Uw Ccs Blog Cases

These are the notes I made for ccs: For online cases: Foreign body aspiration: Methyl prednisone. Cefazolin. Rigid bronchoscopy

COPD exacerbation: Albuterol, Ipratropium, methyl prednisone, lovefloxacin (PEFR q1) Bronchiolitis: Albuterol,nasotracheal suction,nss,epinephrine (one time). Observe. Croup: neck xray. Epinephrine. Dexamethasone. Humidified air. Acute bacterial Sinusitis: No test needed. Amoxicillin oral, Acetaminophen, Pseudoephidrine, Oral hydration PCP: ABG, PCP (sputum). BACTRIM (TMP-SMX), prednisone, LDH, G6PD. HIV western blot, viral load, CD4, Vaccine, HIV support. Pulmonary Embolism: ABG, D-dimer, Cancel OCP, Spiral chest, Lovenox (if creatinine normal), Warfarin, monitor with INR, platelet. No s DVT: Lower extremity Doppler USG, D-dimer, Enoxaparin SQ, Warfarin, Percocet oral, medication side effect, no smoking, PT/INR each Hemophilia: Factor VIII. PTT. Genetic consults. Cellulitis: Clindamycin IV, percocet, leg elevation. When improve change clindamycin to oral. Septic arthritis: Knee xray, Morphine (one time), acetaminophen,ceftriaxone,vancomycin. Ortho consult, Arthoscopy later cancel IV ceft Acoute gout: Indomethacin oral. No aspirin, no alcohol, low protein. Esr, pt, ptt, foot xray, synovial fluid (gram, crystals, c and s, viscosity Temporal arteritis: Urine Culture, Blood culture, ESR, head CT, Prednisone, Temporal artery biopsy, Aspirin oral, Pantoprazole oral, Calci Polymyalgia Rheumatica: ANA, CRP, RF, CPK, CXR, ESR. Prednisone, Calcium, Vit D. Later ESR, CRP, CBC, Dexa Scan. Bacterial Meningitis: Head CT, Head Elevation, Ceftriaxone, Vancomycine, Dexamethasone, Phenergan, Acetaminophen, all IV. Cancel H improves, case ends. Cryptococcal meningtitis: Serum cryptococcal antigen, HIV elisa, head CT, LP, CSF, India ink, fungal culture, Amphotericin B IV, flucytosi group. Herpes simplex encephalitis: Head CT, LP, blood culture, CSF (don’t forget PCR for HSV), Head elevation, Phenergan, Acetaminophen IV Major depression: Fluoxetine, suicide contract, pt education Alzheimer’s disease: Donepezil, Vit E, cognitive rehab, occupational therapy, support group, good nutrition, medication alert Panic attack: alprazolam sl once. No caffeine

Bipolar I, acute mania: Olanzapine IM, lithium oral, suicide contract, psychiatry consult, psychotherapy, medication side effects. TIA: Aspirin, Carotid Doppler, Cefazolin, CEA Essential HTN: Low fat, low salt, exercise, if lifestyle fails after 6 months, medication on 3rd high BP reading. Hypertensive emergency: Nitroprusside. Arterial line Unstable angina: Aspirin. Nitroglycerine. Metoprolol. Heparin. Later oral metoprolol, simvastatin eptifibatide (iv) cardiac catheterize, cor Acute pericarditis: Ibuprofen,colchicine,echocardiogram Ruptured abdominal aortic aneurysm: Cancel metoprolol, aspirin. Morphine, phenergan, Abdominal USG, Vascular surgery consult, cefaz Constipation: metamucil. High fiber,low fat. Irritable bowel syndrome: Lactose free diet, high fiber diet, loperamide, biofeedback Acute appendicitis: Morphine.phenergan. Cefoxitin. Laparoscopy.

Perforated Duodenal Ulcer: Cancel Ibuprofen, NG suction, UO, Morphine, Phenergan, Pantoprazole, BACTRIM (TMP-SMX). Acute diverticulitis: Abdominal XRAY, CT, Blood culture, BACTRIM, Morphine, Phenergan, After 12-24 hours, if pt improves, dc all iv, d/c Sigmoid Volvulus: Abdominal xray, GI consult, IV morphine, Flexible sigmoidoscopy, rectal tube, 12-24 hours, pt improves then IV Cefazo Acute Cholecystitis: Abdominal xray, Abdominal USG, NG tube, Piperacillin-tazobactum, ketorolac IM, Phenergan, Pt improves, Laparos Intussusception: Morphine, Phenergan, Ngtube, Abdominal Xray, Abdominal USG, Surgery consult, Barium enema. Renal Cell Carcinoma: (Don’t forget:Serum Iron, Ferritin, TIBC), Abdominal CT, Chest CT, Cefazolin, Nephrectomy. Splenic hematoma: Cervical spine immoblization,morphine,phenergan,get ct result. Colon Cancer: Polyethylene glycol before colonoscopy, abdominal CT, CXR, CEA, Iron sulfate, Metronidazole, Ciprofloxacin, Hemicolecto Child abuse: CXR, or Xray of involved injury, CPS, Ibuprofen, chest physiotherapy, Psychiatry consult, if retinopathy ophthalmology cons Pregnancy tests: A BB CC HH P RR UU Uncomplicated cystitis with pregnancy: Nitrofurantoin

