ADULT

Body Name Cause Signs/Sympto Diagnostics Treatment Notes/Concerns Guidelines/Recomm

System/Differ ms endations
ential
Viral Adenovirus, Redness, Self-limiting (up to 2 weeks) -Contagious
HEENT Conjunctivitis coxsackievirus, watery, stringy -Lubricating eye drops -Can have
ECHO viruses discharge, adenopathy
burning, gritty (preauricular or
sensation, submandibular),
"stuck shut" fever, pharyngitis
unilateral but -Gets worse before
2nd eye better
infected within
24-48hrs,
bumpy tarsal
conjunctiva
URI sx
Bacterial S. aureus, S. Redness, thick Erythromycin ointment or -Contagious
Conjunctivitis pneumoniae, purulent trimethoprim polymyxin B -Contact lens
H. influenzae, discharge from drops (Dosing is 0.5 inch or 1- wearers should be
treated with a
M. catarrhalis, one or both 2 drops QID for 5-7 days, fluoroquinolone
N. eyes that reduce to BID if improve after when keratitis is
gonorrhoeae, continues a few days ruled out.
and chlamydia throughout the Alt: bacitracin oint, -Keratitis may be
day, "stuck sulfacetamide oint, bacitracin- likely if there is
photophobia and
shut" polymyxin B oint,
decreased visual
fluoroquinolone drops, or acuity
azithromycin drops -Consider other
condition of redness
is localized (foregin
body)
Allergic Airborne Redness, -Lubricating drops
Conjunctivitis allergens watery/stringy
discharge
bilateral eyes,
"stuck shut",
ITCHING,
bullous
chemosis (
common with
cat allergy)
 Non-allergic Transient Resolves within 24 hrs
conjunctivitis mechanical or
chemical, dry
eye
Acute angle-
closure
glaucoma
Acute Otitis S. Otalgia, 1st line: Amoxicillin (500 mg TID
Media pneumoniae, decreased x5-7 days)
hearing, may 2nd line: Macrolide
H. influenzae have conductive (azithromycin, erythromycin
hearing loss, combined with sulfisoxazole,
usually or clarithromycin)
unilateral *Failed initial tx give
amoxicillin-clavulanate or a
second-generation
cephalosporin
Otitis Externa Mild: topical acetic Clean outer ear, to
acid/hydrocortisone clean and enhance
Mod: Cipro HC or Cortisporin penetration of
Severe: place wick to aid with medications
med admin
Otitis media barotrauma hearing loss or Decongestants, may need Teach
with effusion (Increased fullness and tubes if there isn't relief after autoinsufflation
pressure) or possible 12 weeks
allergy history of
recurrent
AOM.
Otoscopy
reveals fluid
and an
immobile
retracted
membrane

Body System Name Cause Signs/Symptoms Diagnostics Treatment Notes/Concerns

Vital Rhinitis Nasal congestion/ Self limiting, lasts 7-10 days
cough Nasal: combination
antihistamine/decongestan
t, intranasal/inhaled
cromolyn sodium,
intranasal ipatropium
bromide
--> Saline nasal spray,
decongestants, and
exectorants are of
minimal benefit
--> Don't use zinc (may
have perm. Loss of
smell)
 Cough:
dextromethorphran,
Allergic 1st Line:Glucocorticoid
Rhinitis nasal spray most effective
(fluticisone propionate) -->
Start at highest dose and
taper down until effective
-May use 2nd generation
antihistamine to avoid
sedation (Claritin)
Viral URI symptoms Self-limiting
Pharyngitis
Bacterial Group A Sore throat, Throat culture 1st line: Penicillin V 500
Pharyngitis Streptococcus cervical mg BID for 10 days
lymphadenopathy 2nd: Cephalexin 500 mg
, fever, tonsillar BID for 10 days (mild
penicillin allergy)
exudates
OR Azithromycin 500 md
daily for 3 days
(anaphylaxis to penicillin)
Viral Sinusitis symptomatic management
(resolves within 7-10 days)
Antipyretics, analgesics,
saline irrigation, intranasal
glucocorticoids,
oral/intranasal decong,
antihistamines, mucolytics
Bacterial S.pneumoniae, H. 1st line: Amoxicillin-
Sinusitis influenzae, M. clavulanate (500mg PO TID
catarrhalis, S. in pt with no risk factors for
aereus resistance)
-Add antihistamine nasal
spray to glucocorticoid if
glucocorticoid is not
effective (azelastine)
(Can get combination
product)
-Cromolyn nasal spray
most effective for
children
-May also add on oral
antihistamine/deconges
tant combination or
montelukast
-Use montelukast if
patient has asthma
when glucocorticoid
alone is not working
-May need systemic
antihistamine (side
effects)
*Centor criteria >3
benefit from testing
**If fails to improve
>10days more likely
bacterial
Orbital cellulitis,
periorbital cellulits,
intracranial abscess,
meningitis
 2nd line: Doxycycline
(100mg PO TID) OR
Clindamycin 150mg Q6hr +
Cefixime 400mg
daily/cefpodoxime 200mg
PO BID
3rd line: Last resort
fluoroquinolone
(Levofloxacin 500mg PO
daily)

Pregnant: Augmentin,
azithromycin (PCN allergy),
Clindamycin
+cephalosporin

Peritonsillar Peritonsillar Group A. Strep, Sore throat, Refer to ED, usually needs
cellulitis, epiglotitis Abscess S.aureus, fever, muffled admission with antibiotics
respiratory voice, drooling
anaerobes and trismus,
uvula is pushed
over to the other
side of where the
abscess is
milk deposits, Candida Mouth -Pastilles: 200,000 units
stomatitis, aphthous
ulcer, hairy leukoplakia
pain/soreness. lozenge QID for 14days.
white patches -Nystatin: 500,000 units
that don't wipe QID for 14days or two
off 500,000 unit tablets TID for
14 days.
-Clotrimazole troche: 10mg
5x/day for 14 days;
monitor for side effects
-Fluconazole: 200mg x1
then 100mg daily for 5-7
days.
Mono Epstein-Barr virus fever, tonsillar Monospot, white blood supportive care (APAP or Risk of splenic injury,
pharyngitis, and cell count with NSAIDs, rest, hydration airway obstruction - wait
lymphadenopathy, differential and a 4 weeks before contact
Splenomegaly, heterophile test sports. Most acute
palatal petechiae, (Lymphocytosis) symptoms resolve in one
generalized
 maculopapular, to two weeks, although
urticarial, or fatigue and poor
petechial rash functional status can
persist for months

*Rash is more common

following the
administration of
ampicillin or amoxicillin
Pulmonary Bronchitis -Infection of Cough with or Assessment, Chest x-ray Usually self-limiting (1-3 --> only considered
lower respiratory without phlegm not needed unless weeks) acute it no hx of COPD
tract for at least 5 days unable to differentiate Non pharmacologic tx for
(bronchioles) from pneumonia cough: smoking cessation, --> considered chronic if
with respiratory
cough drops, tea cough lasts longer than
viruses, such as
rhinoviruses, Pharmacologic tx for 3 months with one
coronaviruses, cough: dexamethorphan or episode once per year
influenza viruses, guaifenesin, only use for 2 years
and respiratory albuterol for
syncytial virus wheezing/underlying lung
-Bacterial in less disease
than 10%
Asthma Lung disease -Coughing -Pulmonary function Moderate to severe: -Personalized asthma
where airways (usually worse at testing Monitor peak expiratory action plan
become inflamed,
narrow and swell, night), wheezing, -Allergy testing may be flow rate at home -Increase/decrease
and produce extra SOB, chest helpful to avoid triggers -Control environmental meds as needed
mucus, which tightness Use classification of triggers -Refer if recently
makes it difficult to -Cough may severity of asthma (see Mild (step 1): quick-acting hospitalized, not
breathe brought on
dry/productive below) and treat inhaled beta-2-selective responding after 3-6
my triggers and
relieved by (clear or pale accordingly adrenergic agonist months, 2 bursts of
bronchodilators yellow) Mild persistent (step 2): steroids
-Pale, swollen -May be helpful to get a daily low dose inhaled -May need to start
-Symptoms vary glucocorticoid with PRN
nasal cavities with chest x-ray in adults patient on inhaled or
over time and in SABA
intensity with cobblestone over 40 with moderate Moderate persistent (step oral GC until symptoms
variable expiratory appearance to to severe to exclude 3): low-doses of an are better controlled
airflow limitation posterior diag. that may mimic inhaled glucocorticoid plus -May be a diagnosis for
pharyngeal wall asthma (mass/heart fx) a long-acting inhaled beta unexplained chronic
(allergic asthma) agonist (LABA), or cough
-Gray medium doses of an
polyps=aspirin inhaled glucocorticoid with
exacerbated PRN SABA
Severe persistent (step
asthma, think CF
4/5): medium (Step 4) or
if polyps seen in high (Step 5) doses of an
 adolescent with inhaled glucocorticoid, in
resp. Signs combination with a long-
-Clubbing not a acting inhaled beta-
feature agonist with PRN SABA,
leukotriene modifier may
-Atopic dermatitis
be added for "triple
likely therapy", may need
accompanies glucocorticoid daily or
EOD.

