USMLE Quick Treatments

USMLE Quick Treatments for USMLE Step 2 and 3.

High Yield resources can be used for the COMLEX Level 2 and 3 as well.

Acne

Anthrax

• Treatment:
  • cipro or doxycycline
     

Aortic Dissection

• Treatment:
  • B blockers and nitroprusside

Aortic Injury

• Due to Trauma:
  • If hemodynamically stable, get CT angio
    
  • if unstable: TEE and emergent surgery

Bacteriuria

• Asymptomatic bacteriuria in pregnancy:
  • Amoxicillin
    
  • if PCN allergy, use nitrofurantoin

Brain Abscess

• Treatment:
  • ceftriaxone, metronidazole (+/- vanc) for 6 weeks

Brain Cancer

• Brain Biopsy Empiric Treatment:
  • penicillin
    
  • metronidazole
    
  • ceftriaxone

Bronchitis

• Bronchitis (productive cough, fever, neg CXR):
  • first line is azithromycin.
  • Alt = Doxy or moxiflox

Cellulitis

• In the clinic and not super sick:
  • Cephalexin, Clindamycin, or Bactrim
    
• If septic or inpatient:
  • Vancomycin, linezolid

Clostridium perfringens 

• Gas gangrene, crepitus, air in soft tissue on Xray:
  • Clindamycin and penicillin
    
  • and rapid surgical debridement, especially if signs of NEC fasciitis

Conjunctivitis

• Bacterial Conjunctivitis:
  • Erythromycin ointment, bactrim drops, or azithro drops
    
  • IF WEAR CONTACTS: FQ

COPD exacerbation

• Treatment:
  • B agonist and ipratropium inhalers/nebs
    
  • Glucocorticoids
    
  • Antibiotics if infection present
    
  • NPPV if ventilatory failure

Cystitis

• bactrim, nitrofurantoin, or fosfomycin
  
• may be given amoxicillin as the best choice
  
• uncomplicated = 3 days
  
• complicated = 7 days

Dermatitis herpetiformis

• Treatment:
  • dapsone and gluten-free diet

Diabetic Keto-Acidosis

• Treatment:
  • – IV normal saline. Dextrose once glucose < 200
    
  • – IV insulin. SQ once below 200/able to eat (overlap by 1-2 hours)
    
  • – IV potassium if K <5.2
    
• NOTE: if K < 3.3 HOLD INSULIN and give K
  
  • – give bicarb IF pH < 6.9
    
  • – phosphate if P < 1 or card/resp problems

Endocarditis

• Native valve:
  • vancomycin
    
• Prosthetic valve:
  • Vanc + Gent
    
  • – if w/in 60 days:
    • add cefepime
      
  • – if over 1 year:
    • add ceftriaxone

Epilepsy

• Status Epilepticus:
  • benzo first
    
  • then phenytoin/fosphenytoin if not working
    
  • then can try phenobarbitol
    
  • last line is an anesthetic (succinylcholine)

EPS

• Acute dystonia due to EPS SE:
  • Benztropine
    
  • OR diphenhydramine
• EPS SE from antipsychotic drugs:
  • Can give benztropine (anti-chol) for any of them, OR:
    
  • – Acute dystonia: diphenhydramine
    
  • – Akasthesia: B blocker or Benzo
    
  • – Parkinsonism: amantadine
    
  • – TD: valbenazine, deutrabenazine

Gonorrhea and chlamydia

• Gonorrhea:
  • ceftriaxone IM 1 time
    
• Chlamydia:
  • 7 days Doxy or 1 IM of Azithro

Headache

• Cluster Headache

  • Acute Treatment:
    • is 100% O2 and steroids (and lithium)
      
  • ppx:
    • verapamil

• Migraine

  • Acute Migraine:
    • Treatment:
      • triptans or ergots
        
    • Prophylaxis:
      • B blockers if get them >3 times a month
        can also use CCB, TCA, etc..)

• Pseudotumor Cerebri

  • Treatment:
    • serial LPs
      
    • weight loss
      
    • acetazolamide

H ducreyi

• azithromycin or cipro
   

Herpetic Zoster

• Postherpetic Neuralgia:
  • TCAs, gabapentin, carbamazepine, or phenytoin
    topical capsaicin

Histoplasmosis

• if mild:
  • supportive
    
• if chronic cavitary lesions:
  • itraconazole for >1 year
    
• Severe acute pulmonary disease:
  • amphotericin B for 14days and itraconazole for 1 year

HIV

• Prophylaxis in HIV based on CD4 count (3 big ones):
  • CD4 < 200 = ppx for PCP w/ bactrim
    
  • CD4 < 100 = ppx for toxo w/ double bactrim
    
  • CD4 < 50 = ppx for MAC w/ azithromycin
    

  • if cant use Bactrim, use dapsone
    
  • if G6PD deficiency = use atovaquone
• Post-exposure prophylaxis following HIV exposure:
  • Tenofovir and Emtricitabine

HTN

• HTN w/ Cocaine-induced Chest Pain:
  • verapamil/diltiazem

Huntington’s Disease

• Treatment:
  • no cure
    
  • treat dyskinesia w/ tetrabenazine
    
  • treat psychosis w/ haloperidol/quetiapine

Kawasaki Disease

LGV

• Painless chancre with PAINFUL lymphadenopathy (suppurative):
  
