SUNY Downstate NFNP 5230 Health Promotion & Disease Prevention (Management 2) – Final Exam Study Guide | 100% Updated Fall 2025–2026.

NFNP 5230 Final Exam – Health Promotion & Disease Prevention (Management 2) | Complete Study & Review Guide | SUNY Downstate | 2025–2026 Final Exam Study Guide – December 11th, 2025 Week One: Health Promotion and Disease Prevention Levels of Prevention Level What It Does Example Primary Prevent the disease before it occurs Immunizations, lifestyle counseling Secondar y Detect early disease (screening) BP screening, cancer screening Tertiary Limit disability/progression of known disease PT/OT, chronic disease management Health Promotion Counseling Behavior Key PDF Points Smoking Ask about current use; advise quitting; assist with plan Alcohol Ask about frequency + quantity Nutrition Encourage balanced diet + limit saturated fat Exercise Increase activity (no specific time listed in file) Sexual Health Education on safe sex practices Decision-Making Capacity needs all 5 1. Understand relevant info 2. Appreciate consequences 3. Express consistent choice 4. Communicate decision 5. Explain Reasoning (most important) If a patient cannot explain WHY, they lack capacity. VACCINATIONS (Adult) From your file: Do NOT give live vaccines to pregnant or immunocompromised. Vaccine Who Gets It Interval / Notes Tdap/Td All adults Tdap once, then Td/Tdap every 10 yrs Influenza All adults Yearly HPV Up to age 45 Pneumococca l Adults ≥65 receive once Shingrix Age ≥50, 2-dose series USPSTF SCREENINGS Screening Who Grade PDF Notes AAA Ultrasound Men 65–75 who ever smoked Grade B One-time screening Cervical Cancer Women 21–65 Grade A Pap per age guidelines Colorectal Cancer Adults 50–75 Grade A Your file starts at 50 (not 45) Lung Cancer (LDCT) 55–80 w/ 30 pack-year & smoked in past 15 yrs Grade B Stop if 15 yrs quit Breast Cancer (Mammogram) Women 50–74 Grade B Q2 yrs BP Screening All adults Grade A Routine Obesity All adults BMI Grade B Counseling recommended HIV Screening 15–65 yrs, sexually active Grade A Offer testing Hepatitis C Screening Born 1945–1965 Grade B One-time USPSTF PearlsGrade A = Strongly recommended; high certainty of net benefit. Grade B = Recommend; moderate benefit. HIGH-YIELD EXAM CLUES Clue Answer Only give live vaccines to? Do NOT give to pregnant or immunocompromised Single AAA screen Men 65–75 who ever smoked Capacity MOST important criterion Explains reasoning behind choice Shingles vaccine Shingrix at age ≥50, 2 doses Mammograms Women 50–74 Q2 yrsWeek Two: Endocrine (DM, Adrenal Disorders) Type 1 vs Type 2 vs LADA Feature Type 1 DM Type 2 DM LADA (Latent Autoimmune Diabetes in Adults) Cause Autoimmune β-cell destruction Insulin resistance + β-cell dysfunction Autoimmune like Type 1, but slow onset in adults Age Onset Children/young Adults, obese Adults (often misdx as T2DM) Body Size Thin or normal Overweight/obese Normal or overweight Treatment Needs Insulin required Lifestyle + oral meds → maybe insulin Initially responds to oral agents, but eventually needs insulin Key Clue DKA risk Metabolic syndrome Initially looks like T2DM but fails oral therapy quickly Insulin Management Basal vs Bolus Type Action Basal insulin Controls glucose between meals and overnight Bolus insulin Controls glucose after meals How to Start InsulinSituation What to Do Marked hyperglycemia at diagnosis Start insulin immediately Type 1 & LADA requiring insulin Long-term → follow endocrinology Somogyi vs Dawn Phenomenon Feature Somogyi Effect Dawn Phenomenon Cause Nighttime hypoglycemia → rebound morning hyperglycemia Early-morning rise in hormones (cortisol, GH) → hyperglycemia Clue Check 3 AM glucose is LOW Check 3 AM glucose is HIGH/normal Treatment Decrease evening insulin Increase evening insulin Hypoglycemia Level Blood Glucose Symptoms Mild 70 mg/dL Shaky, sweating, hungry Moderat e 54 mg/dL Confusion, slurred speech, weakness Severe Requires help Seizure, coma Treatment of HypoglycemiaStep What to Do Conscious patient 15 g fast carbs → recheck in 15 min Severe/unconscious Glucagon IM or IV dextrose If on insulin Adjust regimen to prevent recurrence ADDISON’S vs. CUSHING’S Feature Addison’s Disease (Adrenal Insufficiency) Cushing’s Syndrome (Cortisol Excess) Key Problem ↓ Cortisol ± ↓ Aldosterone ↑ Cortisol Symptoms Weight loss, fatigue, hyperpigmentation, hypotension, N/V, abdominal pain Weight gain (central obesity), moon face, buffalo hump, purple striae, HTN, hyperglycemia Crisis Risk Adrenal crisis = emergency — Emergency Tx IV fluids + high-dose steroids — Diagnosis ACTH stimulation test 24-hr urine free cortisol or dexamethasone suppression Adrenal Crisis Clinical Clue Hypotension + weakness + abdominal pain + history of steroid withdrawal → Immediate IV steroids + fluids Exam Quick Facts Clue Answer Normal adult who “looks Type 2” but fails oral meds fast LADA Morning high blood sugar + low 3 AM glucose Somogyi effect Morning high blood sugar + high 3 AM glucose Dawn phenomenon Hyperpigmentation + weight loss Addison’s Purple striae + moon face Cushing’s Suspected adrenal crisis Immediate IV steroidsWeek Three HEENT EYE DISORDERS Disorder Key Findings Red Flags / Risks Management Cataracts Progressive cloudy/blurred vision, glare, halos Painless vision loss Refer for surgery when affecting ADLs Glaucoma(Chronic/Primary Open Angle) ↑ IOP → damage to optic nerve Can lead to blindness if untreated Lower intraocular pressure (specific meds not listed → managed by ophthalmology) Macular Degeneration (AMD) Loss of central vision; difficulty reading or recognizing faces Wet type more severe Refer; nutritional counseling discussed in notes (general) Diabetic Retinopathy Leading cause of blindness in 20– 74 yrs Retinal damage from chronic hyperglycemia Yearly eye exam recommended Retinal Detachment Sudden flashes, floaters, curtain over vision EMERGENCY to prevent blindness Immediate referral / Emergency care HIGH-YIELD EXAM CLUES Clue in Stem Diagnosis “Painless progressive blurry vision + glare” Cataracts “Gradual vision loss, optic nerve damage, ↑ pressure” Glaucoma “Central vision loss → can’t read or recognize faces” Macular Degeneration “Floaters + flashing lights + curtain over vision” Retinal Detachment (Emergency) “Leading cause of blindness age 20–74” Diabetic Retinopathy When to Refer Immediately Situation Action Sudden vision changes, flashes, curtain Emergency Retinal Referral Visual loss interfering with ADLs (e.g., cataract) Refer for surgery Suspicion of glaucoma or AMD Refer for management Diabetic patient → routine Yearly screeningONE-LINE MEMORY TRICK Cataract = cloudy. Glaucoma = pressure. AMD = central loss. Retinal detachment = curtain emergency. EAR DISORDERS Disorder Key Symptoms Special Clues Management Otitis Media (OM) (Middle Ear Infection) Ear pain, fever, hearing changes Often follows URI Antibiotics if persistent, otherwise supportive Meniere’s Disease Recurrent episodes of vertigo, nausea/vomiting, hearing loss, tinnitus