COPD
Pneumonia Abnormal vitals: -Initial tx usually empiric -Cough and dyspnea may
(T>38.0, HR>100, -Do not use macrolide continue after course of
R>24, O2 <95%), monotherapy if received ATB and is not an
AMS > 75 y.o., antibiotics within the indication to continue
Signs of previous 3 months or if therapy
consolidation resistance is > 25%.
(rales) -Use macrolide --> -Re-evaluate patient if no
-Infiltrate on azithromycin or response to ATB after 2-3
chest x-ray gold clarithromycin (1st days
standard line)or doxycycline (2nd
line) when resistance -Duration of symptoms:
not anticipated https://www.uptodate.co
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-Use algorithm to select
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-If local resistance >

25%or unable to take
macrolide and without
comorbidities or recent
 ATB use give
doxycycline 100 mg BID
for 5 days

-Those with major

comorbidity or recent
ATB use and doxycycline
resistance greater than
25% give combination
therapy beta-lactam
plus a macrolide or
doxycycline or mono
therapy with
fluoroquinolone

-Should be fever free for

48 hours before
stopping ATB

Acute heart PE -Arise from LE -Dyspnea, chest -PE wells score (see -Those with low risk of
failure, pleuritis, proximal veins pain (pleuritic), below), D-dimer testing bleeding/high suspicion for
pericarditis, MSK (iliac, femoral, cough, symptoms (> 500 ng/mL), and CT PE empiric anticoag is recc.
pain popliteal) of DVT pulmonary angiography Until testing is complete or
-May come from -Hemoptysis -See evaluation criteria with low suspicion for PE
renal/upper unusual below where testing will take
extremity veins presenting longer than 24 hours and
-Usually in lower symptom moderate risk where
lobes -May be testing will take longer
asymptomatic or than 4 hours
have non specific -Do no anticoag those with
symptoms high bleeding
risk/contraindications
-Unfractionated
heparin/warfarin
 Psoriasis Immune -Well defined, red Mild to moderate: Topical -For facial or
Integumentar corticosteroids or intertriginous areas,
(chronic mediated raised plaques
y plaque is most response, genetic covered with emollients topical tacrolimus or
Seborrheic common, silvery scales pimecrolimus may be
Emollient: petroleum used as alternatives or
dermatitis, lichen guttate (elbows, scalp,
jelly/thick cream (Use after as corticosteroid
simplex chronicus, psoriasis, knees, gluteal bath/shower)
pustualr -30% also have folds) sparing agents, though
atopic dermatitis, Full
psoriasis, psoriatic arthritis Corticosteroid cream: improvement may not
nummular eczema, skin exam, suspected if
erythrodermic (joint pain, back -Auspitz sign: Scalp/external ear be as rapid. Localized
fungal infection, involved in scalp,
psoriasis, pain), arthritis pinpoint areas of (fluocinonide 0.05% or phototherapy is another
lupus or elbows, knees, option for recalcitrant
inverse usually presents bleeding remain umbilicus and nails with clobetasol propionate
scabies=less psoriasis, nail before plaques on when plaque is 0.05%-may use shampoo) disease
a family history
common psoriasis) the skin removed Face/intertriginous -Severe usually requires
(Hydrocortisone cream) management by
-Koebner dermatologist
phenomenon: Extensor surfaces -Guttate psoriasis:
psoriasis in areas (betamethasone 0.05% or severe form resulting
not normally seen clobetasol propionate from Gr A strep
0.05%) infection
-Peak beginning -Risk factors (smoking,
Severe: May need topical
30-39 and retinoid, methotrexate, or high BMI, meds (beta
50-69 biologic agent, UVB blockers & lithium),
-May need skin phototherapy infection, alcohol, vit. D
biopsy def., & stress

