AANP FNP m
Basal mCell mCarcinomam-mCorrectmAnswer--
painless,mpearly,mulceratedmnodulemwith moverlyingmtelangiectasis
-foundmon msun mareas
ActinicmKeratosesm-mCorrectmAnswer--slightlymrough,mpinkmormflesh-coloredmlesion min msun-
mexposedmarea
-pharmacological mtreatment:m5-fluorouracil m(topical mchemotherapy)
-non-pharmacological mtreatment:mchemical mpeel,mcryotherapy,mlasermresurfacing
Tuberculosism-mCorrectmAnswer-I.mTransmission
A. Mycobacteriummtuberculosismcarriedmin mairbornemdroplets
B. ActivemPulmonarymormLaryngeal mTuberculosismtransmitted
1.mSneeze,mcough,mspeak,mormsing
II. Symptoms
A. LatentmTuberculosismismasymptomatic
B. ActivemTuberculosismpresentation moften mmimicsmcancermpresentation
1. Non-specificmpresentation m(mostmcommon)
a. Fatigue
b. Weightmloss
c. Cachexia
d. NightmSweats
C. PulmonarymTuberculosismsymptoms
1. Productivemcough m(typicallym2-3mweeks)
2. Hemoptysism(uncommon)
3. PleuriticmChestmPain
4. Dyspnea
III. Signs
A. Sitesmof mInvolvement
1. Primaryminfection:mlungminvolvement
B. DisseminatedmDisease
IV. Management
A. LatentmTuberculosis
1. PositivemPPDmwithoutmsignsmof mActivemTb
2. Treatmentmindicatedmif mriskmof mTbmProgression mfrommlatentmtomactivemdisease
B. ActivemTuberculosis
Goutm-mCorrectmAnswer-I.mPathophysiology
A. *Goutmoccursmwhen mUricmAcidmlevelsmexceedmsolubilitymlimits*
1. Monosodiummuratemcrystalsmdepositmin mjoints,mKidney,mandmsoftmtissues
2. Crystal mdeposition mtriggersmaminflammatorymresponsemfrommcytokinesmandmNeutrophils
,3. Jointmspacemismirreversiblyminjuredmwith mongoingmattacks
II. RiskmFactors
A. Mostmcommon
1. Obesity
2. Alcohol musem(especiallymbeer)
3. High mpurinemdietm(redmmeats,mturkeymandmwildmgame,morgan mmeats,mseafood)
4. Drinksmsweetenedmwith mhigh mfructosemcorn msyrup
5. DiureticmtherapymincludingmThiazidemDiuretics
6. Othermrisks
a. DiabetesmMellitus
b. Hyperlipidemia
c. Hypertension
d. Atherosclerosis
e. Renal mInsufficiency
f. Myeloproliferativemdisease
III. Symptoms
A. AssociatedmSymptoms
1. Chills
2. Fevermasmhigh masm104mFm(40mC)
3. Severity:mVerymseverempain
a. Unablemtombearmweight
b. Toompainful mtomputmon msocks
c. Intollerantmtomlightmtouch mfrommblankets
B. RegionsmLowermextremities
1. *FirstmMetatarsophalangeal mjointmof mgreatmtoe*m(mostmcommon)
a. Known masm*Podagra*
i.mAffectedminm50%mofmfirstmgoutmattack
smMid-tarsal mjoints
2. AnklemJoints
3. KneemJoints
C. Regionsmuppermextremities
1. Fingers
2. Wrists
3. Elbows
D. Characteristics:mJointmPain
1. Excruciating,mcrushingmtypempain
2. Timing:mJointmPain
3. Acutemonsetmof mlowermextremitymJointmPain
4. Wakensmpatientmfrommsleep
IV. Signs
A. Acute
1. JointmInflammation
2. Erythema,mtendernessmandmswellingmatmaffectedmjoint
,a. Pain mextendsmwell mbeyondmjoint
b. Entiremfootminvolvedmin msomemcases
3. Asymmetricmjointminvolvement
a. Maymonlyminvolvemonemsidemwith mthemfirstmattack
4. Skin movermjointmismtensemandmshiny
B. Chronic
1. GoutymTophi m(developmafterm10myears)
a.mSubcutaneousmNodulesmofmmonosodiummuratemcrystalsmandmlipids,mproteinsmandmmucopoly
