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226 Cards in this Set
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- Back
Tension headaches
Cluster headaches Migraines |
NSAIDs, acetaminophen, ASA; severe, than meds used in migraines
DOC: sumatriptan (imitrex) also, O2; prophylactic: nifedipine Mild: NSAIDs, acetaminophen. Severe: dihydroergotamine or triptan (sumatriptan). Note: migraines are due to serotonin depletion; therefore, DHE and triptans that are 5-HT1 agonist are used; prophylactics: DOC: amitriptyline and propranolol; 2nd line: verapamil, valproic acid, methysergide; menstrual migraines: NSAIDs (decreases prostaglandin. Note: contraindications to DHE: CAD, pregnancy (DHE), TIAs, PVD, sepsis; contraindications to triptan: CAD, uncontrolled HTN; basilar a. migraine, hemiplegic migraine, use of MAOI, SSRI, lithium. |
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Antitussive meds
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Codeine, dextromethorphan, benzonatate
Note: expectorants: guaifenesin and water. |
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Sinusitis
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Acute: amoxicillin; chronic: fluoroquinolones or amoxicillin/clavulanate
Antibiotics and decongestants (pseudoephedrine or oxymetazoline) for 1 - 2 w, saline nasal spray, nasal steroid [(fluticasone, beclomethasone) if 2ndary to allergic rhinitis]; no improvement, than sinus films, penicillinase-resistant antibiotic, consider ENT consultation (anatomic difficulties in drainage). |
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Sore throat
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Strep: penicillin for 10d (erythromycin if allergic to penicillin).
Mono: acetaminophen/ibuprofen, rest Symptomatic treatment/viral: acetaminophen/ibuprofen; gargling with warm salt water; humidifier; sucking on throat lozenges, hard candy, popsicles. |
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Dyspepsia not related to H. pylori
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Endoscopy, but not routinely done. One so when there are indicates to, such as with failure with antacids, followed by H2 blockers, sucralfate, PPI
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Barrett's esophagus
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Endoscopy q 3 y or so; long-term PPIs.
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GERD
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Avoid fatty foods, coffee, alcohol, OJ, chocolate, large meals before bedtime; sleep with body elevated; stop smoking
Antacids; H2-blockers, PPIs, add promotility agent [metoclopramide (dopamine blocker), bethanechol (cholinergic agonist)] Surgery: nissen fundoplication (procedure of choice with normal esophageal motility), partial fundoplication (when esophageal motility is poor). |
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Diarrhea
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Loperamide (imodium): if mild to moderate, not recommended with fever or blood in stools.
Ciprofloxacin 5 d; quinolones. Replacement of electrolytes, hydration, maybe NPO |
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Diarrhea from bacteria:
Salmonella, shigella, Campylobacter jejuni, giardiasis |
Ciprofloxacin, TMP/SMX, erythromycin, metronidazole.
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IBS
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Diarrhea: diphenoxylate, loperamide (imodium)
Constipation:colace, psyllium |
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Vomiting with IV fluids
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1/2 NS with potassium
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Nausea/vomiting
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Prochlorperazine (compazine), promethazine (phenergan); liquid diet (liquid is cleared from the stomach quicker than solid foods); avoid large and fatty meals; nasogastric suction.
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Internal hemorrhoids
External hemorrhoids |
Rubber band ligation (for internal hemorrhoids), hemorrhoidectomy.
Elliptical excision of the acutely thrombosed tissue under local anesthesia, mild pain medication, and sitz baths |
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Patellofemoral pain and patellar tendinitis ("jumper's knee")
Osgood-Schlatter disease |
Quadricepts/hamstrings rehabilitation (stretching/strengthening) for both.
Note: patellofemoral pain: anterior knee pain; worse with climbing and descending stairs.patellar tendinitis: pain at the inferior pole of the patella Resolves with skeletal maturity |
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Ankle sprain
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(RICE): rest, ice, compression, elevation; followed by pain-free ROM exercises.
Surgery is rarely needed, even in grade 3 sprain. |
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Lateral epicondylitis at the elbow ("tennis elbow")
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Splitting the forearm (counterforce brace).
Note: do not split or wrap the elbow itself! |
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DeQuervain's disease
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Perform the Finkelstein's test.
Treatment: thumb spica splint and NSAIDs. |
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Olecranon bursitis
Trochanteric bursitis |
Treatment is conservative. Drainage if there is an infection.
Local cortisone injections; NSAIDs |
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Carpal tunnel
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Wrist splints, NSAIDs, local corticosteroid injections, surgical release.
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Osteoarthritis
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DOC: acetaminophen. NSAIDs are just as effective, but risk for GI bleed; intra-articular injections (no more ethan 3 to 4/y); viscosupplementation (injections of hyaluronic acid).
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Osteoporosis
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Bisphosphonates, Ca, vitamin D, calcitonin (nasal spray), estrogen (suppresses osteoclasts), raloxifene (estrogen agonist and antagonist), weight bearing exercise, stop smoking cigs.
