Upgrade to remove ads
Only $2.99/month

Reviewed ⅓ : Step 2 CK: Next Step in Management

Terms in this set (193)

What is the next Step in Management for
- high-grade reflux in females that persists into adulthood with no clear secondary cause.
surgical repair
What is the next Step in Management for
- multiple 2nd trimester spontaneous abortions.
cervical cerclage
What is the next Step in Management for
- erythematous knee with effusion and fever.
arthrocentesis to tell apart crystal disease (gout) from infection (septic arthritis).
What is the next Step in Management for
- spontaneous pneumothorax in a tall young man.
supplemental oxygen
What is the next Step in Management for
- (+) clue cells seen in vaginal swab in a fertile woman.
oral metronidazole
What is the next Step in Management for
- acute open-angle glaucoma
1) B-2-antagonist eye drops i.e. timolol, betaxolol
2) carbonic anhydrase inhibitors
3) if medication fails, then a trabeculoplasty or trabeculectomy can improve aqueous drainage
What is the next Step in Management for
- chronic sinusitis refractory to medical Tx or
- (+) neurological deficits.
CT scan of the face (coronal section)
What is the next Step in Management for
- someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo:
dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's disease)
What is the next Step in Management for
- someone that comes in with headaches and shows papilledema in the opthalmic exam.
CT scan of the head non-contrast - r/o mass or bleed.
What is the next Step in Management for
- treatment for scabies:
permethrin
What is the next Step in Management for
- Scaphoid fracture that is negative on X-ray.
spica cast and re-evaluate in 2~3 weeks
What is the next Step in Management for
- 3-hour old infant with poor feeding who vomits green material:
next step: U/S --> r/o (+) double-bubble:
What is the next Step in Management for
- 3-hour old infant with poor feeding who vomits green material with a (+) double-bubble on U/S:
nasogastric tube for decompression of the GI tract...
What is the next Step in Management for
- mini-mental status exam of <24
neuropsychologic testing to rule-out alzheimer's (other causes of dementia)
What is the next Step in Management for
- cord compression confirmed with CT-spine:
dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)
What is the next Step in Management for
- Pulmonary edema in acute CHF exacerbation:
100% O2 therapy
What is the next Step in Management for
- Pulmonary edema in acute CHF exacerbation after 100% O2 therapy:
IV furosemide
What is the next Step in Management for
- supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus rhythm:
Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or adenosine
What is the next Step in Management for
- Asymptomatic aortic stenosis:
Hydrocholorothiazide to reduce preload
What is the next Step in Management for
- Hypertension with underlying diabetes type 2:
ACE-inhibitor or ARB
What is the next Step in Management for
- Syncope with normal vitals and no previous episodes:
Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and arrythmia
What is the next Step in Management for-
PR interval=o.3 sinus rhythm normal:
Nothing, no management needed; PR>0.2 is first degree heartblock
What is the next Step in Management for
- A-fib secondary to hypertension for >48 hours.
Diltiazem; rate control + anticoagulant
A patient presents with hypertension and chest pain on exertion:
Next Step in Management:
IV nitroglycerin for lowering the blood pressure
Palpitations with underlying lung disease i.e. COPD
Next Step in Management:
72 hr Holter monitor
Angina symptoms:
Next Step in Management:
Beta-blockers - they increase the threshold of angina
Posterior anterolateral MI and Percutaneous coronary intervention
Next Step in Management:
Clopidogrel
teenage patient grunting and blinking many times a day for at least 1 year:
Next Step in Management:
haloperidol
prinzmetal angina:
Next Step in Management:
calcium channel blockers or nitrates (also for esophageal spasm)
Lambert Eaton Syndrome
Next Step in Management:
radiation and chemotherapy as it is the manifestation of a pre-existing small cell carcinoma of the lung.
