USMLE III Flashcards
Oropharyngeal dysphagia def
difficulty swallowing, cough, drooling, or aspiration
Initial test oropharyngeal dysphagia
Nasopharyngeal laryngoscopy
Symptoms lateral medullary infarct
Loss of pain/temp ipsilateral face and contralateral body; vestibular impairment; motor spared.
Calculation of SAAG
Serum albumin minus ascites fluid albumin
Conditions for SAAG >/= 1.1 g/dL
CHF, cirrhosis, and Etoh hepatitis
conditions for SAAG < 1.1
peritoneal carcinomatosis, peritoneal TB, nephrotic syndrome, pancreatitis and serosis
Main worries for TCA overdose
CNS, arrhythmias, and anticholinergic findings
Treatment for TCA overdose
Worry about arrhythmias and treat with sodium bicarbonate
Screening for renovascular HTN
MR angiography of renal arteries
Etiology of constrictive pericarditis
viral, cardiac surgery, radiations, and TB
Symptoms/findings for constrictive pericarditis
Calcifications heart border, increase jVD, edema, Knock, ascites, pulsus paradoxes
Scoring system for severity of pancreatitis
APACHE II
APACHE II most imports calculating info
BUN and Hematocrit (Pancreatitis severity)
Red Flag back pain
> 50, weight loss, IV drugs, recent bacterial infection, night pain, hx malignancy
Clinical features adenomyosis
dysmenorrhea, heavy bleeding, chronic pelvic pain, diffuse uterine enlargement (globular uterous)
When iron supplementation for ESRD
HgB < 10.0, transferrin saturation =/< 30%, and ferritin = 500 ng/mL
Most common causes of dilated cardiomyopathy
Idiopathic and Ischemic
New unexplained case dilated cardiomyopathy what are next initial tests
Stress testing or coronary engiogram
Routine prenatal screening at 24-28 weeks
Hgb/Hct, Antibody screen for Rd, 50 g 1-hr GTC
Calculating odds ratio
ad/bc (see table in book)
Type of studies odds ratio used in
Case control studies
What is subclinical hypothyrodism
Elevated TSH but normal T4
Subclinical hypothyrodism with only mild elevation in TSH
Antithyroid peroxidase antibody titer, if abnormal they may benefit from treatment
Complications if subclinic hypothyroidism not treated
Recurrent miscarriages, severe preeclapsia, preterm birth, low birth weight, and placental abruption
What are the first trimester complications from elevated sugars
CHD, NTD, small left colon, spontaneous apportion
What are the 2nd and 3rd trimester complications from elevated sugars
Fetal hypoglycemia, polychythemia, organomegaly
Contraindication to Tdap
Anaphylaxis or encephalopathy, not minor illness, local irritation or immunocompromised
Initial test for polycythemia
Serum erythropoietin level
Ddx for polycythemia with low serum erythropoietin level
polycythemia vera
Ddx for polycythemia with high serum erythropoietin level
Chronic hypoxia or renal cell carcinoma (most common)
First test scrotal mass (no pain)
Scrotal ultrasound
Treatment of Tourette syndrome in children versus adults
Children: Second-gen antipsychotics (eg, resperidone, aripiprazole), tetrabenazine and habit reversal therapy
Adults: First-gen antipsychotics: Haloperidol and pimozide
Type of lung cancers that causes SIADH (normovolemic hyponatremia)
Small cell carcinoma of the lung
In a study what is external validity
“How generalized are the results of a study to other populations”?
In a study what is internal validity
“Are we observing/measuring what we think we are observing/measuring?”
In preventative medicine what is primary prevention
Action taken before a patient develops the disease
In preventative medicine what is secondary prevention
Action taken that attemps to halt the progression of a disease in its initial stage
In preventative medicine what is tertiary prevention
Limit impairment and disabilities
Type of test that evaluate the association between a quantitative dependent variable and the independent variables of interest while controlling for the effects of other factors?
Multiple linear regression
Initial biopsy site for possible metastatic cancer?
