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CCS cases Flashcards

1
Q

Prenatal labs (after confirmed with urine Hcg?)

also don’t forget transvaginal ultrasound!!!

A
  • CBC with diff
  • BMP
  • Pap smear
  • HIV (elisa)
  • RPR
  • chlamydia
  • Hep B surface antigen
  • Blood type and Rh
  • U/A
  • UCx
  • Rubella antibodies
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2
Q

What treatment to order for pregnant patient?

A
  • pregnancy counseling
  • prenatal vitamins
  • iron sulfate
  • folic acid
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3
Q

When to schedule follow up for pregnant patient?

A

4 weeks

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4
Q

What labs to get in possible HIV patient?

A

CBC, CMP, U/A, HIV (elisa) + confirm w/ western blot if positive, HIV viral load, CD4 count

TB skin test/interferon gamma, RPR, TORCH Hep A IgG+IgM, HBsAB, HBcAB, Hep C serology, (can just type in Hepatitis panel) gonorrhea/chlamydia

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5
Q

what vaccines to order for newly diagnosed HIV patient

A

Hepatitis, pneumococcal, influenza, MMR, varicella, DPT, HPV

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6
Q

What other things to order for newly diagnosed HIV patient?

A

HIV support group
counsel safe sex
infectious disease consult

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7
Q

pt with possible UC; what labs to get? what imaging?

A

CBC with diff, CMP, stool ova/parasites, PT/INR, PTT, ESR, stool for WBCs, stool culture; then send pt home if stable

then get flex sigmoidoscopy, rectal biopsy

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8
Q

What therapies to order once UC diagnosis confirmed

A

5 ASA (mesalamine), antidiarrheals (loperamide), antispasmodic (dicyclomine), dietary consult, counseling then send pt home and follow up in 2 weeks

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9
Q

What to do when suspect ectopic pregnancy in office via urine bHCG?

A

admit to ward!
NPO, serum quant HCG, vitals q1h, IV access, NS, activity (bedrest), transvaginal US, type and cross, blood type RH, CBC with diff, PT/INR/ PTT, BMP, LFTs, gonococcal, chlamydia (ALL STAT)

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10
Q

What to order when ectopic confirmed with quant HcG and serum

A

OB Gyn consult, methotrexate vs laparoscopy (if stable can just do methotrexate),

once stable, send home with orders for rest; follow up in 4 days

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11
Q

reasonable initial tests to order when you suspect IBS?

A

CBC with diff, BMP, stool ova/parasites, stool wbc, stool bacterial culture, 72 hour stool fat, FOBT, ESR (routine)

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12
Q

what therapies to order for IBS patient

A

high fiber diet, lactose free diet, reassurance, counseling, biofeedback, relaxation, behavioral therapy, antidiarrheal, antispasmodic, follow up two weeks

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13
Q

What labs to order fo vaginitis?

A

wet mount, vaginal pH, vaginal gram stain, cervical culture (r/o G/C), U/A

keep them in clinic until wet mount results come back then start meds
candida - fluconazole
trich - metronidazole + treat partner + safe sex
BV - metronidazole
THEN SCHEDULE FOLLOW UP

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14
Q

What labs/imaging to get for suspefted Alzheimer’s dementia?

A

CBC, BMP, Vit b12, tsh

CT head non contrast

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15
Q

What to start for dementia patient?

A

CLinically diagnose (no f/u needed); cholinesterase inhibitor, antipsychotic (if psychotic or paranoid), use atypical, Vitamin E if no heart disesaes;

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16
Q

What to order when someone comes into ED SOB (before anything else)

A 
Pulse ox
Cardiac monitor
IV access
oxygen
elevate head of bead
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17
Q

What initial labs/to get when suspect COPD exacerbation?

DON”T FORGET IMAGING

A 
CBC with diff
BMP
CXR (PA+L)
PEFR q1h
ABG
EKG

ALL STAT ORDERS!

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18
Q

How to manage acute COPD (what therapies)

A

inhaled bronchodilators (albuterol neb continuous) + ipraproprium
steroids (IV if only they’re VERY BAD)
abx (levaquin if inpatient, tmp-sulfa if outpatient)

monitor q1-4hours until improved

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19
Q

After seeing improvement in COPD and thinking about discharge, WHAT CAN THEY NOT LEAVE WITHOUT?

A

pneumo vaccine
influenza
smoking cessation
counseling

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20
Q

If woman >40 yo comes into clinic with any breast mass, what three things does she need?

A
  1. Physical (esp breast + lymph nodes)
  2. Mammography (do not do if <35)
  3. FNA
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21
Q

When to follow up for benign breast mass?

