Treatments 5 Flashcards
(131 cards)
1
Q
Iron deficiency anemia
A
Iron supplementation (several months) Find cause
2
Q
Lead poisoining
A
EDTA or succimer for chelation
Add dimercaprol in children if severe
3
Q
Folate/B12 deficiency anemia
A
Folate / B12 supplementation
4
Q
Anemia of chronic disease
A
Treat underlying condition
Maybe supplemental EPO (ESRD, HIV, some cancers)
5
Q
Aplastic anemia
A
Stop offending agent
BM transplant may be needed
6
Q
Sideroblastic anemia
A
Vitamin B6 (hereditary) Supplemental epo (acquired) Phlebotomy/chelation w/ deferoxamine
7
Q
Thalassemia
A
If needed
Folate supplementation
Transfusions + iron chelation
8
Q
Sickle cell disease
A
Hydration, supplemental O2, analgesics during crises
Hydroxyurea (increases Hgb F production)
Chronic transfusions
Folate supplementation
Vaccinations and prophylactic penicillin until age 5 to help prevent pneumococcal infx
9
Q
Sickle cell disease recommended vaccinations
A
Pneumococcal (+prophylactic penicillin til age 5) Hib Meningococcal Hep B Annual flu
10
Q
Type I hypersensitivity rxn
A
Antihistamines, LT inhibitors, bronchodilators, steroids
Epi pen
11
Q
Type II hypersensitivity rxn
A
Anti-inflammatories
Immunosuppressive agents
Plasmapheresis
12
Q
Type III hypersensitivity rxn
A
Anti-inflammatories
13
Q
Type IV hypersensitivity rxn
A
Steroids
Immunosuppressive agents
14
Q
Anaphylaxis
A
ABCs
Epinephrine
Antihistamines, bronchodilators, steroids
IVF, vasopressors if needed for hypotension
15
Q
Antiphospholipid syndrome
A
Anticoagulate w/ heparin and/or warfarin
16
Q
HELLP syndrome
A
Deliver if fetus >34 weeks
17
Q
von Willebrand disease
A
Desmopressin (first line)
vWF / factor VIII concentrate, cryoprecipitate
OCPs for menorrhagia
Avoid ASA, other anti-platelet medications
18
Q
Hemophilia
A
Factor VIII (A) or IX (B) replacement Desmopressin, transfusions
19
Q
DIC
A
Treat underlying disorder
Replace platelets, FFP, cryprecipitate as needed
Heparin for chronic thrombi
20
Q
Sepsis
A
ABCs
Hydration, vasopressors (NE), inotropes, perfusions as needed
Glucocorticoids if needed
Blood/urine/sputum cx then start broad antibiotics then narrow when cx return
Maintain glycemic control (glucose 140-180)
21
Q
Malaria
A
Antimalarials (chloroquine, primaquine, quinine; atovaquone-proguanil, mefloquine in chloroquine-resistant)
22
Q
Herpes zoster / Herpes simplex
A
Acyclovir, valacylovir, famcyclovir
Foscarnet for resistant strains
23
Q
Kaposi sarcoma
A
Topical -tretinoins
Chemo, radiation, laser therapy
24
Q
Isospora diarrhea
A
TMP-SMX
25
Strongyloides diarrhea
Ivermectin
26
Cryptosporidium diarrhea
Self-limited (immuno-competent)
| Nitazoxonide (immunocompromised)
27
Coccidiomycosis
Fluconazole or amphotericin B
28
Candida esophagitis
Oral fluconazole / -azoles
| Nystatin swish and swallow
29
PCP
TMP-SMX, corticosteroids
| Pentamadine if sulfa allergy
30
Histoplasmosis
Amphotericin B or itraconazole
31
Cerebral toxoplasmosis
Pyrimethamine +/- clindamycin
| Sulfadiazine + Leukovorin
32
Progressive multifocal leukoencephalopathy
None (HAART)
33
Cryptococcal meningitis
Amphotericin B + Flucytosine then transition to
| Oral fluconazole
34
Cytomegalovirus
Ganciclovir or valganciclovir
| Foscarnet
35
Mycobacterium avium complex (MAC)
Macrolides (first line, eg clarithromycin, azithromycin)
36
HIV
HAART
| Start w/ 2 NRTIs and 1 protease inhibitor, NNRTI or integrase inhibitor
37
HIV prophylactic antibiotics
Start at CD4 <200
PCP/Toxoplasmosis: TMP-SMX
MAC: macrolides (clarithromycin or azithromycin)
38
Polycythemia vera
Serial phlebotomy
Hydroxyurea (BM suppression)
ASA (thrombus prophylaxis)
IFN-a for refractory pruritis or erythrocytosis
Allopurinol for symptomatic hyperuricemia
39
Multiple myeloma
Radiation, chemo, BM transplant
40
Hodgkin lymphoma
Radiation, chemo
41
Non-Hodgkin lymphoma
Palliative radiation, chemo
42
Philadelphia chromosome positive leukemias
```
Mostly CML (5% ALL, rare AML)
Imatinib
```
43
Colles fx
