Usmle 2-Treatment Step Up To Medicine

Front 1

Tension headaches

Cluster headaches

Migraines

Back 1

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.

Front 2

Antitussive meds

Back 2

Codeine, dextromethorphan, benzonatate

Note: expectorants: guaifenesin and water.

Front 3

Sinusitis

Back 3

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).

Front 4

Sore throat

Back 4

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.

Front 5

Dyspepsia not related to H. pylori

Back 5

Endoscopy, but not routinely done. One so when there are indicates to, such as with failure with antacids, followed by H2 blockers, sucralfate, PPI

Front 6

Barrett's esophagus

Back 6

Endoscopy q 3 y or so; long-term PPIs.

Front 7

GERD

Back 7

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).

Front 8

Diarrhea

Back 8

Loperamide (imodium): if mild to moderate, not recommended with fever or blood in stools.

Ciprofloxacin 5 d; quinolones.

Replacement of electrolytes, hydration, maybe NPO

Front 9

Diarrhea from bacteria:

Salmonella, shigella, Campylobacter jejuni, giardiasis

Back 9

Ciprofloxacin, TMP/SMX, erythromycin, metronidazole.

Front 10

IBS

Back 10

Diarrhea: diphenoxylate, loperamide (imodium)
Constipation:colace, psyllium

Front 11

Vomiting with IV fluids

Back 11

1/2 NS with potassium

Front 12

Nausea/vomiting

Back 12

Prochlorperazine (compazine), promethazine (phenergan); liquid diet (liquid is cleared from the stomach quicker than solid foods); avoid large and fatty meals; nasogastric suction.

Front 13

Internal hemorrhoids

External hemorrhoids

Back 13

Rubber band ligation (for internal hemorrhoids), hemorrhoidectomy.

Elliptical excision of the acutely thrombosed tissue under local anesthesia, mild pain medication, and sitz baths

Front 14

Patellofemoral pain and patellar tendinitis ("jumper's knee")

Osgood-Schlatter disease

Back 14

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

Front 15

Ankle sprain

Back 15

(RICE): rest, ice, compression, elevation; followed by pain-free ROM exercises.

Surgery is rarely needed, even in grade 3 sprain.

Front 16

Lateral epicondylitis at the elbow ("tennis elbow")

Back 16

Splitting the forearm (counterforce brace).

Note: do not split or wrap the elbow itself!

Front 17

DeQuervain's disease

Back 17

Perform the Finkelstein's test.

Treatment: thumb spica splint and NSAIDs.

Front 18

Olecranon bursitis

Trochanteric bursitis

Back 18

Treatment is conservative. Drainage if there is an infection.

Local cortisone injections; NSAIDs

Front 19

Carpal tunnel

Back 19

Wrist splints, NSAIDs, local corticosteroid injections, surgical release.

Front 20

Osteoarthritis

Back 20

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).

Front 21

Osteoporosis

Back 21

Bisphosphonates, Ca, vitamin D, calcitonin (nasal spray), estrogen (suppresses osteoclasts), raloxifene (estrogen agonist and antagonist), weight bearing exercise, stop smoking cigs.

Front 22

Age-related macular degeneration

Back 22

Laser photocoagulation if there is subretinal neovascularization.

Front 23

Chronic open angle glaucoma

Acute angle-closure glaucoma

Back 23

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.

Front 24

Cataracts

Back 24

Surgery

Front 25

Blepharitis

Episcleritis

Scleritis

Acute anterior uveitis (aka iritis or iridocyclitis)

Back 25

Lid scrubs and warm compresses; antibiotics for severe cases.

NSAIDs

Prompt evaluation by ophthalmologist: corticosteroids

Prompt evaluation by ophthalmologist.

Semiurgent ophthalmology referal; acyclovir

Front 26

Bacterial conjunctivitis (acute and hyperacute)

Viral conjunctivitis

Chlamydial conjunctivitis

Back 26

Acute: broad-spectrum (erythromycin, ciprofloxacin, sulfacetamide); hyperacute: gonococcal, ceftriaxone 1g IM

Cold compress, strict hand washing

Oral tetracycline, doxycycline, erythromycin for 2 weeks.

Front 27

Sleep apnea

Back 27

Avoid supine position, CPAP, uvulopalatopharyngoplasty, tracheostomy (last option when other options have failed or life-threatening conditions).

Front 28

Nacrolepsy

Back 28

Methylphenidate (Ritalin); planned naps during the day.