Ectopic pregnancy: Methotrexate, (3.5cm or bhcg >5000 laparoscopy), Morphine Vaginal Candidiasis: Vaginal Miconazole/clotrimazole 14 days or one time oral fluconazole Fibroadenoma of breast: Mammogram/USG. FNA Pap. 3-6 m f/u PID: Morphine. Phenergan. Cefoxitin. Doxycycline. Acetaminophen Later dc all iv and give oral doxycyclin DUB (16year): Prolactin,tsh,pap then ocp(low estro low prog), iron.

Menopause: Estrogen-progesterone, vit D, calcium, low salt diet, high calcium diet, exercise, pap, mammography, dexa, colonoscopy, lip Simple Ovarian Cyst with torsion: Pelvic USG, IV Morphine, Phenergan, Laparoscopy. Ovarian Cancer: Pelvic USG, Abdominal CT, CA 125, Colonoscopy, Mammogram, Pap, CXR, Cefazolin, LMWH SQ, TAH-BSO by laparoto Turner’s Syndrome: Karyotype, FSH, LH, TSH, Fasting glucose, Skeletal Survey, Pelvic USG, Renal USG, Hearing test, Echocardiogram, G Psychiatry for IQ test.

For read out cases of uw: Atrial fibrillation: Pulse ox, IVA, EKG, Metoprolol or Cardizem IV bolus, (if copd), CBC, BMP, CXR, Cardiac enzyme q8*2, UA, LFT, TSH, Fr Consistent carbohydrate diet, HbA1C stat, Accuchecks Q6, Echocardiogram, Cardizem IV continous drip, Heparin IV continous, PTT Q6, repeat ekg, check in 6 hours, once hr 1 cm, need thoracocentesis), Consent, Thoracocentesis, Pleural fluid analysis (Gram stain, AFB, C & Protein, Rheumatology consult, Prednisone oral, safe sex, contraception counseling (AVOID OCPs), exercise, Low fat, high fiber diet. [C/

Cardiac tamponade from MVA: NSS, Pericardiocentesis, Elevate legs, EKG, CXR portable, TTE, Pericardial fluid for cell count, ABG, CVTS consult, Shift to ICU, Swan-Ganz catheter, Foley, UO q2, PT, PTT, Omeprazole oral, Percocet, Type and screen, If Hb 92, wean oxygen, Pt education, Cardiac rehabilitation, Smoking cessation, Regular exercise, f/u 2 weeks. DKA: Finger stick Glucose, CBC, BMP, Calcium, EKG, Amylase, Lipase, UA, ABG, Serum Osmolality, Serum Ketones qualitative, Regular Insulin iv, Phenergan once, Admit to ICU, NPO, Urine Output, KCL IV continuous, HbA1C, Serum Phosphorus, BMP q4 then q12, ABG q2*2, After 4 hours, stop NS give ½ NS, monitor serum potassium, once nausea decreased oral fluid, At discharge, NPH insulin sq, regular insulin, diabetic diet, diabetic teaching, diabetic foot care, home glucose monitoring. ARF: oxy, iva, nss, foley catheter, EKG, ABG, CBC, BMP, Magnesium, Phosphorus, UA, Urine C & S, Urine Na and Creatinine, FeNa, D/C lisinopril, d/c ibuprofen, transfer to ward, vitals q2, 24 hour urine protein, Heparin sq, Renal usg routine, daily weights, strict input & output, Accucheck q6, HbA1C routine, insulin, if pt does not respond to fluid lasix to increase urine output, if cause of renal hypoperfusion is heart failure start dobutamine and dopamine, once pt improves, d/c bedrest, out of bed to chair, d/c foley, continue renal diet, plenty of oral fluids, if fever blood culture. Nephrotic Syndrome: UA, BMP, CBC, LFT, Lipid panel, PT/INR, PTT, Complement 3 and 4, Input/Output, Consult Nephrology, Albumin, Furosemide, KCL, CMP in am, No salt added, High protein diet, Prednsone oral 4-6 wks, Repat albumin and lasix.

