Imaging Studies and Other Interventions for Step 3 Flashcards
(94 cards)
1
Q
Intussusception
A
DX: Abdominal ultrasound, AXR, BMP, CBC CS: Srx TX: NPO, IVF/access, IV morphine x1, NG TUBE, promethazine, Barium or air-contrast enema Abx: CeFAZolin
2
Q
Cholecystitis
A
DX: Abdominal US TX: Lap chole when afebrile, ketorolac ABX: Cetriaxone + Metronidazole or Piperacillin-Tazobactam
3
Q
AA rupture
A
Dx: Abd US, CT with contrast TX: CeFAZolin x 1, repair, bed rest, phenergan
4
Q
Trichomonas
A
Dx: Wet mount Tx: Metronidazole
5
Q
Sigmoid voluvulus
A
Dx: Abdominal Xray Tx: Flex sig, rectal tube, NG tube, bed rest
6
Q
Colon cancer needs hemicolectomy
A
Dx: Colonsocopy, Abd CT Tx: Ceftriaxone x 1, metronidazole x 1 prior to srx FU: CEA
7
Q
COPD exacerbation
A
Dx: CXR Tx: Ipratropium, Albuterol, PREDNISONE, Oxygen, Budesonide Abx: Amoxicllin or Doxycycline, or TMP-SMX or Clarithromycin FU: PFRF, ABG
8
Q
Cellulitis
A
Dx: bld clx, ESR, CBC, BMP, X ray Tx: Clindamycin or Vanc IV, when better can do Clinda PO and send home; leg elevation FU: Daily CBC
9
Q
Epidural abscess
A
Dx: MRI spine Tx: Drainage by NSG, Ceftriaxone + Metronidazole + Vancomycin
10
Q
GBS at 36 wks GA
A
Ampicillin when deliver
11
Q
Community acquired cystitis
A
Dx: UA and clx Tx: TMP-SMX x 3 d OR FQ x 3d
12
Q
Hospital acquired cystitis
A
FQ + IV cef TRIaxone
13
Q
Pyelonephritis
A
Dx: UA, urine culture, BLOOD Culture Tx: FQ IV Nonresponders: get US for abscess
14
Q
PID
A
Ceftriaxone + Doxycycline and remove the IUD
15
Q
Lyme disease
A
Dx: Western blot, PCR Tx: Doxy or Amoxi or CefTRIaxone if neuro or cardiac sxs or young pt
16
Q
AAA rupture srx ppx
A
ceFAZolin x 1
17
Q
Intussusception
A
ceFAZolin x 1
18
Q
Sinus infection
A
Amoxicillin + Acetaminophen + PSEUDOEPHEDRINE + ORAL HYDRATION FU 2 wks
19
Q
Alzheimers
A
ARICEPT + MEMANTINE
20
Q
Any pt with cardiac sxs or sudden SOB
A
Initial Tx: IV access + Oxygen + Cardiac monitor + BP monitor + Pulse ox +/- ASA Tests: ECG + CXR + ABG + cardiac enzymes
21
Q
Pulmonary embolus
A
Initial: IV, O2, Cardiac/BP monitor, Pulse ox Labs: Cardiac enzymes + D Dimer + ABG + CBC + BMP + CXR Imaging: CXR, then Spiral CT TX: Heparin IV, continuous –> INR 2-3 –> switch to Warfarin Monitoring: Pulse Ox Q2H + PTT Q6H!
22
Q
If you hear rales
A
Don’t give fluids
23
Q
Mild persistent asthma
A
Definition: > twice a month night sxs, > twice a week day sxs TX: Albuterol inhaler + Fluticasone low dose (inhaled steroid)
24
Q
Mild intermittent asthma
A
Definition: < twice a month night sxs, < twice a week day sxs TX: Albuterol inhaler
25
Moderate persistent asthma
Definition: weekly night sxs, daily day sxs TX: Albuterol inh + Fluticasone med dose inh + Salmeterol (LABA)
26
Severe persistent asthma
Definition: almost nightly night sxs, continuous day sxs TX: Albuterol inh + Fluticasone high dose inh + Salmeterol + Prednisone
27
Are asthma drugs ok in pregnancy?
