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UWORLD 8 - CCS Flashcards

1
Q

Treatment of cystitis

Uncomplicated

Complicated

Pregnancy

A

Uncomplicated (normal non pregnant)

  • 3 day of TMP SMZ
  • if allergic do 3 day of fluoroquinolone (ex: ciprofloxacin)

Complicated (male, DM, anatomic, indwelling catherer, symptoms > 7 days, reurrent, >65)

  • 7 day TMP-SMZ

Cytitis in Pregnancy

  • 7 day course of Nitrofurantoin
  • If allergic, then 7 day of amoxicillin-calvulanate
  • Avoid TMP as it is a folic acid antagonist
  • avoid FQ due to caraliage damage
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2
Q

Cystitis and Diagnostic tests

A

B-HCG (qualitiative)

U/A

Urine Culture

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3
Q

Pregnant and uncomplicated cystits

therapy

monitoring

A

nitrofurantoin

prenatal vitamins

counseling

Monitoring - follow up urine culture in one to two weeks

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4
Q

routine pre-natal laboratory tests in pregnancy

A

Atypical antibody

Blood Type & Rh

BMP

CBC

Chlamydia

HBV,

HIV

Pap-Smear

RPR, Rubella

Urine Culture,

U/A

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5
Q

Treatment & Follow up for Pregnant Patients

A

Treatment: Is For Pregnant Patients

  • Iron
  • Folate
  • Prenatal Vitamins
  • Prenatal Counseling

Follow up vist in 4 weeks

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6
Q

Management of Ulcerative Colitis

Treatment of mild proctitis

A
  • Topical therapy with 5-ASA compounds (mesalamine suppository)
  • Taper over 4-6 weeks
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7
Q

Management of UC:

Moderate proctitis

A
  • Oral thereapy with 5-ASA compounds (sulfasalzine, mesalamine, olsalzine)
  • Folic acid supplementation for patients taking sulfasalzine
  • Steriods are added with 5-ASA compounds fail to induce remission
  • Steriods should not be used for maintenance of remissions
  • Immunodulators (azathioprine, 6-MP) for refractory cases
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8
Q

Mgmt of UC:

Severe proctitis

A
  • Hospitalize and resucitate with IV fluids & electrolytes
  • NPO, TPN
  • Abdominal exams, vitals and abdominal xray to monitor for complications
  • IV steriods
  • COnsider giving broad spectrum antibiotocisf or fever, luekocytosis or sepsis
  • Surgery is considered for refractory cases
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9
Q

Other for Mgmt for UC

A
  • dietary counseling in all cases
  • annual surveillance colonoscoy beginning 8-10 years after diagnosis
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10
Q

Diagnostic tests needed for UC

A

ESR

Sigmoidoscopy

Rectal Biopsy

*CBC with diff

*BMP

*Stool ova & parasites

*Stool for White cells

*Stool culture

*LFTs

*PT/INR

*PTT

*rule out alternative diagnosis

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11
Q

Managing diarrhea/cramps/mood for UC

A

Antidiarrhea agents (loperamide) for diarrhea (avoid in severe proctitis)

  • Anticholinergic agents for abd. cramps
  • Antiderpessants/anxiolytics for associated mood disorders
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12
Q

Diagnostic tests needed for Ectopic pregnancy

A
  1. Beta-HCG, uine qualitative or Beta HCG serum
  2. Beta-HCG quantitative
  3. Transvaginal ultrasound
  4. Type and Cross matching
  5. Blood group & Rh
  6. CBC with diff
  7. PT/INR
  8. PTT
  9. BMP
  10. LFTs
  11. Gonoccoccal culture
  12. Chalmydia culture
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13
Q

Therapy & Follow up for ectopic pregnancy

A
  1. MTX or laproscopy
  2. NPO
  3. IV access
  4. Normal saline, IV
  5. Bed rest, complete
  6. Morphone
  7. OB/GYN consult
  8. Counseling
  9. All Rh negative patients treated for ectopic pregnancy must receive Rh immunoglobulin
  10. Follow up in 4 days (if MTX is given to monintor serum HCG levels)
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14
Q

What do you need to monitor for Ectopic pregnancy

A
  1. Vital signs Q 1 hour
  2. If MTX is given, follow up in 4 days to monitor serum HCG level
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15
Q

IBS DIagnostic tests

A

IBS is a diagnosis of exclusion without a specfic confirmatory test

CBC with diff

BMP

FOBT

ESR

STOOL OVAL AND PARASITE

STOOL FOR WBC

STOOL FOR BACTERIAL CULTURE

72-HOUR STOOL FAT

PAP SMEAR

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16
Q

Therapy & Follow up for IBS

A

Lactose free diet

High fiber diet

Loperamide

Biofeedback

Reassurance

Relaxation exercise

Patient counseling

Schedule an appointment in two weeks

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17
Q

Diagnostic tests for Major Depression?

A

CBC with differential

BMP

TSH

Vitamin B12

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18
Q

Therapy & follow up for major depression

A

SSRI or other antidpressant

Medication compliance

Regular exercise

Patient education

FOLLOW UP: Every 1-2 weeks for the first 6-8 weeks of treatment

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19
Q

Diagnostic tests for Candidiasis

A

Vagina pH (<4.5 for Canidida and >4.5 for BV and Trich)

wet mount

Vaginal gram stain

Pap smear

GC culture

Chlamydial culture

UA

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20
Q

Therapy and follow up for Candida vaulvovaginitis

A

Anti-fungal (Miconazole, vaginal)

Counseling

  • patient education
  • Safe sex
  • No alcohol
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21
Q

Diagnostic tests for Alzheimer’s dementia

A
  1. CBC with differential
  2. BMP
  3. LFTs
  4. TSH
  5. Vitamin B12, serum
  6. CT of the head or MRI of the head
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22
Q

Therapy and follow up for Alzheimer’s dementia

A
  1. Cholinesterase inhibitor (Donepezil, oral, continous)
  2. Vitamin E
  3. Atypical antipsychotic (Olanzepine)
  4. Counseling

Follow up in 6 weeks.

