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Imaging Studies and Other Interventions for Step 3 > Imaging Studies and Other Interventions for Step 3 > Flashcards

Imaging Studies and Other Interventions for Step 3 Flashcards

1
Q

Intussusception

A

DX: Abdominal ultrasound, AXR, BMP, CBC CS: Srx TX: NPO, IVF/access, IV morphine x1, NG TUBE, promethazine, Barium or air-contrast enema Abx: CeFAZolin

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2
Q

Cholecystitis

A

DX: Abdominal US TX: Lap chole when afebrile, ketorolac ABX: Cetriaxone + Metronidazole or Piperacillin-Tazobactam

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3
Q

AA rupture

A

Dx: Abd US, CT with contrast TX: CeFAZolin x 1, repair, bed rest, phenergan

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4
Q

Trichomonas

A

Dx: Wet mount Tx: Metronidazole

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5
Q

Sigmoid voluvulus

A

Dx: Abdominal Xray Tx: Flex sig, rectal tube, NG tube, bed rest

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6
Q

Colon cancer needs hemicolectomy

A

Dx: Colonsocopy, Abd CT Tx: Ceftriaxone x 1, metronidazole x 1 prior to srx FU: CEA

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7
Q

COPD exacerbation

A

Dx: CXR Tx: Ipratropium, Albuterol, PREDNISONE, Oxygen, Budesonide Abx: Amoxicllin or Doxycycline, or TMP-SMX or Clarithromycin FU: PFRF, ABG

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8
Q

Cellulitis

A

Dx: bld clx, ESR, CBC, BMP, X ray Tx: Clindamycin or Vanc IV, when better can do Clinda PO and send home; leg elevation FU: Daily CBC

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9
Q

Epidural abscess

A

Dx: MRI spine Tx: Drainage by NSG, Ceftriaxone + Metronidazole + Vancomycin

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10
Q

GBS at 36 wks GA

A

Ampicillin when deliver

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11
Q

Community acquired cystitis

A

Dx: UA and clx Tx: TMP-SMX x 3 d OR FQ x 3d

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12
Q

Hospital acquired cystitis

A

FQ + IV cef TRIaxone

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13
Q

Pyelonephritis

A

Dx: UA, urine culture, BLOOD Culture Tx: FQ IV Nonresponders: get US for abscess

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14
Q

PID

A

Ceftriaxone + Doxycycline and remove the IUD

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15
Q

Lyme disease

A

Dx: Western blot, PCR Tx: Doxy or Amoxi or CefTRIaxone if neuro or cardiac sxs or young pt

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16
Q

AAA rupture srx ppx

A

ceFAZolin x 1

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17
Q

Intussusception

A

ceFAZolin x 1

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18
Q

Sinus infection

A

Amoxicillin + Acetaminophen + PSEUDOEPHEDRINE + ORAL HYDRATION FU 2 wks

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19
Q

Alzheimers

A

ARICEPT + MEMANTINE

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20
Q

Any pt with cardiac sxs or sudden SOB

A

Initial Tx: IV access + Oxygen + Cardiac monitor + BP monitor + Pulse ox +/- ASA Tests: ECG + CXR + ABG + cardiac enzymes

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21
Q

Pulmonary embolus

A

Initial: IV, O2, Cardiac/BP monitor, Pulse ox Labs: Cardiac enzymes + D Dimer + ABG + CBC + BMP + CXR Imaging: CXR, then Spiral CT TX: Heparin IV, continuous –> INR 2-3 –> switch to Warfarin Monitoring: Pulse Ox Q2H + PTT Q6H!

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22
Q

If you hear rales

A

Don’t give fluids

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23
Q

Mild persistent asthma

A

Definition: > twice a month night sxs, > twice a week day sxs TX: Albuterol inhaler + Fluticasone low dose (inhaled steroid)

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24
Q

Mild intermittent asthma

A

Definition: < twice a month night sxs, < twice a week day sxs TX: Albuterol inhaler

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25
Q

Moderate persistent asthma

A

Definition: weekly night sxs, daily day sxs TX: Albuterol inh + Fluticasone med dose inh + Salmeterol (LABA)

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26
Q

Severe persistent asthma

A

Definition: almost nightly night sxs, continuous day sxs TX: Albuterol inh + Fluticasone high dose inh + Salmeterol + Prednisone

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27
Q

Are asthma drugs ok in pregnancy?