What is the next Step in Management for
- stroke outside the 3 hour period but within 6 hours:
intra-arterial tPA administration
What is the next Step in Management for
- osteopenia in an elderly patient:
calcium, vitamin D, and weight-baring exercise
tracheobronchial rupture:
Next Step in Management:
bronchoscopy (flexible or rigid)
abdominal pain out of proportion to clinical findings
Next Step in Management:
laparatomy
Guillane Barre Syndrome
Next Step in Management:
plasmapheresis or IVIG with admission to ICU
shoulder dystocia on observing the Turtle sign(retraction of head back into perineum)
Next Step in Management:
McRoberts maneuver - flexion of mother's thighs against her abdomen
central retinal artery occlusion:
Next Step in Management:
ocular massage with high flow oxygen
nephrogenic diabetes insipidus:
free water and hydrochlorothiazide
carbon monoxide poisoned pregnant lady with carboxyhemoglobin >15%:
Next Step in Management:
hyperbaric oxygen (oxygen >100%)
flu-like illness with cherry red lips; multiple family membersl; carboxyhemoglobin <25%
Next Step in Management:
100% oxygen
a digoxin user with a potassium of 5.5 mg/dL
Digibind (Fab fragment
Wernicke's Encephalopathy:
Next Step in Management:
thiamine, then glucose ( in that order)
Alcohol withdrawal:
Next Step in Management:
fluid resuscitation, thiamine, dextrose, folate, benzodiazepines(diazepam, chlordiazepoxide)
septic arthritis
Next Step in Management:
ceftriaxone + vancomycin
prophylaxis against acute limb ischemia in a person with a-fib
dabigatran
acute febrile non-hemolytic transfusion reaction
Next Step in Management:
discontinue transfusion, give IV acetaminophen
acute cholecystitis
Next Step in Management:
IV fluids, pain medication, and cholecystectomy within 72 hours
abscess size >3cm
Next Step in Management:
CT-guided percutaneous drainage
single 2cm nodule on Chest X-ray in a 25 yo male:
Next Step in Management:
check old Chest-X-ray to compare size or presence of the nodule.
ulcer that is not infected and does not involve the bone
Next Step in Management:
debridement
how to diagnose hepatorenal syndrome
IV colloid challenge , if no improvement then positive for hepatorenal syndrome
Primary light chain amyloidosis
Next Step in Management:
mephalan and prednisone
local baldness:
Next Step in Management:
minoxidil
severe acute pancreatitis >30% necrosis on MRI:
Next Step in Management:
imipenem followed by percutaneous needle biopsy
pseudocyst on CT-abdomen:
Next Step in Management:
if expanding or pain symptoms, then drain it. otherwise leave it alone.
elderly patient with intermediate to high risk factors for coronary artery disease.
Next Step in Management:
stress test
needle-stick and unvaccinated for HepB
Next Step in Management:
give HepB IV-IgG and HepB vaccine
MRI contraindicated in suspicious looking equivocal X-ray:
Next Step in Management:
Technetium bone scan
man comes in with a painless chancre on the penis:
Next Step in Management:
swab the exudate and perform dark-field microscopy
vesicles on skin and mucous membranes which erode into ulcers with inguinal lymphadenopathy
Tzanck positive
Next Step in Management:
acyclovir
famciclovir
valacyclovir
methods of treating genital warts:
Next Step in Management:
cryotherapy , lasers, trichloroacetic acid or podophyllin
imiquimod(originally for basal cell , acktinic akeratosis) , no side effects
acute viral pericarditis recurrence prevention:
Next Step in Management:
colchicine
pericardial effusion:
Next Step in Management:
pericardiocentesis or pericardial window placement.
