Table Of Contents
Screening
| AAA screening | -Males 65-75 y/o who have ever smoked -Abdominal ultrasound |
| Breast Cancer screening | -50-74 y/o -Mammogram q2yr |
| Cervical Cancer screening | -21-65 y/o -21-29: Cytology q3yr -30-65: Cytology + HPV co-testing q5yr |
| Chlamydia/gonorrhea testing | Females <24 y/o |
| Colon Cancer screening | -50-85 y/o -If FH in 1st degree relative before 60 y/o, 10 years before age of diagnosis or 40 y/o (whichever comes first) -FOBT q year -FIT q year -FIT DNA q 1-3 years -Sigmoidoscopy q 5 years with FIT q year -Colonoscopy q 10 years |
| Hep C screening | all adults from 18-79 y/o |
| HIV screening | 15-65 y/o |
| Lung cancer screening | -50-80 y/o -20 pack year history -Current smoker or quit within 15 years -Low-dose CT q1yr |
| Osteoporosis screening | -Females >65 y/o -DEXA scan |
| Pregnancy screening | 1st trimester screening tests: -CBC -Urinalysis -STD -HIV -Hepatitis B -Pap smear -Blood typing -Rubella 2nd trimester screening tests: -Gestational diabetes -CBC -Rhogam shot 3rd trimester screening tests: -GBS (vaginal/rectal swab) Note: If positive, give penicillin 4 hours before delivery |
Vaccines
| Vaccine | Given |
|---|---|
| Flu Vaccine | 6 months |
| HPV Vaccine | 9-26 y/o |
| Tdap | Tetanus vaccine administered during pregnancy: 27-36 weeks |
| Zoster Vaccine | >60 y/o |
Preventative
| Breast Feeding | CI: -HIV -Chemotherapy |
| Emergency Contraception | Most Effective: Copper IUD Side Effect MC: Menorrhagia |
| SVT | Tx: -Adenosine (stable) -Cardioversion (unstable) |
| Ventricular Tachycardia | Tx: -Amiodarone (stable) -Cardioversion (unstable) |
Diseases and Disorders
| Actinic Keratosis | Tx: -Cryosurgery -Topical 5-FU -Topical Imiquimod |
| Acute bacterial diarrhea | Avoid Loperamide |
| Asthma | Tx: -Supplemental oxygen -PO/IV steroids -Bronchodilators |
| Atopic Dermatitis | Tx: -Topical steroids, UV light |
| Bariatric Surgery | Treat stromal stenosis (dumping syndrome): -Small meals with high protein |
| Basal Cell Carcinoma | Dx: full thickness excisional bx Tx: Excision w/3-5mm margin or Mohs |
| Bite | Dog/Cat bite: -Pasturella multicoda Human bite: HACEK Tx: Amoxicillin-Clavulanate Note: HIV and Hepatitis B prophylaxis for human bite |
| Blood Transfusion | Indication: Hb <7 |
| Boerhaave syndrome | Dx: -Gastrograph and swallow (shows dye extravasating out of esophagus) |
| Breast Cancer | Risk Factor: 1. Age |
| Cellulitis | Bug: Staph aureus (purulent), GAS (non-purulent) Dx: clinical, may culture, MRI to r/o bone involvement Tx: oral cephalexin, dicloxacillin, or clindamycin – may consider IV if real bad |
| Cholesterol | Decrease Triglycerides: Fibrates Best to increase HDL: Niacin |
| Chronic Heart Failure | Decrease Mortality: -B-blocker (carvedilol, metoprolol succinate, bisoprolol) -ACE-i -Spironolactone -Sacubitril/valsartan (Entresto) -SGLT-2 Inhibitors |
| Chronic Kidney Disease | #1 cause of death: CVD |
| Chronic venous insufficiency | Px: -Medial malleolus ulcer |