Eczema/Atopic -Chronic, pruritic, Skin dryness, -Suspect allergic contact -Avoid triggers: low
dermatitis inflammatory skin erythema, oozing, dermatitis when there humidity and heat
disease and crusting, and is no response to topical -Maintain hydration with
lichenification therapy or it continues emollients BID and after
bathing(OTC suficient) -->
-Deficiency in (thick and to spread
Use one with
stratum conreum leathery patches glycyrrhetinic acid (4X
lipids and natural of skin from -May use patient- more effective)
moisturizing itching and oriented eczema --> May use cetafil
factor rubbing), pruritis, measure (POEM) to (emollient/humectant)
assess severity -Treat skin infection PRN
(Usually S. aureus treated
Mild – Areas of dry with mupirocin 2% cream
BID for 1-2 weeks, may
skin, infrequent itching need PO ATB if more
(with or without small extensive)
areas of redness); little -Control itching:
impact on everyday Antihistamines are more
activities, sleep, and effective for itching/eye
irritation, may use
psychosocial wellbeing
loratadine with urticaria or
Moderate – Areas of concurrent allergic
dry skin, frequent conjunctivitis, may use
itching, redness (with topical doxepin (risk for
or without excoriation allergic dermatitis),
pimecrolimus 1% cream
and localized skin or tacrolimus 0.03-0.1%
thickening); Moderate cream if other treatments
impact on everyday fail, moisturizers with
activities and pnenol, menthol and
comphor may be effective
psychosocial wellbeing, -Treat stress/anxiety
frequently disturbed -Dietary changes not
sleep proven helpful (egg-free
Severe – Widespread diet in infants with
sensitivity?)
areas of dry skin, -Tepid bath
incessant itching,
redness (with or -Mild to moderate: Initial
without excoriation, treatment are topical
corticosteroids/emollients,
extensive skin
steroid potency should be
thickening, bleeding, based on age, body area
oozing, cracking, and and degree of
alteration of inflammation, may use
topical calcineurin
pigmentation); severe
inhibitors as steroid
limitation of everyday alternative, especially to
activities and the face and folds if low
psychosocial dose steroid not effective
(2nd line) --> may have
functioning, nightly loss
greater risk of cancers)
of sleep -Mild: low potency steroid
daily with emollients
multiple times per day,
group 5&6 see table 1
-Use low dose steroid on
face: Group 6 see table 1
-Moderate: Medium to
high potency group 3&4
see table 1
-May use super high or
high potency for acute
flares for up to 2 weeks
and then replace with
 lower potency until lesions
resolve
-Always start with low
potency steroid on
face/skin folds (high risk
for atrophy), but may use
high potency for 5-7 days
if needed
-May need maintenance
therapy for moderate to
severe with intermittent
use of steroids (group 3-
5)/calcineurin inhibitor
twice weekly (2
consecutive days) for up
to 16 weeks
-Severe may require
phototherapy or systemic
immunosuppressant
-An acute flare of chronic
eczema may be treated
with systemic
glucocorticoid (prednisone
40-60 mg/day for 3-4 days
then 20-30mg/day for 3-4
days)
Allergic contact, Contact -Localized -Mild skin dryness -Clinical finding with hx -Avoid irritant -Use gloves, barriers
atopic contact, dermatitis inflammatory skin and erythema to of chemical/physical
(irritant) response to acute/chronic irritant -Severe acute/chronic with
psoriasis, and skin thickening
eczema, fungus, chemical/physical eczematous
(lichenification) not
agent (allergic is dermatitis and -Patch testing to rule
scabies involving face/flexural
immune skin necrosis from out allergic contact areas: High potency group
mediated) a burn dermatitis 1 (see table 6) topical
-Common -Erythema, corticosteroids daily/BID
chemical irritants edema, vesicles, -Criteria: onset within for 2-4 weeks
include water bullae and oozing minutes/hours of
and wet work, -may have exposure -Mild not involving
detergents and burning, stinging face/flexural areas: High
surfactants, potency (group 2 or 3)
or pain
solvents, topical corticosteroid
oxidizing agents, -Glazed, parched,
daily/BID for 2-4 weeks
acids, and or scalded
alkalis. Physical appearance -Acute/chronic
irritants include face/flexural areas
metal tools, medium/low potency
wood, fiberglass,
 plant parts, - (group 5/6) topical
paper, and dust Scaling/hyperkera corticosteroid daily/BID for
or soil. tosis, fissuring 1-2 weeks
-May be seen
-Efficacy of topical
chronically in the
corticosteroids not proven
dorsum of the -Use emollient multiple
hands, fingertips times per day (see table
and finger webs 7)
-May be on face
from cosmetics
Lymes Tick: borrelia Early: erythema *Diagnosis can be made -Children > 8 or adults *Subjective symptoms
burgdorferi migrans soley by erythema with early lyme disease: usually resolve by 6
with/without viral migrans: serologic doxycyline (100 mg BID x months
syndrome testing will be negative 10-21 days), amoxicillin
(500 mg TID x 14-21 *Consider other tick-
(headache, msk as lesion appears before
days) or cefuroxime axetil borne infection with
pain, athralgia, lab testing is positive. (500 mg BID x 14-21 persistent high fever
fatigue) days)
*Do serologic testing -Treat for 21 days in early *May need IV ATB with
when criteria is met: disseminated disease with acute neurologic
Recent hx in area with no neurologic manifestations
endemic for lyme and disease/isolated facial
risk factor for tick nerve palsy *May lyme carditis: ask
exposure and symptoms about symptoms of
-doxycycline is best as it syncope, dyspnea or
of disseminated disease
covers lyme and human chest pain): needs
or late disase granulocytic anaplasmosis hospitalization with
(meningitis, these symptoms, 2nd or
radiculopathy, cranial *See chart for tx with more 3rd degree AV block or
nerve palsy, arthritis, advanced lyme: 1st degree with
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Herpes simplex Herpes simplex -Vesicular lesions -Viral culture -Acyclovir (400 mg TID for -Lesions can last 10-14
(“cold sore”) virus of the oral 7-10 days), valacyclovir days
mucosa grouped and famiciclovir
in a single -May have reactivation
-Needs to be given with of infection after the
anatomic site
72 hours of symptoms to primary infection
have best outcome resolves after episode
 -May or may not of stress, underlying
have systemic -Can give single day immunodeficiency
symptoms of dosing for recurrent
fever and symptomatic herpes -May develop
labialis (1500 mg gingivostomatitis and
malaise.
famciclovir once or pharyngitis (self-
valacyclovir 2g BID for limiting)
one day)
Cellulitis -non purulent -Use algorithm to -May need IV ATB with
infection manage signs of systemic
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Bite Wounds Oral flora of the -irrigate and explore to -Give tetanus and
biting animal and identify any injury to rabies prophylaxis
human skin flora underlying structures and -Follow up in 2-3 days
(staphylococci foreign body presence to asses wound
-Need head CT for deep -Postexposture for hep
and streptococci)
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-Do not close wounds at

high risk for infection
(crush, puncture, cat or
human bite unless on
face,
immunocompromised)

-Antibiotics for dog/cat

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Impetigo S. aureus Superficial -Small number lesions: -Hand hygiene

bacterial infection Topical therapy-
manifesting on mupirocoin BID or
the retapamulin TID for 5 days
face/extremities
-Numerous impetigo
with lesions that lesions: oral ATB that
progress from covers S. aureus and
papules to streptoccal infection
vesicles, pustules, (dicloxacill 250-500mg
and crusts QID or cephalexin 250-
500 mg QID for 7 days)
-May be followed
by
poststreptococcal
glomerulonephriti
s or rheumatic
fever

Genitourinary Cystitis Typically E. coli,
can be Klebsiella
Vaginitis, painful
pneumoniae and
bladder syndrome, Proteus mirabilis
Urethritis, PID or staph
dysuria, urinary -CVA tenderness, 1st line: Nitrofurantoin (100 https://www.uptodate.c
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urinary urgency,
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pain, hematuria.
-UA (simple cystitis does 2nd line: Augmentin 500 ch=simple%20cystitis&r
Older women
can have a not require culture) mg BID for 5-7 days
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nonspecific with fever, chills and (levofloxacin 250 mg daily_link
urinary rigors (may sig. for 3 days) (simple vs complicated)
symptoms. Pyelonephritis) -Chronic nocturia,
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-Do culture with all men algorithm for ATB routinely prompt urine
presenting with poss. selection testing to evaluate for
Cystitis cystitis

-Radiologic testing -
should be done in
presence of persistent
symptoms after correct
ATB therapy
Pyelonephritis Primarily E. coli, Same as simple UA with C&S Oral fluoroquinolone (5-7 bacteremia, sepsis,
but can be other cystitis with CVA days) (if resistance greater multiple organ system
Enterobacteriace tenderness, will than 10% give one-time dysfunction, shock,
ae, other gram- have fever, chills dose of long acting IV ATB and/or acute renal
and signs of such as ertapenem), may failure
negative bacilli
systemic use Bactrim for 7-10 days
(pseudomonas involvement
aeruginosa),
staph,
enterococci,
candida

Cervical Cancer A: recommends

screening 21-65 with
Pap every 3 yrs (>30
every 5yrs)
Cardiovascular CVD Class of diseases May develop *Adults over 20 years -Lifestyle change (low *may lead to heart
that involve chest pain due to old should have sodium/low fat diet, failure over time due to
heart/blood reduced blood assessment of CVD risk: increase in physical activity, weak heart muscle or
vessels flow (most Statin therapy should be stop smoking) arrhythmia
common -Meds to tx high cholesterol *May have myopathy
CAD: Plaque offered in those with a
symptom of (see algorithm below), HTN, with statin (low dose
buildup on the CAD/CHD) 10-year CVD risk of 7.5- rouvastatin may be
walls of the 10 % or greater, if LDL > a-fib, low blood flow
best tollerated), may
arteries that 190 a statin is given -Primary prevention: Low
need to use PCSK9.
to moderate intensity statin
supply blood to automatically
(start with moderate statin
the heart (may CAD testing: Only done of atorvastatin 20 mg or 5- *10 year
cause MI, stroke, when symptomatic 10mg rosuvastatin). There is cardiovascular risk
PAD) unless in "special no need to intensify therapy calculator
Atherosclerosis: population" unless the patient has https://www-uptodate-
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can at risk beyond the
with intolerance to statin. http://www.jbs3risk.com
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May consider non- /pages/risk_calculator.h
block blood flow Diabetes mellitus = 2
statin/antiplatelet with high tm
fold increase of CAD,
stroke, & CVD risk/high LDL with statin Other calculators:
mortality; also high intolerance. https://www-uptodate-
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CAD when regardless of baseline LDL _link
asymptomatic (want a 50% reduction in
-EKG LDL or under 70 mg/dL
-Echo within, if not achieved
-Exercise stress test consider non-adherence,
-Chest xray then add ezetimibe or PCSK9
-Cardiac cath inhibitor (PCSK9 inhibitor
-Coronary angiogram has risk and may be costly))
-Check LDL within 6 weeks
of initiating meds for effects
then every 6-12 months
(may see increase in LDL
with adherant patient with
menopause)
-Surgical procedure
-Low dose aspirin in those >
50 years old without excess
bleeding risk with greater
than 10% 10 year risk (also
prevents colorectal CA) -->
shared decision making with
patient based on
risk/benefit
 -Aspirin recommended for
secondary prevention to
prevent subsequent risk,
clopidogrel may be given
instead with hx of GI bleed
or if unable to take aspirin,
do not give aspirin in
addition to long-term oral
anticoag.
Stable Myocardial -12 lead EKG -Beta blocker preferred *considered angina if
ischemic heart oxygen demand -Stress testing for -Calcium channel relieved by nitro/rest
disease/CAD exceeds oxygen severity blocker/nitrates used when -Most patients with
supply initial tx with beta blocker CAD experience this
not
successful/contraindicate
-Ranolazine used when
previously stated not
successful
-aspirin, statin, control blood
pressure, manage diabetes
Angina -Chest -Sublingual is therapy of
discomfort that choice, may take during
occurs episode or before exertion
predictably and -Other meds: isosorbide
reproducibly at a dinitrate or isosorbide
certain level of mononitrate
exertion and
relieved with
rest/nitro