Biopsy the most easily obtainable side (eg supraclavicular lymph nodes)
Treatment for severe neonatal hyperbilirubinemia
Exchange transfusion (unresponsive to phototherapy or >25 mg/dL)
Suggestive symptoms of Legionnaires’ disease
Confusion, ataxia, or diarrhea, hyonatremia
Treatment of Legionella pneumonia
Respiratory fluoroquinolone or newer macrolide (azithromycin)
Recurrent symptoms after treatment of H. pylori-associated ulcers
Repeat test for eradication of bacteria (urea breath testing and fecal antigen testing)
Consent in ER with patients that lack decision-making capacity
Implied consent - treat patient of what a reasonable person would expect
Concerning ddx for dialysis patient who just finished hemodialysis and now has developed dyspnea in the setting of iron replacement or other medications
ACS or anaphylaxis
CXR findings for malignant pleural mesothelioma
Pleural effusion, pleural thickening, calcifications or mass
How is malignant mesothelioma diagnosed
Thoracentesis with cytology, video-assisted thorascopic biopsy, or open thoracotomy
Manifestations of malignant mesothelioma
Pleura most commonly affected
Cough, dyspnea, chest pain, night sweats, weight loss
Pleural effusion is usually prominent
Hx abdominal pain with fat malabsorption; especially in setting of heavy alcohol use
suspicious for chronic pancreatitis
Diagnosis of chronic pancreatitis
magnetic resonance cholangiopancreatography (MRCP) or an abdominal CT
First line treatment of chronic pancreatitis
Pain management, stop vices, frequent small meals, pancreatic enzyme supplements
Non-controllable risk factors for colorectal cancer
family history, polyposis syndromes, inflammatory bowel disease, and African-American race
Preventable risk factors for colorectal cancer
alcohol intake, cigarette smoking, and obesity
Protective factors for colorectal cancer
high-fiber diet, regular NSAIDs, hormone replacement therapy, and regular exercise
Symptoms of overflow urinary incontinence
constant dribbling of urine, incomplete bladder emptying
Typical examination findings with overflow incontinence include
Neuropathy (decreased perineal sensation) and an increased post-residual urine volume (>150).
Reversible and non-reversible cardiotoxicity chemotherapy medications
Non-reversible: doxorubicin and cyclophosphamide
Reversible: Trastuzumab
Most likely condition with rapidly enlargement of the thyroid gland
Thyroid lymphoma
Symptoms of pituitary enlargement, hyperpigmentation, and visual field defects following bilateral adrenalectomy
Nelson’s syndrome
Nelson’s syndrome
Symptoms of pituitary enlargement, hyperpigmentation, and visual field defects following bilateral adrenalectomy
What interventions best help facilitate recovery for a patient with critical illness (eg., ICU, intubation)
Early PT for progressive mobilization
Order of therapy in management of heart failure
- Angiotensin
- Diuretic therapy, BB (EF <40% once euvolemic), spironolactone (EF < 35% with stable renal function & potassium), defibrillators for EF = 30%
- Isosorbide dinitrate/hydralazine OR Digoxin if symptomatic with spironolactone
- Transplant/Ventricular assist device evaluation
HF treatment with EF <40%
BB (EF <40% once euvolemic)
HF treatment with EF <35 with what exceptions
Spironolactone but need stable renal function and potassium
HF treatment with EF <30%
Defibrillators
Potential benefits of quitting smoking include
reduction in mortality (within 5 years), reduced risk of cardiac events, reduced risk of osteoporosis, and less decline in lung function over time
Older adults with new-onset of cognitive impairment (even significant) should be assessed for what other conditions outside of dementia
Pseudodementia (late-life depression), which may be reversible with treatment
Indications for diagnostic testing for pheochromocytoma
Episodic headaches, diaphoresis & tachycardia
Hyperadrenergic spells (eg, nonexertional palpitations, pallor)
Resistant hypertension or onset of hypertension at young age
Patient with episodic symptoms of headaches, diaphoresis, paroxysmal hypertension, and tachycardia should be tested for what
Pheochromocytoma specifically plasma free metanephrine
Antidepressant effects on manic patients (especially bipolar disorder)
Can induce mania. First step in managing emergent mania is to discontinue any antidepressants.