| COPD classifications | Mild: FEV1 >80% = SABA Moderate: 50-80% = LABA Severe: 30-50% = ICS Very severe: <30% = Supplemental Oxygen (Indications: PaO2 <55, SaO2 <88%) Tx: -Supplemental oxygen -PO/IV steroids -Bronchodilators Note: Only COPD gets antibiotics |
| Coronary Artery Disease | TIMI score: determine if UA and STEMI need Cath |
| Dermatitis herpetiformis | Tx: Dapsone |
| Diverticulitis | Px: -LLQ pain -Constipation -Fever -Leukocytosis Dx: Abdominal CT Tx: -Metronidazole (flagyl) -Fluoroquinolones (Cipro) |
| Erythema Multiforme | Bugs: HSV, hepatitis, mycoplasma, Yersinia Tx: abx & NSAIDs |
| Fibromyalgia | Tx: Amitriptyline |
| Folliculitis | Bug: staph, strep, gram neg Dx: clinical Tx: topical abx mupirocin (I&D if develops into carbuncle/furuncle) |
| GERD | Px: -Dysphagia -Microcytic anemia -Weight loss |
| Gout | Acute Gout: -NSAID (indomethacin, colchicine) -Intra-articular steroid (if renal disease) Gout ppx: -Allopurinol (if urine uric acid is high) -Probenecid (if urine uric acid is low) |
| Huntington Disease | Tx: Tetrabenazine |
| Hypercalcemia | Elevated calcium > 10 Normal calcium level (8-10) 1st line: IV fluids |
| Hyperkalemia | Tx: -Calcium gluconate -Insulin |
| Hyperglycemia | hypertonic hyponatremia |
| Hyperparathyroidism | -Methimazole -Propylthiouracil |
| Hypertension | Tx: 1st line: -ACE-i (MOA in kidney: Vasodilation of efferent arteriole) -CCB -Thiazides |
| Hyponatremia | Normal serum osmolarity: 275-295 Eq serum osmolarity: 2Na+ + Glucose/18 + BUN/3 Hypertonic hyponatremia: Hyperglycemia Isotonic hyponatremia: Elevated protein and fat Hypotonic hyponatremia, hypervolemic: -CHF -Cirrhosis -CKD Hypotonic hyponatremia, euvolemic: -Primary polydipsia -SIADH Tx: Fluid restriction Hypotonic hyponatremia, hypovolemic: -Vomiting -Diuretics Tx: -Normal saline -Severe and symptomatic: Hypertonic saline 3% |
| Impetigo | Bug: nonbullous (GAS or staph) or bullous (staph) Dx: clinical Tx: -mild: topical mupirocin or retapamulin -severe: oral cephalexin or dicloxacillin -MRSA: bactrim, clindamycin or doxycycline |
| Joint | septic: >50k WBC inflammatory: <50k WBC |
| Mastitis | Tx: -Dicloxacillin |
| Meinere’s disease | Px: -Tinnitus -Hearing loss -Vertigo |
| Meningitis | MC causes: -S. pneumoniae -H. influenzae -Neisseria meningitis Tx: -Ceftriaxone -Vancomycin |
| Myocardial Infarction | Decrease Mortality: -B-blocker -ACE-i -Aspirin Indications for LHC: -STEMI -New left BBB with symptoms of MI |
| Nausea | Pregnancy: Dietary changes- small frequent meals, don’t get hungry, don’t get too full, avoid high sugar and high fat, ginger and mint may help Medication: vitamin B6 (pyridoxine) |
| Nodule | Hyperthyroid nodule: benign Next step: Radioactive iodine uptake study Euthyroid nodule: malignant Next step: FNA (Note: If >1 cm) |
| Osteopenia | DEXA: -1 to -2.5 |
| Osteoporosis | DEXA: <-2.5 Risk Factor: 1. Age |
| Otitis Externa | MC cause: Pseudomonas Tx: -Alcohol-acetic acid ear drops -Addition of corticosteroids to dilution May be beneficial -Other agents: neomycin, polymyxin B, ciprofloxacin |
| Pancreatitis | MC cause: -Gallstones -Alcohol |
| Pancreatic Cancer | Courvoisier’s sign: -Painless jaundice -Palpable gallbladder |
| Peritonsillar abscess | Px: Uvular deviation |
