Ccs Flashcards
Intususception-STAT
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
Ruptured AAA-STAT
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
Acute bacterial rhinosinusitis
No imaging needed
Abx, analgesics, NS irrigation, topical steroids
If allergic to augmentin, foxy/flouro
Acute chole
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
Sigmoid volvulus
GI for sigmoidoscopy and rectal tube
If complications-surgery
Ovarian cancer
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
Whenever patient follows up
Interval history and exam
Polymyalgia rheumatica
CBC, BMP, ESR, ANA, RF, CPK, TSH
Taper steroids later, GI ppx, calcium, vitamin D, baseline DEXA
Follow up: ESR, CRP, CBC
Temporal arteritis f/u
Treatment
ESR, CRP, CXR, CBC
Aspirin and steroid
Fever with AMS
Complete infectious work up, all the CSF studies
Oxygen (thinking of something happening in brain)
Turner
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
Essential htn
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
Diverticulitis
Get UA, blood cultures, abdominal CT
Repeat CT if no improvement in 2-3 days
Colonoscopy in 2-6 weeks
Inpatient: IV zosyn
Fall
FULL exam
Child abuse differential
Check for coagulopathy
Psych consult
Rib fracture: analgesics, incentive spirometer, chest PT
Menopause
Hormone replacement unless clots/breast cancer
If <45 yo->TSH, prolactin, FSH, UPT
Calcium, vitamin d, exercise, preventive health
DVT treatment
PT/INR, Fobt before
Lovenox+ warfarin
CBC on day 3 and 5 (HIT)
Pt/INR every day
Suspected cancer
Admit to hospital for staging, pre op, prophylactic antibiotics
Strep pneumo meningitis
DEXA
Before starting lithium
BUN, creatinine, calcium, TFTs, CBC, ECG, B-HCG
Mania
Suicide contract
Psychotherapy
General approach
- Standard ER (IV access, monitors)
- Symptoms
- CBC, BMP
- Diagnosis
- Diff
Septic arthritis
Fluid studies
IV abx, blood cultures, arthrocentesis->arthroscopy
Culture, gram stain, cytology, glucose, crystals
OCP in dysfunctional uterine bleeding
Low estrogen, low progesterone
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
Splenic rupture
Serial exams, CBC q6hours, BP monitor
Diagnosis
Admit or not.
Suspected cancer
Think about every organ.
Constipation diff
Electrolytes, cancer, hypothyroidism
TSH, FOBT
Asthma exacerbation test
PEFR every hour
If <40%-admit
Croup
CBC, neck x Ray, humidified Air, dexamethasone oral, inhaler epinephrine
No need to admit if not severe enough
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
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
Choking
Rigid bronchoscopy
CXR and neck x Ray
Panic disorder
Emergency orders like ACS + glucose
Get U/A and UDS
Pre op labs
PT/INR, PTT, NPO, fluids
Antibiotics before
TIA
Aspirin stat before CEA
If afib-> apixaban/warfarin
COPD exac
PEFR, ABG, EKG
As patient improves, transfer to ward, P.O. steroids, MDI nebs, walk test before leaving
Breast mass
U/s: simple cyst-> reassure, complex->FNA
Solid:
Mammogram
F/u: every 3 months for a year
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
Outpatient depression
Start SSRI, do not wait for all labs to come back.
F/u: every week for 6-8 weeks
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)
Alzheimer’s
Vitamin E, donepezil + olanzapine
UC management
Mesalamine, loperamide, dicyclomine, dietary consult
Pregnant UTI
Confirm eradication with f/u culture in a week
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
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
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
Rheumatoid arthritis
Consider arthrocentesis
Prednisone + methotrexate
PT/OT
DKA
Serum osmolality, serum ketones
Potassium, check phosphorus
Add glucose once <250
BMPs and ABGs q2h
ACS antibiotics
Azithromycin, cefuroxime
Exchange transfusion
Anaphylaxis
IM epi, glucagon if on beta blockers
Steroids, diphenhydramine, ranitidine, albuterol
Outpatient RAST testing
Medical alert bracelet
GI bleed in office
FOBT,
H. Pylori-clarithromycin, amoxicillin, ppi
Hypothyroidism
Check lipids
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
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
TSS
Clindamycin
Pancreatitis
Get RUQ U/s to rule out gallstone panc
If dilated CBD, ERCP
Hepatitis f/u
PT, INR, notify health department
Brady
EKG, echo, trop
Transcutaneous pacing
Cards for transvenous
Rhabdo
Electrolytes, sodium bicarbonate?
TB
Get LFT, uric acid, eye exam before meds Isoniazid, pyrimethamine, pyrazinamide, ethambutol, rifampin AFBs till negative LFTs
Minimal change disease
Lasix+ albumin
Prednisone