Symptoms occur in attacks Dietary changes (low salt) + symptom control Vestibular Neuritis Sudden vertigo without hearing loss Often post-viral Steroids + symptomatic care Labyrinthitis Vertigo + hearing loss Distinguishes it from neuritis Steroids (in notes with others) Otosclerosis Gradual conductive hearing loss Bony overgrowth in ear Refer for possible surgical treatment HIGH-YIELD EXAM CLUES Clue Condition Vertigo + hearing loss + tinnitus Meniere’s Disease Sudden vertigo after viral infection Vestibular Neuritis Vertigo + hearing loss (not neuritis) Labyrinthitis Gradual hearing loss, no vertigo Otosclerosis Ear pain + recent URI Otitis Media WHICH NEEDS REFERRAL? Disorder Referral? Otosclerosis Yes → possible surgery Sudden hearing loss Yes (under OM/Meniere’s caution) Persistent OM symptoms Yes if non-responsive Severe vertigo + neurologic symptoms Urgent eval (general warning implied) ONE-LINE MEMORY TRICKHearing loss + tinnitus + vertigo = Meniere’s Hearing loss + vertigo after virus = Labyrinthitis Vertigo only = Vestibular Neuritis Conductive hearing loss = Otosclerosis Week Four: Respiratory (Chronic Cough and Lung Cancer) CHRONIC COUGH Causes & Workup Key Points (From Notes) GERD may cause cough → try PPI trial Treat the underlying cause Remove triggers: smoking, ACE inhibitors, allergens Patients often expect antibiotics, but many coughs are viral and may last 4–8 weeks Educate about avoiding unnecessary antibiotics When to Refer or Hospitalize (Pulmonary Red Flags) Referral to Specialist When Hospitalization When Chronic cough does not resolve with treatment Wheezing + hypoxia Cough related to cardiac disease, carcinoma, foreign body, or other pathology Oxygen instability Refer to Pulmonology, ENT depending on presentation — LUNG CANCER (Bronchogenic Carcinoma) Epidemiology & Risk Key Stats • Leading cause of cancer death in US (men & women) • Median diagnosis age: 70 years • Cigarette smoking accounts for 85–95% of cases • Other risks: secondhand smoke, pollution, asbestos, radon, chemicals • ↑ Risk with pulmonary fibrosis, COPD, sarcoidosis Types of Lung CancerType Key Fact NSCLC (85%) Most common Adenocarcinoma (40%) Most common in non-smokers Squamous Cell (25– 30%) Smoking association SCLC (10–15%) Small “blue” cells, aggressive, smokers Clinical Presentation Symptoms That Should Alarm You • Cough, weight loss, chest pain, dyspnea, hemoptysis • Persistent cough in a smoker or ex-smoker • Change in chronic cough or new cough • Recurrent pneumonia in the same lobe Metastatic Disease Indicators Diagnostics Tests Purpose Chest X-ray, CT chest/abdomen/pelvis Imaging PET scan Staging Sputum cytology Diagnosis CBC, CMP, LFTs, creatinine Workup Biopsy = Gold Standard Diagnosis Refer to Pulmonology for bronchoscopy and biopsy Specialist care STAGING & TREATMENT (NSCLC) Stage Treatment Stage I & II Surgical therapy (curative) Stage I may not need chemo — Stage II Chemo recommended If not surgical candidate Radiation (SBRT) Stage III Curative intent + non-consensus therapy Stage IV Palliative chemo/immunotherapy SCLC Treatment (Aggressive) Type Treatment Limited stage Chemo + radiation Extensive stage NOT curable → chemo When Lung Cancer Requires Emergency Action Site Symptoms Bones Focal skeletal pain Liver Hepatomegaly Brain Headache, extremity weakness, neuro deficits Weight loss 10 lbs Red flag DVT due to hypercoagulable state Also seenRed Flag Emergencies • Severe back pain + neuro deficits • Plethora + dilated neck veins (SVC syndrome) • Severe respiratory compromise • Seizures • Unilateral leg edema • Tumor-related fever, pneumonitis, colitis HIGH-YIELD QUESTIONS Clue Diagnosis “Persistent cough in a smoker” Lung cancer “Recurrent pneumonia in the same location” Lung tumor “Weight loss + bone pain + cough” Metastatic lung cancer “Horner syndrome (ptosis, miosis, anhidrosis)” Lung tumor compression Week Five: Infectious Diseases Cellulitis (including Purulent vs Non-purulent) Aspect Details Definition Infection of skin + soft tissue underneath; involves deeper dermis + subcutaneous fat; spreads rapidly and can extend deep; can progress to severe infection/osteomyelitis or life-threatening disease. Portal of entry Non-intact skin: traumatic lacerations, diabetic/vascular ulcers, chronic dermatoses w/ skin breakdown (eczema, macerated tinea pedis), surgical wounds, insect bites. Risk factors Venous/lymphatic compromise from prior cellulitis, peripheral edema, prior radiation, lymph node resection, lymphedema, obesity. Common organisms Group A β-hemolytic strep (most common in adults); non-group A strep (lymphedema); Staph aureus (purulent); CA-MRSA; others w/ animal bites, water exposure, immunocompromise. Clinical presentation Local erythema, swelling, warmth, tenderness, pain; often pus, induration; systemic: fevers, chills, malaise; possible bullae, abscess, erosions, necrosis, hemorrhage; most common on lower extremities. Purulent vs Non-purulent + Severity Type Key Points Typical Bugs Work-up/Treatment Purulent cellulitis / Abscess Pus collection in dermis or deeper tissue; painful, raised, fluctuant, red or nodular lesion, often w/ central pustule + erythematous margins. Includes furuncles (at hair follicles) + carbuncles (coalesced furuncles). Management Exam 2 Study Guide 2 Polymicrobial from skin/mucosal flora. I&D is key; small furuncles may drain w/ moist heat; larger furuncles/carbuncles/abscesses require surgical I&D + debridement; NSAIDs for pain. Non-purulent Diagnosis is mostly clinical; may not Usually Streptococcus; If no obvious source: start empiric antibiotics;cellulitis have a drainable source. Management Exam 2 Study Guide 2 sometimes Staph. obtain cultures from vesicle/pus/ulcer if present. Blood cultures only if extensive involvement, immunocompromised/comorbid, water/animal bite exposure, or recurrent/refractory disease. Severity Levels & Antibiotics Severity Definition Treatment Mild Hemodynamically stable; outpatient; may only need I&D ± oral antibiotics. Target Strep + Staph; 5–7 days (extend to 14 if slow). Options: penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin. Adjust dose in renal/hepatic impairment. Moderate Purulent drainage with systemic involvement. Needs systemic antibiotics; often oral or IV depending on status. Severe Refractory to PO or I&D; hemodynamic changes (T 100.4, HR90, RR24, WBC12K or 400); immunocompromised → hospital. IV antibiotics + possible admission; broader coverage and surgical consult if necrosis. MRSA vs MSSA Empiric (Moderate/Severe Purulent) Bug Target Oral Options MRSA TMP-SMX or Doxycycline PLUS Amoxicillin (for Strep coverage). MSSA Penicillinase-resistant penicillin (Dicloxacillin). Key Pearls Always reassess in 48–72 hrs; extend therapy up to 14 days if slow; diabetics/immunocompromised need broader coverage ± IV. Elevate limb, consider compression if vascular status OK. Herpes Simplex Virus (HSV-1/2) Aspect Details Types HSV-1: usually oral; HSV-2: usually genital. Both are DNA viruses; no