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GI OSCE

Terms in this set (39)

Cystitis
- Nitrofurantoin 100mg BID x3-5 days
- Fosfomycin 3g one dose

Kidney/Ureteral stones
- IVF
- Indomethacin 25mg TID PRN
- Morphine 2.5mg IV q2-6 hrs
- Zofran 4mg q8-12 hr

Pyelonephritis
- PO: Cipro 500mg BID x10-14 days
- IV: Rocephin 1g IV once daily

Perinephric abscess

Urge incontinence
- Kegels + bladder training (spacing out the time in between voids)
- Oxybutynin: 2.5mg BID
- Mirabegron 25mg daily

Stress incontinence
- Kegel exercises, vaginal devices, weight loss, caffeine reduction, smoking cessation
- Pseudoephedrine 15mg PO TID

Mixed incontinence

BPH "improve lower urinary tract symptoms, both voiding & storage"
- Not bothersome: reduce fluids at night, limit caffeine & ETOH, diuretics earlier in the day
- Bothersome: Tamsulosin 0.4mg daily, max- 0.8mg
- Prostate volume >30g on imaging: finasteride 5mg PO daily

Chlamydia "eradicate infection & f/u on sexual contacts"
- Doxy 100mg BID x7 days
- Pregnant: Azithro 1g PO single dose

Gonorrhea "reduce morbidity & mortality, interrupt transmission"
- Rocephin 500mg IM once

Trichomoniasis
- Flagyl 500mg PO BID x7 days

BV
- Flagyl 500mg PO BID x7 days

Candida
- Fluconazole 150mg PO once

PID
- Mild/Mod: Rocephin 500mg IM + Doxy 100mg PO BID x14 days + Flagyl 500mg PO BID x14 days
- Severe: Rocephin 1g IV daily + Doxy 100mg IV BID + Flagyl 500mg IV BID
PMS Reassess 24-48 hrs later

Endometriosis
- Ibuprofen 400mg QID PRN
- OCP or Progesterone IUD or Depo Provera

Prostatitis
- w/out sepsis: Cipro 500mg PO BID x2-4 weeks
- w/ sepsis: Zosyn IV TID

Epididymitis
- bed rest, scrotal elevation, ibuprofen 400mg
- Ceftriaxone 500mg IM + Doxy 100mg BID x 10 days
- Anal intercourse: Ceftriaxone 500mg IM + Levaquin 500mg daily x10 days
Gallbladder/CBD
- E. coli (GNR): Cholecystitis, Cholangitis
- Tx: Rocephin + Flagyl

Spleen

Stomach
- H. pylori: MCC of gastritis (Tx: CL-A-P or Treat My Belly Pain)

Liver
- HCV: chronic can lead to cirrhosis
- HBV: can cause cirrhosis
- HDV: can cause cirrhosis, dependent on HBV co-infection to proliferate
- HEV: incr. risk of fulminant hepatitis in pregnant patients (esp. 3rd trimester)

Small intestine
- Hookworm: iron def. & eosinophilia. Order O&P. Albendazole.

- Shiga-Toxin producing E.coli: undercooked beef (hemolytic anemia, thrombocytopenia, AKI)

- Norovirus: MCC of gastroenteritis world wide

- Salmonella (GNB): bacterial gastroenteritis. Tx: ORT, antibiotics reserved for invasive disease (sepsis), infants <3-mo or immunocompromised

- Shigella (GNR): bacterial gastroenteritis. Tx: ORT, antibiotics reserved for invasive disease (sepsis), infants <3-mo or immunocompromised.

- Yersinia enterocolitica (GNB): bacterial gastroenteritis. Tx: ORT, antibiotics reserved for invasive disease (sepsis), infants <3-mo or immunocompromised.

- Campylobacter (GNR): bacterial gastroenteritis. Tx: ORT, antibiotics reserved for invasive disease (sepsis), infants <3-mo or immunocompromised.

Large Intestine
- C. diff: toxic megacolon. PO Vancomycin

- CMV: toxic megacolon

- Entamoeba histolytica (protozoan): developing countries (diarrhea, bloody stools, abdominal pain, RUQ pain). O&P or stool antigen. Tx: Flagyl + intraluminal paromomycin

Appendix
- Bacteroides fragilis
- E. coli (GNR)

Anus
- Pinworm "helminth infection": nocturnal perianal pruritus, "tape test".
- Tx: Albendazole
KIDNEY
- E. coli (Gram neg. bacillus): Pyelonephritis (>80%)

- Proteus mirabilis (Gram neg. anaerobic rod): Pyelonephritis, urease-producing organism (struvite stones or larger staghorn calculi), urine pH >8

- Klebsiella pneumoniae (Gram neg. anaerobic rod): Pyelonephritis, urease-producing bacteria, urine pH >8

- Staphylococcus saprophyticus (Gram pos. coccus): Pyelonephritis

- Legionella & Streptococcus: Acute interstitial nephritis

- GAS: post-infectious acute glomerulonephritis

BLADDER
- E. coli (GNR): Macrobid, Bactrim, or Fosfomycin

- Staph saprophyticus (GPC in clusters)