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23
Q

Emergency orders (before Physicial examination) for COPD exacerbation

A

Elevate head of bed

Cardiac monitor

Pulse Ox

Oxygen

IV access

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24
Q

Diagnostic tests for COPD exacerbation

A

PEFR (Q1 hour) (Peak Expiratory Flow Rate)

CXR, PA lateral

ABG

EKG

CBC

BMP

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25
Q

Therapy for COPD Exacerbation

A

Bronchodilators (inhaled) - albuterol nebulizer, continous

Steriods (IV methyl prednisone)

Antibiotics (oral or IV)

Counseling

Influenza vaccine

pneumococcal vaccine

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26
Q

Fibroadenoma Diagnostic tests

A

Mammography (not commonly used for women <35)

FNAB and/or Breast US

Pap Smear

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27
Q

Therapy and follow up

A

Reassurance

Counseling (patient counseling, contraception advise, safe sex, smoking cessation. limit alcohol intake, safety plan, seat belt use, regular exercise)

Follow up physical exam every 3 to 6 months for 1 year

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28
Q

Management of Hypertensive Emergency

Inital BP lowering management

After 25% drop in BP is achieved

Once BP is under control

A

Inital BP lowering management

  • If no evidence of stroke, lower DBP to 100-105 over 2-6 hours. Do NOT drop BP by more than 25%
  • IV nitroprusside (first line)
  • Alteratives (IV labetalol, nicardipine)
  • Transfer to ICU
  • Arterial line for BP measurement

After 25% drop in BP is achieved

- Transfer to ward

  • D/C arterial line
  • Change to PO anti-hypertensive

Once BP is under control

-Discharge to home

  • Lipid profile
  • Counseling (medication compliance, smoking cessation, exercise, limit alcohol intake, low salt diet)
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29
Q

Hypertensive Emergency - Emergency Orders

A

IV access

Oxygen

Pulse Ox

Cardiac Monitor

BP Monitor

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30
Q

Diagnostic tests for Hypertensive Emergency

A

12 Lead ECG

Head CT (without contrast)

CBC

BMP

CXR

UA

Llipid profile

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31
Q

Therapy for Hypertensive Emergency

A
  1. NPO
  2. Complete bed rest
  3. IV antihypertensive (IV Nitropressuide, continous)
  4. Counseling
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32
Q

Foreign body aspiration in 7 month old - emergency orders

A

Oxygen

Pulse Oximetry

IV access

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33
Q

Diagnostic tests for foreign body aspiration in 7 month old

A
  1. CXR-PA/Lateral
  2. X-ray Neck
  3. CBC
  4. Rigid bronchoscopy
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34
Q

Therapy and follow up

A
  1. Bronchoscopy
  2. Counseling

Schedule appt in 1-2 weeks

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35
Q

Panic attacks Emergency Orders

A

IV access

Pulse Ox

Oxygen

Cardiac Monitor

ECG

Glucometer Glucose

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36
Q

Diagnostic Tests for Panic Disorder

A

CBC

BMP

CXR

TSH

U/A

Urine toxiciology screen

Cardiac enzymes

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37
Q

Panic attack - therapy & Follow up

A

1) Benzodiazepines (Alprazolam, sublingual, one time)
2) Reassurance
3) Counseling (patient counseling, no caffeine, no nicotine, no alcohol)

Follow up in two weeks

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38
Q

Carotid Stenosis

Indications

Contraindications

Pharmcotherapy for Cartoid endarterectomy (CEA)

A

Indications

  • symptomatic with 70% to 99% stenosis
  • Greatest benefit if done within 14 days of the last symptomatic event

Contraindications

  • 100% carotid stenosis
  • Previous stroke with persistent neurologic symptoms
  • Poor surgical candidate

Pharmcotherapy with aspirin is indicated prior to the procedure and shoudld be continued indefinitey. Clopidogrel is an acceptable alternative in patients who are unable to tolerate aspirin.

-Warfarin and heparin are NOT INDICATED unless there is AFIB

-Pre-ops antibotics (Cefazolin, 1 gram, IV) recommended due to frequent use of prosthetic material

- Risk factor management (HTN, DM, smoking, dysplipidedmia)

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39
Q

Cardioembolic

Management

A

Antithrombotic therapy for AFIB

-Heparin use for acute TIA is controversial

  • Anticoagulate with warfari, dabigatran, apixaban, or rivaroxaban is used for all patients who can tolerate anticoagution therapy
  • use of direct thrombin inhibitor or a factor Xa inhibitor is preferred to warfarin, unless there are cost or compliance concerns, the patient is already on warfarin, or there is signifcant renal failure (GFR <30)
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40
Q

Diagnostic test for transient ischemic attack

A

Head CT (without contrast)

CBC with diff

BMP

ECG

Cardiac monitor

Carotid Doppler

Glucometer glucose

Echocardiogram

Lipid profile

HBA1C

MRI, head

MRI, brain

Before CEA surgery

NPO

PT/INR

PTT

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41
Q

Therapy for Transient ischemic attack due to Carotid stenosis

A

IV access

Aspirin

CEA

Cefazolin, IV one time

Counseling (no smoking, no alcohol, regular excerise, diabetic diet, med compliance, better BP control, DM control)/

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42
Q

Diagnostic tests for PID suspicion

A

HCG, qualitative

Gram stain, cervix

Gonococcal culture

Chlamydial culture

UA
Urine culture

CBC

BMP

VDRL or RPR

HIV

Pap smear

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43
Q

Therapy for PID

A

IV access

Normal Saline

Antibotics

Inpatient: IV cefoxitin, IV doxycycline

Outpatient: Doxycycline, oral x 14 days

Antimetics

Analgesics (IV morphine, one time)

Antipyretics (Acetaminophen, IV)

NPO

Bedrest

*Do not wait for culture results to initate empiric antibiotics against N.gonorrha and C.trachomatis

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44
Q

Prolonged PTT with normal PT may be due to a number of hereditary or acquired conditions inolving which coagulation pathway?

Inherited causes include?

Acquired causes?

A

Intrinsic coagulation pathway

Inherited causes

Factor VIII (hemophilia A)

Factor IX (hemophilia B)

Factor XI

Von Williebrand disease

Acquired causes

Antiphospholipid syndrome

Heparin use

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45
Q

Diagnostic tests for suspected Hemophilia A

A

CBC with differential

BMP

Bleeding Time

PT

PTT

LFT

Factor VIII, plasma

Factor IX, plasma

Factor XI, plasma

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46
Q

Therapy for Hemophilia A

A

Factor VIII, therapy

No aspirin

Counseling

Consult, genetics

*Monitor PTT value

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47
Q

Emergency orders for chest pain

A

pulse oximetry

oxygen

cardiac monitor

continous BP monitor

12 lead ECG

IV access

ASA

Nitroglycerine

*MUST ORDER THESE BEFORE PHYSICAL EXAM

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48
Q

Diagnostic tests that need to be order for chest pain

A

12 lead ECG

Cardiac enzymes

CXR

CBC

BMP

LFT

Lipid profile

PT/INR and PTT

Echocardiography

Cardiology consult

Cardiac catherization

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49
Q

Therapy for chest pain

A

IV access

Oxygen

Aspirin

Nitroglycerine

Hepatrin

Metoprolol

Eptifibatide (GP IIB/IIIA inhibitor should be added before sendin gpatient for catherization)