ADPKD: CBC, BMP, UA, USG of kidneys, EKG, (Renal failure can cause metabolic acidosis, hyperkalemia, hypocalcemia, anemia, EKG change (peaked T wave), Calcium gluconate IV bolus, D50 and insulin iv bolus, sodium bicarbonate oral continuous, kayexalate oral continuous, UO, Nephrology consult, Serum potassium, BMP every 12 hours, serum phosphorus, serum iron, ferritin, TIBC, Amlodipine oral continuous, Calcium acetate? Not in software, Erythropoietin SQ routine. Jaundice (G6PD def anemia): CBC, BMP, LFT, PT, Admit to floor, IVA, NSS, Regular diet, ambulate at will, Reticulocyte count, Haptoglobin, LDH, UA, Type and cross, PRBC (2 units), G6PD blood quantitative, Coomb’s test direct stat, limit alcohol, f/u in 2 months. Cystic Fibrosis: Admit, Sputum (gram, C&S), Blood cultures, CBC, BMP, CXR, Sinus xray, Sweat Chloride, 72 hour fecal fat, Augmentin, Albuterol, Multivitamin, Chest physiotherapy, D5NS, Regular diet, Ambulation at will, D/C all iv, Influenza vaccine, Pneumococcal vaccine, Consult dietician, Pancreatic enzyme oral, Genetic counseling, high protein, high calorie diet. SLE with pleural effusion: Pulse ox, CBC, IV, BMP, UA, CXR, EKG, ANA, ESR, PT/INR, PTT, Anti-Ds DNA, Complement C3, C4, Decubitus film (>1 cm, need thoracocentesis), Consent, Thoracocentesis, Pleural fluid analysis (Gram stain, AFB, C & S), Protein, Glucose, LDH, Cell count, Cytology, pH), Serum LDH, Serum Protein, Rheumatology consult, Prednisone oral, safe sex, contraception counseling (AVOID OCPs), exercise, Low fat, high fiber diet. [C/I to thoracocentesis: PT or PTT >twice normal, platelet count 6], Pleural fluid pH ur wc, these are the rest, I could not post last night for internet troubles in usmleforum, if it helps, pray for me. I need lot of prayers. Sickle cell anemia: CBC, BMP, Blood cultures, UA, urine culture, sputum gram stain and culture, cxr, ekg, type and screen, D5 ¼ NSS, morphine, Cefuroxime, Azithromycin, Incentive Spirometry, Albuterol nebulization, Repeat H and H in 4 then 8 hours, CBC, BMP next day, High calorie diet, Chronic therapy:Penicillin prophylaxis ( 4months to 3 years), Pneumococcal vaccine, Folic acid, hydroxyurea for recurrent vasoocclusive crisis GBS Pneumonia: CBC, BMP,

Blood Cultures, CSF (protein, glucose, cell count, gram stain), CXR, CRP, D5 NS, Ampicillin, Cefotaxime, Input/Output, CBC &BMP daily, Change antibiotic to oral amoxicillin if sensitive to it. Lung Cancer: Pulse ox, osteoarthropathy indicate lung ca, oxygen, IVA, NSS, Urine output q4, CXR, Blood Culture, Sputum for gram stain, Culture and Cytology, CBC, BMP, Levofloxacin, albuterol q2 and ipratropium q6, Spiral CT scan of chest, Bronchoscopy, Consult Pulmonary medicine for bronchoscopy, CBC and BMP daily, LFT, PFT, Serum Calcium, CT of abdomen and pelvis, MRI brain with and without contrast, Bone scan, Consult oncology, consult radiation oncologist, quit tobacco, Supplement diet with high protein nutritional shakes. Bacterial Meningitis: NPO, Hold atenolol, Pneumatic, Urine output q2, Head elevation, Blood cultures, UA, urine C & S, CBC qd, BMP qd, PT/INR, PTT, Phenergan, Acetaminophen, IV ceftriaxone, Vancomycin, LP, CSF (cell count, protein, glucose, gram stain, fungal stain, culture and sensitivity). Vertrebral fracture: Toradol, ESR, CBC, BMP, Serum Calcium, Spine x-ray, lumbosacral, SPEP (to r/o mm), TSH, Naproxen oral, calcium carbonate, vit D, Fosamax (Alendronate), calcium enriched diet. In f/u 7 days, Dexa scan.

TSS: Clindamycin. IV dopamine, iv phenergan one time, foley. Acute bacterial prostatitis:

Ampicillin, Gentamicin, later oral amoxicillin. Diverticulosis: Anoscopy, CBC, BMP, LFT, PT, PTT, EKG, Type and crossmatch, NGT aspiration, D/C if taking Glyburide, statin or lisinopril, PRBC, FFP, H and H Q6, Urine output, Accucheck Q6, Consult Gastroenterology for Colonoscopy, Golytely, High fiber diet, avoid nuts and fruits. Infective endocarditis: Vancomycin, Gentamicin. TEE, Daily blood culture, later D/C Vancomycin, add oral Nafcillin. Angioedema: Epinephrine SQ, stat, ABG, albuterol, hydrocortisone, Diphenhydramine, ranitidine, dopamine,all iv continous, urine output, d/c all IV, oral prednisone, oral diphenhydramine. At discharge, EpiPen. After 6 weeks, RAST. Avoid allergen, Immunology consult for anaphylaxis. Folic Acid deficiency: Fobt, serum folate, serum vit b12, lft, reticulocyte, iron sulfate therapy, thiamine oral, multiviamin oral, iron enriched diet, folic acid therapy. All postmenopausal: Cal, Vit D. Urosepsis: D/C foley, IV ceftriaxone, after 24 hours, oral bactrim or ciprofloxacin.