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1

Bacterial meningitis <1 month

Ampicillin (Listeria) + cefotaxime/gentamicin (E. coli, GBS)

2

Bacterial meningitis (1 month-60 yrs)

Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone

3

Bacterial meningitis > 60 yrs

Ampicillin (Listeria), Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone

4

Prophylaxis, meningococcal/HiB meningitis

Rifampin or Ciprofloxican

5

Fungal meningitis

Amphotericin B intrathecally

6

TB active infection (meningitis, pulmonary)

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

7

Viral meningitis

Supportive, empiric abx until bacterial meningitis excluded, Acyclovir if suspected HSV

8

Reye syndrome

Supportive

9

Viral encephalitis

Supportive, maintain normal ICP, Acyclovir until HSV r/o

10

Brain abscess empiric abx for comorbid oral, sinus, ear infx

Metronidazole + 3rd gen ceph (ceftriaxone)

11

Brain abscess empiric abx for hematologous spread, neurosurgery

Ceftriaxone + vancomycin (MRSA)

12

Brain abscess

Empiric abx, corticosteroids for mass effect (to decrease swelling), usu need neurosurgical drainage

13

Rabies

Clean wound thoroughly, Rabies IG + vaccine

14

Tension HA

NSAIDs, can use triptans, dihydroergotamine

15

Cluster HA

100% O2 (>6 L/min on non-rebreather for >15-20 min)
Can use triptans, dihydroergotamine

16

Migraine HA

Triptans (sumatriptan) or Dihydroergotamine (vasoconstrictors), NSAIDs, anti-emetics (chlorpromazine, prochlorperazine, metoclopramide) in varying combos

17

Pseudotumor cerebri

Acetazolamide (first line, start low and increase)
Discontinue inciting agents (vit A, Accutane, long term tetracyclines for acne, corticosteroid withdrawal), weight loss if obese
Invasive - serial LPs, optic nerve sheath decompression, lumboperitoneal shunting

18

Trigeminal neuralgia

Carbamazepine (first line), Baclofen (alone or combo), Anticonvulsants, Surgical decompression

19

First TIA

ASA + statin if LDL >100

20

TIA/stroke due to AF

Warfarin + statin if LDL >100

21

TIA/stroke + CAD

Clopidogrel + statin if LDL >100

22

Repeat TIA/stroke while on ASA

Clopidogrel or Aggrenox + statin if LDL >100

23

CAD surgical indications

Carotid endarterectomy:
Symptomatic patients w/ narrowing 70-99%
Symptomatic men w/ narrowing 50-69%
Asymptomatic patients w/ narrowing 80-99% if life expectancy >5 yrs

24

CAD nonsurgical treatments

HTN 35, TG <7%
Smoking cessation, exercise, red wine (avoid heavy drinking), ASA/Aggrenox/Clopidogrel

25

Ischemic stroke

Thrombolysis w/i 3-4.5 hrs, 6 hrs if direct catheter to brain and no C/I (hemorrhagic - look at CT/MRI, recent surgery/bleed, current AC, BP >185/100)
Antiplatelet started w/i 48 hrs (ASA/Clopidogrel/Aggrenox, Warfarin)
Statin started w/i 3 days
BP control if >220/120 or if CAD (wait for BP control in ischemic, may decrease perfusion)
PT, treat underlying disorders

26

Hemorrhagic stroke

Reverse AC (restart 2 wks after stable)
Control BP
Control ICP
Surgical decompression w/ shunt if blood collection
Usu need neurosurgery consult
PT, treat underlying disorders

27

Control increased ICP

Mannitol (lasts 4-5 hrs)
Hyperventilation
Anesthesia
Head of bed to 30 degrees

28

Parenchymal hemorrhage

Supportive, control ICP
Seizure prophylaxis w/ anticonvulsants
Surgical decompression if large
AVM or aneurysm repair if needed

29

SAH

Reverse and d/c AC
Systolic BP <150 if cognitive fxn intact (Labetalol, avoid nitroprusside and nitroglycerine - can +ICP)
Nimodipine (CCB) to prevent vasospasm
Good brain environment (avoid hypoxia, hypoglycemia; maintain normal pH, euvolemia, normothermia)
Ventriculostomy to monitor ICP in some patients
Surgical clipping/coiling if aneurysm

30

Epidural hematoma

Control ICP, good brain environment
Drain blood (surgical burr hole, drain w/ radiographic guidance)

