Derm/GI Review

Ajouté : 2026-05-24

[00:00:00]those are example of contact dermatitis is like a diaper rash that time of thing you're in contact so you're going to have it's going to create a a skin breakdown subaric is has to do with oil glands and you're going to see that on the head cradle tap things like that and then um psoriasis is usually associated it's usually really well demarcated around the edges and it's usually the words the terms are usually plaque psoriasis and you know when somebody has toasis on a lot of times you're going to put steroids on on these things to try to make them go away but if it's on the face or it's covering a very large area then you're going to think about doing oral you know if you don't want to put a strong steroid on the face or and then and then psoriasis is actually an autoimmune problem and so you've seen those biologics that they have on the T on the commercials on TV and you know the risks of them are TV death everything in the world so you know it's got to be pretty severe I think psoriasis to to go for any those drugs but that would be my opinion s of itching itching is usually a manifestation it can be renal it can be just about anything right okay pan Ika have y'all have y'all seen thumbnails in the clinics this semester anybody seen one removed several yeah and and fact my son said to me other day he said I hope I never get an ingrown toenail because I guess his friend had one and he was really appalled at what they did to him so what did what did you see and you just saw them did they did they just inject under the nail and then cut it off with scissors or how did they remove it um we did we did a block at the for the hot to the entire toe and then we would do a wedge okay when what are you calling a wedge what's that just just the just outside of the toenail in in like a pie shape in a wedge yeah like with scissors did they use scissors just to cut it off or how did they do it it was it was a I can't remember what he called them it's a special kind of scissors that had they were flat on the bottom and then they cut on the top so you could get underneath the nail to cut it and then make sure you got underneath all of them okay good so and I've seen them remove the whole thing and I see seen them removed you know just the what you're calling the wedge right so but you know that's patient teaching and and that's really a procedure you know the the teaching is don't trim the toenail below the below the Ed you know below the top of the toe you want to keep it grown out so it can't grow into the edge you want to keep it straight don't curve it you know um that nowadays you see women with these toenails that have they're they're doing a French manicure on the toe on the toenail so you know they're plenty long enough okay so animal bite you're going to be giving antibiotics for those right and are we going to do also are we going to do any kind of um kutus [Music] shot what are we going to do for the animal bites uh dog bites are those going to be have the real puncture dogs dogs tend to grab and tear so um you know they're they can be serious but and cats you're definitely going to you're definitely going to get antibiotics and um this so just kind of review the antibiotics it's mainly dog and cat they'll get into this and don't worry about wound closure you're going to want to be able to see your patient in the clinic know if it's something serious you know if you could handle there or if you need to send them out and then give them their their antibiotics and their tetanus that's really the you know the what you need to do but W closure we're really not going to go you know we're not going to be test that right we um have a clinic on that petasis rosacea did y'all study that at all let's see let's find what that looks like a Christmas tree is it a Christmas tree pattern yeah okay cases we've got that and usually on these on the boards what they're looking for is they're looking for if you can recognize it and then you know and then have some idea of what you know patient teaching things like that but what I saw when I when I was tested was those you know Christmas tree paddent pattern Herald patches and they might also show a picture okay so just be familiar with that and um and and alopecia I never saw anything on alopecia on my board um so I'm there's not a lot to do about that right we maybe think of differentials to do with alopecia and um steroid even steroid shampoos I've seen them doing that people will have some alopecia you know when they're pregnant they'll the hair all the growth of the hair it kind of sinks up so that they're not losing hair while they're pregnant and that all of these these Les kind of get sinked so that after they deliver then they they tend to lose some hair because of the of the hairy and then but you want to look for you know you want to think about hypothyroidism things like that you're going to look at male pattern male pattern uh you know hair loss things like that even in femal okay so you're going to look at hair pulling things like that but I you know that's not um I don't think that's real real CR you know just like that that's not one of the critical things that I would see tested on your boards but it's important