animal vectors/seasonality; asymptomatic shedding common. Transmission & Patho Direct contact with infected lesions/secretions; enters via skin breaks or mucosa, replicates in epithelial cells → vesicles; then spreads via sensory/autonomic nerves to ganglia → latent; reactivation travels back along axon to same dermatome. Phases of HSV Phase Key Features Primary Most severe; incubation 2–14 days (up to 26). Multiple painful vesicles that ulcerate + crust; burning/tingling prodrome; tender LAD; may have fever, dysuria, discharge, malaise. Heals in 2–3 wks in immunocompetent. Latent Virus dormant in ganglion of nerve serving dermatome. Recurrent Reactivation in same dermatome; triggered by immunosuppression, stress, local trauma, poor sleep, etc. Episodes shorter + milder with fewer lesions. Diagnosis & Treatment Category Details Dx Clinical (history + exam). Lab confirms recommended for new diagnoses. Gold standard: viral culture of lesion. PCR highly sensitive; HSV type-specific serology detects IgG. Topical/oral management Oral herpes often self-limiting. OTC: Docosanol (Abreva). Rx topicals: Penciclovir cream (q2h while awake × 4 days), Xerese (acyclovir/hydrocortisone) 5×/day × 5 days. Avoid salicylic-acid products. Use OTCanalgesics/anesthetics & skin protectants. Key pearl Start antivirals within 48–72 hours of symptom onset; consider suppressive therapy for frequent recurrences; immunocompromised or pregnant patients need specialist management. Herpes Zoster (Shingles) Aspect Details Etiology Reactivation of latent varicella-zoster virus in dorsal root or cranial nerve ganglion after primary chickenpox. Incidence ↑ with age & immunosuppression; younger pts milder, older ↑ complications. Clinical Papular/vesicular rash on erythematous base in dermatomal distribution; painful, burning, itching. Prodrome: pain/tingling/dysesthesia days before rash. Contagious from rash onset until all lesions crusted. Dx usually clinical; confirm with PCR (best), culture, or scraping if needed. Treatment Component Details Antivirals (start ≤48–72 hrs) Valacyclovir 1000 mg TID ×7 days (preferred) OR Famciclovir 500 mg TID ×7 days OR Acyclovir 800 mg 5×/day ×7–10 days. Continue until all lesions crusted; 7 days if immunocompetent, 7–14 days if immunocompromised. Pain control (acute) NSAIDs or Tylenol; sometimes gabapentin, pregabalin, amitriptyline, or opioids as last resort. Post-herpetic neuralgia (PHN) Pain 4 months after rash; symptomatic only. Options: topical lidocaine/capsaicin (after healing), oral analgesics, gabapentin/pregabalin, TCAs, nerve blocks/epidural. Prevention & Referral Topic Details Vaccine Shingrix (recombinant): ≥50 yrs, 2 doses 2–6 months apart; give regardless of prior shingles or Zostavax. Contact precautions Immunocompetent w/ localized disease: completely cover lesions + standard precautions until crusted. Immediate ophthalmology referral Lesions on tip of nose, forehead, around eyes (ophthalmic branch of trigeminal nerve) → risk keratitis, scarring, vision loss. Immunocompromised may need IV acyclovir + hospitalization. PARASITIC: SCABIES Aspect Details Cause Infestation with mite Sarcoptes scabiei (not visible to naked eye). Transmission Direct, prolonged skin-to-skin contact; sexual contact; sharing a bed; more common in hot, humid, overcrowded, low-SES settings. Symptoms Intense pruritus, especially at night (hypersensitivity reaction). Signs 2–4 weeks after first infection. Burrows in web spaces of fingers, flexor wrists/arms, genitals, feet, buttocks, axillae. Small papules on erythematous base; serpiginous intra-epidermal burrows. Head/palms/soles usually spared in adults. Dx Scabies prep: mineral oil on burrow, scraped + microscopic ID of mites/eggs/feces. Adhesive tape test is another option. Treatment First-line: Permethrin 5% cream – apply to body, leave 8–12 hrs then wash off; repeat in 7–14 days. Oral ivermectin 200 mcg/kg single dose, repeat in 1–2 weeks; benzyl benzoate lotion as alternative. Important Treat all household contacts; wash clothing/bedding in hot water + hot dry; bag non-washables for 1 week or dryinstructions clean; vacuum furniture; symptoms can persist up to 2 weeks after treatment. Have pt list contacts from past 30 days. HIV / AIDS Aspect Details Definition / AIDS HIV destroys CD4 T-lymphocytes (normal 500–1500). AIDS: CD4 200 or any AIDS-defining condition (e.g., oral candidiasis, Kaposi’s, Pneumocystis). Median 10 yrs from infection to AIDS. Acute HIV Very infectious (viral load 100,000). 50–90% symptomatic 2–4 weeks after infection: fever, HA, sore throat, lymphadenopathy, rash, arthralgia, myalgia – mimics mono. During acute phase, antibodies may be negative; PCR detects 7–28 days post-exposure. Testing (4th gen algorithm) Step 1: HIV-1/2 Ab + p24 Ag combo immunoassay. If +, Step 2: HIV-1/2 Ab differentiation. If indeterminate → HIV RNA NAT. Older method: ELISA + confirm Western blot. HIV RNA PCR also used for infants of HIV+ moms and indeterminate cases. Viral load # HIV RNA copies/mL; higher → faster CD4 drop, more progression. Best marker of success = undetectable VL (50 copies/mL). CD4 counts Used to stage disease & monitor ART response; test same time of day and same lab. Opportunistic Infections Infection CD4 Features 1st-line Tx Toxoplasma gondii (CNS) 10 0 HA, fever, blurred vision, confusion, imbalance; brain abscesses. Sulfadiazine + pyrimethamine or TMP-SMX. Test for IgG after HIV dx. Pneumocystis jirovecii PNA (PCP) 20 0 Opportunistic pneumonia. TMP-SMX; if sulfa allergy → Dapsone + trimethoprim. Check G6PD before Dapsone (risk hemolytic anemia). Vaccines (HIV) • Use inactivated vaccines only: Hep A, Hep B, annual inactivated flu, pneumococcal, Td/Tdap q10 yrs, HPV if eligible. • Best if CD4 200. Usually given by HIV/ID specialist—coordinate care. PEP vs PrEP (high yield) PEP (Post-Exposure) PrEP (Pre-Exposure) For emergency exposures (occupational, sexual assault, needle sharing). Start ASAP, within 72 hrs, don’t wait for labs if delayed. Use ≥3 ART drugs for 28 days. Baseline labs: HIV rapid & Ab/Ag, HCV RNA, For ongoing high-risk HIV-negative individuals (partner w/ HIV, high-risk sexual behavior). Daily oral regimen; check HIV before start, then q3 months.HBsAg. Reduces transmission 90%. Week 6: Infections and Inflammations Feature Coronavirus (SARS) MERS (Middle East Respiratory Syndrome) Type Coronavirus in humans & animals; cause of emerging infectious disease Previously unknown coronavirus now called MERSCoV Origin Emerged in 2002, Guangdong Province, China Linked to Arabian Peninsula (Saudi Arabia, Qatar, Jordan, UAE) Symptoms - Severe, often fatal pneumonia - Fever, influenza-like illness - Fever, cough, shortness of breath - GI symptoms: diarrhea, nausea, vomiting- Diarrhea, leukopenia, thrombocytopenia, lymphopenia Incubation 4–7 days 2–14 days Complications About 25% develop severe pneumonia → ARDS Most patients also progress to ARDS with multiorgan failure Mortality Up to 50% in older patients & those with comorbidities Mortality approx. 