Lice and Scabies

Typical scabies rash Typical scabies rash Lice (Head, Body, and Genital)
  • Dx – must see the lice. Seeing nits alone does NOT diagnose, and is not an excuse for the kid to be out of school.
  • Rx – Permethrin 1% Shampoo. Leave on 10 min, then rinse. Repeat in 1 week to kill off any hatched eggs. Wash all clothes, bedsheets, towels
  • Acne

    Cotopaxi, Ecuador Some Tid-Bits
  • Four factors lead to acne formation: increased sebum production, hyperkeratinization, propionibacterium acnes colonization, and inflammatory reaction.
  • Treatment Steps (from mild to severe)
    1. Comedones – Rx Topical Retinoids (Tretinoin, Adapalene, Tazarotene) – generally works about the same. For the following additional symptoms:
    2. Inflammation – Add Topical Non-Abx (Benzoyl Peroxide, Azelaic Acid) +/- Topical Abx (Clindamycin,

    Insomnia

    woman with yellow hair Woman with yellow hair, 1931, Picasso Some Facts:
  • Insomnia (ICSD-3 Definition) – Difficulty falling asleep, difficulty staying asleep, early awakening, daytime impairment (i.e. fatigue, poor concentration, moody, increased errors, social dysfunction, worry). Occurs at least 3x per week x1 month. Chronic if >3 months.
  • Comorbid Conditions – OSA/breathing disorders, circadian rhythm disorders, GI issues, pruritus, heart failure, pain, restless legs
  • Erectile Dysfunction

    Viagra Viagra H&P
  • Check for psych factors, medications that may cause ED, and possible medical contributions to ED (DM2, obesity, CAD). Do physical exam to check for hypogonadism, peyronie’s disease, or other possible causes of ED.
  • Labs
  • Total testosterone level (deficient if <300), TSH, lipid panel, A1C. Remember, ED can be a sentinel marker for CAD.
  • First-Line Treatment
  • Phosphodiesterase-5 Inhibitors
  • Scoliosis

    Cobb Angle Scoliometer – have patient bend over and place on patient’s back to measure angle of incline. There are also scoliometer apps you can download on your smart phone.  Background
  • Definition: >10° lateral curve to spine with vertebral rotation
  • Types: classified as congenital, neuromuscular, or idiopathic. Idiopathic scoliosis is further classified by age: Infantile (0-2 yo), Juvenile (3-9 yo), Adolescent (>10
  • Osteoporosis

    ostoeporosis Screening
  • USPSTF recommends all women 65 years and older get screened for osteoporosis with a DEXA scan to measure bone density.
  • You can also screen for osteoporosis in women younger than 65 who score high on the FRAX WHO Fracture Risk Assessment Tool.
  • USPSTF does not recommend routine screening in men unless they are older than 50 and have a history
  • Non-Insulin Meds for DM2

    Galega Officinalis, from which Metformin was derived First Line – Start with this.
  • Biguanide (Metformin)
  • MOA: inhibits gluconeogenesis
  • Weight loss, decreased mortality, decreased CV events. Because of this, continue even when insulin-dependent.
  • AE: GI. Take with meals.
  • CI in men with Cr >1.5 or women with Cr >1.4, or GFR<30.
  • Cheapest ($4/month)
  • Second Line – Add to Metformin if no improvement in A1C in 3 months. Can add…

    Anticoagulation

    hqdefault Risk Classifications Schemes
  • Caprini Risk Assessment – estimates venous thromboembolism risk for non-orthopedic surgeries. Low risk use SCDs. Mod risk use meds or SCDs. High risk use meds+SCDs. If risk of bleeding, use SCDs only.
  • CHADS2 – estimates stroke risk in Afib patients. Easiest one to use. Recommends aspirin, anticoagulant, or both, depending on risk.
  • CHA2DS2-VASc – a more accurate
  • Onychomycosis

    490px-Oncymycosis Facts about Onychomycosis
  • Onychomycosis is very common. 50% of patients older than 70 years old have it.
  • Onychomycosis is most often caused by dermatophytes of the genus Trichophyton. Non-dermatophyte molds are less common.
  • Treating onychomycosis is more than just about cosmetics. It can lead to cellulitis in the elderly, and foot ulcers in diabetics.
  • Onychomycosis is hard to treat, since
  • Supraventricular Tachycardia Management

    SVT.jpg Types of SVT:
  • AVNRT – caused by a slow and fast pathway in the node, causing reentry.
  • AVRT – caused by an accessory pathway between the atrium and ventricle, not in the node. If there is delta wave and tachycardia, it is WPW.
  • Atrial Tachycardia – caused by focal area of automaticity in atrium.
  • Acute Treatment
  • Vagal Maneuvers – Valsalva x15 sec.
  • Botanical Medicine