pneumonia, dyspnea, dry cough, fever, chest pain in HIV patient:
Next Step in Management:
Bronchoscopy with alveolar lavage
dysuria, suprapubic pain, and hematuria continue despite empiric antibiotics for UTI:
Next Step in Management:
CT-scan of the abdomen and pelvis
the first test to determine beta-thalassemia anemia in genetic counseling:
Next Step in Management:
WHAT IS THE LOGIC BEHIND THESE STEPS? complete blood count in the female (if no abnormality found, then there is no need for hemoglobin electrophoresis testing; if abnormal then test the partner)
no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus:
Next Step in Management:
measure serum FSH (do not measure estrogen because the lack of breast development already tells you there is a lack of it)
dog bite with suspicion of rabies:
Next Step in Management:
quarantine the dog for 10 days; if asymptomatic the whole time, then no need for management (post-exposure prophylaxis)
pinpoint calcifications in a newborn whose mother owns a cat:
Next Step in Management:
pyramethamine and sulfadiazine (Treats toxoplasmosis)
peripartum cardiomyopathy - biventricular cardiac failure:
Next Step in Management:
supportive care
eisenmenger's syndrome in a pregnant woman:
Next Step in Management:
avoid hypotension give pressors
Rheumatic mitral stenosis in a pregnant woman:
Next Step in Management:
decrease the heart rate to allow time for blood to fill the left ventricle; reduce the IV fluid volume
pregnant woman of 16 weeks gestation with fasting blood glucose of 140 mg/dL:
Next Step in Management:
do quadruple marker screen assess for neural tube defects - specifically caudal regression syndrome - she has overt diabetes mellitus. sacral agenesis (or hypoplasia of the sacrum) is a congenital disorder in which there is abnormal fetal development of the lower spine—the caudal partition of the spine. Sacral agenesis syndrome (agenesis of the lumbar spine, sacrum, and coccyx, and hypoplasia of the lower extremities) is a well-established congenital anomaly associated with maternal diabetes mellitus (not gestational diabetes).
Estimated fetal weight is >4.5kg by sonogram:
Next Step in Management:
C-section
perinatal management of gestational diabetes:
Next Step in Management:
IV D5w with insulin drip maintain glucose within 80-100mg/dL
non-reactive stress test:
Next Step in Management:
vibroacoustic stimulation- wake up the baby because most commonly non-reactive ST due to the baby sleeping
Non-reactive stress test with fetus and positive contractions:
Next Step in Management:
delivery the baby immediately
fibromuscular dysplasia treatment:
percutaneous angioplasty with stent placement
4 month old boy with leg-length discrepancy and positive Ortolani test:
Next Step in Management:
U/S of the hip followed by Pavlik Harness (splint that holds hip in flexion and abduction) - prevents extension and adduction
45 yr old woman overdosed on pills comes in with tinnitus, fever, and tachypnea:
Next Step in Management:
1. aspirin intoxiciation - supportive care, activated charcoal, IV hydration, bowel irrigation
a. moderate intoxication =>IV sodium bicarbonate to alkalinize the urine and promote excretion
b. severe intoxication => hemodialysis
suspicion in an immigrant man with hypopigmented skin patch with loss of sensation. Had a flu-like illness 1 month prior.
Next Step in Management:
perform a skin biopsy -> top ddx is Lepromatous leprosy.
A man with mediastinal widening on chest X-ray and equal blood pressures on both arms and moderate pericardial effusion:
Next Step in Management:
Trans esophageal echo
5 day old newborn has lost 7% of their body weight:
Next Step in Management:
follow up 10-14 days to see if baby has regained it (normal loss of fluid due to labor and in-utero)
skin lesions in a patient with celiac disease:
Next Step in Management:
dapsone (Tx for dermatitis herpetiformis)
clinical suspicion for abnormal uterine bleeding:
Next Step in Management:
endometrial biopsy
reproductive-age woman with widespread pain ,fatigue, poor-sleep, frequent headaches and tenderness to palpation of her neck, shoulders and back. Vitals and labs are normal.
Next Step in Management:
exercise program with aerobic conditioning (Tx for fibromyalgia). Medications - duloxetine, TCAs are a secondary measure.