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Age-related macular degeneration
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Laser photocoagulation if there is subretinal neovascularization.
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Chronic open angle glaucoma
Acute angle-closure glaucoma |
Topically with beta-blocker, alpha-agonist, carbonic anhydrase inhibitor, prostaglandin analogue singly or in combination; laser or surgical treatment for refractory cases.
Referral to ophthalmologist immediately! Pilocarpine drops, IV acetazolamide, oral glycerin; laser or surgical iridectomy is definitive treatment. |
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Cataracts
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Surgery
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Blepharitis
Episcleritis Scleritis Acute anterior uveitis (aka iritis or iridocyclitis) |
Lid scrubs and warm compresses; antibiotics for severe cases.
NSAIDs Prompt evaluation by ophthalmologist: corticosteroids Prompt evaluation by ophthalmologist. Semiurgent ophthalmology referal; acyclovir |
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Bacterial conjunctivitis (acute and hyperacute)
Viral conjunctivitis Chlamydial conjunctivitis |
Acute: broad-spectrum (erythromycin, ciprofloxacin, sulfacetamide); hyperacute: gonococcal, ceftriaxone 1g IM
Cold compress, strict hand washing Oral tetracycline, doxycycline, erythromycin for 2 weeks. |
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Sleep apnea
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Avoid supine position, CPAP, uvulopalatopharyngoplasty, tracheostomy (last option when other options have failed or life-threatening conditions).
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Nacrolepsy
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Methylphenidate (Ritalin); planned naps during the day.
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Cerumen impaction
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Softening with carbamide peroxide (debrox), triethanolamine (cerumenex), followed by irrigation.
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Urge incontinence
Stress incontinence Neurogenic bladder Overflow incontinence |
Anticholinergic (oxybutynin), TCAs (imipramine), newer muscarinic receptor antagonists such as solifenacin (Vesicare)
Kegel exercises, estrogen replacement therapy, surgery (urethropexy), pseudoephedrine; the tone of the internal sphincter is modulated through alpha receptors. Stimulation of these receptors with pseudoephedrine or imipramine can increase internal sphincter tone and alleviate symptoms. intermittent self-catheterization; cholinergic agents (bethanechol) to increase bladder contractions; alpha-blockers (terazosin, doxazosin) to decrease sphincter resistance. Initially treated with a strict urination schedule, which may be coupled with Crede's maneuver. Further treated with bethanechol. Some PTs use intermittent self-catheterization of the bladder. Ultimately, the patient may require resection of the internal sphincter of the bladder neck. |
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Alcohol withdrawal
Treatment of alcoholism |
Long acting BZ (diazepam), thiamine, folate, glucose
Acamprosate (seems to be the most effective; has both GABA and glutamine neurotransmission); disulfiram (antabuse), naltrexone (trexan). Note: naloxone (narcan) is used for opioid OD |
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Smoking cessation
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Nicotine patch (with smoking, cases of MIs), chewing gum, and buproprion (zyban).
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Claudication
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Initial treatment should consist of vigorous risk factor modification and exercise.
ASA and vasodilators do not help |
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Preeclampsia
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treating with parenteral magnesium sulfate, and planning prompt delivery either vaginally or by cesarean section
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Raynaud's
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Nifedipine is the calcium channel blocker of choice
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A-fib
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Beta blockers (which can do it during exercise, unlike digitalis)
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DVT
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Enoxaparin (Lovenox), a low-molecular-weight heparin. Patients chosen for outpatient care should have good cardiopulmonary reserve, normal renal function, and no risk for excessive bleeding. Oral anticoagulation with warfarin can be initiated on the first day of treatment after heparin loading is completed.
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AAA
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Surgery when the AAA approaches 5.5 cm in diameter
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Aortic stenosis
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prompt correction of his mechanical obstruction with aortic valve replacement
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Wolff-Parkinson-White syndrome
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Radiofrequency catheter ablation of bypass tracts
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acute delirium in the ICU
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Intravenous haloperidol has been found to be more effective than lorazepam and has minimal physiologic side effects.
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Pregnant woman with hypertension
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Intravenous hydralazine, intravenous labetalol, or oral nifedipine may be used. So can methyldopa and CCB
Atenolol and propranolol are associated with intrauterine growth retardation when used for prolonged periods during pregnancy. They are class D agents during pregnancy. Other beta-blockers may not share this risk. |
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CHF due to left ventricular systolic dysfunction,
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ACE inhibitors and beta blockers (except those with dyspnea at rest or hemodynamically unstable).
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prophylaxis against deep vein thrombosis, such as with knee surgery.
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The two regimens recommended are low–molecular-weight heparin [Enoxaparin (Lovenox)] and adjusted-dose warfarin.
