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Family Medicine

o More in obese
o diagnosed by ambulatory 24-pH monitoring.
o Upper endoscopy with biopsy is the appropriate next step in a patient with refractory
GERD or severe symptoms such as dysphagia, odynophagia, or gastrointestinal
 Home health care = less than 24 hr care needed
 Assisted Living Facility or nursing home = 24 hr care
 OSHA must be notified of any workplace injury or death.
 DTRs
o C5 = biceps tendon
o C6 = brachioradialis
o C7 = triceps
o C8 = no DTR
 Allergic Rhinosinusitis
o Fall = ragweed
o Spring = grass pollen and tree pollen (rose fever)
o High humidity = mold or house dust mites
 Otitis Externa + Diabetic = Pseudomonas
o Malignant otitis externa
o Can also be swimmers or immunocompromised
o Dx: Brain CT or MRI (r/o extension into brain)
o Tx: Abx + surgical debridement
 Lead poisoning (old home, poor living, chipped pain, battery factory) + anemia = Sideroblastic
o INH, alcohol, and chloramphenicol can also cause sideroblastic anemia
 Patients with type 2 diabetes mellitus should be screened yearly with eye exam, foot exam, and
microalbuminuria screen
 High altitude sickness
o Prevention = Acetazolamide
o Acute treatment w/o severe symptoms = Acetazolamide
o Cerebral or Pulmonary edema (severe symptoms) = Dexamethasone + hyperbaric O2
 Lateral C-spine signs
o Sail sign = thymus gland
o Steeple sign = croup
o Thumbprint sign = epiglottitis (tx with ceftriaxone > ampicillin)
 Spondyloarthropathies
o Syndesmophytes = bony growths inside ligaments leading to fusion = AS
o Osteophytes = DJD = OA
o Enthesophytes = bony growths at attachment sides of ligaments = chronin tendinopathy
 It is possible for EBV to cause mild transient thrombocytosis.
 An MRI of the elbow can help confirm the diagnosis of a distal biceps tendon rupture.
 Corneal Abrasion
o Post-op complication of anesthesia
o Dx: slit lamp exam
o Tx: Erythromycin ointment (not eye patches)
 NSAIDs are contraindicated in pregnancy.
 Burning sensation in feet + worse at night = DM polyneuropathy
 Nikolsky's sign = toxic epidermal necrolysis and is associated with pemphigus vulgaris.
o pemphigus vulgaris (positive) and bullous pemphigoid (negative)
o bullous pemphigoid require steroids for 6-60 months