Dyslipedemia -Triglyceride levels -Goal is to lower trig under -Test family members
greater than 886 with 500 to prevent post prandial with hypertrig without
no improvement with elevation secondary cause
nonpharmacologic -1st line: fibrate -Fibrates interfere with
-fenofibrate 145 mg daily warfarin metabolism
interventions, drug
-gemfibrozil 600 mg BID (30%)
therapy is necessary to
prevent pancreatitis -Bezafibrate 400 ER daily
-Check lab in 6 weeks
-When trig not improved
may need fibrate, fish oil
and nicotinic acid(1500-
2000mg daily) (used rarely)
-May need to reduce refined
carbs, alcohol, and restrict
 calories with recurrent
pancreatitis
HTN See JNC-8 algorithm
MI -Event caused by -Women, Use this approach: -Do not give supplemental -Medical emergency
myocardial diabetics and 1. EKG (repeat o2 if oxygen sats are greater
Differential: ischemia when elderly present every 10-15 than 90%. https://www-uptodate-
PE, aortic there is evidence with atyptical minutes until -Aspirin 162-325 mg com.mclibrary.idm.oclc.
symptoms -Nitrates org/contents/image?im
dissection, of myocardial chest pain
(dyspnea, ageKey=CARD%2F568
pneumothorax injury/necrosis weakness, N&V, resolves or 13&topicKey=EM%2F1
-Criteria met palpitations, and diagnosis is 84&source=see_link
when there is syncope, with or made) (MI algorhythm)
rise/fall in cardiac without chest -STEMI: ST rise of
biomarkers with discomfort) 0.1 in 2 anatomically -https://www-uptodate-
supportive contiguous leads or com.mclibrary.idm.oclc.
evidence of -OPQRST >2 in leads V2 or V3 org/contents/image?im
symptoms, EKG, mnemonic: or new LBBB while ageKey=CARD%2F750
O: gradual onset, 32&topicKey=EM%2F1
or imaging with symptomatic
intensity may 84&source=see_link
new loss of viable wax and wane -NSTEMI/unstable (Rapid overview ACS)
myocardium or P: provoked by angina: ST
new regional wall activity, does not depression or deep
motion change with T wave inversion
abnormality respiration or without Qwaves or
position, may not no EKG change
respond to meds 2. Serum troponin
(nitro/GI cocktail) or troponin t
(relief of meds
3. If tropnin is not
not a good
indicator of elevated repeat
ischemic vs non) in 6-9 hours
Q: quality more (may do earlier
of discomfort if high suspect
rather than pain for NSTEMI),
and may be may repeat in
difficult to another 12-24
describe hours of still
(squeezing, tight,
negative
pressure,
crushing,
burning, fullness,
lump in throat,
heavy weight on
chest), toothache
with radiation to
lower jaw, not
 sharp or
stabbing, Levine
sign: clenched
fist in center of
chest
R: often radiates
to other parts of
body like upper
abdomen,
shoulders, arms,
wrist, fingers,
neck, throat,
lower jaw and
teeth, not to
upper jaw or to
the back, "pain
above the nose
or below the
navel rarely
cardiac in origin"
S: not in one site,
but diffuse, like
entire chest, not
one spot
T: Angina usually
brief (2-5 min)
and relieved with
rest/nitro, with
ACS may have
chest pain at rest
and usually lasts
longer than 30
minutes
CHF
Differenital: muscle DVT -Edema -Modified wells score Proximal DVT (common -May treat outpatient
strain/tear/venous -Pain -Low prob: do D-dimer femoral, femoral/popliteal): unless DVT is massive
insufficiency, -Warmth (if elevated greater than anticoag. (iliofemoral, phlegmasia
Baker's cyst, -Usually 500 do Ultrasound) Distal DVT : surveillance with cerulea dolens DVT)
unilateral serial US over 2-week period and hemodynamically
cellulitus -Moderate prob: D-
-Confined to calf instead of anticoag. stable, low bleed risk,
with distal DVT dimer unless hx of no renal insufficiency or
recent surgery, then do -Anticoag those with distal
-Whole leg with concurrent PE and can
US right away DVT with thrombus
proximal DVT give meds at home
extension
-Malignancy -High risk: do whole leg without comorbidities
raises risk -LMW heparin, sub. Q.
US, no D-dimer
fondaparinus, Xa inhibitors
(rivaroxaban/apiaban),
 **Usually institutionally unfractionated heparin, https://www-uptodate-
based if whole leg or transition to warfarin if not com.mclibrary.idm.oclc.
proximal leg using Xa inhib. org/contents/image?im
-Treat for minimal of 3 ageKey=PULM%2F971
months 17&topicKey=PULM%2
-Treat with LMW heparin in F1362&search=dvt%20
pregnancy/active cancer treatment%20adult&ran
k=1~150&source=see_l
long term (can use warfarin
ink
with active malignancy as
(algorithm for DVT)
alternative)
-Massive iliofemoral
DVT/phlegmasia cerulea
dolens with symptoms less
than 14 days do
systemic/catheter directed
thrombolytic therapy for
clot removal
-Early ambulation
-Compression socks not
recommended

Body System Name Cause Signs/Symptoms Diagnostics Treatment Notes/Concerns Guidelines

GERD Pyrosis, upper endoscopy 1st: Lifestyle and -Barretts Screening for
GI regurgitation,dysphagi and esophageal dietary change esophagus, Barrett’s esophagus
esophageal is typically
a, chest pain, water impedance pH 2nd: histamine 2
stricture, recommended for
brash, globus testing antagonists esophageal patients with
sensation, 3rd: switch to PPI adenocarcinoma, multiple risk factors
odynophagia, daily chronic laryngitis, (one of which must
extraesophageal *Antacids used exacerbation of be duration of
symptoms, nausea intermittently asthma GERD of at least 5
-changes in therapy to 10 years).
at two- to four-week
intervals
Crohn's Fatigue, prolonged Colonoscopy, Sulfasalazine, Perianal disease,
diarrhea with CBC, Lytes, Renal mesalamine, abscess, fistulas,
abdominal pain, weight tests, liver olsalazine, embolism, DVT
loss, and fever, with or enzymes, ESR, Glucocorticoids,
without gross bleeding
CRP, iron, vit D, immunomodulato
B12, stool culture rs (methotrexate),
biologic therapies
(-mab)
Ulcerative colitis Recurring episodes Endoscopy and 1st line: topical 5- bleeding, toxic
inflammation in colon, biopsy, Anemia, ASA meds megacolon,
chronic diarrhea, ESR, low albumin, (mesalamine perforation,
melena lyte abnormal, rectal) strictures, and
the development
stool panel, 2nd line: oral 5-
of dysplasia and
ASA colorectal cancer
Peptic Ulcers H. pylori, Asymptomatic OR -Upper endoscopy 1st line: Bleeding, perf,
Dyspepsia, epigastric visualization clarithromycin, penetration/fistul
NSAID/ASA pain, pain that worsens -urea breath test a, gastric outlet
amoxicillin, and
use with eating, and stool antigen obstruction
postprandial belching, a PPI
test (H. Pylori)
epigastric fullness, 2nd line:
early satiety, fatty food clarithromycin,
intolerance, nausea, metronidazole,
occasional vomiting
and a PPI
-iron deficiency anemia
3rd line: bismuth,
metronidazole,
tetracycline, and
a PPI

