AANP FNP n
Basal nCell nCarcinoman-nCorrectnAnswer--
painless,npearly,nulceratednnodulenwith noverlyingntelangiectasis
-foundnon nsun nareas
ActinicnKeratosesn-nCorrectnAnswer--slightlynrough,npinknornflesh-colorednlesion nin nsun-
nexposednarea
-pharmacological ntreatment:n5-fluorouracil n(topical nchemotherapy)
-non-pharmacological ntreatment:nchemical npeel,ncryotherapy,nlasernresurfacing
Tuberculosisn-nCorrectnAnswer-I.nTransmission
A. Mycobacteriumntuberculosisncarriednin nairbornendroplets
B. ActivenPulmonarynornLaryngeal nTuberculosisntransmitted
1.nSneeze,ncough,nspeak,nornsing
II. Symptoms
A. LatentnTuberculosisnisnasymptomatic
B. ActivenTuberculosisnpresentation noften nmimicsncancernpresentation
1. Non-specificnpresentation n(mostncommon)
a. Fatigue
b. Weightnloss
c. Cachexia
d. NightnSweats
C. PulmonarynTuberculosisnsymptoms
1. Productivencough n(typicallyn2-3nweeks)
2. Hemoptysisn(uncommon)
3. PleuriticnChestnPain
4. Dyspnea
III. Signs
A. Sitesnof nInvolvement
1. Primaryninfection:nlungninvolvement
B. DisseminatednDisease
IV. Management
A. LatentnTuberculosis
1. PositivenPPD nwithoutnsignsnof nActivenTb
2. Treatmentnindicatednif nrisknof nTbnProgression nfromnlatentntonactivendisease
B. ActivenTuberculosis
Goutn-nCorrectnAnswer-I.nPathophysiology
A. *Goutnoccursnwhen nUricnAcidnlevelsnexceednsolubilitynlimits*
1. Monosodiumnuratencrystalsndepositnin njoints,nKidney,nandnsoftntissues
2. Crystal ndeposition ntriggersnaninflammatorynresponsenfromncytokinesnandnNeutrophils
,3. Jointnspacenisnirreversiblyninjurednwith nongoingnattacks
II. RisknFactors
A. Mostncommon
1. Obesity
2. Alcohol nusen(especiallynbeer)
3. High npurinendietn(rednmeats,nturkeynandnwildngame,norgan nmeats,nseafood)
4. Drinksnsweetenednwith nhigh nfructosencorn nsyrup
5. DiureticntherapynincludingnThiazidenDiuretics
6. Othernrisks
a. DiabetesnMellitus
b. Hyperlipidemia
c. Hypertension
d. Atherosclerosis
e. Renal nInsufficiency
f. Myeloproliferativendisease
III. Symptoms
A. AssociatednSymptoms
1. Chills
2. Fevernasnhigh nasn104nFn(40nC)
3. Severity:nVerynseverenpain
a. Unablentonbearnweight
b. Toonpainful ntonputnon nsocks
c. Intollerantntonlightntouch nfromnblankets
B. RegionsnLowernextremities
1. *FirstnMetatarsophalangeal njointnof ngreatntoe*n(mostncommon)
a. Known nasn*Podagra*
i.nAffectedninn50%nofnfirstngoutnattacksn
Mid-tarsal njoints
2. AnklenJoints
3. KneenJoints
C. Regionsnuppernextremities
1. Fingers
2. Wrists
3. Elbows
D. Characteristics:nJointnPain
1. Excruciating,ncrushingntypenpain
2. Timing:nJointnPain
3. Acutenonsetnof nlowernextremitynJointnPain
4. Wakensnpatientnfromnsleep
IV. Signs
A. Acute
1. JointnInflammation
2. Erythema,ntendernessnandnswellingnatnaffectednjoint
,a. Pain nextendsnwell nbeyondnjoint
b. Entirenfootninvolvednin nsomencases
3. Asymmetricnjointninvolvement
a. Maynonlyninvolvenonensidenwith nthenfirstnattack
4. Skin novernjointnisntensenandnshiny
B. Chronic
1. GoutynTophi n(developnaftern10nyears)
a.nSubcutaneousnNodulesnof nmonosodiumnuratencrystalsnandnlipids,nproteinsnandnmucopolysa