Long arm cast
44
Smith fx
Casting
45
Scaphoid fx
Thumb spica cast
46
Boxer fx
Closed reduction/surgical pinning
47
Monteggia fx
Surgery
48
Galeazzi fx
Surgery
49
Hip fx
Surgery
50
Femur fx
Surgery
51
Ankle fx
Cast, surgery if unstable
52
Compartment syndrome
Emergency fasciotomy (all compartments)
53
Osteoporosis
Bisphosphonates
SERM (raloxifene)
Pulsatile teriparatide (moderate-severe)
54
Osteopetrosis
Transfuse marrow components
| Activity restriction
55
Osteogenesis imperfecta
Bisphosphonates
56
Gout, acute
NSAIDs
Steroids
Colchicine (third line)
57
Gout, chronic
Allopurinol
Probenecid
Colchicine
58
Pseudogout
NSAIDs
| Colchicine
59
Septic arthritis
Surgical I&D (not required for gonorrhea if mild)
| Vanco (S. aureus) or IV CTX + doxy (N. gonorrhea)
60
Osteomyelitis
IV abx for 4-6 wks
61
Lyme disease
Doxycycline x14-21 days (early)
IV Ceftriaxone x21-28 days (late)
Amoxicilin or cefuroxime for pregnant patient
62
Rocky Mountain Spotted Fever
Doxycycline x7 days
| Chloramphenicol for pregnant patient
63
Osteoarthritis
Activity modification
Heat, NSAIDs, weight loss, PT
Steroid or hyaluronic acid injections
Joint replacement in advanced cases
64
Bone metastases
Chemo, radiation
Bisphosphonates
Fracture fixation
65
Osteosarcoma
Surgical excision + chemo
66
Ewing sarcoma
Surgical excision + radiation + chemo (Dactinomycin)
67
Osteochondroma
Only necessary if soft tissue irritation, neurovascular compromise or continued growth (surgical excision)
68
Polymyositis and dermatomyositis
High dose steroids + MTX or azathioprine 4-6 wks
| Or IVIG, other immunosuppresants
69
Polymyalgia rheumatica
Low dose steroids
70
Fibromyalgia
Reassurance, walking, stretching, relaxing, stress reduction, journaling, sleep hygiene
Address any psychiatric disorders
TCAs, Tylenol/Tramadol, Pregabalin, Duloxetine, Fluoxetine, Milnacipran
71
Ankylosing spondylitis
PT, NSAIDs, exercise
| Sulfasalazine, MTX, anti-TNF
72
Psoriatic arthritis
NSAIDs, MTX, sulfasalazine, anti-TNF
73
Scleroderma
ACEi (renal HTN)
CCB and avoid caffeine, nicotine, decongestants
MTX, steroids
74
Mixed connective tissue disease
NSAIDs, steroids, ACEi
75
Sjogren syndrome
Supportive care, steroids
76
Developmental hip dysplasia
Pavlik harness 2 years old
| May not be able to correct after 8 years old
77
Rickets
400 IU vitamin D for all neonates (esp breast fed, dark skinned, live in North) starting in first few days of life
78
JIA (JRA)
NSAIDs = doc
| 2nd line = MTX or steroids
79
Osgood-Schlatter
Stretching, NSAIDs
Can continue sports if minimal pain
Usu resolves w/i 6-18 months
80
Clavicle fracture (pediatrics)
No treatment in neonates
| Sling or figure of 8 for older children
81
Physeal fractures
Reduction for type I, II, III
Type III may need fixation
Type IV needs perfect reduction, still guarded prognosis
Type V can't do much, probable growth arrest
82
Nursemaid's elbow
Closed manual reduction (supination + flexion or hyperpronation)
83
Club foot
Serial casting
| Surgery in long-standing cases
84
Scoliosis
Observation (small)
Bracing (moderate)
Surgery (severe, older patients)
85
Duchenne muscular dystrophy
PT, steroids, pulm and cardiac support (ACE)
| Usu die by 20 years old
86
Cellulitis
Oral cephalosporins or penicillinase-resistant B-lactams 10-14 days
IV abx, vanco/linezolid for MRSA
87
Skin abscess
I&D +/- antibiotics
88
Community acquired MRSA
SMP-TMX + rifampin
| Clindamycin + rifampin
89
Necrotizing fasciitis
Prompt, emergent surgical debridement, I&D
| IV antibiotics
90
Dry gangrene
Allow autoamputation (or amputate)
91
Wet gangrene
Debridement
Possible amputation
Antibiotics if infection
92
Gas gangrene
Emergency surgical exploration and debridement w/ possible amputation
93
Hidradenitis suppurativa
Surgical drainage
| Antibiotics (tetracycline, macrolide)
94
Impetigo
```
Topical antibiotics for uncomplicated (mupirocin)
Oral antibiotcs (erythromycin, cephalexin)
```
95
Acne vulgaris
Topical retinoids (first line)
