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Step 2 DIT 😱 > Treatments 5 > Flashcards

Treatments 5 Flashcards

1
Q

Iron deficiency anemia

A 
Iron supplementation (several months)
Find cause
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2
Q

Lead poisoining

A

EDTA or succimer for chelation

Add dimercaprol in children if severe

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3
Q

Folate/B12 deficiency anemia

A

Folate / B12 supplementation

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4
Q

Anemia of chronic disease

A

Treat underlying condition

Maybe supplemental EPO (ESRD, HIV, some cancers)

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5
Q

Aplastic anemia

A

Stop offending agent

BM transplant may be needed

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6
Q

Sideroblastic anemia

A 
Vitamin B6 (hereditary)
Supplemental epo (acquired)
Phlebotomy/chelation w/ deferoxamine
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7
Q

Thalassemia

A

If needed
Folate supplementation
Transfusions + iron chelation

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8
Q

Sickle cell disease

A

Hydration, supplemental O2, analgesics during crises
Hydroxyurea (increases Hgb F production)
Chronic transfusions
Folate supplementation
Vaccinations and prophylactic penicillin until age 5 to help prevent pneumococcal infx

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9
Q

Sickle cell disease recommended vaccinations

A 
Pneumococcal (+prophylactic penicillin til age 5)
Hib
Meningococcal
Hep B
Annual flu
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10
Q

Type I hypersensitivity rxn

A

Antihistamines, LT inhibitors, bronchodilators, steroids

Epi pen

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11
Q

Type II hypersensitivity rxn

A

Anti-inflammatories
Immunosuppressive agents
Plasmapheresis

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12
Q

Type III hypersensitivity rxn

A

Anti-inflammatories

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13
Q

Type IV hypersensitivity rxn

A

Steroids

Immunosuppressive agents

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14
Q

Anaphylaxis

A

ABCs
Epinephrine
Antihistamines, bronchodilators, steroids
IVF, vasopressors if needed for hypotension

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15
Q

Antiphospholipid syndrome

A

Anticoagulate w/ heparin and/or warfarin

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16
Q

HELLP syndrome

A

Deliver if fetus >34 weeks

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17
Q

von Willebrand disease

A

Desmopressin (first line)
vWF / factor VIII concentrate, cryoprecipitate
OCPs for menorrhagia
Avoid ASA, other anti-platelet medications

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18
Q

Hemophilia

A 
Factor VIII (A) or IX (B) replacement
Desmopressin, transfusions
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19
Q

DIC

A

Treat underlying disorder
Replace platelets, FFP, cryprecipitate as needed
Heparin for chronic thrombi

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20
Q

Sepsis

A

ABCs
Hydration, vasopressors (NE), inotropes, perfusions as needed
Glucocorticoids if needed
Blood/urine/sputum cx then start broad antibiotics then narrow when cx return
Maintain glycemic control (glucose 140-180)

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21
Q

Malaria

A

Antimalarials (chloroquine, primaquine, quinine; atovaquone-proguanil, mefloquine in chloroquine-resistant)

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22
Q

Herpes zoster / Herpes simplex

A

Acyclovir, valacylovir, famcyclovir

Foscarnet for resistant strains

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23
Q

Kaposi sarcoma

A

Topical -tretinoins

Chemo, radiation, laser therapy

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24
Q

Isospora diarrhea

A

TMP-SMX

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25
Q

Strongyloides diarrhea

A

Ivermectin

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26
Q

Cryptosporidium diarrhea

A

Self-limited (immuno-competent)

Nitazoxonide (immunocompromised)

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27
Q

Coccidiomycosis

A

Fluconazole or amphotericin B

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28
Q

Candida esophagitis

A

Oral fluconazole / -azoles

Nystatin swish and swallow

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29
Q

PCP

A

TMP-SMX, corticosteroids

Pentamadine if sulfa allergy

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30
Q

Histoplasmosis

A

Amphotericin B or itraconazole

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31
Q

Cerebral toxoplasmosis

A

Pyrimethamine +/- clindamycin

Sulfadiazine + Leukovorin

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32
Q

Progressive multifocal leukoencephalopathy

A

None (HAART)