ccharides
C. ChronicnArthritis
1. Chronicndeposition noccursnwith nrecurrentnattacks
Dix-HallpikenManeuvern-nCorrectnAnswer-
Central nVertigon-nCorrectnAnswer-I.nFindings:nSuggestivenof ncentral ncauses
A. Nystagmus
1. Vertical norntorsional nNystagmusn(purenHorizontal nNystagmusnmaynoccurnwith neithern
peripheral norncentral ncause)
2. NonNystagmusnon nHorizontal nHeadnImpulsenTest
3. Persistsn<6nsecondsnafternDix-HallpikenManeuver
4. Fixation nof neyesnon nobjectndoesnnotninhibitnNystagmus
5. Requiresnweeksntonmonthsntonresolve
B. Episodesnlastnhoursntondays
C. Severenimbalancenimpairsnstandingnandnwalking
D. NonHearingnLossnornTinnitusnin nmostncentral ncases
E. AcutenVestibularnSyndromen(PosteriornCirculation nin n25%nof ncases)
1. Rapidnonsetn(<1nhour)nof nacute,npersistent,ncontinuousnVertigonornDizziness
2. Associatednwith nNystagmus,nNauseanornVomiting,nheadnmotionnintolerance,nandngaitn
unsteadiness
F. PositivenHiNTsnExamnCriterian(atnleastn1nofn3npositive)narensuggestivenof ncerebellarn
CVAnornBrainstemnCVAn(100%nsensitive,n96%nspecific)
1. Normal nHorizontal nHeadnImpulsenTestn(nonsaccade/correction non nheadnrotation)nOR
2. Nystagmusnthatnchangesndirectionn(ornVertical nNystagmusnorntorsional nNystagmus)n
OR
3. Skew nDeviationnonnAlternatenEyenCovernTestninnwhichnuncoveredneyendemonstratesn
quicknvertical ngazencorrections
III.nCauses:nCentral nVertigo
A. Non-VascularnCentral nCausesnof nVertigon(CN n8nornCNS)
1. Tumor
a. AcousticnNeuroman(VestibularnSchwannoma)
b. Infratentorial nependymoma
c. Brainstemnglioma
d. Medulloblastoma
e. Neurofibromatosis
2. MigrainenHeadache
, 3. MultiplenSclerosis
B. Vascularndiseasenrelatedntransientncerebral nanoxia
1. Specificnanoxiantonvertebrobasilarnsystem
a. Vessel nspecific
i. BrainstemnInfarctn(associatednwith nHearingnLoss)
1. AnteriornInferiornCerebellarnArterynInfarction
2. AnteriornVestibularnArterynInfarction
ii. BrainstemnInfarctn(nonHearingnLoss)
1. PosteriornInferiornCerebellarnArteryninfarction
2. LabyrinthinenArterynInfarction
b. Precipitatingnconditions
i. Arteriosclerosis
ii. Hypertension
iii. Anemia
iv. Atrial nFibrillation
C. OthernCauses
1. Postural nHypotension
2. Syncope
Peripheral nVertigon-nCorrectnAnswer-I.nFindings:nSuggestivenof nperipheral ncauses
A. Pathognomonicnfornperipheral ncause
1. Sudden nonsetnwith nbrief nepisodesnoften non nawakening
2. RotarynIllusion nwith nNausea,nVomiting
B. Nystagmus
1. Combinednhorizontal nandntorsional nNystagmus
2. Persistsn5-20nsecondsnafternDix-HallpikenManeuver
3. Fixation nof neyesnon nobjectninhibitsnNystagmus
C. Moderatenimbalance
D. NauseanornVomiting
E. Associatednfindings
1. HearingnLoss
2. Tinnitus
F. Tullio'snPhenomenon
1. NystagmusnandnVertigonprovokednbynloudnsounds
II.nCauses:nCommon n(Peripheral nVertigo)
A. AcutenVestibularnNeuronitis
B. Benign nParoxysmal nPositional nVertigo
C. Meniere'snDisease
III.nCauses:nOthern(Peripheral nVertigo)
A. EarnInfections
1. SerousnOtitisnMedia
2. ChronicnOtitisnMedia
3. OtitisnExterna
4. Mastoiditis