OTC benzoyl peroxide (second line)
Oral/topical antibiotics (second line) (tetracyclines)
OCP, Spironolactone for excess androgens
Isotretinoin last line of defense (big gun, multiple AEs)
96
HSV
Incurable
| Acyclovir family may shorten duration of recurrences (episodic) or suppress (continuous)
97
VZV - chicken pox
Usu no antivirals
Antipruritics/antihistamines
Acyclovir for IC, >12, taking steroids, taking oral salicylates
98
VZV - shingles
```
Acyclovir, valacyclovir, etc w/i 72 hrs
Pain control (opioids)
```
99
Postherpetic neuralgia
Gabapentin, Pregabalin
| TCAs, lidocaine patch, capsaicin cream
100
Rosacea
Topical metronidazole or sulfacetamide
| Tetracyclines, isotretinoin (severe refractory)
101
Warts (skin)
Sometimes self-limited (3 months, 25%)
| Chemical, laser, cryotherapy removal
102
Molluscum contagiosum
Often self-limited (1 year)
| Chemical, laser, scrape, cryotherapy removal
103
Scabies
Permethrin cream (8-10 hrs)
Oral ivermectin
Diphenhydramine for pruritis
Wash clothing, towels, linens in hot water
104
Tinea versicolor (pityriasis versicolor)
Topical antifungal (terbinafine, clotrimazole)
Selenium sulfide shampoo
Ketaconazole shampoo
Oral ketaconazole, etc
105
Tinea corporis, cruris, pedis
Topical/oral antifungal
106
Tinea capitis
Oral griseofulvin, terbinafine or itraconazole
107
Tinea unguium/onychomycosis
Oral terbinafine or itraconazole (6/8-12 weeks)
108
Pediculosis capitis or pubis
```
Permethrin cream or pyrethrin
Malathion lotion
Ivermectin
Wet combing for capitis in <2 years old
Wash bedding and clothing
```
109
Type I or Type IV skin hypersensitivity reactions
Remove offending agent / contact
Topical steroids + antihistamines
Oral steroids for worse cases
110
Erythema multiforme
Stop offending agent
Maybe self-limited
Steroids, antipruritics, analgesics
111
Stevens-Johnson syndrome
Stop offending agent
| Steroids, analgesics, IVF, often treated on burn unit
112
Toxic epidermal necrosis
Stop offending agent
Treat in burn unit
IVF, steroids, IVIG
113
Seborrheic dermatitis
Shampoo w/ selenium (infants), tar, ketoconazole
| Topical steroids, antifungals
114
Seborrheic keratitis
None necessary
| Can remove w/ cryo, electrocautery, shave excision
115
Atopic dermatitis
Moisterizing creams and soaps
Topical steroids, tacrolimus (more severe)
Oral steroids, antihistamines (very severe)
116
Psoriasis
Topical (NOT oral) steroids
| Can try calcipotriene, tazaroene, tar, retinoids, tacrolimus, antifungal agents, DMARDS/phototherapy if severe
117
Pityriasis rosea
Self-limited (4-6 weeks)
| Topical steroids, phototherapy can decrease length
118
Erythema nodosum
Self-limited
| NSAIDs, potassium iodide, steroids
119
Lichen planus
Medium to high potency steroids (topical or intralesional or oral if topical unsuccessful)
Acitretin (oral retinoid)
120
Decubitus ulcers
Nutrition, relieve pressure
| Protective dressing, wound care (avoid wet-to-dry), debridement if needed
121
Stasis dermatitis
High pressure compression stockings
Elevation of legs above heart
Topical steroids, horse chestnut seed extract, aspirin 300-325 mg/day
122
Pemphigus vulgaris
Oral high dose steroids + azathioprine or cyclophosphamide
| Fatal if untreated, 5% mortality w/ treatment
123
Bullous pemphigoid
Topical steroids
| Oral steroids or azathioprine
124
Porphyria cutanea tarda
Periodic phlebotomy
Low-dose chloroquine or hydroxychloroquine
Sunscreen, avoid triggers
125
Melasma
Hydroquinone, azelaic acid
126
Vitiligo
Sunscreen, dyes, makeup
| Steroids, tacrolimus or pimecrolimus
127
Acanthosis nigricans
Treat underlying disorder
Lightening agents (tretinoin, topical steroids)
Fish oil
128
Strawberry hemangioma
None
129
Alopecia areata
Fluocinolone oil/shampoo
Intralesional steroid injection
Topical minoxidil, anthralin (children), SADBE/DPCP (children)
130
Telogen effluvium
Self-limited
131
Androgenic alopecia
Minoxidil 5% (men and women)
Finasteride (ONLY men)
Spironolactone (women, maybe)