A

Salmeterol and fluticasone are OK

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28
Q

Ruling out asthma

A

methacholine challenge, reversible by bronchodilators

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29
Q

TX asthma exacerbation

A

O2 sat, ABG, head elevation, IV access, cardiac monitor CXR, EKG, CBC, BMP PEFR < 40% -O2, albuterol-atrovent neb, IV steroid taper, PEFR Q1h PEFR > 40% - O2, albuterol neb, PO steroid taper (add atrovent if PEFR doesn’t increase to 70% in 1 hour) (Reevaluate Q1h and admit if in 4 H if PEFR < 40% predicted, DC home if >70%–on admit give complete bedrest, npo, IV nss, peak flow Q2h)

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30
Q

TX COPD exacerbation

A

Follow with PEFR DX: CXR Tx: O2 + albuterol, Ipratropium + Prednisone PO taper + Amox or TMP-SMX or Doxy or Azithro or Clarithro

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31
Q

PTX (tension)

A

Needle thoracostomy FIRST, O2, morphine, NSAIDs

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32
Q

PTX, regular

A

CXR, chest tube, O2, morphine, NSAIDS

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33
Q

Diabetes insipidus (HYPERnatremia)

A

central: DDAVP nephrogenic: low salt diet + thiazides + hypotonic saline or D5W or PO water (best) 12 meq/L/day

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34
Q

5 mm kidney stone

A

passes on its on its own with alpha blockers and pain meds thiazides if hypercalciuria

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35
Q

3 cm kidney stone

A

lithotripsy or percutaneous nephrolithotomy

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36
Q

Time to tPA or angioplasty

A

TPA for stroke within 3 hrs of ONSET of sxs Angioplasty for MI within 90 minutes of GETTING TO HOSPITAL

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37
Q

Stroke vs Bell’s Palsy

A

Stroke spares upper face

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38
Q

Stroke

A

Imaging: CT w/o contrast, MRI with DWI/PWI, MRA, TEE, Carotid doppler (Vs MRI and MRA: CT perfusion and CT angio) Labs: glucose stat, CBC, BMP, PT/PTT/INR, HBA1C, fasting lipids TX: NPO, elevate head of bed, ICU admit, cardiac/BP monitor, BP: Hemorrhagic: keep BP 160 Ischemic getting TPA: BP < 185/110 Ischemic no TPA: BP > 160/80 Acute ischemic: ASA, if already on ASA add dipyridamole or change to clopidogrel

39
Q

Severe migraine tx

A

IVF + Reglan + dexamethasone + ergotamine

40
Q

Moderate migraine tx

A

Sumatriptan

41
Q

Mild migraine tx

A

NSAID + Reglan

42
Q

Tension headache tx

A

NSAIDs, Tylenol

43
Q

Cluster HA tx

A

100% O2 or low dose prednisone

44
Q

Parkinson’s tx

A

Carbidopa-levodopa together + bromocriptine + selegiline Deep brain stimulation or pallidotomy

45
Q

Dementia workup

A

MMSE, neuropsych testing, CBC, BMP, B12, TSH, VDRL, HIV, UTOX, CT/MRI brain

46
Q

First prenatal visit

A

Vitals: Weight, BP, Fetal heart tones Labs: CBC, type and cross, Rh Ab screen, UA with clx, Gonorrhea/Chlamydia clx, Rubella Ab titer, HBsAg, RPR, PPD, HIV Counsel: nutrition Supplement: folate, zinc? (Ca and iron later months) Counsel: smoking and alcohol cessation

47
Q

6-11 week preg visit

A

US to determine gestational age

48
Q

15-19 week visit

A

Triple screen or quadruple test Amniocentesis if > 35 yo

49
Q

18-21 week visit

A

Screening US

50
Q

26-28 week visit

A

1 hr glc challenge, if >140 do 3 hr glc challenge Repeat H/H

51
Q

28 wks

A

RHOGAM for RH - Fetal kick counts

52
Q

35-37 wks

A

Rectovaginal swab for GBS H/H repeat Gonorrhea + chlamydia clx if high risk Leopold maneuvers for position US

53
Q

10-12 wks

A

CVS if desired for down syndrome

54
Q

Kawasaki disease

A

ASA + IVIG Follow with Echo

55
Q

Polymyalgia rheumatica

A

The one associated with temporal arteritis Tests: ESR, CPK, CK, CBC, TSH, T4, EMG, mm bx SXS: pelvic girdle and pectoral wkns, shoulder, neck pain ESR: very high Muscle biopsy and EMG: normal TX: Steroids for long time! to prevent temporal arteritis FU frequently with ESR