Basal nCell nCarcinoman-nCorrectnAnswer--
painless,npearly,nulceratednnodulenwith noverlyingntelangiectasis
-foundnon nsun nareas
ActinicnKeratosesn-nCorrectnAnswer--slightlynrough,npinknornflesh-colorednlesion nin nsun-
nexposednarea
-pharmacological ntreatment:n5-fluorouracil n(topical nchemotherapy)
-non-pharmacological ntreatment:nchemical npeel,ncryotherapy,nlasernresurfacing
Tuberculosisn-nCorrectnAnswer-I.nTransmission
A. Mycobacteriumntuberculosisncarriednin nairbornendroplets
B. ActivenPulmonarynornLaryngeal nTuberculosisntransmitted
1.nSneeze,ncough,nspeak,nornsing
II. Symptoms
A. LatentnTuberculosisnisnasymptomatic
B. ActivenTuberculosisnpresentation noften nmimicsncancernpresentation
1. Non-specificnpresentation n(mostncommon)
a. Fatigue
b. Weightnloss
c. Cachexia
d. NightnSweats
C. PulmonarynTuberculosisnsymptoms
1. Productivencough n(typicallyn2-3nweeks)
2. Hemoptysisn(uncommon)
3. PleuriticnChestnPain
4. Dyspnea
III. Signs
A. Sitesnof nInvolvement
1. Primaryninfection:nlungninvolvement
B. DisseminatednDisease
IV. Management
A. LatentnTuberculosis
1. PositivenPPD nwithoutnsignsnof nActivenTb
2. Treatmentnindicatednif nrisknof nTbnProgression nfromnlatentntonactivendisease
B. ActivenTuberculosis
Goutn-nCorrectnAnswer-I.nPathophysiology
A. *Goutnoccursnwhen nUricnAcidnlevelsnexceednsolubilitynlimits*
1. Monosodiumnuratencrystalsndepositnin njoints,nKidney,nandnsoftntissues
2. Crystal ndeposition ntriggersnaninflammatorynresponsenfromncytokinesnandnNeutrophils
,3. Jointnspacenisnirreversiblyninjurednwith nongoingnattacks
II. RisknFactors
A. Mostncommon
1. Obesity
2. Alcohol nusen(especiallynbeer)
3. High npurinendietn(rednmeats,nturkeynandnwildngame,norgan nmeats,nseafood)
4. Drinksnsweetenednwith nhigh nfructosencorn nsyrup
5. DiureticntherapynincludingnThiazidenDiuretics
6. Othernrisks
a. DiabetesnMellitus
b. Hyperlipidemia
c. Hypertension
d. Atherosclerosis
e. Renal nInsufficiency
f. Myeloproliferativendisease
III. Symptoms
A. AssociatednSymptoms
1. Chills
2. Fevernasnhigh nasn104nFn(40nC)
3. Severity:nVerynseverenpain
a. Unablentonbearnweight
b. Toonpainful ntonputnon nsocks
c. Intollerantntonlightntouch nfromnblankets
B. RegionsnLowernextremities
1. *FirstnMetatarsophalangeal njointnof ngreatntoe*n(mostncommon)
a. Known nasn*Podagra*
i.nAffectedninn50%nofnfirstngoutnattacksn
Mid-tarsal njoints
2. AnklenJoints
3. KneenJoints
C. Regionsnuppernextremities
1. Fingers
2. Wrists
3. Elbows
D. Characteristics:nJointnPain
1. Excruciating,ncrushingntypenpain
2. Timing:nJointnPain
3. Acutenonsetnof nlowernextremitynJointnPain
4. Wakensnpatientnfromnsleep
IV. Signs
A. Acute
1. JointnInflammation
2. Erythema,ntendernessnandnswellingnatnaffectednjoint
,a. Pain nextendsnwell nbeyondnjoint
b. Entirenfootninvolvednin nsomencases
3. Asymmetricnjointninvolvement
a. Maynonlyninvolvenonensidenwith nthenfirstnattack
4. Skin novernjointnisntensenandnshiny
B. Chronic
1. GoutynTophi n(developnaftern10nyears)
a.nSubcutaneousnNodulesnof nmonosodiumnuratencrystalsnandnlipids,nproteinsnandnmucopolysa