Acute Pancreatitis Gallstones, acute onset of -US

ETOH, drug persistent, severe, -CT
induced/wit epigastric pain often Amylase, lipase,
hdrawal, radiating to the back, leukocytosis,
elevation in serum
post elevated hct (d/t
lipase or amylase to
procedure, three times or greater 3rd spacing)
elevated than the upper limit of
triglycerides normal, and
characteristic findings
of acute pancreatitis
on imaging
+Cullen's sign (bruising
periumbilical region),
 +Grey Turner (bruising
flank)
Acute Infected Acute onset high fever, CBC – 1st line: Cipro + Sepsis, ileus,
Diverticulitis diverticula anorexia, N/V, LLQ pain, leukocytosis with Metronidazole 10- perforation
Gram- +Rovsing's sign, neutrophilia and 14 days.
negative boardlike abdomen on left shift. 2nd line: TMP-SMX
rods and exam CT + metronidazole
anaerobes 3rd line:
amoxicillin-
clavulanate
4th line:
Moxifloxacin (if
intol to flagyl and
beta lactam)

F/U 48-72 hrs

Diff dx: Ectopic Acute -Right lower quadrant -Pelvic exam -Surgery within 12 *Most common
preg, ruptured Appendicitis abdominal pain, should be done in hours of cause of acute
cyst, Chrones anorexia, fever, nausea, women identification abdomen and
disease, abscess and vomiting reason for
-Initial pain is -WBC with emergent surgery
periumbilical then differential and
radiates to right lower CRP
quadrant
-Atypical or nonspecific -Serum pregnancy
symptoms, such as in children old
indigestion, flatulence, child bearing age
bowel irregularity, and
generalized malaise -Modified
-Not all patients will Alvarado score
have migratory (https://www.upt
abdominal pain. odate.com/conte
nts/image?image
Key=SURG%2F111
766&topicKey=SU
RG%2F96169&sea
rch=appendicitis%
20adult%20diagn
osis&rank=1~150
&source=see_link)
: Score 0-3 low
risk of
 appendicitis and
other causes
should be
explored

-CT with IV
contrast if append
is suspected

Acute Syndrome of -Abdominal pain, most -Should be -Cholecystectomy

Cholecystitis right upper commonly in the right suspected with
quadrant upper quadrant or right upper
pain, fever, epigastrium quadrant or
and -Pain may radiate to epigastric pain,
leukocytosis right shoulder or back fever, and a
associated -Pain prolonged (4-6 leukocytosis
with hours), steady and (needs urgent
gallbladder severe ultrasound)
inflammatio -May have N&V -Positive
n and is murphy’s sign
usually -H&P and labs not
related to confirmative
gallstone -
disease https://www.upto
date.com/content
s/image?imageKe
y=GAST%2F50032
&topicKey=GAST
%2F666&search=c
holecystitis&rank
=1~150&source=s
ee_link (Algorithm
for diagnosis):
sonographic
murphys sign,
gallbladder wall
thickening/edema
, or fx for
gallbladder to fill
during
cholescintigraphy
 Colon Cancer A: recommend
screening starting
at 50 - 75
Chlamydia C. Asymptomatic/abnorm -First-line: -Treat sexual B: screening for
STI chlamydia in
trachomatis trachomatis al vaginal doxycycline (daily partners sexually active
is a gram- discharge/dysuria/dysp or BID PO x7 -PID, Infertility, women age 24
negative areunia (painful sex) days) and pregnancy years and younger
bacterium azithromycin and in older women
complications
(1gm PO single who are at
dose – ok for -No intercourse increased risk for
preg) for 7 days infection.

Males: I
-Second-line: **Report to
Ofloxacin (300 health dept
mg PO BID x7)
Levofloxacin 500
mg PO daily x7)

-Second-line for
preg:
Erythromycin or
amoxicillin– need
test of cure 3
weeks post, then
swab 3 months
post
Gonorrhea Neisseria Asymptomatic/ 1st line **Report to B: screening for
Co treat with gonorrhea in
gonorrhoea dysuria/yellow-green health dept sexually active
e discharge chlam:
women age 24
Ceftriaxone -Treat partners years and younger
(250mg IM once) and in older women
+ Azithromycin who are at
(1gm PO) increased risk for
2nd line: infection.
Ceftriaxone +
Doxycycline (100 Males: I
mg PO BID x 7)
Pregnancy:
ceftriaxone +
azithromycin
 *If ceftriaxone
unavailable, use
other injectable
cephalosporin
Syphilis Treponema Primary syphilis: -Serologic testing -Penicillin for all -Test if high risk or
pallidum Typically consists of a (use stages (Early with signs and
single painless chancre nontreponemal/tr phase tx: symptoms
at the site of eponemal tests, Penicillin G -Test those
benzathine 2.4
inoculation, may use either sexually active
million units IM
accompanied by one for initial once) with undiagnosed
regional adenopathy. screening) --> test genital ulcer or a
Secondary syphilis: may be positive -2nd line: rash that involves
A systemic illness that with hx of doxycycline 100 palms/soles
often includes a rash previous treated mg BID x 14 -Test those with a
(disseminated and/or infection which days or sexual partner
involving the palms and may indicate new tetracycline QID with early syphilis
soles), fever, malaise, infection, x 14 days and treat
and other symptoms response to empirically
https://www.upto
such as pharyngitis, recent tx, tx date.com/content -MSM
hepatitis, mucous failure or serofast s/image?imageK -HIV infected
patches, condyloma state. ey=ID%2F50435 individuals
lata, alopecia. -Confirmatory &topicKey=ID%2 -Pregnancy
Early latent: testing with both F7597&search=s women
Refers to the period is necessary yphilis%20treatm -History of
when a patient is -+ nontreponemal ent&rank=1~150 incarceration/com
infected with test followed by – &source=see_lin mercial sex work
k (treatment
Treponema pallidum as treponemal test = -Should offer HIV
algorithm)
demonstrated by false positive testing or other
serologic testing, but -Obtain STI testing if
has no symptoms. Early nontreponemal positive
latent syphilis occurs titer ideally on 1st -
within the first year of day of treatment Neurological/cardi
initial infection. ovascular/gumma
tous complication
-May be less specific: if untreated
cranial neuropathy, -Clinical exam and
chronic headache, serologic testing
aortic insufficiency, with a
meningitis nontreponemal
test (eg, RPR) at 6
 and 12 months
after tx

