Leik’s Exam Tips + My Extra Good Stuff

Medication 1) Aspirin irreversibly suppresses platelet function for up to 7 days (due to irreversible acetylation). 2) Discontinue ASA if patient complains of tinnitus (possible aspirin toxicity). 3) For chronic use, the recommended dose is 81 mg/day (some exceptions exist). 4) Aspirin given post-MI or after a stroke/TIA is considered tertiary prevention. 5) Avoid using in children with viral infections who are less than 16 years of age (Reye’s syndrome). 1) Memorize the FDA category and dose of finasteride (Proscar 5 mg PO once a day). Finasteride is also a teratogen. Cat X medication 2) Accutane is a potent teratogen. Reproductive-aged females must use 2 reliable forms of birth control and must have a negative pregnancy test 1 month before, during, and 1 month after Accutane. 3) High-dose vitamin A is teratogenic in animal studies—avoid “mega-doses” of vitamins in pregnancy. 4) Avoid mixing warfarin with sulfa drugs—can increase INR and bleeding risk. HEENT ■Treatment for otitis externa is Cortisporin Otic drops. ■ Otitis externa’s common bacterial pathogen is Pseudomonas. ■ Ruptured spleen is a catastrophic event. Avoid contact sports (i.e., 4 weeks) until ultrasound documents resolution. ■ Betimol (timolol) which is an eye drop used for glaucoma, has the same contraindications as oral beta blockers. ■ Cholesteatoma, periorbital sinusitis complication which can cause hearing loss in the affected ear and is a “cauliflower like growth” accompanied by foul smelling discharge. Patient will have history of chronic otitis media. TM not visible due to tumor. Refer to ENT. ■ Do not use amoxicillin if used in the past 3 months. Advance to second-line antibiotics such as Augmentin which is a beta lactam or Ceftin. ■ Penicillin-allergic patients, use macrolides, sulfas (avoid cephalosporins, especially if had Class I reaction or anaphylaxis from penicillins). ■ Learn to recognize a description of eye findings such as pinguecula, pterygium, chalazion. Pinguecula: yellow, triangular thickening of the bulbar conjunctiva (skin covering eyeball). Caused by UV light damage to collagen. Pterygium: yellow, triangular (wedge-shaped) thickening of the conjunctiva that extends to the cornea on the nasal or temporal cornea. UV damage, chronic sun exposure – benign – can be red and inflamed at times. Chalazion: chronic inflammation of the Meibomian gland of the eyelids (classic case: complains of gradual onset of a small superficial nodule that is discrete and moveable on the upper eyelid that feel like a bead, painless, can slowly enlarge over time.) ■ Rinne test result of BC greater than AC with conductive hearing loss (i.e., cerumenosis, AOM). NORMAL IS AC>BC which means the patient hears longer in front of the ear rather than over the mastoid. ■ Weber test result is lateralization to the “bad” or affected ear with conductive hearing loss. NORMAL IS NO LATERALIZATION. ■ Weber or Rinne are testing the acoustic or CN 8. ■ Lateralization on the Weber exam is an abnormal finding. ■ Normal finding in Rinne test is air conduction that lasts longer than bone conduction (AC greater than BC). ■ Remember what 20/40 vision means: patient can see at 20 feet what a person with normal vision can see at 40 feet. ■ Carbamide peroxide (similar to hydrogen peroxide) is one of the most common OTC treatments for cerumenosis.