31

Subdural hematoma

Supportive monitoring if no neural deficits
Surgical drainage if needed

32

Normal pressure hydrocephalus

Ventricoperitoneal shunt

33

Grand-mal (tonic-clonic) seizures

Valproate, Carbamazepine, Phenytoin, Lamotrigine, Topiramate

34

Partial seizures

Carbamazepine, Lamotrigine, Phenytoin > Valproate, Topiramate

35

Absence seizures

Ethosuximide (Valproate second line)

36

Myoclonic seizures

Valproate

37

Non-medical treatment for recurrent seizures

Surgery (especially partial)
Vagal nerve stimulator (refractory)

38

Status epilepticus

ABC
IV benzos immediately
Phenytoin to prevent recurrence
Phenobarbital for refractory (last resort)
Treat underlying disorder

39

Eclampsia - seizures

IV magnesium sulfate (first line)
Deliver baby
Benzos (last resort)

40

Depression

SSRI/SNRI (first line)
TCA (second line)
MAOI (third line)
ECT (refractory, psychotic, can't wait, catatonic stupor)

41

Atypical depression

MAOI > TCA (SSRI also work)

42

Depression w/ seasonal pattern

Phototherapy (first line)
SSRI/Bupropion (second line)

43

Serotonin syndrome

D/c serotonergic agents
Supportive care
Sedation w/ benzos (or cyproheptadine, serotonin antagonist if refractory)
Sedation, paralysis and ET tube for temp >41.1

44

NMS

Dantrolene

45

Nephrogenic DI caused by lithium toxicity

HCTZ + amiloride (closes Na channels in CT where lithium acts)

46

Bipolar disorder

Mood stabilizer (first line)
Atypical antipsychotic (first/second line)
AD (not first line)
ECT

47

Cyclothymia

Mood stabilizer
Psychotherapy

48

Anxiety disorders (in general)

SSRI/SNRI (first line)
TCA (much less), MAOI (rarely)
Buspirone
Benzos

49

GAD

SSRI/SNRI (Venlafaxine)
Buspirone
Beta blocker
CBT

50

Panic disorder

CBT
SSRI
Benzo (acute)
Relaxation training

51

Specific phobia

Systematic desensitization

52

Social anxiety disorder

CBT
Beta blockers
SSRI (severe)
MAOI (refractory)
Benzo (acute)

53

PTSD

Psychotherapy (behavioral/exposure, CBT)
SSRI (first line med)
TCA/MAOI
Mood stabilizers (carbamazepine/valproate) for impulsive behavior, arousal, flashbacks
Alpha-blockers (prazosin) for nightmares/sleep problems
Atypical antipsychotics (refractory)

54

Benzodiazepine OD

Flumazenil

55

Schizophrenia

Atypical antipsychotics (first line), Typical antipsychotics (second line), Clonazapine (third line)

56

Acute dystonia (typical AP side effect)

Anticholinergic (benztropine or diphenhydramine)

57

Tardive dyskinesia

Stop offending medication and start one with less movement AE

58

Parkinson's

1st line: Levodopa-Carbidopa (Sinemet)
2nd line: DA agonists (bromocriptine, etc.)
Selegiline (MAOI), early disease
COMT inhibitors (potentiate LD)
Anticholinergics (tremor)
Amantadine (increases DA release)

59

ALS

Riluzole

60

Huntington disease

DA antagonists (antipsychotics, tetrabenazine)

61

Alzheimer's disease

Donepezil, Rivastigmine, Galantamine (ACHase inhibitors)
Memantine (MNDA receptor blocker)

62

MS

Corticosteroids (very high dose; acute attacks), IFN-B (maintenance)
Methotrexate, Glatiramer (maintenance), Natalizumab

63

Syringomyelia

Surgical decompression, shunting for recurrence

64

Nephrogenic DI

HCTZ

65

Benign essential tremor

Beta blockers (propranolol)
Self medicated w/ alcohol
Benzodiazepines
Primidone
Thalamotomy/DBS (refractory)

66

Chorea

Treat underlying disorder (hyperthyroidism, Huntington, SLE, rheumatic fever, levodopa use)

67

Athetosis

Treat underlying disorder (cerebral palsy, encephalopathy, Huntington, Wilson)