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Pertussis
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DOC: macrolides
2nd line: TMP-SMX |
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Croup
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Corticosteroids produce significant improvement, such as single-dose dexamethasone
Racemic epinephrine is used before intubating the PT since EPI reduces the incidence of intubation. By EPI nebulization is indicated in severe croup, such as intercostal retractions. Note: humidification of inspired air is sometimes beneficial |
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RSV
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Supportive care--single dose of albuterol. A trial of an inhaled bronchodilator, albuterol, or epinephrine, with treatment continued only if the initial dose proves beneficial.
Ribavirin is controversial. |
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Croup
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Oral steroids (dexamethasone).
Also, O2. |
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Essential tremor DOC
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Propranolol (not so much with other beta-blockers), and primidone. Also topiramate (Topamax)
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Cholinesterase inhibitors used for Alzheimer's
NMDA receptor antagonist (therefore, blocking glutamate) |
Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl)
Memantine Note: While the medication will not restore memory, it does prevent the rapid loss of more memory. Also, nursing home may be delayed by a year or more; modest improvement of cognition; activities of daily living and global measurements of functioning; they do NOT change the progression of neurodegeneration. At normal levels, glutamate aids in memory and learning, but if levels are too high, glutamate appears to overstimulate nerve cells, killing off key brain cells. |
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Carotid stenosis
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carotid endarterectomy
Note: urgent endarterectomy is probably indicated for patients with internal carotid artery stenosis of 70%–99% and in selected patients with stenosis of 50%–69% who can be treated surgically with a low risk of complications. |
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migraine prophylaxis
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Riboflavin (vitamin B2)
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Treatment of disabling unilateral tremor and dyskinesia from Parkinson’s disease.
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Thalamotomy and pallidotomy
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Febrile seizures
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Antipyretics, such as acetaminophen
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Lost of libido from SSIRs
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Bupropion (wellbutrin)
Note: Bupropion is a norepinephrine and dopamine reuptake inhibitor with essentially no direct serotonergic activity. Improvement in sexual functioning has been reported when sustained-release bupropion was either substituted for other antidepressants or added to a regimen of SSRIs. |
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Herpes zoster DOC
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DOC: oral valacyclovir (Valtrex)
Also: acyclovir or famciclovir. Corticosteroids can be used for acute pain but have no effect on the development of postherpetic neuralgia. IV antiviral therapy for immunosuppressed patients, and those at high risk for ocular complications. |
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Postherpetic neuralgia
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Capsaicin cream
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parkinsonian and dystonia side effects of neuroleptic drugs
Akathisia |
anticholinergics
anticholinergics and beta blockers |
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DOC for preventing the spread of meningococcal disease and HiB
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Rifampin
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Current methods for reducing the risk of renal failure induced by contrast material include
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adequate hydration, sodium bicarbonate and the use of N-acetylcysteine.
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Treatments available for childhood nocturnal enuresis
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bed-wetting alarm have a higher success rate and a lower relapse rate
After the alarm, DOC is desmopressin; 2nd line is imipramine. |
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Social phobia or social anxiety disorder
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Paroxetine (paxil)
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Initial treatment of mania
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Lithium or valproic acid (depakote)
Note: Carbamazepine is used when lithium and valproic acid are unresponsive. |
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Premenstrual dysphoric disorder
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SSRIs
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Peripheral neuropathy
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Phenytoin and gabapentin
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Atopic dermatitis (eczema)
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In addition to the regular use of emollients, the mainstay of maintenance therapy, topical corticosteroids have been shown to be the best first-line treatment for flare-ups
Topical calcineurin inhibitors (tacrolimus and pimecrolimus) should be second-line treatment for flare-ups, but are not recommended for use in children under 2 years of age. Antihistamine for pruritus. |
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Bullous impetigo is a localized skin infection characterized by large bullae; it is caused by a group 2 phage type of Staphylococcus aureus.
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penicillinase-resistant penicillin, cephalosporin, TMP/SMX and clindamycin
Note: unsure about this answer. . . |
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Scabies
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Permethrin (Elimite) 5% cream
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Psoriasis
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Betamethasone dipropionate. Systemic treatment is reserved for patients with disabling psoriasis that does not respond to topical treatment. This would include phototherapy, methotrexate, and etretinate.
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Lice
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permethrin is the DOC is less toxic than lindane (neurotoxicity). Permethrin and pyrethrins are less effective than malathion, although they are acceptable alternatives. These insecticides, as well as lindane, are not recommended in children 2 years of age or younger.
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torsades de pointes
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IV Mg
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Gallstone, primary biliary cirrhosis
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Ursodiol (Actigall)
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Cholestatic pruritus
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Cholestyramine (Questran)
Also for systemic pruritus, antihistamines, doxepin (with it s antihistamine properties), and mirtazapine. |
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Rosacea
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Avoidance of precipitating factors and use of sunscreen.
