General Flashcards
Vulvovaginal Candidiasis Presentation
Thick, whitish discharge that has no odor
Significant pruritis of external and internal genitalia
Vaginal area can be edematous with erythema
Discharge has pH 4.0-5.0
Protocol for newborn with HBV+ mother
HBV vaccine + Hepatitis B immune globulin within 12 hr birth Dose 2 @ 1-2mo Dose 3 @ 6 mo If hepatitis status of mother is unknown, give vaccine @ birth, test mother, and if positive give IG within 7d.
COPD with FEV1 50-80%
Stage 2 (Moderate COPD) Long-acting bronchodilators
Lesion? Causes?
“Ringworm” = Trichophyton rubrum or Tinea tonaurans, T mentagrophytes, M canis
Well demarcated plaque with central scaling, usually pruritic.
PNA tx for hospitalized patient NOT in ICU
Beta-lactam (Piperacillin/tazobactam, cefepime, imipenem, or meropenem) + fluoroquinolone (levofloxacin, moxifloxacin) OR aminoglycoside
Centor Criteria for Rapid Strep Test
Patient gets one point for each of the following:
- absence of cough
- enlarged/tender anterior cervical adenopathy
- fever of at least 100.4F
- tonsillar exudates
- pt age 3-14 yr
- Deduct a point for age of 45 or higher
0-1 Points = no further testing and no abx indicated
2-3 points = perform rapid strep or throat culture and tx with antibiotic if positive
4+ points = consider empiric abx
Spermatocele
Asymptomatic nodules, generally found attached to the spermatic cord.
No further tests needed unless diagnosis remains unclear, then can use US.
Sleep aid for transient sleep onset problems?
Zolpidem (ambien) Eszopiclone (Lunesta)
Outpatient PNA treatment
Macrolide (clarithromycin or azithromycin)
OR
Doxycycline
Follow up 3-4d to assess response to therapy
Treatment options for abdominal pain in IBS
Antispasmodics: dicyclomine & hyoscyamine
Low-Dose TCAs
SSRIs if comorbid depression or anxiety
Rifaximin of NO constipation symptoms
Probiotics & peppermint oil
Laryngitis + Pharyngitis?
Most commonly viral in nature and only supportive care is needed.
Outpatient PNA treatment for patient with comorbidities
Fluoroquinolone (levofloxacin, moxifloxicin))
OR
Beta-lactam (amoxicillin, amoxicillin-clavulunate, cefpodoxime, cefuroxime) + macrolide
Symptoms of Alcohol Withdrawal
<12 hour: insomnia, tremors, anxiety, GI upset, diaphoresis, headache, palpitations
12-24 hr: visual, auditory, or tactile hallucinations
24-48 hr: generalized tonic-clonic seizures
48-72 hr: DTs (hallucinations, tachycardia, fever, HTN, etc…)
Hypovolemic Hyponatremia Common Causes
(Urinary Na < 20 mEq/L)
Cerebral Salt Wasting
Skin loss
Diuretic use
GI losses
Mineralcorticoid deficiency
COPD-cough, sputum production, normal spirometry
Stage 0 (At Risk)
Vaccines Address risk factors: smoking, occupational exposure, smoke from cooking/heating fuel
Headache that begins after age 50 y/o especially with jaw pain on chewing
Differential:
- Temporal arteritis
- Mass lesions
Workup:
- neuroimaging
- ESR
Side Effects of Phenothiazines Antiemetics (compazine and phenergan) and tigan?
Drowsiness
Dry mouth
Dizziness
Symptoms of opioid withdrawal
Muscle cramps & arthralgias
Anxiety
Vomiting & diaphoresis
Piloerection
Lacrimation and rhinorrhea
Elevated BP
Insomnia
Scoring Criteria for Risk of Ischemic stroke in First 7 Days after TIA
ABCD2 Criteria
Age ≥ 60 (1 point)
BP ≥ 140/≥90 (1 point)
Clinical Features
- Unilateral Weakness = 2 points
- Isolated speech disturbance = 1 point
- Anything else = 0 points
Duration
- ≥ 60 min = 2 points
- 10-59 min = 1 point
- < 10 min = 0 points
Diabetes = 1 point
Scoring System
Score 0-3 = Low risk
Score 4-5 = moderate risk (`4%)
Score 6-7 = high risk (8 %)
Prophylactic Tx of Cluster Headaches
CCB-nifedipine
Indomethacin
Prednisone
Lithium
Note: to be used only during the attack period
Hypernatremia Common Causes
High Urine Osm (>400 mOsm/kg): Excessive sweating, GI losses
Low Urine Osm (<300 mOsm/kg): Diabetes Insipidus
ACA Stroke Sx
Lower extremity deficits
Cognitive or personality changes
Trichomoniasis Presentation
Thin, frothy, green-yellow or gray malodorous discharge
Vaginal soreness or dyspareunia
Sx/ may be exacerbated during menses
Cervix can have “strawberry” appearance (erythematous with punctuation) or redness of the vagina and perineum
Who should receive imaging for neck pain?