55% Counseling / Prevention Screen travel history; consult infectious disease if needed For travelers → strict handwashing, avoid contact, avoid sharing utensils, disinfect doorknobs • Emerging diseases + COVID intro • SARS symptoms, mortality, ARDS • MERS origin, symptoms, mortality, prevention High-Yield Clues Clue Answer Severe pneumonia + diarrhea + lymphopenia SARS Came from Arabian Peninsula + GI symptoms MERS Both may progress to ARDS with multiorgan failure TRUE Mortality higher in MERS ~55 % One-Sentence Memory Trick SARS kills lungs + low WBC; MERS comes from Middle East + causes GI symptoms + higher mortality. GI & SYSTEMIC INFECTIOUS DISEASES (Overview) Infectious & Traveler’s Diarrhea • Non-inflammatory: Enterotoxin/virus in proximal small bowel; large-volume watery stools (e.g., cholera, viral gastroenteritis). • Inflammatory: Bloody, small-volume stools + fever, severe abd pain, tenesmus; colon involvement (dysentery). • Penetrating: Invasion into wall w/ systemic manifestations (enteric fever, Salmonella typhi).Traveler’s Diarrhea • Usually non-inflammatory, short, fecal-oral (food/water). Common: EAEC/ETEC E. coli; also Campylobacter, Shigella, Salmonella. • Prevention: Avoid untreated water/ice, unpasteurized milk, raw fruits/veg, undercooked meat; drink only sealed/carbonated beverages. • Tx: Oral fluids; Loperamide 4 mg, then 2 mg after each stool (max 16 mg/day). Bismuth subsalicylate 2 tabs q30–60 min (avoid in gout, ASA allergy, renal insufficiency). If needed: Cipro 500 mg BID ×3–5 days or Azithro 500 mg daily ×3 days. Antibiotics not usually for prophylaxis. Vibrio Cholera • Massive watery diarrhea → dehydration, electrolyte imbalance, renal failure, metabolic acidosis. • Think in severe watery diarrhea with rapid volume depletion, esp. if from endemic areas. • Main Tx: Rapid rehydration + electrolyte replacement (IV for severe/hypovolemic shock). Oral fluids as adjunct. Antibiotics as adjunct after rehydration to shorten disease. Clostridioides difficile • Follows broad-spectrum antibiotic use → alters flora → C. diff overgrowth; can cause pseudomembranous colitis. High-risk drugs: fluoroquinolones, clindamycin. • First-line for initial, non-severe: o Fidaxomicin 200 mg BID ×10 days (targets C. diff, less recurrence) o OR Vancomycin 125 mg QID ×10 days o Alternative: Metronidazole 500 mg TID ×10–14 days • Severe/complicated: may need IV Flagyl + rectal vanco, fecal microbiota transplant, or colectomy in toxic megacolon/perforation. • Prevention: Antibiotic stewardship; soap and water (hand sanitizer doesn’t kill spores). Norovirus & General Diarrhea Management • Norovirus = most common cause of self-limited noninflammatory gastroenteritis: diarrhea, N/V, stomach pain, fever, resolves in 2–3 days. • Antibiotics NOT indicated for typical norovirus. • Red flags for bacterial/inflammatory diarrhea: fever, severe abd pain, tenesmus, 6 stools/day, blood/mucus, frail/elderly, immunocompromised → consider stool testing & empiric abx. • Always assess dehydration, chronic illness, HIV status; consider noninfectious causes (hyperthyroid, malignancy, fecal impaction, gynecologic, etc.). UTI’s Overview Key Points Source Most common outpatient infectious disease in adults Management Exam 2 Study Guide 2 40% of women experience at least one UTI in their lifetime Management Exam 2 Study Guide 2 Common pathogens: E. coli, Proteus, Klebsiella, Enterococcus Management Exam 2 Study Guide 2Community-acquired UTIs usually treatable outpatient Management Exam 2 Study Guide 2 UTI TYPE BREAKDOWN Type Definition Symptoms Notes Cystitis (lower UTI) Bladder infection Dysuria, frequency, urgency, suprapubic pain, foul odor, hematuria Most common Pyelonephritis (upper UTI) Kidney infection Flank pain, fever/chills, N/V, CVA tenderness, systemic symptoms Requires urgent treatment Complicated UTI Infection with structural, functional, or comorbid issues May be severe or atypical Examples below Complicated UTI — Who is High Risk? Risk Factors Examples Structural abnormalities Stones, stents, obstruction Functional changes Neurogenic bladder, reflux Comorbidities Diabetes, CKD, immunocompromised Males, pregnancy, children All need special evaluation Diagnostic Evaluation Test Purpose High Yield Urinalysis (UA) Initial screen Leukocyte esterase, nitrites Urine culture Not always needed for simple cystitis; must for pyelo, recurrent, complicated, pregnancy ID organism & resistance Additional tests STI workup if needed Dysuria + discharge may indicate STI TREATMENT 1) Uncomplicated Cystitis First-line agents Notes (from PDF) Nitrofurantoin Common outpatient drug Trimethoprim–sulfamethoxazole (TMP– SMX) Avoid if sulfa allergy Cephalexin or other oral cephalosporins Good if allergy/alternative needed Duration commonly short (3–7 days). 2) Pyelonephritis Action Medication MUST obtain urine culture – Often treat outpatient if stable Fluoroquinolones (e.g., Ciprofloxacin) per PDF If severe/systemic → ED/hospital IV antibiotics 3) Complicated UTI Recommendation Notes Broader antibiotics based on culture Delay culture? Start empiric Address pathology (stones, obstruction) May require imaging Refer or hospitalize if moderate/severe Decision varies by case Pregnancy and UTIs Key Points Source Always treat bacteriuria in pregnancy Prevent pyelonephritisMust obtain urine culture Required Avoid fluoroquinolones & TMP-SMX late trimester Safety consideration (Pregnancy management implied in high-risk category & typical outpatient practice from PDF.) HIGH-YIELD “DON’T MISS” PEARLS Pearl Meaning Dysuria + discharge? Evaluate for STI, not only UTI CVA tenderness + fever Think pyelonephritis, NOT cystitis Recurrent UTIs → get culture Needed due to resistance Immunocompromised? Diabetic? Male? Treat as complicated Hospitalize if toxic, vomiting, septic For IV therapy Prevention & Education Counseling Points Source Hydration & hygiene Management Exam 2 Study Guide 2 Avoid unnecessary antidiarrheals & misuse of meds GI overlap in patient teaching Food safety in immunocompromised patients Applicable to UTI risk Exam Tip Summary (Rapid Fire) • Most UTIs = E. coli • Nitrofurantoin, TMP-SMX, or Cephalexin = common outpatient cystitis treatment • Get a urine culture in: pyelo, recurrent, pregnant, complicated, immunocompromised • CVA tenderness + fever = Pyelonephritis • Pregnancy UTIs always treat • Males = complicated until proven otherwiseDIVERTICULOSIS vs DIVERTICULITIS MASTER CHART Feature Diverticulosis Diverticulitis Definition Presence of diverticula (outpouchings) in colon Inflammation or infection of diverticula Symptoms Often asymptomatic; may have mild LLQ discomfort, changes in bowel habits LLQ abdominal pain, fever, N/V, constipation or diarrhea Complications Risk of bleeding; most people never progress Abscess, perforation, peritonitis, obstruction, fistula Diagnosis Typically found incidentally (screening colonoscopy, imaging) Clinical diagnosis with LLQ pain + systemic symptoms; CT abdomen if severe/complicated Location Most common in sigmoid/descending colon Same area most affected Treatment High-fiber diet, lifestyle management Antibiotics for moderate/severe; bowel rest; fluids Who is at higher risk? Age, low fiber diet Same risks + infection/inflammation present MANAGEMENT PEARLS Topic Key Points Diet High fiber diet recommended for diverticulosis; limit red meat; increase physical activity. Fluids & Motility Poor bowel motility + constipation = higher risk. Encourage hydration & exercise. Complications Diverticulitis can lead to perforation, abscess, or bleeding; can become surgical emergency. Clinical Presentation Diverticulitis symptoms: LLQ abdominal pain, nausea, fever, constipation/diarrhea. Pain increases after meals, decreases after defecation. Diagnosis Consideration Most mild cases diagnosed clinically based on symptoms + risk factors; CT used for severe cases or complications. When to Refer Complicated cases & recurrent episodes may need surgical consultation. TREATMENT SUMMARY Severity Treatment Mild diverticulitis (uncomplicated) Outpatient: bowel rest, diet adjustment, hydration, oral antibiotics Moderate/severe or complicated (fever, persistent pain, comorbid, elderly) Hospital referral → IV fluids + IV antibiotics + CT scan Recurrent or chronic disease Refer to GI or surgery for further evaluation Diverticulosis (no infection) NO antibiotics; lifestyle & diet only RED FLAG SYMPTOMS If present → Hospital evaluation + CT imaging • High fever • Severe abdominal pain • Peritonitis signs (rigidity, guarding, rebound) • Inability to tolerate PO • Immunocompromised or elderly • Suspected abscess or perforation HIGH-YIELD EXAM CLUES Clue Diagnosis LLQ pain + fever + constipation/diarrhea Diverticulitis LLQ pain that improves after bowel movement Diverticulosis (or mild diverticular disease) Found incidentally during screening colonoscopy Diverticulosis Needs antibiotics Diverticulitis ONLYDiet change only Diverticulosis Diverticulosis = pouches, no infection, no antibiotics. Diverticulitis = infected pouches, LLQ pain + antibiotics. Week Seven/ Week Eight Cardiology Part 1/ Part 2 CARDIAC ARRHYTHMIAS Rhythm Key Features (PDF) Symptoms Treatment (PDF) Special HighYield Atrial Fibrillation (A-Fib) Disorganized atrial activity → irregularly irregular rhythm; atria quiver, blood pools, clot risk Palpitations, fatigue, dizziness, SOB; may be asymptomatic Rate or rhythm control + anticoagulation based on stroke risk Cardiovert within 48 hours if unstable or new onset Atrial Flutter Atrial impulses fire rapidly in a circuit → sawtooth pattern Similar to A-fib; may feel less symptomatic Managed similar to A-fib; control HR, consider cardioversion, anticoagulate if risk Regular rhythm but fast atrial rate Sick Sinus Syndrome (SSS) SA node dysfunction → alternating tachycardia + bradycardia, long pauses Dizziness, syncope, palpitations, fatigue Pacemaker for symptomatic SSS Calcium channel blockers may worsen symptoms Sinus Tachycardia HR 100 bpm originating in SA node Anxiety, pain, fever, hyperthyroid Treat underlying cause Normal physiologic response PVCs (Premature Ventricular Contractions) Early beat from ventricle; may be unifocal or multifocal “Skipped beats,” palpitations Address electrolyte imbalance, avoid stimulants Can indicate myocardial irritability A-FIB & FLUTTER: MANAGEMENT & PEARLS RATE vs. RHYTHM CONTROL Strategy When Used Drugs Mentioned in PDF Rate Control Stable patients; chronic management Beta-blockers, calcium channel blockers Rhythm Control New onset, symptomatic, persistent despite rate control Cardioversion (timing important) Cardioversion Rule If onset 48 hours, may cardiovert directly. If 48 hrs or unknown → anticoagulation first. ANTICOAGULATION PEARLS PDF Notes • Anticoagulation is based on stroke risk. • Not every A-fib pt gets anticoagulated. • NOACs are contraindicated in pregnancy. (high yield) SPECIAL ARRHYTHMIA PEARLS Arrhythmia Don’t Forget A-Fib “Irregularly irregular”; can cardiovert 48 hrs if unstable or new A-Flutter “Sawtooth” pattern SSS (Sick Sinus Syndrome) Pacemaker if symptomatic PVCs May be early sign of myocardial irritability NOACs Do NOT use in pregnancy Rate control meds caution In SSS, calcium channel blockers can worsen symptomsWHEN TO SEND TO ED Send to ED if: • Hemodynamic instability (hypotension, altered mental status) • New onset A-fib with symptoms + unable to cardiovert in office • Severe symptoms (syncope, chest pain, severe SOB) • Suspected severe electrolyte imbalance or acute ischemia RHYTHM IDENTIFIERS (Rapid Recognition) Clue Arrhythmia “Irregularly irregular” A-Fib Sawtooth pattern Atrial Flutter Tachy-brady syndrome Sick Sinus Syndrome Early wide beat w/ pause PVC HR 100 due to underlying issue Sinus Tachycardia (not primary arrhythmia) ONE-LINE MEMORY TRICKS A-Fib = chaotic atria → clot risk → anticoagulate by stroke risk. Flutter = sawtooth circuit → treat like A-Fib. SSS = broken SA node → pacemaker only if symptomatic. PVCs = ventricular irritability → check electrolytes & triggers. HEART FAILURE (HFrEF vs HFpEF) MASTER CHART Feature HFrEF HFpEF Name Heart Failure with reduced EF Heart Failure with preserved EF EF Value 40% 40% Former Name Systolic HF Diastolic HF Primary Problem Ventricles cannot pump/eject enough blood Ventricles are stiff and cannot fill Mechanism Weak LV muscle → ↓ contractility Stiff LV wall → ↓ filling capacity Common Cause CAD, MI, dilated cardiomyopathy Long-standing HTN leading to LV hypertrophy Stroke Volume Decreased Normal/near-normal, but poor ventricular filling HFrEF = pump problem. HFpEF = filling problem. LEFT vs. RIGHT HEART FAILURE Side of Heart Key Symptoms Left HF Dyspnea on exertion, orthopnea, PND (night SOB), dry cough, crackles, fatigue Right HF Ascites, JVD, hepatosplenomegaly, N/V, weight gain, LE edema, tachycardia DIAGNOSTICS Test Purpose EKG Assess rhythm complications (A-Fib) Echocardiograph y Determines EF & structure Chest X-Ray Fluid overload BNP Confirms HF severity Labs CBC, CMP, TSH, cardiac enzymesWeight checks Track fluid status HEART FAILURE TREATMENT HFrEF (Systolic 40% EF) Drug Class Medications in PDF ACE Inhibitors For systolic HF ARNI (Preferred) Sacubitril/Valsartan (Entresto) Beta Blockers Metoprolol, Carvedilol, Bisoprolol Diuretics Loop diuretics; Spironolactone Digoxin For symptomatic control Lifestyle ↓ Na intake, exercise, no alcohol/tobacco, flu & pneumonia vaccines Contraindications/Barriers to Entresto Do NOT start if: • SBP 100 mmHg • Serum K+ 5 mmol/L • eGFR 30 mL/min/1.73m2 • History of angioedema When to Send to ED Red Flags • Hemodynamic instability (decompensated HF) • Worsening symptoms needing IV therapy • Severe dyspnea, pulmonary edema • New arrhythmia with instability HIGH-YIELD HF EXAM PEARLS Clue Diagnosis EF 40% + pump issue HFrEF EF 40% + stiff ventricles HFpEF No ACE/ARNI if SBP 100, K+ 5, angioedema Entresto Barrier A-Fib causes ↓ cardiac output HF contributor