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FM OSPE

Apr 01, 20255 min read

15M - 1H

OSBE

Lina Serhan

1. Dermatological Conditions

1.1 Tinea Capitis

  • Diagnosis: Tinea Capitis
  • Treatment: Oral terbinafine 250mg/day for 1.2-3 months

1.2 Tinea Pedis

  • Diagnosis: Tinea Pedis
  • Treatment: Local antifungal for 3 weeks
  • Common to see in which patient?: Diabetic

1.3 Tinea Cruris

  • Diagnosis: Tinea Cruris
  • Treatment: Topical antifungal twice daily for 3 weeks; apply 2 cm beyond the lesion

1.4 Tinea Unguium

  • Diagnosis: Tinea Unguium
  • Treatment: Oral terbinafine 250mg/day for 1.2-3 months

1.5 Tinea Versicolor (Hypopigmented Type)

  • Diagnosis: Tinea Versicolor (Hypopigmented Type)
  • Treatment: Topical antifungal twice daily for 3 weeks; apply 2 cm beyond the lesion

1.6 Acne Vulgaris

  • Diagnosis: Acne Vulgaris
  • Treatment:
    • Topical Retinoid
    • Topical Antibiotic
    • Oral Erythromycin 250 mg/day 4 times for 3 months

1.8 Herpes Zoster

  • Diagnosis: Herpes Zoster
  • Treatment: Acyclovir 800 mg/day 5 times for 7-10 days
  • Most common complication?: Post herpetic neuralgia

1.9 Herpes Simplex

  • Diagnosis: Herpes Simplex
  • Treatment:
    • Topical analgesic (in children)
    • Acyclovir 200 mg/day 5 times for 5 days

1.10 Varicella (Chicken Pox)

  • Diagnosis: Varicella (Chicken Pox)
  • Treatment:
    • Symptomatic treatment; can use permanganate 1/8000 to dry the vesicles
    • Paracetamol 15 mg/kg/dose every 6 hours for the first 2 days, then as needed

1.11 Verruca Valgaris (Wart)

  • Diagnosis: Verruca Valgaris (Wart)
  • Treatment: Salicylic acid

1.12 Molluscum Contagiosum

  • Diagnosis: Molluscum Contagiosum (characterized by central umbilication)
  • Treatment: Cryotherapy

1.13 Pityriasis Rosea

  • Diagnosis: Pityriasis Rosea
  • Treatment: Symptomatic Antihistamine and topical steroid
  • How did you know?: Herald patch

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1.14 Impetigo

  • Diagnosis: Impetigo
  • Treatment: Topical antibiotic 2 times a day for 7-10 days

1.15 Scarlet Fever

  • Diagnosis: Scarlet Fever
  • Treatment: Amoxicillin 50-100 mg/kg/day 3 times for 7-10 days

1.16 Erysipelas

  • Diagnosis: Erysipelas
  • Treatment:
    • Diabetic: 2nd - 3rd generation cephalosporin; may need hospitalization for IV antibiotics
    • Non-diabetic: 1st generation

1.17 Atopic Dermatitis

  • Diagnosis: Atopic Dermatitis
  • Treatment:
    • Topical corticosteroids
    • Emollient

1.18 Napkin Contact Dermatitis

  • Diagnosis: Napkin Contact Dermatitis
  • Treatment:
    • Drying
    • Topical corticosteroids

1.19 Napkin Candidiasis

  • Diagnosis: Napkin Candidiasis
  • Treatment:
    • Drying
    • Topical antifungal

1.20 Scabies

  • Diagnosis: Scabies
  • Treatment:
    • Permethrin 1%; repeat after 7 days
  • How did you know?:
    • Burrows
    • Interdigits
    • Pleomorphic lesions

1.21 Pediculosis

  • Diagnosis: Pediculosis
  • Treatment:
    • Permethrin 1%; repeat after 7 days

1.22 Acanthosis Nigricans

  • In Dyslipidemic Patients using Statins for a Long Time:
    • Arcus Senilis
    • Xanthelasma
    • Tendon Xanthoma

  • In Diabetic Patients:

2. Musculoskeletal Conditions

2.1 Spondylolisthesis

  • Diagnosis: Osteoarthritis

Osteoarthritis

  • Signs:
    • Narrowing the space of joint
    • Bone erosion
    • Subchondral sclerosis
    • Osteophyte formation

DiseaseWBCsCrystals/Polarization
DJD<2,000Negative traumatic
Inflammatory5,000-50,000Gout: needle-shaped, negative birefringent
Pseudogout (CPPD): Rhomboid-shaped, positive birefringent
Septic>50,000Negative (Gram stain and culture usually negative for GC but positive in Staph, strep, and gram-negative)

3. Contraceptive Methods

3.1 IUD

  • Contraindications:
    • Active PID
    • Uterine anatomical abnormality
    • STD

3.2 Progesterone Only Contraceptive Pills

  • Non-contraceptive Benefits:
    • Safe in lactation
    • Reduce PID
    • Reduction of heavy menstrual bleeding
    • No drug interactions