Oral metronidazole, doxycycline, or tetracycline also can be used, especially if there are ocular symptoms. These are often ineffective for the flushing, so low-dose clonidine or a nonselective β-blocker may be added. |
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Sustained ventricular tachyarrhythmias; also with atrial fibrillation only in symptomatic patients with left ventricular dysfunction and heart failure
Note: it is not useful in atrial fibrillation. |
Amiodarone (Cordarone)
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Thoracic vertebral compression fracture
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Markedly decreased activity until the pain lessens, possibly followed by some bracing. Vertebroplasty is an option when the pain is not improved in 2 weeks. Complete bed rest is unnecessary and could lead to complications.
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PT with polycystic ovary syndrome (oligomenorrhea, acne, hirsutism, hyperandrogenism, infertility) who wants to become pregnant.
Premenopausal hirsutism |
Metformin is the only treatment listed that is likely to decrease hirsutism and improve insulin resistance and menstrual irregularities. Metformin and clomiphene alone or in combination are first-line agents for ovulation induction.
Spironolactone (Aldactone) |
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Restless leg syndrome
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Recommendations for treatment include lower-body resistance training and avoiding or changing medications that may exacerbate symptoms (e.g., antihistamines, caffeine, SSRIs, tricyclic antidepressants, etc.). It is also recommended that patients with a serum ferritin level below 50 ng/mL take an iron supplement (SOR C). Magnesium supplementation does not improve restless legs syndrome. Ropinirole may be used if nonpharmacologic therapies are ineffective.
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Heparin-induced thrombocytopenia (HIT)
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Discontinue heparin and start a non-heparin anticoagulant such as argatroban or desirudin (Iprivask)
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Insomnia
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Cognitive-behavioral therapy
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COPD </ 88% O2 saturation
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O2 therapy
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Chronic cough
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Think of GERD, therefore PPI even in the absence of GI symptoms.
GERD is the most common cause of chronic cough. |
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Systolic dysfunction
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Ace inhibitors and beta blockers (except those with dyspnea at rest or hemodynamically unstable).
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Lichen sclerosus
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High-potency topical corticosteroids
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Treatment of pain and sleep disturbance in patients with fibromyalgia
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amitriptyline and duloxetine
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Paget’s disease of bone
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bisphosphonates
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Melanoma
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The diagnosis should be made by simple excision with clear margins. A shave biopsy should be avoided because determining the thickness of the lesion is critical for staging
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TB
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INH, ethambutol, rifampin, and pyrazinamide
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Gestational diabetes
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combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin (e.g., lispro) twice daily
Keep glucose <95 in gestational diabetes |
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ST-segment elevation myocardial infarction (STEMI)
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oral clopidogrel (Plavix), and should also chew 162–325 mg of aspirin.
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life threatening, an acute dystonic reaction
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IV diphenhydramine or benztropine.
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Allergic rhinitis.
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Topical intranasal glucocorticoids are currently believed to be the most efficacious medications. More so than antihistamine and cromolyn spray
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Post-thrombotic syndrome (PTS) as a complication of acute deep-vein thrombosis (DVT)
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Compression stockings should be applied when anticoagulation therapy is started, not when it has been completed.
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best INITIAL management for hypercalcemic crisis
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IV saline
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Acute pericarditis
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NSAIDs, such as aspirin and ibuprofen. Recent studies demonstrate that adding colchicine to aspirin may be beneficial in reducing the persistence and recurrence of symptoms.
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alopecia areata (caused by a localized autoimmune reaction to hair follicles)
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ntralesional corticosteroid injections. Minoxidil is an alternative for children younger than 10 years of age or for patients in whom alopecia areata affects more than 50% of the scalp.
Note: Finasteride inhibits reductase to reduce dihydrotestosterone levels, and is used for androgenic alopecia (male-pattern baldness). Spironolactone is sometimes used for androgenic alopecia because it is an aldosterone antagonist. |
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community-acquired pneumonia
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azithromycin. This covers the atypical organism Mycoplasma pneumoniae, which is one of the most common causes of community-acquired pneumonia. Certain fluoroquinolones such as levofloxacin also cover atypical causes, but ciprofloxacin does not.
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onychomycosis
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Oral terbinafine (Lamisil) daily for 12 weeks
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corneal abrasion
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A white or gray appearance at the edge of a corneal abrasion may indicate infection, and referral to an ophthalmologist is indicated
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Peripheral arterial disease (PAD)
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Routine exercise up to near-maximal pain on a regular basis has been shown to be one of the most effective treatments for symptoms of PAD. Smoking cessation and aspirin are also standard recommendations, and can both prevent CVEs and slow the rate of progression of PAD symptoms. Also statins (specifically simvastatin and atorvastatin).
