Uw Ccs Blog Cases

8/11/2019 Uw Ccs Blog Cases

1/5

These are the notes I made for ccs:

For online cases:

Foreign body aspiration: Methyl prednisone. Cefazolin. Rigid bronchoscopy

COPD exacerbation: Albuterol, Ipratropium, methyl prednisone, lovefloxacin (PEFR q1)

Bronchiolitis: Albuterol,nasotracheal suction,nss,epinephrine (one time). Observe.

Croup: neck xray. Epinephrine. Dexamethasone. Humidified air.Acute bacterial Sinusitis: No test needed. Amoxicillin oral, Acetaminophen, Pseudoephidrine, Oral hydration

PCP: ABG, PCP (sputum). BACTRIM (TMP-SMX), prednisone, LDH, G6PD. HIV western blot, viral load, CD4, Vaccine, HIV suppo

Pulmonary Embolism: ABG, D-dimer, Cancel OCP, Spiral chest, Lovenox (if creatinine normal), Warfarin, monitor with INR, plat

DVT: Lower extremity Doppler USG, D-dimer, Enoxaparin SQ, Warfarin, Percocet oral, medication side effect, no smoking, PT/

Hemophilia: Factor VIII. PTT. Genetic consults.

Cellulitis: Clindamycin IV, percocet, leg elevation. When improve change clindamycin to oral.

Septic arthritis: Knee xray, Morphine (one time), acetaminophen,ceftriaxone,vancomycin. Ortho consult, Arthoscopy later canc

Acoute gout: Indomethacin oral. No aspirin, no alcohol, low protein. Esr, pt, ptt, foot xray, synovial fluid (gram, crystals, c and s

Temporal arteritis: Urine Culture, Blood culture, ESR, head CT, Prednisone, Temporal artery biopsy, Aspirin oral, Pantoprazole

Polymyalgia Rheumatica: ANA, CRP, RF, CPK, CXR, ESR. Prednisone, Calcium, Vit D. Later ESR, CRP, CBC, Dexa Scan.

Bacterial Meningitis: Head CT, Head Elevation, Ceftriaxone, Vancomycine, Dexamethasone, Phenergan, Acetaminophen, all IV

improves, case ends.

Cryptococcal meningtitis: Serum cryptococcal antigen, HIV elisa, head CT, LP, CSF, India ink, fungal culture, Amphotericin B IV

group.

Herpes simplex encephalitis: Head CT, LP, blood culture, CSF (dont forget PCR for HSV), Head elevation, Phenergan, Acetamin

Major depression: Fluoxetine, suicide contract, pt education

Alzheimers disease: Donepezil, Vit E, cognitive rehab, occupational therapy, support group, good nutrition, medication alert

Panic attack: alprazolam sl once. No caffeine

Bipolar I, acute mania: Olanzapine IM, lithium oral, suicide contract, psychiatry consult, psychotherapy, medication side effects

TIA: Aspirin, Carotid Doppler, Cefazolin, CEA

Essential HTN: Low fat, low salt, exercise, if lifestyle fails after 6 months, medication on 3rd high BP reading.

Hypertensive emergency: Nitroprusside. Arterial lineUnstable angina: Aspirin. Nitroglycerine. Metoprolol. Heparin. Later oral metoprolol, simvastatin eptifibatide (iv) cardiac cathe

Acute pericarditis: Ibuprofen,colchicine,echocardiogram

Ruptured abdominal aortic aneurysm: Cancel metoprolol, aspirin. Morphine, phenergan, Abdominal USG, Vascular surgery con

Constipation: metamucil. High fiber,low fat.

Irritable bowel syndrome: Lactose free diet, high fiber diet, loperamide, biofeedback

Acute appendicitis: Morphine.phenergan. Cefoxitin. Laparoscopy.

Perforated Duodenal Ulcer: Cancel Ibuprofen, NG suction, UO, Morphine, Phenergan, Pantoprazole, BACTRIM (TMP-SMX).

Acute diverticulitis: Abdominal XRAY, CT, Blood culture, BACTRIM, Morphine, Phenergan, After 12-24 hours, if pt improves, dc

Sigmoid Volvulus: Abdominal xray, GI consult, IV morphine, Flexible sigmoidoscopy, rectal tube, 12-24 hours, pt improves then

Acute Cholecystitis: Abdominal xray, Abdominal USG, NG tube, Piperacillin-tazobactum, ketorolac IM, Phenergan, Pt improves

Intussusception: Morphine, Phenergan, Ngtube, Abdominal Xray, Abdominal USG, Surgery consult, Barium enema.

Renal Cell Carcinoma: (Dont forget:Serum Iron, Ferritin, TIBC), Abdominal CT, Chest CT, Cefazolin, Nephrectomy.

Splenic hematoma: Cervical spine immoblization,morphine,phenergan,get ct result.