A

3-6 months (esp if mammogram negative)

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22
Q

IV drug of choice hypertensive emergency

A

IV nitroprusside

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23
Q

Stat labs to get in hypertensive emergency

A

EKG, head CT (rule out stroke first), CBC, BMP, UA, CXR-PA

once you get CT head results…BEGIN IV BP MANAGEMENT

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24
Q

what to order in any un-HDS pt (even htn emergency) before anything elese

A

IV ACCESS
pulse ox
cardiac monitor
BP monitor

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25
How to manage HTN emergency once stroke ruled out via head CT
IV nitorprusside ARTERIAL LINE transfer to ICU (NPO, complete bed rest, monitor urine output)
26
How often to monitor HTN emergency pt after ICU admission
q1h vitals once symptom free and BP under control, switch to PO BP and transfer to ward can get lipid profile
27
suspect FBA in child; what to order first
(assuming you've already done oxygen, IV access, pulse ox) 1. CXR 2. neck xray to r/o croup/epiglottitis 3. CBC
28
once imaging initial imaging is done for FBA; what to order next?
BRONCHOSCOPY + REMOVAL OF FOREIGN OBJECT may need to consult pulm to do this then re-assess in ED until symptoms improve; schedule f/u 1-2 weeks
29
pt comes in with panic attack (possible); what to order first
MUST RULE OUT SCARY THINGS so do EMERGENCY ORDERS - IV access - cardiac monitor - pulse ox - ecg - glucometer gluocose
30
labs to order for panic disorder
CBC, BMP, CXR, TSH UA, UDS, cardiac enzymes
31
How to manage panic attack in ED
``` alprazolam sublingual (one time) interval follow up, see if they want to do psychological/cvs exam cancel puls ox, cardiac monitor reassurance 2 week follow up ```
32
Initial labs/imaging after pt comes in after TIA (stable)
``` ECG CT head CBC BMP IV access ```
33
What contininuous med to put patient on after TIA
ASA (assuming CT head negative for bleed); can then transfer to ward orders for ward: diabetic diet, , glucometer q8h, CAROTID DOPPLER, ECHO, MRI head, hba1c, lipid profile
34
After results of CEA come back, (70% stenosis) what to do next
Vascular consult for Carotid endarterectomy,...then PT/INR, PTT, NPO cefazolin
35
initial labs for PID
``` CBC with diff cervical gram stain + culture chlamydia culture gonococcal culture (cervical) B HCG u/a ucx pap smear ESR VDRL HIV (elisa) blood cx ```
36
inpatient orders after transferring PID pt to ward
``` NPO bedrest, bathroom IV cefoxitin + IV doxy continuos (pain, fever, nausea) = IV morphine, IV acetaminophen, IV phenargan IV NS ``` then re-evaluate q12 with abd+genital exams with improvement can transition to PO doxy; DC after counseling for safe sex f/u 1 week
37
how to confirm dx of Hemophilia A
get PT/INR + PTT PTT will be prolonged then ADMIT TO WARD check Factor VIII, IX, XI (intrinsic factors)...Factor VIII will be low so give Factor VIII and continue to check Factor VIII + PTT until normal get genetic counseling then follow up 1-2 weeks
38
kid with barking cough....what to get after physical, O2, o2 monitor?
neck x ray CXR CBC
39
suspect viral croup...what to immediately start?
PO dexmethasone inhaled epinephrine humidified air f/u results + interval f/u after 4 hours f/u 1 week
40
when "last orders need to put in" WHAT TO ALWAYS PUT IF YOU HAVEN'T ALREADY
``` COUNSEL COUNSEL COUNSEL COUNSEL COUNSEL COUNSEL ```
41
what to order if you suspect COPD or asthma exacerbation
Peak flow (usually q2 hours)
42
management acute asthma
Peak flow, ABG, BMP, CXR, ECG, CBC....if peak flow low...can admit to ward - inhaled albuterol...then iprattropium if not working - steroids (PO prednisone continuous or IV Methylpred contininouous) - reassess q 1-2 hours until improvement COUNSEL COUNSEL COUNSEL before dc'ing all meds also keep patient NPO
43
what labs to get for constipation
CBC, BMP, Mg, Phos, TSH, !!FOBT!!! then colonoscopy if indicated (need to rule out colon cancer), HbA1C (in any diabetic pt) can order all of these routine if pt stable
44
rx chronic constiapation
``` counseling high fiber diet high liqiuid diet metamucil (fiber supplement) send pt home f/u 1 week ```
45
kid in office fever, RLQ, abdominal pain...?
appendicitis SEND TO ER!!!!!!!!!!!!
46
once kid with appendicitis in ER...order?
``` abdominal x-ray abdominal US CBC with diff LFTs U/A iv access NPO PT/INR PTT IV morphine/ IVphenargan ```
47
once diagnosis confirmed for appendicitis...
order surgery consult START PRE-OP IV CEFOXITIN IV NS
48
after lap appendectomy
