PLAB 2 NewCase_6: Primary Hyperhidrosis

1. Which of the following are common presenting symptoms of primary hyperhidrosis? (Select all that apply.)

A) Excessive sweating localized to certain areas
B) Generalized body sweating during sleep
C) Visible dripping of sweat from hands or feet
D) Sweating that interferes with daily activities

Answers: A) Excessive sweating localized to certain areas

C) Visible dripping of sweat from hands or feet

D) Sweating that interferes with daily activities

Explanation:

Primary hyperhidrosis typically presents with excessive sweating localized to specific areas such as the palms, soles, underarms, or face. Patients may experience visible dripping of sweat, and the condition often interferes with daily activities and social interactions. Generalized sweating during sleep and significant weight loss are not characteristic of primary hyperhidrosis.

2. How might primary hyperhidrosis impact a patient's daily life? (Select all that apply.)

A) Difficulty gripping objects due to sweaty palms
B) Social embarrassment and anxiety
C) Skin maceration and infections
D) Improved athletic performance

Answers:

A) Difficulty gripping objects due to sweaty palms

B) Social embarrassment and anxiety

C) Skin maceration and infections

E) Disruption of work tasks

Explanation:

Excessive sweating can make it hard to grip pens, tools, or other objects, affecting work and daily activities. Social embarrassment can lead to anxiety or avoidance of social situations. Continuous moisture can cause skin maceration, increasing the risk of infections. Improved athletic performance is not a typical impact of hyperhidrosis.

3. What are the possible differential diagnoses for primary hyperhidrosis? (Select all that apply.)

A) Hyperthyroidism
B) Menopause
C) Pheochromocytoma
D) Anxiety disorders

Answers:

A) Hyperthyroidism

B) Menopause

C) Pheochromocytoma

D) Anxiety disorders

Explanation:

Differential diagnoses include conditions that can cause secondary hyperhidrosis, such as hyperthyroidism (increased metabolism leading to sweating), menopause (hot flashes), pheochromocytoma (catecholamine-secreting tumor causing excessive sweating), and anxiety disorders. Diabetes insipidus leads to excessive urination, not sweating.

4. Which investigations are useful in diagnosing primary hyperhidrosis? (Select all that apply.)

A) Starch-iodine test
B) Skin biopsy
C) Thyroid function tests
D) Blood glucose levels

Answers:

A) Starch-iodine test

C) Thyroid function tests

D) Blood glucose levels

Explanation:

The starch-iodine test helps visualize areas of excessive sweating. Thyroid function tests and blood glucose levels can rule out hyperthyroidism and diabetes mellitus, which can cause secondary hyperhidrosis. Skin biopsy is not typically used, and autonomic function tests are more relevant for autonomic neuropathies.

5. During physical examination, which signs are indicative of primary hyperhidrosis? (Select all that apply.)

A) Moist or wet skin in localized areas
B) Enlarged lymph nodes
C) Tachycardia and hypertension
D) Absence of sweating during sleep

Answers:

A) Moist or wet skin in localized areas

D) Absence of sweating during sleep

E) Skin infections like fungal or bacterial dermatitis

Explanation:

Physical examination may reveal moist skin in affected areas. Primary hyperhidrosis typically does not occur during sleep. Continuous moisture can lead to skin infections. Enlarged lymph nodes and vital sign changes like tachycardia are not characteristic of primary hyperhidrosis but may point to secondary causes.

6. How would you explain primary hyperhidrosis to a patient in layman's terms? (Select all that apply.)

A) "Your sweat glands are overactive in certain areas of you
B) "You have an infection causing excessive sweating."
C) "Your body's cooling system overworks in some areas."
D) "It's a hormonal imbalance causing you to sweat more."

Answers:

A) "Certain areas have overactive sweat glands."

C) "Your body's cooling system overworks in some areas."

E) "Your nerves trigger excess sweat in specific areas."

Explanation:

These explanations accurately describe primary hyperhidrosis, which is due to overactivity of sweat glands often triggered by the sympathetic nervous system in localized areas. It's not typically caused by infections or hormonal imbalances.

7. What lifestyle modifications can help manage primary hyperhidrosis? (Select all that apply.)

A) Wearing breathable, loose-fitting clothing
B) Using antiperspirants regularly
C) Avoiding spicy foods and caffeine
D) Increasing physical activity levels

Answers:

A) Wearing breathable, loose-fitting clothing

B) Using antiperspirants regularly

C) Avoiding spicy foods and caffeine

E) Applying talcum powder to absorb moisture

Explanation:

Lifestyle modifications include wearing clothing that allows the skin to breathe, using antiperspirants (not just deodorants), avoiding triggers like spicy foods and caffeine, and using talcum powder to keep skin dry. Increasing physical activity may temporarily exacerbate sweating.