Diff dx: Condyloma HPV 6 and -Develops on vulva, -Physical exam -1st line: -Acquired through
seborrheic Acuninata HPV 11 are penis, groin, perineum, -May need to imiquimod- sexual activity
(Genital Warts) responsible and perianal skin or biopsy if unsure 3.75% cream -30% resolve in 4
keratosis, (apply a thin
acrochordon for most suprapubic skin -May benefit from months
layer prior to bed
-Photos cases of CA -Warts may be flat, additional STI -Resolution does
(skin tag), pearly and leave on for
(https://www.upt dome-shaped, testing 8 hours then not guarantee
penile papules,
odate.com/conte cauliflower shaped, remove with eradication of
fordyce spots nts/image?image filiform, funfating, HPV
soap/water;
(papules to Key=DERM%2F10 pendunculated, continue until -Malignancy is
penis) 8140~OBGYN%2F cerbriform, plaque-like clearance for rare
60946~OBGYN%2 smooth, verrucous, or maximum of 8 -incubation 3
F51759~DERM%2 lobulated. weeks), 5% weeks to eight
F108145~DERM% -Usually white, skin- cream (apply a months
thin layer three
2F108144~DERM colored, erythematous, -Refer to urology
times per week
%2F108141~DER violeceous, or brown. on alternate days if in urethral
M%2F108146~DE -1mm to more than prior to bed; meatus
RM%2F108147&t several centimeters in leave on 6-10 -Do speculum
opicKey=DERM%2 diameter hours and exam if in genitals
F99981&search=c -May have associated remove with soap -Refer to
ondyloma%20acu urethral, vaginal, and water, max GI/colorectal
minata&rank=2~1 cervical or anal canal duration of 16 surgeon if in anal
20&source=see_li involvement weeks area
-2nd line:
nk)
Sinecatechins
(0.5 cm strand
TID until cleared;
maximum of 16
weeks)
-If no response
after 3 weeks or
no clearance by
6-12 weeks
switch tx
-Biopsy not
necessary to
exclude
precancer/cancer
ous lesions
unless patient is
immunocomprom
 ised or
postmenopausal
Epididymitis N. unilateral testicular pain urinalysis, urine -First line (< 35):: Scrotal elevation
gonorrhoea and tenderness, culture, and a ceftriaxone (250 decreases pain
e or C. hydrocele, and palpable urine nucleic acid mg IM once) +
trachomatis swelling of the doxycycline (100
amplification test
epididymis mg PO BID x10)
(NAAT), US
2nd line (> 35):
Ofloxacin (300
mg PO BID x10)
or levofloxacin
(500 mg PO x
10) are given
instead of
doxycycline (+
ceftriaxone)
*if have anal sex
d/t poss enteric
organisms
Bacterial presence of 3 Amsel Gram's stain of 1st line choices: risk of: preterm
Vaginosis criteria vaginal discharge is Metronidazole delivery,
the gold standard 500 mg twice
-Homogeneous, thin, Endometrial
for diagnosis of BV
grayish-white discharge daily PO x 7 bacterial
that smoothly coats the -Metronidazole colonization,
vaginal walls. gel 0.75 % once Plasma-cell
Wet mount
vaginally x5. endometritis,
-Vaginal pH >4.5.
-Clindamycin 2% Postpartum fever,
-Positive whiff-amine vaginal cream Posthysterectomy
test (fishy odor when a once @HS x7 vaginal cuff
drop of 10 %KOH is cellulitis,
-Clindamycin 300
added to a sample of Postabortal
mg PO BID x7
vaginal discharge. infection
-Clindamycin 100
-Clue cells on saline wet mg vaginal -probiotics for
mount suppositories HS prevention
x3
-Clindamycin
bioadhesive
cream
(Clindesse) 2%
once vaginal
 2nd
line: tinidazole
PO and
secnidazole PO
Pregnant:
Metronidazole
500 BID or 250
TID x 7
Clindamycin 300
PO BID x7
Trichomoniasis protozoa Female: purulent, -Wet mount: motile Males and nonpreg -Always treat even
Trichomonas malodorous, thin dc with trichomonads - 1st line: if asymptomatic.
vaginalis burning, pruritus, dysuria, positive culture, - metronidazole or
frequency, lower abdominal positive NAAT, or -Follow up: retest
pain, or dyspareunia tinidazole single 2
positive rapid ALL women
g PO dose
-erythema of the vulva and antigen or nucleic treated. Repeat
vaginal mucosa. The acid probe test 2nd line: testing is NAAT 2
classically described green- desensitization weeks after and
-pH >4.5
yellow, frothy, malodorous within 3 months of
rather than using
discharge, strawberry cervix
an alternative class complete
Male: asymptomatic in over of drugs treatment.
¾ of cases and often
transient (spontaneous
resolution within 10 days) OR
mucopurulent urethral Pregnant: 1st line: Treat partners,
discharge and/or dysuria, metronidazole abstain from sex
pruritus or burning sensation
single 2 g PO dose for 7 days after Rx
complete
2nd line: d/t nausea
metronidazole 500
mg BID PO x5-7
No ETOH with abx

Risk for: urethritis

or cystitis

Erectile
Dysfunction
Musculoskele Gout https://www.upto
date.com/content
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039&topicKey=RH
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e_link
Osteoarthritis
Carpel Tunnel Tinel's sign
Phalen's sign
Rheumatoid
Arthritis
Ankle Sprain -Injury to a GRADING -Pain with gentle -RICE for first 2-3 -Emergency eval Special testing:
ligament -Grade I sprain results inversion/eversio days (may use with https://www-
n to determine if crutches if neurovascular uptodate-
from mild stretching of
lateral/medial needed); ace compromise com.mclibrary.id
a ligament with wrap for swelling
sprain -May need lace up m.oclc.org/conten
microscopic tears. -Use ankle support to prevent
-Do squeeze test, support or air ts/ankle-
Patients have mild further injury
external rotation cast sprain?search=an
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-Early weight
tenderness. There is activity
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no joint instability on test -NSAIDs h_result&selected
examination, and the -If there is no -Range of motion Title=1~112&usag
swelling/bruising (dorsi/plantar e_type=default&d
patient is able to bear
and physical exam flex, foot circles) isplay_rank=1#H6
weight and ambulate -No need for
with minimal pain. Due
does not elicit
immobilization for
pain and Ottawa grade 1 sprain;
to their benign nature,
ankle criteria not ace wrap for a
these injuries are not met then there few days
frequently seen in the most likely no -Use ace
office. structural damage wrap/aircast
-Grade II sprain is a **Ottowa Ankle combination few
more severe injury Rules a few weeks for
(https://www- grade 2 sprain
involving an -May need 10
incomplete tear of a uptodate-
days of
com.mclibrary.id immobilization for
ligament. Patients
m.oclc.org/conten grade III sprain,
have moderate pain,
ts/image?imageK then use air
swelling, tenderness, ey=EM%2F69818 cast/ace wrap
and ecchymosis. &topicKey=SM%2 -PT
There is mild to F189&search=ankl -If symptoms
moderate joint e%20pain%20adul persist ore than
t&rank=1~112&so 6-8 weeks do
instability on exam with MRI to r/o talar
some restriction of the urce=see_link)
dome fx or
range of motion and
 loss of function. -Ankle x-rays: syndesmosis
anteroposterior, injury
Weightbearing and
ambulation are painful. lateral, mortise
plain films
-Grade III sprain
-+ squeeze test or
involves a complete
external rotation
tear of a ligament. stress test may
Patients have severe indicate
pain, swelling, syndesmosis
tenderness, and injury (high
ecchymosis. There is ankle); refer to
significant mechanical ortho
instability on exam and
--> Refer to ortho
for any fracture,
significant loss of
dislocation or
function and motion. subluxation,
Patients are unable to tendon rupture or
bear weight or wound
ambulate penetrating to
joint
Back pain Most with pain less Non-pharm: heat, *Refer spinal cord Ed: causes of
than 4 wks = no imaging massage, or cauda equina back pain,
acupuncture, compression (new favorable
>4 weeks or after 4-6 spinal urinary retention prognosis,
manipulation, generally minimal
weeks of conservative or incontinence,
exercise and PT value of
therapy reeval Pharm: initial: new fecal incont,
diagnostic
NSAIDs, APAP saddle anesthesia, testing, activity
Patients without 2nd: muscle motor deficits not and work
concerns for particular relaxants localized to single recommendation
etiology with no (cyclobenzaprine, nerve root) s, and follow-up
improvement after 12 methocarbamol,
wks get xray and refer baclofen, etc)
3rd:
opioids/tramadol
3-7 days
Endocrine DM1
DM2
Hypothyroidism -Hashimotos -May have goiter -Elevated TSH -Levothyroxine -Use same
- -Low free T4 (T4) (1.6 formulation, if it is
-Fatigue, cold intoll., ***May be mc/kg/day) changed recheck
muscle cramps, and subclinical -Elderly patients TSH in 6 weeks
should be started
weight gain (Elevated TSH and
 normal T4): on 25-50 -Most need
https://www- mcg/day lifelong treatment
uptodate- *** Doses vary:
com.mclibrary.id 50 to greater
than 200
m.oclc.org/conten
mcg/day
ts/image?imageK -Take on empty
ey=ENDO%2F108 stomach, 1 hour
867&topicKey=EN before breakfast
DO%2F7883&sour
ce=see_link (see
algorithm)
***Central (more
mild symptoms.
T4 is low or
normal and TSH
may be low,
normal or
elevated up to 10
mU/L, elevated
T3, may be
deficient in other
pituitary
hormones)
-Recheck TSH
every 6 weeks and
change dose until
therapeutic (0.5-
5.0 mU/L)
***Hashimotos
(high serum TPO
antibody)
*** Elderly have
an age-related
shift towards
higher TSH (7.5
mU/L in 80-year
olds)
-Euthyroid Hyperthyroidism anxiety, emotional Same as graves' Risk for Monitoring:
hyperthyroxinemia lability, weakness, TSH = low osteoporosis d/t Thionamides- TSH
-Low serum TSH without tremor, palpitations, Serum free T4 and accelerated bone 4-6 week intervals
hyperthyroidism heat intolerance, T3 remodeling. Take Radioiodine: free
1200-1500mg T4, total T3, and
-Assay interference with increased perspiration, Overt = high T4 elemental calcium TSH 4-6weeks
biotin ingestion and weight loss and T3. Some daily post tx then 4-6
PE: thyroid have one week intervals x6
enlargement, elevated. Avoid biotin – months.
hyperactivity and rapid
Subclinical: TSH causes falsely low Surgery: start
speech, warm/moist
skin, thin/fine hair, below normal values in TSH and thryoid hormone
tachycardia, (>0.05) free T4, falsely high T3 T4 prior to d/c,
hyperreflexia, tremor, T3, free T3 normal serum TSH 6-8
proximal muscle *After labs No I131 in weeks later and
weakness, determine the pregnancy or adjust to keep
cause (Graves, breastfeeding normal ref range
adenoma,
nonthyroidal Preg: measure
illness, pituitary TRAb
mass
-Radioactive
Iodine
Graves' disease exopthalmos, Most serum T3 -Antityroid drugs
periorbital and increases > serum (methimazole
conjunctival edema, T4 initial: 15-60
limited eye movement, mg/day;
infiltrative dermopathy maintenance
dose: 5-15
mg/day)
-radioiodine,
-surgery
*Don't have to be
mutually
exclusive
-Atenolol 25-
50mg daily up to
200mg to reduce
pulse to < 90 (if
no
contraindications)