Persons needing antimicrobial prophylaxis following Neisseria meningitidis exposure:
People in same house, roomate, or intimate contact
Child care center workers
Direct exposure to respiratory or oral secretions
Seated next to for >/= 8 hours
Antimicrobial chemoprophylaxis for Neisseria meningitidis exposure
Rifampin (not if on oral contraceptives), ciprofloxacin, and ceftriaxone
In type I diabetic what is the most common reason for decreasing insulin requirements and what is first test(s)
Adrenal failure
Cosyntropin stimulated cortisol levels
Most common emergency Orders CCS Cases (before physical exam)
Pulse oximetry Oxygen IV access Normal Saline Cardiac Monitor BP Monitor ECG Ect
When do you perform a full physical exam on CCS
In clinic or non-acute setting
On CCS when do you assess location of patient
After physical exam. Decide if patient needs immediate transfer (eg., to ER)
Some initial test might later get you to transfer patient
Order of ordering test and meds
Labs then Imaging and then symptoms management
On CCS what orders need to be completed when admitting a patient.
Diet Activity IV access IV fluids Vitals (should be set)
On CCS monitoring
Check things during case
On CCS what to check at follow-up
Short exam and may consider follow-up testing
On CCS what are important things to complete/consider prior to surgery
Need surgery consult NPO IV access (fluids if needed) PT/PTT Type and cross match ECG Cefazolin
On CCS consults
Use if needed
At end of case you have two minutes to order
the final labs, treatment or counseling
On CCS case of meningitis what are big things not too miss
Antibiotics and lumbar puncture
Example of counseling
Stop smoking Etoh Safe sex Contraception Mediation side effects
When should a CT be completed in a patient with possible pancreatitis?
uncertain diagnosis of pancreatitis
Can diagnosis with serum lipase (or amylase) levels > 3 times upper limit of normal in the setting of characteristic symptoms and hx
What type of imaging with patient with pancreatitis but persistent abdominal pin and clinical deterioration
Abdominal CT scan with IV contrast looking for gas within pancreatic necrosis
What does kappa statistic represent
Represents the extent to which inter-rater agreement is an improvement on change agreement alone.
Inter-rater reliability
What follow-up test for patients with fracture following minor trauma
Dual-energy x-ray absorptiometry
Symptoms to watch for in patient with higher dose of metochlopramide?
Extrapyramidal effect
Drugs of choice of the immediate treatment of metoclopramide-induced acute dystonia
Diphenhydramine or benztropine
Order of treatment for peripheral artery disease
Risk factor management
Supervised exercise therapy
Cilostazol
Revascularization for persistent symptoms
What to test pprior to starting biologic medication (TNF inhibitors)
Screened for latent TB (opportunistic infections)
What is the most reliable method for verification of entotracheal tube placement
Capnography
Treatment for organophosphate poisoning
Atropine
Acquired methemoglobinemia recognition and causes
Large oxygen saturation gap (low pulse ox but normal PaO2)
Most common medications include topical anesthetics (eg, benzocaine), dapsone, and nitrates (in infants)
How to rule out a diagnosis using PPV/NPV/Sensitivity/Specificity
A negative result on a highly sensitive diagnostic test helps to rule out a diagnosis
Define likelihood ratio
Probability of a given test result occurring in a patient with a disorder compared to the probability of the same result occurring in a patient without the disorder
Highest increase risk for pelvic inflammatory disease
Multiple sexual partners
Most common pathogens in acute otitis media
Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis
What pathogen causes otitis-conjunctivitis syndrome (purulent conjunctivitis at same time as acute otitis media)
H. influenzae
