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Flashcards in Emed Objectives Deck (231):
1

Middle aged pt w uncontrolled HTN and tearing pain radiating to back

aortic dissection

2

Aortic dissection GS test

CT angiography

3

MC EKG finding in PE

tachycardia

4

PERC Criteria

(no to all = 1.8% chance of missing PE)

Sa O2 <95%?

Unilateral leg swelling?

HR > 100 BPM?

Recent surgery or trauma?

History of DVT or PE?

Hemoptysis?

Age >50 years old?

Current hormone use?

5

Corneal abrasion tx for contact lens wearer

Pseudomonas coverage (moxifloxican) + no contacts for2 wks or until optho okays

topical analgesia in ER only

6

TOC for 25 yof healthy c/o lump down there, PE- fluctuant, erythematous lump 4 cm

I and D is TOC and definitive tx

7

First tx for 14 yo type 1 diabetic high glucose Likely DKA

Fluids

8

When evaluating the metabolic status of pt with hyperglycemia what lab value must be corrected

serum sodium because hyperglycemia lowers it

9

Preferred O2 tx for unstable pt due to respiratory issues (such as COPD) and fatigued

NO intubation bc hard to wean off vent

Try Bi-pap instead

10

PE diagnostic test if high risk

CT Pulmonary Angiography

11

Vesicles on the tip of the nose

Herpes zoster ophthalmicus

12

Tx for UTI in preg woman

Cephalosporins -Cephalexin 500 mg 4 times daily OR

Ampicillin 500 mg 4 times daily OR

Nitrofurantoin 100 mg twice daily OR

Aminoglycosides (Gentamycin or Tobramycin)

13

Abx to avoid in pregnancy

Tetracyclines (adverse effects on fetal teeth and bones and congenital defects)

Bactrim - TMP/SMX in the first trimester (facial defects and cardiac abnormalities)

Chloramphenicol (gray syndrome)

Sulfonamides in the third trimester (hemolytic anemia in mothers with glucose-6-phosphate dehydrogenase [G6PD] deficiency, jaundice, and kernicterus)

14

First line tx for young healthy female w/ UTI

Bactrim 160 mg/800 mg 1 tablet PO BID for 3d (use when bacterial resistance is < 20% and patient has no allergy) OR

Nitrofurantoin 100 mg PO BID for 5-7d or

15

When should you NOT perform a speculum exam

Painless vag bleeding >20 wks

16

Dx for abscess in neck

CT soft tissue w/ IV contrast to look for fluid collection

17

s/r for face

3-5 days

18

s/r for LE

8-12 d

19

s/r for torso/UE

7-10 d

20

s/r for scalp

7 d

21

s/r for joints

10-14 d

22

Hyperkalemia tx

Calcium gluconate if they have EKG changes*** + the following:

insulin quick (can give now)

Calcium gluconate if they have EKG changes*

Kayexalate - takes longer so not good if emergent

Bicarb

23

Necrotizing otitis externa tx

admit bc need IV abx (mc cause is pseudomonas)

24

Standing for LT, cramped, hot, a lot of people and pass out

vasovagal syncope

25

Abrupt LOC w/ facial trauma, no defensive wounds
No prodrome (or v brief)
Assoc w/ phys activity or exercise

cariogenic syncope

26

Postictal

5-30 min

drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms

27

Bronchitis tx

fluids and rest ± antitussives in adults

inhaler, corticosteroid if not responsive to inhaler

28

Reversible Causes of cardiac arrest

Hypovolemia, hypoxia, H+ ion (acidosis), hypo/hyperkalemia, hypothermia

Cardiac Tamponade, toxins, thrombosis (pulm and coronary)

29

typical exam finding for Addisons

Bronzed skin mostly in palms and skin folds

30

Floaters

Vitreous detachment

31

Painless, sudden monocular vision loss, cherry-red fovea

Central retinal artery occlusion

32

Painless monocular vision loss, preceding floaters, curtain effect, usually periph 1st

Retinal Detachment

33

Most SENSITIVE way to find out if someone has SAH

LP is most sensitive

Do non-contrast CT first to r/o mass effect due to herniation risk

34

Confused, lethargic, slurred speech what should you do first

First thing you would do is check glucose (quick and can do it now for pt with AMS)

35

Coughs and common cold tx

Supportive, inhaler

36

Who should we NOT give supplemental oxygen to

Heavy smokers, COPD pts → if you put them on oxygen they stop breathing on their own and can't get them off → oxygen-induced hypercapnia


