Term
| List the 7 steps before you begin the chief complaint portion of the interview. |
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Definition
1. Introduction
2. Wash hands
3. General survery - "Pt appears healthy and in no apparent distress".
4. Level of consciousness - (name, where are they, date) - "pt is AO x 3".
5. Age - "pt appears stated age".
6. Grooming/Hygiene - "pt is well groomed and dressed appropriately".
7. Body Habitus - "pt has a normal body habitus without any obvious physical deformity". |
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Term
| List the 20 steps of the CC/HPI/PMH. |
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Definition
1. CC.
2-8. HPI - OPPQRST (has this happened before?).
9. General symptoms (nausea, vomiting, diarrhea, fever, chills, night sweats, weight loss, loss of appetite, fatigue, SOB, headache, photophobia, syncope, dizziness, paresthesia, extra stress, trauma)
10. Current illness/disease.
11. Childhood illness/disease.
12. Current medications.
13. Past hospitalization/surgery
14. Any allergies (environmental or drug).
15. Preventative care (immunizations or screening tests).
16. Family history of disease.
17. Social history (occupation, sick contacts, married, children).
18. Sexual history
19. Drug use (alcohol, tobacco, illicit, caffeine).
20. Recent travel. |
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Term
| 6 specific questions for acne vulgaris? |
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Definition
1. Does your face flush when eating hot/spicy food?
2. Have you changed any medications lately?
3. Do you use cosmetics?
4. Have you changed any lotion/soap/facial products lately?
5. How often do you wash your face?
6. Have you been under any extra stress? |
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Term
| What labs would you order for acne vulgaris? |
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Definition
| None, unless it is resistant to treatment. |
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Term
What is the treatment for acne vulgaris?
Severe tx? |
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Definition
Twice daily cleansing of the face with benzoyl peroxide wash, clindamycin lotion, topical retinoids and tetracycline.
Severe = Isotretinoin |
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Term
| How would you educate a patient with acne vulgaris? |
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Definition
| Use only non-comodogenic products on skin, do not pick at the lesions and if they are on Isotretinoin they must be very careful not to get pregnant because it has extreme teratogenic effects so they must take monthly pregnancy tests. |
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Term
|
Definition
| Acne vulgaris, impetigo, folliculitis, acne rosacea, perioral dermatitis. |
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Term
| 4 specific questions for Psoriasis? |
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Definition
1. Recent trauma to the area?
2. Any changes in soap/deodorant/lotion?
3. Any joint pain?
4. Increased stress? |
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Term
| What labs would you order for Psoriasis? What do you want to make sure you check for on PE? |
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Definition
| None needed. Check for Auspitz sign during the PE. |
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Term
What is the treatment for Psoriasis?
Severe Psoriasis? |
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Definition
| 1-2% salicylic acid cream, cortisone cream, vitamin D3 analog cream, and phototherapy. Severe = Methotrexate. |
|
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Term
| How would you educate a patient with psoriasis? |
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Definition
| Do not scratch or rub because it will stimulate the proliferation process. |
|
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Term
|
Definition
| Psoriasis, Lichen Simplex Chronicus, Lichen Planus, Tinea Corporis, or Psoriasiform drug eruption. |
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Term
| 9 specific questions for Herpes Simplex. |
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Definition
1. Burning/irritation while urinating?
2. Any genital discharge?
3. Any lower abdominal pain?
4. Do you use contraceptives?
5. Last STD (HIV) test?
6. Result of last STD test?
7. Number of sexual partners?
8. Sexual orientation?
9. Any neurologic dysfunction? (For encephalitis/meningitis) - (photophobia, irritability, seizures, confusion). |
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Term
| What are some common clinical manifestations of Herpes Simplex? |
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Definition
| Mucocutaneous infection is most common, erythema multiforme, genital infection is sexually transmitted, and it can possibly cause herpes encephalitis. |
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Term
| What labs would you order for Herpes Simplex? |
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Definition
| Direct immunofluorescent assay, Western blot, and ELISA. |
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Term
| What is the treatment for Herpes Simplex? |
|
Definition
|
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Term
| How would you educate a patient with Herpes Simplex? What else must you do? |
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Definition
| Safe sex and sunscreen to prevent outbreaks. Must inform CDC and have all sexual partners tested. |
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Term
| 5 DDX for Herpes Simplex? |
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Definition
| Herpes Simplex, Syphilis, Chancroid, Lymphogranuloma venereum, and Apthous ulcers. |