to know I had a lady one time actually believe it or not she comes into the clinic and she had she had a whose dog is barking my dog barking if you keep it up um she had a a poster board you can mute your microphone if you if you have the dog um she had a poster board and she had lines drawn on it and she had hair glued into each place on on like 10 different sections and she had pulled it out of her drain and glued it on this thing to prove that she was losing hair every day well she was losing hair she was insisting she had hypo fism and she did have it but she was treated and she was euid but she it was she was losing in this male pattern uh male pattern and and a and you know we asked her she was 75 or so she was she was pretty she was up there and we asked her you know did anybody else in your family have it and sure enough it was familial other people in her family had had the same problem so you know think about that when you look for male patterns baldness even in even in females and then um Okay so as far as Dermatology you can see that there's probably going to be about 17 questions and the majority of them are dermatitis recognizing the skin cancers and you know malignant melanoma everybody knows there's I found a a melanoma risk and there's another one that they use it's like Glasco 7 or something but um I thought this one was kind of cool from the National Cancer Institute and it goes to the South you know you can say I did I did me um light skin lightly tan 5 to 11 and then it it it count calculates your risk so absolute R risk is 35 is a 35% an average of 3.5 people will develop melanoma out of 1,000 women living in this region so you know I I think that you know knowing who's at risk for it and you know if melanoma you know it's it's it's a you want to protect the skin is one of the main things protect it from the Sun and look for those you know variations in the in the the types of lesions that they're going to have abnormal borders they're going to be changing uh they may be uh they may have some sensation and um tingling itching those things um no know which one uh is most uh frequent you know what what you're going to see most often and those things in the difference between just a a keratosis and a and a carcinoma okay and so there's going to be three questions on skin cancers and then acne and you can expect you know some meds on there and and that type of thing okay so uh GI system we kind of had a review over the GI system but um I don't know if you have additional questions um what we talked about before was a little bit um it was kind of brief and so I just thought that we could go over a couple things did y'all have any questions about the GI system or any areas of weakness that you were concerned about the one question I have is the what about Hepatitis B uhhuh just that you know there's that new medication that new medication that it's saying that there's 96 to 99% that it can cure hepatitis C if it's genotype one would test I that Specialty Care okay yeah yeah I wouldn't I wouldn't go the main thing that you're going to see if you look at any of the review books what you're going to see is diagnosis you're going to look for risk factors you're going to look at transmission and and the the labs and you know how long are they going to be sick and you know I looked up the hepatitis B1 and and it usually clears the acute acute symptoms usually clear in a couple of weeks you know weeks but it can take up to six months so that's why um that's why I was a little confused on that but um it's it can take up to six months for acute Sy symptoms to really go away and if you look at the at the there they have all these um some pretty good stuff in uh hepatitis B infection you know they can they show all the the little tests and stuff but I thought we might go over the testing if you wanted to look at that a little bit because that um did y'all learn it really well um it's it's you know it's one of those things that you kind of learn and then you forget and you learn and forget again but um I know there's some some ways to learn it but we'll we'll talk a little bit about you know kind of doing a few little um read some tests and see how they they go but alt and a I know you've probably seen this that that if the ratio is greater you know alt to a is greater than one that think viral hepatitis and I I don't know what the heck that means right so well maybe I know a little bit but um if I were gonna want to know what this is how you explain it is that you know if you have a ratio of alt to a you're going to put a alt over a you're going to divide it by so you guys are probably recent enough with your education that you don't need to remind yourself of that but so you're going to separate if you have a ratio of 140 to 88 you're going to put 140 over 88 and then you're going to do number so you would you would see in here that alt ratio to as that means alt divided by as is greater than one so that would mean that alt had to be more alt is higher than as and that and sometimes people remember that by the L for liver problem with the liver and and you can associate that with you know a liver inflam inflammation or heti that's just a a memory trick and then the opposite is true for a is greater