Front 29

Cerumen impaction

Back 29

Softening with carbamide peroxide (debrox), triethanolamine (cerumenex), followed by irrigation.

Front 30

Urge incontinence

Stress incontinence

Neurogenic bladder

Overflow incontinence

Back 30

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.

Front 31

Alcohol withdrawal

Treatment of alcoholism

Back 31

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

Front 32

Smoking cessation

Back 32

Nicotine patch (with smoking, cases of MIs), chewing gum, and buproprion (zyban).

Front 33

Claudication

Back 33

Initial treatment should consist of vigorous risk factor modification and exercise.

ASA and vasodilators do not help

Front 34

Preeclampsia

Back 34

treating with parenteral magnesium sulfate, and planning prompt delivery either vaginally or by cesarean section

Front 35

Raynaud's

Back 35

Nifedipine is the calcium channel blocker of choice

Front 36

A-fib

Back 36

Beta blockers (which can do it during exercise, unlike digitalis)

Front 37

DVT

Back 37

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.

Front 38

AAA

Back 38

Surgery when the AAA approaches 5.5 cm in diameter

Front 39

Aortic stenosis

Back 39

prompt correction of his mechanical obstruction with aortic valve replacement

Front 40

Wolff-Parkinson-White syndrome

Back 40

Radiofrequency catheter ablation of bypass tracts

Front 41

acute delirium in the ICU

Back 41

Intravenous haloperidol has been found to be more effective than lorazepam and has minimal physiologic side effects.

Front 42

Pregnant woman with hypertension

Back 42

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.

Front 43

CHF due to left ventricular systolic dysfunction,

Back 43

ACE inhibitors and beta blockers (except those with dyspnea at rest or hemodynamically unstable).

Front 44

prophylaxis against deep vein thrombosis, such as with knee surgery.

Back 44

The two regimens recommended are low–molecular-weight heparin [Enoxaparin (Lovenox)] and adjusted-dose warfarin.

Front 45

Pertussis

Back 45

DOC: macrolides

2nd line: TMP-SMX

Front 46

Croup

Back 46

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

Front 47

RSV

Back 47

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.

Front 48

Croup

Back 48

Oral steroids (dexamethasone).

Also, O2.

Front 49

Essential tremor DOC

Back 49

Propranolol (not so much with other beta-blockers), and primidone. Also topiramate (Topamax)

Front 50

Cholinesterase inhibitors used for Alzheimer's

NMDA receptor antagonist (therefore, blocking glutamate)

Back 50

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.

Front 51

Carotid stenosis

Back 51

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.

Front 52

migraine prophylaxis

Back 52

Riboflavin (vitamin B2)

Front 53

Treatment of disabling unilateral tremor and dyskinesia from Parkinson’s disease.

Back 53

Thalamotomy and pallidotomy

Front 54

Febrile seizures

Back 54

Antipyretics, such as acetaminophen

Front 55

Lost of libido from SSIRs

Back 55

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.

Front 56

Herpes zoster DOC

Back 56

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.

Front 57

Postherpetic neuralgia

Back 57

Capsaicin cream

Front 58

parkinsonian and dystonia side effects of neuroleptic drugs


Akathisia

Back 58

anticholinergics

anticholinergics and beta blockers

Front 59

DOC for preventing the spread of meningococcal disease and HiB

Back 59

Rifampin

Front 60

Current methods for reducing the risk of renal failure induced by contrast material include

Back 60

adequate hydration, sodium bicarbonate and the use of N-acetylcysteine.

Front 61

Treatments available for childhood nocturnal enuresis

Back 61

bed-wetting alarm have a higher success rate and a lower relapse rate

After the alarm, DOC is desmopressin; 2nd line is imipramine.

Front 62

Social phobia or social anxiety disorder

Back 62

Paroxetine (paxil)

Front 63

Initial treatment of mania

Back 63

Lithium or valproic acid (depakote)


Note: Carbamazepine is used when lithium and valproic acid are unresponsive.

Front 64

Premenstrual dysphoric disorder

Back 64

SSRIs

Front 65

Peripheral neuropathy

Back 65

Phenytoin and gabapentin

Front 66

Atopic dermatitis (eczema)

Back 66

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.

Front 67

Bullous impetigo is a localized skin infection characterized by large bullae; it is caused by a group 2 phage type of Staphylococcus aureus.

Back 67

penicillinase-resistant penicillin, cephalosporin, TMP/SMX and clindamycin

Note: unsure about this answer. . .

