Summary
Highlights
COPD is classified into four stages based on lung function. Treatment escalates from albuterol (Stage 1), to adding a LABA (Stage 2), then an ICS (Stage 3), and finally oxygen (Stage 4) if saturation is below 88%.
Weight loss is the most effective lifestyle modification for lowering systolic blood pressure, followed by the DASH diet, exercise, dietary sodium reduction, and limiting alcohol intake.
For acute gout, the first-line treatment is indomethacin. Avoid NSAIDs in patients with kidney problems and use steroid injections instead. For chronic gout, measure uric acid in the urine to determine if the problem is excretion (treat with propenecid) or overproduction (treat with allopurinol).
Key pediatric milestones include rolling at 3 months, sitting up at 6 months, walking at 12 months, and using pincer grasp at 9 months. Familiarize yourself with common milestones and their timelines.
Normal fetal heart rate is 110-160 bpm. Tachycardia (above 160 bpm) is often associated with maternal fever or infection.
Otitis media (middle ear infection) presents with a bulging, red eardrum and is treated with amoxicillin. Otitis media with effusion shows bubbles in the eardrum and is managed supportively. Otitis externa (swimmer's ear) is often caused by Pseudomonas.
Crohn's can affect any part of the GI tract, with skip lesions and rectal sparing and non-caseating granulomas. Ulcerative colitis is a continuous colonic lesion always involving the rectum, and presents with mucosal inflammation and bloody diarrhea.
IBS involves alternating diarrhea and constipation, with symptoms relieved by defecation. Treat diarrhea-predominant IBS with loperamide and constipation-predominant IBS with increased fiber intake.
Celiac disease presents with bulky, greasy stools, diarrhea, rash, abdominal pain, and weight loss. Diagnosis involves testing for anti-transglutaminase, anti-endomysial, and anti-gliadin antibodies.
Migraines are unilateral, pulsatile, and may involve photophobia. Cluster headaches are sharp and located behind the eye, often with nasal congestion. Tension headaches are band-like with muscle tenderness.
Croup is caused by parainfluenza virus, presenting with a barking cough and stridor. Treat with corticosteroids, and racemic epinephrine for severe cases. Epiglottitis is often caused by Haemophilus influenzae type B (Hib), presenting with a tripod position, drooling, and high fever. X-ray shows a thumbprint sign.
Consolidation (e.g., pneumonia) is the only condition with increased tactile fremitus. Hyperresonance on percussion suggests pneumothorax.
HIV patients should receive HAV, HBV, and HPV vaccines if not immune. Influenza vaccine annually and meningococcal vaccine for those 11-18 years. Tdap every 10 years (and with each pregnancy). Avoid live vaccines (MMR, varicella) if CD4 count is less than 200.
Topics discussed include plantar fasciitis (heel pain worse after rest, treated with heel pads and stretching), Achilles tendinopathy (posterior heel pain and swelling), and the Ottawa ankle rules for determining the need for ankle/foot x-rays. Review common arthritis types.