Cushings Causes: facial plethora, Confirmed by 1.Surgery Determine cause Refer to endo
https://ww proximal myopathy, biochecmial tests Removal of
w-uptodate- striae (>1 cm wide and Hypercorisolism ACTH-secreting Exclude
com.mclibra red/purple), and easy *diagnosis of CS tumor exogenous
bruising 2.Cabergoline or
ry.idm.oclc. when at least two glucocorticoids
pasireotide
org/content different first-line
3.pituitary
s/image?im tests abnormal
irradiation
ageKey=END 4.adrenalectomy
 O%2F79853 a.late-night
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NDO%2F156 (2
&source=ou measurements),
b.24-hour urinary
tline_link
free cortisol
(UFC) excretion
(two
measurements),
c.overnight 1 mg
dexamethasone
suppression test
Addisons
Pituitary
Psychiatric Depression Major Depressed mood, loss -PHQ-2 screen -Start with SSRI, Medication chart: B: recommends in
depressive of interest, change in (https://www- but SNRI, https://www- adult population
episode appetite/weight (up or uptodate- atypical and uptodate- + preg and
lasting at down), sleep com.mclibrary.id serotonin com.mclibrary.id postpartum.
modulator is
least 2 disturbance, m.oclc.org/conten m.oclc.org/conten
reasonable
weeks with fatigue/loss of energy, ts/image?imageK alternative ts/image?imageK -DSM-5:
5 or more neurocognitive ey=PC%2F89663& -Tricyclic and ey=PC%2F53818& https://www-
symptoms dysfunction, topicKey=PC%2F8 MAOI is not first topicKey=PSYCH% uptodate-
psychomotor 3887&search=dep line d/t safety 2F1725&search=d com.mclibrary.id
agitation/retardation, ression&rank=5~1 -Start at lowest epression%20trea m.oclc.org/conten
feeling worthles, 50&source=see_li dose and titrate tment&rank=1~15 ts/image?imageK
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(https://www- Side effects: CH%2F14685&sou
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com.mclibrary.id improvement in uptodate-
m.oclc.org/conten 4-6 weels com.mclibrary.id
ts/image?imageK administer next m.oclc.org/conten
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topicKey=PC%2F8 -Severe ey=PC%2F62488&
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diagnose -If patient has k
depression little response
to max dose of
initial drug then
 -Do during routine add a 2nd
health assessment generation
antipsychotic
(aripiprazole,
quetiapine,
risperidone)
-If no symptom
relief at all add
second
antidepressant
from different
drug class
-Discuss with
patient their
preference: it is
appropriate to
switch classes or
augment with a
2nd drug
depending on
side effects or
effectiveness
Anxiety
Insomnia
Anorexia nervosa
Alcoholism B: screen adults
aged 18 + for
alcohol misuse and
provide persons
engaged in risky or
hazardous drinking
with brief behavioral
counseling
interventions
ADHD
Tobacco -Bupropion SR Individual, group, Identify,
dependence and telephone document use
-Nicotine gum
counseling status, advise to
-Nicotine inhaler stop, provide
-Nicotine lozenge behavioral
-Nicotine nasal interventions and
spray pharmacotherapy
for every pt seen
-Nicotine patch
-Varenicline
Nervous Acute bactirial
meningitis
System
Temporal arteritis
Migraines
Trigeminal
Neuralgia
Bell's Palsy

VACCINATIONS

https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-pocket-size.pdf

https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf

Useful Links to reference

complications of pharyngitis: https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=ID%2F116703&topicKey=PC%2F6867&search=pharyngitis%20adult&rank=1~150&source=see_link

deep neck space infection/epiglottitis throat differentials. https://www-uptodate-

com.mclibrary.idm.oclc.org/contents/image?imageKey=ID%2F116704&topicKey=PC%2F6867&search=pharyngitis%20adult&rank=1~150&source=see_link

Peritonsillar abscess: https://www-uptodate-

com.mclibrary.idm.oclc.org/contents/image?imageKey=EM%2F112062&topicKey=EM%2F6079&search=peritonsillar%20abscess&rank=1~51&source=see_link

GERD: https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=GAST%2F89545&topicKey=GAST%2F2258&search=GErd&rank=2~150&source=see_link

Med therapy in active UC: https://www-uptodate-

com.mclibrary.idm.oclc.org/contents/image?imageKey=GAST%2F86774&topicKey=GAST%2F4051&search=ulcerative%20colitis%20diagnosis&rank=4~150&so
urce=see_link

Screening Recommendations for STIs: https://www-uptodate-

com.mclibrary.idm.oclc.org/contents/image?imageKey=ID%2F103391&topicKey=ID%2F7596&source=see_link

Pylonephritis med algorithm (complicated UTI) https://www-uptodate-

com.mclibrary.idm.oclc.org/contents/image?imageKey=ID%2F116091&topicKey=ID%2F16109&search=pyelonephritis&rank=1~86&source=see_link
 Asthma

https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=PULM%2F58247&topicKey=PULM%2F547&search=asthma&rank=1~150&source=see_link

PE

https://www-uptodate-com.mclibrary.idm.oclc.org/contents/calculator-pulmonary-embolism-wells-score-in-adults?source=see_link

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=PULM%2F113963&topicKey=PULM%2F8253&search=pulmonary%20embolism&rank=1~150&source=see_link

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=PULM%2F113962&topicKey=PULM%2F8253&search=pulmonary%20embolism&rank=1~150&source=see_link

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=PULM%2F113961&topicKey=PULM%2F8253&search=pulmonary%20embolism&rank=1~150&source=see_link

Psoriasis

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=DERM%2F99438~DERM%2F94790~DERM%2F99440~DERM%2F69799&topicKey=DERM%2F5664&search=psori
asis%20diagnosis&rank=1~150&source=see_link