counsel parents restart diet cancel IV access
49
When suspect septic arthritis what to order
ADMIT TO WARD CBC, BMP, knee xray, SYNOVIAL FLUID (glucose, gram stain, culture, crystaklscell count, viscositiY)...just search synovial fluid and do everything) ``` NPO IV ACCESS IV NS IV MORPHINE IV TYLENOL IV ABX (CEFTRIAXONE + VANCOMYCIN) ```
50
what to do after confirm dx of septic arthritis
iv abx with IV vanc + cef NPO IV hydration consult ortho for arthroplasty
51
what to order in HDS patient with abnormal uterine bleeding (adolescent)
``` CBC with diff TSH PROLACTIN!!!! PT/INR + PTT URINE HCG!!!!!!! Pap smear ```
52
How to treat dysfun uterine bleeding (assuming all other labs are pretty much normal)
OCPs (estrogen +/- progesterone) iron sulfat oral continuous counsel, f/u 3 months
53
ECG shows diffuse ST elevations...what to order next
``` acute pericarditis CBC with diff ESR blood cx CXR cardiac enzymes ibuprofen colchicine ``` then admit to ward echo, reassurance, ambulate, regular diet
54
pt with blunt abdominal trauma....what to do even before full physical?
``` EMERGENCY ORDERS c-spine immobilization IV access puls ox cardiac monitor BP monitor IV NS oxygen NPO ```
55
what to order after full physical for BAT
``` abdominal CT CBC BMP LFT PT/INR PTT u/a uds blood alcohol bhcg ecg spine xray chest xr NPO surgery consult IV morphine IV phenargan ```
56
after CT results for BAT what to do next
transfer to WARD! foley catheter check urine output continue to assess until better or surgery wants to do something
57
if suspect cellulitis, what to order and what meds to start
IV access IV NSS ``` CBC with diff xray (leg?) BMP blood culture start IV clinda (transition to PO once stable) pain control (percocet) ``` send pt home after improvement with f/u in 1-2 weeks make sure to counsel and DC all inpt orders
58
once you discover pneumoperitoneum on abdominal xray...what to do
PREP FOR SURGERY ``` IV ampicillin-sulbacttam IV morphine IV phenargan IV pantoprazole (discontinue any NSAIDS) type and crossmatch consult general surgery PT/INR PTT NPO Nasogastric tube compllete bed rest admit to ward urine output proceed to LAPARATOMY ``` after procedure re-evalauate q4h, transition to clear liquid diet
59
suspect turner syndrome after full physical? what labs to order
KARYOTYPE ANALYSIS serum FSH/LH send pt home and f/u 1 week ``` then order: echo skeletal survey pelvic US renal US hearing test BMP LFTs fasting glucose serum TSH ``` check for gonadal, renal, endocrine, cardiovascular, neuro anomalies
60
What therapies to order for Turner syndrome
``` growth hormone + estrogen-progesterone therapy CONSULTS!! Ob Gyn consult Endocrinology consult Ophthalmology consult Psychology consult (IQ + intelligence) Vit D+Ca supplement dietary consult ``` counseling (regluar diet/exercise, med compliance), parent counseling
61
Normal guy with BP 160>90...how to manage
initial: labs (CBC, BMP, UA, lipid panel, ECG) then counsel on LIFE STYLE MODIFICATIONS (exercise, low salt/fat/calorie diet, smoking cessation, no alcohol/caffine) schedule follow up 3 months w/interval hix focused physical...BP still elevated schedule another follow up in . 3months with interval+focused hx (DIAGNOSE ESSENTIAL HTN)...start lisinopril/amlodipine (if af AM)
62
inpt regimen abx for diverticulitis
IV metro + IV cipro transition to PO after clinical improvement counsel high fiber diet, exercise, no alcohol/caffine schedule f/u 2 weeks
63
suspect NAT after full physical...what to get?
``` PT/INR PTT CXR/skeletal survey CBC physiotherapy CPS STAT admit to hospital parental counseling pain control (ibuprofen) ```
64
suspect menopause, what to do next?
no necessary confirmatory testing COUNSELING (exercise, high calcium/low salt diet, med compliance/side effects) ESTROGEN + PROGESTIN (if they still have uterus) therapy for symptoms f/u 6 weeks for treatment response
65
DVT confirmed via Doppler...what next?
enoxiparin sub q continuous + warfarin percocet send home and have pt come back DAILY to check PT/INR PTT (until therapeutic INR reached) re-check CBC on Day 3 to assess for HIT
66
positive colonoscopy now what
admit to ward with intent to stage and resect ``` IMAGING: abd ct, ct chest PRE-op labs - cbc, PT/INR PTT, ECG, !!!CEA!!!, blood type cross and match, UA CONSULT: oncology, surgery Cancer diagnosis counseling get results ``` then IV access, NPO, NS pre op abx (iv metro+cipro) HEMICOLECTOMY re-eval q12-24; restart diet, cancel fluids, COUNSEL: no smoking/alcohol

STEP 3 CCS (1 decks)

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