Acute Infectious Rash
Pt presents to the office with c/o lesions that appears to be flat, measuring .4cm in diameter, and others that are elevated and solid measuring .2cm in diameter. Name the rash based on the presenting lesions. BONUS! name at least one viral infection that has this general type of exanthem.
What is that this is a maculopapular rash due to the presence of both macules that are flat and less than 1cm in diameter and papules that are solid elevated lesions that are less than 1cm in diameter? BONUS! Some viral infections that have this general type of exanthem(on top of their specific features) include Measles (with Koplik spots), Roseola (with white haloes), and Rubella (with postauricular lymphadenopathy).
Identify the layers of the epidermis and the major characteristics of each.
What is:
Stratum corneum(anucleated, flat cells, acid mantle to inhibit bacterial growth)
Stratum lucidum(1 layer of "ghost cells" in thick skin ONLY)
Stratum granulosum(several layers with keratohyalin granules, desmosomes present)
Stratum spinosum(several layers, desomosomes, thicker in areas with continuous abrasion, Langerhan cells)
Stratum Basale(1 cell layer, mitotic, hemidesmosomes, melanocytes).
Name the parasitic infection that can be obtained through swimming in freshwater sources, has a poor prognosis, and causes meningoencephalitis.
What is Naegleria fowleri? It enters the nose and migrates along the olfactory nerve. It starts 1-9 days after swimming or other NASAL exposure. Dx is made through examination of CSF, usually made after the death of the pt.
Name the branch of the Trigeminal Nerve that exits the cranial cavity via the superior orbital fissure to innervate the general sensation of the forehead and median nose.
What is the Ophthalmic division (CN V1)?
Name the three factors that generate the pressure gradient for lymph movement. BONUS! Name the three factors that cause lymphedema.
What are skeletal muscle action, respiratory movement, and contraction of smooth muscle cells in vessel walls? BONUS! the three factors that cause lymphedema are lymphatic hypoplasia, impaired lymphatic function, and obstruction of lymph flow. Overall, it is insufficient lymph transport.
Pt presents to the office with c/o foot pain and nail care. Upon examination, it was found that the pt's toenails are thicker than usual at the distal portion with yellowing also present. Name the most common agent (as specific as possible) of this infection and the treatment.
What is that this is onychomycosis which is usually caused by trichophyton rubrum and is treated with oral Terbinafine along with hygiene habit improvements?
_____ glands secrete into hair follicles superior to it while ___glands have an excretory portion that secretes in the dermis. BONUS! name the only holocrine gland mentioned in the material.
What is Apocrine and Eccrine ducts respectively? BONUS! Sebaceous glands
Name the ectoparasite that is obtained in grassy woodland areas, attracted to CO2 and warmth, and produces a Neurotoxin that blocks ACh release at the NMJ. BONUS! name whether it is male or female that causes paralysis.
What is that this is a tick? BONUS! Females since they need the blood for nutritional value for their offspring.
Identify the area in which the sensory function of CN V is tested.
What is that the pt is to close their eyes and respond when types of touch are felt at the skin of the forehead (V1), cheek (V2), and lower jaw (V3)?
Pt is an infant that presents to the office with a maculopapular rash on the chest and abdomen. Parents state that the pt had been sick for the past week, with a 104-degree fever that broke 3 days before the rash appeared. Identify the viral infection and the causative agent.
What is that this is Roseola that is caused most commonly by HHV-6, but can be caused by HHV-7?
Pt is a 3 y/o male that has been scratching at their scalp for the past three days. While taking a history, the parents stated how they suspected that the pt had the same thing that the other daycare kids had and placed olive oil on the pts head after thoroughly washing their hair. Upon examination, the physician identifies a few clear to white ovular-shaped objects on the hair in the postauricular scalp, but no tan/brown colored ones or anything moving. Identify if this pt currently has an infection and the name of the suspected ectoparasite. BONUS! name the first line treatment for this infestation.
What is that since the physician did not identify immature nymphs, viable eggs(tan/brown), or adult lice, the pt no longer has the infection? It is suspected that the parents suffocated the lice through old school methods (not supported by evidence-based data). BONUS! If the pt was found to still have the infestation, then they would be prescribed Pyrethrin + Piperonyl Butoxide on dry hair with repeating treatment in 7-10days. If the pt was >2months, but <2 y/o the first line treatment would be Permethrin 1% lotion applied to damp hair and repeated in 7-10 days
Hair follicles are only present in ____ skin.
What is thin skin?
Pt presents to the office complaining of small erythematous, itching lesions on their arms and legs. They stated that they were recently on vacation at a 2-star hotel and the lesions appeared after staying there for the first night. Upon examination, the physician noticed that the lesions had a "breakfast, lunch, and dinner" pattern to them. Name the causative agent and treatment.
What is that this is most likely an infestation of bed bugs (Climex lectularis) and is treated symptomatically(topical steroids/antihistamines), with ensuring that eradication of the bed bugs takes place?
Pt presents to the ED with c/o a laceration to their head from a fight over the infamous Alli's chocolate chip cookies. Although the pt was calm(they won the cookies), it was found that their wound was on the scalp and was gaping. This pt was immediately sent to a room and was provided a thorough cleaning. Identify the layer of the scalp that was injured and the reason why the medical staff was concerned for infection in this pt.
