dg and rx

Question 1

esophageal stuff

Answer 1

dg- manometry, esophagogram, barium esophageogram
rx- depends on which one

Question 2

extra order in infectious stool testing

Answer 2

stool PCR

Question 3

splenic rupture in EBV

Answer 3

first vol rescus, then ct abdominal WITH contrast to see what ruptured and where. consult surgery for exploratory lap or splenectomy.

Question 4

hepatic adenoma

Answer 4

ct with contrast! which will show well demarcated and PERIPHERALLY ENHANCED mass. rx- less than 5cm or asympto= stop OCPs. >5cm or symptomatic-resection. high chance of malignancy so serial follow ups and alpha fetoprotein needed.

now, focal nodular will have scarring AND DIFFUSE uniform!!! enhancement

Question 5

hirschprung

Answer 5

abdo usg, air or water enema, then abdomen X-ray to make sure no rupture.

Question 6

mesenteric ischemia

Answer 6

order amylase phosphate ABG. look for metabolic acidosis. dg- ct or mr angiography depending on kidney function.

Question 7

gastric emptying

Answer 7

EGD, upper endoscopy, then nuclear empty

Question 8

hematochezia

Answer 8

if unstable, can be upper bleed so EGD. if stable- colonoscopy

Question 9

GERD

Answer 9

just give PPIs. endoscopy if long time since >5 yrs ds bcz risk of Barrett esophaguse malignancy or also if alarm simps! ph monitor if pPPIs not working.

Question 10

malabsorption symtoms

Answer 10

don’t forget stool osmotic gap. inc in lactulose and celiac

Question 11

celiac

Answer 11

iron, folate, vit d, DEXA scan, give pneumococcal vaccine due to hyposplenism

Question 12

toxic megacolon

Answer 12

abdo xray!!! can also see for rupture. DONT DO COLONOSCOPY! rx- medical management with STEROIDS! if perforation hasn’t occurred. if it has, surgery consult.

Question 13

pancreatitis

Answer 13

acute- lipase amylase. chronic- mrcp or abdo ct. you’ll see hallmark pancreases calcifications and dilated ducts. rx. Pain management- TCA, NO morphine.bcz no opioid use in pancreas stuff. will make it worse! pregablin will work. amytriptylline pancreases enzymes, small meals, no alcohol smoking.

Question 14

SAH

Answer 14

ct no contrast, then LP if nothing found. xanthochromia is PERSISTENTLY or elevating counts of RBCs. if declines- its traumatic tap.. then angiography to find the source of bleeding!

Question 15

any headache red flags

Answer 15

MRI with contrast!!! WITH contrast

Question 16

transverse myelitis

Answer 16

motor weakness, bladder bowel simps, sensory deficit, treat with glucocorticoids.

Question 17

TIA

Answer 17

MRI> ct. more sensitive to detecting small ischemia which causes the transient attacks. then CT or MR angiography to find the source artery. carotid USg. and echo to find embolic source! also give anti platelet therapy! aka aspirin, clopidogrel!

Question 18

sarcoidosis

Answer 18

exclude TB, chest xray, ophtho consult, esr and cry for arthritis, check calcium!, ACE, lyme serology, check for HSM!!- then do biopsy of skin or LN.

Question 19

frontotemporal dementia

Answer 19

clinical but do ct to rule out other shit. rx- behavior mod and SSRI. survival 8-10 years. another extra- can also develop ALS type simps with hypo and hyper reflex

Question 20

l5 radiculopathy

Answer 20

lateral shin and dorsal foot

Question 21

femoral nerve entrapment symps

Answer 21

decreased knee jerk, sensaiton loss over anterior thigh, leg and foot. all medial. quad muscle weakness.

Question 22

obturator nerve

Answer 22

medial inner thigh

Question 23

lewy body dementia rc

Question 23

lewy body dementia rx

Answer 23

melatonin for sleep bcz dec REM cycle. Dopamine cuz parkinsonsim and rivastigmine for alzeihemrs. if pyschotic symps are severe, quietapine (2nd gen) w less s/e.

Question 24

narcolepsy

Answer 24

polysomnography!

Question 25

narcolepsy

Answer 25

modafinil or any stimulants- methylphenidate. but nonpharm is equally impt- sleep hygiene counsel. daytime naps!.

Question 26

cataplexy rx

Answer 26

venlafaxine which is a SNRI, but can also use TCA, SSRIs, and sodium oxybute.

Question 27

perinauds syndroma

Answer 27

loss of upward gaze and ataxia! headache due to obstruction. some tumours can also secrete bhcg!!!! which can cause precocious puberty.

Question 28

cluster headaches rx

Answer 28

ox2 for current but if no response or partial response- sumatriptan. then verapamil or topiramate (anticonvulsants) to prevent.