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33
Q

Cryptococcal meningitis

A

Amphotericin B + Flucytosine then transition to

Oral fluconazole

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34
Q

Cytomegalovirus

A

Ganciclovir or valganciclovir

Foscarnet

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35
Q

Mycobacterium avium complex (MAC)

A

Macrolides (first line, eg clarithromycin, azithromycin)

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36
Q

HIV

A

HAART

Start w/ 2 NRTIs and 1 protease inhibitor, NNRTI or integrase inhibitor

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37
Q

HIV prophylactic antibiotics

A

Start at CD4 <200
PCP/Toxoplasmosis: TMP-SMX
MAC: macrolides (clarithromycin or azithromycin)

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38
Q

Polycythemia vera

A

Serial phlebotomy
Hydroxyurea (BM suppression)
ASA (thrombus prophylaxis)
IFN-a for refractory pruritis or erythrocytosis
Allopurinol for symptomatic hyperuricemia

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39
Q

Multiple myeloma

A

Radiation, chemo, BM transplant

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40
Q

Hodgkin lymphoma

A

Radiation, chemo

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41
Q

Non-Hodgkin lymphoma

A

Palliative radiation, chemo

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42
Q

Philadelphia chromosome positive leukemias

A 
Mostly CML (5% ALL, rare AML)
Imatinib
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43
Q

Colles fx

A

Long arm cast

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44
Q

Smith fx

A

Casting

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45
Q

Scaphoid fx

A

Thumb spica cast

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46
Q

Boxer fx

A

Closed reduction/surgical pinning

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47
Q

Monteggia fx

A

Surgery

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48
Q

Galeazzi fx

A

Surgery

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49
Q

Hip fx

A

Surgery

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50
Q

Femur fx

A

Surgery

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51
Q

Ankle fx

A

Cast, surgery if unstable

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52
Q

Compartment syndrome

A

Emergency fasciotomy (all compartments)

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53
Q

Osteoporosis

A

Bisphosphonates
SERM (raloxifene)
Pulsatile teriparatide (moderate-severe)

54
Q

Osteopetrosis

A

Transfuse marrow components

Activity restriction

55
Q

Osteogenesis imperfecta

A

Bisphosphonates

56
Q

Gout, acute

A

NSAIDs
Steroids
Colchicine (third line)

57
Q

Gout, chronic

A

Allopurinol
Probenecid
Colchicine

58
Q

Pseudogout

A

NSAIDs

Colchicine

59
Q

Septic arthritis

A

Surgical I&D (not required for gonorrhea if mild)

Vanco (S. aureus) or IV CTX + doxy (N. gonorrhea)

60
Q

Osteomyelitis

A

IV abx for 4-6 wks

61
Q

Lyme disease

A

Doxycycline x14-21 days (early)
IV Ceftriaxone x21-28 days (late)
Amoxicilin or cefuroxime for pregnant patient

62
Q

Rocky Mountain Spotted Fever

A

Doxycycline x7 days

Chloramphenicol for pregnant patient

63
Q

Osteoarthritis

A

Activity modification
Heat, NSAIDs, weight loss, PT
Steroid or hyaluronic acid injections
Joint replacement in advanced cases

64
Q

Bone metastases

A

Chemo, radiation
Bisphosphonates
Fracture fixation

65
Q

Osteosarcoma

A

Surgical excision + chemo

66
Q

Ewing sarcoma

A

Surgical excision + radiation + chemo (Dactinomycin)

67
Q

Osteochondroma

A

Only necessary if soft tissue irritation, neurovascular compromise or continued growth (surgical excision)

68
Q

Polymyositis and dermatomyositis

A

High dose steroids + MTX or azathioprine 4-6 wks

Or IVIG, other immunosuppresants

69
Q

Polymyalgia rheumatica

A

Low dose steroids

70
Q

Fibromyalgia

A

Reassurance, walking, stretching, relaxing, stress reduction, journaling, sleep hygiene
Address any psychiatric disorders
TCAs, Tylenol/Tramadol, Pregabalin, Duloxetine, Fluoxetine, Milnacipran