ccharides
C. ChronicnArthritis
1. Chronicndeposition noccursnwith nrecurrentnattacks
Dix-HallpikenManeuvern-nCorrectnAnswer-
Central nVertigon-nCorrectnAnswer-I.nFindings:nSuggestivenof ncentral ncauses
A. Nystagmus
1. Vertical norntorsional nNystagmusn(purenHorizontal nNystagmusnmaynoccurnwith neithern
peripheral norncentral ncause)
2. NonNystagmusnon nHorizontal nHeadnImpulsenTest
3. Persistsn<6nsecondsnafternDix-HallpikenManeuver
4. Fixation nof neyesnon nobjectndoesnnotninhibitnNystagmus
5. Requiresnweeksntonmonthsntonresolve
B. Episodesnlastnhoursntondays
C. Severenimbalancenimpairsnstandingnandnwalking
D. NonHearingnLossnornTinnitusnin nmostncentral ncases
E. AcutenVestibularnSyndromen(PosteriornCirculation nin n25%nof ncases)
1. Rapidnonsetn(<1nhour)nof nacute,npersistent,ncontinuousnVertigonornDizziness
2. Associatednwith nNystagmus,nNauseanornVomiting,nheadnmotionnintolerance,nandngaitn
unsteadiness
F. PositivenHiNTsnExamnCriterian(atnleastn1nofn3npositive)narensuggestivenof ncerebellarn
CVAnornBrainstemnCVAn(100%nsensitive,n96%nspecific)
1. Normal nHorizontal nHeadnImpulsenTestn(nonsaccade/correction non nheadnrotation)nOR
2. Nystagmusnthatnchangesndirectionn(ornVertical nNystagmusnorntorsional nNystagmus)n
OR
3. Skew nDeviationnonnAlternatenEyenCovernTestninnwhichnuncoveredneyendemonstratesn
quicknvertical ngazencorrections
III.nCauses:nCentral nVertigo
A. Non-VascularnCentral nCausesnof nVertigon(CN n8nornCNS)
1. Tumor
a. AcousticnNeuroman(VestibularnSchwannoma)
b. Infratentorial nependymoma
c. Brainstemnglioma
d. Medulloblastoma
e. Neurofibromatosis
2. MigrainenHeadache
, 3. MultiplenSclerosis
B. Vascularndiseasenrelatedntransientncerebral nanoxia
1. Specificnanoxiantonvertebrobasilarnsystem
a. Vessel nspecific
i. BrainstemnInfarctn(associatednwith nHearingnLoss)
1. AnteriornInferiornCerebellarnArterynInfarction
2. AnteriornVestibularnArterynInfarction
ii. BrainstemnInfarctn(nonHearingnLoss)
1. PosteriornInferiornCerebellarnArteryninfarction
2. LabyrinthinenArterynInfarction
b. Precipitatingnconditions
i. Arteriosclerosis
ii. Hypertension
iii. Anemia
iv. Atrial nFibrillation
C. OthernCauses
1. Postural nHypotension
2. Syncope
Peripheral nVertigon-nCorrectnAnswer-I.nFindings:nSuggestivenof nperipheral ncauses
A. Pathognomonicnfornperipheral ncause
1. Sudden nonsetnwith nbrief nepisodesnoften non nawakening
2. RotarynIllusion nwith nNausea,nVomiting
B. Nystagmus
1. Combinednhorizontal nandntorsional nNystagmus
2. Persistsn5-20nsecondsnafternDix-HallpikenManeuver
3. Fixation nof neyesnon nobjectninhibitsnNystagmus
C. Moderatenimbalance
D. NauseanornVomiting
E. Associatednfindings
1. HearingnLoss
2. Tinnitus
F. Tullio'snPhenomenon
1. NystagmusnandnVertigonprovokednbynloudnsounds
II.nCauses:nCommon n(Peripheral nVertigo)
A. AcutenVestibularnNeuronitis
B. Benign nParoxysmal nPositional nVertigo
C. Meniere'snDisease
III.nCauses:nOthern(Peripheral nVertigo)
A. EarnInfections
1. SerousnOtitisnMedia
2. ChronicnOtitisnMedia
3. OtitisnExterna
4. Mastoiditis
