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STEP 3 CCS > CCS cases > Flashcards

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
Q

How to manage HTN emergency once stroke ruled out via head CT

A

IV nitorprusside
ARTERIAL LINE
transfer to ICU (NPO, complete bed rest, monitor urine output)

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26
Q

How often to monitor HTN emergency pt after ICU admission

A

q1h vitals
once symptom free and BP under control, switch to PO BP and transfer to ward

can get lipid profile

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27
Q

suspect FBA in child; what to order first

A

(assuming you’ve already done oxygen, IV access, pulse ox)

  1. CXR
  2. neck xray to r/o croup/epiglottitis
  3. CBC
28
Q

once imaging initial imaging is done for FBA; what to order next?

A

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
Q

pt comes in with panic attack (possible); what to order first

A

MUST RULE OUT SCARY THINGS so do EMERGENCY ORDERS

  • IV access
  • cardiac monitor
  • pulse ox
  • ecg
  • glucometer gluocose
30
Q

labs to order for panic disorder

A

CBC, BMP, CXR, TSH UA, UDS, cardiac enzymes

31
Q

How to manage panic attack in ED

A 
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
Q

Initial labs/imaging after pt comes in after TIA (stable)

A 
ECG
CT head
CBC
BMP
IV access
33
Q

What contininuous med to put patient on after TIA

A

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
Q

After results of CEA come back, (70% stenosis) what to do next

A

Vascular consult for Carotid endarterectomy,…then PT/INR, PTT, NPO cefazolin

35
Q

initial labs for PID

A 
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
Q

inpatient orders after transferring PID pt to ward

A 
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
Q

how to confirm dx of Hemophilia A

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
Q

kid with barking cough….what to get after physical, O2, o2 monitor?

A

neck x ray
CXR
CBC

39
Q

suspect viral croup…what to immediately start?

A

PO dexmethasone
inhaled epinephrine
humidified air

f/u results + interval f/u after 4 hours

f/u 1 week

40
Q

when “last orders need to put in” WHAT TO ALWAYS PUT IF YOU HAVEN’T ALREADY

A 
COUNSEL
COUNSEL
COUNSEL
COUNSEL
COUNSEL
COUNSEL
41
Q

what to order if you suspect COPD or asthma exacerbation

A

Peak flow (usually q2 hours)

42
Q

management acute asthma

A

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
Q

what labs to get for constipation

A

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
Q

rx chronic constiapation

A 
counseling
high fiber diet
high liqiuid diet
metamucil (fiber supplement)
send pt home f/u 1 week
45
Q

kid in office fever, RLQ, abdominal pain…?

A

appendicitis

SEND TO ER!!!!!!!!!!!!

46
Q

once kid with appendicitis in ER…order?

A 
abdominal x-ray
abdominal US
CBC with diff
LFTs
U/A
iv access
NPO
PT/INR
PTT
IV morphine/ IVphenargan
47
Q

once diagnosis confirmed for appendicitis…

A

order surgery consult
START PRE-OP
IV CEFOXITIN
IV NS

48
Q

after lap appendectomy

A

counsel parents
restart diet
cancel IV access

49
Q

When suspect septic arthritis what to order

A

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
Q

what to do after confirm dx of septic arthritis

A

iv abx with IV vanc + cef
NPO
IV hydration
consult ortho for arthroplasty

51
Q

what to order in HDS patient with abnormal uterine bleeding (adolescent)

A 
CBC with diff
TSH
PROLACTIN!!!!
PT/INR + PTT
URINE HCG!!!!!!!
Pap smear
52
Q

How to treat dysfun uterine bleeding (assuming all other labs are pretty much normal)

A

OCPs (estrogen +/- progesterone)
iron sulfat oral continuous

counsel, f/u 3 months

53
Q

ECG shows diffuse ST elevations…what to order next

A 
acute pericarditis
CBC with diff
ESR
blood cx
CXR 
cardiac enzymes
ibuprofen
colchicine

then admit to ward
echo, reassurance, ambulate, regular diet

54
Q

pt with blunt abdominal trauma….what to do even before full physical?

A 
EMERGENCY ORDERS
c-spine immobilization
IV access
puls ox
cardiac monitor
BP monitor
IV NS
oxygen
NPO
55
Q

what to order after full physical for BAT

A 
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
Q

after CT results for BAT what to do next

A

transfer to WARD!

foley catheter
check urine output
continue to assess until better or surgery wants to do something

57
Q

if suspect cellulitis, what to order and what meds to start

A

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
Q

once you discover pneumoperitoneum on abdominal xray…what to do

A

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
Q

suspect turner syndrome after full physical? what labs to order

A

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
Q

What therapies to order for Turner syndrome

A 
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
Q

Normal guy with BP 160>90…how to manage

A

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
Q

inpt regimen abx for diverticulitis

A

IV metro + IV cipro
transition to PO after clinical improvement

counsel high fiber diet, exercise, no alcohol/caffine
schedule f/u 2 weeks

63
Q

suspect NAT after full physical…what to get?

A 
PT/INR
PTT
CXR/skeletal survey
CBC
physiotherapy
CPS STAT
admit to hospital
parental counseling
pain control (ibuprofen)
64
Q

suspect menopause, what to do next?

A

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
Q

DVT confirmed via Doppler…what next?

A

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
Q

positive colonoscopy now what

A

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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