deck 2 Flashcards
sleep problems management
1st line = sleep hygiene
2nd line –> sleep onset problems + zolpidem (ambient) or eszopiclone (lunesta)
management of sleep maintenance problems
zaleplon (sonata)
use of melatonin
adjusting to sleep-wake cycle
hep A and chronic hepatitis?
never happens
incontinence etiologies
1) hyperglycemia
2) diuretics
3) stool impaction
4) atrophic vaginitis
antihypertensive that can cause urinary leakage and urgency
b-blockers (inhibit bladder relaxation)
first step in evaluation of vaginal bleeding in postmenopausal woman
endometrial biopsy
treatment of primary dysmennorhea
NSAIDS — Primary dysmenorrhea is caused by the release of prostaglandin from the endometrium at the time of menstruation. Treatment focuses on the reduction of endometrial prostaglandin production. This can occur either by using medications that inhibit prostaglandin synthesis, or by suppressing ovulation. NSAIDs are generally the first-line therapy, given their favorable risk to benefit ratio and effectiveness. They should be started a day before menstruation, if possible.
common med that can cause hyperprolactinemia
- benzos, SSRIs, TCAs
progestin challenge test
separates patients with estrogen deficiency from those with normal or excess estrogen. Any bleeding in the week after the administration of Provera indicates that the patient has sufficient estrogen to menstruate, and that the amenorrhea is likely due to anovulation, as in polycystic ovarian syndrome. Those with premature ovarian failure would not have a withdrawal bleed. Neoplasm, Turner syndrome, and Asherman syndrome would not likely present in this way.
hyperalert confusion usually due to…
alcohol withdrawal
chronic N/V in diabetic patient suggests
gastroparesis
mgmt of gastroparesis
metoclopramide
impt exam finding with ileus
ABSENT bowel sounds
cervical dystonia mgmt
botulinum toxin is first line
rapid and irregular heartbeat suggests
afib or aflutter
ectopic pregnancy presentation
nausea + colicky pain + adnexal mass
erythematous pharynx without exudate suggests…
viral infection (thus only supportive treatment)
pathogens responsible for epididymitis
- younger than 35 and sexually active = chlamydia or gonorrhoeae.
- older than 35 = e coli, enterobacter and pseudomonas
spermatocele on exam
asymptomatic nodule attached to the spermatic cord
contributory factors to acne
Contributory factors to acne include certain medications, emotional stress, and occlusion and pressure on the skin, such as by leaning the face on the hands (acne mechanica). Acne is not caused by dirt, chocolate, greasy foods or the presence or absence of any foods in the diet.
treatment of mild acne
combination therapy with topical antibiotics, benzoyl peroxide gels, and topical retinoids
pharmacologic therapy of rosacea
topical brimonidine.
first line for rosacea
Behavioral changes can be beneficial in patients with erythematotelangiectatic rosacea. We educate all patients on the avoidance of triggers of flushing, proper use of sun protection, and gentle skin care
keratoacanthoma vs. SCC vs. BCC
rapid growth (over a couple weeks). BCC and SCC are slow growing.
treatment of pityriasis rosea
It will spontaneously resolve in 6 to 12 weeks, and recurrences are uncommon. The treatment is symptomatic, and includes antihistamines or corticosteroids to relieve itch. There is no role for the other agents listed.
treatment of hot tub folliculitis
usually self-limited, and therefore reassurance is all that is necessary
HSV recurrence management
- No treatment for patients with minimal symptoms
- episodic treatment for patients with prodromal symptoms
- Chronic suppression with acyclovir or valacyclovir helps to reduce the number of clinical HSV episodes in individuals with frequently recurrent lesions
treatment of genital herpes
Treatment options for genital herpes include treating each outbreak (episodic therapy) or using chronic antiviral therapy on a daily basis to prevent outbreaks (suppressive therapy). If episodic therapy is used, it should begin at the first sign of an outbreak, but in discordant couples, daily suppressive therapy is now recommended. Suppressive therapy seems to reduce, not eliminate, asymptomatic viral shedding. Suppressive therapy does not alter the natural course of the infection and is not associated with antiviral resistance. Daily suppressive therapy may reduce the risk of HIV transmission or acquisition, but more studies are needed.
shingles management
The patient shown has herpes zoster, or “shingles.” Antiviral therapy is the treatment of choice, and can decrease the time for lesion healing and shorten the overall duration of pain if initiated within 72 hours after the onset. In some cases, no benefit will occur if treatment starts after the 72 hour cutoff, but it should be initiated regardless of time in patients over 50, those who are immunosuppressed, or those with eye involvement.
tinea capitis treatment
griseofulvin for 4-8 weeks
colloquial name for tinea corporis
ringworm
most common cause of ringworm
trichophyton rubrum
absent feature of conjunctivitis
pain
treatment of viral conjunctivitis
supportive – cold compresses + lubricating drops
scleritis presentation
Scleritis is a unilateral diffuse injection of the deeper scleral vessels. Symptoms include decreased vision, deep “boring” eye pain, and a surrounding headache. It is usually associated with systemic autoimmune diseases
impt feature of sinusitis
- long symptom duration (Duration of illness of less than 7 days may be used as a negative diagnostic criterion. )
typical cause of recurrent sinusitis
allergic rhinitis
most common bacterial pathogen in bacterial sinusitis
strep pneumoniae
treatment of patellofemoral syndrome
strengthening the quadriceps muscles and hip rotators
use of tilt table testing
patients with unexplained recurrent syncope in whom cardiac causes including arrhythmias have been ruled out. An abnormal result suggests vasovagal syncope.
treatment of recurrent vaginal candidiasis/yeast infections
treat partner, especially if he has balanitis
PE presentation
acute shortness of breath + increased RR + wheezing + pleuritic pain
treatment of PE
anticoagulation
evaluation of wheezing in patient with no history of asthma
CXR
ED most commonly due to…
vascular problems