    Echinacea Purpurea Botanical (Herbal) medicine has been used all over the world, and in different ways. In a 2005 CDC survey, 19% of adult Americans take dietary supplements and most use them without medical advice. Because many of your patients may be taking botanicals at home, as a medical practitioner, it is important to at least be familiar with them, and even consider integrating some of…

    Treatment for Allergic Rhinitis

    Misc_pollen When treating allergic rhinitis, you should take into account the severity of symptoms, patient’s age, whether they are pregnant or not, price, and other factors. For asthmatics, allergic rhinitis is especially important to be treated as it can lead to asthma exacerbation. And of course, one should try to avoid known allergens as well. For Mild Intermittent Symptoms:
  • Second Generation
  • Nausea and Antiemetic Medications

    3205_-_Milano,_Duomo_-_Giorgio_Bonola_-_Miracolo_di_Marco_Spagnolo_(1681)_-_Foto_Giovanni_Dall'Orto,_6-Dec-2007-cropped Nausea and vomiting happens when the Vomiting Center in the medulla is stimulated by one of three different neurotransmitter pathways:
  • Visceral Stimulation (of intestines, stomach) – i.e. nausea from gastroenteritis
  • mediated by dopamine and serotonin
  • Chemoreceptor Trigger Zone (in medulla oblongata) – i.e. nausea from chemotherapy
  • mediated by dopamine and serotonin
  • Vestibular Stimulation (in inner ear) – i.e. nausea from motion sickness
  • mediated
  • Skeletal Muscle Relaxants

    Synapse_diag4 Skeletal Muscle Relaxants can be prescribed for musculoskeletal pain only if you find no relief with acetaminophen or NSAIDs. Skeletal muscle relaxants have not been proved to be more effective than acetaminophen or NSAIDS, and because of the side effects and lack of evidence for long-term efficacy, they should only be prescribed if Acetaminophen or NSAIDs have failed, and should be…

    COPD and Asthma

    320px-COPD COPD TREATMENT 1. Smoke cess, flu vax
    2. SABA or SAC
    3. LABA or LAC
    4. (LABA or LAC) + ICS
    5. (LABA or LAC) + ICS + O2 (if <88) Theophylline isnt that great. SAC = short acting anticholinergic (ipratropium)
    LAC = long acting anticholinergic (tiotropium) ASTHMA TREATMENT 1. SABA
    2. SABA + ICS (or LTRA, cromolyn, zil)
    3.…

    Cellulitis

    800px-Cellulitis1 ERYSIPELAS – caused by strep
    1. Penicillin, Amoxicillin, Ampicillin (covers strep specificallly) CELLULITIS – caused by strep and staph
    No Abscess or pustular drainage – likely MSSA, MSSE
    1. Cephalexin, Dicloxacillin – PO, for minor infxn
    2. Oxacillin, Nafcillin, Cefazolin – IV, for more severe infxn
    Abscess or purulent drainage present – likely MRSA, MRSE
    3. TMP/SMX (Septra), Clindamycin, Doxycycline…

    Eyelid Swelling

    1280px-Eye_iris Anatomy Zeis gland = sebaceous gland of eyelash (external)
    Moll gland = apocrine gland of external eyelid
    Meibomian gland = sebaceous gland of internal eyelid Pathology Infxn of Meibomian = internal hordeolum (internal stye)
    Infxn of Zeis or Moll = external hordeolum (external stye)
    Blocked Meibomian that is not infected (no pain, no erythema) = Chalazion Internal hordeolums can resolve…

    How Skeletal Muscle Contracts

    800px-Human_skeletal_muscle_tissue_1_-_TEM 1. When you want to move your muscle, your central nervous system sends an electrical signal down nerves to your muscle. At the neuromuscular junction where the nerve and muscle meet, this electrical signal opens up presynaptic voltage-gated calcium channels, causing calcium (Ca) to flow into the nerve terminal...

    Acute Limb Ischemia

    345px-Ischemia_rotate What is it? Acute limb ischemia happens when there is a sudden interruption of the blood supply in the arteries of the limb, with no time for collateral blood circulation to form. Causes There are three main causes of Acute Limb Ischemia:
    1. Thrombosis — 85%
    2. Embolus — 15%
    3. Vascular Trauma — <1%
    Thrombosis Thrombus can form in atherosclerotic arteries in…

    The Numbers Game

    428px-Charles_Demuth_-_Figure_5 Recently on a Friday evening in the ER with the resident I was following, I met an older gentleman in his early 70s who had come in complaining that he felt that his abdomen was pulsating with his heart. He had mild pain around his abdomen but was otherwise feeling fine elsewhere. After laying him down on the patient bed…
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