Simvastatin

Cardiology consult

Cardiac catherization

NPO

Bed rest

Counseling

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50
Q

Management of viral coup

Mild coup

moderate to severe symptoms

In all cases

A

Mild (barking cough, no stridor at rest, no retractions)

  • cool humidified mist and oxygen (relieves airway edema and decreases viscosity of mucus)
  • monitor for development of bronchospasm in suspectible children
  • oral dexamethasone

Moderate-severe symptoms (stridor at rest, moderate-severe retractions, anxious/agitated)

  • add nebulized epinephrine
  • if no improvement, admit

In all cases

  • if bacterial infection is suspected, add antibiotics (2nd generation cephalosporin)
  • arrange outpatient follow up
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51
Q

Emergency orders for viral coup

A

oxygen

pulse oximetry

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52
Q

Diagnostic tests for viral coup

A

CBC

Neck Xray

BMP

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53
Q

Therapy for viral coup

A

humidified air

epinephrine (inhaled)

dexamethasone (oral)

counsel patient

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54
Q

Asthma management

If impending respiratory arrest is suspected, then?

A

If impending respiratory arrest is suspected, then?

- Intubate, mechanically ventilate and admit to ICU

  • Administer nebulized albuterol/ipratropium
  • Administer systemic steriods
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55
Q

Asthma management

If there is not suspiction of impending respiratory arrest, then?

Decision to admit?

A

PEFR <40% predicted:

  • Administer oxygen therapy with goal pulse ox >=90%
  • Administer albuterol/ipratropium by nebulizer (q20 min)
  • IV steriods (then gradully taper)
  • Reassess PEFR every hour
  • Decision to admit within 4 hours

PEFR >40% predicted:

  • administer oxygen therapy with goal pulse ox> or -90%
  • administer albuterol by nebulizer (q20mins)
  • consider oral steriods (gradually taper if initated)
  • If PEFR does not improve to >70% predicted, then add ipratropium
  • decisiton to admit within 4 hours.

Decision to admit

  • Admit for PEFR <40% predicted at 4 hours
  • Consider admission for PEFR 40-70% at 4 hours
  • Discharge to home for PEFR >70% at 4 hours
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56
Q

Emergency orders for asthma exacerbation

A

Pulse oximetry

oxygen

IV access

Head elevation

Cardiac monitor

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57
Q

Diagnostic tests for asthma exacerbation

A

Peak flow (PEFR)

ABG

ECG

CXR

CBC

BMP

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58
Q

Therapy for mild to moderate asthma exacerbation

A

Oxygen

albuterol, nebulizer

Iptratropium bromide (nebulizer, continuous)

Steriods

counseling

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59
Q

Diagnostic tests for chronic constipation

A

CBC with diff

BMP

Serum magnesium

Serum phosphate

TSH

FOBT

Colonoscopy

HBA1C

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60
Q

Therapy for chronic constipation

A

High fiber diet

Metamucil (psyllium)

oral hydration

low salt diet

low fat diet

exercise program

patient counseling

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61
Q

Appendicitis diagnostic tests

A

CBC with differential

BMP

LFT

FOBT

Abdominal xray

Abdominal US

UA

PT/INR

PTT

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62
Q

Therapy for appendicitis

A

NPO

IV access

IV Normal saline

IV analgesia (morphine)

IV antiemetics

IV cefoxitin

Surgery consulut

Laproscopy

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63
Q

Diagostic tests for septic arthritis?

A

CBC with diff

BMP

Blood cultures

PT/INRPTT

X-ray of the Knee

Synovial fluid analaysis

Synovial fluid gram stain & culture

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64
Q

Therapy for septic arthritis

A

IV access
IV NSS 0.9%

Acetaminophen, oral, continuous

NPO

IV analgesia (Morphine, IV, one time)

IV antibotics
Ortopedic consult

Arthroscopy (when there is failure to adequately drain the knee joint with joint aspiration)

Counseling

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65
Q

What is the inital antibotic therapy while waiting for gram stain results?

A

Broad spectrum coverage

IV 3rd generation cephalosporin (ceftriaxone, ceftazidmine, cefotaxime) with IV vancomycin.

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66
Q

Adjust antibiotic regimen when gram stain results are obtained:

Gram stain shows gram-positive cocci

Gram stain shows gram-negative bacilli

A

Gram stain shows gram-positive cocci

MRSA: IV Vancomycin x 4-6 weeks

MSSA: IV nafcillin or IV cefazolin for 2 weeks then 2-4 more weeks of oral antibiotics

*Staph aureus is the most common cause of non-gonococcal arthritis in adults

Gram stain shows gram-negative bacilli

IV 3rd geeneration cephalosporin (ceftriaxone x 14 days), then 14 days oral antibiotics

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67
Q

Diagnostic tests for Dysfunctional Uterine Bleeding

A

Qualitive urine HCG

Serum TSH

Serum Prolactin

CBC with differential

PT/INR

PTT

68
Q

Once Dysfunctional Uterine Bleeding is confirmed, what is the treament for

Mild DUB

Moderate DUB

Severe DUB

A

Mild DUB (normal Hgb)

Iron supplementation alone is sufficient

Moderate DUB (Hgb = 10-12)

Iron supplementation

Progestin-only OCP (preferred in absence of active bleeding)

Combination OCP (preferred in presence of active bleeding)

Severe DUB (Hgb<10)

Depending on severity, hospitalization, transfusion as needed

Hormonal therapy: Combination OCPs with high estrogen if stable; IV estrogen if unstable (D&C and/or surgery are rarely necessary)

69
Q

Therapy for moderate DUB

A

OCP

Iron sulfate

Reassurance

Counseling

  • Med. compliance
  • safe sex
  • regular exercise
  • seat belt use
70
Q

Emergency orders for suspected pericardits

A

Pulse Ox

Oxygen

Cardiac monitior

BP monitor

12 lead ECG

IV access

71
Q

Diagnostic tests for pericarditis

A

CBC with differenital

BMP

Chest x-ray

CK-MB

Troponin I

ESR

BLood cultures

Echocardiography

72
Q

Therapy for pericarditis

A

NSAIDs

Colchicine

Reassurance

Counseling

73
Q

Management of Blunt abdominal trauma:

Stable, alert and non-intoxicated

Unstable, unconscious or intoxicated

A

Stable, alert and non-intoxicated

  • proceed with abdominal CT with contrast
  • If no intradominal injury, just observe and perform serial exams
  • If intrabdominal injury +/- hemoperitoneum, hospitalize and consider conservative management or immediate lapartomy, depending on the extend of injury and the quantity of blood loss

Unstable, unconscious or intoxicated

  • proceed with abdominal US
  • If there is no intraperitoenal hemorrhage, perform abdominal CT; then manage as above
  • If there is intraperitoneal hemorrhage, perform immediate lapraotomy.