71
Q

Ankylosing spondylitis

A

PT, NSAIDs, exercise

Sulfasalazine, MTX, anti-TNF

72
Q

Psoriatic arthritis

A

NSAIDs, MTX, sulfasalazine, anti-TNF

73
Q

Scleroderma

A

ACEi (renal HTN)
CCB and avoid caffeine, nicotine, decongestants
MTX, steroids

74
Q

Mixed connective tissue disease

A

NSAIDs, steroids, ACEi

75
Q

Sjogren syndrome

A

Supportive care, steroids

76
Q

Developmental hip dysplasia

A

Pavlik harness 2 years old

May not be able to correct after 8 years old

77
Q

Rickets

A

400 IU vitamin D for all neonates (esp breast fed, dark skinned, live in North) starting in first few days of life

78
Q

JIA (JRA)

A

NSAIDs = doc

2nd line = MTX or steroids

79
Q

Osgood-Schlatter

A

Stretching, NSAIDs
Can continue sports if minimal pain
Usu resolves w/i 6-18 months

80
Q

Clavicle fracture (pediatrics)

A

No treatment in neonates

Sling or figure of 8 for older children

81
Q

Physeal fractures

A

Reduction for type I, II, III
Type III may need fixation
Type IV needs perfect reduction, still guarded prognosis
Type V can’t do much, probable growth arrest

82
Q

Nursemaid’s elbow

A

Closed manual reduction (supination + flexion or hyperpronation)

83
Q

Club foot

A

Serial casting

Surgery in long-standing cases

84
Q

Scoliosis

A

Observation (small)
Bracing (moderate)
Surgery (severe, older patients)

85
Q

Duchenne muscular dystrophy

A

PT, steroids, pulm and cardiac support (ACE)

Usu die by 20 years old

86
Q

Cellulitis

A

Oral cephalosporins or penicillinase-resistant B-lactams 10-14 days
IV abx, vanco/linezolid for MRSA

87
Q

Skin abscess

A

I&D +/- antibiotics

88
Q

Community acquired MRSA

A

SMP-TMX + rifampin

Clindamycin + rifampin

89
Q

Necrotizing fasciitis

A

Prompt, emergent surgical debridement, I&D

IV antibiotics

90
Q

Dry gangrene

A

Allow autoamputation (or amputate)

91
Q

Wet gangrene

A

Debridement
Possible amputation
Antibiotics if infection

92
Q

Gas gangrene

A

Emergency surgical exploration and debridement w/ possible amputation

93
Q

Hidradenitis suppurativa

A

Surgical drainage

Antibiotics (tetracycline, macrolide)

94
Q

Impetigo

A 
Topical antibiotics for uncomplicated (mupirocin)
Oral antibiotcs (erythromycin, cephalexin)
95
Q

Acne vulgaris

A

Topical retinoids (first line)
OTC benzoyl peroxide (second line)
Oral/topical antibiotics (second line) (tetracyclines)
OCP, Spironolactone for excess androgens
Isotretinoin last line of defense (big gun, multiple AEs)

96
Q

HSV

A

Incurable

Acyclovir family may shorten duration of recurrences (episodic) or suppress (continuous)

97
Q

VZV - chicken pox

A

Usu no antivirals
Antipruritics/antihistamines
Acyclovir for IC, >12, taking steroids, taking oral salicylates

98
Q

VZV - shingles

A 
Acyclovir, valacyclovir, etc w/i 72 hrs
Pain control (opioids)
99
Q

Postherpetic neuralgia

A

Gabapentin, Pregabalin

TCAs, lidocaine patch, capsaicin cream

100
Q

Rosacea

A

Topical metronidazole or sulfacetamide

Tetracyclines, isotretinoin (severe refractory)

101
Q

Warts (skin)

A

Sometimes self-limited (3 months, 25%)

Chemical, laser, cryotherapy removal

102
Q

Molluscum contagiosum

A

Often self-limited (1 year)