1 month old boy with a harsh holosystolic murmur over the left lower sternal border:
Next Step in Management:
echocardiography - he has a VSD
infant with symmetric descending paralysis, drooling and constipation, poor suck and gag reflex also seen:
Next Step in Management:
botulism immuneglobulin + supportive therapy(respiratory support, NGT feeding)
Lichen sclerosus:
Next Step in Management:
corticosteroids
admission to inpatient ward with febrile neutropenia:
Next Step in Management:
piperacillin-tazobactam
cafe au lait spots with sensorineural hearing loss:
Next Step in Management:
MRI with gadolinium (suspect acoustic neuroma)
MI status post CABG post-op day 5 small pericardial effusion with fever, tachycardia, a-fib.
Next Step in Management:
drainage, surgical debridement and antibiotics ( acute mediastinitis)
DVT identified on ultrasound:
Next Step in Management:
CT scan of abdomen, chest, and pelvis - search for any embolism
Rhabdomyolysis:
Next Step in Management:
IV fluids, mannitol and bicarbonate
Baseline EKG changes on patient with SSx of stable angina
Next Step in Management:
Stress echocardiography instead of exercise treadmill stress test -- (echo you need to have a normal EKG reading at rest)
presence of bilateral popliteal artery aneurysms:
Next Step in Management:
CT Abdomen -> 25% chance of abdominal aortic aneurysm present.
Asystole:
Next Step in Management:
CPR and epinephrine(lowers defibrillation threshold, increases myocardial and cerebral blood flow) ; defibrillation does not work for asystole
hepatorenal syndrome
midodrine and octreotide
Needlestick from an HIV infected person:
Next Step in Management:
Triple HAART therapy for 28 days
pancreatic cancer with elevated direct bilirubin:
Next Step in Management:
endoscopic stent to relieve jaundice from extrahepatic cholestasis
positive whiff test:
Next Step in Management:
amine production with KOH prep = bacterial vaginosis -- Tx --> clindamycin or metronidazole
symptoms of malabsorption returning from a foreign country.
Next Step in Management:
Tx empirically with metronidazole. i.e. giardiasis, amoebiasis.
skin rash in a person with gluten-intolerance.
Next Step in Management:
dapsone for dermatitis herpetiformis
patient with hypothermia that is 1). comatosed at 2). 32-35C, 3). 28-32C, and 4). 27C degrees.
Next Step in Management:
general - IV hot crystalloid for hypotension with endotracheal intubation in comatose patients.

32-35 degrees - dry and cover with blankets
28-32 degrees - warm bath, heating pad, blankets
<28 degrees - pleural, peritonealwarm irrigation -internal rewarming
recurrent coughs with mucopurulent sputum
Next Step in Management:
CT scan - bronchiectasis - dialated bronchiolar airways
microcytic, hypochromic anemia in an otherwise healthy adult.
Next Step in Management:
test for stool occult blood - because the most common cause of iron-deficiency anemia is GI blood loss. Otherwise, colonoscopy is indicated because it has a higher sensitivity and specificity
meningitis in people age 2-50.
Next Step in Management:
vancoymcin + 3rd generation cephalosporin
meningitis in people older than 50.
Next Step in Management:
vancomycin + ampicillin + 3rd generation cephalosporin: ceftriaxone
infection post-neurosurgery shunt.
Next Step in Management:
vancomycin + 4th generation cephalosporin (cefepime)
meningitis in an immunocompromised state.
Next Step in Management:
vancomycin + ampicillin + 4th generation cephalosporin(cefepime)
infection after penetrating trauma to the skull.
Next Step in Management:
vancomycin + 4th generation cephalosporin (cefepime)
Tx of carcinoid syndrome.
Next Step in Management:
Treat only Symptomatic Patients:
1. 1st: octreotide
2. 2nd: remove tumor
patient has blood cultures that grow Streptococcus bovis and has vegetations on mitral valve.
Next Step in Management:
perform colonoscopy NOT FOBT- colonoscopy is more sensitive and specific
patient had a Hx of flu ten days earlier but now has increased tactile fremitus in LLL of the lung and a fever.
Next Step in Management:
Tx: anti-staph penicillin i.e. methicillin, oxacillin, dicloxacillin, naficillin - most common organism is Staph aurues post-influenza pneumonia.
patient with a PMH of drug addiction and addiction comes in with severe pain from a motor vehicle accident. What analgesic do you give him?