Note: Although lowering abnormally high blood pressure is recommended in PAD patients, only ACE inhibitors have been shown to reduce symptoms of PAD directly. Furthermore, the combination of atenolol and nifedipine has actually been shown to worsen symptoms of PAD. |
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Cocaine associated chest pain
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hypertension, tachycardia, and chest pain will often respond to intravenous benzodiazepines as early management. While β-blockers are recommended for acute myocardial infarction, they can exacerbate coronary artery spasm in cocaineassociated chest pain. Fibrinolytic therapy should be given only to patients who clearly have an STsegment elevation myocardial infarction and cannot receive immediate direct percutaneous coronary intervention.
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Hip fraction prevention in a postmenopausal woman.
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800 IU vitamin D and 1200 mg calcium
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hydrocele of the tunica vaginalis testis
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requently at birth but usually resolves in a few weeks or months. No treatment is indicated during the first year of life unless there is a clinically evident hernia.
Note: A simple scrotal hydrocele without communication with the peritoneal cavity and no associated hernia should be excised if it has not spontaneously resolved by the age of 12 months. |
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Hypotensive sepsis
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Norepinephrine and dopamine currently are the preferred pressor agents; however, norepinephrine appears to be more effective and has a lower mortality rate. Phenylephrine, epinephrine, or vasopressin should not be used as first-line therapy. Vasopressin is employed after high-dose conventional vasopressors have failed. The use of low-dose dopamine is no longer recommended based on a clinical trial showing no benefit in critically ill patients at risk for renal failure. If an agent is needed to increase cardiac output, dobutamine is the agent of choice.
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Acute ankle sprain
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Semi-rigid brace that allows flexion and extension.
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Alcohol withdrawal syndrome
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Chlordiazepoxide (Librium)
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subarachnoid hemorrhage
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CT without contrast.
Note: Patients with a positive CT result for subarachnoid hemorrhage should proceed directly to angiography and treatment. Patients with a suspected subarachnoid hemorrhage who have negative or equivocal results on head CT should have a lumbar puncture. |
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How to lower K in hyperkalemia
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These interventions include sodium bicarbonate, glucose with insulin, and albuterol. Total body potassium can be lowered with sodium polystyrene sulfonate, but this takes longer to affect the plasma potassium level than translocation methods.
Note: the goal is to translocate potassium from the serum to the intracellular space should be instituted next, as they can quickly (albeit temporarily) lower the plasma concentration of potassium. |
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Osmotic demyelination syndrome can usually be avoided by
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limiting correction of chronic hyponatremia to <10-12 mmol/L in 24 hours and to <18 mmol/L in 48 hours.
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Any child younger than 29 days old with a fever
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Admit to the hospital; obtain urine, blood, and CSF cultures; and start intravenous antibiotics
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The most appropriate initial pharmacologic treatment of panic disorder is
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SSRI
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Septic shock
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recombinant activated protein C
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preventing and treating traveler's diarrhea due to E. coli
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Rifaximin
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seborrheic dermatitis
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Topical steroids or selenium sulfide products.
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Necrotizing enterocolitis
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Management depends on presence or absence of perforation of bowel:
No free air present: bowel rest with nasogastric decompression; systemic antibiotics Free air present: surgical consultation. |
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Varicocele and hydrocele
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Reassurance
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Malignant hyperthermia
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Dantrolene
Test of choice: caffeine contracture test (muscle biopsy is exposed to caffeine). |
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Acute disseminated encephalomyelitis
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High dose steroids
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Rocky Mountain spotted fever
Lyme disease |
Doxycycline if > 8 yoa
Ampicillin or doxycycline |
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Cryptosporidium (which occurs in immunocompromised and children)
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Nitazoxanide
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Acute bronchitis
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Inhaled or oral steroid taper
Note: use this when there is a hyperreponsive airways called postbronchitic cough |
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Peripheral vestibular disorder
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Antihistamines, such as meclizine and diphenhydramine
note: they suppress the vestibular end organ receptors and inhibit activation of the vagal response. |
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Pityriasis rosea
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Antihistamines or corticosteroids to relieve.
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Tinea capitis
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Oral griseofluvin
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Anogenital warts
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Imiquimod
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Bacterial conjunctivitis in contact lens wearers
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Gentamicin
Note: bacterial conjunctivitis is mostly from Strep and Staph; however, in contact lens wearers, gram- most be thought off. |
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Vaginal candidiasis
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Topical azole
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Smoking cessation
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Varenicline, bupropion (wellbutrin)(contraindicated in pts with seizures), nicotine replacement, clonidine (2nd line)
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Pneumocystis pneumonia
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TMP-SMX and steroids if PA02 < 70
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What can prevent a reoccurrence of a stroke?
