treatments Flashcards
(104 cards)
1
Q
treatment for male vs female androgenic alopecia
vs alopecia areata
A
MALE: topical minoxidil +
oral finasteride
FEMALE: topical minoxidil + oral spironolactone (xmas tree pattern on head)
ALOPECIA AREATA: intralesional corticosteroid injections (patchy hairloss)
2
Q
treatment for keloids vs hypertrophic scars
A
intralesional corticosteroids
i.e. triamcinolone
3
Q
topical treatment for atopic dermatitis or psoriasis
A
topical tacroimus (an immunosuppressant)
4
Q
treatment of diabetes in pregnancy
A
gestational diabetes =
BS is 95+ fasting, 140+ 1hr postprandial, 120+ 2 hr postprandial
fail lifestyle
1. insulin
2. metformin or sulfonylurea
5
Q
54 yo plumber comes in for tremor and wrist drop, only supplement takes is daily miralax for chronic constipation. PE shows teeth with black lines on the edge.
dx and treatment?
A
lead poisoning
chelate with dimercaprol or succimer
6
Q
farmer comes to rural clinic in for really bad N/V/D and palpitations.
PE= patches of tan skin and hyperkeratosis, decreased sensation fingers and toes
EKG shows QRS 525,
dx and treatment
A
arsenic poisoning
chelate with dimercaprol or succimer
7
Q
34 yo WM comes in for N+D after returning from his food tour of japanese islands. pt also notes trouble sleeping and racing thoughts
PE shows red and inflamed lips and gums, which are painful.
dx and trx
A
mercury poisoning
trx w succimer and dimercaprol
8
Q
pt comes from a rave w tachy, convulsions and respiratory depression. lots of other people from the same rave come in w similar sx
dx and trx
A
cyanide poisoning
trx = amyl nitrate first and then thiosulfate
OR hydroxycobalamin
9
Q
middle aged WM w history of recently diagnosed anxiety and depression comes in with hematemesis .
PR shows jaundice and keyser flescher rings.
dx and trx
A
copper poisoning
trx= d-penicillamine
10
Q
keratosis pilaris
A
= benign keratosis of if individual hair follicles, +/- surrounding erythema
1st line = emollients
- keratolytics, like salicylic acid
11
Q
psoriasis 1st line
A
1st line = high dose corticosteroids
i.e. betamethisone, clobetasol
12
Q
acne vulgaris
A
topical retinoids
i.e. tretinoin, tazarotene
13
Q
hydradenitis suppurativa
stage 1, 2, 3
A
= chronic follicular occluding ds
trx= abx (tetracyclines)
stage 1: assess with no sinus tract or scarring
- topical clindamycin
stage 2: abscess with sinus tract and scarring
- oral tetracycline
stage 3: diffuse abscesses with a bunch of sinus tracts that all connect
- oral tetracycline
refractory= combine clinda+rifampin
14
Q
von willibrand ds
minor bleeds vs major bleeds
A
= dec/defective vWF (binds platelets to sub endothelial structures, carries Factor 8 to the scene)
minor bleeding
- 1st desmopressin
- 2nd line, transexamic acid, vWF concentrate
major bleeding:
- factor 8
15
Q
acetaminophen toxicity
A
N-acetyl cysteine
16
Q
anticholinergics toxicity
A
physostigmine, neostigmine
17
Q
benzo toxicity
A
flumazenil
18
Q
beta blocker toxicity
A
- atropine
- glucagon w IV fluids
19
Q
calcium channel blocker toxicity
A
calcium chloride
or
glucagon
20
Q
dopamine toxicity
A
phentolamine
21
Q
heparin toxicity
A
protamine
22
Q
isoniazid toxicity
A
pyridoxine (vitamin b6)
23
Q
organophosphate toxicity
A
pralidoxime, atropine
24
Q
salicylate toxicity
A
sodium bicarb
25
TCA toxicity
sodium bicarb
26
warfarin toxicity
vitamin K, fresh frozen plasma, prothrombin complex concentrate
27
magnesium toxicity
calcium glutinate
28
treatment of chronic myelogenous leukemia
what is MOA
imatinib, dasatinib
= tyrosine-kinase inhibitors = target gene rearrangement
29
diverticulitis
IV ceftriaxone / IV metronidazole
30
bacterial vaginosis
common AE of this treatment
metronidazole
= disulfiram-like reaction
31
basal cell carcinoma
Mohs surgery = take out the afflicted cells and a minimal margin around
32
89 yo female w hx of CABG 10 yo s/p MI and smokes 2ppd, presents with sudden onset SOB, dizziness, and confusion.