Next Step in Management:
Give him IV morphine. It doesn't matter what his drug abuse history is. Physicians never undertreat pain even with a risk of abuse.
lupus nephritis.
Next Step in Management:
1. mycophenolate mofetil
2. cyclophosphamide + corticosteroids
OR
3. azathioprine + corticosteroids
MALT lymphoma restricted to the mucosa with no lymph node involvement
Next Step in Management:
PPI + clarithromycin + amoxicillin ( most common cause is H-pylori) then use
a. multiple consecutive PVCs without symptoms

b. what if you DO have symptoms with multiple consecutive PVCs?
a. observation;
b. if multiple consecutive PVCs with symptoms then you give beta-blockers first, then amiodarone as a second-line therapy.
cancer-related anorexia and/or cachexia symptoms
Next Step in Management:
megestrol acetate ( progesterone analogs) they are superior to cannabinoids
positive PPD test in HIV patients
Next Step in Management:
isoniazid + vitamin B6 for 9 months.
unstable patient with narrow-complex tachycardia
Next Step in Management:
DC cardioversion stat
supraventricular tachycardia = narrow complex tachycardia
patient with flank pain gets abdominal imaging showing 6mm calculus in distal right ureter. No hydronephrosis seen. IV hydration and analgesics started. What is the next step?
Next Step in Management:
alpha-1 receptor blocker i.e. tamsulosin - acts at the distal ureter lowering muscle tone and reduces ureteral spasm from stone impaction.
elderly patient with abnormal gait, incontinence and dementia showing enlarged lateral ventricles on CT scan
Next Step in Management:
1. serial large volume lumbar punctures
2. ventriculoperitoneal shunting if symptoms relieved by sequential CSF removal by the lumbar punctures
painless hematuria with elevated hemoglobin, 50 pk-yr smoking history.
Next Step in Management:
CT Scan of the Abdomen
symmetrical pain and stiffness in the neck, shoulders, and hip with elevated ESR.
Next Step in Management:
low dose prednisone ( Polymyalgia Rheumatica)
widened pulse pressure, irregular breathing, and elevated ICP.
Next Step in Management:
intubation with possible ventilation, elevated head of the bed , mannitol
symmetric descending flaccid paralysis that started with dry mouth and diplopia
Next Step in Management:
administer antitoxin with high clinical suspicion simultaneously with collecting specimens identify in stool, serum or gastric lavage -> botulinum toxin.
hypertonic extremities with lockjaw.
Next Step in Management:
(1)admit to ICU immediately,
(2) diazepam, and give
(3)1x dose of IM tetanus immunoglobulin
(4) active immunization with Td(tetanus/diptheria toxoid)
empiric osteomyelitis Tx.
Next Step in Management:
1. Classes of RX that can be used:
a. cephalosoprins,
b. fluoroquinolones,
c. vancomycin,
d. linezolid,
e. daptomycin, and
f. clindamycin
2. Rifampin for biofilm penetration
3. Gram negative suspected add aminoglycoside +/- beta lactam ( PCN, Ceflosporines)
septic arthritis in an immunocompetent adult.
Next Step in Management:
IV beta lactamase resistant penicillin --> oxacillin OR 1st generation cephalosporin ; MRSA coverage -> vancomycin
septic arthritis in a immunocompromised adult.
Next Step in Management:
1. Ceftriaxone
or
2. Gentimicin + Pipericillin/Tazobactum
______________________________________________________________________________________________________________________________________

1. broad spectrum antibiotic - 3rd generation cephalosporin (Ceftriaxone)
OR
2. Consider pseudomonal coverage with aminoglycoside + extended spectrum pencillin (Aminoglycoside (Gentimicin) + Pipericillin/Tazobactum)
warts.
Next Step in Management:
(1) freezing lesions with liquid nitrogen
(2) salicylic acid daily topically applied for several weeks
(3) 5-FU cream - retinoic acid cream for flat warts
(4) surgical excision OR laser therapy
(5) podophyllin for genital warts
molluscum contagiosum.