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Term
| 8 specific questions for Lyme disease? |
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Definition
1. Been outdoors or in wooded areas lately?
2. Did you notice a tick bite?
3. Do you use insect repellent?
4. Any facial paresthesias?
5. Any lymph node involvement?
6. Is it hot to the touch?
7. Have you noticed any purple lumps anywhere?
8. Any neurological problems? (Meningitis) - think headache, fever, stiff neck |
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Term
| Characteristic lesions/progression of disease and causative agent of Lyme disease? |
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Definition
| "Bull's Eye" rash that progresses to a purple lump on earlobe, nipple or scrotum and eventually causes neuropathy, it is caused by Borrellia burgdorferi. |
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Term
| What labs would you order for Lyme disease? |
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Definition
| ELISA with confirmatory Western blot. Spinal tap if meningitis suspicion. |
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Term
| How do you treat Lyme disease? |
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Definition
Children = amoxicillin.
Adults = Doxycycline. |
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Term
| How would you educate a patient with Lyme Disease? |
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Definition
| Avoid tick infested areas, cover up with clothes, use repellent and let them know about the Lyme disease vaccine. |
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Term
|
Definition
| Lyme Disease, Cellulitis, Erythema multiforme, Bell's Palsy, meningitis with insect bite, and Rickettsiosis. |
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Term
| 6 specific questions for Vitamin B12 / Iron deficiency anemia? |
|
Definition
1. Any tongue changes?
2. Any changes to the corners of your mouth?
3. Have you noticed that your extremities are pale or cold?
4. Ice or other unusual cravings?
5. Difficulty sleeping or concentrating?
6. Hearing problems? |
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Term
| What labs would you order for Vitamin B12/Iron deficiency anemia? How will they be distinguished? What test do you want to make sure you do on physical exam? |
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Definition
CBC -(B12 deficiency will be macrocytic and Iron deficiency will be microcytic).
Serum vitamin B12 levels and serum ferritin (both will be low with their respective diseases). Also order a rectal hemoccult.
Make sure to do a neuro check on the extremities (sharp/dull and light touch). |
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Term
| What is the treatment for Vitamin B12 deficiency? Iron deficiency anemia? |
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Definition
| B12 supplementation and Iron supplementation. Possible RBC transfusion if severe. Must also find the root cause! |
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Term
| 6 DDX for Vitamin B12/Iron deficiency anemia? |
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Definition
| Vitamin B12 anemia, Iron deficiency anemia, Folic acid anemia, dementia, lead poisoning, Thalassemia. |
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Term
| 9 specific questions for Sickle cell anemia? |
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Definition
1. Are you staying hydrated?
2. Are your extremities cold or pale?
3. Have you had any ulcers?
4. Have you noticed any hand/foot swelling?
5. Have you experienced any visual problems?
6. Have you experienced any hearing problems?
7. Do you have cravings for ice or any other unusual items?
8. Difficulty sleeping or concentrating?
9. Chest ROS (chest discomfort, palpitations, exertional dyspnea, orthopnea, PND, murmurs, last EKG/stress test/echo). |
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Term
| What labs would you order for Sickle cell anemia? |
|
Definition
| Hb electrophoresis to diagnose, peripheral smear, cardiac enzymes to rule out MI. |
|
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Term
| What is the treatment for Sickle cell anemia? |
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Definition
| Analgesics and IV hydration, blood transfusion, antibiotic prophylaxis and Hydroxyurea to reduce the rate of sickle cell crisis. |
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Term
| How would you educate a patient with sickle cell anemia? |
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Definition
| Avoid high altitudes and dehydration, and treat any infection promptly. |
|
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Term
| 6 DDX for Sickle cell anemia? |
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Definition
| Sickle cell anemia, Appendicitis, chronic anemia, gout, heart disease, kidney stone. |