Surgery consult should be obtained in all cases.

74
Q

Emergency orders before phyical examination for Blunt abdominal trauma

A

C-spine immobilization

IV access

IV NSS 0.9%

Pulse Oximetry

Oxygen

BP Monitor

Cardiac Monitor

*Cervical spine immobilization should be performed before the physical exam

75
Q

Diagnostic test for BAT

A

CBC with diff

BMP

LFT

Serum Amylase

Serum Lipase

UA

ABG

PT/INR

PTT

Blood type & crossmatch

Blood ethanol

Urine toxicology screen

Urine Qualitative HCG

12 lead ECG

Spine Xray

CXR

Abdominal Ct

Urine output

*Surgery ocnsult should be obtained immediately following the exam

76
Q

THerapy for BAT

A

NPO

General Surgery consult

Foley catheter

IV analgesia

IV anti-emetics

Cousneling

  • Avoid contact sport
  • no alcohol
  • no smoking
  • seat belt use

**Surgery ocnsult should be obtained immediately following the exam

77
Q

Management of cellulitis

A

Mild:

  • No diagnostic investigations
  • Outpatient empiric antibotics
  • If purulent cellulitis (purlent drainage or exudate, no drainable abscess), MRSA is suspected - Clindamycin, TMP-SMX (Bactrim), Doxycycline or Linezolid
  • If nonpurlent cellulitis (no purlent drainage, exudate, or abscess), beging empiric coverage for beta-hemolytic streptocci and MSSA- Clinidamycin, Amoxiccillin + TMP-SMX, Amoxicllin+Doxyclicline, or Linezolid

Severe: Systemic toxicity, extensive skin involvement, or failure of the inital antibiotics regimen

  • Hospitalize
  • Limited diagnostic work-up to rule out alternative diagnosies (xray of the affected extremity, CBC, BMP, blood cultures)
  • Parenteral antibiotics with IV vancomycin (until MRSA is ruled out) or clinidamycin; switch to oral antibiotics upon clinical improvement
  • *Supportive therapy (leg elevation and heydration) in all cases; treatment of underlying conditions if present*
78
Q

Managemen of acute gouty arthritis

what is the DOC if there are no contraindications present?

What if they are contraindicated?

What if they can tolerate both above?

What is used for prevention of recurrent gout?

A

NSAIDS (naptroxen, indomethacin) are the drugs of choice for acute gouty arthritis if no contraindications (renal failure, heart failure, PUD, NSAID allergy) are present

If NSAIDS are contraindicated, use intraarticular or oral steriods

If NSAIDs and Steriods cannt be given, administer cholchicine, but be aware of the high incidence of side effects (diarrhea, abdominal cramps, N&V).

Allopurinol should not be presecribed in acute gouty arthritis because it may worsen the acute attack. It is primarily used for prevention of recurrent gout.

79
Q

What should be advised to all patients with gout?

A

Avoid aspirin & diuretics (if possible), excessive amoutn of alcohol and purine rich food.

For overweight and obese patients, recommend weight loss through diet and exercise.

80
Q

Diagnostic tests for acute gouty arthritis?

A

CBC with diff

BMP

PT/INR

PTT

ESR

Serum Uric Acid

Xray of the foot/toes

Synoval fluid analysis

81
Q

Diagnositc test in a stable patient with suspected PCP

A

Pulse Oximetry

CBC with diff

BMP

ABG

Serum LDH

Sputum PCP stain

CXR

Blood G6PD (in anticipation of the potential need of dapsone or primaquine)

HIV test by ELIZA

HIV test by West. blot

CD4 count

HIV viral load

82
Q

Therapy of a stable PCP patient

A

TMP-SMZ

Glucocorticoids

Oxygen

Influneza vaccine

Pneumococcal vaccine

Start HAART (Efavirenz/Tenofovir/Emtricitable)

Counseling

  • Medication compliance
  • no alcohol
  • safe sex
  • HIV support group
  • Patient counseling

*Must add steriods if P02 <70 or A-a gradient is >35 mm Hg

83
Q

Suppect RCC when any of the following are present?

What is ordered for suspected RCC?

A

Unexplained hematuria

Flank pain

Palpable flank mass

Order Abdominal CT (provides presumptive diagnosis, provides staging info)

84
Q

If abdominal CT provides presuptive diagnosis of RCC, then:

A
  • Obtain CT chest for further staging info
  • Bone scan if there is bone pain or elevated alkaline phosphatase

Determine stage based on abmoninal CT/chest Ct/+/- bones scan

  • Nephretcomy is prefered for isolated renal mass (diagnostic and therapeutic)
  • Biopsy preferred for suspected metastic dz; further treatment dictated by result
85
Q

Diagnostic tests for suspected RCC

A

CBC

BMP

LFT

UA

FOBT

Abdominal CT

Chest CT

Serum Iron

TIBC

Ferritin

PT

PTT/INR

BLood type and cross match

86
Q

Therapy for RCC (isolated mass)

A

NPO

Oncology consult

Surgery consult

PT

PTT/INR

blood type & Cross match

IV cefazolin

Nephrotomy

Counseling

  • No smoking
  • No alcohol
  • Cancer diagnosis

*Must remember to order nephretcomy

87
Q

Emergency orders for suspected perforated peptic ulcer

A

Pulse Ox

IV access

BP monitor

Oxygen

12 lead EKG

Cardiac monitor

88
Q

Diagnostic tests for perforated duodenal ulcer

A

CBC with differential

BMP

LFT

serum lipase

Serum amylase

Abominal or CXR

PT/INR

PTT

Type and cross match

89
Q

Therapy for perforated duodenal ulcer

A

Bedrest

NPO

NG tube

IV NSS

IV analgesia (morphine)

IV antiemetics

IV antisecretory drug (PPI)

IV antibotics (ampicilin–sulbactam)