BP=71/45
HR= 31
RR=36
Osat= 85%
she is oriented to person only. breathing is shallow only.
EKG shows p waves that don't match up with the QRS wave
shock in the setting of 3rd degree AV block
trx= transcutaneous pacing always
(even tho she is breathing!)
transcutaneous pacing is easy and quick, don't need IV access, and will reverse the cause of shock
-- afterwards might help to have IV atropine/dopamine/dobutamine
-- eventually will need a pacemaker
33
pulmonary arterial hypertension
group 1
prostoglandins = epoprostenol
"-prost"
34
acute pericarditis secondary to viral illness
NSAIDs i.e. ibuprofen
35
menopause
replacement with
-estrogen + progesterone
-venlafaxine
-or clonidine
36
patient is 36 weeks pregnant comes in for GBS testing and is found to be positive. what is the treatment?
intra-partum IV abx (during L&D)
- typically ampicillin/penicillin
- if allergic, cefzolin or erythromycin
37
prinzemetal (variable) angina
vs.
stable angina
vs.
unstable angina
prinzemetal = CCB aka diltiazem, amlodipine, nifedipine
stable =
-ASA
-nitroglycerin
-ACE/ARB
-beta blocker
-statin
- lifestyle changes
unstable =
- all above for stable
- cardiac catheterization required
38
first line for HTN in a patient with osteoporosis
thiazide diuretic = furosemide
39
first line for HTN in a patient with migraines
beta blocker or CCB
40
first line for HTN in a patient with benign prostatic hyperplasia
alpha blocker i.e. prazosin, doxazosin
41
56 year old male presents for 2 years of blistering and scarring of his hands. he works in construction, notes blistering and scarring is worse in the summer and better in the winter. patient has had 6 beers/day for 30 years.
PE reveals blisters and scarring on the back of his neck and ears which he did not know about.
vitals wnl.
dx?
porphyria cutanea tarda
= blisters and scarring in sun exposed areas associated with liver ds (alcohol use, cirrhosis, hep C, etc)
42
56 yo male presents for several years of worsening blistering on his face and back of the neck. notes severe pruritus. patient is retired but enjoys gardening when the weather is nice. PMH sign for HTN and DMT2, denies substance use history.
PE shows blisters on his face and back of the beck, no erythema or scarring.
dx?
polymorphic light eruption
= papules and plaques in sun exposed areas, common in spring and summer
NO scarring, super itchy blisters
43
single agent coverage of anaerobic / enteric organisms
what about abx combos
i.e. e. coli, klebsiella, enterobacter (internal infections)
single = bactrim = piperacillin-tazobactam
multiple= metronidazole + ceftriaxone
44
treatment of community acquired pneumonia in
<1 month old
1 mo-3 mo old
3 mo-5 yo
5-18 yo
comfortable but has respiratory sx (productive cough)
<1 = inpatient hospitalization
(GBS/E coli)
1mo-3mo = inpatient hospitalization
(c. trachomatis, strep pneu)
3mo-5yo = amoxicillin/ amoxicillin-clavulanate, a macrolide if allergic
( strep pneumo, staph aureus, strep pyogenes)
5yo-18yo = macrolide = azithromycin
( mycoplasma, chlamydia pneumo, strep pneumo)
45
pt comes in with worsening migraines, that are no longer contained with triptan + naproxen
next step of management (name 4 possible meds)
-life style modifications
- preventative medications
- oral propranolol
- oral valproate (depakote)
- oral verapamil
- oral venlafaxine
46
treatment of QRS widening
sodium bicarbonate
47
cocaine intoxication and cocaine induced cardiac injury
IV benzos for the behavior and HTN = IV lorazepam, etc
if they BP is still high +/or they continue to complain of sx (i..e CP) give an IV alpha blocker
= IV phentolamine/nitroprusside/nitroglycerin
--- also treat w ASA, nitroglycerine.. bc of potential ischemia
48
acute pancreatitis
fluids
insulin
inpatient treatment
not always NPO, feed based on severity --> the earlier they can eat the better prognosis
49
chronic treatment to prevent recurrence of high-triglyceride induced pancreatitis (2 meds)
statin + fenofibrate
- fenofibrate = good at lowering triglycerides
both meds have potential side effect of myopathy so be careful
50
treatment of high total cholesterol with high LDL levels
= statin + ezetimibe
ezetimibe= decreased absorption of dietary and biliary cholesterol