56
Q

Polymyositis

A

The one associated with cancer Tests: ESR, CPK, CK, CBC, TSH, T4, EMG, mm bx SXS: proximal muscle weakness ESR: increased Muscle biopsy and EMG: abnormal CPK increased TX: steroids *got this wrong on the test

57
Q

Fibromyalgia

A

Tests: ESR, CPK, CK, CBC, TSH, T4, mm bx, EMG SXS: tender at 18 points, anxiety, stress, insomnia ESR, mm bx, EMG: normal TX: NSAIDs and SSRIs, rest

58
Q

Acute gout

A

PE: everything but breasts and psych Tests: limited! CBC, BMP, ESR, PT/PTT/INR, X-ray affected joint, Arthrocentesis with fluid analysis Tx: Indomethacin; if renal probs give interarticular glucocorticoids instead

59
Q

Chronic gout

A

Get rid of HCTZ, furosemide, ASA, stop using alcohol I guess check uric acid levels? Allopurinol or probenicid chronically

60
Q

Septic arthritis

A

joint culture, blood culture, urethral/cervical swabs, rectal swab and culture

61
Q

Thyroid storm

A

PTU > methimazole + Glucocorticoids, Iodine, beta blockers (nonselective)

62
Q

ASCUS

A

do HPV test

63
Q

ASCUS with negative HPV

A

f/u on routine screening in 1 yr

64
Q

ASCUS with positive HPV

A

Colposcopy

65
Q

Colposcopy shows CIN 2,3

A

LLETZ

66
Q

ASCUS or ASCH Colposcopy shows CIN 1

A

Either 1. HPV test in 12 months - if HPV positive do colpo - if HPV negative f/u in 1 yr 2. Repeat pap in 6-12 months: - if ASCUS or ASCH do colpo - if paps are negative x 2 f/u in 1 year

67
Q

ASCH

A

Colposcopy

68
Q

HSIL

A

LEEP or Colpo

69
Q

HSIL with unsatisfactory colposcopy

A

LEEP

70
Q

HSIL with satisfactory colposcopy showing ANYTHING BUT CIN 2,3 (i.e., CIN 1)

A

Different from ASCUS and ASCH Either: 1. LEEP 2. Colposcopy + Pap in 6-12 months

71
Q

HSIL with satisfactory colposcopy showing CIN 2,3

A

LLETZ

72
Q

Chest pain at rest

A

Prior to physical: O2, IV access, cardiac monitor, EKG, ASA, NTG if BP ok, then focused PE (EKG: No ST elevation –> NSTEMI vs unstable angina) Cardiac enzymes at time 0 and 8 hrs, CBC, BMP, LFT, CXR, PT/PTT, INR (Enzymes negative = unstable angina) Intervention: Cardiology consult, abciximab, lipid profile, tranfer to ICU, cardiac cath and angioplasty, echo for after cath Later workup: TSH if dyslipidemic Counsel: smoke cess, diet low sodium and fat, exercise program, relaxation exercises

73
Q

Cellulitis

A

Tx: IV Clindamycin and admission if severe, PO if not Labs: Blood clx, ESR, CBC, BMP, perhaps X-ray or doppler Follow treatment with CBC DAILY Switch to PO after clinical improvement and send home

74
Q

MVA - abdominal trauma + LUQ pain

A

Cervical spine immobilization, pulse ox, BP/Cardiac monitor STAT, IV access, NSS, O2 PE: COMPLETE Order: NPO, Type and cross, EKG, amylase/lipase, B-HCG, spine XR, CXR, CT abdomen, ABG, PT/PTT/INR, Utox, BAL, CBC/BMP/LFT, surg c/s, morphine, phenergan (CT shows hematoma) Transfer: to ICU or ward Order: Foley catheter and UOP, cancel C-spine immobilization (Splenic hematoma- watch it Q4-6 h- stable 24 h go home, f/u 1-2 wks) Counsel: seat belt, avoid contact sports, no EtOH, no smoking

75
Q

Labs in ALL HIV+ Pts

A

(FOLLOW:) CBC (Q 3-6 months) PPD (initially and yearly) Pap smear (initially and yearly) CD4 count + viral load (INITIAL:) BMP baseline RPR/VDRL (either) HBsAg HCAb TOXOPLASMA serology

76
Q

PPX in HIV+ pts

A

HAART (efavirenz, tenofovir, emtricitabine = Atripla) TMP-SMX for CD4 < 200 (PCP) Azithromycin if CD4 < 50 (MAC)

77
Q

Good HAART regimen (Atripla)