ONE HIGH-RISK FACTOR: age > 65, dangerous mechanism of action, or numbness/tingling in extremities
IS THERE A LOW RISK FACTOR? Simple rear-end collision, patient ambulatory at scene, absence of neck pain at scene, absence of c-spine tenderness (if no to any of these, need imaging).
CAN PT ACTIVELY ROTATE NECK 45 DEGREES TO L AND R, regardless of pain. (“No” requires imaging)
Characteristics that make palpitations more likely to be cardiac in origin?
Male
Description as “irregular heartbeat”
Personal hx of heart disease
Event duration > 5 min
Iron Deficiency Tx
Oral ferrous sulfate @ 325mg (65mg elemental iron) TID for ~6-8wk
Pt with malabsorption, CKD, HF, or significant blood loss may need IV iron
Oral Herpes Tx
Topical antiviral
Chronic suppression can decrease frequency of symptomatic recurrence and asymptomatic viral shedding
Treatment for mild acne
Topical antibiotics + Benzoyl peroxide gel + topical retinoids
Improvement occurs over 2-5 months
Apply topical retinoids at night and topical antibiotics and benzoyl peroxide gel in the day
Fever 1-4wk post-op
Infectious
- SSI
- C-Diff
- Cather-related infection
- Device-related infection
- Abscess
Non-infectious:
- Med toxicity
- DVT/PE
- Thrombophlebitis
Symptoms of tobacco withdrawal
Headaches
Irritability, depresison, anxiety
Cognitive & attention deficits
Sleep disturbances
Increased appetitie
Trichomonias Treatment
Oral metronidazole given in single 2g oral dose
1 week of 500mg BID metronidazole for both and partner
Involvement of GI tract in Crohn Disease vs. Ulcerative Colitis
CROHN DISEASE: extends from mouth → anus (mostly ileum and colon), skip lesions, rectum usually spared ULCERATIVE COLITIS: always involves rectum with continuous lesions
Treatment for PID
Outpatient management: ceftriaxone 250mg IM + doxycycline 100mg BID for 14d +/- metronidazole 500mg BID for 14d
If patient is pregnant, presents with fever and vomiting, or if surgical intervention cannot be ruled out, should be treated inpatient.
Acral Letiginous Melanoma
Most common melanoma in African Americans and Asians
Flat, irregular, dark-brown or black lesions that occur on the palms, soles, and under nails
HTN Tx in nonblack patient >60 y/o
CCB
Thiazide diuretic
ACE inhibitor/ARB
Ottowa Knee Rules
- Age 55 or older
- Isolated patella tenderness
- Tenderness of the head of the fibula
- Inability to flex the knee to 90 degrees
- Inability to bear weight for 4 steps immediately and in the exam room
Clinical Manifestations of Crohn Disease vs. Ulcerative Colitis
CROHN DISEASE: diarrhea, only bloody if colitis
ULCERATIVE COLITIS: bloody diarrhea
Prehn Sign
Testicular pain relieved upon elevation of the testicle while the patient is supine.
COPD with FEV1 < 30%
Stage 4 (Very severe COPD) Long-term O2 therapy Possible surgical intervention
Lesion? Treatment?
Tinea capitis
Systemic therapy necessary for cure
- Griseofulvin 4-8wks (1st line)
- Fluconazole 3-4wk
- Can also use terbinafine, itraconazole, fluconazole, and ketoconazole
Topical ketoconazole shampoo or selenium sulfide lotion may kill spores on hair.
Rosacea Treatment
First line = oral antibiotics like minocycline and doxycycline
Can also use topical metronidazole, antibiotics, and sodium sulfacetamide
Treatment for sleep Maintenence problem?
Zaleplon (Sonata)
Rome Criteria for IBS
Recurrent abdominal pain or discomfort at least 3d/month for the past 3 months with at least 2 or more of the following…
- Improvement with defecation
- Onset associated with change in frequency of stool
- Onset associated with change in form (appearance) of stool
Primary amenorrhea evaluation in pt with secondary sex characteristics
- Labs: pregnancy test, TSH, prolactin
- Progestin challenge
- If no withdrawal bleeding from progestin, do estrogen-progestin challenge to distinguish inadequate estrogen production from outflow tract obstruction
Causes of fever intra-operatively up to 24 hr after surgery
Infectious:
- Preexisting infection
- Bacteremia from urologic procedures
- Intraperitoneal leak (up to 36 hr)
- Invasive soft-tissue infection
- TSS
Non-infectious:
- Surgical trauma
- Meds
- Blood products
- Malignant hyperthermia
Treatment for Lyme Disease
EARLY LOCALIZED DZ: amoxicillin or doxycycline for 2-3wk
EARLY DISSEMINATED DZ: IV ceftriaxone or cefotaxime + chloramphenicol for 2-3wk