Balance the need for inc Pa02 against the possibility of producing hypercapnia

Pts w/ chronic respiratory acidosis rely on hypoxia for respiratory drive

37

Acute CP lat to affected side, unilat ↓ or absent breath sounds, hypotension, hyper-resonance

pneumothorax

38

CXR→ focal consolidation, effusions (mc bacterial)

pneumonia

39

Cough, dyspnea, CP, ↓ breath sounds, LE edema, orthopnea, night sweats, unintentional weight loss, fever, pleuritic chest pain, dullness to percussion, egophony, pleural friction rub and effusion on CXR

pleural effusion

40

Q waves/ST elevation V1-V4

Anteriorseptal

LAD

41

Q waves/ST elevation V1 and V2

Septal

Proximal LAD

42

Q waves/ST elevation I, avL, V5, V6

lateral

CFX

43

Q waves/ST elevation I, aVL, V4 + V5 + V6

anterolateral

Mid LAD or CFX

44

Q waves/ST elevation II, III, avF

inferiot

RCA

45

ST depression in V1-V2

posterior

RCA, CFX

46

Contralateral leg weakness > arm weakness

Anterior Cerebral Artery (ACA)

47

Deficits may be hidden until formally tested

Light-touch and pinprick sensation may be markedly ↓

May have visual cortex defects

Posterior Cerebral Artery (PCA)

48

If in dominant hemisphere (left for most ppl) → aphasia

Homonymous hemianopia→visual field loss on the same side of both eyes

Middle Cerebral Artery (MCA)

49

Tx for OM

1st line: Amoxicillin 500 mg po tid x 7-10d

2nd line: Augmentin 875 mg po bid x 7-10 d

If PCN all → azithromycin, clarithromycin, clindamycin

50

Tx for OE

Acetic acid soln, Neomycin, polymycin B, ofloxacin, clotrimazole

51

Tx for TM perd

Keep dry, refer to ENT, cortisporin otic suspension 1 drop qid or cipro ophthalmic 1 drop qid (abx controversial and only necessary if inf sus)

52

Otorrhea, hearing changes, tinnitus, pain

TM perf

Weber lateralizes to side of perf

53

Tx for cerumen impactation

Curette, warm water irrigation (unless TM perf), wax softeners (Debrox)

54

Vertigo tx

IV hydration

1st line: Meclizine 25-50 mg po q8-12 h or diazepam 5-10 mg IV 2-4 mg Ima, diphenhydramine 50 mg IM or po q6-8h

55

Unilateral hearing loss, tinnitus, vertigo w/ sudden onset and short duration (intense, N/V, distress)

Meniere’s disease

56

Meniere’s disease tx

low salt diet, meds for vertigo, some need surg

57

Mastoiditis tx

ENT, admit, IV abx (cefotaxime 1 g IV q 24 h or ceftriaxone 1-2 g IV q24h)

58

Barotrauma tx

Open eustachian tube → gum, Valsalva, yawn

Antihistamines, decongestants, abx to prevent inf

59

Foreign body tx

Irrigation (safest), suction, alligator forceps, acetone (Styrofoam or glue)

Antibiotic drops if trauma (dexamethasone)

