Leik’s Exam Tips + My Extra Good Stuff Medication 1) Aspirin irreversibly suppresses platelet function for up to 7 days (due to irreversible
... [Show More] acetylation). 2) Discontinue ASA if patient complains of tinnitus (possible aspirin toxicity). 3) For chronic use, the recommended dose is 81 mg/day (some exceptions exist). 4) Aspirin given post-MI or after a stroke/TIA is considered tertiary prevention. 5) Avoid using in children with viral infections who are less than 16 years of age (Reye’s syndrome). 1) Memorize the FDA category and dose of finasteride (Proscar 5 mg PO once a day). Finasteride is also a teratogen. Cat X medication 2) Accutane is a potent teratogen. Reproductive-aged females must use 2 reliable forms of birth control and must have a negative pregnancy test 1 month before, during, and 1 month after Accutane. 3) High-dose vitamin A is teratogenic in animal studies—avoid “mega-doses” of vitamins in pregnancy. 4) Avoid mixing warfarin with sulfa drugs—can increase INR and bleeding risk. HEENT ■Treatment for otitis externa is Cortisporin Otic drops. ■ Otitis externa’s common bacterial pathogen is Pseudomonas. ■ Ruptured spleen is a catastrophic event. Avoid contact sports (i.e., 4 weeks) until ultrasound documents resolution. ■ Betimol (timolol) which is an eye drop used for glaucoma, has the same contraindications as oral beta blockers. ■ Cholesteatoma, periorbital sinusitis complication which can cause hearing loss in the affected ear and is a “cauliflower like growth” accompanied by foul smelling discharge. Patient will have history of chronic otitis media. TM not visible due to tumor. Refer to ENT. ■ Do not use amoxicillin if used in the past 3 months. Advance to second-line antibiotics such as Augmentin which is a beta lactam or Ceftin. ■ Penicillin-allergic patients, use macrolides, sulfas (avoid cephalosporins, especially if had Class I reaction or anaphylaxis from penicillins). ■ Learn to recognize a description of eye findings such as pinguecula, pterygium, chalazion.Pinguecula: yellow, triangular thickening of the bulbar conjunctiva (skin covering eyeball). Caused by UV light damage to collagen. Pterygium: yellow, triangular (wedge-shaped) thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea. UV damage, chronic sun exposure – benign – can be red and inflamed at times. Chalazion: chronic inflammation of the Meibomian gland of the eyelids (classic case: complains of gradual onset of a small superficial nodule that is discrete and moveable on the upper eyelid that feel like a bead, painless, can slowly enlarge over time.) ■ Rinne test result of BC greater than AC with conductive hearing loss (i.e., cerumenosis, AOM). NORMAL IS AC>BC which means the patient hears longer in front of the ear rather than over the mastoid. ■ Weber test result is lateralization to the “bad” or affected ear with conductive hearing loss. NORMAL IS NO LATERALIZATION. ■ Weber or Rinne are testing the acoustic or CN 8. ■ Lateralization on the Weber exam is an abnormal finding. ■ Normal finding in Rinne test is air conduction that lasts longer than bone conduction (AC greater than BC). ■ Remember what 20/40 vision means: patient can see at 20 feet what a person with normal vision can see at 40 feet. ■ Carbamide peroxide (similar to hydrogen peroxide) is one of the most common OTC treatments for cerumenosis. Xerostomia: Dry mouth Xerophthalmia: Dry eyes Papilledema: swollen optic disc due to IOP often due to bleeding or brain tumor. HTN retinopathy: copper and silver wire arterioles DM retinopathy: Cotton wool spots Koplik’s spots: red papules w blue-white centers inside cheeks by lower molars seen in measles. Dermatology Differentiate between contact dermatitis and atopic dermatitis. The best clue is the unilateral location and the shape of the lesions in contact dermatitis. Contact dermatitis: reaction due to contact with irritating external substance; can be single lesion or generalized rash within several minute or hours after contact. Classic Case: acute onset of one to multiple bright red and pruritic lesions that evolve into bullous or vesicular lesions;easily ruptures, leaving bright red moist areas that are painful. When rash dries, it becomes crusted; very pruritic and get lichenfied from chronic itching. Asymmetric distribution, or localized area like around the finger where a ring would be. Atopic dermatitis (eczema): chronic, inherited disorder extremely pruritic rashes on hands, flexural folds which are AC and popliteal spaces, and neck. Exacerbated by stress and cold. Infants up to 2 years will often have on cheeks, trunk, knees and elbows. ■ Rashes that are very pruritic at night and located on the interdigital webs and/or penis are scabies until proven otherwise. Treat entire family. Wash linens/clothes in hot water. ■ Preferred antibiotic is Augmentin for human, dog, and cat bites. ■ Do not confuse actinic keratosis (precursor to squamous cell cancer) with seborrheic keratoses (benign). Actinic Keratosis: Older to elderly – numerous dry, round and red lesions with rough texture that do not heal. Slow growing, most common in sun exposed areas such as cheeks, neck, face, arms and back. Light colored skin highest risk. Precursor to squamous cell cancer. Seborrheic Keratosis: soft, round, wart like fleshy growths in the truck, mostly on the back. Lesions can vary in color from light tan to black. Asymptomatic and benign. ■ Diagnose hidradenitis suppurativa, psoriasis, RMSF, meningococcemia, erythema migrans (Lyme disease), contact dermatitis, rosacea. Hidradenitis suppurativa: usually staph aureus. patient complains of acute onset painful, large, dark red nodules and papules under one or both axillae that become abscessed. Ruptured lesions drain purulent green colored discharge. Pain resolves with draining and healing of abscess. C&S of discharge. Treat with Augmentin or dicloxacillin, mupirocin ointment to nares and fingernails, antibacterial soap and avoid deodorants during acute phase. Psoriasis: Auspitz sign or Koebner phenomenon: New psoriatic plaques form over areas of skin trauma. RMSF: petechiae starting on both hands and feet, rapidly progressing to trunk until it becomes generalized. Appears on third day after abrupt onset of fever (103-105 degrees) with severe headache, myalgia, conjunctival injection, n/v, and arthralgia. Can be fatal. Mortality rate 3-9%. Usually during spring and early summer. DO NOT DELAY TREATMENT OR WAIT FOR LAB RESULTS. Treat with Doxycycline. Meningococcemia: Sudden onset sore throat, cough, fever, headache, stiff neck, photophobia, changes in LOC. Appearance could be toxic, can have petechial hemorrhage to axillae, flanks, wrists, and ankles. High risk is college students residing in dorms. Spread by aerosol droplets. DO NOT DELAY TREATMENT IF HIGH INDEX OF SUSPICION REFER TO ED STAT. Treat with Rocephin plus Vanc. Treat any close contacts with Rifampin x 2 days. Erythema migrans (Lyme Dz): Classic bulls eye lesion appearing 7-14 days after tick bite accompanied by flu like symptoms. Treat w doxycycline [Show Less]