saccharides
C. ChronicmArthritis
1. Chronicmdeposition moccursmwith mrecurrentmattacks
Dix-HallpikemManeuverm-mCorrectmAnswer-
Central mVertigom-mCorrectmAnswer-I.mFindings:mSuggestivemof mcentral mcauses
A. Nystagmus
1. Vertical mormtorsional mNystagmusm(puremHorizontal mNystagmusmmaymoccurmwith meith
ermperipheral mormcentral mcause)
2. NomNystagmusmon mHorizontal mHeadmImpulsemTest
3. Persistsm<6msecondsmaftermDix-HallpikemManeuver
4. Fixation mof meyesmon mobjectmdoesmnotminhibitmNystagmus
5. Requiresmweeksmtommonthsmtomresolve
B. Episodesmlastmhoursmtomdays
C. Severemimbalancemimpairsmstandingmandmwalking
D. NomHearingmLossmormTinnitusmin mmostmcentral mcases
E. AcutemVestibularmSyndromem(PosteriormCirculation min m25%mof mcases)
1. Rapidmonsetm(<1mhour)mof macute,mpersistent,mcontinuousmVertigomormDizziness
2. Associatedmwith mNystagmus,mNauseamormVomiting,mheadmmotionmintolerance,mandmga
itmunsteadiness
F. PositivemHiNTsmExammCriteriam(atmleastm1mofm3mpositive)maremsuggestivemofmcerebell
armCVAmormBrainstemmCVAm(100%msensitive,m96%mspecific)
1. Normal mHorizontal mHeadmImpulsemTestm(nomsaccade/correction mon mheadmrotation)mOR
2. Nystagmusmthatmchangesmdirection m(ormVertical mNystagmusmormtorsional mNystagmu
s)mOR
3. Skew mDeviationmonmAlternatemEyemCovermTestminmwhichmuncoveredmeyemdemonstrat
esmquickmvertical mgazemcorrections
III.mCauses:mCentral mVertigo
A. Non-VascularmCentral mCausesmof mVertigom(CN m8mormCNS)
1. Tumor
a. AcousticmNeuromam(VestibularmSchwannoma)
b. Infratentorial mependymoma
c. Brainstemmglioma
d. Medulloblastoma
e. Neurofibromatosis
2. MigrainemHeadache
, 3. MultiplemSclerosis
B. Vascularmdiseasemrelatedmtransientmcerebral manoxia
1. Specificmanoxiamtomvertebrobasilarmsystem
a. Vessel mspecific
i. BrainstemmInfarctm(associatedmwith mHearingmLoss)
1. AnteriormInferiormCerebellarmArterymInfarction
2. AnteriormVestibularmArterymInfarction
ii. BrainstemmInfarctm(nomHearingmLoss)
1. PosteriormInferiormCerebellarmArteryminfarction
2. LabyrinthinemArterymInfarction
b. Precipitatingmconditions
i. Arteriosclerosis
ii. Hypertension
iii. Anemia
iv. Atrial mFibrillation
C. OthermCauses
1. Postural mHypotension
2. Syncope
Peripheral mVertigom-mCorrectmAnswer-I.mFindings:mSuggestivemof mperipheral mcauses
A. Pathognomonicmformperipheral mcause
1. Sudden monsetmwith mbrief mepisodesmoften mon mawakening
2. RotarymIllusion mwith mNausea,mVomiting
B. Nystagmus
1. Combinedmhorizontal mandmtorsional mNystagmus
2. Persistsm5-20msecondsmaftermDix-HallpikemManeuver
3. Fixation mof meyesmon mobjectminhibitsmNystagmus
C. Moderatemimbalance
D. NauseamormVomiting
E. Associatedmfindings
1. HearingmLoss
2. Tinnitus
F. Tullio'smPhenomenon
1. NystagmusmandmVertigomprovokedmbymloudmsounds
II.mCauses:mCommon m(Peripheral mVertigo)
A. AcutemVestibularmNeuronitis
B. Benign mParoxysmal mPositional mVertigo
C. Meniere'smDisease
III.mCauses:mOtherm(Peripheral mVertigo)
A. EarmInfections
1. SerousmOtitismMedia
2. ChronicmOtitismMedia
3. OtitismExterna
4. Mastoiditis