Eczema/atopic dermatitis

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=DERM%2F115549&topicKey=DERM%2F1730&search=eczema&rank=1~150&source=see_link

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=DERM%2F62402&topicKey=DERM%2F1730&search=eczema&rank=1~150&source=see_link

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=DERM%2F64525~DERM%2F55375&topicKey=DERM%2F1730&search=eczema&rank=1~150&source=see_link
(picture of moderate/severe)

Contact dermatitis

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=DERM%2F71250~DERM%2F61579&topicKey=DERM%2F13661&search=contact%20dermatitis%20adult&rank=
1~150&source=see_link

(photo for reference)

 https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=DERM%2F56560&topicKey=DERM%2F13661&search=contact%20dermatitis%20adult&rank=1~150&source=se
e_link

(diagnosis)

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=DERM%2F62402&topicKey=DERM%2F13661&search=contact%20dermatitis%20adult&rank=1~150&source=se
e_link

(Table 6)

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=PEDS%2F72872&topicKey=DERM%2F13661&search=contact%20dermatitis%20adult&rank=1~150&source=see
_link

(Moisturizers)

HTN

http://www.nmhs.net/documents/27JNC8HTNGuidelinesBookBooklet.pdf

CAD

https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=CARD%2F114470&topicKey=CARD%2F112841&search=coronary%20artery%20disease%20treatment&rank=9~
150&source=see_link

MSK

Imaging for low back pain https://www-uptodate-

com.mclibrary.idm.oclc.org/contents/image?imageKey=PC%2F103713&topicKey=PC%2F7782&search=back%20pain&source=outline_link&selectedTitle=1~15
0

See "Society guideline links: Acute rhinosinusitis".)

●(See "Society guideline links: Community-acquired pneumonia in adults".)

●(See "Society guideline links: Drug allergy and hypersensitivity".)

●(See "Society guideline links: Hypertension in adults".)

●(See "Society guideline links: Hypothyroidism".)

 ●(See "Society guideline links: Screening for prostate cancer".)

●(See "Society guideline links: Urinary incontinence in adults".)

●(See "Society guideline links: Urinary tract infections in children".)

https://www-uptodate-com.mclibrary.idm.oclc.org/contents/preventive-care-in-adults-recommendations?topicRef=2767&source=related_link

https://www-uptodate-com.mclibrary.idm.oclc.org/contents/image?imageKey=PC%2F72728&topicKey=PC%2F7574&source=see_link <65

https://www-uptodate-com.mclibrary.idm.oclc.org/contents/image?imageKey=PC%2F75220&topicKey=PC%2F7574&source=see_link >65

https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/

PEDIATRIC POPULATION
HEENT

Viral/Bacterial conjunctivitis

Otitis media/externa

Rhinitis (allergic, viral)

Pharyngitis

Sinusitis

Peritonsillar/oral abscess

Candida

Dx: white curd like plaques coating buccal mucosa that cannot be removed, cultures are not routine. Irritability, refusal to eat.
Differential dx: milk deposits, stomattis, aphthous ulcer, hairy leukoplakia
 Tx: 1-11 months https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=PEDS%2F115621&topicKey=PEDS%2F5972&search=yeast%20infection%20children&rank=2~1
50&source=see_link
12 months and older https://www-uptodate-
com.mclibrary.idm.oclc.org/contents/image?imageKey=PEDS%2F115622&topicKey=PEDS%2F5972&search=yeast%20infection%20children&source=o
utline_link&selectedTitle=2~150
Plan: breastfeeding: clean breasts and nipples well with warm water between feedings. (possible antifungal cream to breasts – needs to be
washed off prior to nursing)

Bottle feeding: boil bottles, nipples, pacifiers

Instruct caregiver to attempt removal of large plaques (q-tip/gauze) prior to inserting medications

Tx: Oral – Nystatin suspension 1mL 4x/day for 1 week. Rub directly on plaques with swab

Follow up: Call if child refuses to eat, no improvement, lasts longer than 10 days, or unexplained fever.

INTEGUMENTARY

Lymes

Contact dermatitis

Yeast

Sx: genital area red rash and satellite papular lesions

Tx: Nystatin cream 3-4x/day for 7-10 days. Discontinue baby wipes, lotions, powders,

and creams.

Follow up: Call if child refuses to eat, no improvement, lasts longer than 10 days, or unexplained fever.

Lice/Scabies

Warts

Impetigo

PULMONARY

Asthma
 Bronchitis

Bronchiolitis

CARDIOVASCULAR

HTN: screening evidence insuff in asymptomatic

GASTROINTESTINAL

GERD

Pyloric Stenosis

Colic

Umbilical hernia

GENITOURINARY

Vesicoureteral reflux

Hydronephrosis

UTI

Hydrocele

MUSCULOSKELETAL

LCP disease: aseptic or avascular necrosis of femoral head

1. Unknown etiology – poss vascular interruption, anthropometric abnormalities, transient synovitis, nutrient def; common in white males 4-9
2. Slow onset of limp with knee pain activity related and resolves with rest, pain in groin or lateral hip
3. Diff: transient synovitis, septic arthirits, osteomyelitis, hemoglobinopathy, Gaucher's disease, hypothyroidism, epiphyseal dysplasias
4. Findings: limited passive internal rotation and abduction, hip flexion contracture and leg muscle atrophy in long-standing cases
5. Diagnostics: xray to dx, labs no indicated
6. Management: educate duration 1-3 years and potentially serious if not treated properly, observation if full ROM preserved, aggressive tx when more
than ½ femoral head invovled and older than 8 years; use of orthosis- rarely used today; surgical tx – femoral osteotomy, shelf arthropasty

Slipped Capital Femoral Epiphysis (SCFE): spontaneous dislocation of femoral head posteriorly and medially typically in adolescent growth spurt (10-17)

1. Etiology unknown – poss puberty hormones, common in males and AA race

2. Limp, degrees of aching or pain (groin referred to thigh), some severe pain and inability to walk or move hip
3. Diff: trauma, septic arthritis, transient synovitis, juvenile arthritis, LCP disease, knee complaint no obvious cause
4. Findings: unable to flex hip, limb shortening, loss of internal rotation with hip flexed
5. Diagnostics: xray confirms, labs to r/o infection or inflammation
 6. Management: Refer to ortho, prevent further slippage, no ambulation on acute/unstable SCFE, surgery pin to stablize femur and cause growth
plate to close, monitor other hip

Osgood Schlatters: inflammation of tibial tubercle d/t repeated stress in athletes

1. Tiny stress fractures associated with rapid growth spurt, usually 10-15yr olds
2. Diff dx: osteomyelitis, osteosarcoma, patellar tendonitis
3. Findings: point tenderness over tuberacle, prominence/enlargement, 50% bilateral
4. Diagnostics: exam, xray to r/o serious pathology, CT/MRI rarely
5. Mangement: *self limiting condition, pain resolves with full ossification and closure of apophysis, activity limitations, ICE, cortisone NOT
recommended, surgery if pain persists after skeletal maturity

Scoliosis: lateral curvature of the spine; Screening aged 10-18 evidence is insufficient

1. Common before or during adolescent growth spurt, Female > Males, positive family hx in 70% cases
2. Parents may notice change in contour, detected at appointment, rarely painful
3. Diff: hip disease, LCP disease, slipped capital femoral epiphysis, leg length discrepancy
1. Findings: asymmetry of shoulder height, hip level, waistline, rib asymmetry, scapulae, thoracic spinal curve
2. Diagnostics: Adam's forward bend; Xray
3. Management: pain needs further eval, treatment depends on degree of curvature (25 – no further treatment/evaluation if skeletally mature, follow up if still
growing) (40-50: if done growing can still increase to > 50, surgery likely for T curve > 50 or L curve > 40)
4. Pulmonary restriction occurs in T curve > 75

ENDOCRINE

DM1/DM2

Hypothyroidism

PYSCHIATRIC

Autism: I- insufficient in children 18-30 months with no concerns raised

VACCINATIONS

https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-pocket-pr.pdf