Front 68

Scabies

Back 68

Permethrin (Elimite) 5% cream

Front 69

Psoriasis

Back 69

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.

Front 70

Lice

Back 70

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.

Front 71

torsades de pointes

Back 71

IV Mg

Front 72

Gallstone, primary biliary cirrhosis

Back 72

Ursodiol (Actigall)

Front 73

Cholestatic pruritus

Back 73

Cholestyramine (Questran)

Also for systemic pruritus, antihistamines, doxepin (with it s antihistamine properties), and mirtazapine.

Front 74

Rosacea

Back 74

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.

Front 75

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.

Back 75

Amiodarone (Cordarone)

Front 76

Thoracic vertebral compression fracture

Back 76

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.

Front 77

PT with polycystic ovary syndrome (oligomenorrhea, acne, hirsutism, hyperandrogenism, infertility) who wants to become pregnant.

Premenopausal hirsutism

Back 77

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)

Front 78

Restless leg syndrome

Back 78

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.

Front 79

Heparin-induced thrombocytopenia (HIT)

Back 79

Discontinue heparin and start a non-heparin anticoagulant such as argatroban or desirudin (Iprivask)

Front 80

Insomnia

Back 80

Cognitive-behavioral therapy

Front 81

COPD </ 88% O2 saturation

Back 81

O2 therapy

Front 82

Chronic cough

Back 82

Think of GERD, therefore PPI even in the absence of GI symptoms.

GERD is the most common cause of chronic cough.

Front 83

Systolic dysfunction

Back 83

Ace inhibitors and beta blockers (except those with dyspnea at rest or hemodynamically unstable).

Front 84

Lichen sclerosus

Back 84

High-potency topical corticosteroids

Front 85

Treatment of pain and sleep disturbance in patients with fibromyalgia

Back 85

amitriptyline and duloxetine

Front 86

Paget’s disease of bone

Back 86

bisphosphonates

Front 87

Melanoma

Back 87

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

Front 88

TB

Back 88

INH, ethambutol, rifampin, and pyrazinamide

Front 89

Gestational diabetes

Back 89

combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin (e.g., lispro) twice daily

Keep glucose <95 in gestational diabetes

Front 90

ST-segment elevation myocardial infarction (STEMI)

Back 90

oral clopidogrel (Plavix), and should also chew 162–325 mg of aspirin.

Front 91

life threatening, an acute dystonic reaction

Back 91

IV diphenhydramine or benztropine.

Front 92

Allergic rhinitis.

Back 92

Topical intranasal glucocorticoids are currently believed to be the most efficacious medications. More so than antihistamine and cromolyn spray

Front 93

Post-thrombotic syndrome (PTS) as a complication of acute deep-vein thrombosis (DVT)

Back 93

Compression stockings should be applied when anticoagulation therapy is started, not when it has been completed.

Front 94

best INITIAL management for hypercalcemic crisis

Back 94

IV saline

Front 95

Acute pericarditis

Back 95

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.

Front 96

alopecia areata (caused by a localized autoimmune reaction to hair follicles)

Back 96

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.

Front 97

community-acquired pneumonia

Back 97

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.

Front 98

onychomycosis

Back 98

Oral terbinafine (Lamisil) daily for 12 weeks

Front 99

corneal abrasion

Back 99

A white or gray appearance at the edge of a corneal abrasion may indicate infection, and referral to an ophthalmologist is indicated

Front 100

Peripheral arterial disease (PAD)

Back 100

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.

Front 101

Cocaine associated chest pain

Back 101

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.

Front 102

Hip fraction prevention in a postmenopausal woman.

Back 102

800 IU vitamin D and 1200 mg calcium

Front 103

hydrocele of the tunica vaginalis testis

Back 103

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.

Front 104

Hypotensive sepsis

Back 104

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.

Front 105

Acute ankle sprain

Back 105

Semi-rigid brace that allows flexion and extension.

Front 106

Alcohol withdrawal syndrome

Back 106

Chlordiazepoxide (Librium)

Front 107

subarachnoid hemorrhage

Back 107

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.

Front 108

How to lower K in hyperkalemia

Back 108

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.

Front 109

Osmotic demyelination syndrome can usually be avoided by

Back 109

limiting correction of chronic hyponatremia to <10-12 mmol/L in 24 hours and to <18 mmol/L in 48 hours.