than alt and the ratio is greater than two uh and that that usually is a drugs and alcohol acetaminophen statins alcohol things like that so you're going to see those and you know we talked a little bit about the the um non nonalcoholic therosis and things like that and you're going to see in the fatty liver you're going to see those kind of enzymes uh elevated um and that is hepatitis non-stat hepatitis you know so that you're going to say you're you would expect the alt to be higher than the as so when you see that that ratio just think it's it's greater than you know it's higher but it has to be a certain amount higher so does that make sense to y'all so yeah it's just it's just a way of looking at those lab tests that if you see the S think Statin I would say when I see the S I think Statin and then I just think drugs you know can be alcohol you know that type of thing U but Statin I think it's something acting upon the liver like a Statin and then when I think of alt I think it's the actual liver or inflammation of the liver so I pulled a couple of questions um colon sign is most commonly associated with which problem um y'all know what colen Stein is thank you T yeah that that's the correct answer it's it's where you have um that little uh yellowish blue coloration around the belly button and and it's because the pancreatic enzymes may run around along that ligament so um that was just one of them and then diverticulitis okay this is talking about antibiotic the reason we want to know what type of organism is because we want to know what antibiotic to treat them with and so you know you'll see some broad spectrum stuff going on but do y' all do y' all know this is a trick question so don't feel like you can don't feel like um feel like you have to know the answer but U diverticulitis is most often infected with which type of organism now you're going to think about the gut right what's the most what's the obvious in in organism in the gut that that can you can become infected with the E right Eco and that's gram negative so we're sure we're sure there's going to be gram negative but in the literature what it says is anerobic microorganisms anerobic organism so I'm like which ones are anerobic because I'm not quite sure MRSA no andru caucus maybe right which what's anerobic but if you look right here it show I I printed out I I I copy and pasted some Anor robic so you have grand negative and Grand positive Anor robes okay but diverticulitis is is is associated with gram negative most of that's what we think of because it's the gut and we always think of you know below the below the waist is gram negative and above the waist is G gram positive but um you can see that in the in the DI reticulitis it's going to be anerobic so it'll be grand positive and gram negative so the reason that that was kind of a trick question is because both of these are right but there's they're saying anerobic so those are the terms that you're going to read and from what from what um if you look at the the um the treatment for diverticulitis not all diverticulitis uh needs anti iotics you know some of it can just be clear liquids and you know rest your gut and things like that but if you do decide to do an antibiotic as an outpatient you're going to look at the look at look at cpro and you can see and I have to I have to always have to look again so cpro is gram negative and and a weak gram positive and then you have metronidazol so you're giving Two drugs and what you're saying is that that is a that is a broad spectrum you're going you're going to go broad spectrum a MOX theum is gram positive and gram negative and betal actimate so this is a broad spectrum it's one drug right and so then you have maybe some allergies but I just kind of wanted to show you that but know that not all diverticulitis needs antibiotics um but you'll probably see them given you know but it it depends on the patient condition and you know some of them need hospitalization and and some of them don't so um that was kind of a I I want promise it won't be any tricks on the test right no tricks no tricks for you okay so now that the an uh the hepatitis um hepatitis uh testing and I I I in the um I put in the soft chalk is there let me find the hepatitis one I put a little chart and I know y'all did some charts too which one is it this is part one is this part two yeah part two yeah let's see let's see oh I keep it keeps going okay sorry it keeps you know it's every time I go up to the top it pull something else down let me see if I can get it there we go okay part one and then we're going to go to um let's see if I've got hepatitis there we go okay so some of y'all may have listened to how many people listen to amal's lecture on this do y'all listen to that at all am haer AA she has those I'm think some of y'all might be going to a review session soon or or maybe wait till next year but her her disc she does a really good job of explaining this and I like the way she does it but let's think about what the the most of the questions that you're going to get you're going to get questions on the boards like how does how is Hepatitis A transmitted you know that's FAL oral root right and so you're going to get some questions on hepatitis C and a lot of