Surgery consult

Lapartomy/laparoscopy

Counseling

  • No smoking
  • patient counseling
90
Q

Diagnostic tests for Turners syndrome

A

Karoytpe analysis

Serum FSH

Serum LH

Serum TSH

BMP

Fasting glucose

Lipid profile

Renal US

Pelvic US

Echocardiography

Skeletal survey

Hearing test

91
Q

Therapy for Turner’s syndrome

A

Growh hormone therapy

Estrogen progesterone therapy

Vitamin D

Calcium

Dietary consult

Psychiatry consult (estimate IQ)

Opthalmology consult

Counseling

  • reglar diet
  • regular exercise
  • medication compliance
  • parent counseling
92
Q

Goal of hypertensive therapy

A

Goal BP <140/90 for age <60; CKD, DM

Goal BP is <150/90 for > or = 60

93
Q

Prefferd drug in the presence of comorbidities:

Afib/Aflutter

Angina pectoris

MI

CHF

DM (no proteinuria)

Proteinuria

Osteoporosis

BPH

A

Afib/Aflutter (rate control) - BB, Non-dihydroyrine CCB

Angina pectoris - BB, CCB

MI - ACE I/ARB, BB, or aldosterone antagonist

CHF - ACE I/ARB, BB, diuretic, or aldosterone antagonist

DM (no proteinuria) - Diuretic or ACE I

Proteinuria - ACE I or ARB

Osteoporosis - Thiazide diuretic

BPH - Alpha-blocker (Prazosin, Terazosin, or Doxazosin)

94
Q

What must you remember in patients with HTN?

A

make sure to repeat BP readings at least two more times over a period of weeks to months.

95
Q

Diagnostic tests for essential HTN

A

CBC

BMP

UA

Lipid profile

12-lead ECG

96
Q

Therapy for essential HTN

A

Life sytle modificaitons

  • low salt diet
  • regular exercise
  • no smoking
  • no alsochol
  • calorie restricted diet
  • low fat diet

Oral antihypertensives

97
Q

Diagnostic tests for acute diverticulitis

A

CBC with diff

BMP

LFT

UA

Abdominal CT

Blood culture

98
Q

Therapy for acute diverticulitis

A

NPO

IV access

IV NSS 0.9%

IV analgesia

IV antiemetics (Phenergan)

IV ampicillin-sulbactum

Advance diet/clear liquids

Counseling

  • High fiber diet
  • Medication compliance
  • Medication side effects
  • Regular excercise

*Empiric antibiotics and bowel rest should be initated immediately following the physical exam

99
Q

Diagnostic tests for child abuse

A

Pulse ox

CBC with diff

PT

PTT/INR

Bleeding time

CXR

100
Q

Therapy for child abuse

A

Analgesia (Nsaids or narcotics)

chest physiotherapy

Incentive spirometry

Child protective service consult

Psychiatric consult

Regular diet

Counsel parent

*Must promptly report suspicion of child abuse to child protective services

101
Q

Diagnostic tests for menopause

A

None

Menopause is a clinical diagnosis, defined by 12 months of ammenorrhea in a women over 45 years of age, in the absence of an alternative explanation.

102
Q

Therapy for menopause

A

Estrogen-progesterone therapy

Counseling

  • regular exercise
  • high calcium diet
  • low salt diet
  • medication compliance
  • medication side effects
  • HRT
103
Q

Outpatient managment of DVT

A

Simple DVT is often managed on an outpatient basis.

Choices for anticoagulant therapy includes LMWH (enoxparin) plus warfarn or fondaparinux plus wafarin.

Enoxparin (lovenox) is the most commonly used LMWH.

Coagulation monitoring is unnecessary for LMWH, but the platelet count should be obtained on day 3 and 5 because of the risk of HIT.

Warfarin is begun within 24 hours of heparin initation.

Heparin is distoninuted after 5 days if the INR has been therapeutic (INR =2-3) for 24-48 hours.

Stop heparin if platelet count drops under 100.000 or is reduced by >50%

104
Q

Inpatient management of DVT

A

Commonly used anticoagulant therapy is unfractionated heparin (UFH) plus warfarin or LMWH plus warfarin.

In addition to monitoring the platelet count (as outline in outpatiet management), PTT should also be monitored while on UFH, with a therapetic PTT goal of 60-80.

105
Q

Deep vein thrombosis diagnostic tests

A

CBC

BMP

D-dimer

Lower extremity doppler US

*Must not delay diagnosis caused by failure to order US

106
Q

Therapy for DVT

A

Heparin or fondaparinux

Warfarin

Bed rest

Counseling

  • medication compiance
  • medication side effects
  • no smoking
107
Q

What must you monitor on heparin therapy

A

INR (goal 2-3)

Platelet count on day 3 and 5

PTT if UFH is used

108
Q

How do you determine PE probability?

Management if probablity is low versus high?

What provides a definitive diagnosis?

What do you do whie pending test results?

Management of the following:

  • Postive CT/High probabilty scan:
  • Negative CT/Low probabily scan:
  • Inconclusive CT/Intermediate scan:
A

Based on modified Well’s score

PE unlikely if Well’s score < or = 4, obtain D-Dimer, and proceed to CT-PA or V/Q if D-dimer >500.

PE likely (score >4), proceed directly to CT or V/Q

Spiral CT pulmonary angiography (CT-PA) or V/Q scan provide definitive diagnosis

Empirically start hepatrin/fondaparinux pending test results

  • Postive CT/High probabilty scan: continue with therapy
  • Negative CT/Low probabily scan: discontinue heparin
  • Inconclusive CT/Intermediate scan: Order pulmonary angiogram or serial lsower extremeity doppler; presence of DVT or Positive pulmonary anigogram warrants treatment. Pulmonary anigogram is the gold standard, but is only used if spiral CT or V/Q scan are inconclusive.
109
Q

Commonly used Anticoagulant therapy for Pulmonary embolism

What is preferred in hemodynamicaly stable patients without renal failure?

What about those with renal failure?

A

LMWH + Warfarin,

UFH + Warfarin, or

Fondaparinux + Warfarin

SC LMWH is preferred in hemodynamicaly stable patients without renal failure, while IV UFH is preferred in cases of hemodynamic instability, advanced renal failure, high risk of bleed and in anticipating for thrombolytic therapy.