VAGINA
- Group B Streptococcus: test at 35-37 weeks

- Gardnerella vaginalis: BV "clue cells" (Metronidazole)

- Trichomonas vaginalis: Trichomoniasis "strawberry cervix" (Metronidazole)

- Candida albicans: Candia vaginitis (Fluconazole)

- Chlamydia trachomatis (Doxy or Zpack)

- Neisseria gonorrhea (Ceftriaxone)

- Treponema pallidum: Syphilis- primary (chancre), secondary (diffuse rash). Check RPR at time of tx and 6-12 months later. Tx: PCN G or Doxy if allergic

- HSV: Genital herpes (Valacyclovir)

- Haemophilus ducreyi: Chancroid

- Klebsiella granulomatis: Donovanosis (Granuloma inguinale)

- HPV 16 & 18: cervical cancer

- Pox virus: Molluscum contagiosum. Cryotherapy, curettage, topical cantharidin, podophyllotoxin *test for other STI's when on groin, genitals, upper thighs*

- P. pubis "Parasitic infestation (crabs)": Pediculosis pubis. Skin-to-skin sexual contact. Topical permethrin cream

URETHRA

EPIDIDYMIS
- Chlamydia trachomatis (GNR): Epididymitis. Azithromycin 1g OR Doxycycline 100mg x10 days

- Neisseria gonorrhoeae (GN diplococci): Epididymitis. Ceftriaxone 500 IM

- E. coli (GN bacillus): Epididymitis. Ciprofloxacin or Levofloxacin or Bactrim
Terminal ileum
- Chron's dz (MC location)

Zenker's diverticulum
- Outpouching in the esophagus, food gets stuck causing halitosis
- Dx w/ barium esophagram

Pylorus hypertrophy
- Pyloric stenosis, initial dx test with US

Meckel's diverticulum
- A persistent portion of the embryonic vitelline duct, leading to formation of a true diverticulum of the small intestine
- MC congenital GI malformation

Anaphylaxis
- Presents with N/V, abdominal pain

Celiac disease
- AI disorder that causes malabsorption d/t villous atrophy, triggered by gluten-containing wheat products. CM: steatorrhea, low muscle mass, low subq fat, low iron (pallor, fatigue), low calcium & vitamin D (bone pain, fracture), low vitamin K (easy bruising), low vitamin A (hyperkeratosis)

Achalasia
- esophageal motility disorder, absence of esophageal peristalsis in the distal esophagus & incomplete relaxation of a hypertonic LES. All d/t immune-mediated destruction of inhibitory ganglion cells in the esophageal wall. Neurons in the myenteric plexus responsible for esophageal smooth muscle relaxation are destroyed, whereas excitatory cholinergic neurons responsible for smooth muscle relaxation are relatively spared. Chronic dysphagia to both liquids and solids. Botulinum toxin into the LES causes cholinergic blockade, leading to sphincter relaxation.

Hirschsprung disease
- aganglionic colon, results from failed neural crest cell migration during intestinal development, the affected colonic segment cannot relax. CM- fail to pass meconium (newborns first poop, sticky green), poor feeding, abdominal distention
Parathyroid hormone
- increase Ca reabsorption in the distal tubule

Metabolic alkalosis
- Involves total body chloride depletion are characterized by hypovolemia and demonstrate low urine chloride (<20mEq) b/c adequate Chloride delivery to the distal renal tubules is needed for HCO3 excretion
-- NG suctional, severe vomiting, loop or thiazide diuretic overuse
--- Saline responsive

- In the absence of chloride depletion include conditions of mineralocorticoid excess, such as primary hyperaldosteronism
-- Patients are typically hypervolemic and the metabolic alkalosis is primarily driven by aldosterone-mediated H+ loss from the kidney
--- High urine chloride (>20mEq) is present.
---- Not saline responsive

Renal tubular acidosis
- Causes of non-AG metabolic acidosis. Low pH with low HCO3

Continuous OCP
- provide constant E&P levels, which exert negative feedback on the hypothalamus and the anterior pituitary gland to decrease gonadotropins (FSH, LH) and prevent the mid-cycle LH surge, thereby suppressing ovulation.

Discontinuing OCP
- rising estrogen levels during the follicular phase results in increase in quantity of cervical mucus, which facilitates the transfer and maturation of sperm for fertilization

Anovulation
- common during the first few years of menarche, leading to irregular & heavy menstrual periods. The endometrium builds up under the influence of estrogen but lacks of influence of progesterone to slough off the endometrium.
-- Tx is w/ combo OCP and high-dose estrogen

Imperforate hymen
- on pelvic exam typically reveals a blue, bulging vaginal mass or membrane that swells with Valsalva. Common anatomic cause of primary amenorrhea, patients present with cyclic lower abdominal pain in the absence of apparent vaginal bleeding