AAFP January 2023

#melaninmagic

100

Name this condition 

Postinflammatory Hyperpigmentation - a reactive hyper melanosis that occurs after endogenous inflammation or external injury 

200

Define the condition in this image: 

Keloids - firm, rubbery proliferative nodules that occur 1 to 12 months after injury 

They extend beyond the boundary of the original injury and do not regress spontaneously

300

Name and treatment 

Pseudofolliculitis Barbae aka "ingrown hairs" - erythematous or hyperpigmented, firm papules and pustules in a beard distribution. It is caused by follicular penetration of recently shaved curly hair. 

Treatment: avoiding shaving for 8 weeks. Possible meds include benzoyl peroxide, clindamycin gel, tretinoin cream 

400

Treatment for postinflammatory hyperpigmentation 

Standard therapy = topical lightening agent hydroquinone 4% 1-2x / day for 3 months 

Other options: adapalene 0.3% gel & tretinoin 0.1% cream (for acne associated)

500

Name and treatment 

Acne keloidalis nuchae -  a chronic inflammatory condition leading to scarring of the hair follicles, development of keloid-like papules and plaques, and cicatricial alopecia of the nuchal and occipital scalp 

Tx: triamcinolone with topical retinoids or clindamycin 1% (mild). intralesional triamcinolone (moderate). surgical excision (severe). 

Derm- phototherapy and laser therapy

Tonsils on fleek

100

Tonsilloliths can be asymptomatic when small and appear as mineralized, white or yellow collections in the deep tonsillar crypts. Symptoms include recurrent sore throat, halitosis, sensation of a foreign body in the throat, odynophagia, and hoarseness. 

200

Treatment for bacterial GAS tonsillitis

Penicillin V 500mg BID or TID x 10d

Amoxicillin 500mg BID (50mg/kg daily in kids) x 10d

Penicillin G 1.2 million units IM x1 

Cephalosporins for mild to moderate penicillin allergy

Macrolides for severe penicillin allergy 

300

Percentage of tonsillitis that are viral

70-95%

400

List the centor criteria

+1 for 3-14 years, -1 for >44 years 

tonsillar swelling or exudates +1 

Tenders/swollen anterior cervical lymph nodes +1 

Fever +1 

Cough absent +1 

*consider test for score of 2 or more. IDSA recommends treatment only for positive testing. 

500

Complications of bacterial tonsillitis (name 2) 

Abscess

Rheumatic fever (group A strep) -  a nonsuppurative sequela that occurs two to four weeks following group A Streptococcus (GAS) pharyngitis and may consist of arthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules. Damage to cardiac valves may be chronic and progressive, resulting in cardiac decompensation. Usually in children 5-15 years. Seldom occurs before age of 2-3 years or in adults. 

Acute glomerulonephritis 

Scarlet fever (diffuse erythematous skin eruption) 

Ouch all over

100

Patient presents with pain in hands, worse in the morning and improves during the day for the past 3 months. Exam reveals swelling in the MCP and PIP joints. CRP and ESR mildly elevated. Rheumatoid factor positive. 

XRay findings: 

RA

200

Presenting symptoms for inflammatory arthropathy (name 4) 

Redness 

Swelling 

Warmth with prolonged morning stiffness 

Pain at night 

Stiffness with rest 

300

Differential diagnosis for ACUTE inflammatory polyarthritis (name 5) - <6 weeks

Gonorrhea, infectious endocarditis, Lyme disease, meningitis, rheumatic fever

Gout, pseudogout

Polymyalgia rheumatica, psoriatic arthritis, reactive arthritis, rheumatoid arthritis, SLE 

Sarcoidosis 

HIV, parvovirus B19, viral hepatitis 

400

Differential diagnoses for CHRONIC inflammatory polyarthritis (name 3) - 6 weeks or more

Pseudogout, gout, IBD associated arthritis, polymyalgia rheumatica, psoriatic arthritis, reactive arthritis, rheumatoid arthritis, sjogrens, SLE 

500

Work up for inflammatory arthropathies 

ESR & CRP 

RA & CCP ab testing 

ANA 

Joint aspiration if applicable 

X-ray 

Okurrr

100

Preferred medication treatments of acute or chronic hyperkalemia 

Patiromer (Veltassa) and sodium zirconium cyclosilicate (Lokelma) 

200

Indications for IV potassium ( as opposed to PO) replacement - name 2

Severe hypokalemia (<2.5 mEq) 

ECG abnormalities (peaked T waves) 

neuromuscular symptoms (or other physical sx) 

Unable to tolerate PO

300

Describe EKG changes for hyperkalemia -> hypokalemia 

High to low: Wide QRS, bradyarrhythmias, prolonged PR interval, peaked T wave,  U waves, prolonged QT

400

Name 4 causes for hypokalemia

Medical: type 1 or 2 renal tubular acidosis, hypomagnesemia, chronic/acute diarrhea, bowel prep, vomiting, refeeding syndrome, alkalosis, thyrotoxicosis, hypothermia, anorexia, starvation, TPN 

Medications: thiazide or loop diuretics, mineralocorticoids, exogenous steroids, laxatives/enemas, insulin, beta agonists, caffeine 

500

Define the different stages of CKD (1-5) based on GFR and associated recommended potassium intake

1: eGFR 90 or higher - 3510 mg

2: eGFR 60-89 - 3510 mg

3: eGFR 30-59 - 3510 mg unless severe hyperK

4: eGFR 15-29 - <3000 mg

5: eGFR <15 - <3000 mg

Mono and TMJ

100

First line treatment for temporomandibular disorders

Naproxen

200

Testing for mono

CBC with diff 

Rapid heterophile antibody test (monospot) 

300

What restriction is associated with mono?

No sports/exercise for 3 weeks due to risk for splenic rupture. 

Most splenic rupture occurs 21 days after symptom onset. 

400

Symptoms associated with mono (name 5) 

Pharyngitis, fever, fatigue, tonsillar enlargement or exudate, lymphadenopathy, and/or palatal petechiae 

500

Presenting symptoms of temporomandibular disorder (name 5) 

headache, bruxism (teeth grinding), pain at the TMJ, otalgia, jaw popping/clicking, tinnitus, dizziness, decreased hearing, or hyperacuity to sound