8. Which medications might be prescribed for primary hyperhidrosis? (Select all that apply.)

A) Topical aluminum chloride hexahydrate
B) Oral anticholinergic agents
C) Beta-blockers
D) Antibiotics

Answers:

A) Topical aluminum chloride hexahydrate

B) Oral anticholinergic agents

E) Botulinum toxin injections

Explanation:

Topical aluminum chloride is a first-line treatment. Oral anticholinergics reduce sweat production systemically. Botulinum toxin injections block nerve signals to sweat glands. Beta-blockers may help with anxiety-induced sweating but are not standard for hyperhidrosis. Antibiotics are not indicated unless there is an infection.

9. In addition to lifestyle changes and medication, what other treatments may be necessary for primary hyperhidrosis? (Select all that apply.)

A) Iontophoresis
B) Endoscopic thoracic sympathectomy
C) Radiation therapy
D) Psychotherapy

Answers:

A) Iontophoresis

B) Endoscopic thoracic sympathectomy

D) Psychotherapy

Explanation:

Iontophoresis uses electrical currents to reduce sweating, especially in hands and feet. Endoscopic thoracic sympathectomy is a surgical option for severe cases. Psychotherapy can help if anxiety exacerbates symptoms. Radiation therapy and laser therapy are not standard treatments for hyperhidrosis.

10. What safety netting advice should be given to a patient with primary hyperhidrosis? (Select all that apply.)

A) "Return if symptoms worsen or don't improve."
B) "Report any side effects from medications immediately."
C) "No follow-up needed unless new symptoms develop."
D) "Seek help if hyperhidrosis affects your mental health."

Answers:

A) "Return if symptoms worsen or don't improve."

B) "Report any side effects from medications immediately."

D) "Seek help if hyperhidrosis affects your mental health."

Explanation:

Patients should be advised to return if symptoms persist or worsen, report medication side effects, and seek support for mental health issues like anxiety or depression resulting from hyperhidrosis. Regular follow-up is important, and new symptoms should not be ignored.

11. Should a referral be made for a patient with primary hyperhidrosis, and to which specialist? (Select all that apply.)

A) Yes; refer to a dermatologist
B) Yes; refer to a neurologist
C) Yes; refer to a psychologist or psychiatrist
D) No; manage entirely in primary care

Answers:

A) Yes; refer to a dermatologist

C) Yes; refer to a psychologist or psychiatrist

E) Yes; refer to an endocrinologist

Explanation:

A dermatologist specializes in skin conditions and can offer advanced treatments. Referral to a psychologist or psychiatrist may be beneficial if the patient experiences significant psychological impact. An endocrinologist may be involved to rule out hormonal causes if secondary hyperhidrosis is suspected. A neurologist is less commonly involved unless there is suspicion of neurological disorders.

12. Which examination techniques are useful in assessing primary hyperhidrosis? (Select all that apply.)

A) Visual inspection of affected areas
B) Minor's starch-iodine test
C) Measuring body temperature
D) Assessing for lymphadenopathy

Answers:

A) Visual inspection of affected areas

B) Minor's starch-iodine test

E) Evaluating for signs of anxiety

Explanation:

Visual inspection helps assess the extent and location of sweating. The Minor's starch-iodine test identifies sweating patterns. Assessing for anxiety is important as it can exacerbate hyperhidrosis. Measuring body temperature is less helpful unless fever is suspected. Lymphadenopathy is not typically related to primary hyperhidrosis.

13. What are common patient complaints during daily activities with primary hyperhidrosis? (Select all that apply.)

A) Difficulty using electronic devices due to wet hands
B) Clothing stains from excessive underarm sweating
C) Slipping in footwear due to sweaty feet
D) Frequent dehydration

Answers:

A) Difficulty using electronic devices due to wet hands

B) Clothing stains from excessive underarm sweating

C) Slipping in footwear due to sweaty feet

E) Avoidance of handshakes

Explanation:

Patients may have trouble with electronic devices, stained clothing, slipping in shoes, and social embarrassment leading to avoidance of handshakes. Frequent dehydration is not a common complaint unless sweating is extreme and generalized.

14. Which factors can contribute to the development or exacerbation of primary hyperhidrosis? (Select all that apply.)

A) Genetic predisposition
B) Warm environmental temperatures
C) Stress or emotional stimuli
D) Obesity

Answers:

A) Genetic predisposition

B) Warm environmental temperatures

C) Stress or emotional stimuli

E) Consumption of spicy foods

Explanation:

Primary hyperhidrosis can be hereditary. Heat, stress, and certain foods can trigger or worsen sweating episodes. Obesity is more associated with secondary hyperhidrosis due to increased body mass and insulation, but it's not a primary cause.

15. What is the primary goal in managing primary hyperhidrosis? (Select all that apply.)

A) Reduce excessive sweating to improve quality of life
B) Cure the condition with antibiotics
C) Prevent secondary skin infections
D) Address any underlying psychological impact

Answers:

A) Reduce excessive sweating to improve quality of life

C) Prevent secondary skin infections

D) Address any underlying psychological impact

Explanation:

Management aims to control sweating to enhance quality of life, prevent skin complications, and address psychological effects. Antibiotics are not used unless treating an infection. Increasing overall sweating is not a goal; rather, the aim is to reduce it.

PLAB 2 NewCase_6: Primary Hyperhidrosis

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