Broad-spectrum antibiotics for PID
Cefoxitin plus doxycycline
Acoustic neuromas are from proliferation of what type of cells
Swhwann cells (schwannomas)
Cystitis in Pregnancy
7-day course of Augmentin OR fosfomycin
May use nitrofuratoin but not until 2/3 trimester
Patient >60 years old with cherry-red lesions and GI bleed
Angiodysplasia
Causes of angiodysplasia in colon
ESRD, von Willebrand disease and aortic stenosis
Oral contraceptives / pregnancy’s effects on Thyroid
Estrogen stimulate hepatic synthesis of TBG, thus require higher dose of levothyroxine
Most effective nonpharmacologic intervention for decreasing blood pressure
Weight loss (6 per 10-kg loss)
Next step in patient with newly diagnosed medullary thyroid cancer
Serum calcitonin
Carcinoembyronic antigen
Neck ultrasound (regional mets)
Genetic testing for germline RET mutations
Evaluation for coexisting tumors (hyperparathyrodism, pheochromocytomas)
Medications that cause an increased risk of infantile hypertrophic pyloric stenosis
Azithromycin and erythromycin
Medications used for postexposure prophylaxis against pertussis
Azithromycin and erythromycin
DDx to think about in patient with meningo symptoms
Could be viral or bacterial, treatment based on history
Main features / findings of lactose intolerance
Diarrhea after lactose-containing meals
Increase stool osmotic gap
Decrease stool pH
+ Lactose hydrogen breath test
Main features / findings of chronic pancreatitis
Greasy stools
Abdominal pain radiating to back
Main features / findings of celiac disease
Increase stool osmatic gap
Microcytic anemia, iron deficiency
Villous atrophy
Main features / findings of small intestinal bacterial overgrowth
Macrocytic anemia, B12 deficiency
+ Lactulose breath test
Calculate attributable risk percent (ARP)
Strokes
Smokers = 1:1000
Non-smokers = 0.5:1000
Measure of excess risk (stroke in smoker population)
(Risk in exposed - Risk in unexposed) / Risk in exposed
Or
(RR - 1) / RR
Answer 50%
Relative risk calculation
Population 1 = 1:1000
Population 2 = 0.5:1000
0.1/0.05 = 2
Calculate population attributable risk
Strokes
Smokers = 1:1000
Non-smokers = 0.5:1000
Risk within the population
(Risk in total population - Risk in unexposed) / Risk in total population
Risk in total population = (Risk in smokers)(Proportion of smoker) + (Risk in nonsmokers)(Proportion of nonsmokers) = 0.1 * 0.5 + 0.05*0.5) = 0.075%
PARP = (0.075 - 0.05) / 0.075 = 0.33 (33%)
How should traumatic amputation be transferred
Goal temp 33.8-50 F
Wrap in saline-moistended gauze and place in a sealed, bag and misssed with saline with 50/50 mixture of ice.
Diagnosis of narcolepsy
One of the following:
Cataplexy
Hypocretin-1 deficiency (CSF)
Sleep study showing rapid eye movement sleep latency <15 minutes
Treatment of narcolepsy
Modafinil
Medication to help treat cataplexy in narcolepsy
SNRI, SSRI, Tricyclic
Diagnostic tests for GI bleed
ESR Sigmoidoscopy Rectal biopsy (suspect UC) CBC with differential BMP Stool ova and parasites Stool for white cells Stool culture LFTs PT/INR PTT
Treatment of UC with mild proctitis
Topical therapy with 5-ASA compounds (mesalamine suppository)
Treatment of UC with moderate proctitis
Oral therapy with 5-ASA compounds (sulfasalazine, mesalamine, olsalazine)
Steroids are added when 5-ASA compounds faile to induce remission
Immunomodulators (azathioprine, 6-MP) for refractory cases
Management of UC with severe proctitis
Hospital with IV fluids and electrolytes NPO, TPN IV steroids Consider BS antibiotics for fever, leukocytosis or sepsis Surgery for refractory cases
Managing diarrhea/cramps/mood in UC with bleeding
Loperamide (avoid in severe proctitis)
Anticholinergic agents for abdominal cramps
Antidepressants/anxiolytics for associated mood disorders
Methotrexate versus laparoscopy for ectopic pregnancy
MTX for stable patient with B-Hcg < 5,000, tubal mass <3.5 cm, and no fetal cardiac activity.