110
Q

Emergency orders for patient suspected of PE

A

Pulse oxidmetry

Oxygen

IV access

ECG

Cardiac monitor

111
Q

Diagnostic tests for PE

A

D-dimer

Cardiac enzymes

CBC

BMP

CXR

ABG

Spiral chest CT or V/Q scan

*Delay in diagnosis caused by failure to order d-dimer, spiral CT-PA or V/Q scan

112
Q

Therapy for PE

A

DIscontinue OCP

LMWH/UFH/Fondaparinux

Warfarin

Counseling

  • no smoking
  • medication compliance
  • medication side effects

*Do not delay treatment with heparin or fondaparinux

*Fialure to add warfarin to heparin or fondaparinux

113
Q

DIagnostic tests for suspected colon cancer

A

CBC

BMP

LFTs

Colonoscopy

Abdominal CT

CXR

CEA

UA

ECG

PT

PTT/INR

Blood type & cross match

114
Q

Therapy for colon cancer

A

NPO

Pre-colonscopic MBP

Polyethyelen glycol

Pre-op antiotics

hemicolectomy

Oncology consult

Surgery consult

Counseling

  • cancer diagnosis
  • no smoking
  • no alcohol
115
Q

Orders for patietn suspected of bipolar I disorder, acute manic episode

A

CBC with diff

BMP

TSH

Urine toxicology screen

116
Q

Therapy for patient with bipolar I disorder, acute manic episode

A

Antipsychotic or BZD

Mood stabilizer

Psychiatry consultation

Psychotherapy

Counseling

  • Medicaiton compliance
  • medication side effects
  • suicide contract
  • regular exercise
  • patient education

*do not delay in treatment with antipsychotc or benzo

*Do not fail to add mood stabilizer

117
Q

CSF findings suggestive of bacterial mengingitis include

A

turbid appearance

WBC >1000

PMN predominance

Glucose <45

protein >250

118
Q

Early empiric antibiotic therapy pending CSF gram stain for suspicion of bacterial meningitis

Adjust antibiotic rigment when gram stain results are available.

  • Gram postive cocci
  • Gram negative cocci
  • Gram positive bacilli
  • Gram negative bacilli
A

Early empiric antibiotic therapy

Broad spectrum coverage against major pathogens of bacterial mengitis:

IV 3rd generation cephalosporin (ceftriaxone, cefotaxime, ceftazidime) plus IV vancomycin

Ampillicin is added to this regimen if the patient is immunocompromised

Gram postive cocci (Strep pneumo, mcc of acute bacterial mengigitis in adults)

- continue with above therapy

Gram negative cocci (Neisseria)

- IV 3rd generation cephalosporin (ceftriaxone, cefotaxime)

Gram positive bacilli (Listeria)

- IV ampillicn plus IV gentamycin

Gram negative bacilli (Enterobacteriaceae)

-IV 3rd generation cephalosporin (ceftriaxone, cefotazime, ceftazidime) plus IV gentamycin

119
Q

Diangostic tests in stable patient with suspected bacterial menigitidis

A

CBC with diff

UA

BMP

CXR

Blood culture

Lumbar puncture

CSF cell count

CSF glucose

CSF protein

CSF gram stain

CSF bacterial antigen

CSF culture

Head CT

*Delay in diagnosis caused by failure to order CSF analysis

120
Q

Therapy for bacterial mengititis

A

NPO

Head elevation

Complete bedresst

IV access

IV NSS 0.9

IV antibitoics

IV dexamethasone

IV antiemetics

Anitpyretics

Patient counseling

*Delay in treatment with parenteral antibitoics

*Failure to order steriods in pneumoccal mengitis.

121
Q

Management of Cryptococcal meningitis

Pharmacotherapy (acute and maintenance)

Management of ICP

A

Pharmacotherapy (acute and maintenance)

-Acute: IV ampthotericin B plus oral flucotosine for 14 days (alt. is fluconazole plus flucytosine). This regiment is discontinued if clinical improvement is noted. Afterward, it is followed by consolidation therapy with fluconazole 400 mg/d for 8-10 weeks.. HAART can be initated at the end of acute treatment.

Maintenance therapy: Fluconazole 200 mg is the preferred drug; consider itraconazole if patient is allergic to fluconazole. Discountinue maintenance therapy in asymptomatic patients with CD4>100 for 1 year. Reinstitue maintenace therapy if CD4 <100.

Management of ICP:

  • Repeat LP daily until OP <200 mm H20 or > 50% reduction
  • If high ICP persists despite daily LP, consider lumbar drain or ventricular shunt.
122
Q

Findings suggestive of AIDs-related CNS cyrptococcosis

A

Lymphopenia and monocytosis on CBC

postive HIV by ELIZA

High opening pressure during LP

CSF analysis shows mononuclear pleocytosis, slightly elevated protenin, presence of encapsulated yeast on India ink stain and postive CrAg.

123
Q

Diagnostic tests for suspected cryptococcal meningitis

A

CBC with differenital

BMP

Head CT/MRI

Lumbar puncture

CSF cell count

CSF glucose

CSF protein

CSF gram stain

CSF bacterial antigen

CSF culture

CSF CrAg

CSF India ink stain

CSF fungal culture

CSF AFB

Serum CrAg

HIV by ELISA

Blood Culture

*Delay in diagnosis cuased by failure to order CSF CrAg, CSF India ink stain, or CSF fungal culture

124
Q

Therapy for Crytococcal meningitis

A

IV access

Antifungals

  • first IV amphotercin B, IV, continous & Flucoytosine, oral, continous
  • then discontinue after two weeks and start fluconazole, oral, continous

Counseling

  • medication compliance
  • no smoking
  • no alcohol
  • safe sex-

HIV support group

125
Q

Suspect herpes encephalitis if any of the following are present?

A
  • Febrile encephalopathic patient with focal neuroloica deficits on the physical exam
  • CSF analysis revealing lymphotocytic pelocytosis, elevated protein, elevated RBCs but normal glucose
  • Temporal lobe abnormaltiies on CT/MRI
126
Q

Management of Herpes Encephalitis

A

Early empiric antiviral therapy with IV acyclovir (pending PCR results) is recommended to avoid neurologic sequelae or death.

Patient should be treated for 14-21 days.

  • Hydration with NSS should be given to avoid acyclovir-induced kidney injury from crystal formation
  • Adjust acyclovir dose in patietns with kidney failure
127
Q

Diagnsotic tests for suspected Herpes simplex encephalitis

A

CBC with diff

UA

BMP

CXR

Blood culture

Urine culture

Lumbar puncture

CSF cell count

CSF glucose

CSF protein

CSF gram stain

CSF bacterial antigen

CSF PCR for HSV

CSF culture

PIT/INR

PTT

Head CT/MRI

*delay in diagnosis cuased by failure to order PCR of CSF for HSV

128
Q

Therapy for herpes encephalitis

A

NPO

Head elevation

Complete bedrest

IV access

IV NSS 0.9%

IV acyclovir

IV antiemetics

Patient counseling

129
Q

Diagnostic criteria for temporal arteritis

A

include the presence of at least 3 of the following 5:

  • age >50
  • new onset headache
  • temporal artery tenderness or decreased pulsations
  • elevated ESR (>50) and/or CRP
  • Biopsy showing necrotizing vasculitis or granulomas

Additional amnifestations may include fever, fatigue, weight loss, jaw claudification, visual disturbances and symptoms of PMR

130
Q

Management for temporal arteritis

A

Uncomplicated temporal arteritis (can be managed as an outpatient)

-Acute therapy: Begin with a high dose oral steriod (40-60 mg/day of prednisone) until clinical response is noted.