  • Tx is for chlamydia = Doxycycline

Lichen Sclerosis

• Treatment:
  • topical steroids

Lyme

• Lyme disease:
  • doxycycline
    
• if causes meningitis:
  • Ceftriaxone

MAC

• Disseminated MAC:
  • clarithromycin and ethambutol (SE is optic neuritis)

Malaria

• Treatment:
  • chloroquine, as well as primaquine for resistance
    
• Severe disease:
  • IV quinidine
    
• ppx:
  • Atovaquone-proguanil and mefloquine

Meningitis

• Bacterial meningitis:
  • Vancomycin and Ceftriaxone
    
  • if young or old, give ampicillin to cover for listeria
• Cryptococcal meningitis:
  • will be in an AIDS pt w/ CD4<200
    
  • IV Amphotericin and FLucytosine
• Lyme meningitis:
  • Ceftriaxone

Myasthenia Gravis

• acute MS:
  • steroids
    
• help prevent relapse:
  
  • – glatiramer
    
  • – B IFN
    
  • – fingolimod
    
  • – Azathioprine
    
  • – Cyclophosphamide

Myocardial Infarction

Neutropenic Fever

• Fever >101 (or 100.4 for 24hrs) and absolute neutrophil count <500:
  
  • – prophylaxis with cefepime or Zosyn
    
• If no resolution in 72hrs:
  • give antifungals

Osteomyelitis

• Treatment:
  • clindamycin plus one of the following:
    
    • – Cipro
      
    • – ampicillin
      
    • – nafcillin
      

• If MRSA:
  • vancomycin
    
• IF diabetic:
  • tx for gram neg organisms with ceftriaxone/cipro

Otitis Externa

• Treatment:
  • cipro

Otitis Media

• 1st line:
  • amoxicillin
    
• if allergic, not anaphylactic:
  • ceph
    
• Anaphylactic:
  • azithromycin

Overdose

• TCA overdose:

  • manage ABCs and then give Sodium bicarb

Parkinson

Pericarditis

• Initial Test:
  • Xray is best initial test
    
  • confirmation or best test overall is CT

Pertussis

• Treatment:
  • azithromycin
    
  • also give azithromycin to close contacts

Pharyngitis

• First line:
  • amoxicillin-clavulanate

Pheochromocytoma

• Treatment:
  • alpha-blockers first, then B blockers

Pneumonia

• CAP (Community-acquired pneumonia):
  • Azithromycin and Ceftriaxone (FQ is alt)
    
• HAP (Hospital-acquired pneumonia):
  • Vanc and Zosyn
    
• Aspiration pneumonia or abscess is just like CAP:
  • Ceftriaxone and a macrolide
    
• ATYPICAL/WALKING pneumonia is treated like bronchitis:
  • First line: azithromycin only
  • Alt: Doxyclycine or moxifloxacin 

Prostatitis

• Chronic Bacterial Prostatitis:
  • 6 weeks of fluoroquinolones
    male with recurrent UTIs and pain w/ ejaculation

PVCs

• B blocker or inc in B blocker dosage but only if frequent and symptomatic (palpitations)
   

Pyelonephritis

• Treatment:
  • IV ceftriaxone 10 days
    
• if ambulatory Pyelo:
  • PO Cipro

Restless Leg Syndrome

• Treatment:
  • pramipexole

Rocky Mountain Spotted Fever

• Treatment:
  • doxycycline or chloramphenicol if preg

Seizures

Sickle Cell Disease

• If under 5yo, give kids:
  • prophylactic penicillin BID due to splenic auto-infarction

Sinusitis

• First line:
  • amoxicillin-clavulanate (for all URIs)
    
  • DONT use azithromycin

Surgery

• If going to have mouth or throat surgery AND
  – congenital heart defect w/ residual problem
  – bad valve in a transplanted heart
  – or prosthetic valve:
  • THEN give AMOXICILLIN
  • IF asymptomatic valve problem, dont ppx
• If GI/GU surgery:
  • Ampicillin
• If skin surgery or placement of prosthetic valve surgery:
  • Give vanc

Syphilis

• Primary (painless chancre and lymphadenopathy):
  • IM penicillin once
    
• Secondary:
  • IM penicillin once
    
• Tertiary:
  • IM penicillin 1-2 weeks
    
• If latent (positive RPR but no symptoms) get IM penicillin once a week for 3 weeks

Tic Disorders

• Treatment:
  • fluphenazine (antipsychotic 1st gen) (dopamine antagonist)

Tocolytics

• 1st line:
  • Indomethacin:
    • <32weeks (SE include gastritis, plt dysfunction, oligohydramnios, and PDA closure)
      
  • Nifedipine (CCB):
    • FIRST LINE BETWEEN 32-34 weeks (SE of tachycardia, palpitations, nausea, flushing, HA)

Toxoplasmosis

• Treatment:
  • pyrimethamine and sulfadiazine for 6wks
• Ppx:
  • double-strength Bactrim