Chemical, laser, scrape, cryotherapy removal

103
Q

Scabies

A

Permethrin cream (8-10 hrs)
Oral ivermectin
Diphenhydramine for pruritis
Wash clothing, towels, linens in hot water

104
Q

Tinea versicolor (pityriasis versicolor)

A

Topical antifungal (terbinafine, clotrimazole)
Selenium sulfide shampoo
Ketaconazole shampoo
Oral ketaconazole, etc

105
Q

Tinea corporis, cruris, pedis

A

Topical/oral antifungal

106
Q

Tinea capitis

A

Oral griseofulvin, terbinafine or itraconazole

107
Q

Tinea unguium/onychomycosis

A

Oral terbinafine or itraconazole (6/8-12 weeks)

108
Q

Pediculosis capitis or pubis

A 
Permethrin cream or pyrethrin
Malathion lotion
Ivermectin
Wet combing for capitis in <2 years old
Wash bedding and clothing
109
Q

Type I or Type IV skin hypersensitivity reactions

A

Remove offending agent / contact
Topical steroids + antihistamines
Oral steroids for worse cases

110
Q

Erythema multiforme

A

Stop offending agent
Maybe self-limited
Steroids, antipruritics, analgesics

111
Q

Stevens-Johnson syndrome

A

Stop offending agent

Steroids, analgesics, IVF, often treated on burn unit

112
Q

Toxic epidermal necrosis

A

Stop offending agent
Treat in burn unit
IVF, steroids, IVIG

113
Q

Seborrheic dermatitis

A

Shampoo w/ selenium (infants), tar, ketoconazole

Topical steroids, antifungals

114
Q

Seborrheic keratitis

A

None necessary

Can remove w/ cryo, electrocautery, shave excision

115
Q

Atopic dermatitis

A

Moisterizing creams and soaps
Topical steroids, tacrolimus (more severe)
Oral steroids, antihistamines (very severe)

116
Q

Psoriasis

A

Topical (NOT oral) steroids

Can try calcipotriene, tazaroene, tar, retinoids, tacrolimus, antifungal agents, DMARDS/phototherapy if severe

117
Q

Pityriasis rosea

A

Self-limited (4-6 weeks)

Topical steroids, phototherapy can decrease length

118
Q

Erythema nodosum

A

Self-limited

NSAIDs, potassium iodide, steroids

119
Q

Lichen planus

A

Medium to high potency steroids (topical or intralesional or oral if topical unsuccessful)
Acitretin (oral retinoid)

120
Q

Decubitus ulcers

A

Nutrition, relieve pressure

Protective dressing, wound care (avoid wet-to-dry), debridement if needed

121
Q

Stasis dermatitis

A

High pressure compression stockings
Elevation of legs above heart
Topical steroids, horse chestnut seed extract, aspirin 300-325 mg/day

122
Q

Pemphigus vulgaris

A

Oral high dose steroids + azathioprine or cyclophosphamide

Fatal if untreated, 5% mortality w/ treatment

123
Q

Bullous pemphigoid

A

Topical steroids

Oral steroids or azathioprine

124
Q

Porphyria cutanea tarda

A

Periodic phlebotomy
Low-dose chloroquine or hydroxychloroquine
Sunscreen, avoid triggers

125
Q

Melasma

A

Hydroquinone, azelaic acid

126
Q

Vitiligo

A

Sunscreen, dyes, makeup

Steroids, tacrolimus or pimecrolimus

127
Q

Acanthosis nigricans

A

Treat underlying disorder
Lightening agents (tretinoin, topical steroids)
Fish oil

128
Q

Strawberry hemangioma

A

None

129
Q

Alopecia areata

A

Fluocinolone oil/shampoo
Intralesional steroid injection
Topical minoxidil, anthralin (children), SADBE/DPCP (children)

130
Q

Telogen effluvium

A

Self-limited

131
Q

Androgenic alopecia

A

Minoxidil 5% (men and women)
Finasteride (ONLY men)
Spironolactone (women, maybe)

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