Next Step in Management:
(1) curettage
(2) podophyllin drops
(3) cantharidin
(4) cryosurgery
silvery scales on knees and elbows.
Next Step in Management:
corticosteroids are first line
calcipotriene and calcitriol - 1st/ 2nd line
tars
tazarotene ( vit A derivative)
anthralin (anthracene derivative - smoke carcinogen)
young woman with tender breast mass on the upper outer quadrant. LMP was three weeks ago. She has no family history of breast cancer.
Next Step in Management:
Ask her to come back after the menstrual period and ask her to take note if the size of the mass has decreased after the menstrual period. Otherwise ultrasound, FNA, and excision biopsy would be the option.
acute exacerbation of COPD
Next Step in Management:
IV methylprednisolone 1-2x doses followed by oral therapy for 5 days.
allergic conjunctivitis
Next Step in Management:
olopatadine, azelastine
non-herpes viral conjunctivitis.
Next Step in Management:
supportive therapy, warm compresses
collapsed gestational sac with no fetal heart tone on transvaginal ultrasound in a hemodynamically stable female at 8 wks gestation.
Next Step in Management:
follow-up outpatient ; no suction and curretage.
meningitis in a 55 year-old man.
Next Step in Management:
3rd gen. cephalosporin + vancomycin + ampicillin + dexamethasone
bruit left periumbilical region on auscultation in middle-aged man with hypertension.
Next Step in Management:
captopril renal scan
eye pain with Hx of occupational trauma.
Next Step in Management:
1. Fluorescein slit lamp examination: tetracaine for pre-op anesthesia.
- The slit-lamp examination provides a stereoscopic magnified view of the eye structures in detail, enabling anatomical diagnoses.
- A fine strip of paper, stained with fluorescein dye, is touched to the side of the eye staining the tear film on the surface of the eye to aid examination.
- The dye is rinsed out by tears.
2. A subsequent test may involve placing drops in the eye in order to dilate the pupils. - The drops take about 15 to 20 minutes to work, after which the examination is repeated, allowing the back of the eye to be examined.
elderly male comes in with 1 episode of syncope with no smoking history BP equal on both arms and widened mediastinum and pericardial effusion on chest X-ray. Next Step in Management:
transesophageal echocardiogram --> it could be a type A retrograde aortic dissection , so the BP could be normal.
frostbite injuries. Next Step in Management:
rapid rewarming with warm water
high blood pressure in an otherwise healthy woman of child-bearing age. Next Step in Management:
1st step: discontinue oral contraceptive pills
2nd step: diet and exercise
3rd step: introduce thiazide diuretic
5mm radiolucent stone in the ureter. Next Step in Management:
potassium citrate --> uric acid is soluble at high pH
elderly male with history of recurrent aspiration presents with neck mass and RLL consolidation. Next Step in Management:
1. barium esophagram to rule out Zenker's diverticulum,
2. CT scan of neck is indicated for airway obstruction by foreign object; bronchoscopy is 2nd line.
postpartum fever with leukocytosis and non-foul smelling bloody vaginal discharge. Next Step in Management:
reassurance. You don't even need empirical antibiotics. Endometritis requires the presence of foul smelling lochia
acute exacerbation of COPD. Next Step in Management:
non-invasive positive end expiratory pressure for 2hours
acute exacerbation of COPD with failed NPPV trial. Next Step in Management:
mechanical intubation
malignant hypertension. Next Step in Management:
lower BP 10-20% in the first hour , then 5-15% across the next 23 hours.
Next Step in Management:
- hypertension diagnosed in a young individual.