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ACE inhibitor and diuretic (thiazides)
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Hypertension and chronic renal disease
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ACE inhibitor or ARB
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Acute phase of mania in biopolar
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Neuroleptics
Note: Lithium, valproic acid, carbamazepine, and amotrigine are used for once the acute mania is under control. |
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Nocardiosis (acid fast)
Actinomyces israelli (gram +) |
Sulfonamides
Penicillin |
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absence (petit mal) seizures
Partial seizures |
Ethosuximide or valproic acid
Phenytoin |
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Intussusception
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Air contrast enema
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Bruton's agammaglobulinemia
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IV Ig
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Acute rheumatic fever
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Benzathine penicillin G
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Idiopathic (immune) thrombocytopenic purpura (occurs in children)
thrombotic thormbocytopenic purpura hemolytic urremic syndrome |
Observation; or treat with corticosteroids when platelets < 30,000; (IV Ig with steroids in adults)
Plasmapheresis to reduce circulating antibodies against ADAMTS13 and replenish blood levels of the enzyme Supportive, plasmapheresis, dialysis if necessary, and steroids; antibiotics are NOT needed! |
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Von Willebrand disease and hemophilia A
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Desmopressin
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Lactase deficiency
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Improvement from abstaining from diary products; presence of positive reducing sugars; diagnosis is confirmed by a positive hydrogen breath test; lactose tolerance test; acidic pH of stools (bacteria ferments lactose into short-chain FAs and excess amounts of hydrogen).
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Guillain-Barre syndrome
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Plasmapheresis or human Ig
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Pyloric stenosis
Duodenal atresia |
IV hydration and K replacement before surgery; Pyloromyotomy.
Decompression with a nasogastric tube, correction of electrolyte and surgery. |
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Necrotizing enterocolitis
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Antibiotics
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Hyaline mm disease or respiratory distress syndrome
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CXY shows ground glass appearance: discrete, uniform infiltrate due to microatelectasis
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Wilson disease
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Penicillamine or trientine
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Diamond-Blackfan anemia or congeital pure red cell aplasia
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Corticosteroids
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Minimal change disease (nephrotic syndrome)
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Steroids
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Nursemaid's elbow aka subluxed radial head
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Rotating the hand and forearm to supination with pressure over the radial head reduces the annular ligament to restore full ROM.
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Henoch-Schonlein Purpura
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Steroids and monitoring renal function
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Lesch-Nyhan syndrome
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Allopurinol
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Instructions to mother with laryngomalacia
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Hold the child in an upright position for half an hour after feeding, and never feed the child when lying down.
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Gonococcal conjunctivitis
Congenital chlamydial infection |
Treatment: ceftriaxone (do not give to someone younger than 28, ceftriaxone-calcium deposits in the lungs); porophylaxis at birth: silver nitrate
Oral erythromycin (not topical since it will not lessen the risk of chlamydial pneumonia). |
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Sickle cell
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Hydroxyurea; prophylactics with penicillin until 5 oya
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Neonatal meningitis (to cover both gram + and -)
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Ampicillin and gentamicin or ampicillin and cefotaxime.
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Homocystinuria
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High dose of B6; restriction of methionine with supplements of cysteine
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Live vaccines to HIV if CD4 > 200
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MMR, VZV, yellow fever
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MCV4 (2 doses)
HAV (2) MMR (2) |
Minimum age, is 24 m; Between two doses is 8 w apart
Minimum age, is 6 w; At least 4 w between doses. Minimum age, is 12 m; Between two doses is 6 m |
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HiB (4 doses)
Inactivated Polio (4) DTaP (4) Note: Minimum age for all is 6 w; 6 m has to at least follow the third shot for all. |
2, 4, 6, 12 - 18 m.; 4th dose can be at 12 m if the preceding dose was at least 6 m apart.
2, 4, 6, 15 - 18 m.; 4th dose can be at 12 m if the preceding dose was at least 6 m apart. 2, 4, 6- 18 m, than on or after 4 yoa by following 6 m after 3rd vaccine; 4th dose can be at 12 m if the preceding dose was at least 6 m apart. |
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Rotavirus (3 doses)
HBV Influenza |
Minimum age 6 wk; 2, 4, 6 m (not needed if given at 2 and 4 m); first dose MUST be given BEFORE 12 w
0, 1-2, 6 - 18 m; mom has HBsAB, give infant HBIG and HBV vaccine All PTs > 50 y; • Minimum age is 6 m for inactive; 2 yoa for live influenza (egg allergy is a no give) |
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o Pneumococcal vaccination
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• PCV
o Minimum 6 w o 1 dose PCV7 between 24 – 59 m; PCV13 14 – 59 m for those who had PCV7; another PCV7 60 – 71 for those at risk. o PCV13 should be given 8 w after PCV7 o Children less than 2 years of age should receive the 13-valent conjugate vaccine as a part of their routine well child vaccinations at 2, 4, 6, and 12 to 15 months of age. o Polyvalent vaccine does not cause a good antibody response in children under the age of 2. • PPSV o Minimum age is 2 yoa |
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Vaccines contraindicated in HIV
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BCG, anthrax, oral typhoid, intranasal influenza, and oral polio.