Basal mCell mCarcinomam-mCorrectmAnswer--
painless,mpearly,mulceratedmnodulemwith moverlyingmtelangiectasis
-foundmon msun mareas
ActinicmKeratosesm-mCorrectmAnswer--slightlymrough,mpinkmormflesh-coloredmlesion min msun-
mexposedmarea
-pharmacological mtreatment:m5-fluorouracil m(topical mchemotherapy)
-non-pharmacological mtreatment:mchemical mpeel,mcryotherapy,mlasermresurfacing
Tuberculosism-mCorrectmAnswer-I.mTransmission
A. Mycobacteriummtuberculosismcarriedmin mairbornemdroplets
B. ActivemPulmonarymormLaryngeal mTuberculosismtransmitted
1.mSneeze,mcough,mspeak,mormsing
II. Symptoms
A. LatentmTuberculosismismasymptomatic
B. ActivemTuberculosismpresentation moften mmimicsmcancermpresentation
1. Non-specificmpresentation m(mostmcommon)
a. Fatigue
b. Weightmloss
c. Cachexia
d. NightmSweats
C. PulmonarymTuberculosismsymptoms
1. Productivemcough m(typicallym2-3mweeks)
2. Hemoptysism(uncommon)
3. PleuriticmChestmPain
4. Dyspnea
III. Signs
A. Sitesmof mInvolvement
1. Primaryminfection:mlungminvolvement
B. DisseminatedmDisease
IV. Management
A. LatentmTuberculosis
1. PositivemPPDmwithoutmsignsmof mActivemTb
2. Treatmentmindicatedmif mriskmof mTbmProgression mfrommlatentmtomactivemdisease
B. ActivemTuberculosis
Goutm-mCorrectmAnswer-I.mPathophysiology
A. *Goutmoccursmwhen mUricmAcidmlevelsmexceedmsolubilitymlimits*
1. Monosodiummuratemcrystalsmdepositmin mjoints,mKidney,mandmsoftmtissues
2. Crystal mdeposition mtriggersmaminflammatorymresponsemfrommcytokinesmandmNeutrophils
,3. Jointmspacemismirreversiblyminjuredmwith mongoingmattacks
II. RiskmFactors
A. Mostmcommon
1. Obesity
2. Alcohol musem(especiallymbeer)
3. High mpurinemdietm(redmmeats,mturkeymandmwildmgame,morgan mmeats,mseafood)
4. Drinksmsweetenedmwith mhigh mfructosemcorn msyrup
5. DiureticmtherapymincludingmThiazidemDiuretics
6. Othermrisks
a. DiabetesmMellitus
b. Hyperlipidemia
c. Hypertension
d. Atherosclerosis
e. Renal mInsufficiency
f. Myeloproliferativemdisease
III. Symptoms
A. AssociatedmSymptoms
1. Chills
2. Fevermasmhigh masm104mFm(40mC)
3. Severity:mVerymseverempain
a. Unablemtombearmweight
b. Toompainful mtomputmon msocks
c. Intollerantmtomlightmtouch mfrommblankets
B. RegionsmLowermextremities
1. *FirstmMetatarsophalangeal mjointmof mgreatmtoe*m(mostmcommon)
a. Known masm*Podagra*
i.mAffectedminm50%mofmfirstmgoutmattack
smMid-tarsal mjoints
2. AnklemJoints
3. KneemJoints
C. Regionsmuppermextremities
1. Fingers
2. Wrists
3. Elbows
D. Characteristics:mJointmPain
1. Excruciating,mcrushingmtypempain
2. Timing:mJointmPain
3. Acutemonsetmof mlowermextremitymJointmPain
4. Wakensmpatientmfrommsleep
IV. Signs
A. Acute
1. JointmInflammation
2. Erythema,mtendernessmandmswellingmatmaffectedmjoint
,a. Pain mextendsmwell mbeyondmjoint
b. Entiremfootminvolvedmin msomemcases
3. Asymmetricmjointminvolvement
a. Maymonlyminvolvemonemsidemwith mthemfirstmattack
4. Skin movermjointmismtensemandmshiny
B. Chronic
1. GoutymTophi m(developmafterm10myears)
a.mSubcutaneousmNodulesmofmmonosodiummuratemcrystalsmandmlipids,mproteinsmandmmucopoly