Colon Cancer: Polyethylene glycol before colonoscopy, abdominal CT, CXR, CEA, Iron sulfate, Metronidazole, Ciprofloxacin, He

Child abuse: CXR, or Xray of involved injury, CPS, Ibuprofen, chest physiotherapy, Psychiatry consult, if retinopathy ophthalmo

Pregnancy tests: A BB CC HH P RR UU

Uncomplicated cystitis with pregnancy: Nitrofurantoin


2/5

Ectopic pregnancy: Methotrexate, (3.5cm or bhcg >5000 laparoscopy), Morphine

Vaginal Candidiasis: Vaginal Miconazole/clotrimazole 14 days or one time oral fluconazole

Fibroadenoma of breast: Mammogram/USG. FNA Pap. 3-6 m f/u

PID: Morphine. Phenergan. Cefoxitin. Doxycycline. Acetaminophen

Later dc all iv and give oral doxycyclin

DUB (16year): Prolactin,tsh,pap then ocp(low estro low prog), iron.

Menopause: Estrogen-progesterone, vit D, calcium, low salt diet, high calcium diet, exercise, pap, mammography, dexa, colono

Simple Ovarian Cyst with torsion: Pelvic USG, IV Morphine, Phenergan, Laparoscopy.

Ovarian Cancer: Pelvic USG, Abdominal CT, CA 125, Colonoscopy, Mammogram, Pap, CXR, Cefazolin, LMWH SQ, TAH-BSO by

Turners Syndrome: Karyotype, FSH, LH, TSH, Fasting glucose, Skeletal Survey, Pelvic USG, Renal USG, Hearing test, Echocard

Psychiatry for IQ test.

For read out cases of uw:

Atrial fibrillation: Pulse ox, IVA, EKG, Metoprolol or Cardizem IV bolus, (if copd), CBC, BMP, CXR, Cardiac enzyme q8*2, UA, LF

Consistent carbohydrate diet, HbA1C stat, Accuchecks Q6, Echocardiogram, Cardizem IV continous drip, Heparin IV continous,

repeat ekg, check in 6 hours, once hr 1 cm, need thoracocentesis), Consent, Thoracocentesis, Pleural fluid analysis (Gram stain,

Protein, Rheumatology consult, Prednisone oral, safe sex, contraception counseling (AVOID OCPs), exercise, Low fat, high fibe

Cardiac tamponade from MVA: NSS, Pericardiocentesis, Elevate

legs, EKG, CXR portable, TTE, Pericardial fluid for cell count, ABG,

CVTS consult, Shift to ICU, Swan-Ganz catheter, Foley, UO q2, PT,

PTT, Omeprazole oral, Percocet, Type and screen, If Hb 92, wean

oxygen, Pt education, Cardiac rehabilitation, Smoking cessation,

Regular exercise, f/u 2 weeks.

DKA: Finger stick Glucose, CBC, BMP, Calcium, EKG, Amylase,

Lipase, UA, ABG, Serum Osmolality, Serum Ketones qualitative,Regular Insulin iv, Phenergan once, Admit to ICU, NPO, Urine

Output, KCL IV continuous, HbA1C, Serum Phosphorus, BMP q4

then q12, ABG q2*2, After 4 hours, stop NS give NS, monitor

serum potassium, once nausea decreased oral fluid, At discharge,

NPH insulin sq, regular insulin, diabetic diet, diabetic teaching,

diabetic foot care, home glucose monitoring.

ARF: oxy, iva, nss, foley catheter, EKG, ABG, CBC, BMP, Magnesium,

Phosphorus, UA, Urine C & S, Urine Na and Creatinine, FeNa, D/C

lisinopril, d/c ibuprofen, transfer to ward, vitals q2, 24 hour urine

protein, Heparin sq, Renal usg routine, daily weights, strict input &

output, Accucheck q6, HbA1C routine, insulin, if pt does not respond

to fluid lasix to increase urine output, if cause of renal hypoperfusion

is heart failure start dobutamine and dopamine, once pt improves,

d/c bedrest, out of bed to chair, d/c foley, continue renal diet, plenty

of oral fluids, if fever blood culture.

Nephrotic Syndrome: UA, BMP, CBC, LFT, Lipid panel, PT/INR, PTT,

Complement 3 and 4, Input/Output, Consult Nephrology, Albumin,

Furosemide, KCL, CMP in am, No salt added, High protein diet,

Prednsone oral 4-6 wks, Repat albumin and lasix.


3/5

ADPKD: CBC, BMP, UA, USG of kidneys, EKG, (Renal failure can

cause metabolic acidosis, hyperkalemia, hypocalcemia, anemia, EKG

change (peaked T wave), Calcium gluconate IV bolus, D50 and

insulin iv bolus, sodium bicarbonate oral continuous, kayexalate oral

continuous, UO, Nephrology consult, Serum potassium, BMP every

12 hours, serum phosphorus, serum iron, ferritin, TIBC, Amlodipineoral continuous, Calcium acetate? Not in software, Erythropoietin

SQ routine.

Jaundice (G6PD def anemia): CBC, BMP, LFT, PT, Admit to floor,

IVA, NSS, Regular diet, ambulate at will, Reticulocyte count,

Haptoglobin, LDH, UA, Type and cross, PRBC (2 units), G6PD blood

quantitative, Coombs test direct stat, limit alcohol, f/u in 2 months.

