WITH ANSWERS GRADED A+
✔✔Hospitalization in HF - ✔✔-Goal is to stay out of hospital
-Lack of compliance is large contributor; 41% of cases; pt education is key
-Est. that >50% of readmissions are preventable (no reimbursement)
✔✔Treatment Approach in HF - ✔✔-Alleviate sxs
-Delay progression
-Reduce mortality
✔✔Treatment Approach in HF by Stage - ✔✔Stage A: Treat HTN and other
comorbidities, encourage healthy lifestyle
Stage B: Continue Stage A tx plan; ACEI, BB
Stage C: Continue Stage A tx plan; Diuretics, ACEI,, BB, Digoxin, Aldosterone
Inhibitors, Lifestyle modifications (Na+/Fluid restriction)
Stage D: All previous measures, mechanical assist, Heart transplant, Hospice
✔✔Lifestyle Management of HF - ✔✔-2gm Na restriction
-1 tsp salt =2,300mg sodium
-Daily I&Os at home
-Need close, continuous monitoring
-Telemedicine services
-Specialized HF clinic-based care
✔✔Hair Changes due to Aging - ✔✔Men:
-Men begin to lose during their 20's
-Hairline recedes or male pattern baldness may occur
-Increased hair growth in ears, nostrils and on eyebrows
-Loss of body hair
Women:
-May experience a receding hairline but do not usually bald
-Hair becomes thinner, loss of body hair
-Increased hair growth at chin and around lips
✔✔Toenail Changes due to Aging - ✔✔-Becme thicker and more difficult to cut
-Grow more slowly
-May have a yellowish color
✔✔Epidermis Changes due to Aging - ✔✔-The number of epidermal cells decreases by
10% per decade and they divide more slowly making the skin less able to repair itself
quickly
-Epidermal cells become thinner making the skin look noticeably thinner
-Changes in epidermis allows more fluid to escape the skin
,✔✔Dermis Changes due to Aging - ✔✔-Dermal layer thins
-Less collagen is produced
-Elastin fibers that provide elasticity wear out
-Function of sebaceous and sweat glands contribute to dry skin (Xerosis)
✔✔Subcutaneous Changes due to Aging - ✔✔-The fat cells get smaller
-This leads to more noticeable wrinkles and sagging
✔✔Skin Cancer - ✔✔-Most common cancer in US
-Basal cell is the most common type of skin cancer
✔✔Actinic Keratosis - ✔✔Pre-cancerous
-Size and shape variable
-Pink-red base
-Rough/gritty keratotic surface
-Macule or papule
-Areas w/most sun exposure (head, neck, hands)
-10-20% risk of actinic keratosis turning into Squamous Cell Carcinoma
-Multiple treatment modalities including LN2, curettage, topical chemotherapy (5-FU) or
immunotherapy- imiquimod
✔✔Squamous Cell Carcinoma - ✔✔-SCC typically appear as persistent, thick, rough,
scaly patches that can bleed if bumped, scratched or scraped, they often look like warts
and sometimes appear as open sores w/a raised border and a crusted surface
-Can metastasize
-"Doesn't heal"
✔✔Basal Cell Carcinoma - ✔✔Most common type of skin cancer
Commonly presents as a sore that seems to get better and then recurs and may start to
bleed
BCC commonly occurs on face/neck (sun exposure)
Locally invasive, burrowing
Do NOT metastasize
-Variable size/shape
-Typically translucent-pink color w/torturous telangiectasias (pigmented BCCs that have
dark brown/black globules)
-Pearly smooth/lobular/rolled borders may have a hemorrhagic crust/ulcerated center
-Papule/plaque
-Photoexposed areas
-Slow growing
-Lighter Fitzpatrick skin types
✔✔Melanoma Risk Factors - ✔✔-Asymmetry- irregular shape
-Borders- irregular/ragged, not smooth and even
-Colors- multiple
, -Diameter- +6mm
-Evolving- changing
-Fair skin/Family hx
-UV exposure/blistering sun burns
✔✔Patterns of Skin Lesion Distribution - ✔✔-Annular: ring pattern
-Scattered: generalized over body w/o a pattern
-Confluent: more than one lesion together
-Linear: line like or streaks
-Reticular: net-like
-Dermatomal: follows dermatome
✔✔Treatment for Acne - ✔✔-Retinoids
-Benzoyl peroxide
-Extraction/peels/microdermabrasion
-Topical abx, oral abx
-Consider OCP is r/t menses
-Accutane for cystic acne/failed other methods
✔✔PO Treatments for Acne - ✔✔Oral Abx:
-Tetracycline 500mg BID
-Doxycycline 100mg QD/BID
-Minocycline 100mg QHS/BID
-Erythromycin 333mg TID
-Bactrim DS BID
Hormonal- OCPs/Aldactone
Accutane- Referal to derm
✔✔Psoriasis - ✔✔-Squamous epithelial cells undergo rapid turnover producing plaques
-Chronic, autoimmune, possible AD inheritance
-Rare in childhood, men = women
-Caucasians > African Americans > Asians
-Environmental factors precipitate disease, especially stress
-QOL considerations
-Demarcated, red, scaling papules into round/oval plaques
-Adherent silvery white scale
-Auspitz's sign: bleeds when removed
-Elbows, knees, scalp, gluteal cleft, fingernails, toe nails, extensor surfaces, more than
flexor surfaces
-Can occur w/or preceed psoriatic arthritis
✔✔Grading Tumors - ✔✔-Refers to the degree of differentiation of cell type
G1
G2
G3 (highest malignant potential)