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Ccs Flashcards

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1
Q

Intususception-STAT

A

Exam: rectal, genital, abd
Supportive care: NPO, bowel rest, IV access, fluids, analgesics, antiemetics
NGT decompression, abd X-ray, surgery consult, u/s, CBC, bmp
Barium enema
Ward->bed rest, urine output
F/u, preventive care, counsel

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2
Q

Ruptured AAA-STAT

A

IV access, BP monitor, cardiac monitor, pulse oximetry, ECG
IV fluids, morphine, phenergan
Pre op: PTT, PT/INR, type and cross, NPO, bed rest
ICU
Abx (cefazolin), repair AAA
Cancel NPO, regular diet, re evaluate

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3
Q

Acute bacterial rhinosinusitis

A

No imaging needed
Abx, analgesics, NS irrigation, topical steroids
If allergic to augmentin, foxy/flouro

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4
Q

Acute chole

A

CBC, BMP, LFTs, blood cultures, amylase, lipase, abd x ray, abd u/s, pre op labs
Assessing clinical status: order interval history, focused physical exam

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5
Q

Sigmoid volvulus

A

GI for sigmoidoscopy and rectal tube

If complications-surgery

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6
Q

Ovarian cancer

A

Stage: LFTs, UA, colonoscopy, mammogram, Pap smear, CA 125, CXR
Pre op (laparotomy): PT/INR, PTT, ECG, NPO
Cefazolin before, DVT prophylaxis
Surgery: gyn onc
Follow up with onc

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7
Q

Whenever patient follows up

A

Interval history and exam

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8
Q

Polymyalgia rheumatica

A

CBC, BMP, ESR, ANA, RF, CPK, TSH
Taper steroids later, GI ppx, calcium, vitamin D, baseline DEXA

Follow up: ESR, CRP, CBC

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9
Q

Temporal arteritis f/u

Treatment

A

ESR, CRP, CXR, CBC

Aspirin and steroid

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10
Q

Fever with AMS

A

Complete infectious work up, all the CSF studies

Oxygen (thinking of something happening in brain)

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11
Q

Turner

A

First diagnose with karyotype analysis
Then FSH, LH, TSH, bmp, glucose, lipids, renal, pelvic u/s, echo, bone scan, hearing test
Consult ophtho, psych, nutrition
Give estrogen-progestin, growth hormone, vitamin d, calcium

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12
Q

Essential htn

A

Obtain CBC, BMP, UA, lipids, ECG
2 more measurements before diagnosis (3 month periods)
Lifestyle interventions in between, then meds at 3rd visit
F/u in 6 weeks

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13
Q

Diverticulitis

A

Get UA, blood cultures, abdominal CT
Repeat CT if no improvement in 2-3 days
Colonoscopy in 2-6 weeks
Inpatient: IV zosyn

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14
Q

Fall

A

FULL exam

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15
Q

Child abuse differential

A

Check for coagulopathy
Psych consult
Rib fracture: analgesics, incentive spirometer, chest PT

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16
Q

Menopause

A

Hormone replacement unless clots/breast cancer
If <45 yo->TSH, prolactin, FSH, UPT
Calcium, vitamin d, exercise, preventive health

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17
Q

DVT treatment

A

PT/INR, Fobt before
Lovenox+ warfarin
CBC on day 3 and 5 (HIT)
Pt/INR every day

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18
Q

Suspected cancer

A

Admit to hospital for staging, pre op, prophylactic antibiotics

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19
Q

Strep pneumo meningitis

A

DEXA

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20
Q

Before starting lithium

A

BUN, creatinine, calcium, TFTs, CBC, ECG, B-HCG

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21
Q

Mania

A

Suicide contract

Psychotherapy

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22
Q

General approach

A
  1. Standard ER (IV access, monitors)
  2. Symptoms
  3. CBC, BMP
  4. Diagnosis
  5. Diff
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23
Q