Weight gain 2–4 lbs/week → adjust diuretics Fluid overload Flu & Pneumonia vaccines HF management Quick Memory Trick HFrEF = Reduced = weak pump. Treat with ACE/ARNI + Beta Blockers + Diuretics. HFpEF = Preserved = stiff ventricle. Manage symptoms + causes (HTN, CAD).Week Nine: Genitourinary and Gastrointestinal Hepatitis Quick Charts Viral Hepatitis Comparison Feature HAV HBV HCV HDV HEV Genetic material RNA DNA RNA RNA RNA Chronic infection No Yes Yes Yes (only w/ HBV) No Transmission Fecaloral Parenteral, sexual, vertical Parenteral Must have HBV Fecal-oral Prevention Vaccine Vaccine No vaccine No vaccine Vaccine outside US Notes Acute only Risk cirrhosis & HCC Screen age 18–79; leading cause cirrhosis & transplant Coinfection causes fulminant hepatitis Occurs in poor sanitation areas Serology Interpretation (HBV) Status HBsAg AntiHBc Anti-HBs IgM anti-HBc Susceptible Immune (vaccine) Immune (prior infection) Acute infection Chronic infection HBeAg indicates active viral replication and infectivity. Key Diagnostic Tests Virus Screening Test What Positive Means Next Step HAV IgM anti-HAV Acute infection & contagion None, supportive care HBV HBsAg Active infection Interpret full panel HCV Anti-HCV Ab Exposure (not immune) Order HCV RNA PCR Treatment Summary Condition Treatment Acute HAV Supportive care, avoid hepatotoxins, hospitalize severe cases Acute HBV Supportive, monitor LFTs q2 weeks Chronic HBV Interferon alfa-2b, nucleoside analogs (Entecavir, Tenofovir) Hepatitis C (HCV) Direct acting antivirals (Mavyret, Harvoni, Epclusa) Drug-induced hepatitis Stop agent; may use N-acetylcysteine for acetaminophen Alcoholic hepatitis Alcohol abstinence, vitamin replacement (parenteral B vitamins) NASH/NAFLD Weight loss, Vit E 400–800 IU, treat hyperlipidemia Autoimmune hepatitis Corticosteroids, Azathioprine (may need transplant)Clinical Presentation Summary Type Notable Findings General/acute viral hepatitis Fever, anorexia, myalgia, nausea, RUQ pain, jaundice Alcoholic Hepatitis Fever, jaundice, leukocytosis, tender hepatomegaly, spider telangiectasia, ascites, encephalopathy Autoimmune Hepatitis Fatigue, malnourished, RUQ pain, arthralgia, diarrhea; often cirrhosis at diagnosis Drug-Induced Hepatitis Fever, rash, eosinophilia (drug hypersensitivity) Common Hepatotoxic Drugs May cause drug-induced liver injury • Antibiotics: Augmentin (most common), Bactrim, Ciprofloxacin, INH • NSAIDs • Green tea extract, anabolic steroids, multi-ingredient supplements • Statins, Amiodarone • Valproate, Phenytoin • Methotrexate MASTER RENAL FAILURE CHART (AKI vs CKD vs ESRD) Feature AKI CKD ESRD Definition Abrupt loss of kidney function within ≤7 days Progressive decline in kidney function End stage; requires renal replacement Key Criteria ↑ Creatinine 0.3 mg/dL in 48 hrs OR 1.5× baseline in 7 days GFR 60 mL/min/1.73m² ≥ 3 months GFR very low, usually no urine output Urine Output 0.5 mL/kg/hr for 6–12 hrs (oliguria) May be normal until late stage Anuria (100 mL/day) Etiologies Volume depletion, hypotension, nephrotoxins, hospitalization DM, HTN, nephrotoxins, autoimmune/inflammatory Final progression of CKD Risk Factors Advanced age, liver disease, diabetes, vascular disease, hospitalization HTN, DM, nephrotoxic medications, recurrent kidney damage Same as CKD; longterm uncontrolled factors Clinical Presentation Sudden confusion, anorexia, N/V, edema, weight gain Few symptoms early; ↓ GFR, ↑ Cr, albuminuria Anuria, uremic symptoms, needs transplant or dialysis Urgent Signs Oliguria or anuria + ↑ creatinine Persistent albuminuria & decreasing GFR Severe metabolic/electrolyte derangement Diagnostics ↑ Creatinine, ↓ urine output, AlbuminCreatinine Ratio, UA, CMP, CBC, renal US Same + ACR preferred method for albuminuria screening (30 mg/g, repeat on morning sample) Labs to monitor electrolytes, anemia, etc. Screening Monitor patients on nephrotoxins or hospitalized ACR (preferred) + eGFR Dialysis monitoring Differential Etiologies Pre-renal: volume loss; Medications:NSAIDs/antibiotics; To xic chemicals, radiation, contrast dye Same + inflammatory & autoimmune Final stage of prior causes Management Remove offending agents/nephrotoxins, correct electrolytes BP control (ACE), HbA1c 7%, protein reduction, smoking cessation Dialysis, transplant When to Refer to Nephrology AKI with oliguria/anuria + ↑ Cr GFR 30 (stage 4–5), albuminuria 300 mg/g, refractory HTN, persistent K+ imbalance, urine RBC 20/hpf, CKD progression ESRD: continue care, dialysis, transplantHospitalization AKI with oliguria/anuria + ↑ Cr; hypotensive crisis; systemic inflammation or sepsis Pulmonary edema, HF exacerbation, acute fluid derangement Required for many cases Complications Volume overload, electrolyte imbalance CV disease, HF, anemia, metabolic issues LV hypertrophy (70% on dialysis have LVH), infection risk, metabolic derangements Immunization/Prevention Avoid nephrotoxins Smoking cessation, early referral, BP & DM control Vaccines: Flu, Pneumonia, Hep B Nutrition — ↓ Protein diet Varies by dialysis type Anemia Management — Consider if chronic RBC transfusion, ESAs HIGH-YIELD TEST PEARLS Topic High-Yield Clue Best screening for albuminuria Albumin/Creatinine Ratio (ACR) — random sample first, repeat in morning if 30 mg/g Most common cause of AKI Hospitalization with reduced perfusion + nephrotoxin exposure Most common AKI causes: medications NSAIDs, antibiotics, antineoplastics, HIV drugs, illicit drugs Dialysis fistula Takes 4–6 weeks to mature Dialysis complications LVH, pulmonary edema, infection, electrolyte imbalances When to hospitalize AKI with oliguria/anuria and electrolyte crisis, sepsis, pulmonary edema, acute HF Parkinson’s Disease + Trigeminal Neuralgia MASTER CHART Feature Parkinson’s Disease Trigeminal Neuralgia Definition Slowly progressive neurodegenerative disease; loss of dopamine receptors in substantia nigra Nerve pain disorder affecting the trigeminal nerve (5th cranial nerve) Cause / Pathology Dopamine depletion in the basal ganglia; loss of smooth purposeful movement Compression of trigeminal nerve root (most common), blood vessel pressure; can be secondary or idiopathic Risk Factors Age 50; men women; genetics; pesticides/cleaning chemicals; heavy metals; concussions; obesity; anemia Aging, aneurysm, AV malformation, tumors, multiple sclerosis, stroke, facial trauma, surgical injury; genetic abnormal blood vessel formation Key Symptoms 3 classic symptoms: tremor (pill rolling, worse at rest), muscular rigidity, bradykinesia; shuffling gait, postural instability; hypophonia, masked facies; cognitive decline, depression, hallucinations Sudden, severe, unilateral electric shock-like facial pain episodes; triggered by chewing, talking, brushing teeth, cold air, smiling; pain lasts seconds–minutes; may have burning/aching Later / Additional Symptoms Difficulty initiating voluntary movement (freezing), festination, decreased arm swing, sleep disturbance Facial muscle spasms; pain-free periods between