60

Allergic rhinitis tx

Nasal steroids, oral antihistamines

61

mc location of epistaxis bleeding

MC in anterior septum/Kiessellbach’s Plexus

62

MC arterial source of posterior bleed

sphenopalatine artery

63

Anterior epistaxis tx

direct pressure 20 min, oxymetazoline pretreat

Topical anesthesia, vasoconstrict, cauterize → bacitracin x 1 wk

Pack for 24-48 h

64

Posterior epistaxis tx

packing 72-96 h, taper deflate balloon

Complications: necrosis of nasal ala → protect w/ gauze

65

Bacterial sinusitis tx

cephalosporins, macrolides

66

Viral sinusitis tx

sx treatment, intra-nasal corticosteroids

67

Foreign body tx

Topical vasoconstrictors, suction, balloon cath, alligators, + pressure

68

Tooth fx tx

irrigate, dry and cover w/ ca hydroxide paste + dental referral

69

Tooth avulsion tx

milk, replant immediately, splint tooth, 5 d abx pphx

70

Dental abscess tc

I& D, abx, pain control

71

Acute tonsillitis tx

IV fluid, pain control, steroids and abx

72

grey exudate, cranial and periph neuritis

Diphtheria

73

Lateral, worsening sore throat, erythema, drooling, unilat uvular deviation

peritonsillar abscess

74

gold standard for peritonsillar abscess diagnosis

collection of pus from abscess through needle aspiration

75

Tx for peritonsillar abscess

I&D or needle asp, abx, fluids, steroids

76

Enlarged, painful salivary gland, purulent drainage, fever, ↓ saliva

Sialadenitis

77

Sialadenitis tx

heat/cold compress, aggressive hydration, lemon drops

Pen VK 250-500 mg qid, erythromycin 250 mg qid, Augmentin

78

Formation of hardened deposits in ductal salivary gland system due to stagnation

Colicky postprandial pain and swelling

Sialolithiasis

79

Sialolithiasis tx

lemon drops, citrus juice, Abx for S. aureus, Nsaids, warm compress

80

most sensitive diagnostic test for organic foreign matter

US

81

wound is closed by us at or near the time of injury

Primary Intention

82

How long do you have to close face wound

must close w/in 24 hr

83

Time limit for primary intention closure

8 h

84

wound closes by natural process

Secondary Intention

85

wound prepped in ER → repaired later by us

Tertiary Intention (delayed primary)-

86

What wounds should you allow to heal by tertiary intention

Good for high bacteria load or delayed access to definitive care

Clean→ 72-96 h re-irrigate → close

87

Healing Continuum

Initial epithelization within 24-48 h

Peak collagen btwn 5-7 d

Continue to heal over next 12 mo

88

CI to anesthetic agent for wounds

Epi in fingers, toes, nose, genitalia, ↓ blood flow, blanching affects align

Cardiac or vascular dz pts, pts on propranolol

Bupivacaine in preg

89

What sutures should you avoid in contaminated wounds?

gut and silk

90

Sutures for fact

6- or 7-0

91

Suture for low tension

5-0

92

High tension suture (scalp)

3-0 or 4-0

93

Alt method to wound mgmt for linear low ten facial wound

glue

94

When should tetanus be given for wounds

>7 yr since last

Tdap preferred

95

Animal bites mgmt

Loosely close (if <8 hr) or delay primary closure

Amoxicillin-clavulanate or fluoroquinolone + clinda (if PCN all) x 3-5 d

96

Monkey bite tx

Valtrex/acyclovir x 14 d

97

ST depression (horizontal, down/upslope) and T wave inversion

Positive cardiac enzyme

Non-STEMI

98

NSTEMI mgmt

PCI w/in 72 h

Antithrombotic therapy→ Aspirin, clopidogren, UFH, enoxaparin

Adjunctive therapy→ Beta blockers (metoprolol), Nitrates, morphine, CCB

99

UA and NSTEMI mgm

Antithrombotic therapy→ Aspirin, clopidogren, UFH, enoxaparin

Adjunctive therapy→ Beta blockers (metoprolol), Nitrates, morphine, CCB

100

STEMI mgmt

Reperfusion therapy w/in 12 hrs onset

PCI w/in 3 h or thrombolytic (rTPA) w/in 12h

Antithrombotic → aspirin (chewed) or heparin

Adjunctive → beta blocker, ACEI*

If cocaine induced avoid beta blockers → vasospasm risk

101

MONA LISA

morphine, O2, nitrates, anti-platelet/coag, L v R, intervene, statin, activate PCI

102

Nitrates action

↓pre/afterload do not give if SBP <90, inf infarct or ED drugs)

103

Morphine

↓HRandSBP

104

Why should you avoid NSAIDs w/ STEMI?

block PG→ ↑ platelet aggregation (bad)

105

GS for DVT

Venography

106

DVT 1st line diagnostic test

venous duplex US

107

DVT tx

Anticoag w/ heparin or warfarin

108

Superficial thrombophlebitis tx

Supportive mgmt. (warm compress, elevation, NSAIDs, comp stock)

109

Leg pain, brown hyperpigmented, worse w/ standing

Chronic Venous Insufficiency

110

Chronic Venous Insufficiency tx

compression

111

GS diagnostic test for aortic aneurysm

Angiography

112

Thoracic Aortic aneurysm TOC

CT scan

113

TOC for aortic dissection

GS test for aortic dissection

TOC = CT w/ contrast

GS= CT angiography

114

Harsh/rumble

Stenosis

115

Blowing

Regurgitation

116

what murmur radiates to carotids

AS

117

what murmur radiates to L upper sternal border

AR

118

What murmur radiates to axilla

MR

119

Systolic ej crescendo-decrescendo @ RUSB radiates to carotid (high pitch)