| Pilonidal cyst | Bug: folliculitis w/repetitive trauma = staph, strep, Gram Negs Dx: clinical Tx: I&D – sterile packing of wound w/good hygiene and shaving of skin to prevent Note: aka sacrococcygeal abscess |
| Polyp | Most dangerous: Villous |
| Pregnancy Term | Term: 37-42 weeks Post Term: >42 weeks |
| Pneumonia | Typical PNA MC: -S. pneumoniae -H. influenzae -M. catarrhalis Atypical PNA MC: -Mycoplasma -Chlamydia -Legionella Legionella pneumonia: -Diarrhea -Hyponatremia Aspiration PNA: -Piperacillin-Tazobactam -Clindamycin Adm for PNA: >2 on CURB-65 |
| Polyneuropathy | Tx: Duloxetine, pregabalin, gabapentin, amitriptyline, nortriptyline |
| Rhabdomyolysis | Blood on urine dipstick without RBC on microscopic analysis |
| Rheumatoid Arthritis | #1 cause of death: CVD |
| Ring Enhancing Lesions | -Primary CNS lymphoma -Toxoplasmosis -Brain abscess |
| Sinusitis | -S. pneumoniae -H. influenzae -M. catarrhalis |
| Squamous Cell Carcinoma | Dx: punch or excisional bx Tx: surgical excision or mohs |
| Stroke | Risk Factor: 1. Hypertension |
| Tinea | Bug: trichophyton, microsporum, and epidermophyton species Dx: tinea corporis, capitis, unguium, pedis or cruruis = KOH prep shows hyphae, may do woodlamp to confirm microsporum over trichophyton Tx: Corporis – topical miconazole/ketoconazole Capitis – PO griseofulvin Unguium – PO terbinafine, griseofulvin, -azole Pedis – Topical antifungal Cruris – Topical antifungal |
| Tinea versicolor | Bug: malassezia furfur Dx: –KOH prep shows spaghetti & meatballs Tx: -topical ketoconazole and selenium sulfide, or oral azole |
| Ulcerative Colitis | Assoc: -CRC -Toxic megacolon -Primary sclerosing cholangitis |
| Umbilical Hernia | Tx: -Reassurance -Surgery (Mesh) |
Pediatrics
| 2 months | Lift head to prone position |
| 4 months | Roll over |
| 6 months | Sit up Can use Toothpaste First flu shot |
| 9 months | Crawl/cruise |
| 12 months | Start going to dentist MMR – First live vaccine |
| 4 years old | Audiometry and vision testing begin |
| 5 years old | -Tie shoes -Write name |
| 6 years old | -Dress self -Identify left and right |
| Normal Fetal Heart Rate | 110-160 |
| Fetal tachycardia | Maternal infection |
| Fetal heart rate to be sinusoidal | Fetal anemia |
| Fetus has complete heart block, mother is likely to have | Lupus |
| Fetal acceleration | 15-15-2-20 Heart rate increases by 15 bpm and lasts >15 seconds twice within 20 minutes on non-stress test |
Medication
| Medication | Notes |
|---|---|
| Intranasal steroids | Side Effect: Epistaxis |
| Metformin | CI: -Renal disease -CHF Note: Can cause lactic acidosis |
| OCPs | Decrease Risk of: -Endometrial cancer -Ovarian cancer Increase Risk of: Breast Cancer Contraindications: -Migraine w/ aura -Smokers >35 y/o |
| SSRIs | Length of time to work: 4-6 weeks Continue for: 9 months |
| Thianomides | Side Effect: Agranulocytosis |
| Alcoholism | Tx: 1st line: -Acamprosate -Naltrexone |
| Cocaine | Overdose: Avoid B-blocker (Note: Can cause unopposed a-adrenergic vasoconstriction) |
| Smoking | Tx Cessation: 1st line -NRT -Bupropion -Varenicline |