attacks; progressive worsening Physical Exam Findings Cogwheeling rigidity when flexing/rotating arm; reduced arm swing; flexed posture; pull test for postural reflexes No specific physical test confirms diagnosis; symptoms and history most important Diagnostics Clinical diagnosis (2 of 3: tremor, bradykinesia, rigidity); response to levodopa supports Dx; no standard labs; neuroimaging only to rule out other disorders Clinical diagnosis; MRI may be used to identify vascular compression, MS, tumor First-Line Treatment Carbidopa-Levodopa (Sinemet) for motor symptoms (tremor, rigidity) Carbamazepine (Tegretol), Oxcarbazepine (Trileptal)Other Medications Dopamine agonists (Requip, Mirapex) — risk impulse disorders & hypotension; MAO-B inhibitors (Selegiline, Rasagiline); COMT inhibitors (Entacapone); Anticholinergics (Cogentin) for younger pts Adjuncts: Gabapentin, Lamotrigine, Baclofen; taper meds if pain-free 6–8 weeks Surgical Options Deep brain stimulation Rhizotomy, nerve blocks, or surgery for refractory cases Contraindications / Cautions Don’t stop dopamine agonists abruptly (withdrawal syndrome); anticholinergics avoid in older adults; interaction with SSRIs, MAOIs, TCAs None specified beyond med usage in file Disease Progression Progressive; may develop dementia, psychosis; falling risk May worsen; periods of remission possible Patient Education Fall risk; medication side effects; support groups; speech & physical therapy Avoid triggers; medication adherence; consider taper when symptoms improve Medication Key Pearls Medication Type Key Notes Carbidopa-Levodopa Most effective; don’t stop abruptly; treats tremor + rigidity; dyskinesia risk Dopamine Agonists (Requip, Mirapex) Start low; risk for hallucinations, impulse disorders; can cause orthostatic hypotension MAO-B Inhibitors Avoid with SSRIs, TCAs; side effects: insomnia, confusion in older adults Anticholinergics (Artane, Cogentin) Avoid in elderly; useful for tremors in young patients Carbamazepine/Oxcarbazepine (TN) First-line; slowly taper after sustained improvement Gabapentin/Baclofen (TN) Adjunct options; used when first-line insufficient Hallmark Exam Clues Disease Must Remember Parkinson’s Resting tremor that improves with movement; masked facies; cogwheel rigidity Trigeminal Neuralgia Sudden shock-like unilateral facial pain triggered by touch, chewing, cold HEADACHE MASTER CHART Feature Migraine Tension-Type Headache Cluster Headache Medication Overuse Headache (Rebound) Type Primary Primary Primary Secondary (due to overuse) Key Description Moderate–severe throbbing/pounding headache Tight “band-like” pressure Severe, unilateral, retro-orbital “ice pick” Headache from frequent analgesic use Duration 4–72 hours Minutes to hours 15 min–3 hours (often ~90 min) Persistent headaches Pain Location Ipsilateral; often temporal Bilateral Unilateral behind eye Diffuse Triggers / Aggravating Exercise, stress, foods, light, sound Stress; not worsened by physical activity Often wakes patient up at night, same time daily Frequent NSAIDs/opioids/caffeine combos Associated Symptoms Nausea/vomiting, photophobia, phonophobia; aura may precede Muscle tightness, trapezius spasm; no N/V Ipsilateral tearing, conjunctival injection, rhinorrhea, ptosis, miosis, lacrimation Headache increases when meds wear off Aura Visual scotomas, flashing lights NONE NONE NONE Onset Variable; women men Any age; very common Men 30–40 yrs Chronic headache sufferersAge/Sex Diagnostics Clinical; rule out CVA if severe Clinical MRI recommended initially Clinical history First-Line Treatment Acute: Triptans + NSAIDs (Sumatriptan + Naproxen); antiemetics if vomiting NSAIDs/Acetaminophen; can use Excedrin (caffeine combo) Oxygen 100% (≥12 L/min NRB) + SubQ or intranasal triptan Stop overused medication; limit acute meds Preventive Treatment Beta-blockers, TCAs (Amitriptyline), SNRIs (Effexor), CGRP (Aimovig), Topiramate, Valproate Lifestyle + NSAIDs PRN; avoid triggers Verapamil, Prednisone; alternatives: Topiramate, Valproate, nerve blocks Preventive therapy for underlying headache Emergent Treatment Needs Severe complicated migraine w/ nausea/vomiting → IV antiemetic + nonoral meds Rarely emergent Urgent MRI first diagnosis Consider withdrawal + prevention Avoid Triptans in ischemia, uncontrolled HTN, stroke Opioids Mixing triptans + ergots Using 10 days/month analgesics RED FLAGS: “SNOOP” + Physical Exam Danger Signs Red Flag Category Examples (from file) S – Systemic Fever, chills, weight loss, HIV, cancer N – Neurological Mental status change, seizure, asymmetric reflexes O – Onset Sudden, worst “thunderclap” headache O – Older age New headache ≥ 50 years P – Previous hx First or different headache, worsening pattern Physical Exam Red Flags • Papilledema • Painful temporal arteries • Personality change • “Worst headache ever” • Asymmetry of pupils or reflexes Medication Pearls (by disorder) Medication Used For Notes Sumatriptan + Naproxen (Treximet) Migraine abortion Most effective combo CGRP Antagonists (Nurtec, Ubrelvy) Acute + preventive migraine For triptan contraindications Lasmiditan (Reyvow) Migraine No vasoconstriction — safer for cardiac risks Ergotamine/Caffeine (Cafergot) Migraine DO NOT MIX WITH TRIPTANS Topiramate/Valproate Migraine prevention; Cluster alt Antiseizure meds Verapamil Cluster prevention First-line prophylaxis Prednisone Cluster prevention Used acutely early Oxygen ≥12 L/min Cluster acute First-line! Excedrin / Fioricet Tension But risk MOH warning: limit usage High-Yield Exam Clues Clue Diagnosis “Ice-pick pain” + tearing, rhinorrhea, ptosis Cluster Pulsating + N/V + photophobia Migraine Headache with stress, no N/V, “tight band” Tension Headache worsens when meds wear off Medication OveruseNew headache age 50 + jaw pain + visual changes Think Temporal Arteritis workup (from PMR section) AUTOIMMUNE MASTER CHART Feature SLE (Systemic Lupus) Rheumatoid Arthritis (RA) Polymyalgia Rheumatica (PMR) Temporal Arteritis / Giant Cell Arteritis (GCA) Fibromyalgia (FMS) Type Multisystem autoimmune disease Systemic autoimmune inflammatory arthritis Chronic systemic inflammatory condition Vasculitis of large & medium vessels Chronic pain syndrome (not inflammatory) Key Patho Autoantibodies form immune complexes → tissue inflammation (skin, kidneys, heart, vessels) Synovial inflammation → pannus → joint destruction Inflammatory arthritis, nonerosive; associated w/ GCA Vessel inflammation → stenosis, aneurysm, ischemia CNS dysfunction → amplified pain signals Common Population Women (childbearing age); ↑ in African American & Hispanic women Women; ↑ with age Age ≥50 (peak 70–79); women men Average age ~70 More common in females Major Symptoms Fatigue, fever, weight loss, anemia, lymphadenopathy; malar rash; discoid rash Bilateral & symmetric joint swelling, warmth, stiffness ≥1 hour; systemic fatigue Severe morning stiffness; aching in shoulders & hips; difficulty dressing/getting up Severe unilateral headache, scalp tenderness, ja w