↑ murmur w/ ↑ venous return → squat and lean forward

↓ murmur w/ ↓ venous return→ Valsalva

Aortic Stenosis

120

AS TOC

Surg mgmt aortic valve replacement

AVOID phys activity/vasodilators (nitrates), diuretics, beta block, CCB

121

Diastolic, decrescendo, blowing murmur max @ LUSB (high pitch)

Aortic Regurgitation

122

Aortic Regurgitation mgmt

definitive tx

afterload reduction w/ vasodilators (ACEI, ARB, Nifedipine)

No b blockers

Definitive tx is surgery

123

MC cause of Mitral stenosis

Rheumatic heart dz

124

Early-mid diastolic rumble @ apex (low pitch) *esp in LLD

MS

125

MS tx

Percutaneous balloon valvuloplasty/valvotomy or MV repair

b blockers/CCB, manage A fib and anticoagulate

126

mc valvular dz in western world

Mitral Regurgitation

127

Blowing, holosystolic murmur @ apex w/ radiation to axilla (high pitch)

Mitral Regurgitation

128

Mitral Regurgitation tx

Surgical repair preferred over replacement

Vasodilators to ↓ afterload (ACEI, nitrates, b block)

129

ECG→ diffuse ST elevations in V1-V6

Pericarditis

130

Pericarditis tx

Nsaids, or aspirin x7-14d (Colchine 2nd line)

± Corticosteroids if sx >48 hr and refractory

131

ECG → low voltage QRS

Distant muffled heart soudnds

Pericardial effusion

132

Pericardial effusion tx

± pericardiocentesis

133

distant muddled heart sounds, ↑JVP, hypotension

Pericardial tamponade

134

Pericardial tamponade tx

Immediate pericardiocentesis*, aggressive fluids

135

Unstable radycardia mgmt.

atropine

transvenous pacing (TVP), LT mgmt. = pacemaker

136

Unstable tachy arrhythmia tx

cardioversion (need to anticoag)

137

stable tachy arrhythmia tx

rate control (CCB vs b blocker) + anticoag

138

V tach tx

immediate cardioversion + rhythm control w/ amiodarone

139

V fib tx

shock + amiodarone

140

HTN Emergency

Labetalol, nitro + metoprolol or loop diuretic

141

Esophageal foreign body tx

Tx: glucagon 1 mg IV → relax esophagus, endoscope to gently push

Disc batteries out ASAP, sharp or long (>5cm) may need removal

142

Viral Gastroenteritis tx

Rehydrate (po or IV), anti-emetics, probiotics, BRATY diet

143

Bacterial Gastroenteritis tx

Rehydration po but IV faster, abx, diaper cream, probiotics, BRATY

144

Epigastric pain boring through stomach to back, N/V, improved if supine, fever, tachy, hypotension, toxic/sig pain

Pancreatitis

145

Pancreatitis tx

Pain control, NPO, aggressive IVF, generally no abx (even if febrile)

146

Bright red blood on vomiting, coffee grounds emesis

Melena (black and tarry)

Upper GI bleed

147

Upper GI bleed tx

Two large bore IVs (18g), aggressive fluid resuscitation, IV PPI, O2, NG tube low
suction, ICU consult

Endoscopy for dx and tx

If coagulopathy→ FFP

148

Bright red blood per rectum, maroon stools, ±abd pain

Lower GI Bleed

149

Lower GI Bleed tx

Two large bore IVs (18g), aggressive fluid resuscitation, O2, early transfusion, FFP if pt has coagulopathy, ICU/GI consult, endoscopy

150

MC cause of pneumonia in alcoholics

klebsiella

151

MC cause of pneumonia in IVDu

S. aureus

152

S. pneumo tx

PCN

153

Anaerobic pneumo tx

clindamycin

154

H. flu pneumo tx

3rd gen cephalosporin

155

Legionella pneumo tx

erythromycin

156

Klebsiella pneumo tx

ceftriaxone, carbapenems, aminoglycosides, quinolines

157

S. aureus pneumo tx

oxacillin

158

atypical pneumo tx

macrolides

159

PJP tx

Steroids if PAO2 <70 mmHg + Bactrim po or IV

160

MC lobe for aspiration pneumo

RLL

161

Virchows triad for PE

endothelial damage, venous stasis and hypercoagulability→ clot formation

162

PE tx

airway mgmt., anticoag, IV fluids for shock, dopamine for pressor, tPA

Anticoag stable→ Lovenox 1 mg/kg SQ, unstable → heparin

163

Acute CP lat to affected side, unilat ↓ or absent breath sounds, hypotension, hyperresonance