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Asthma (symptoms, nighttime symptoms, treatment
Mild, intermittent Mild, persistent Moderate, persistent Severe, persistent |
</ 2x/w; </ 2x/m; short acting prn
> 2x/w but <1 x/d; >2 x/m; low-dose corticosteroid (CS) Daily or >/ 2x/w; > 1x/w; Step 3) medium-dose CS or low dose CS + LABA or step 4) medium dose CS + LABA Throughout the day; frequent and often 7x/w; Step 5) High dose CS + LABA or Step 6) High-dose CS +LABA + oral CS; consider omalizumab if allergies are present |
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Ascending aortic dissection
Descending aortic dissection |
Beta-blocker to get the HR below 60
If the systolic blood pressure remains over 100 mm Hg, IV nitroprusside should be added. Note: Without prior beta-blockade, vasodilation from the nitroprusside will induce reflex activation of the sympathetic nervous system, causing increased ventricular contraction and increased shear stress on the aorta. |
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Descending aortic dissection
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surgery is indicated only for complications such as occlusion of a major aortic branch, continued extension or expansion of the dissection, or rupture (which may be manifested by persistent or recurrent pain).
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BP in African-American
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diuretics (thiazides) or CCB over β-blockers or ACE inhibitors.
It has been suggested that hypertension in African-Americans is not as angiotensin II-dependent as it appears to be in Caucasians |
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Prophylaxis for surgery-related cardiac complications
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beta-blockers perioperatively for patients with cardiac risk factors
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Systolic hypertension
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Thiazide and long-acting CCB for first-line
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CONTRAindicated in cocaine induced arrhythmias
Avoided in CHF? |
Beta-blockers (due to unopposed alpha activity)
NSAIDs due to Na and H20 retention, increase vascular resistance |
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Intermittent claudication
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Cilostazol (phosphodiesterase inhibitor)(avoid in CHF)
Also, beneficial HDL effects and in 3rd degree heart block. |
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Decrease mortality later after MI
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Beta-blockers and ACE inhibitors
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CHF
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ACE inhibitors
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Long-term treatment with prednisone (>/ 3 m at dosage >/ 5mg/d)
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PTs should receive bisphosphonates
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Acute dystonic reaction
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Diphenhydramine or benztropine
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Provides pain relief within a few days in many patients with osteoporotic vertebral compression fractures.
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Calcitonin
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Fibrositis-fibromyalgia syndrome.
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Amitriptyline or cyclobenzaprine
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Fracture of scaphoid
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Thumb spica splint; referral to othro if proximal 1/3rd is fractured due to avascular necrosis
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small spontaneous pneumothorax involving less than 15%-20% of lung volume
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O2 and observation. pneumothorax will resorb in 10 d.
Note: chest tube placement is used with larger pneumothoraces. |
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Tension pneumothorax
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Decompression with anterior placement of IV catheter
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Allergic rhinitis
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Intranasal glucocorticoids are the preferred treatment over antihistamines.
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Nursing-home-acquired pneumonia
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Levofloxacin
must cover Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and gram-negative bacteria. |
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Health care-associated pneumonia
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ceftazidime and gentamicin (?)
Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter species. MRSA, depending on local prevalence. |
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Ciprofloxacin
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Not approved for PTs < 18
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Dental infection complicated by cellulitis
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DOC: penicillin; 2nd line if allergic is clindamycin
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Food tolerated in diarrhea
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Foods with complex carbohydrates (e.g., rice, wheat, potatoes, bread, and cereals), lean meats, yogurt, fruits, and vegetables are well tolerated.
Foods high in simple sugars (e.g., juices, carbonated sodas) should be avoided because the osmotic load can worsen the diarrhea. Fatty foods should be avoided as well. |
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Traveler's diarrhea
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Ciprofloxacin
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To prevent vertical transmission of HIV
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zidovudine and nevirapine
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Vitamins in Alzheimer's
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Beta-carotene, Vitamin C and E may be beneficial.
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Antipsychotic of choice in patients with dementia associated with Parkinson’s disease.
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Quetiapine (seroquel)
Quetiapine is an atypical antipsychotic that has no clinically significant effect on the dopamine D2 receptor, which is responsible for the parkinsonian side effects of antipsychotic medications |
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Has been used in tardive dyskinesia
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Lithium
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Generalized anxiety, but not effective for depression
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Buspirone (BuSpar)
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Rosacea
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Avoidance of precipitating factors and use of sunscreen.
Oral metronidazole, doxycycline, or tetracycline also can be used, especially if there are ocular symptoms. These are often ineffective for the flushing, so low-dose clonidine or a nonselective β-blocker may be added. |
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Pain relief in renal dysfunction
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Acetaminophen is the first-line treatment in this case.
NSAIDs are contraindicated |
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Glycopyrrolate (Robinul)
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Is a muscarinic blocker
Can reduce respiratory secretions and does not cross the BBB |
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Activated charcoal
Gastric lavage, cathartics, or whole bowel irrigation |
Is the decontamination treatment of choice for most medication ingestions. It should be used within 1 hour of ingestion of a potentially toxic amount of medication.