Then, slowly decrease steriod dose to 10 mg/day.

-Maintenance therapy: Once predinisone of 10 mg/day is achiveved, gradually taper predinisone in 1 mg decrements over a period of at least 9 months.

Complicated (ex: vision loss)

  • acutely initate IV steriods (dexamethasone or methylprednisolone) for three days, and then switch to oral steriods as above.

In all cases, prophylactic therapy for gastroduodenal protection with misoprostol, H2 blocker or PPI is indicated.

Prophylactic osteoporosis prevention with clacium plus vitamin D is also indicated.

Baseline DEXA scan should be obtained to assess the need for bispohosphonates.

131
Q

Diagnostic tests suspected temporal (giant cell) arteritis

A

CBC with differential

ESR

BMP

UA

Urine Culture

Blood Culture

Head CT

CXR

Temp. artery biopsy

*Delay in diagnosis cuased by failure to order temporal artery biopsy

132
Q

Therapy for temporal (giant cell) arteritis

A

Biopsy, temporal artery, routine

Prendisone, oral continous

Aspirin, oral, continous

Pantoproazole, oral, continous

Calcium, oral, continous

Vitamin D, oral, continous

Counseling

  • patient counseling
  • medication compliance

*Delay in treatment with steriods

133
Q

PMR is a clinical diagnosis based on the following criteria

A

Age > 50

Bilateral pain and morning stiffness (lasting > 30 mins) for more than a month and involving the shoulders, neck, hips or torso

ESR > 40 mm/hr or ESR < 40 mm/hr plus elevated CRP

Rapid response to steriods, usually within 3 days

Exclusion of alternative diagnoses

134
Q

Therapy of PMR

A

Steriods are the mainstay of therapy

Prompt resposne to low dose steroids is typical of PMR.

Inital steriod dose is maintained for two to four weeks after symptoms resolution. Then it is gradually tapered every two to four weeks to the lowest dose that is needed to suppress the patient’s symptoms and maintated at this level for one to two years.

Prophylactic therapy with misoprostal, H2-blocker, or PPI is indicated for gastroduodenal protection.

In addtion, calcium and vitamin D are recommended for osteoporosis prevention.

Baseline DEXA scan should be ordered to assess the need for bisphosophonates.

135
Q

Diagnostic tests for PMR

A

CBC with differential

BMP

ESR

CRP

RF

ANA

Serum TSH

SErum CPK

CXR

*Delay in diagnosis caused by failure to order ESR and additonal lab testrs to rule out alternative diagnoses.

136
Q

Therapy for PMR

A

Prednisone, oral, continuous

Calcium, oral, continous,

Vitamin D, oral, continuous

Counseling

  • Patient counseling
  • Medication compliance
137
Q

Diagnostic tests for simple ovarian cyst with torsion

A

CBC with diff

BMP

UA

Pregnancy test

Pelvic US

PT/INR

PTT

*Delay in diagnosis caused by failure to order pelvic US

**Failure to rule out pregnancy by not ordering HCG

138
Q

Therapy for simple ovarian cyst with torsion

A

IV access

IV NSS 0.9%

IV antiemetics

IV analgesics

NPO

Bedrest

Gynecology consult

Laproscopy/Laparotomy

Counseling

*Delaying surgical intervention

139
Q

Diagnostic tests for ovarian cancer

A

CBC with differential

BMP

LFT

UA

Pelvic US

colonosocpy

Mammogram

Pap smear

Abdominal/pelvic CT

CA 125

CXR

ECG

PTT

PT/INR

  • *Delay in diagnosis caused by failure to order pelvic US/CT*
  • **Failure to request preoperative orders: CBC, BMP, LFT, UA, FOBT/Colonoscopy, mammogram, pap smear, CXR, ECG, PTT, PT/INR and CA 125*
140
Q

Therapy for ovarian cancer

A

NPO

Gynecology consult

IV cefazolin

DVT prophylaxis

Laparotomy

Oncology consult

Counseling

  • cancer diagnosis
  • no smoking
  • no alcohol
141
Q

Diagnostic tests for sigmoid volvulus

A

CBC with differential

BMP

Abdominal x-ray

UA

*Delay in diagnosis caused by failure to order abdominal x-ray

142
Q

Therapy for sigmoid volvulus

A

NPO

IV access

IV D5NS or D5-1/2 NS with KCL

NG tube

IV analgesics

Gastroenterology consult

Sigmoidoscopy

Counseling

*Failure to order, sigmoidsocopy, colonoscopy or rectal tube placement

143
Q

Diagnostic tests for Acute cholecystits

A

CBC with differential

BMP

LFT

BLood cultures

Adominal x-ray

Abdominal US

PTT

PT/INR

*Delay in diagnosis caused by failure to order CBC and adominal US

144
Q

Therapy of acute cholecystitis

A

NPO

NG tube

IV access

IV D5-1/2NS or NS

Analgestics (ex: ketorolac)

IV antiemetics

IV antibiotics

Bed rest with BRP

Surgery consult

Laparoscopy/laparotomy

Cousneling

  • *delay in initating appoproiate empiric antibiotics*
  • **failure to request cholecystectomy by laparoscopy or laparotomy*
145
Q

Therapy for acute bacterial rhinosinusitis

A

Empiric antibiotic therapy for 5-7 days is recommended.

Oral amoxicillin-clavulanate is the drug of choice.

If PCN allergy is present, consider doxycycline or respiratory fluoroquinolones (levofloxacin or moxifloxacin)

Supportive therapy include analgesics, nasal saline irrigation, topical glucocorticoids, and adequate hydration.