68

Dystonia

Levodopa/Carbidopa
Botulinum toxin
Treat underlying disorder

69

Hemiballismus

Haloperidol

70

Tics

DA antagonist (fluphenazine, pimozide, tetrabenazine)

71

Guillain-Barre syndrome

Supportive care (monitor for respiratory distress)
Plasmapheresis/IVIG
NO steroids

72

Lambert-Eaton

Treat cancer
ACHase inhibitors (neostigmine, pyridostigmine)
Immunosuppressors (prednisone, azathioprine)
Plasmapheresis

73

Myasthenia Gravis

ACHase inhibitors (neostigmine, pyridostigmine)
Immunosuppressors (prednisone, azathioprine)
Thymectomy
Plasmapheresis, IVIG (refractory)

74

Bell's palsy

Eye care to prevent corneal damage
Glucocorticoids
+/- Valacyclovir

75

Enuresis

Benzos (not in kids) (decrease N3 sleep)

76

Night terrors

Benzos (decrease N3 sleep)

77

Narcolepsy

Modafinil (stimulant) - first line; other ADHD stimulants
Venlafaxine, fluoxetine, atomoxetine - for cataplexy
Avoid drugs that cause sleepiness
Scheduled naps
Support group

78

Insomnia

Melatonin (OTC)
Valerian (OTC)
Antihistamines
Trazodone
TCAs
Benzodiazepines (short term)
Zolpidem/Zaleplon (short term)
Eszopiclone (long term)
Ramelteon (non-addictive)

79

Restless leg syndrome

Avoid caffeine, increase exercise
Pramipexole or ropinirole (DA agonists) or Levodopa, Carbidopa
Iron replacement
Clonazepam, Gabapentin, Opioids

80

Empiric therapy in ER w/ LOC

Glucose (with thiamine first)
Naloxone (opioid OD)

81

Febrile seizures

Acetaminophen/Ibuprofen
Respiratory support if needed
Parental reassurance

82

Childhood hydrocephalus

Acetazolamide or furosemide
Surgical shunting

83

Tay Sach's

Supportive care (death within a few years)
Genetic counseling

84

NTD

Surgical repair unless mild, shunting, PT

85

CP

For spasms: botulinum toxin, dantrolene, baclofen, benzos; PT, bracing, shunting, surgery
Speech therapy, special education, social and psychological support

86

Retinoblastoma

Enucleation (large tumors w/ no vision potential)
Radiation (b/l tumors, tumors near optic nerve)
Cryotherapy or laser photocoagulation (smaller tumors)
Chemotherapy (mets or vision salvage)

87

Myopia

Corrective lenses, laser correction

88

Hyperopia

Corrective lenses, laser correction

89

Astigmatism

Corrective lenses

90

Strabismus

Vision training, surgery frequently required

91

Amblyopia

Vision training, levodopa/carbidopa

92

Conjunctivitis

Self-limited
Topical sulfonamides or erythromycin reduce duration of bacterial
Antihistamines improve allergy symptoms
handwashing

93

Uveitis

Topical antibiotics if caused by infection
Systemic corticosteroids if not (treat underlying condition)

94

Chalazion

Usu self-limiting
Can treat w/ surgical excision and/or steroid injection

95

Hordeolum (stye)

Hot compress 3-4x/day for 10-15 min
I&D if unresolved in 48 hrs
+/- antibiotic ointment q3 hrs

96

Anterior blepharitis

Wash lid margins daily w/ shampoo
Remove scales daily w/ cotton ball
Antibiotic ointment qd to lid margins

97

Cataracts

Lens replacement surgery

98

Open angle glaucoma

Topical BB (timolol) and carbonic anhydrase inhibitors (acetazolamide)
Prostaglandin analogues
Alpha-adrenergic agonists and cholinergic agonists (pilocarpine)

99

Acute open or closed angle glaucoma

Pilocarpine (cholinergic agonist) = DOC

100

Closed angle glaucoma

Eye drops (BB, adrenergic agonists, cholinergic agonists, prostaglandin analogues)
Acetazolamide (oral)
Mannitol (IV) (refractory)
Laser peripheral iridotomy

101

Macular degeneration

Vitamin C, E, B-carotene, copper, zinc
Intravitreal ranibizumab (VEGF inhibitor) (exudative)
Laser photocoagulation
Treatment effectiveness limited

102

Retinal detachment

Laser photocoagulation or cryotherapy (halt progression)
Surgical reattachment of retina

