Cerebri meningitis Headache subsequent to head trauma Intracranial hemorrhage Subdural hematoma Epidural hematoma Post-traumatic headache Neuroimaging of skull and possibly cervical spine Source: Clinch,C.R.(2001). Evaluations of Acute Headaches in Adults. Am Fam Physician, 63(4),685-693. Treatment Migraine Cluster Tension Acute Medications 1st line: Ibuprofen, ASA, Naproxen, Acetaminophen 2nd line: Triptans, antiemetics (for nausea) 3rd line: Naproxen+Triptan 4th line: Combination analgesics Triptans 100% oxygen Ibuprofen, or ASA, or Naproxen, or Acetaminophen Prophylactic Medications 1st line: B-blocker or TCA 2nd line: Topiramate, Candesartan, Gabapentin 1st line: Verapamil 2nd line: Lithium 1st line: TCA 2nd line: Mirtazapine, Venlafaxine Source: Top Optimized Practice. (2012). Summary Guideline For Management of Primary Headache in Adults. Edmonton, AB: Toward Optimized Practice. t
Pain Neuropathic Pain Starting dose Maintenance dose FIRST LINE TCAs 10-25mg/day; increase by 10mg q1week 50-150mg/day Gabapentinoids Pregabalin 75-150mg/day; increase by 50-150mg q1week 150-300mg BID Gabapentin 300mg/day; increase by 300mg q1week 300-1200mg TID SECOND LINE SNRIs Venlafaxine 37.5mg/day; increase by 37.5mg q1wk 150-225mg/d Duloxetine 60mg/day 60-120mg/d Topical Lidocaine 5% patches or gel applied to painful area x 12h LINE Tramadol 50mg/day; increase by 50mg q1wk 50-150mg QID Opioids Morphine 15mg q12h q12h Oxycodone 10mg q12h 20-60mg q12h Fentanyl 25mcg/h patch 25-100mcg/h patch FOURTH LINE Cannabinoids Methadone
Red Eye Conjunctivits History Symptoms Treamtent Allergic Atopy or allergies Itching, rhinitis Bilateral watery eyes, papillae Cool compression, oral/ topical antihistamine, artificial tears Bacterial Burning, tearing, foreign body sensation, mild photophobia, blurry vision Purulent discharge, papillae, “may progress to periorbital cellulitis” Topical antibiotic x1 week Gonococcal/ Chlamydia Sexual contact, possible vertical transmission in neonates Chronic, unilateral conjunctivitis not responsive to drops. Tearing, foreign body sensation. LUTS +new sexual partner Mucoid discharge. Follicles Treat for both gonococcal and chlamydial infection. Ceftriaxone=1g IM once AND azithromycin 1g PO +/- topical abc. Ophthalmology referral Viral (adenovirus most common) Sick contact Recent URTI, burning, itching, foreign body sensation. Mild photophobia. Typically affects one eye first, with spread to other eye after a few days Clear mucoid discharge. Follicles. Tender pre-auricular lymphadenopathy Self-limiting (resolves in 2-3 weeks). Contagious for weeks after sx onset. Cold warm compresses. Artificial tears. Proper hand hygiene
Smoking Cessation Medications Medication Dosing Adverse Effects NICOTINE REPLACEMENT THERAPY Gum 1st cigarette ≤30 minutes after waking: 4mg 1st cigarette >30 minutes after waking: 2mg Weeks 1-6: 1 piece q1-2 hours Weeks 7-9: 1 piece q2-4 hours Weeks 10-12: 1 piece q4-8 hours Maximum 24 pieces/day 24 pieces/day and park Chew and pa Chew and park soreness Hiccups Dyspepsia Hypersalivation Effects associated with incorrect chewing technique: Lightheadedness Nausea/vomiting Throat and mouth irritation Lozenge 1st cigarette ≤30 minutes after waking: 4mg 1st cigarette >30 minutes after waking: 2 mg Weeks 1–6: 1 lozenge q1–2 hours Weeks 7–9: 1 lozenge q2–4 hours Weeks 10–12: 1 lozenge q4–8 hours Maximum, 20 lozenges/day Maximum, 20 lozenges/day Nausea Hiccups Cough Heartburn Headache Flatulence Insomnia Transdermal >10 cigarettes/day: -21 mg/day x 4 -14 mg/day x 2 weeks -7 mg/day x 2 ≤10 cigarettes/day: -14 mg/day x 6 -7 mg/day x 2 weeks - skin reactions (erythema, pruritus, burning) - Headache - Sleep disturbances (insomnia, abnormal/vivid dreams): associated with nocturnal nicotine absorption *May wear patch for 16 hours if patient experiences sleep disturbances (remove at bedtime) Nasal Spray 1–2 doses/hour (8–40 *One dose = 2 sprays (one in each nostril) - Maximum: 5 doses/hour or 40 doses/day - Duration: 3–6 months Duration: Nasal and/or throat irritation (hot, peppery, or burning sensation) Rhinitis Tearing Sneezing - Cough Headache