Salmeterol and fluticasone are OK
28
Ruling out asthma
methacholine challenge, reversible by bronchodilators
29
TX asthma exacerbation
O2 sat, ABG, head elevation, IV access, cardiac monitor CXR, EKG, CBC, BMP PEFR \< 40% -O2, albuterol-atrovent neb, IV steroid taper, PEFR Q1h PEFR \> 40% - O2, albuterol neb, PO steroid taper (add atrovent if PEFR doesn't increase to 70% in 1 hour) (Reevaluate Q1h and admit if in 4 H if PEFR \< 40% predicted, DC home if \>70%--on admit give complete bedrest, npo, IV nss, peak flow Q2h)
30
TX COPD exacerbation
Follow with PEFR DX: CXR Tx: O2 + albuterol, Ipratropium + Prednisone PO taper + Amox or TMP-SMX or Doxy or Azithro or Clarithro
31
PTX (tension)
Needle thoracostomy FIRST, O2, morphine, NSAIDs
32
PTX, regular
CXR, chest tube, O2, morphine, NSAIDS
33
Diabetes insipidus (HYPERnatremia)
central: DDAVP nephrogenic: low salt diet + thiazides + hypotonic saline or D5W or PO water (best) 12 meq/L/day
34
5 mm kidney stone
passes on its on its own with alpha blockers and pain meds thiazides if hypercalciuria
35
3 cm kidney stone
lithotripsy or percutaneous nephrolithotomy
36
Time to tPA or angioplasty
TPA for stroke within 3 hrs of ONSET of sxs Angioplasty for MI within 90 minutes of GETTING TO HOSPITAL
37
Stroke vs Bell's Palsy
Stroke spares upper face
38
Stroke
Imaging: CT w/o contrast, MRI with DWI/PWI, MRA, TEE, Carotid doppler (Vs MRI and MRA: CT perfusion and CT angio) Labs: glucose stat, CBC, BMP, PT/PTT/INR, HBA1C, fasting lipids TX: NPO, elevate head of bed, ICU admit, cardiac/BP monitor, BP: Hemorrhagic: keep BP 160 Ischemic getting TPA: BP \< 185/110 Ischemic no TPA: BP \> 160/80 Acute ischemic: ASA, if already on ASA add dipyridamole or change to clopidogrel
39
Severe migraine tx
IVF + Reglan + dexamethasone + ergotamine
40
Moderate migraine tx
Sumatriptan
41
Mild migraine tx
NSAID + Reglan
42
Tension headache tx
NSAIDs, Tylenol
43
Cluster HA tx
100% O2 or low dose prednisone
44
Parkinson's tx
Carbidopa-levodopa together + bromocriptine + selegiline Deep brain stimulation or pallidotomy
45
Dementia workup
MMSE, neuropsych testing, CBC, BMP, B12, TSH, VDRL, HIV, UTOX, CT/MRI brain
46
First prenatal visit
Vitals: Weight, BP, Fetal heart tones Labs: CBC, type and cross, Rh Ab screen, UA with clx, Gonorrhea/Chlamydia clx, Rubella Ab titer, HBsAg, RPR, PPD, HIV Counsel: nutrition Supplement: folate, zinc? (Ca and iron later months) Counsel: smoking and alcohol cessation
47
6-11 week preg visit
US to determine gestational age
48
15-19 week visit
Triple screen or quadruple test Amniocentesis if \> 35 yo
49
18-21 week visit
Screening US
50
26-28 week visit
1 hr glc challenge, if \>140 do 3 hr glc challenge Repeat H/H
51
28 wks
RHOGAM for RH - Fetal kick counts
52
35-37 wks
Rectovaginal swab for GBS H/H repeat Gonorrhea + chlamydia clx if high risk Leopold maneuvers for position US
53
10-12 wks
CVS if desired for down syndrome
54
Kawasaki disease
ASA + IVIG Follow with Echo
55
Polymyalgia rheumatica
The one associated with temporal arteritis Tests: ESR, CPK, CK, CBC, TSH, T4, EMG, mm bx SXS: pelvic girdle and pectoral wkns, shoulder, neck pain ESR: very high Muscle biopsy and EMG: normal TX: Steroids for long time! to prevent temporal arteritis FU frequently with ESR
56
Polymyositis