51
ectopic pregnancy with rupture
emergent laparoscopy
- surgery in any ectopic pregnancy with the beta hcg>5000, any fetal cardiac activity noted, or if the patient is hemodynamically unstable
- if small ectopic pregnancy and stable, can use methotrexate and follow with serial beta hcgs
CANNOT use MTX if -immunocomp, - multiple or viable pregnancy, - abn renal labs or CBC
52
patient comes in for treatment of an NSTEMI, get a stent placed
what medications do they NEED to be on upon discharge (5)
1. ASA
2. clopidogrel (a P2Y12 inhibitor for x plt clotting
3. statin
4. ACE-I (lisinopril)
5. beta blocker (metoprolol)
treatment of ACS requires ASA + clopidogrel = the DUAL ANTI-PLATELET THERAPY
53
hyperkalemia
calcium gluconate
54
candida esophagitis
oral flucanazole
(oral nystatin has a high failure rate)
55
acute diverticulitis
give trx for
- inpatient single agent
- inpatient combo trx
-outpatient single agent
-outpatient combo trx
inpatient single agent =
- etanercept or piperacillin-tazobactam
inpatient combo=
- metronidazole + cefazolin/ceftriazone/ -floxacin
outpatient single=
- amoxicillin-clavulanate
outpatient combo =
- metronidazole + TMP-SMX/ -floxacin
56
patient presents to ED and suddenly loses consciousness and pulses are absent. EKG shows vtach
trx?
defibrillation for pulseless V tach
if the patient had a pulse and had V tach, would do cardio version
57
viral or idiopathic pericarditis
colchicine + NSAID (ibuprofen)
58
methanol poisoning
fomepizole
59
pt with severe cirrhosis comes in very sick and spontaneously started vomiting up blood
what three prophylactic treatments would you start
1. for possible PUD = pantoprazole
2. for possible SBP = ceftriaxone
3. for the bleeding = octreotide
60
animal bite of the hand that does not look infected
prophylactic amoxicillin-clavulanate bc the hand has so many small compartments
bite in another body area that does not look infected can get supportive care
61
pertussis aka "whooping cough"
macrolide = azithromycin
/erythromycin/clarithromycin
62
lice/nats
topical pyrethrin or permethrin
63
a-fib that is stable but has tachy
rate control = diliazem or verapamil (non-dihydropyrodine CCB)
64
a-fib that is stable but has tachy
rate control = diliazem or verapamil (non-dihydropyridine CCB)
65
treatment of a flutter
stable patient = catheter ablation
unstable patient = synchronized cardioversion
66
hyperosmolar hyperglycemia
presents with high serum osmolality, hypotension, and hypercglycemia (AMS and dehydration )
isotonic saline
67
myxedema coma
IV fluids if hemodynamically unstable
IV levothyroxine
IV hydrocortisone until adrenal insufficiency has been rule out
68
SIADH
fluid restriction first
demeclocycline = antagonist ADH in the collecting ducts
refractory SIADH = tolvaptan is a vasopressin antagonist
69
exercise induced bronchospasm
cromolyn sodium
blocks mast cell degranulation
70
acute lead poisoning
presents with neurotoxicity (poor prognosis with cerebral edema), microcytic anemia, vomiting
oral chelation with a succimer
OR parenteral chelation with dimercaprol or EDTA
71
hypertensive emergency
>180/120 + end organ damage
IV hypertensives continuos drip + ICU
72
uncomplicated UTI empiric
TMP-SMX or cephalexin (1st/2nd gen cephalosporin)
73
perianal abscess
drainage
empiric abx = amoxicillin-clavulanate OR metronidazole OR ciprofloxacin
74
hypertensive emergency
aka BP > 180/>120 with end organ damage
IV antihypertensives
1st choice = IV nicardipine
no longer hydralazine bc of unpredictability and rebound tachy
75
Vtach with faint pulses
synchronized cardioversion
- wide complex tachy is unstable tachy
if no pulse = not shockable
-adenosine, BB or CCB
76
treatment of pseudogout
what does aspirate look like
birefringent positive or negative
NSAIDS or colchicine
= rhomboid shaped crystals, birefringent positive
77
gout
immediate and preventative
immediate = NSAIDS , colchicine , steroids
preventative = allopurinol (urate lowering)
78
staph scalded skin syndrome
aka pemphigus neonatum, presents 3-7 days old with diffuse rash and flaccid blisters due to exotoxin A and B breaking up the desmogleins
the staph aureus strain that causes this is penicillin resistant SO..