Depot medroxy- progesterone acetate (DMPA) (IM progesterone injection every 12-13 weeks) Effectiveness (99.7% - perfect use, 97% - typical use) ↓ menstrual flow or Amenorrhea ↓ risk of endometrial cancer ↓ endometriosis symptoms ↓ PMS and chronic pelvic pain symptoms ↓ Seizures Possible ↓ risk of PID and sickle-cell crises 6-day “window of forgiveness” Irregular bleeding Delayed return of fertility Headache, ↓ libido, nausea, breast tenderness, weight gain, mood effects Weight gain ↓ Bone mineral density Copper Intrauterine Device (5 years) Effectiveness (99.4% - perfect use, 99.2% - typical use) Possible ↓ risk of endometrial cancer Can be used as emergency contraception Irregular bleeding ↑Menstrual flow Dysmenorrhea Perforation Expulsion Increased risk of PID for first 20 days Hormonal Intrauterine Device (5 years) Effectiveness (99.9% - perfect use, 99.9% - typical use) ↓ Menstrual flow/ Amenorrhea ↓ dysmenorrhea May protect against endometrial hyperplasia Irregular bleeding Systemic hormonal side effects Functional cysts Perforation Expulsion Increased risk of PID for first 20 days Male Condom use) Effectiveness (98%- perfect use, 85% - typical use) Protects against STIs No prescription required Female Condon use) Effectiveness (95%- perfect use, 79% - typical use) Same as male condom Female controlled Can be during intercourse Can be difficult to insert Can cause discomfort during intercourse Diaphragm (one-time use) Effectiveness (94%- perfect use, 84% - typical use) Some protection against STIs Can be used during menses Can be difficult to insert Must be left in for 6 after intercourse Must be used with spermicide Does not protect against HIV or spermicide allergy Must be fitted by health care provider May ↑ risk of UTI,
Sponge (one-time use) Effectiveness (Nulliparous: 91% - perfect use, 84% - typical use; Parous: 80% - perfect use, 68% - typical use) One size fits all No prescription required Can be difficult to insert and remove Must be left in 6 hours after intercourse Possible spermicide sensitivity Should not be used during menstruation Less effective in multiparous women Fertility Awareness and Symptothermal Method Effectiveness (91-99% - perfect use, 80% - typical use) Greater awareness of gynaecological health High probability of failure if not used consistently and correctly Lactational Amenorrhea Method Effectiveness 98% Menses must have not returned Must be fully breastfeeding Baby must be < 6 months of age Abstinence Effectiveness 100% No STI risk if no exchange of body fluids May be too restrictive for some couples Can frustration Does not encourage use of other methods of contraception, if behaviour changes Source: Fisher, W.A., Black, A (March 27, 2007). . CMAJ. 176(7), 953-961.(http:// www.cmaj.ca/content/176/7/953.full.pdf)