what they're going to talk about is The Chronic hepatitis C and the the risk and how how you know if it's become chronic you know what are the lab values to show if it's chronic and then what are the risks of it you know for cancer things like that how does it and I have a patient right now who is converted over he had hepatitis C andos ceros and he has liver cancer so I have he has all three and he's he's doing okay he's still alive so he's not too old so he may he may get there but um so the antigen the surface antigen if you think of if you think of um hepatitis as being a viral let's say it's a it's a viral um I wish I could draw I should have drawn it for you um I don't think I can I I I would I would have to figure that out but it's a virus and it's a it it's it's picture is a round virus and a surface antigen is is is something that's on the surface of that Circle okay so this is actually the virus when they when they when there is something on this AG antigen when it's on the surface of the virus it's a it's infected somebody's infected with it AG means they're infected it's the virus but when you have an AB that's an antibody and you know that your body produces antibodies to fight infection and so that's your response to it okay so if you're thinking about if you see these you know so the H is hepatitis the B is the type of hepatitis and then the you got surface antigens those are on the surface of the virus and then you have surface antibodies and core antibodies well if you have a if you have a core antibod that means that that the antibodies are all the way into the core of the cell and you have a you have a it's a marker for an acute chronic or resolved Hepatitis B it's not immunity from from a immunization so core hepatitis core means you have the infection because it got all the way into the cell think of it that way and you know it may not be what I'm doing is giving you memory tricks I'm not giving you U you know a really a a pathophysiologic iCal lecture I'm trying to help you remember what these what these values mean okay so you have hepatitis B surface antibody and that means that you're immune so somebody that's had an immunization uh this is what you would expect to be positive but you would expect the antigens to be negative because they don't have the virus and you would expect the core antibody to be negative because they never had an infection they just have immunity so you know if you're looking at this IG that means that that it's post exposure and IGM means that I've heard miserable IGM m means miserable that means that they're that they have it now wait that's that's what I remember would I type it wrong G is gone m is what minute you have it right now yeah yeah okay that's what I think that's what I said I'm not sure if I typed it right but I'm not reading I'm I'm talking but anyway I saw this right here this is anti-i so but yeah M for miserable M for minute you know you can do that so you've got some little memory tricks here and I think it's important to you know at least get these things in right here you know the Hepatitis B surface antigen Hepatitis B surface antibody hepatitis B uh core antibodies to really understand those and you can apply them to hepatitis C you know what I mean if you just take hepatitis C Surface antigen hepatitis C Surface antibodies so if you if you understand what these little letters mean then you can think your way through it okay hopefully so let's let's think our our way through a couple if we can hopefully I can help you with this okay so we have hepatitis the surface antigen is negative so the surface antigen means that right now you know there's antigens on there so that's the virus that's the virus on on the cell okay so that's negative now we have Hepatitis B surface anybody negative so we know that on the that those that that means that they're not immune right and we hepatitis core anybody's Negative they never had an infection so this person is is NE not sick now NE not immune and never been sick so we would want that person to be immunized for Hepatitis B this this is somebody you would recommend immunization for and so let's go to the next one you go Hepatitis B service antigen negative that that means that that there's no virus on the cell right now hepatitis surface anti antibody is positive and we already talked about this this is the one where where can you see what what's going on here what how would you what would you think about this person they have they've never had the disease right and but they're immune from an immunization okay so let me see if I can find let me find one more let me see okay so let's say that you have um Hepatitis B service antigen is negative and hepatitis B service anybody is positive so this one right here is positive and now this one is also positive what would you think this person have do you think they're sick right now no he's been immunized by for C and yeah well but we've got hepatitis body is positive so that means that at some point he had his own immuni yeah he produced his own immunity can you see how that so this is this a core that means that the antibody got all the way in and that means he was sick if it went to the core he was sick to the the core okay but if if he's and then