oxacillin
nafcillin
vancomycin
79
the flu aka influenza
oseltamivir
80
methanol poisoning
fomepizole or ethanol
81
guillan barre trx
IVIG or plasma exchange
82
osteoporosis
(4 options)
FIRST LINE- bisphosphonates like alendronate
-teriparatide
-SERM (selective estrogen receptor modulators)
-intranasal calcitonin
dx w DEXA, but also fragility fractures are diagnostic enough to start medication treatment and not need a DEXA scan
83
pre-eclampsia
most serious possible AE to this trx is?
magnesium sulfate
hypermagnesemia can cause neuromuscular changes leading to RESPIRATORY DEPRESSION
84
empiric treatment for a spinal epidural abscess
MC cause is s. aureus (MRSA and MSSA)
- IV vanc and IV cefepime
85
lyme ds
in pregnant/lactating ppl?
doxycycline
preg/lactating = amoxicillin > doxy
86
uncomplicated short bowel obstruction
perforated SBO
conservative trx which could include NPO, nasogastric tube, IV fluids
perforated = emergency surgical consult
87
BP control for pheochromocytoma while waiting for surgery
alpha blockade = phenoxybenzamine or doxazosin
+ beta blocker if needed for HR = propranolol
88
hydatidiform mole
= trophoblastic ds presenting with abnormally high hcg and uterine sac LGA and snowstorm pattern on US
trx = D&C to "evacuate" the uterus
if suspicion for malignancy can get one dose of MTX
89
trx for gonnorrhea and chlamydia
G = ceftriaxone
C = doxycycline
90
pseudomonas coverage
cefepime, floroquinolone
91
neurotrophic fever
= fever 101.5+ and WBC < 1500
= cefepime = pseudomonas coverage
92
reverse warfarin
vitamin K = takes time
prothrombin complex concentrate = in an emergency i.e. before emergent surgery
93
pt w hx of cirrhosis comes in w severe hematemesis and melena. pt becomes obtunded, hypotensive, hgb 5
treatment (6)
for varices bleeding
IV blood transfusion
IV fluid rescucitation
IV proton pump inhibitor
IV octreiotide
IV ceftriaxone
consult GI for EGD
94
TCA overdose
sodium bicarbonate
= cardiac, convulsions, coma
95
which cranial technique is used for babies that have trouble latching on for breastfeeding
condylar decompression
96
acute bacterial rhinosinusitis
-- mild
--what is the feared complication and how do you treat?
---amoxicillin +/- clavulanate
if allergic to penicillin, then do azithromycin
-- spread of infection --> orbital cellulitis
- get a CT
- eval by optho
- trx IV with MRSA and G- coverage = IV ceftriaxone + IV vancomycin + IV metronidazole
97
PCOS for ovulation induction
clomiphene citrate or letrozole
98
patient with pain with urination, inc frequency, and suprapubic fullness
cystitis (NOT UTI, which also has systemic signs)
= nitrofurantoin is first line empiric
other first line options = fosfomycin and TMP/SMX
99
outpatient trx in acute DVT, no comorbid complications
3 months of a Xa inhibitor
=rivaroxaban, etc
100
what is the equation for the hourly fluid maintenance amount for kids
4-2-1 rule : 4 mL/kg for the first 10, 2 ml/kg for the next 10, and 1 mg/mL for the next 20 kilograms
101
tularemia
streptomycin/gentamicin
doxycycline
ciprofloxacin
102
necrotizing fasciitis
meropenem OR piperacillin-tazobactam = G- and anaerobes
vancomycin = MRSA
clindamycin = anti-toxin effect
103
which 4 meds improve mortality in heart failure
beta blockers
ace-i
arbs
spironolactone
104
myxedema coma
IV levothyroxine
IV hydrocortison
bc they present with bradycardia, hypotension, and hypothermia