Cefprozil 30mg/kg/d divided BID x10-14d Bacterial Conjunctivitis S. aureus S. pneumoniae H. influenza M. catarrhalis Erythromycin 0.5 ointment 1/2 inch QID x5-7 day Contact lens users: Ciprofloxacin 0.3% drops 1-2 dr Urinary Tract Infection E.coli S. saprophyticus gram –ve bacilli TMP/SMX 1DS tab BID x 3 days Nitrofurantoin 100mg BID x 5 days (CI in pregnancy after 36wk) Cephalexin 250-500 mg QID x 7 days (if pregnant) Pyelonephritis E. coli K. pneumonia P. mirabilis Ciprofloxacin 500mg BID x 7 days Urethritis N. gonorrhea C. trachomatis Ceftriaxone 250mg IM x 1 AND Azithromycin 1g PO once Bacterial Vaginosis Overgrowth of: G. vaginalis M. hominis Anaerobes Metronidazole 500mg BID PO x 7 days Peptic Ulcer Disease (non- NSAID) H. pylori “HP-PAC” BID x7d P: PPI (eg. omeprazole 20mg BID x 7d) A: Amoxicillin 1000mg BID x 7 d C: Clarithromycin 500mg BID x 7d
Developmental Milestones Age Gross Motor Fine Motor Language Social/Cognition 1 month Lifts head to 45 degrees Follow to midline Startles to loud noise Smiles spontaneously 2 months head up when on stomach Follows past midline Coos (gurgly sounds), squeals, laughs Smiles responsively, recognizes caregivers 6 months Sits without support, rolls from back to side Transfers between hands Babbles, uses dada/ mama non specifically Feeds self, stranger anxiety 9 months Pulls to stand Thumb-finger grasp, bangs 2 cubes held in hand Uses dada/mama specifically bye, plays pat-a-cake, indicates wants 12 months Stands alone, walks Puts block in cup, scribbles 2-3 Imitates activity, play ball 18 months Walks up steps, kicks ball Builds tower of 4 cubes Combines speech half understandable Wash and dry hands, brush teeth with help 2 years Jumps, throws ball overhand Builds tower of 6 cubes Knows 6 body parts, names 1 picture friend, puts on clothing Sources: Dash M, Arnold A. Guide to the Canadian Family Medicine Examination. New York, NY: McGraw-Hill Education; 2013. Frankenburg, W.K., et al.: The DENVER II: A major revision and restandardization of the Denver Developmental Screening Test.Pediatrics, 89:91-97, 1992 Frankenburg, W.K., et al.: The DENVER II Technical Manual 1996, Denver Developmental Materials, Denver, Co. Rourke, L., Leduc, D., Rourke, J. (2014). Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance. Retrieved fr
Dermatology Glossary Term Characteristics Diameter Example Macule Flat, non-palpable, change in of skin <1cm Freckles Patch Flat, non-palpable, change in color of skin >1cm Vitiligo Papule Solid raised lesion, well circumscribed <1cm Nevi Plaque raised lesion, well circumscribed, superficial, may be flat topped or rounded >1cm Psoriasis Nodule Solid palpable lesion, height>width, appreciable depth. <1cm Dermatofibroma Tumour Usually found in dermal or subcutaneous tissue and the lesion may be above level with or below the skin surface >1cm Lipoma Vesicle Raised, pus-filled lesion <1cm HSV Bulla Raised, pus-filled lesion >1cm Burns Pustule Raised, pus-filled lesion <1cm Pustullar psoriasis (Hive/ Urticaria) Transient, circumscribed elevated papules or plaques often with erythematous borders and pale centres. Often pruritic, formed by edema in the dermis Allergic reaction Erosion Superficial break in the skin due to loss of part or all of the epidermis; heals without scarring Ulcer Loss of epidermis and at least part of dermis; heals with scarring Fissure Break in the skin extending from epidermis to dermis Telegiectasia Foci of visibly dilated capillaries Rosacea Purpura Red or purple macule or patch that is non-blancheable; area of hemorrhage Coagulopathies Lichenification Diffuse thickening of the epidermis, accentuating normal skin markings Eczema Crust Dried exudate of serum, pus or blood originating from a lesion Impetigo Scales A dry build-up of dead skin cells Psorasis Atrophy Thinning of the skin Chronic sun exposure Source: MacNeal, RJ. (2015). Description of Skin Lesions 62 dermatologic-disorders/approach-to-the-dermatologic-patient/description-of-skin-lesions)