How to interpret odds ratios
OR >1 means that exposure is associated with higher odds of outcome
OR <1 means that exposure is associated with lower odds of outcome
OR = 1 exposure has no effect on odds of outcome
What complication is most commonly associated with compartment syndrome
Acute renal failure
Features of ocular melanoma
small, densely pigmented lesion with irregular borders in the choroid, iris, ciliary body
Ocular melanoma management
diameter <10 mm, thickness <3 mm can manage with close follow-up as long as no eye pain or visual disturbances
If larger, treatment is radiotherapy
Clinical features of post-intensive care syndrome
Psychiatric: >50% with maro depression, PTSD
Neurocognitive: decrease attention/memory, executive function, and processing speed
Physical: >50% with decrease mobility and independence
Looking for what in urine when concerned about rhabdomyolysis
UA positive for blood but there is no RBC’s/hpf
If RBCs are present then likely exercise induced hematuria
Bugs in pediatric septic arthritis
Age <3 months: Staph aureus, group B streptococcus, gram-negative bacilli
Age >3 months: Staph aureus, group A Streptococcus
Treatment of septic arthritis in a 4 month old
Joint drainage and debridement
IV vancomycin
Treatment of septic arthritis in a 2 month patient
Joint drainage and debridement
IV vancomycin and cefotaxime
When are renal/bladder ultrasounds or voiding cystourethrogam be completed in pediatric patients following an UTI
Renal ultrasound if <24 months
Cystourethrogram with abnormal ultrasound or recurrent infections
When should menigitis be suspected in pateints
nuchal rigidity
headache
bulging fontanelle
prolonged altered mental status
Next step when there is concern that a patient does not understand the consequences of refusing treatment
A formal assessment of decision-making capacity
Difference between Type I/II error
Type I: False Positive
Type II: False negative
DVT prophylaxis recommendations for stroke patient who did not receive thrombolytics and are still in the hospital
If only receiving aspirin therapy patient should also started on intermittent pneumatic compression and low dose heparin
Safe and effective treatment for severe bipolar mania during pregnancy
First generation antipsychotics (haloperidol) –> second gen antipsychotic –> Lithium (Ebstein anomaly)
Avoid carbamazepine and valproate
Overrepresented health issues in women who have sex with women
Cardiovascular disease Type 2 diabetes mellitus Obesity Cervical cancer Breast cancer Ovarian cancer Depression, anxiety Intimate partner violence Bacterial vaginosis
Most of these are increased due to this population having poor healthcare maintenance.
Resting period before returning to the previous step in gradual return-to-play protocol
24-hour rest period
Treatment for neonatal polycythemia
Adequate hydration
Correction of metabolic derangements (hypoglycemia)
Partial exchange transfusion
Pathogen and Presentation of impetigo
Staph aureus and Strep pyogenes
Papules and pustules with honey-crusted, adherent coating
Plus/minus pain or pruritus
Pathogen and Presentation of eczema herpeticum
HSV Type I
Painful vesicular rash
“Punched-out” erosions and hemorrhagic crusting
Pathogen and Presentation of molluscum contagiosm
Poxvirus
Skin-colered papules with central umbilication
Pathogen and Presentation of Tinea corporis
Trichophyton rubrum
Pruritic circular patch with central clearing
Raised, scaly border
Diagnostic tests for diarrhea
CBC with diff. BMP TSH FOBT ESR Stool O&P Stool WBC Stool bact. culture 72-hour stool fat PAP smear????
Therapy for irritable bowel syndrome
Lactose free diet High fiber diet Loperamide Biofeedback Reassurance Relaxation exercise Patient counseling
Diagnostic test in depressed pateint
CBC with diff
BMP
TSH
Vitamin B12
Diagnostic test UTI/Yeast infection
Vaginal pH Wet mount Gram stain, vagina GC, culture Chlamydia, culture U/A
When should NIPPV be started in a COPD exacerbation
PCO2 >45 or pH <7.30
Outpatient antibiotics for COPD exacerbation
TMP-SMZ or doxycycline
Inpatient antibiotics for COPD exacerbation
levofloxacin, moxifloxacin, ceftriaxone, or cefotaxime
Therapy for COPD exacerbation
Bronchodilators Steroids Antibiotics Counseling Influenzae vaccine Pneumococcal vaccine
When is a fine-needle aspiration completed following a mammogram
If it demonstrates a complex cyst or solid mass
