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Project - USMLE Step 3 > !!!! CCS !!!! > Flashcards

!!!! CCS !!!! Flashcards

1
Q

UTI

A 
Urine HCG female
UA
Urine culture
Tx: bactrim/nitrofurantoin
*make sure you follow up uc 1-2 weeks after therapy
*confirm pregnacy before urine culture.
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2
Q

Pregnancy

A

Pregnancy Test
Pelvic Ultrasound for dating
1st-trimester labs:

A, BB, CC, HH, P, RR, UU

Atypical antibody
BMP, Blood Type/Rh
Chlamydia/ Gonorrhea, CBC
HBV, HIV
Pap-Smear
RPR, Rubella
U/A, UC

*at risk gonorrhea, TB, red cell indices, hemoglobin electrophoresis for sickle cell or thalassemia, hexosaminidase a, cystic fibrosis, serum phenylalanine level, toxoplasmosis screen, and hepatitis C antibodies

Treatment: Is For Pregnant Patients

  • Iron
  • Folate
  • Prenatal Vitamins
  • Prenatal Counseling.

Follow up
Glucose screening: 50g 1 hr glucose tolerance test between 24-28 weeks’ gestation. Results >135 are abnormal if the patient is greater than 25, FH obesity, DM, prior infant weight of 4000, recurrent spontaneous abortions.

GBS if 35-37 weeks

  • .
  • Recommendations for nutrition weight gain, regular exercise, rest, and sexual activity.
  • Routine pregnancy monitoring,
  • listeria precautions
  • toxoplasmosis precautions
  • Abstinence from alcohol, cigarettes, and illicit drugs
  • Recommendations for seat belts during pregnancy
  • childbirth classes and breastfeeding recommendations
  • confidentiality issues
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3
Q

Ulcerative Colitis

A

Diagnosis:
PT/PTT, cbc, lft, bmp
*Sigmoidoscopy, Rectal biopsy, ESR, stool O/P, stool leukocyte, stool culture,
Tx:
Mild - Topical 5-ASA (mesalamine, sulfasalazine, olsalazine) treat diarrhea/pain with loperamide, dicyclomine, *dietary consult

Mod - oral 5 ASA compounds( [sulfasalazine *give folic acid], mesalamine, olsalazine), consider steroids or immunomodulators like 6-MP/azathioprine when asa fails to induce remission.

Severe - 
Hospitalize, resusitate with IV fluids
NPO, TPN
Serial abdominal exams, vitals, abdominal xay
IV steroids (review which one)
Broad spectrum abx(
Consider Surgery in refactory cases
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4
Q

Ectopic Pregnancy

A

Dx: Beta-HCG, Transvaginal ultrasound,

*Surgical workup (PT/PTT, Type and cross, blood group, Rh status), GC/CT

Tx: Methotrexate

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5
Q

IBS

A

Dx: CBC/BMP, TSH, FOBT, ESR, Stool workup (O/P, leukocyte, culture)

Tx: Diet modification, Dicyclomine, loperamide, amitriptyline

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6
Q

Depression

A

Dx: CBC, BMP, TSH, B12

Tx: SSRI, Counseling

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7
Q

Vaginitis

A

Dx: Vaginal PH, Wet mount, gram stain, Pap smear, GC/CT, U/A

Tx: Yeast - fluconazole/clotrimazole,
BV - Metronidazole,
Trich - Metronidazole

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8
Q

Dementia

A

Dx: CBC/BMP, LFT, TSH, Vitamin B12, CT

Tx: Donepazil-Aricept, vitamin E, atypical antipsychotic for psychotic sx???, can add on memantine

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9
Q

COPD Exacerbation

A

Dx: Peak flow, CBC/BMP, CXR, ABG, EKG
Tx: Albuterol, ipratropium, PO steroids, consider antibiotics i.e. Doxy (outpatient) Levaquin (inpatient)

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10
Q

Breast Lump

A

Dx: Mammography, Ultrasound,

FNA automatically, counseling

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11
Q

Hypertensive Emergency

A

Dx: Look for evidence of end organ damage (CBC, BMP, ECG, head CT, UA)

Tx: Transfer to ICU, Art line for monitoring, Oxygen, pulse ox, nitroprusside (1), labetalol (2),

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12
Q

Foreign Body Aspiration

A

Dx: CXR, Neck X-ray, bronchoscopy

Tx: Oxygen, pulse ox, bronch

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13
Q

Panic Attack

A

Lots to rule out! Dx: ECG, Trop, CXR, CBC, BMP, Urine drug, glucose, TSH, UA

Tx: Oxygen, benzo

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14
Q

Immediate stabilization options

A

Oxygen, pulse ox, head elevation, Cardiac monitoring, BP monitoring, IV access

Shock panel tropinin, bnp, cxr, abg

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15
Q

TIA

A

Dx: CBC, BMP, Glucose, ECG, head CT, carotid Doppler, echo, lipid panel, A1C

Tx: IV access, aspirin, Carotid endarectomy, counseling

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16
Q

PID

A

Dx: Pelvic Exam, GC/CT swab, gram stain swab, pelvic ultrasound, blood cultures, UA, Urine culture, urine HCG, HIV, RPR