Question 29

b12 deficiency

Answer 29

vibration sense but also corticospinal leading to hyperreflexia and spastic paresis. and ataxia aka romberg sign positive

Question 30

wilsons ds

Answer 30

5-35 years of age

Question 31

hemolytic orders

Answer 31

ldh, haptoglobin, pblood smear, liver orders, pt, ptt, bilirubin. reticulocyte count, mcv.

Question 32

NPH

Answer 32

ct scan head- ventriculomegaly. LP for relief. definite rx- venticuloperitoneal shunting. so all fluid that keeps collecting in head goes to peritoneum to be peed out etc.

Question 33

multiple sclerosis

Answer 33

mri brain to see white lesions, csf to see oligoclonal bands.rx- methylprednisone . oral if no eye symps. IV if optic neuritis. then beta interferon or glatiremer interferon for ch maintenence. baclofen for spazzing. gabapentin for neuropathic pain.

Question 34

thiamine

Answer 34

give even if suspicion bcz not all 3 symps of wernickes are always present and its a dire problem so give right away! could be live saving! check for korsakoff by doing MRI to see the mammillary bodies.

Question 35

als spared symps

Answer 35

sensory, bladder and bowel.

Question 36

stroke didnt get tpa

Answer 36

then give aspirin.

Question 37

TIA vs stroke

Answer 37

tia symps resolve so just give aspirin and clopidogrel. not tpa.

Question 38

cholestatic cirrhosis orders

Answer 38

alp, mitochondirial antibodies, MRCP, C ANCA antibodies,

Question 39

wilsons

Answer 39

ceruloplamsmin, urinary cu, genetic test.

Question 40

hematochromotosis

Answer 40

ferritin, transferrin, genetic test.

Question 41

hep b rx

Answer 41

tenofovir

Question 42

alzeihmers rx

Answer 42

rivastigmine, donepezil.

Question 43

parkinsons rx

Answer 43

pramipexole, ropinarole, carpidopa, l dopa, amantadine, entacapone.

Question 44

chest pain and SOB orders

Answer 44

chest xray, troponins, BNP, echo, d dimer, chest ct, echo

Question 45

cough extra orders

Answer 45

pefr, elisa for hiv, tb tests, neck xray, chest xray, PEFR< sputum orders.

Question 46

abdominal pain

Answer 46

FAST us, us abdo, tranvag us. abdo xray, abdo ct, barium enema, endoscopy,

Question 47

back pain

Answer 47

prostate US, xray spine,

Question 48

stool extras

Answer 48

clostridium dif. p anca, sweat test

Question 49

bleeding

Answer 49

factor 8 and 9, ristocetin, von willebrands factor, platelet antibody, pt ptt,

Question 50

vaginal extras

Answer 50

KOH prep, HPV dna, cervical bx if needed, colposcopy

Question 51

constipation order

Answer 51

docusate

Question 52

diarrhea

Answer 52

loperamide

Question 53

severe body pain

Answer 53

ketorolac

Question 54

chest pain meds

Answer 54

aspirin and NG

Question 55

ADMIT orders- ADMITCO nemonic

Answer 55

activity, diet, meds, ina and outs (urine), temp bp vitals, compression stockings, OMEPRAZOLE.

Question 57

COPD orders!!

Answer 57

albuterol, ipratropium, levofloxacin, methylprednisone!

Question 58

rhabdo orders

Answer 58

urine myoglobin, cpk,

Question 59

iv drug use rx

Answer 59

pip tazo, ceftriaxone, vanco.

Question 60

back pain referral

Answer 60

physical therapy!

Question 61

meningitis emperic orders

Answer 61

dexamethasone, ceftriaxone, vanco, tylenol for fever.

Question 62

suspect overdose orders

Answer 62

emergency orders then glucose, thiamine, naloxone, d5. intubate.

Question 63

pill overdose rx

Answer 63

urine tox, serum alc, serum salicylate, serum aceta, serum tca, sodium bicarb

Question 64

cholecystitis orders

Answer 64

pip tazo for infection, morphine, zofran for nausea.

Question 65

PCP orders

Answer 65

bactrim, hospitalize, ldh, infec disease consult!!!

Question 66

HIV order dont forget

Answer 66

torch antibodies and then NOTIFY PUBLIC DPT

Question 67

pregnant mom orders

Answer 67

pelvis US then transvag US, fetal doppler to see how the baby is doing, 24 hour protein, pt ptt cross rh esp if c section needed.

Question 68

pre eclamspia early esp before 33 weeks

Answer 68

betamethasone, mg sulfate, hydralazine, labetalol, COMPLETE BED REST, consult gyne

Question 69

streptococcus orders

Answer 69

stretolysin, anca antibodies, c3 c4, anti glomerular antibodies, ANA, cryoglobulin.

Question 70

cystic fibrosis rx

Answer 70

iv antibx for strep pneump and psuedomonas, chest physiotherapy, panc enzymes, vitamins.