Front 110

Any child younger than 29 days old with a fever

Back 110

Admit to the hospital; obtain urine, blood, and CSF cultures; and start intravenous antibiotics

Front 111

The most appropriate initial pharmacologic treatment of panic disorder is

Back 111

SSRI

Front 112

Septic shock

Back 112

recombinant activated protein C

Front 113

preventing and treating traveler's diarrhea due to E. coli

Back 113

Rifaximin

Front 114

seborrheic dermatitis

Back 114

Topical steroids or selenium sulfide products.

Front 115

Necrotizing enterocolitis

Back 115

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.

Front 116

Varicocele and hydrocele

Back 116

Reassurance

Front 117

Malignant hyperthermia

Back 117

Dantrolene

Test of choice: caffeine contracture test (muscle biopsy is exposed to caffeine).

Front 118

Acute disseminated encephalomyelitis

Back 118

High dose steroids

Front 119

Rocky Mountain spotted fever

Lyme disease

Back 119

Doxycycline if > 8 yoa

Ampicillin or doxycycline

Front 120

Cryptosporidium (which occurs in immunocompromised and children)

Back 120

Nitazoxanide

Front 121

Acute bronchitis

Back 121

Inhaled or oral steroid taper

Note: use this when there is a hyperreponsive airways called postbronchitic cough

Front 122

Peripheral vestibular disorder

Back 122

Antihistamines, such as meclizine and diphenhydramine

note: they suppress the vestibular end organ receptors and inhibit activation of the vagal response.

Front 123

Pityriasis rosea

Back 123

Antihistamines or corticosteroids to relieve.

Front 124

Tinea capitis

Back 124

Oral griseofluvin

Front 125

Anogenital warts

Back 125

Imiquimod

Front 126

Bacterial conjunctivitis in contact lens wearers

Back 126

Gentamicin

Note: bacterial conjunctivitis is mostly from Strep and Staph; however, in contact lens wearers, gram- most be thought off.

Front 127

Vaginal candidiasis

Back 127

Topical azole

Front 128

Smoking cessation

Back 128

Varenicline, bupropion (wellbutrin)(contraindicated in pts with seizures), nicotine replacement, clonidine (2nd line)

Front 129

Pneumocystis pneumonia

Back 129

TMP-SMX and steroids if PA02 < 70

Front 130

What can prevent a reoccurrence of a stroke?

Back 130

ACE inhibitor and diuretic (thiazides)

Front 131

Hypertension and chronic renal disease

Back 131

ACE inhibitor or ARB

Front 132

Acute phase of mania in biopolar

Back 132

Neuroleptics

Note: Lithium, valproic acid, carbamazepine, and amotrigine are used for once the acute mania is under control.

Front 133

Nocardiosis (acid fast)

Actinomyces israelli (gram +)

Back 133

Sulfonamides

Penicillin

Front 134

absence (petit mal) seizures

Partial seizures

Back 134

Ethosuximide or valproic acid

Phenytoin

Front 135

Intussusception

Back 135

Air contrast enema

Front 136

Bruton's agammaglobulinemia

Back 136

IV Ig

Front 137

Acute rheumatic fever

Back 137

Benzathine penicillin G

Front 138

Idiopathic (immune) thrombocytopenic purpura (occurs in children)

thrombotic thormbocytopenic purpura

hemolytic urremic syndrome

Back 138

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!

Front 139

Von Willebrand disease and hemophilia A

Back 139

Desmopressin

Front 140

Lactase deficiency

Back 140

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).

Front 141

Guillain-Barre syndrome

Back 141

Plasmapheresis or human Ig

Front 142

Pyloric stenosis

Duodenal atresia

Back 142

IV hydration and K replacement before surgery; Pyloromyotomy.

Decompression with a nasogastric tube, correction of electrolyte and surgery.

Front 143

Necrotizing enterocolitis

Back 143

Antibiotics

Front 144

Hyaline mm disease or respiratory distress syndrome

Back 144

CXY shows ground glass appearance: discrete, uniform infiltrate due to microatelectasis

Front 145

Wilson disease

Back 145

Penicillamine or trientine

Front 146

Diamond-Blackfan anemia or congeital pure red cell aplasia

Back 146

Corticosteroids

Front 147

Minimal change disease (nephrotic syndrome)

Back 147

Steroids

Front 148

Nursemaid's elbow aka subluxed radial head

Back 148

Rotating the hand and forearm to supination with pressure over the radial head reduces the annular ligament to restore full ROM.

Front 149

Henoch-Schonlein Purpura

Back 149

Steroids and monitoring renal function

Front 150

Lesch-Nyhan syndrome

Back 150

Allopurinol

Front 151

Instructions to mother with laryngomalacia

Back 151

Hold the child in an upright position for half an hour after feeding, and never feed the child when lying down.