A

Efavirenz Tenofovir Emtricitabine

78
Q

chronic constipation

A

COMPLETE PE CBC, BMP, Magnesium, Phosphate, TSH, HBA1C, FOBT, Colonscopy, Urine microalbumin Metamucil Counsel low fat/low salt, high fiber diet, oral hydration, exercise program F/u 1 week

79
Q

Septic joint

A

Focused PE Admit PT/INR/PTT, bld clx, XRay, arthrocentesis with fluid studies stat, ESR, CBC, BMP NPO, IV access, NSS, morphine x 1, Tylenol If gram + cancel ceftriaxone Stat arthroscopy

80
Q

Bronchiolitis

A

3 month old, looks like asthma Hospitalize if nasal flaring, tachypnea, decreased PO intake, or decreased O2 sat Cardiac monitor, ABG, CBC, BMP, pulse ox Q1H then Q8, CXR, oxygen if O2 sat < 92%, NT suction, NSS Albuterol, Epi x 1 if not improved in 1 hr Ribavirin if immunocomp, steroids if chronic lung dz Home when O2 ok, taking PO FU 1-2 wks

81
Q

Croup

A

give racemic epi and dexamethasone send home when no stridor at rest

82
Q

Pericardial effusion

A

Pulse ox, IV access, O2, cardiac/BP monitor, ECG stat Focused PE Pericarditis on ECG- ORDER: CXR, ESR, bld clx, cardiac enzymes, CBC, BMP, ibuprofen, colchicine (ASA if post-MI) Admit to ward Ambulate at will, reg diet, routine echo, reassure pt, cancel O2 No tamponade on echo- ORDER: cancel cardiac and BP monitor, cancel IV access, reevaluate daily Cancel vitals, counsel, send home Appt in 2 wks

83
Q

ECtopic pregnancy

A

B-hcg, US If unstable to go lap If stable serial BHCG and MTX if 3.5 cm and no heart beat or lap if larger/heart beating Reevaluate at 20 wks and consider cerclage

84
Q

DUB

A

Complete PE Bhcg, CBC, TSH, PROLACTIN, PT/INR/PTT, PAP, type and cross F/u in 1 wk Iron for all! Anemia Hgb 10-12-Give Irone, low estrogen/low progesterone if active bleed, progesterone only if no bleeding, f/u in 3 months Anemia Hgb < 10-Hospitalize, transfuse, if stable give combo OCP with high estrogen, if unstable give IV estrogen and consider D&C, give iron

85
Q

person who looks anemic: tests and exam

A

Serum iron, TIBC, Ferritin, UA, CBC, BMP, LFT FULL physical exam if stable

86
Q

UA shows microhematuria and CBC shows anemia of chronic disease. NSIM?

A

Abdominal CT

87
Q

Abdominal CT shows solid renal mass. NSIM?

A

Transfer to Ward Chest CT, PT/PTT/INR, NPO, IV access, NSS, ceFAZolin, surgery and oncology consult, NEPHRECTOMY if CT shows no mets (BX if it does), cancer counseling

88
Q

Turner syndrome follow-up

A

Yearly: PE, Lipids, fasting blood glucose, LFT, GGT, UA Q2 Yrs: Echocardiogram Q3 Yrs: Audiology and DEXA scan

89
Q

Turner syndrome TX

A

GH therapy if < 20th %ile Estrogen-progesterone therapy Vitamin D and Calcium Psych consult for IQ Ophthalmology consult Audiology consult Nutrition consult for growth failure Surgery consult for streak ovaries Counsel: Med compliance, reg diet, exercise

90
Q

Turner syndrome workup

A

LH, FSH, Karyotype, Genetics c/s Fu in 1 wk US pelvis, US kidney, audiogram, echocardiogram, fasting glucose, skeletal survey, TSH, lipids, UA, CBC, BMP

91
Q

Workup routine exam 45 yo M

A

CBC BMP UA Lipid profile EKG

92
Q

NSIM for guy with essential HTN (BP < 160/100)

A

Counsel lifestyle modification, f/u in 1 month If still high f/u in 6 months If still high after 6 months of modifications start with ACEI If still high then change to HCTZ if not < 140/90 If still high then do both or ACEI + CCB

93
Q

NSIM for guy with BP >160/100

A

Start 2 drug therapy and do full workup right away (amlodipine + lisinopril)

94
Q

Cryptococcal meningitis

A

IV flucytosine and amphotericin

Imaging Studies and Other Interventions for Step 3 (1 decks)

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