|
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Term
| 5 specific questions for ITP (Idiopathic thrombocytopenic purpura)? |
|
Definition
1. Any mucous membrane bleeding?
2. Recent viral illness/live vaccine?
3. Abnormally heavy menstruation?
4. Do you have any previous labs?
5. Any previous or pending consults? |
|
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Term
| Describe the etiology and symptoms seen with ITP. |
|
Definition
| Autoimmune destruction of platelets that commonly follows a viral infection. Symptoms include petechial rash, easy brusing, and mucosal bleeding. |
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Term
| What labs would you order for a patient with ITP? |
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Definition
| CBC - platelet count will be low |
|
|
Term
|
Definition
| Oral prednisone, gamma-globulin injection, drugs that increase thromocyte production, and immunosuppressants. |
|
|
Term
|
Definition
| ITP, Thrombocytopenia due to other diseases (anemia, leukemia), pseudothrombocytopenia, TTP, DIC, HUS. |
|
|
Term
| 8 specific questions for dog bite? |
|
Definition
1. Do you know the owner of the dog?
2. Do you know if the dogs immunizations are UTD?
3. Was the dog foaming at the mouth?
4. Where is the dog now?
5. Have you noticed any neurologic changes? (anxiety, drooling, convulsions, excitability, paresthesias, or muscle weakening).
6. Do you have full range of motion?
7. Are you right or left handed?
8. Have you done anything to treat the wounds? |
|
|
Term
| What labs would you order for a dog bite? |
|
Definition
| CBC with differential, test serum/CSF for Rabies. |
|
|
Term
| What is the treatment for a dog bite? |
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Definition
| Wound care, antibiotics, post-exposure rabies vaccine and human rabies immunoglobulin if suspicion of rabies. |
|
|
Term
| How do you educate a patient with a dog bite? |
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Definition
| Stay away from stray animals and vaccinate your pets. |
|
|
Term
|
Definition
| Rabies, tetanus, meningitis, encephalitis. |
|
|
Term
| 6 specific questions for RMSF? |
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Definition
1. Have you recently spent time in heavily wooded areas lately?
2. Did you notice a tick on your body anywhere?
3. Did you use insect repellent?
4. Any neurologic symptoms (headache, restlessness, insomnia or delerium)?
5. Do you have any muscle aches?
6. Do you have any joint pain? |
|
|
Term
| Describe the clinical presentation of RMSF. |
|
Definition
| Fever accompanied by myalgia, arthralgia and neurological symptoms (headache, restlessness, insomnia and delerium) and then a rash appears on the periphery and spreads to the trunk. |
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|
Term
| What labs would you order for RMSF? |
|
Definition
CBC - increased WBCs and decreased platelets.
CSF - increased protein and decreased glucose. (If spreads to meningitis) |
|
|
Term
| What is the treatment for RMSF? |
|
Definition
|
|
Term
| How would you educate a patient with RMSF? |
|
Definition
| Avoid heavily wooded areas, use insect repellent, come back in immediate if you start to experience neurological symptoms. |
|
|
Term
|
Definition
| RMSF, meningitis, Syphilis (2nd degree), Typhoid, Measles, Typhus, Scarlet Fever. |
|
|
Term
| 2 specific questions for Cellulitis/MRSA? |
|
Definition
1. Any recent insect bites or other new portals of entry?
2. Have you been swimming in a lake or ocean lately? |
|
|
Term
|
Definition
| Characterized by a bright red appearance of the involved skin which forms a sharply demarcated line from surrounding normal skin. (It may blister). |
|
|
Term
| What labs would you order for MRSA/cellulitis? |
|
Definition
| CBC with diff, blood culture and swab analysis of the wound. |
|
|
Term
| What is the treatment for MRSA? |
|
Definition
|
|
Term
| How do you educate a patient with MRSA? |
|
Definition
| Wash hands regularly, regular bathing, avoid sharing items that may be contaminated and keep any open wounds clean and covered. |
|
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Term
| 4 DDX for MRSA/Cellulitis? |
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Definition
| MRSA/Cellulitis, insect bite, folliculitis, necrotizing fascitis. |
|
|
Term
| What PE test should you do to differentiate Vitamin B12 deficiency? |
|
Definition
| Do vibratory test, only vitamin B12 deficiency will have problem. |
|
|
Term
| What exam should you always add to the PE for derm cases? |
|
Definition
|
|
Term
| Which organ systems are required regardless of the disease? |
|
Definition
| HEENT, Pulm, CV, Abdomen and Extremities |
|
|
Term
| What conditions require a neuro test? |
|
Definition
| DM and anemia(just the periphery). |
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