claudication, visual changes Widespread musculoskeletal pain, fatigue, nonrestorative sleep, headaches, IBS Specific Signs Photosensitive “butterfly” rash; discoid lesions Swan neck, boutonniere deformity; rheumatoid nodules “Gel phenomenon” (severe stiffness after rest) Tender, cordlike temporal artery; risk of blindness ≥6 pain sites; extreme fatigue; normal labs ExtraRenal/Orgs Nephritis (proteinuria, RBC casts) Pericarditis, uveitis, scleritis, vasculitis Systemic symptoms possible Vision loss, stroke risk Mood issues, memory issues Key Labs +ANA; anti–dsDNA + antiSmith specific; CBC abnormalities; ↑ESR/CRP; urinalysis protein/casts ↑ESR/CRP; +RF, +Anti-CCP (very specific); anemia ↑ESR & CRP; normal RF, ANA, anti-CCP ↑ESR & CRP; biopsy gold standard Normal labs (CBC, ESR/CRP, thyroid). Diagnosis based on symptoms Special Labs Antiphospholipid antibodies (risk thrombosis, fetal loss) Check CV risk; check for TB before biologics — Liver enzymes may be ↑ Do NOT order ANA/RF unless symptoms of SLE/RA Treatment NSAIDs, Early rheumatology Steroids High-dose Amitriptyline,steroids, Hydroxychloroquine, Methotrexate, anticoagulants, biologics referral; DMARDs (MTX, HCQ); NSAIDs; steroids; Anti-TNF biologics (rapid improvement) steroids immediately!; +/- MTX or Tocilizumab for steroidsparing SSRIs/SNRIs, Cyclobenzaprine, Pregabalin, Gabapentin Must Avoid / Caution Methotrexate contraindicated in pregnancy Avoid biologics in infection; screen TB first Risk for GCA (educate patients on symptoms) Delay → bilateral blindness Avoid opioids, NSAIDs not effective Referral Rheumatology; nephrology for renal Ophthalmology for uveitis; surgery for deformities Rheumatology if unclear Rheumatology + Ophthalmolog y or ED urgently Psych, Rheum, Pain Mgmt if needed Unique Pearl Antiphospholipid syndrome → clots + miscarriages Rheumatoid nodules; hand deformities Very high risk for GCA development Temporal artery biopsy gold standard Pain without inflammation; labs normal Medication Pearls ONLY from Your File Medication Used For Key Notes Hydroxychloroquine (Plaquenil) SLE & RA May require eye exams (risk retinal damage) Methotrexate (MTX) SLE, RA, PMR (steroid-sparing), GCA (steroid-sparing) Do NOT use in pregnancy; give folic acid 1 mg daily Biologics / anti-TNF (Humira, Enbrel, Remicade) RA Check TB before starting; ↑ risk infection, squamous cell cancer, lymphoma Tocilizumab (TCZ) GCA steroid-sparing Used for high-risk or adverse steroid effects Steroids (High Dose) PMR, GCA, severe SLE Must start IMMEDIATELY in suspected GCA Anticoagulation Lupus w/ antiphospholipid syndrome Prevent thrombosis Amitriptyline, Duloxetine, Pregabalin, Cyclobenzaprine Fibromyalgia Helps pain, mood, and sleep HIGH-YIELD EXAM CLUES Clue Disorder “Butterfly rash + proteinuria + anemia” SLE “Morning stiffness 1 hour + symmetric swollen joints” RA “Older patient can’t lift arms to dress + high ESR” PMR “Unilateral headache + jaw claudication + risk blindness” Temporal Arteritis (GCA) “Pain everywhere but labs normal, sleep problems, IBS” Fibromyalgia DERMATOLOGY MASTER CHART Condition Key Features Population Notes Diagnosis Treatment (from file) Pearls Acne Vulgaris Comedones, papules, pustules, nodules; scarring with squeezing Pomade acne common in African Americans (hair products) Clinical; evaluate type, severity Normalize keratinization, ↓ sebum, ↓ P. acnes; varies by severity Post-inflammatory hyperpigmentation common in darker skin Seborrheic Dermatitis Greasy, scaling plaques; erythematous or hypo/hyperpigmented in dark skin Common in immunocompromised; cradle cap infants KOH prep to rule fungus Adjust to hairgrooming practices; topical agents Color differences make it subtle in darker skin Psoriasis Well-demarcated Young adulthood; linked Clinical Topical steroids (higher In dark skin →plaques w/ silvery scale; may affect scalp, knees, elbows to arthritis & CV disease potency on extender surfaces), retinoids, UVB, emollients, biologics for severe violet plaques, gray scale; risk dyspigmentation Atopic Dermatitis (Eczema) Chronic pruritic rash; flexural folds; lichenification; hyperpigmentation in dark skin Associated w/ asthma, allergic rhinitis Clinical Topical steroids + emollients; antihistamines if severe itch Appears “bumpy” in dark skin; dyspigmentation risk Contact Dermatitis Bright red pruritic rash after irritant/allergen exposure Under-recognized in darker skin History + exam Identify & remove irritant; topical steroids 1–2 weeks; antihistamines; oatmeal/calamine Systemic steroids if severe (gradual taper) Tinea (Fungal) Tan/white or brown/black lesions in skin of color Tinea versicolor: nonpruritic hypopigmented macules on trunk KOH prep; fungal culture Antifungals (not specified beyond test in file) May lack redness in dark skin Rosacea Flushing, papules/pustules, telangiectasia; can mimic acne but no comedones Harder to see erythema in darker skin Clinical Metronidazole gel/cream, azelaic acid, sulfacetamide cleanser, OCPs/beta blockers/clonidine (off label), oral tetracyclines; isotretinoin per derm Eye involvement → refer ophthalmology immediately Alopecia Hair loss; scarring vs. non-scarring; pattern varies Central Centrifugal Cicatricial Alopecia common in African American women; traction alopecia Scalp exam + “hair pull” Minoxidil; Finasteride (Pregnancy X); treat underlying cause Traction alopecia requires hair practice education SKIN CANCER MASTER MINI-CHART Type Key Features Risk Factors Treatment Notes Melanoma Dark, changing, irregular lesions; ABCDE Fair skin, dysplastic nevi, 50 nevi; men 50 Biopsy; check non–sun-exposed areas in skin of color (palms, soles, nails) Basal Cell Carcinoma Pearly/waxy; ulcerated center; bleeds easily; may be dark in skin of color Severe sunburns Biopsy; often translucent or glossy black in Asian/dark skin Squamous Cell Carcinoma Rough, scaly, non-healing lesion; may mimic psoriasis/eczema in dark skin Most common skin cancer in Blacks and Indians (non–sunexposed sites) Biopsy; attention to lower extremities, genital area, scalp Actinic Keratosis Dry, scaly, red lesions; sun-exposed; precancerous for SCC Fair-skinned, older Cryotherapy, curettage, chemical peel Seborrheic Keratosis “Stuck-on” wart-like papules; painless; middle age Common in dark skin (Dermatosis Papulosa Nigra) Cryotherapy, curettage, electrosurgery Vehicle Selection Cheat Sheet Vehicle Best Use Notes Ointment Thick plaques (psoriasis) Most potent; avoid hairy areas Cream Mild inflammatory lesions Less potent Lotion Moist, pruritic, large areas “Cooling effect” Gel Hairy areas Transparent; good absorptionHIGH-YIELD DERM EXAM CLUES Clue Likely Condition Hypopigmented trunk macules, non-pruritic Tinea versicolor Violet plaques w/ gray scale Psoriasis in dark skin Flushing + papules but no comedones Rosacea Papules worsen with hair products Pomade Acne “Stuck on” papules, dark, small on face Seborrheic Keratosis (DPN variant) Scaly non-healing lesion that bleeds SCC Pearly ulcerated lesion BCC