Front 152

Gonococcal conjunctivitis

Congenital chlamydial infection

Back 152

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).

Front 153

Sickle cell

Back 153

Hydroxyurea; prophylactics with penicillin until 5 oya

Front 154

Neonatal meningitis (to cover both gram + and -)

Back 154

Ampicillin and gentamicin or ampicillin and cefotaxime.

Front 155

Homocystinuria

Back 155

High dose of B6; restriction of methionine with supplements of cysteine

Front 156

Live vaccines to HIV if CD4 > 200

Back 156

MMR, VZV, yellow fever

Front 157

MCV4 (2 doses)

HAV (2)

MMR (2)

Back 157

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

Front 158

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.

Back 158

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.

Front 159

Rotavirus (3 doses)

HBV

Influenza

Back 159

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)

Front 160

o Pneumococcal vaccination

Back 160

• 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

Front 161

Vaccines contraindicated in HIV

Back 161

BCG, anthrax, oral typhoid, intranasal influenza, and oral polio.

Front 162

Asthma (symptoms, nighttime symptoms, treatment

Mild, intermittent

Mild, persistent

Moderate, persistent

Severe, persistent

Back 162

</ 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

Front 163

Ascending aortic dissection

Descending aortic dissection

Back 163

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.

Front 164

Descending aortic dissection

Back 164

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).

Front 165

BP in African-American

Back 165

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

Front 166

Prophylaxis for surgery-related cardiac complications

Back 166

beta-blockers perioperatively for patients with cardiac risk factors

Front 167

Systolic hypertension

Back 167

Thiazide and long-acting CCB for first-line

Front 168

CONTRAindicated in cocaine induced arrhythmias

Avoided in CHF?

Back 168

Beta-blockers (due to unopposed alpha activity)

NSAIDs due to Na and H20 retention, increase vascular resistance

Front 169

Intermittent claudication

Back 169

Cilostazol (phosphodiesterase inhibitor)(avoid in CHF)

Also, beneficial HDL effects and in 3rd degree heart block.

Front 170

Decrease mortality later after MI

Back 170

Beta-blockers and ACE inhibitors

Front 171

CHF

Back 171

ACE inhibitors

Front 172

Long-term treatment with prednisone (>/ 3 m at dosage >/ 5mg/d)

Back 172

PTs should receive bisphosphonates

Front 173

Acute dystonic reaction

Back 173

Diphenhydramine or benztropine

Front 174

Provides pain relief within a few days in many patients with osteoporotic vertebral compression fractures.

Back 174

Calcitonin

Front 175

Fibrositis-fibromyalgia syndrome.

Back 175

Amitriptyline or cyclobenzaprine

Front 176

Fracture of scaphoid

Back 176

Thumb spica splint; referral to othro if proximal 1/3rd is fractured due to avascular necrosis

Front 177

small spontaneous pneumothorax involving less than 15%-20% of lung volume

Back 177

O2 and observation. pneumothorax will resorb in 10 d.

Note: chest tube placement is used with larger pneumothoraces.

Front 178

Tension pneumothorax

Back 178

Decompression with anterior placement of IV catheter

Front 179

Allergic rhinitis

Back 179

Intranasal glucocorticoids are the preferred treatment over antihistamines.

Front 180

Nursing-home-acquired pneumonia

Back 180

Levofloxacin

must cover Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and gram-negative bacteria.

Front 181

Health care-associated pneumonia

Back 181

ceftazidime and gentamicin (?)

Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter species. MRSA, depending on local prevalence.

Front 182

Ciprofloxacin

Back 182

Not approved for PTs < 18

Front 183

Dental infection complicated by cellulitis

Back 183

DOC: penicillin; 2nd line if allergic is clindamycin

Front 184

Food tolerated in diarrhea

Back 184

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.

Front 185

Traveler's diarrhea

Back 185

Ciprofloxacin

Front 186

To prevent vertical transmission of HIV

Back 186

zidovudine and nevirapine

Front 187

Vitamins in Alzheimer's

Back 187

Beta-carotene, Vitamin C and E may be beneficial.

Front 188

Antipsychotic of choice in patients with dementia associated with Parkinson’s disease.

Back 188

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

Front 189

Has been used in tardive dyskinesia

Back 189

Lithium

Front 190

Generalized anxiety, but not effective for depression

Back 190

Buspirone (BuSpar)

Front 191

Rosacea

Back 191

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.