Tx: IV cefoxitin, IV doxycycline (24 hours), morphine*, saline, NPO, Tylenol

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17
Q

Hemophilia

A

Dx: CBC, INR/PTT, bleeding time, BMP, LFT. Then Factor VIII, IX, or XI *
Tx: Replace missing factor, trend levels*

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18
Q

Unstable Angina/MI

A

First: IV Access, pulse ox, oxygen, ECG, aspirin,/nitroglycerine, cardiac monitoring, BP monitoring

Dx: Cardiac enzymes, CBC, BMP, LFT, lipid profile, INR/PTT, Echo, Card consult, Catheterization

Tx: Add on heparin, metoprolol, G2b/3a inhibitor -eptfibatide, simvastatin

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19
Q

Croup (barking cough)

A

First: oxygen, pulse ox
Dx: CXR, neck X-ray, CBC, BMP
Tx: Dexamethasone, Racemic Epi

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20
Q

Asthma Exacerbation

A

First: Head Elevation, Oxygen, Pulse Ox, cardiac monitoring, ECG
Dx: ABG, CBC, BMP, Peak flow also called Peak Expiratory Flow Rate (PEFR) , CXR
Tx: Salmbuterol, ipatroprium, oral or IV steroid based on severity
Monitor: Peak flow

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21
Q

Constipation

A

Dx: CBC, BMP, Mag, Phos, TSH, FOBT,
Tx: Fiber, senna, docusate

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22
Q

Appendicitis

A

Dx: CBC, BMP, LFT, FOBT, Abdominal X-ray, abdominal ultrasound, UA, PT/INR, PTT
Tx: NPO, IV access, NS, Morphine, antiemetics, Cefoxitin!!!, surge consult, laparoscopy

23
Q

Joint Infection

A

CBC, BMP, Blood culture, INR/PTT
*Dx: Joint aspiration, joint X-ray, synovial culture/gram stain/cell count.
Tx: IV vanc and ceftriaxone. Joint arthroscopy if fluid can’t be removed.
Ortho consult. IV access, IV morphine, counseling

24
Q

Dysfunctional Uterine Bleeding

A

CBC, prolactin, TSH, Ferritin, GC/CT, INR/PTT, urine HCG, LFTs
Dx: GYN exam, Consider endometrial biopsy, pelvic ultrasound,
Tx: OCs, Iron sulfate

