Caused by strep pyogenes or group A B-hemolytic strep, or viruses (rhinovirus, coronavirus, adenovirus, HSV, parainfluenza) Mononucleosis differential: splenomegaly, cervical adenopathy. A diffuse rash 2-3 days after PCN dose is indicative of mono. If you have to guess a sub for PCN allergic patients in ANYTHING chose a macrolide. Treatment: PCN V or Amoxil for […]
Urinary Incontinence
Causes (DRIP): Drugs, delirium Retention, Restricted mobility Impaction, infection, inflammation Polyuria, prostatitis Treatment: Urge: Anti-muscarinic and anticholinergic: oxybutynin, tolterodine, fesoterodine, trospium, solifenacin, darifenacin B-agonist: mirabegron Stress: alpha-adrenergic agonists: pseudoephedrine, phenylephrine topical estrogens if other signs of estrogen deficiency SSRI/SNRI: only duloxetine Overflow: alpha-adrenergic agonists: alfuzosin, tamsulosin 5-alpha-reductase inhibitors: finasteride, dutasteride Parasympathomimetic: bethanechol Phosphodiesterase inhibitor: tadalafil BPH: Meds that […]
Glaucoma
Angle-closure is a medical emergency: 1 drop of timolol, apraclonidine, pilocarpine stat until ophthalmologist. Open-angle: brinzolamide, dorzolamide (carbonic anhydrase inihibitors) or latanoprost: prostaglandin
Arthritis
Osteoarthritis:Risk factors: age, female sex, obesity, genetics, sports, occupation, injury, acromegaly and other illnesses.Treatment: Lifestyle: weight loss, exercise, PT and surgery Drugs: APAP up to 3g daily NSAIDS if APAP not working. Take ASA at least 30 minutes before NSAID if on ASA. Topical agents, especially for the knee (capsaicin, diclofenac 1% gel) Intraarticular glucocorticoid […]
Inflammatory Bowel Disease
Ulcerative Colitis: Rectum and colonic mucosa involvement, no small intestine involvement, no skip lesions Blood diarrhea, spasm of anal sphincter (Tenesmus), weight loss, fever Staging: Mild < 4 stools a day, no symptoms Mod > 4 stools a day, minimal symptoms Severe > 6 stools a day, temp > 99.5 F, HR > 90, ESR […]
GERD, PUD, Stress Ulcer Prophylaxis
GERD (gastroesophageal reflux disease) Only screen for H. pylori in the case of PUD, history of documented peptic ulcer disease or gastric mucosa-associated lymphoma. No endoscopy needed unless there are alarm symptoms. Lifestyle Modifications: Avoid alcohol, caffeine, chocolate, citrus, garlic, onions and mint Reduce fat Avoid eating 2-3 hours before bedtime Remain upright for 2 hours after […]
Helicobacter Pylori Treatment
PPI Triple Treatment: 3 drugs, 10-14 days PPI BID + clarithromycin 500 mg BID and amoxicillin 1000 mg BID or metronidazole 500 mg BID Bismuth-based treatment: 4 drugs, 14 days PPI BID+ metronidazole 250 mg TID and tetracycline 500 mg four times a day and bismuth 2 tabs four times a day Salvage Therapy: levofloxacin-based treatment for 10 […]
Liver Disease
Child-Pugh Scores for Cirrhosis Variable 1 Point 2 Points 2 Points encephalopathy absent mild-moderate severe to coma ascites absent slight moderate bilirubin <2 2-3 >3 albumin >3.5 2.8-3.5 <2.8 prothrombin time 1-4 4-6 >6 Class A = 5 points, class B=7-9 points, class C=10 or more points Ascites: Reduce dietary sodium, restrict fluid to 1.5 […]
Hepatitis
Hepatitis A – viral – spread person to person via feces. Pre-exposure prophylaxis Vaccines are available. Children are routinely vaccinated between their first and second birthdays. People who should consider vaccine – are traveling to countries where hepatitis A is common, are a man who has sex with other men use illegal drugs, have a […]
Spontaneous Bacterial Peritonitis
What Causes SBP Gram-Negative Bacteria (50%) E.coli (37%) Klebsiella other Gram-Positive Bacteria (50%) Strep pneumonia (10%) Other Strep Staphylococcus aureus Treatment of SBP SPB has a high mortality rate. Start treatment immediately. If ascitic fluid polymorphonuclear cell count is greater than 250, start antibiotics. (PMN= total number of white cells * % of neutrophils) Poorer prognosis if […]