on hands and feet; tx is doxycycline/vibramycin Lyme Disease Answer: bulls' eye rash, 3 stages; tx also doxycycline except pregnancy with Lyme disease then the treatment is amoxicillin; rash is erythema migrans both tick-born diseases 14. St. Johns Wart vs. Kava Kava Answer: SJW Answer: depression; monitor drug interactions especially serotonin/serotonin syndrome i.e., confusion, HA, N/V, diarrhea, dilated pupils, tachycardia, sweating KVKV Answer: anxiety 15. ACL vs. Meniscus Answer: ACL= stabilizes knee joint; s/s will see automatic swelling; utilize Lachman and Anterior Drawer Test; occurs from sudden stops and changing directions; injury is painful and patients unable to finish game or activity Lachman Test more specific Meniscus Answer: twisting with weight on the knee; patients report knee catching or locking up; will have delayed swelling; McMurray and Apley Grind Test 16. Chronic Venous Insufficiency (CVI) vs. Peripheral Artery Disease (PAD) Answer: - CVI Answer: VEINY - Very great pulses, Edematous, Indistinct shaped wounds/Inconsistent blood pooling, No severe pain/dull pain, Yucky reddish-brown ankles; patient may report irregularly shaped sores (stasis dermatitis); tx by pushing blood back up to body i.e., compression stockings, leg elevation, exercise PAD Answer: arteries=away; PAD results from narrowing of these arteries; decreased oxy- genated blood flow from your heart out to your body 17. Fidelity vs. Veracity Answer: Faithful Answer: calling a patient when we say we will; reliability Truthful Answer: being honest, clear, truthful about a bad diagnosis, even when difficult 18. Signs of Pregnancy (Presumptive, Probable, Positive) Answer: Presumptive Answer: N/V, amenorrhea, breast tenderness, quickening "Assumptions" - subjective s/s Probable Answer: hcg pregnancy test; HCG=Hegar, CHadwick, Goodell signs - "Probably Pregnant" Hegar Answer: softening of the lower part of the uterus Chadwick Answer: bluish discoloration of the cervix Goodell Answer: softening of the soft Positive Answer: think "PUF" - palpation, ultrasound, and fetal heart tones "definitely preg- nant" 19. Lichen Simplex Chronicus vs. Lichen Sclerosus Answer: LSC Answer: leads to chronic itch- ing; skin appears leathery/rubbery in appearance; atopic dermatitis/eczema can lead to this; tx includes topical steroids to reduce inflammation and antihistamines to limit itching LS Answer: most commonly found on genital and anal areas; postmenopausal women at high risk; s/s painful intercourse, tearing and white skin on the vulva; treated with high potency topical steroid clobetasol Note Answer: these patients are at a higher risk for squamous cell carcinoma cancer 20. S3 and S4 Heart Sounds Answer: Which can be heard in pregnancy and heart failure due to additional fluid? =S3 Also S3 in young healthy individuals like athletes S4 Answer: uncontrolled HTN, left ventricular hypertrophy, normal in older adults What heart sound is heard with closing of the semilunar valves? S2 i.e., aortic and pulmonic valves 21. Enterobiasis Answer: Pinworms 22. Measles Answer: Rubeolla 23. Stye Answer: Hordeollum (painful) 24. Swimmers Ear Answer: Otitis Externa 25. Cervical Spine Instability Answer: Atlanto-axial Instability 26. Temporal Arteritis Answer: Gaint Cell Arteritis 27. Heberden vs. Bouchard nodes Answer: Heberden Answer: DIP Bouchard Answer: PIP (both OA and RA) 28. Ischemic vs Hemorrhagic stroke Answer: Ischemic Answer: More common; clot develops in brain and impedes blood flow; No pain, No impaired consciousness Hemorrhagic Answer: blood vessel in brain bursts; more deadly; Headache + neurologic deficits gradually worsens as the hemorrhage expands A fib Answer: higher risk for ischemic stroke b/c can cause blood clots HTN Answer: hemorrhagic stroke 29. Basal Cell Carcinoma vs. Squamous Cell Carcinoma Answer: BCC- more common, sun exposed, de novo, papule nodule w/out central erosion, pearly waxy. Tissue destruction risk but low metastatic risk Telangiectasias SCC- less common, sun exposed, AK or de novo, red conical hard lesions Greater Metastatic risk Answer: lip, oral cavity, genitalia