What is that this pt at least had their aponeurosis layer of the scalp cut due to the gaping and infection is at high risk due to the danger area of the scalp being exposed (loose CT layer)? The gaping of the wound is due to the pulling of the frontal and occipital bellies of the occipitofrontalis muscle in opposite directions. Moreover, the Loose CT space is considered to be the danger space of the scalp due to the easy spread of pus or blood as well as the infection through the emissary veins which can reach intracranial structures.
20-day old pt presents to the ED with a rectal temperature of 102.4 degrees. Describe the treatment.
What is that this pt will be admitted with additional testing and empirical antibiotic treatment until the pathogen is identified? These tests include CBC with diff, UA with culture, blood culture, CSF with culture, and depending on the source, Chest radiography.
Pt presents to the ED with c/o a single lesion received after spring cleaning their attic. Upon examination, it is found to be 8cm in width, have a purple/blue center with surrounding erythema, with no purulent drainage. Name the offender of this lesion, treatment, and the presentation 7-14 days after the bite.
What is that this is most likely a bite from the brown recluse spider (Loxosceles reclusa) that is treated with rest, ice, and elevation (tetanus toxoid if not vaccinated in the past 10 yrs) and presents with an ulceration 7-14 days after the bite?
What is Molluscum contagiosum? BONUS! this is caused by the pox virus
Pt presents to the ED with c/o weight loss, abdominal pain, and upset stomach after a cookout for the 4th of July. Pt states that they served BBQ back ribs and it was very exciting because they rarely have the chance to eat ribs due to their living situation. After getting stool samples from the pt, it was determined that the pt is infected with a helminth and was treated with Praziquantal. Name the most prevalent T helper cell that is utilized in the host defense mechanisms and its actions against helminths.
What is Th2 which overall causes goblet cell hyperplasia, mucin production, and accumulation of mast cells in mucosal cells? It is thought that helminths cause T cell differentiation into Th2 due to few TLR ligands for IL-12 production which is important for t cell differentiation into Th1. Moreover, it is suspected that they secrete inhibitory molecules that suppress IL-12 actions while simultaneously enhancing cytokine production that induces Th2 cells.
Pt presents to the office with c/o increased trouble hearing. Upon examination, the physician places a vibrating tuning fork on the forehead of the pt and asks which ear hears the sound louder. The pt states that they hear the sound louder in the right ear and the physician confirms this finding after looking into the pt's right ear finding the tympanic membrane to be bulging, erythematous, with the presence of discharge. Identify the test that was used in this encounter and the type of hearing loss that the pt most likely has. BONUS! name another type of hearing loss and what would be found on this examination.
What is that this pt most likely has a conductive hearing loss due to otitis media? The tuning fork was heard louder in the affected ear due to the no background noise being present to dampen the vibrations from the tuning fork. BONUS! If the pt had sensorineural, they would hear the sound louder in the good ear due to no nerve to sense the vibration in the bad ear.
Pt presents to the office for Spencer Technique Treatment. List the steps and which step(s) have the arm abducted.
What are:
Warm up --> milking
1&2 --> FE at shoulder
3&4 --> FE abducted circumduction
5&6 --> adduction with ER/Abduction with IR
Cool down --> Milking
Pt presents to the office with c/o a "red patch" on their skin that has been steadily growing. PMHx includes interdigital maceration from constantly wearing socks (even while sleeping). Upon examination, the "red patch" on the lower leg/foot has diffuse borders, is greater than 1cm in diameter, and is non-fluctuant. Identify the name of the "red patch", most common bacterial agent, and the treatment. BONUS! name the skin infection that this causative agent also causes that commonly gets confused as.
What is that this is cellulitis of the lower leg/foot most likely caused by Strep. pyogenes and is treated with Cephalexin, amoxicillin, or amoxicillin-clavulanate? BONUS! the commonly gets mistaken as Erysipelas, but the difference is that Erysipelas has a defined border where cellulitis does not.
16 y/o pt presents to their dermatologist's office with c/o "bumps on their face". Upon examination, multiple blackheads and whiteheads were present on the pt's face. Explain the pathophysiology behind the nature of blackheads and whiteheads in an individual. BONUS! name the vitamin that is used to help treat this condition.
What is that these are comedones on the pt's face that are follicular papules containing a keratin plug due to increased sebaceous gland production and can either be closed(whiteheads) that are trapped under the epidermis, or open(blackheads) that are not under the epidermis and result in oxidation of melanin pigment?
Pt presents to the ED with c/o headaches. Pt states that they have been present for one month with progressive symptoms of vertigo, photophobia, lethargy, and forgetfulness. Resistance to flexion beyond 60 degrees was present, and crackles in bilateral lung bases were identified. Lab results showed elevated WBC and glucose in CSF and culture had shown an a "halo-ed" organism stained with India ink. Name the most likely cause of the pt's meningitis.
What is Cryptococcus neoformans?
Pt presents to the office with c/o loss of lacrimation as their only symptom. Pt is still able to move their facial muscles and has no hyperacusis. Name the lesion and its location.
What is a lesion of the facial nerve along the greater petrosal nerve pathway?
Pt presents to the office with arm pain. Pt states that about 1-week prior, they fell onto their left shoulder after losing their grip while rock climbing. Upon examination, it was found that the pt had pain while abducting their left arm from 0-10 degrees (they needed to help their arm up as well), and while having a downward pressure placed upon their arms when placed at 45 degrees outward at 90 degrees. Name the UE Dx tests that were performed, possible injury, and next step.
What is that this pt most likely has an injury to their left supraspinatus from the rock climbing incident based on the findings from the Full can test and Painful arch test so they will need to be referred to Ortho? Since there is an obvious trauma and anatomical issue.