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contraceptives, monthly prego testing, only prescribe 1 month supply. Acne Rosacea-chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAMImpetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM
Scarlet fever (Scarlantina)- “sandpaper textured-pink rash with sore throat” strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAMLICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE.INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM Spider bite: fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, txlike cellulitis of the skin, abx ointment at first, watch etc. Exam Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feetthink to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM HEAD/EARS/EYES/NOSE/THROATHerpes keratitis-fluorescein dye “fern like” CN V. Abrupt onset of pain. Corneal Abrasions- Round/Irregular. Was on EXAM. Acute Angle-closureglaucoma- acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM Primary OpenAngle Glaucoma- CN2 gradual changes in peripheral vision LOST FIRST, then second central vision. Cataracts is on EXAM in elderly night vision issues. OpaqueEXAMAge-Related Macular Degeneration – Painless loss of “central vision” reports straightlines appear curved. Periphery is preserved. Give asmler grid.
Retinal Detachment- Floaters, curtain, flashes of light. Painless. EXAMCholesteatoma- cauliflower, foul-smell, hearing loss. If erodes bones in face afects CN VII. SURGERY Canker sores- Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash. Papilledema-optic disc swollen w/ blurred edges due to increased ICP. EXAMHypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). RetinalHemorrhages. EXAMDiabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED Koplik Spots- “clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars”. Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAMSensorineural:Lateralization to good ear. Rinne- AC > BC. Conductive: Lateralization to bad ear. Rinne- BC > AC. Rinne (1stmastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAMHordeolum- painfulswollen red warm abscess TREAT hot compress erythromycin, dicloxacillin.
Acute Otitis Media- middle ear. Usually S. pneumo. (others: h influ, mor catarrhalis). Popping, muffled, afebrile or low-grade, TM can rupture blood and pus on pillow on awakening with relief of ear pain. “erythematous TM” bulging or retracting.