146
Q

Diagnostic tests for acute bacterial rhinosinusitis

A

None

147
Q

Management of suspected AAA rupture

A

Emergency orders: IV access, IV fluids and BP monitor

Proceed according to the patient’s hemodynamic status

Unstable (SBP < 90 mm Hg)

consult vascular surgery immediately

surgical intervention without delay

Stable (SBP >90 and talking)

urgent confirmatory test: urgent abdominal US or CT

Consult vascular surgery

surgical intervention

*Pre-operative orders (CBC, MBP, PTT/PT/INR, blood type and cross match, IV cefazolin and NPO) should be requested, although the restults may not be obtained before surgery

148
Q
A
149
Q

Emergency orders for suspected ruptured AAA

A

IV access

BP monitor

Cardiac monitor

ECG

Pulse Ox

Oxygen

150
Q

Diagnostic tests for suspected ruptured AAA

A

CBC with diff

BMP

PT/INR

PTT

Abdominal US/CT

151
Q

Therapy for ruptured AAA

A

discontinue metoprolol

discountine aspirin

NPO

Bed rest

IV fluids

IV analgesics

IV antiemetics

Type and cross match

Vascular surgery consult

IV cefazolin

Aneurysmectomy

Counseling

152
Q

Diagnostic tests for intussception

A

CBC with differential

BMP

Abdomnal x-ray

Adominal US

*delay in diagnosis caused by failure to order adominal US

153
Q

Therapy for intussception

A

NPO

NG Tube

IV access

IV fluids

IV analgesics

IV antiemetics

Surgery consult

Constrast Enema

Counseling

  • *Failutre to decompress the stomach with NG tube*
  • *Delay in reduction with constrast enema*
  • *requesting laparotomy for uncomplicated intussception*
154
Q

Stat orders for DKA

A

Pulse ox, stat and continuous

Oxygen, inhalation, continuous

IV access, stat

Cardiac monitor, stat

Normal saline, 0.9 Nacl, continous, stat

Finger stick glucose, stat

155
Q

Orders for DKA

A

Urine pregnancy test, stat

CBC with differential, stat

BMP, stat

Calcium, serum, stat

EKG, 12 lead, stat

serum amylase, stat

serum lipase, stat

UA, stat

ABG, stat

Serum osmolality, stat

Serum ketones, qualitative, stat

Reguarlar insulin, IV, continuous,

Phenergan, IV, one time (for nausea)

Discontinue oxygen

156
Q

DKA - Review orders

A

Admit patient to the ICU

NPO

Ved rest

Vitals as per ICU protocol

Urine outpout

KCL, iV, continuous

HbA1C level, routine

Phosphorous, serum, stat (optional)

Follow the patient with

  1. BMP Q2-4 hours, then Q8-12 hours, then Q day
  2. ABG Q2 hours x 2 days

After 4 hours:

  1. stop 0.9 NS and give 1/2 NS saline, IV continus

Monitor potassium deficiency, add IV potassium chloride as needed

Consider antibiotics if the preciptiating cause is an infection, get CXR, obtain blood cuylutres, UA and urine cultures

Once nausea is decreased, start oral fluids

Onc ethe patient is stabilized transfer to ward/floor

157
Q

During discharge of DKA

A

D/C IV insulin, IV fluids, cardiac monitor

NPH insulin, subcutaneous, continous

Regular insulin, subcutaneous, continuous

Diabetic diet

Advance diet

158
Q

Counseling for DKA

A

Diabetic teaching

Patient education, diabetes

Diabetic food care

Home glucose monitoring, instructe patient

No alscohol

No smoking

Safe sex

No illegal drug use

Regular excerise

seat belt use

*follow up appointment in 10 days

159
Q

28 year old white female is brought into ER in unconscious state

A

Emergency management: hemodynamicaly unstable, so A, B, C, D

A: airway suction, pulse ox, stat and coninous monitoring, O2

B: Endotracheal intubation is indicated in patietns who cannot protect their airway or if O2 saturation does not improve with O2 nasal/face mask, or PaO2 <55 or PCO>50 on ABG

C: IV access, cardiac monitor, place a foley, obtain finger stick glucose

D: drugs: Administer thiamine, dextrose 50% and naloxone - all are IV bolus one time dose

160
Q

Emergency Orders for uncouscious state

A

Suction airway, stat

pulse ox, stat and continous

oxygen, inhalation, stat and intubation

IV access, stat

cardiac monitor, continous

finger stick glucose, stat

thiamine, IV stat, one time

Dextrose 50%, IV stat, one time

NS 0.9 NaCl, stat, continous,

ABG, stat

161
Q

Orders for Possible narcotic overdose

A

EKG 12 lead, stat

CBC with diff, stat

BMP, stat

CXR, portable, PA stat

LFTs, stat

UA, stat

Urine toxicology screen, stat

B-HCG, serum, qualiative, stat

Blood alcohol stat

162
Q

Inital treatment with possible narcotic overdose

A

NG tube, gastric lavage, stat

Activated charcol, oral, one time

Naoloxone, IV, stat, continous

163
Q

For narcotic over, after treatment

A

Decison about chaging patient lcoation

move patient to ICU

NPO

bed rest, complete

urine output,

BMP, next eday

Once the patietn is better, D/C oxygen, NG tube, cardiac monitor, IV fluids and naloxone

Regular diet

164
Q

Narcotic overdose - counseling

A

psychiatry consult (stat (reason: suicide attemp)

sucide precaustions

suicide contract

patient cousneling

reassurance

no acohol

no smoking

safe sex

no illegal drug use

reguar exercsie

seat blet use

* start patient on antidepression if neeeded

165
Q

Emergency orders for acute exacerbation of heart failure

A

elevate head of bed

pulse ox, stat and continuous

oxygen, inhalation and continuous

IV access, stat

Cardiac monitor

12-lead ECG, stat

166
Q

Order for suspected acute excerbation of heart failure

A

CXR, PA and lateral views, stat

CBC with diff, stat

BMP, stat

Troponin I, stat and Q6 hours x 2

LFTs, stat

NT-proBNP, stat

Furosemide (lasix) IV, stat and continous

167
Q

Patient with suspected acute excerabation of heart failure

CXR is consistent with b/l pulonary edema.

CBC with differential and troponin I are normal

BMP shows Na 138 and K 4.0

Blood glucose is 380. NT-proBNP is 1800 (elevated)

remainder of the labs are WNL.

next orders?

A

Orders: admit to ward

telemetry

ambulate at will

low satl, low cholesterol, diabetic diet

fluid restriction

input/output moniotor

daily weights

continue all home medications except glyburide

KLC oral, ontinous (as long as lasix is given)

start regular insulin sliding scle, ACHS

Accu check ACHS

Give 10 units regular insulin now

Lovenox, SQ dialy for DVT prophylaxis

BMP, next day (t to check renal function and electrolytes due to furosemid)

HbA1c, routine

lipid profie, routine

Echocardiogram, routine (to asscess Left ventricular function)

Step 3 (10 decks)

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