No further work-up if simple cyst
Procedure to remove aspirated foreign body
Rigid bronchoscopy
Diagnostic test for foreign body aspiration
CXR-PA/lateral
X-ray neck
CBC
Rigid bronchoscopy
Indications for carotid endarterectomy (CEA)
symptomatic patient with 70%-99% within 14 days of last symptomatic event
Contraindications for carotid endarterectomy (CEA)
100% carotid stenosis
Previous stroke with persistent neurologic symptoms
Poor surgical candidate
Difference in pharmacotherapy for carotid stenosis and cardioembolic
Carotid stenosis: Aspirin and/or clopidogrel
Cardioembolic:
Heparin in TIA is controversial
warfarin, rivaroxaban, apixaban (not if GFR <30)
Empirical antibiotics for lower abdominal pain, cervical motion tenderness, or adenexal tenderness Inpatient versus outpatient)
Inpatient:
IV cefoxitin plu IV or PO doxycycline
Outpatient: Ceftriaxone IM (one dose) plus doxycycline PO x 14 days
May add metronidazole for suspected BV, Trich, pelvic abscess or recent gynecologic instrumentations
Patient with bleeding and prolonged PTT with normal PT
Deficiency of: factor VIII (Hemophilia A) factor IX (Hemophilia B) factor XI Von Willebrand's disease
Acquired causes:
antiphospholipid syndrome
heparin use
Patient with bleeding and diagnosed with hemophilia
Purified monoclonal recombinant factor VIII (Hem A) or factor IX (Hem B)
Desmopressin and antibibrinolytic agens
Symptoms of suspected stable coronary artery diease
Elderly patients (eg >80) are more likely to experience anginal symptoms other than chest pain
Symptoms other than chest pain:
SOB
Lightheadedness
Fatigue
Time-to-event data in survival analysis where the event of interest is death
It accounts not only for the number of events in both groups, but also for the timing of the events throughout the follow-up period (eg all die at same time but on group has better life prior to death)
What are the most important predictors of prognosis in patients with COPD
FEV1 < 40%
Age
Treatment of aspiration pneumonia (not aspiration pneumonitis)
Clindamycin or ampicillin-sulbactam or amoxicillin-clavulanate
Evaluation of a child >4 years old with primary nocturnal enuresis
Urinalysis (to exclude other causes)
Voiding diary
Suggestive labs of platelet dysfunction
Increase bleeding time and normal PT/APTT
Treatment for bleeding patient with platelet dysfunction
desmopressin
Characteristic blood findings in thalassemia
microcytic, hypochromic anemia mildly elevated ferritin Normal RCDW Normal Fe Normal to mild decrease TIBC
Clinical features of stress-induced (takotsubo) cardiomyopathy
Chest pain mimicking myocardial infarction
Decompensated heart failure
Moderate troponin elevation
EKG findings in stress-induced (takotsubo) cardiomyopathy
ischemic changes in precordial leads without CA findings
Fitz-Hugh-Curtis syndrome
PID
RUQ pain with elevated transaminases
Fever
Main findings of acute sickle hepatic crisis
Triggered nausea and vomiting resulting in dehydration
Anemia, elevated transaminases, and fever
What are the objective measurements of the MELD (Model for End-Stage Liver Disease):
Bilirubin
INR
Serum creatinine
Serum sodium levels
Need to closely monitor what in patients with Guillain-Barre syndrome
High risk of respiratory failure
Frequent monitoring of tidal volume and negative inspiratory force
Main features of Guillain-Barre syndrome
Symmetric muscle weakness (lower legs first)
Paresthesia
Dysautonomia (eg, tachycardia, urinary retention)
Decreased or absent deep tendon reflexes
Treatment of Guillain-Barre syndrome
Plasma exchange or IV immunoglobulin
In diabetic neuropathy what are main senses testing to assess nerve damage
Pain, temperature, vibratory (tuning fork), and proprioception sense
Ddx with ST depression and elevated cardiac enzyems
NSTEMI
Ddx with ST depression and normal cardiac enzymes
unstable angina
In a patient with unstable angina what should be completed prior to starting Heparin
FOBT
Medications for patient in hospital for unstable angina
Metoprolol
Simvastatin
Eptifibatide
Important orders for hospital patient with unstable angina
NPO, bedrest, 12 lead ECG, urine output Metoprolol Simvastatin Echocardiography Cardiology consult, stat (cardiac catheterization) Eptifibatide Lipid panel, LFTs
Counseling for unstable angina
Smoking cessation Limit alcohol Exercise program Medication compliance Relaxation techniques Diet, low sodium Diet, low cholesterol Follow-up at 2-6 weeks