Septic arthritis

Fluid studies

A

IV abx, blood cultures, arthrocentesis->arthroscopy

Culture, gram stain, cytology, glucose, crystals

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24
Q

OCP in dysfunctional uterine bleeding

A

Low estrogen, low progesterone

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25
ALL trauma patients
Emergency ABCDE before complete physical exam Labs: LFTs, lipase/amylase, UA, ABG, Uds, blood ethanol, hcg, ECG, spine x Ray, chest x Ray, abd CT If surgery needed->immediately after exam
26
Splenic rupture
Serial exams, CBC q6hours, BP monitor
27
Diagnosis
Admit or not.
28
Suspected cancer
Think about every organ.
29
Constipation diff
Electrolytes, cancer, hypothyroidism | TSH, FOBT
30
Asthma exacerbation test
PEFR every hour | If <40%-admit
31
Croup
CBC, neck x Ray, humidified Air, dexamethasone oral, inhaler epinephrine No need to admit if not severe enough
32
Hemophilia
``` bleeding time, PT, PTT, LFTs Factor 8, 9, 11 Transfer to ward or ER Give deficient factor Monitor PTT and factor 8 till within normal level Consult genetics Avoid aspirin and contact sports ```
33
ACS
Stat oxygen, IV access, cardiac monitoring, EKG, ASA, nitro before exam FOBT before heparin drip LFTs, echo *ST depressions in unstable angina->cath Risk reduction on discharge
34
Choking
Rigid bronchoscopy | CXR and neck x Ray
35
Panic disorder
Emergency orders like ACS + glucose | Get U/A and UDS
36
Pre op labs
PT/INR, PTT, NPO, fluids | Antibiotics before
37
TIA
Aspirin stat before CEA | If afib-> apixaban/warfarin
38
COPD exac
PEFR, ABG, EKG | As patient improves, transfer to ward, P.O. steroids, MDI nebs, walk test before leaving
39
Breast mass
U/s: simple cyst-> reassure, complex->FNA Solid: Mammogram F/u: every 3 months for a year
40
Htn emergency
``` CT Head before Nitroprusside ICU, arterial line, NPO, urine output DBP goal 100-105 CXR, UA to check for end organ damage Lipid profile ```
41
Outpatient depression
Start SSRI, do not wait for all labs to come back. | F/u: every week for 6-8 weeks
42
Candida tests | Treatment
Vaginal PH, wet mount, gram stain, Pap smear, gc culture, u/a Counseling: patient ed, safe sex, no alcohol Miconazole, clotrimazole (topical), fluconazole (PO)
43
Alzheimer’s
Vitamin E, donepezil + olanzapine
44
UC management
Mesalamine, loperamide, dicyclomine, dietary consult
45
Pregnant UTI
Confirm eradication with f/u culture in a week
46
Pregnant
Blood type, Rh type, atypical antibody titer, Pap smear, u/a, urine culture, rubella ab, RPR, Hep B surface antigen, HIV, chlamydia, prenatal vitamins, iron sulfate, folic acid F/u in a month
47
Ectopic pregnancy treatment
Stable, hcg<5000, <3 cm-methotrexate Consult ob-gyn LFTs, pt/INR, blood type If mtx->f/u in 4 days to check b-hcg
48
IBS
Complete physical exam ESR, tsh, Fobt, stool studies, stool fat Treatment: diet (high fiber, lactose free), reassurance, education, behavioral therapy, biofeedback Dicyclomine for pain
49
Rheumatoid arthritis
Consider arthrocentesis Prednisone + methotrexate PT/OT
50
DKA
Serum osmolality, serum ketones Potassium, check phosphorus Add glucose once <250 BMPs and ABGs q2h
51
ACS antibiotics
Azithromycin, cefuroxime | Exchange transfusion
52
Anaphylaxis
IM epi, glucagon if on beta blockers Steroids, diphenhydramine, ranitidine, albuterol Outpatient RAST testing Medical alert bracelet
53
GI bleed in office
FOBT, | H. Pylori-clarithromycin, amoxicillin, ppi
54
Hypothyroidism
Check lipids
55
Tea and toast diet
Folic acid, not necessarily b12 deficiency If giving folic acid, five iron as well Thiamine, MVI in alcoholic Rec count as follow up
56
Tea and toast diet
Folic acid, not necessarily b12 deficiency If giving folic acid, five iron as well Thiamine, MVI in alcoholic Rec count as follow up
57
TSS
Clindamycin
58
Pancreatitis
Get RUQ U/s to rule out gallstone panc | If dilated CBD, ERCP
59
Hepatitis f/u
PT, INR, notify health department
60
Brady
EKG, echo, trop Transcutaneous pacing Cards for transvenous
61
Rhabdo
Electrolytes, sodium bicarbonate?
62
TB
``` Get LFT, uric acid, eye exam before meds Isoniazid, pyrimethamine, pyrazinamide, ethambutol, rifampin AFBs till negative LFTs ```
63
Minimal change disease
Lasix+ albumin | Prednisone

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