this he's probably immune because he had the disease he produced his own [Music] immunity okay and I'm not going to you know you can look at Chronic infection you know when somebody has hepatitis surface antigen is positive over a long period of time you know they it stays positive and there's there there's no no immunity and they have you know this U the core is positive that a core positive can mean that they had it before or they have it now either one but it's it's over the length of time so think of time and I I would have to look up what the time frame is but um I think at this point just know that over a period of time you know that it you expect it to go away right we know that a cute symptoms can last you know several weeks or seever or up to six months yeah so just think of it in those terms and you will learn more as you go through you know what I mean you're going to you're going to have a chance to apply these things and I would recommend that you do that but right now what we're doing is we're doing sort of a little um you know giving you an introduction and a license to learn I know Dr Miller covered some of this in um in infectious disease disase right did y'all go over any of this and infectious disease so it's a little bit of a review little bit of a review maybe okay so what time is it we still have a little time um any any questions these are kind of like just just like the basics just the basics some memory tricks and and if you have questions I will try to answer them I know what I know and I and I can always look it up I'm not I'm not the encyclopedia but I I can give it a try okay so I have a few flash cards okay so um there they're over different topics they're not all over um hepatitis but they're just kind of General GI flashcards I don't think I had any I might have put some in there for um let me see if I did any Derm flash cards no no I don't see any when I told you when I was in my program I made about a th flash cards so I was prepared okay so where my flash cards go here we go hbil rubonia can cause what ah so it has to do with protein bound drugs okay I don't think you're going to see that but you know that's something to think about if you have something somebody with with a lot of Billy ruin in their blood then you're it's going to be a problem of pro protein B bound drugs and you're see color Cola colored urine and that's what we would expect right in diarrhea what signs suggests the viral cause everybody should know this right what is it you have a patient with diarrhea or gastron aritis what what would you think is a viral cause fever fever no that's too easy right you're thinking what is it what is it no it's just fever it's not it's not that it was too easy okay so and and I think that GI people do pretty well on this test because um because it is very familiar you I think people are pretty familiar with GI stuff maybe not so much derms and uh and it's not my my strong suit either but I think Dr Miller gave you quite a few little uh quizzes and stuff so um who should be immunized against hepatitis A people that are traveling to third world countries or has that has this changed don't we get this to babies now don't children get don't we just give the hepatitis A to everybody now yes is it it it seems like you know U that flash card might be kind of old my my flash card says you know probably what you said is is uh uh food handlers travel in daycare workers lab workers IV drug use and all patients with hepatitis but has it do we give did y'all study the immunization schedules let's see not on there I thought it was just I said it was just B but I yeah because B was the first one okay okay good okay immunizations for children and oh a is down the road 12 months oh here he say down here oh my good it is so my flash card I didn't publish these for y'all because they were a few years old but you can see that you know that and and there's a little they get it at a year and I just hate that I mean from my perspective I just hate telling these kids full holes that you know if they're not if they're not going to be exposed why are we doing it but that's just my opinion I'm notations I love them to daycare nowadays so yeah it's oral feal yeah that's true that's a good point and you know I teach a TB and in the next class in in the fall we talk about TB and oh like why are we spending all this time on tv nobody has it and then one of my faculty members said here read this book so it was about the worldwide you know fight against TV and how you know the Texas border were really holding the line so you know I I guess I'm you know it's good that I have young minds here to think about these things because daycare is it's speal to oral right so that's really important but I guess if if they're I think of no risk in that age but there is risk so don't listen to me I'm going to cut that out of this recording so I didy I said it okay all right in acute hepatitis A infection ex a to be greater or lower than alt so we're talking about hepatitis hepatitis is that a Statin it's a liver thing right so the alt would be higher than the AF right so I would expect AF to be lower but let's see if I got it right as to be greater than that's not right that that flash card's wrong I think that's