103

Retinal artery occlusion

Thrombolysis w/i 8 hours of onset
Acetazolamide and O2 to decrease congestion and increase perfusion

104

Retinal vein occlusion

Laser photocoagulation

105

Corneal abrasion

Thorough eye exam w/ foreign body removal by irrigation
Topical antibiotics (erythromycin, sulfacetamide, cipro, oflaxacin)
OTC lubricant
Pressure patching optional 3 mm, diminished vision

106

Preeclampsia
1) HTN emergency
2) Uncomplicated HTN

1) IV Labetalol or Hydralazine (nifedipine second line) followed by Magnesium Sulfate when HTN controlled
2) Labetalol, Nifedipine, Methyldopa (less efficacious), Furosemide (second line)

107

Active TB

Rifampin, Isoniazide (INH), Pyrazinamide, Ethambutol

108

Optic neuritis

Think MS (esp in young female)
High dose steroids (500-1000 mg/day) for several days

109

Acute otitis media

May just observe (mild disease)
Amoxicillin x 10 days
Amoxicillin-clavulanic acid or stronger cephalosporin (cefdinir) for resistant strians
Tympanic tubes for recurrence

110

Otitis externa ("swimmer's ear")

Topical polymyxin, neomycin, fluoroquinolone (cipro), hydrocortisone
Oral cephalosporin or cipro for Pseudomonas or infx that spreads to skull
Topical drying agents after water to prevent recurrence

111

BPPV

Epley maneuver

112

Meniere disease

Anticholinergics, antiemetics, antihistamines
Salt restriction and thiazide diuretics
Surgical decompression (refractory)

113

Acoustic neuroma

Surgical excision

114

Bullous myringitis

Mycoplasma pneumoniae is common organism
Oral macrolide (erythromycin, clarithromycin, azithromycin)

115

Acute vestibular neuritis / labyrinthitis

Usu subsides spontaneously w/i weeks
Corticosteroid taper
Treat symptoms for first 48 hrs only (scopolamine patch, meclizine, metoclopramide, promethazine)
Vestibular rehabilitation exercises

116

Cholesteatoma

Surgical removal

117

Ramsay Hunt syndrome (herpes zoster oticus)

Valacyclovir, famciclovir or acyclovir

118

Personality disorders

Mostly psychotheraphy
Cluster A - sometimes low-dose antipsychotics (paranoid, schizoid, schizotypal)
Borderline - low-dose antipsychotics, SSRIs, mood stabilizers

119

Delirium tremens (DTs)

Benzodiazepines (long acting)
Lorazepam, Diazepam, Chlordiazepoxide

120

Alcoholism treatment

AA
Naltrexone, disulfiram
Topiramate, acamprosate

121

Wernicke-Korsakoff

IV thiamine

122

Cocaine OD

Benzodiazepine, antipsychotic
Phentolamine for HTN (alpha antagonist)

123

Amphetamine OD

Benzodiazepine, antipsychotic
Phentolamine for HTN (alpha antagonist)

124

Hallucinogen OD

Isolation, benzos, antipsychotics

125

Marijuana abuse

Counseling

126

Nicotine abuse

Patch, gum, lozenge
Varenicline
Bupropion

127

Opioid OD

Naloxone, Naltrexone
Methadone therapy

128

PCP OD

Isolation, benzos, antipsychotics

129

OCD

CBT + SSRI

130

Anorexia

Psychotherapy
May need inpatient treatment
SSRIs don't help unless associated depression
Anxiolytic before meals

131

Bulimia

SSRI + psychotherapy

132

ADHD

Psychostimulants (methylphenidate, dextroamphetamine)
Atomoxetine
Refractory: Bupropion, alpha agonists (Clonidine), TCAs

133

Tourette's

Psychotherapy
*DA antagonists low-dose for tics (fluphenazine, pimozide, tetrabenazine)
SSRI for comorbid behavior disorders
Botox for focal motor or vocal tics
Clonidine/SSRI for impulse control

134

DM Type I

Insulin

135

DM Type II

Oral hypoglycemic agents, possibly insulin

136

DKA/HHNS

Admit to ICU
IVF (isotonic)
IV insulin (switch to SC when anion gap closes in DKA; when blood sugar lowers may give IV glucose)
IV KCl (in DKA acidosis drives K out of cells, insulin drives K into cells)
Electrolyte correction
Treat underlying disorder