The one associated with cancer Tests: ESR, CPK, CK, CBC, TSH, T4, EMG, mm bx SXS: proximal muscle weakness ESR: increased Muscle biopsy and EMG: abnormal CPK increased TX: steroids \*got this wrong on the test
57
Fibromyalgia
Tests: ESR, CPK, CK, CBC, TSH, T4, mm bx, EMG SXS: tender at 18 points, anxiety, stress, insomnia ESR, mm bx, EMG: normal TX: NSAIDs and SSRIs, rest
58
Acute gout
PE: everything but breasts and psych Tests: limited! CBC, BMP, ESR, PT/PTT/INR, X-ray affected joint, Arthrocentesis with fluid analysis Tx: Indomethacin; if renal probs give interarticular glucocorticoids instead
59
Chronic gout
Get rid of HCTZ, furosemide, ASA, stop using alcohol I guess check uric acid levels? Allopurinol or probenicid chronically
60
Septic arthritis
joint culture, blood culture, urethral/cervical swabs, rectal swab and culture
61
Thyroid storm
PTU \> methimazole + Glucocorticoids, Iodine, beta blockers (nonselective)
62
ASCUS
do HPV test
63
ASCUS with negative HPV
f/u on routine screening in 1 yr
64
ASCUS with positive HPV
Colposcopy
65
Colposcopy shows CIN 2,3
LLETZ
66
ASCUS or ASCH Colposcopy shows CIN 1
Either 1. HPV test in 12 months - if HPV positive do colpo - if HPV negative f/u in 1 yr 2. Repeat pap in 6-12 months: - if ASCUS or ASCH do colpo - if paps are negative x 2 f/u in 1 year
67
ASCH
Colposcopy
68
HSIL
LEEP or Colpo
69
HSIL with unsatisfactory colposcopy
LEEP
70
HSIL with satisfactory colposcopy showing ANYTHING BUT CIN 2,3 (i.e., CIN 1)
Different from ASCUS and ASCH Either: 1. LEEP 2. Colposcopy + Pap in 6-12 months
71
HSIL with satisfactory colposcopy showing CIN 2,3
LLETZ
72
Chest pain at rest
Prior to physical: O2, IV access, cardiac monitor, EKG, ASA, NTG if BP ok, then focused PE (EKG: No ST elevation --\> NSTEMI vs unstable angina) Cardiac enzymes at time 0 and 8 hrs, CBC, BMP, LFT, CXR, PT/PTT, INR (Enzymes negative = unstable angina) Intervention: Cardiology consult, abciximab, lipid profile, tranfer to ICU, cardiac cath and angioplasty, echo for after cath Later workup: TSH if dyslipidemic Counsel: smoke cess, diet low sodium and fat, exercise program, relaxation exercises
73
Cellulitis
Tx: IV Clindamycin and admission if severe, PO if not Labs: Blood clx, ESR, CBC, BMP, perhaps X-ray or doppler Follow treatment with CBC DAILY Switch to PO after clinical improvement and send home
74
MVA - abdominal trauma + LUQ pain
Cervical spine immobilization, pulse ox, BP/Cardiac monitor STAT, IV access, NSS, O2 PE: COMPLETE Order: NPO, Type and cross, EKG, amylase/lipase, B-HCG, spine XR, CXR, CT abdomen, ABG, PT/PTT/INR, Utox, BAL, CBC/BMP/LFT, surg c/s, morphine, phenergan (CT shows hematoma) Transfer: to ICU or ward Order: Foley catheter and UOP, cancel C-spine immobilization (Splenic hematoma- watch it Q4-6 h- stable 24 h go home, f/u 1-2 wks) Counsel: seat belt, avoid contact sports, no EtOH, no smoking
75
Labs in ALL HIV+ Pts
(FOLLOW:) CBC (Q 3-6 months) PPD (initially and yearly) Pap smear (initially and yearly) CD4 count + viral load (INITIAL:) BMP baseline RPR/VDRL (either) HBsAg HCAb TOXOPLASMA serology
76
PPX in HIV+ pts
HAART (efavirenz, tenofovir, emtricitabine = Atripla) TMP-SMX for CD4 \< 200 (PCP) Azithromycin if CD4 \< 50 (MAC)
77
Good HAART regimen (Atripla)
Efavirenz Tenofovir Emtricitabine
78
chronic constipation