wrong yeah it is wrong I think you're yeah your Al is going to so you see you learn more from a bad from a bad card than a good one okay so Murphy's Sign can be elicited by you all know that one right this where they take a you know a breath um Quant yeah and when when they they release their breath right they release blow it out then you push and it'll cause them to to try to Brea you know they'll don't gas right and that's for COI right okay symptoms of dir too easy just pain at Rest Post penial fullness chronic heness nocturnal cough weak sore throat that type of thing okay um most common cause we we've talked about that a lot contaminated water supply hepatitis A infection contaminated water supply okay is an active and requires okay so they're asking what kind of immunization is is it an active or an inactive virus in immunization so it's inactive okay and inur a proton pump inhibitor is a prescribed in order to raise gastric pH level so that's asking do you know if pH is higher or lower you know if you want to kind of reduce acidity base is higher acid is lower okay so a positive Hepatitis B surface antigen means what so we know the antigen is is what that's the virus so let me currently affected with oh y'all are so smart there we go okay so we got a patient with an as T of 22 which is normal an Al of 25 which is normal and an h v IG positive what do that indicate they all hepatitis A infection okay so they're not sick their liver enzymes are fine that they had it in the past and you know have yall read any hepatitis panel have y'all seen hepatitis panel yes I've had a couple in my clinic okay and did did you get the IG and migm and all that stuff on your paneli so you're going to get more than just those three the surface anent the you know core antibody the the surface antibody you're going to get the IGG and the migm if you do a hepatitis panel you're going to get those those two so g means gone and M means minute or miserable right okay uh in a patient with sever gird what other symptoms might the patient oh this is just sore throat yeah sore throat that could be anything but you know that's why I told you the answer most common Reon for a liver transplant it doesn't hepatitis C hepatitis C there you go we talked about that before Larry Hagman right got one okay in statins you expect a slight rise in as true or false yes true y there you go you guys got it okay which cardiac drug exacerbates gerd who knows right anybody know anything that any kind of any kind of um relaxer y yep you got it I think you're right a calcium P blocker can blocker canel blocker yeah you're right because it would relax that uh that valve or whatever what drug history do you use suspecting a patient with erosive gastritis what's the biggest thing that uh biggest and say yeah yeah so you know h K Lori you're going to you're going to want to know you know what what's the what's the the the cocktail that you're going to give them for h pylori when I remembered it I didn't remember the specific antibiotics I just remembered that I was going to give a PP and antibiotic and you know I I remembered you know kind of the drug classes and then because there there's different ones and then they say but they're allergic to this allergic to that so I think if you know kind of the cocktail ta um the first line cocktail you'll be okay but if you have somebody with erosive Gast with gastritis symptoms gird symptoms you can test for um for hpylori and you know when you're looking at peptic ulcer disease peptic ulcers occur in the in the in the stomach and in the duodenum or duodenum however you want to say it so that was the one where you know when when the stomach is empty it's going to hurt when you eat food you know like you eat food and then after the food clears and the acid's able to get to the to the lining that's when it hurts so I hope you remember those kind of little memory tips okay so we're almost out of time and I think just kind of go through these go through these little soft chalk lessons and and um and just you know go review review the assigned readings and I think you'll do fine on our test coming up okay did you with Dr Miller being sick did you write the the Derm questions or did he no he wrote them is he doing okay uh yeah yeah he did he's he's at home and he's he's uh he's recovering and so um but he won't be back this semester but I think he's going to teach this summer but um not an acute and chronic one um he's going to be teaching farm this summer okay yeah so we're we're all you know rooting for him to to feel better and and get well and so but I hope you don't feel like um that you're that you're at a loss on the Derm especially since I spelled it wrong so but we tried to um Dr Bray and I kind of tried to um make sure that you know that everything that you read was what was tested on and all those type of things CU um I think you know Dr M probably would have done a little more with you and things so we we want to make sure that you had a fair chance at it and the test was fair so we think it is so all right so that's it and don't hesitate to ask questions you know if you if you have concerns or whatnot just uh don't hesitate to call on me okay right thank you bye bye thank you man you a all for for for