Cystic Fibrosis: Admit, Sputum (gram, C&S), Blood cultures, CBC,

BMP, CXR, Sinus xray, Sweat Chloride, 72 hour fecal fat, Augmentin,

Albuterol, Multivitamin, Chest physiotherapy, D5NS, Regular diet,

Ambulation at will, D/C all iv, Influenza vaccine, Pneumococcal

vaccine, Consult dietician, Pancreatic enzyme oral, Genetic

counseling, high protein, high calorie diet.

SLE with pleural effusion: Pulse ox, CBC, IV, BMP, UA, CXR, EKG,

ANA, ESR, PT/INR, PTT, Anti-Ds DNA, Complement C3, C4,

Decubitus film (>1 cm, need thoracocentesis), Consent,

Thoracocentesis, Pleural fluid analysis (Gram stain, AFB, C & S),

Protein, Glucose, LDH, Cell count, Cytology, pH), Serum LDH,

Serum Protein, Rheumatology consult, Prednisone oral, safe sex,

contraception counseling (AVOID OCPs), exercise, Low fat, high

fiber diet. [C/I to thoracocentesis: PT or PTT >twice normal, platelet

count 6], Pleural fluid pH

ur wc, these are the rest, I couldnot post last night for internet

troubles in usmleforum, if it

helps, pray for me. I need lot of

prayers.

Sickle cell anemia: CBC, BMP,

Blood cultures, UA, urine

culture, sputum gram stain and

culture, cxr, ekg, type and

screen, D5 NSS, morphine,

Cefuroxime, Azithromycin,

Incentive Spirometry, Albuterol

nebulization, Repeat H and H in

4 then 8 hours, CBC, BMP next

day, High calorie diet,

Chronic therapy:Penicillin

prophylaxis ( 4months to 3

years), Pneumococcal vaccine,

Folic acid, hydroxyurea for

recurrent vasoocclusive crisis

GBS Pneumonia: CBC, BMP,


4/5

Blood Cultures, CSF (protein,

glucose, cell count, gram stain),

CXR, CRP, D5 NS, Ampicillin,

Cefotaxime, Input/Output, CBC

&BMP daily, Change antibiotic

to oral amoxicillin if sensitive to

it.

Lung Cancer: Pulse ox,

osteoarthropathy indicate lung

ca, oxygen, IVA, NSS, Urine

output q4, CXR, Blood Culture,

Sputum for gram stain, Culture

and Cytology, CBC, BMP,

Levofloxacin, albuterol q2 and

ipratropium q6, Spiral CT scan

of chest, Bronchoscopy, Consult

Pulmonary medicine for

bronchoscopy, CBC and BMP

daily, LFT, PFT, Serum Calcium,

CT of abdomen and pelvis, MRI

brain with and without contrast,

Bone scan, Consult oncology,

consult radiation oncologist,

quit tobacco, Supplement diet

with high protein nutritional

shakes.

Bacterial Meningitis: NPO, Hold

atenolol, Pneumatic, Urine

output q2, Head elevation,

Blood cultures, UA, urine C & S,CBC qd, BMP qd, PT/INR, PTT,

Phenergan, Acetaminophen, IV

ceftriaxone, Vancomycin, LP,

CSF (cell count, protein,

glucose, gram stain, fungal

stain, culture and sensitivity).

Vertrebral fracture: Toradol,

ESR, CBC, BMP, Serum

Calcium, Spine x-ray,

lumbosacral, SPEP (to r/o mm),

TSH, Naproxen oral, calcium

carbonate, vit D, Fosamax

(Alendronate), calcium enriched

diet. In f/u 7 days, Dexa scan.

TSS: Clindamycin. IV dopamine,

iv phenergan one time, foley.

Acute bacterial prostatitis:


5/5

Ampicillin, Gentamicin, later

oral amoxicillin.

Diverticulosis: Anoscopy, CBC,

BMP, LFT, PT, PTT, EKG, Type

and crossmatch, NGT

aspiration, D/C if takingGlyburide, statin or lisinopril,

PRBC, FFP, H and H Q6, Urine

output, Accucheck Q6, Consult

Gastroenterology for

Colonoscopy, Golytely, High

fiber diet, avoid nuts and fruits.

Infective endocarditis:

Vancomycin, Gentamicin. TEE,

Daily blood culture, later D/C

Vancomycin, add oral Nafcillin.

Angioedema: Epinephrine SQ,

stat, ABG, albuterol,

hydrocortisone,

Diphenhydramine, ranitidine,

dopamine,all iv continous, urine

output, d/c all IV, oral

prednisone, oral

diphenhydramine. At discharge,

EpiPen. After 6 weeks, RAST.

Avoid allergen, Immunology

consult for anaphylaxis.

Folic Acid deficiency: Fobt,serum folate, serum vit b12, lft,

reticulocyte, iron sulfate

therapy, thiamine oral,

multiviamin oral, iron enriched

diet, folic acid therapy.

All postmenopausal: Cal, Vit D.

Urosepsis: D/C foley, IV

ceftriaxone, after 24 hours, oral

bactrim or ciprofloxacin.

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