Month: February 2016

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 with hot water.

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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 (

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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 syndrome, nocturia, medication side effects, psych

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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 – all

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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 yo).  Adolescent Idiopathic Scoliosis is the most common form.

Etiology unknown. Likely polygenic.

Risk factors for disease progression – initial Cobb angle (angle of curvature of spine) most

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