COMPLETE PE CBC, BMP, Magnesium, Phosphate, TSH, HBA1C, FOBT, Colonscopy, Urine microalbumin Metamucil Counsel low fat/low salt, high fiber diet, oral hydration, exercise program F/u 1 week
79
Septic joint
Focused PE Admit PT/INR/PTT, bld clx, XRay, arthrocentesis with fluid studies stat, ESR, CBC, BMP NPO, IV access, NSS, morphine x 1, Tylenol If gram + cancel ceftriaxone Stat arthroscopy
80
Bronchiolitis
3 month old, looks like asthma Hospitalize if nasal flaring, tachypnea, decreased PO intake, or decreased O2 sat Cardiac monitor, ABG, CBC, BMP, pulse ox Q1H then Q8, CXR, oxygen if O2 sat \< 92%, NT suction, NSS Albuterol, Epi x 1 if not improved in 1 hr Ribavirin if immunocomp, steroids if chronic lung dz Home when O2 ok, taking PO FU 1-2 wks
81
Croup
give racemic epi and dexamethasone send home when no stridor at rest
82
Pericardial effusion
Pulse ox, IV access, O2, cardiac/BP monitor, ECG stat Focused PE Pericarditis on ECG- ORDER: CXR, ESR, bld clx, cardiac enzymes, CBC, BMP, ibuprofen, colchicine (ASA if post-MI) Admit to ward Ambulate at will, reg diet, routine echo, reassure pt, cancel O2 No tamponade on echo- ORDER: cancel cardiac and BP monitor, cancel IV access, reevaluate daily Cancel vitals, counsel, send home Appt in 2 wks
83
ECtopic pregnancy
B-hcg, US If unstable to go lap If stable serial BHCG and MTX if 3.5 cm and no heart beat or lap if larger/heart beating Reevaluate at 20 wks and consider cerclage
84
DUB
Complete PE Bhcg, CBC, TSH, PROLACTIN, PT/INR/PTT, PAP, type and cross F/u in 1 wk Iron for all! Anemia Hgb 10-12-Give Irone, low estrogen/low progesterone if active bleed, progesterone only if no bleeding, f/u in 3 months Anemia Hgb \< 10-Hospitalize, transfuse, if stable give combo OCP with high estrogen, if unstable give IV estrogen and consider D&C, give iron
85
person who looks anemic: tests and exam
Serum iron, TIBC, Ferritin, UA, CBC, BMP, LFT FULL physical exam if stable
86
UA shows microhematuria and CBC shows anemia of chronic disease. NSIM?
Abdominal CT
87
Abdominal CT shows solid renal mass. NSIM?
Transfer to Ward Chest CT, PT/PTT/INR, NPO, IV access, NSS, ceFAZolin, surgery and oncology consult, NEPHRECTOMY if CT shows no mets (BX if it does), cancer counseling
88
Turner syndrome follow-up
Yearly: PE, Lipids, fasting blood glucose, LFT, GGT, UA Q2 Yrs: Echocardiogram Q3 Yrs: Audiology and DEXA scan
89
Turner syndrome TX
GH therapy if \< 20th %ile Estrogen-progesterone therapy Vitamin D and Calcium Psych consult for IQ Ophthalmology consult Audiology consult Nutrition consult for growth failure Surgery consult for streak ovaries Counsel: Med compliance, reg diet, exercise
90
Turner syndrome workup
LH, FSH, Karyotype, Genetics c/s Fu in 1 wk US pelvis, US kidney, audiogram, echocardiogram, fasting glucose, skeletal survey, TSH, lipids, UA, CBC, BMP
91
Workup routine exam 45 yo M
CBC BMP UA Lipid profile EKG
92
NSIM for guy with essential HTN (BP \< 160/100)
Counsel lifestyle modification, f/u in 1 month If still high f/u in 6 months If still high after 6 months of modifications start with ACEI If still high then change to HCTZ if not \< 140/90 If still high then do both or ACEI + CCB
93
NSIM for guy with BP \>160/100
Start 2 drug therapy and do full workup right away (amlodipine + lisinopril)
94
Cryptococcal meningitis
IV flucytosine and amphotericin