pneumothorax

164

Tension pneumo tx

immediate decompression

165

Central retinal artery occlusion tx

Emergency referral for ocular massage, intra-arterial fibrinolytic therapy

166

Acute angle-closure glaucoma

Emergent referral for iridotomy

Acetazolamide 1st line to ↓ IOP, topical Timolol, cholinergic

AVOID anti-cholinergic

167

Pupil mid-dilated, sluggish light reflex, photophobia, HA, nausea, steamy cornea

Acute angle-closure glaucoma

168

Unilateral, painless, visual blurring or vision loss or diplopia

Acute temporal arteritis AKA giant cell arteritis

169

Acute temporal arteritis AKA giant cell arteritis tx

high dose corticosteroids 40-60 mg x 4 wks then taper

Pphx w/ low dose aspirin, PPI, bisphosphonate, Ca and Vit D

170

Conjunctivitis tx

Atopy → topical antihistamines + vasoconstrictors

Bacterial → fluoroquinolone


Gonococcal → systemic late gen cephalosporin

Refer if CL or gonococcal for IV ceftriaxone

171

Pooled blood w/in aqueous humor of anterior chamber

Traumatic Hyphemia

172

Keratitis tx

topical NSAIDs, pphx topical abx- erythromycin ( viral), acyclovir po (HSV, VZV), topical fluoroquinolone (bacterial), irrigation

173

DKA tx

Stabilize w/ A,B, C

FLUIDS FIRST (slow unless in shock → several liters fast)

K+ Replacement

Insulin

Bicarbonate if arterial pH<6.9

174

Hyperglycemic Hyperosmolar Non-Ketotic Syndrome

Fluids, potassium, insulin (Goal is to ↓ by 50-70 mg/dL/hr bc risk cerebral edema*)

175

Hyperthyroidism tx

Beta blockers (atenolol 25-50 mg)

LT antithyroid drugs, radioiodine or surgery (methimazole or PTU)

176

Thyroid storm tx

FLUIDS→ 1L NS/hr

Vasopressor if hypotensive after fluid resuscitation o Phenobarbital for sedation

Fever → cool IV fluids, cool mist, antipyretics

Beta blockers

PTU 600-1000 mg 1st dose → 200-250 mg q4h

Lugol’s iodine 8 drops q6h after PTU

Corticosteroids→ hydrocortisone 100 mg IV q8h

Cholestyramine 4g.q6h

177

What should you AVOID in thyroid storm?

iodine contrast, amiodarone, NSAIDS, ASA and ketamine

178

Hypothyroidism tx

L-thyroxine or levothyroxine

179

Myxedema coma tx

supportive→ airway, fluid, glucose, Na replacement, warming

Rapid thyroid replacement (→ MI or arrhythmia risk)

IV T4 200-500 mcg over 1 hr then 50-100 mcg/d elderly

OR

T3 5-20 mcg/8 h for young or healthy

Broad spectrum abx→ vanc and Zosyn

Hydrocortisone 100 mcg/8hr

180

Shock refractory to fluids and vasopressors

Addisonian Crisis

181

dx TOC for Addisonian Crisis

ACTH Stim Test

182

Addisonian Crisis tx

Hydrocortisone 100 mg IV q8h

If previous dx → dexamethasone 0.1 mg/kg q8h

IV hydration→ 1-3 L NS

183

Pheochromocytoma mgmt

Supportive → IV fluid, O2 correct electrolytes

IV phentolamine 1 mg q5min→ ↑ to 5 mg q5min if no improv

CCB → IV nicardipine or IV Fenoldopam

Benzodiazepines →Lorazepam 1-2 mg IV or diazepam 5-10 mg IV)

Refer for tumor resection

184

Mc cause of mortality in first 12 wks of preg

ectopic preg

185

mc pelvic tumor

fibroids

186

MC GYN ca

uterine

187

Painful vag bleed >20wk

Abrupto placentae

188

Painless vag bleeding >20wk

Placenta previa

189

Abrupto txplacentae

Send to L/D→ emergent C-section

190

Placenta previa tx

Wkly U/S ,bedrest, c-section delivery

NO PELVIC EXAM

Corticosteroids btwn 23-34wk, rho-gam

191

GS for ovarian cyst dx

transvag US

192

PID tx

Ceftriaxone 250 mg IM x 1, doxy 100 mg po BID x 14 d
± metronidazole 500 mg po BID x 14 d