What should be added prior to sending a patient with unstable angina for catheterization
GP IIB/IIIA (Eptifibatide)
Orders for patient with viral croup
CBC with diff, stat Neck x-ray, stat Humidified air Dexamethasone, oral Epinephrine, inhalation (moderate/severe)
Diagnostic test for patient that present for suspected asthma exacerbation
Peak flow (PEFR) q hr ABG ECG CXR CBC BMP
Under what criteria should a asthma exacerbation be admitted to floor
Admit for PEFR (peak expiratory flow rate) <40% predicted at 4 hours
Consider admission for PEFR 40-70% at 4 hours
Discharge to home for PEFR >70% at 4 hours
Basic labs for clinic constipation patient
CBC
BMP
serum magnesium, phosphate, TSH, HgbA1c
FOBT
Preoperative antibiotics
Cefoxitin
ampicillin-sulbactam
cefazolin plus metronidazole
Diagnostic study for suspected appendicitis
Ultrasound then CT
Broad spectrum antibiotics for bacterial arthritis
ceftriaxone with IV vancomycin
Antibiotics with septic knee with gram stain showing gram-positive cocci
MRSA: IV vancomycin x 4-6 weeks
MSSA: IV cefazolin for 2 weeks than 2-4 more weeks of oral antibiotics
Antibiotics with septic knee with gram stain showing gram-negative bacilli
IV 3 generation cephalosporin (ceftriaxone x 14 days), then 14 days of oral antibiotics
Appropriate joint drainage for septic arthritis
Perform in all cases using closed needle aspiration
If closed needle aspiration does not provide adequate drainage, then: Arthroscopy or open drainage (arthrotomy)
Initial labs in patient (pediatric or adult) with abnormal uterine bleeding
Urine pregnancy test Serum TSH Serum prolactin CBC with diff PT/INR PTT
Consider biopsy (perimenopausal women), pelvic ultrasound (obese/PCOS), LFTs (liver disease)
What OCP to start on patient present with dysfunctional uterine bleeding
Hgb 10-12:
- Absence of active bleeding: Progestin-only OCPs
- Presence of active bleeding (combination OCPs, low progesterone, low estrogen)
Hgb < 10:
- Hormonal therapy: Combination OCPs with high estrogen if stable; IV estrogen if unstable
Treatment for idiopathic or viral pericarditis
NSAIDs while patient is symptomatic (steroids if resistant)
Colchicine for 3 months
Avoid NSAIDS (other than aspirin) in post-MI pericarditis
Diagnostic tests for suspected pericarditis
CBC/CMP CXR Troponin/CK-MB ESR Blood cultures Echocardiography
Routine labs in ER trauma patient
CBC with diff BMP LFTs Serum amylase/lipase UA ABG PT/INR/PTT Blood type and cross Ethanol Urine tox screen Urine Hcg 12 lead ECG Chest and Spin x-ray Abdominal CT Urine output
Monitoring for patient with traumatic event (MVA)
Serial exam
H&H q6 hours (bleeding)
Urine Output (Foley catheter)
In a trauma, under what circumstances is ultrasound (FAST exam) versus CT of abdomen
Unstable perform ultrasound
Stable CT
Diagnostic test in patient with suspected gout
CBC with diff BMP PT/IRN PTT ESR Serum uric acid X-ray of the foot/toes Synovial fluid analysis
Initial therapy for gout including lifestyle changes
NSAIDs (indomethacin, naproxen) Low protein diet No alcohol No Smoking No aspirin
Management of PCP pneumonia
Bactrim
PO2 < 70 and/or A-a O2 > 35 add oral steroids
Early treatment for patient with HIV
Early HAART (Efavirenz/Tenofovir/Emtricitabine)
Azithromycin if CD4 <50 for MAC prophylaxis
Preop antibiotic
cefazolin
Preop antibiotics for bowel surgery
Ampicillin-sulbactam or piperacillin-tazobactam
Once Turner syndrome is confirmed what other screening that need to be completed.
Serum FSH and LH UA BMP, fasting glucose, serum TSH Echocardiogram renal and pelvic ultrasound skeletal survey Hearing test
Therapy for Turner syndrome
Growth hormone (height <5%) and anabolic steroids (oxandrolone)
Estrogen replacement (12-13 yr old)
Age >13 begin with combination estrogen and progestin until menopause
Vitamin D and calcium (osteoporosis)
Dietary and Psychiatry consult (IQ)
Ophthalmology consult
Ob/Gyn consult
Exercise
How long attempt non-pharmacologic treatment for BP until starting medications
6-12 months
Treatment for life altering menopausal symptoms
Oral estrogen (no uterus) Estrogen AND Progesterone with intact uterus
Initial treatment of patient with suspected PE
High suspicion just start patient on heparin (LMWH or UFH)
When confirmed add warfarin until therapeutic
IVC filter for patient with contraindication to anticoagulation
thrombolytic therapy for hemodynamically unstable patients