1. R/o co-arctation of the aorta --> check for radio-femoral delay..associated with Turner's, bicuspid aorta, and VSD.
2. Check Meds: OCPs
adnexal mass in a postmenopausal woman. Next Step in Management:
transvaginal ultrasound AND CA-125 serum marker
progressive back pain in prostate cancer patient with previous orchiectomy. Next Step in Management:
radiation therapy (the answer is NOT flutamide or any medical management)
white cloudy dialysate with tender abdomen in a patient getting peritoneal dialysis. Next Step in Management:
trial of antibiotics cefazolin and ceftazidime; if refractory, then remove the catheter.
positive Tinel's sign and flick test. Next Step in Management:
First line: wrist splint
2nd line: injected glucocorticoids
3rd line: surgery
fever, hypertension and tachycardia along with altered mental status. Next Step in Management:
give Librium ( chlordiazepoxide) the patient is going through EtOH withdrawal
post-ictal metabolic acidosis on admission. Next Step in Management:
wait 60-90 min. for the metabolic acidosis to resolve, then redraw labs. No need for immediate medical intervention.
Failure of MALToma to regress after eradication of H-pylori with triple therapy. Next Step in Management:
CHOP therapy - cyclophosphamide, adriamycin, vincristine, and prednisone +/-bleomycin
woman in her thirties whom results for for AchR antibodies test came back positive. Next Step in Management:
CT scan of the anterior mediastinum -- a thymoma is more specific than a Tensilon(Edrophonium) test
opening snap with diastolic rumble in a patient who had a respiratory illness with joint pain an swelling recently. Next Step in Management:
DIAGNOSIS: RHEUMATIC FEVER WITH CARDITIS/
1. No proven heart damage with ECHO BUT, (+) Clincial signs of valve disease: Benzathine penicillin G IM - X 1/Month X 5 YRS or until 21 years old (whichever is longer).
2. No proven heart with ECHO or Clincial signs of valve disease: - 10 years or until 21 yrs old - whichever one is longer
3. Proven heart damage with ECHO and (+) Clincial signs of valve disease: 10 yrs or until 40 years old
precocious puberty showing elevated LH at baseline. Next Step in Management:
MRI of the brain - need to rule out central vs. peripheral gonadotropin dependent precocious puberty
cat bite with puncture wound showing no debris or active bleeding in a patient with recent Td vaccination <5 yrs. Next Step in Management:
amoxcillin-clavulanate for Pasteurella multocida
dyspnea and tachycardia in a pregnant woman with low pretest probability of P.E = (d-dimer). 1st.: chest X-ray. 2nd: Next Step in Management:
1. d-dimer in a pregnant patient has high false negative rate;
2. need to perform V/Q scan to rule out P.E.
3. If V/Q is equivocal then perform CT angiogram.
urge incontinence. Next Step in Management:
1. bladder training ;
2. 2nd line is oxybutynin (anticholinergic) and mirabegron (beta-3 adrenergic agonist @ the detrusor)
gas gangrene infection. Next Step in Management:
IV penicillin - 24 million units per day
1 or 2 coronary vessel stenosis. Next Step in Management:
angioplasty and stent followed by Gp2b3a inhibitor i.e. tirofiban or abiciximab
postmenopausal woman with pruritis of the vulvar region that is refractory to medical management. Next Step in Management:
vulvar biopsy.
history of cancer with suspicion of bony metastasis i.e. back pain
1. radionuclide bone scan ( X-ray of the back is to rule out other causes of bone pain because radionuclide bone scan has high sensitivity BUT low specificity)
suspicion for SLE; which lab test first. Next Step in Management:
1. SN = anti-nuclear antibody first because of high sensitivity;
2. Sp= use anti-dsDNA antibody as a confirmation test because of high specificity
amytrophic lateral sclerosis. Next Step in Management:
riluzole - glutamate receptor antagonist
moderate-to-severe restless leg syndrome.