137

Diabetic retinopathy

Control diabetes
HTN therapy
Annual ophthalmology visit
Laser photocoagulation (neovascularization)
Intervitreal corticosteroid injection to reduce macular edema

138

Diabetic nephropathy

Control diabetes
ACE/ARB (esp if microalbuminuria)
Dialysis may eventually be needed

139

Diabetic neuropathy (sensory)

Control diabetes
Gabapentin, Pregabalin, Duloxetine
(TCAs, phenytoin, carbamazepine
Narcotics or Tramadol for persistent pain)

140

Diabetic neuropathy (gastroparesis)

Dx w/ gastric emptying study
Short term metoclopromide or erythromycin

141

Diabetic atherosclerosis

Control diabetes
Control HTN and hyperlipidemia
Statin
ASA
Smoking cessation

142

Graves disease

Definitive: radioablation w/ radioactive iodine (MC) or
subtotal thyroidectomy (surgery)
Methimazole / PTU to stop thyroid hormone production
BB for symptomatic relief

143

Toxic adenoma / Toxic MNG

Radioablation
Surgical resection
Methimazole / PTU (less often in MNG)

144

Subacute thyroiditis

Self-limited
NSAIDs/BB for symptoms
May need thyroid replacement if hypothyroid during gland recovery

145

Silent thyroiditis

During pregnancy
Self-limited
NSAIDs/BB for symptoms

146

Thyroid storm

ICU monitoring
Methimazole / PTU (higher doses / more frequent)
Beta blockers
IV sodium iodine (helps block thyroid hormone release)
Hydrocortisone (inhibits conversion of T4 to T3)

147

Thyroid cancer (malignant)

Surgical resection + radioiodine ablation
Radiation (local extension)
Chemotherapy (metastases)
Thyroid replacement after surgery

148

Hypothyroidism

Levothyroxine

149

Cretinism

Levothyroxine ASAP (from birth)

150

Primary hyperparathyroidism

Surgical resection (single adenoma)
Surgical resection and replacement of one gland into forearm (four-gland hyperplasia)
IVF and bisphosphonates (hypercalcemia)

151

Hypercalcemia

IVF (first line)
Loop diuretics (furosemide) (2nd line)
Bisphosphonates

152

Hyperparathyroidism due to CRD

Hypophosphatemia
Dietary phosphate restriction
Oral phosphate binders (Ca carbonate and acetate)
Renal osteodystrophy
Calcitriol, other vitamin D analog, cinacalcet (Ca mimetic) to suppress PTH

153

Hypoparathyroidism

Ca and vitamin D supplementation

154

Pseudohypoparathyroidism

Ca and vitamin D supplementation

155

Hyperprolactinemia

DA agonists (cabergoline>bromocriptine, pergolide)
Transsphenoidal surgery, radiation therapy if refractive

156

Acromegaly

Surgical resection of adenoma
Cabergoline or Octreotide to lessen effects
Radiation therapy if refractory

157

Hypopituitarism - GH deficiency

Recombinant GH

158

Hypopituitarism - LH/FSH deficiency

Testosterone (men)
Estrogen-progesterone (women)
Luprolide (GNRH agonist) for people desiring fertility

159

Hypopituitarism - TSH deficiency

Levothyroxine

160

Hypopituitarism - Prolactin deficiency

No need to treat

161

Hypopituitarism - ACTH deficiency

Hydrocortisone, Dexamethasone, Prednisone

162

Cushing syndrome

Adjust steroid dosage
Surgical resection/irradiation (pituitary tumor)
Surgical resection (adrenal tumor)
Chemo/radiation + octreotide (SCLC)
Cortisol replacement after surgery

163

SCLC

Chemo and radiation (non-resectable)

164

Hyperaldosteronism (Conn syndrome)

Surgical resection of otumor
Treat underlying disorder
Aldosterone antagonists (spironolactone) to improve hypokalemia until definitive therapy

165

Adrenal insufficiency

Treat underlying disease
Glucocorticoid and mineralocorticoid replacement
DHEA in women (maybe)
Hydration

166

Addison / adrenal crisis

IV glucose
Hydrocortisone
Vasopressors

167

Pheochromocytoma

Alpha blockers FIRST then BB
Surgical resection

168

Addison's disease

Replace glucocorticoids and mineralocorticoids