25
Pericarditis
CBC, BMP, troponin,ESR, CK-MB, blood cultures, amylase/lipase, Dx: ECG, CXR, echo, Tx: NSAID + colchicine, consider steroid if refractory, consider pericardiocentesis
26
Trauma
First: C-spine immobilization, oxygen, pulse ox, IV access, NS, BP/Cardiac monitoring CBC, BMP, LFTs, ABG, type and screen, UA, INR/PTT, urine pregnancy test, amylase/lipase, urine drug screen Dx: Full physical, , CXR, Abdominal CT/Ultrasound (depending on stability),, ECG, Spine x-ray, Tx: Supportive unless requiring splenectomy, IV analgesia/anti-emetics, foley, surgical consult
27
Cellulitis
CBC, BMP, Blood culture, wound culture Dx: X-ray, Tx: Outpatient: Clinda; Inpatient: IV access, NS, elevation, Vanc (MRSA) or Cefazolin-> Keflex, PO analgesic
28
Gout
, CBC, BMP, ESR, INR/PTT, Uric acid Dx: Joint aspiration, X-ray Tx: Indomethacin, consider colchicine if can't tolerate NSAIDS
29
AIDS with PCP
Dx: CBC, BMP, Sputum culture, pulse ox, ABG, LDH, ELISA followed by western blot then CD4 and viral load, CXR Tx: Bactrim + steroids, oxygen, vaccinations, HAART i.e. Efavirenz/Tenofovir/Emtricitabine
30
Renal Cell Carcinoma
Dx: CBC then iron studies (ferritin, transferrin, TIBC), INR/PTT BMP, LFTs, UA, cystoscopy, abdominal CT, chest CT, FOBT Tx: Nephrectomy (pre-op care i.e. Cefazolin, type and cross, NPO)
31
Duodenal Ulcer
First: IV Access, oxygen, Cardiac/BP monitoring, ECG CBC, BMP, FOBT, amylase, lipase, UA Dx: CXR or AXR, Tx: Laparoscopy (NPO, PPI, NG tube, INR/PTT, Type and cross, NS), IV Zosyn
32
Turner Syndrome
FSH*, LH* CBC, TSH, BMP, fasting glucose, lipid profile, UA Dx: Full exam, Karyotype*,Psych consult for IQ, hearing test, skeletal survey, renal ultrasound, pelvic ultrasound, echo, Tx: Calcium, vitamin D, OCs, growth hormone, diet, ophthalmology consult
33
Essential HTN
Dx: CBC, BMP, LFTs, UA, lipid, ECG. Then have return in 1 month for repeat BP Tx: start with lifestyle management. If no change in 3-5 month period start on medication management. ACE if standard. CCB if AA
34
Diverticulitis
CBC, BMP, LFTs, UA, Blood culture Dx: FOBT, Abdominal CT, Tx: Zosyn -> augmentin. NS, NPO, morphine, anti-emetics. Colonoscopy 3 weeks post recovery.
35
Child abuse
CBC, INR, PTT, bleeding time Dx: Skeletal Survey, consider ophthalmologic exam, if bruising Tx: CPS Consult, Psych consult, admit, DO NOT RETURN HOME
36
Menopause
CBC Dx: FSH, prolactin if worried, Tx: Counseling, estrogen/progestin replacement??
37
DVT
Dx: admit to ED if PE findings present, Dopplers, d-dimer, CBC, BMP Tx: LMWH if Cr normal, Warfarin, will need CBC on day 3 to r/o HIT, INR daily until therapeutic, oxycodone
38
PE
First: Oxygen, pulse ox, IV, ECG, cardiac monitor CBC, D-dimer,INR/PTT, BMP, ABG, Cardiac enzymes Dx: CT spiral, CXR, Tx: LMWH, Warfarin, discontinue pro-clotting meds (OCs)
39
Colon Cancer
Dx: CBC with appropriate workup, UA, BMP, ESR, TSH, stage with CXR and abdominal CT, CEA***** FOBT, Colonoscopy (don't forget mechanical bowel prep***), Tx: Hemicolectomy, pre-op orders antibiotics include cipro + metronidazole
40
Bipolar
Dx: CBC, BMP, UA, Urine Drug Screen, TSH, Tx: Atypical antipsychotic + lithium*****, suicide contract, psych consult, admit
41
Bacterial Meningitis
Dx: CBC, BMP, Blood culture, Head CT, Vanc + ceftriaxone, LP, UA, CXR CSF gram stain, cell count, glucose, protein, culture, antigens Tx: Vanc + ceftriaxone, consider gent if gram neg, Dexamethasone for likely s pneumo, NPO, IV, NS, antipyretics
42
Cryptococcal Meningitis
Dx: CBC, BMP, Blood culture, UA, LP: CSF gram stain, cell count, glucose, protein, culture, antigens + cryptococcal antigen, India ink, fungal culture (Test for everything with AIDS) Head CT, CXR Tx: Amphotericin B, flucytosine
43
HSV Meningitis
CBC, BMP, Blood Culture, INR/PTT, UA, Urine Culture Dx: Head CT, LP with CSF PCR, CXR, Tx: NPO, NS, IV acyclovir
44
Giant Cell Arteritis
CBC, BMP, ESR,UA,blood culture Dx: Temp artery biopsy, CXR, head CT, Tx: Oral steroid, if vision loss - IV steroid. With steroids need: PPI, Vitamin D, calcium. Monitor ESR, CBC*
45
Polymyalgia Rheumatica
Dx: CBC, BMP, ESR, , ANA, RF, CPK, TSH CXR Tx: Oral steroid, With steroid: PPI, Calcium, Vitamin D Monitor: ESR, CRP, CBC, Focused Exam
46
Ovarian Torsion
Dx: CBC, BMP,UA, Urine culture, Blood culture, urine HCG Pelvic Ultrasound, CXR, Tx: Laparoscopy, IV access, NS, anti-emetics, analgesia, with pre-op NPO, INR/PTT, Cefazolin
47
Ovarian Carcinoma
Dx: CBC, BMP, TSH, LFTs, UA,CA-125 pre-op CXR, Pelvic Ultrasound, Colonoscopy, Mammography, Abdominal CT for staging, Tx: Laparotomy with preop orders (ECG, Type and cross, INR/PTT, NPO, IV access, NS)
48
Preventative test for pregnant women?
A, BB, CC, HH, P, RR, UU ``` Atypical antibody BMP, Blood Type/Rh Chlamydia, CBC HBV, HIV Pap-Smear RPR, Rubella Urinalysis, U/A ``` Treatment: Is For Pregnant Patients - Iron - Folate - Prenatal Vitamins - Prenatal Counseling..
49
Preventative test for pregnant women?
B-HCG
50
mysthenia gravis
* sign weakness full phx, CMP, PT/PTT, UA EKG, Telemetry TSH, AchR (don’t need to do tensilon test CXR, EMG, CT scan(espicially after you find something. Presurg lab: CMP, CBC, Type and screen, couags tx: pyridostigmine bromide, steroids, surg consult thymectomy,
51
Steroids
Prednisolone/prednisone/azathioprine/methylprednisolone
52
Pre surgical labs
CMP, CBC, Type and screen, couags
53
UTI
uncomplicated uti in pregnancy

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