3.3 Combined Oral Contraceptive Pills

  • Non-contraceptive Benefits:
    • Menorrhagia and dysmenorrhea
    • PMS
    • Hyperandrogenism
  • Contraindications:
    • Headache with Aura
    • Hypertension
    • Ischemic heart disease

3.4 Progesterone Only DMPA Injection

  • Non-contraceptive Benefits:
    • Reduce heavy menstrual bleeding
    • Reduce PID
    • Reduction of Sickle cell crisis
    • Lack of drug interactions

3.5 Cervical Cap

  • Advantages:
    • Without prescription
    • Protection from STD
    • Safe during lactation
  • Disadvantages:
    • High risk of urethral infection
    • Loss of sensation
    • Breakage

3.6 Male Condom

  • Advantages:
    • Without prescription
    • Protection from STD
    • Safe during lactation
  • Disadvantages:
    • High risk of urethral infection
    • Loss of sensation
    • Breakage

4. ENT Conditions

4.1 Bacterial Tonsillitis

  • Diagnosis: Bacterial Tonsillitis
  • Treatment: Amoxicillin 50-100 mg/kg/day 3 times for 7-10 days

4.2 Viral Tonsillitis

  • Diagnosis: Viral Tonsillitis
  • Treatment:
    • Good hydration
    • Paracetamol 15mg/kg/dose every 6 hours for 2 days as needed

4.3 Acute Otitis Media with Effusion

  • Diagnosis: Acute Otitis Media with Effusion
  • Treatment: Augmentin 90 mg/kg/day 2 times for 10-14 days

5. Pediatric Conditions

5.1 Absence of Red Reflex in Left Eye

  • Cause:
    • Retinoblastoma
    • Phenylketonuria
    • Congenital Rubella Syndrome

5.2 Hip Dysplasia

  • لازم اححد الاتجاه دائماً (اختبار الرجل الي عليها السهم)

5.3 Tests

  • Barlow Test: Adduction and pushing backward
  • Ortolani Test: Abduction and pushing forward

6. Growth Assessment

6.1 Z Score (Percentile)

  • 3 (99)

    • Length/height for age: May be abnormal
    • Weight for age: Obese
    • BMI for age:

  • 2 (97)

    • Length/height for age: Normal
    • Weight for age: Use BMI
    • BMI for age: Overweight

  • ≥1 (85)

    • Length/height for age: Normal
    • Weight for age: Use BMI
    • BMI for age: Risk of overweight

  • 0 (50)

    • Length/height for age: Normal
    • Weight for age: Use BMI
    • BMI for age: Normal

  • <1 (15)

    • Length/height for age: Normal
    • Weight for age: Normal
    • BMI for age: Normal

  • <2 (3)

    • Length/height for age: Stunted
    • Weight for age: Underweight
    • BMI for age: Wasted

  • <3 (1)

    • Length/height for age: Severely Stunted
    • Weight for age: Severely underweight
    • BMI for age: Severe wasted

7. Cardiac Conditions

8. Obstetric Care

First visit

  • cbc (repeat 24-28 & 32-35 wks)
  • ABO -Rh (atypical antibody screen in 24-28 wks)
  • Urine culture (repeat 12-16 wks)
  • Syphilis, hiv, gonorrhea, chlamydia (repeat in 32-36 wks)
  • PAP smear
  • Hepatitis B Surface Antigen (HBsAg)
  • Rubella Antibody Titre

8.1 Prenatal Care

8.1.1 12-16 Weeks

  • Urine culture (USPSTF, AAFP)
  • Nuchal translucency in US (Down syndrome)

16-18 weeks or 15-20 weeks (triple screen for Down syndrome)

  • Alpha-fetoprotein for neural tube defect
  • BhCG increased in trisomy 21
  • Unconjugated estriol decreased in trisomy 18 & 21

8.1.2 24-28 Weeks

  1. Gestational diabetes (by 75 gm OGTT - 92, 180, 153)
  2. CBC
    • Antibody screen for Rh negative and administration of immunoglobulin

8.1.3 32-35 Weeks

  • STD
  • Repeat CBC

8.1.4 35-37 Weeks

  • Group b streptococcal rectovaginal culture
  • genetic counseling, thyroid disease, infectious disease - bv & rubella -, domestic violence, smoking, alcohol, depression

8.2 How to Manage Gestational Age

  • LMP: تاريخ آخر دورة شهرية
  • Fertilization Day: Add 2 days
  • EDD: Subtract 3 from Fertilization month.
  • Fertilization = تاريخ الحمل المتوقع = GA

9. Hematological Conditions

9.1 Anemia Types

  • Diagnosis: Sidroblastic Anemia
    • Sign: Ring sideroblast
  • Diagnosis: Megaloblastic Anemia (Vitamin B12 deficiency)
    • Sign: Hypersegmented neutrophils
  • Diagnosis: G6PD Deficiency Anemia
    • Sign: Bite cells - Heinz bodies
  • Diagnosis: Sickle Cell Anemia
    • Sign: Sickled cell

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