Treat partnets

No sex

193

Gray/white malodorous d/c, clue cells, whiff test

BV

194

BV tx

Metronidazole 500 mg po bid x 7days

195

Candida Vaginitis tx

Non-pregnant: fluconazole 150 mg po once or azole vag cream

Pregnant: vag azole cream (miconazole, fluconazole)

196

Profuse, pruritic, white/yellow/green, frothy, malodorous d/c, strawberry cervix,
motile/flagella

Trichomonas Vaginitis

197

Trichomonas Vaginitis tx

Metronidazole 2 g po x 1 *NO ETOH for 24 h

Treat partners

198

Chlamydia tx

Azithromycin 1 g po x 1 or doxy 100 mg po bid x 7days

199

Gonorrhea tx

Ceftriaxone 250 mg IM x 1 plus azithromycin 1 g PO x 1

200

Progestin only

w/in 72 h

201

Copper IUD

w/in 120 h

202

SE tx

Secure airway → give high flow O2

If blood sugar low → give glucose

If known alcoholic → consider thiamine

Lorazepam 2 mg IV q minute up to 0.2 mg/kg

If lorazepam doesn’t work → phenytoin 20 mg/kg IV at 50 mg/min

If neither work → phenobarbital/general anesthesia

203

Features required for diagnosis: of GB

Progressive weakness in arms and legs

Areflexia

204

GB tx

Admission to hospital (preferable w/ neuro critical care)

IV immunoglobulin or plasmapheresis (cheaper)

Watch close for intubation
Cardiac monitoring

Pain control → gabapentin, opiates

205

Abrupt onset, worst HA of my life or AMS, N/V, nuchal rigidity, photophobia

Subarachnoid Hemorrhage

206

Most impt initial test in dx of stroke

non-contrast CT scan

207

CT w/ ischemic stroke

hypodense area (dark)

208

Ischemic Stroke Algorithm

10 min→ immediate gen assessment and order CT

25 min →neuro assessment and perform CT

45 min→ interpret CT
1 hr→ initiate fibrinolytic therapy if
appropriate (aspirin if not candidate)

209

CT w/ hemorrhagic stroke

hyperintense/bright white (fresh blood) in known vascular distribution

210

SAH tx

Call neuro surg

Large bleed→surg decompression

Avoid ↑ ICP, manage HTN to avoid re-bleed

Nimodipine 60 mg po q6h to ↓ vasospasm

211

Crescent-shaped fluid over surface of brain

Sudden acceleration-deceleration of brain parenchyma w/ subsequent tearing of bridging veins

Subdural hematoma

212

Subdural hematoma tx

Neuro eval→poss blood evacuation

If low GCS → intubate

213

CSF otorrhea or rhinorrhea

Balloon shaped mass over surface of brain

Rupture of middle meningeal artery

Epidural hematoma

214

Sudden onset, severe unilat pain, swelling, N/V, high riding, absent cremasteric

Testicular torsion

215

Priapism tx

Ischemic *mc → intracavernosal sympathomimetic drug (phenylephrine) ± aspiration

Non-ischemic→ usually resolves spontaneously

216

Inability to retract foreskin

Phimosis

217

Phimosis tx

steroid cream or circumcision

218

Entrapment of foreskin behind glans

Paraphimosis

219

Paraphimosis tx

Manual reduction→ consider circumcision

220

Heaviness, unilat dull aching discomfort in scrotum, fevers, chills, ± radiation to ipsilateral flank, enlarged epididymitis

Epididymitis

221

Epididymitis tx

>35 yo→ ciprofloxacin 500 mg bid x10-14 d

<35 yo → ceftriaxone 250 mg IM x 1 then doxy 100 mg bid x 10 d

222

Soft NT, fullness of hemi-scrotum, trans-illuminates

Hydrocele

223

Hydrocele tx

elective surg

224

NT mass, does NOT illuminate, bag of worms

Varicocele

225

TOC for kidney stones

NON-contrast CT

226

kidney stone tx

Hydration (po or IV), analgesics (Toradol IV/IM)

227

Painless hematuria

Bladder ca

228

Flank pain, abd mass, wt loss, hematuria

RCC

229

Dysuria, pruritic, burning, discharge

Urethritis

230

Urethritis Tx

Signs of gonococcal→ Ceftriaxone 250 mg IM + azithromycin 1 g po x 1

W/o signs of gonococcal → Azithromycin 1 g po x 1 then doxy 100 mg BID x 7d

231

Prostatitis tx

Fluoroquinolone or Bactrim x 6 wks + NSAIDs for pain