• Is best for ingestion of medications that are poorly absorbed by activated charcoal (iron, lithium) or medications in sustained-release or enteric-coated formulations. |
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Dupuytren's contracture
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Cortisone injections
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Status epilepticus
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Lorazepam, followed by phenytoin.
Note: Fosphenytoin, midazolam, or phenobarbital can be used if there is no response to lorazepam. |
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BP control in stroke patients
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advise monitoring with no additional treatment for patients with a systolic blood pressure <220 mm Hg or a diastolic blood pressure <120 mm Hg.
Elevated BP is protective to increase cerebral perfusion. |
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Emergency tracheotomy
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Best site for the incision is directly above the cricoid cartilage, through the cricothyroid membrane.
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Temporal arteritis
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Corticosteroids
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Acute ankle sprain
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Semi-rigid brace that allows flexion and extension.
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Acute mountain sickness
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• O2 and immediate descent. If descent and/or administration of oxygen is not possible, dexamethasone and/or acetazolamide may reduce the severity of symptoms. Also nifedipine.
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Prepubertal labial adhesions
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Estrogen cream
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Pseudomonas in CF
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Ceftazidime or penicillin derivative such as ticarcillin + aminoglycoside such as Amikacin or gentamicin.
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Anaphylaxis
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First, endotracheal intubation, followed by subcutaneous EPI.
Additional treatments include plasma expanders, diphenhydramine, cimetidine, corticosteroids. |
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Battery in esophagus
Distal to the esophagus |
Immediate endoscopic removal to prevent ulceration
Passes uneventfully in 90% of cases. PTs are observed to confirm excretion of the battery by stool examination and/or radiographic follow up. |
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Foreign body aspiration
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Direct laryngoscopy and rigid bronchoscopy (not flexible bronchoscopy)
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Cephalohematoma
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Reassurance (2w - 3 m it will resolve)
Note: limited to one cranial bone since it doesn't cross over cranial sutures |
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Encopresis
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Mineral oil or stool softeners and behavioral modifications
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Preseptal cellulitis
Orbital cellulitis |
Outpatient with antibiotics (eyelid discoloration)
Inpatient treatment with IV antibiotics (decrease eye movements, proptosis) |
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Cornebacterium diphtheria treatment in order of importance
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• Administration of diphtheria antitoxin (passive immunization); administer penicillin or erythromycin; DPT vaccine (active immunization)
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Acne
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Benzoyl peroxide and retinoic acid (effective in sloughing the epi)
Topical tetracycline (controls the inflammatory component) |
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Congenital diaphragmatic hernia
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Orogastric tube placement with continuous suction to prevent bowel distension and further lung compression.
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Covers strep and has the best-staph coverage (but not MRSA)
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Dicloxacillin
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Dissolve cholesterol gallstone
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Chenodeoxycholic acid, ursodiol (urosodeoxycholic acid aka Actigall)
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Cholecystitis
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IVFs, antibiotics, cholecystectomy
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Porecelain gallbladder
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Cholecystectomy
Note: it is a calcified gallbladder due to chronic cholelithiasis/cholecystitis that leads to gallbladder carcinoma |
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ST elevation MI and thrombotic states
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Streptokinase and tPA
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DVT
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Heparin, and PT should be switched to warfarin therapy >/ 3 m, with goal INR 2- 3
Note: takes 4 - 5 days for warfarin to reach therapeutic levels. |
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Pre-renal failure from hypovolemia
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First step: change foley catheter to make sure it isn't clogged.
Next step: IV bolus for an IV fluid challenge. |
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Prevention of atelectasis, which also predisposes to pneumonia post-surgery.
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Moving the PT from supine to sitting (reduces intraabdominal pressure); adequate pain control (allows for easier breathing, but at decreasing respiratory drive); and incentive spirometry.
Note: for pain control to help with breathing, better to go with a strong NSAID than an opiate agonist? |
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Cervical spine injury
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1st step: Stabilization of cervical spine.
2nd step: assess the airway (orotracheal intubation with rapid sequence) |
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No matter what the disease or current condition of the PT, always treat what first?
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ABCs
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H. pylori
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1st line therapy: amoxicillin + clarithromycin and PPI
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C-diff
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Metronidazole.
Oral (NOT IV) vancomycin can be used, but there is emergence resistance of vancomycin enterococci, and is more expensive than metronidazole. |
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Antibiotic that can be used to increase GI motility
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Erythromycin (other macrolides?)
Note on other drugs: metoclopramide (Reglan), domperidone (Motilium), neostigmine, mirtazapine (works on the same serotonin receptor--5-HT3--that the popular anti-emetic ondansetron uses). |
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Tension pneumothorax
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Rapid decompression: large-gauge needed inserted into 2nd intercostal space at MCL just ABOVE the 3rd rib.
Note: ipsilateral lung collapse, mediastinal and tracheal shift, and compression of the CONTRAlateral lung. |