Front 192

Pain relief in renal dysfunction

Back 192

Acetaminophen is the first-line treatment in this case.

NSAIDs are contraindicated

Front 193

Glycopyrrolate (Robinul)

Back 193

Is a muscarinic blocker

Can reduce respiratory secretions and does not cross the BBB

Front 194

Activated charcoal

Gastric lavage, cathartics, or whole bowel irrigation

Back 194

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.

Front 195

Dupuytren's contracture

Back 195

Cortisone injections

Front 196

Status epilepticus

Back 196

Lorazepam, followed by phenytoin.

Note: Fosphenytoin, midazolam, or phenobarbital can be used if there is no response to lorazepam.

Front 197

BP control in stroke patients

Back 197

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.

Front 198

Emergency tracheotomy

Back 198

Best site for the incision is directly above the cricoid cartilage, through the cricothyroid membrane.

Front 199

Temporal arteritis

Back 199

Corticosteroids

Front 200

Acute ankle sprain

Back 200

Semi-rigid brace that allows flexion and extension.

Front 201

Acute mountain sickness

Back 201

• 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.

Front 202

Prepubertal labial adhesions

Back 202

Estrogen cream

Front 203

Pseudomonas in CF

Back 203

Ceftazidime or penicillin derivative such as ticarcillin + aminoglycoside such as Amikacin or gentamicin.

Front 204

Anaphylaxis

Back 204

First, endotracheal intubation, followed by subcutaneous EPI.

Additional treatments include plasma expanders, diphenhydramine, cimetidine, corticosteroids.

Front 205

Battery in esophagus

Distal to the esophagus

Back 205

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.

Front 206

Foreign body aspiration

Back 206

Direct laryngoscopy and rigid bronchoscopy (not flexible bronchoscopy)

Front 207

Cephalohematoma

Back 207

Reassurance (2w - 3 m it will resolve)

Note: limited to one cranial bone since it doesn't cross over cranial sutures

Front 208

Encopresis

Back 208

Mineral oil or stool softeners and behavioral modifications

Front 209

Preseptal cellulitis

Orbital cellulitis

Back 209

Outpatient with antibiotics (eyelid discoloration)

Inpatient treatment with IV antibiotics (decrease eye movements, proptosis)

Front 210

Cornebacterium diphtheria treatment in order of importance

Back 210

• Administration of diphtheria antitoxin (passive immunization); administer penicillin or erythromycin; DPT vaccine (active immunization)

Front 211

Acne

Back 211

Benzoyl peroxide and retinoic acid (effective in sloughing the epi)

Topical tetracycline (controls the inflammatory component)

Front 212

Congenital diaphragmatic hernia

Back 212

Orogastric tube placement with continuous suction to prevent bowel distension and further lung compression.

Front 213

Covers strep and has the best-staph coverage (but not MRSA)

Back 213

Dicloxacillin

Front 214

Dissolve cholesterol gallstone

Back 214

Chenodeoxycholic acid, ursodiol (urosodeoxycholic acid aka Actigall)

Front 215

Cholecystitis

Back 215

IVFs, antibiotics, cholecystectomy

Front 216

Porecelain gallbladder

Back 216

Cholecystectomy

Note: it is a calcified gallbladder due to chronic cholelithiasis/cholecystitis that leads to gallbladder carcinoma

Front 217

ST elevation MI and thrombotic states

Back 217

Streptokinase and tPA

Front 218

DVT

Back 218

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.

Front 219

Pre-renal failure from hypovolemia

Back 219

First step: change foley catheter to make sure it isn't clogged.

Next step: IV bolus for an IV fluid challenge.

Front 220

Prevention of atelectasis, which also predisposes to pneumonia post-surgery.

Back 220

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?

Front 221

Cervical spine injury

Back 221

1st step: Stabilization of cervical spine.

2nd step: assess the airway (orotracheal intubation with rapid sequence)

Front 222

No matter what the disease or current condition of the PT, always treat what first?

Back 222

ABCs

Front 223

H. pylori

Back 223

1st line therapy: amoxicillin + clarithromycin and PPI

Front 224

C-diff

Back 224

Metronidazole.

Oral (NOT IV) vancomycin can be used, but there is emergence resistance of vancomycin enterococci, and is more expensive than metronidazole.

Front 225

Antibiotic that can be used to increase GI motility

Back 225

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).

Front 226

Tension pneumothorax

Back 226

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.