1st line - pramipexole, ropinirole
2nd line - alpha-2-delta calcium channel agonists i.e. gabapentin enacarbil
mild restless leg syndrome. Next Step in Management:
1) iron supplementation if serum ferritin <75
2) supportive measures - heating pad exercise
3) avoid triggers - sleep deprivation, medications
sore throat two weeks after starting PTU for treatment of Graves disease. Next Step in Management:
stop PTU. It is causing the agranulocytosis
person with a core body temperature of 88 degrees F, bradycardia and hypotension. Next Step in Management:
active rewarming with blankets - hypothermia will slow the heart and the blood vessel vascular resistance.
patient brought to E.R. after smoke inhalation from a burning building. Next Step in Management:
100% oxygen by facemask - first suspicion is carbon monoxide poisoning.
recent gastrectomy with nausea, diarrhea, abdominal pain and palpitations. Next Step in Management:
manage diet -- dumping syndrome - small frequent meals, avoiding simple sugars, increase fiber and protein, drink fluids during rather than after meals.
patient with Hx of tonic-clonic seizures comes in post-seizure 15 min. ago and has a pH of 7.2. and appears confused. anion gap is elevated. Next Step in Management:
This patient has post-ictal lactic acidosis. No management for the first two hours and draw second labs. a pH >7.1 does not require intervention. If value <7.1 then IV sodium bicarbonate is indicated.
unilateral renal artery stenosis 80%. Next Step in Management:
1. treat initially with ACE-I or ARBs.
2. Stenting and surgical revascularization reserved for patients with
a. resistant HTN
or
b. pulmonary edema
or
c. refractory heart failure due to severe HTN
patient shows morning glucose of 300mg/dL consistently; they deny any late night snacks. Next Step in Management:
make them record their blood sugar at 3am - to determine Somogyi (rebound hyperglycemia 2/2 hypoglycemia) or Dawn effect (cortisol and growth hormone effects)
PCP intoxication. Next Step in Management:
benzodiazepines - midazolam, diazepam, or lorazepam ; 2nd line is haloperidol
R supraclavicular lymph node biopsy shows squamous cell carcinoma cells. Next Step in Management:
do a panendoscopy because the cancer is coming from larynx, bronchus or esophagus most likely.
nausea and vomiting caused by chemotherapy. Next Step in Management:
ondansetron + Fosaprepitant + dexamethasone ( 5HT3 antagonist and NK-1 antagonist) dexamethasone mechanism unclear.
condyloma acuminata - patient wants self-treatment. Next Step in Management:
imiquimod (induction of IFN-alpha leading to reduction in HPV viral DNA synthesis). Canthardin and Podophyllin require in-office administering of the drug.
vomiting, lethargy, dehydration, with posturing in a 10 month old infant. Next Step in Management:
IV dexamethasone; increased ICP can counteract vasogenic edema - corticosteroids have an anti-inflammatory and membrane stabilizing effect
pediatric patient 4 years old has PPD <5mm but lives in the same house as someone who has. Next Step in Management:
isoniazid _ vit B6 along with follow up PPD test in 8-12 week- the kid is still exposed to T.B.
agitation and chest pain in someone with acute-onset chest pain who recently used cocaine. Next Step in Management:
benzodiazepine --> use diazepam
patient comes in with tearing chest pain radiating to the back, has a moderate pericardial effusion and happens to be hemodynamically stable. Next Step in Management:
CT angiogram - definitive test for aortic dissection
an unchanged consolidation in the right lower lobe of the lung after multiple bouts of pneumonia. Next Step in Management:
CT scan of the chest -- concern for malignancy. Bronchoscopy is most commonly for biopsy of hilar centrally located masses.
adnexal mass palpated in a post-menopausal woman. Next Step in Management:
need to obtain a serum CA-125 ( pelvic U/S would have been the first intervention in a pre-menopausal woman)
temporal lesions on MRI in a male with seizure. He also has a fever and altered mental status. Next Step in Management:
empirical treatment with IV acyclovir. If IV acyclovir fails , then lumbar puncture is warranted (temporal lesions = viral)
male in his 20s diagnosed with HOCM, refractory to beta blockers and calcium channel blockers. Next Step in Management:
myomectomy
vomiting in a young child with olive-shaped mass in the epigastric region. Next Step in Management:
correct the metabolic alkalosis first, then consult for surgery for pyloromyomectomy
THIS SET IS OFTEN IN FOLDERS WITH...