saccharides
C. ChronicmArthritis
1. Chronicmdeposition moccursmwith mrecurrentmattacks
Dix-HallpikemManeuverm-mCorrectmAnswer-
Central mVertigom-mCorrectmAnswer-I.mFindings:mSuggestivemof mcentral mcauses
A. Nystagmus
1. Vertical mormtorsional mNystagmusm(puremHorizontal mNystagmusmmaymoccurmwith meith
ermperipheral mormcentral mcause)
2. NomNystagmusmon mHorizontal mHeadmImpulsemTest
3. Persistsm<6msecondsmaftermDix-HallpikemManeuver
4. Fixation mof meyesmon mobjectmdoesmnotminhibitmNystagmus
5. Requiresmweeksmtommonthsmtomresolve
B. Episodesmlastmhoursmtomdays
C. Severemimbalancemimpairsmstandingmandmwalking
D. NomHearingmLossmormTinnitusmin mmostmcentral mcases
E. AcutemVestibularmSyndromem(PosteriormCirculation min m25%mof mcases)
1. Rapidmonsetm(<1mhour)mof macute,mpersistent,mcontinuousmVertigomormDizziness
2. Associatedmwith mNystagmus,mNauseamormVomiting,mheadmmotionmintolerance,mandmga
itmunsteadiness
F. PositivemHiNTsmExammCriteriam(atmleastm1mofm3mpositive)maremsuggestivemofmcerebell
armCVAmormBrainstemmCVAm(100%msensitive,m96%mspecific)
1. Normal mHorizontal mHeadmImpulsemTestm(nomsaccade/correction mon mheadmrotation)mOR
2. Nystagmusmthatmchangesmdirection m(ormVertical mNystagmusmormtorsional mNystagmu
s)mOR
3. Skew mDeviationmonmAlternatemEyemCovermTestminmwhichmuncoveredmeyemdemonstrat
esmquickmvertical mgazemcorrections
III.mCauses:mCentral mVertigo
A. Non-VascularmCentral mCausesmof mVertigom(CN m8mormCNS)
1. Tumor
a. AcousticmNeuromam(VestibularmSchwannoma)
b. Infratentorial mependymoma
c. Brainstemmglioma
d. Medulloblastoma
e. Neurofibromatosis
2. MigrainemHeadache
, 3. MultiplemSclerosis
B. Vascularmdiseasemrelatedmtransientmcerebral manoxia
1. Specificmanoxiamtomvertebrobasilarmsystem
a. Vessel mspecific
i. BrainstemmInfarctm(associatedmwith mHearingmLoss)
1. AnteriormInferiormCerebellarmArterymInfarction
2. AnteriormVestibularmArterymInfarction
ii. BrainstemmInfarctm(nomHearingmLoss)
1. PosteriormInferiormCerebellarmArteryminfarction
2. LabyrinthinemArterymInfarction
b. Precipitatingmconditions
i. Arteriosclerosis
ii. Hypertension
iii. Anemia
iv. Atrial mFibrillation
C. OthermCauses
1. Postural mHypotension
2. Syncope
Peripheral mVertigom-mCorrectmAnswer-I.mFindings:mSuggestivemof mperipheral mcauses
A. Pathognomonicmformperipheral mcause
1. Sudden monsetmwith mbrief mepisodesmoften mon mawakening
2. RotarymIllusion mwith mNausea,mVomiting
B. Nystagmus
1. Combinedmhorizontal mandmtorsional mNystagmus
2. Persistsm5-20msecondsmaftermDix-HallpikemManeuver
3. Fixation mof meyesmon mobjectminhibitsmNystagmus
C. Moderatemimbalance
D. NauseamormVomiting
E. Associatedmfindings
1. HearingmLoss
2. Tinnitus
F. Tullio'smPhenomenon
1. NystagmusmandmVertigomprovokedmbymloudmsounds
II.mCauses:mCommon m(Peripheral mVertigo)
A. AcutemVestibularmNeuronitis
B. Benign mParoxysmal mPositional mVertigo
C. Meniere'smDisease
III.mCauses:mOtherm(Peripheral mVertigo)
A. EarmInfections
1. SerousmOtitismMedia
2. ChronicmOtitismMedia
3. OtitismExterna
4. Mastoiditis
