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1 USMLE Step 3 Main one > !!!! CCS !!!! > Flashcards

!!!! CCS !!!! Flashcards

1
Q

UTI

A 
Urine HCG female
UA
Urine culture
Tx: bactrim/nitrofurantoin
*make sure you follow up uc 1-2 weeks after therapy
*confirm pregnacy before urine culture.
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2
Q

Pregnancy

A

Pregnancy Test
Pelvic Ultrasound for dating
1st-trimester labs:

A, BB, CC, HH, P, RR, UU

Atypical antibody
BMP, Blood Type/Rh
Chlamydia/ Gonorrhea, CBC
HBV, HIV
Pap-Smear
RPR, Rubella
U/A, UC

*at risk gonorrhea, TB, red cell indices, hemoglobin electrophoresis for sickle cell or thalassemia, hexosaminidase a, cystic fibrosis, serum phenylalanine level, toxoplasmosis screen, and hepatitis C antibodies

Treatment: Is For Pregnant Patients

  • Iron
  • Folate
  • Prenatal Vitamins
  • Prenatal Counseling.

Follow up
Glucose screening: 50g 1 hr glucose tolerance test between 24-28 weeks’ gestation. Results >135 are abnormal if the patient is greater than 25, FH obesity, DM, prior infant weight of 4000, recurrent spontaneous abortions.

GBS if 35-37 weeks

  • .
  • Recommendations for nutrition weight gain, regular exercise, rest, and sexual activity.
  • Routine pregnancy monitoring,
  • listeria precautions
  • toxoplasmosis precautions
  • Abstinence from alcohol, cigarettes, and illicit drugs
  • Recommendations for seat belts during pregnancy
  • childbirth classes and breastfeeding recommendations
  • confidentiality issues
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3
Q

Ulcerative Colitis

A

Diagnosis:
PT/PTT, cbc, lft, bmp
*Sigmoidoscopy, Rectal biopsy, ESR, stool O/P, stool leukocyte, stool culture,
Tx:
Mild - Topical 5-ASA (mesalamine, sulfasalazine, olsalazine) treat diarrhea/pain with loperamide, dicyclomine, *dietary consult

Mod - oral 5 ASA compounds( [sulfasalazine *give folic acid], mesalamine, olsalazine), consider steroids or immunomodulators like 6-MP/azathioprine when asa fails to induce remission.

Severe - 
Hospitalize, resusitate with IV fluids
NPO, TPN
Serial abdominal exams, vitals, abdominal xay
IV steroids (review which one)
Broad spectrum abx(
Consider Surgery in refactory cases
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4
Q

Ectopic Pregnancy

A

Dx: Beta-HCG, Transvaginal ultrasound,

*Surgical workup (PT/PTT, Type and cross, blood group, Rh status), GC/CT

Tx: Methotrexate

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5
Q

IBS

A

Dx: CBC/BMP, TSH, FOBT, ESR, Stool workup (O/P, leukocyte, culture)

Tx: Diet modification, Dicyclomine, loperamide, amitriptyline

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6
Q

Depression

A

Dx: CBC, BMP, TSH, B12

Tx: SSRI, Counseling

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7
Q

Vaginitis

A

Dx: Vaginal PH, Wet mount, gram stain, Pap smear, GC/CT, U/A

Tx: Yeast - fluconazole/clotrimazole,
BV - Metronidazole,
Trich - Metronidazole

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8
Q

Dementia

A

Dx: CBC/BMP, LFT, TSH, Vitamin B12, CT

Tx: Donepazil-Aricept, vitamin E, atypical antipsychotic for psychotic sx???, can add on memantine

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9
Q

COPD Exacerbation

A

Dx: Peak flow, CBC/BMP, CXR, ABG, EKG
Tx: Albuterol, ipratropium, PO steroids, consider antibiotics i.e. Doxy (outpatient) Levaquin (inpatient)

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10
Q

Breast Lump

A

Dx: Mammography, Ultrasound,

FNA automatically, counseling

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11
Q

Hypertensive Emergency

A

Dx: Look for evidence of end organ damage (CBC, BMP, ECG, head CT, UA)

Tx: Transfer to ICU, Art line for monitoring, Oxygen, pulse ox, nitroprusside (1), labetalol (2),

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12
Q

Foreign Body Aspiration

A

Dx: CXR, Neck X-ray, bronchoscopy

Tx: Oxygen, pulse ox, bronch

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13
Q

Panic Attack

A

Lots to rule out! Dx: ECG, Trop, CXR, CBC, BMP, Urine drug, glucose, TSH, UA

Tx: Oxygen, benzo

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14
Q

Immediate stabilization options

A

Oxygen, pulse ox, head elevation, Cardiac monitoring, BP monitoring, IV access

Shock panel tropinin, bnp, cxr, abg

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15
Q

TIA

A

Dx: CBC, BMP, Glucose, ECG, head CT, carotid Doppler, echo, lipid panel, A1C

Tx: IV access, aspirin, Carotid endarectomy, counseling

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16
Q

PID

A

Dx: Pelvic Exam, GC/CT swab, gram stain swab, pelvic ultrasound, blood cultures, UA, Urine culture, urine HCG, HIV, RPR

Tx: IV cefoxitin, IV doxycycline (24 hours), morphine*, saline, NPO, Tylenol

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17
Q

Hemophilia

A

Dx: CBC, INR/PTT, bleeding time, BMP, LFT. Then Factor VIII, IX, or XI *
Tx: Replace missing factor, trend levels*

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18
Q

Unstable Angina/MI

A

First: IV Access, pulse ox, oxygen, ECG, aspirin,/nitroglycerine, cardiac monitoring, BP monitoring

Dx: Cardiac enzymes, CBC, BMP, LFT, lipid profile, INR/PTT, Echo, Card consult, Catheterization

Tx: Add on heparin, metoprolol, G2b/3a inhibitor -eptfibatide, simvastatin

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19
Q

Croup (barking cough)

A

First: oxygen, pulse ox
Dx: CXR, neck X-ray, CBC, BMP
Tx: Dexamethasone, Racemic Epi

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20
Q

Asthma Exacerbation

A

First: Head Elevation, Oxygen, Pulse Ox, cardiac monitoring, ECG
Dx: ABG, CBC, BMP, Peak flow also called Peak Expiratory Flow Rate (PEFR) , CXR
Tx: Salmbuterol, ipatroprium, oral or IV steroid based on severity
Monitor: Peak flow

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21
Q

Constipation

A

Dx: CBC, BMP, Mag, Phos, TSH, FOBT,
Tx: Fiber, senna, docusate

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22
Q

Appendicitis

A

Dx: CBC, BMP, LFT, FOBT, Abdominal X-ray, abdominal ultrasound, UA, PT/INR, PTT
Tx: NPO, IV access, NS, Morphine, antiemetics, Cefoxitin!!!, surge consult, laparoscopy

23
Q

Joint Infection

A

CBC, BMP, Blood culture, INR/PTT
*Dx: Joint aspiration, joint X-ray, synovial culture/gram stain/cell count.
Tx: IV vanc and ceftriaxone. Joint arthroscopy if fluid can’t be removed.
Ortho consult. IV access, IV morphine, counseling

24
Q

Dysfunctional Uterine Bleeding

A

CBC, prolactin, TSH, Ferritin, GC/CT, INR/PTT, urine HCG, LFTs
Dx: GYN exam, Consider endometrial biopsy, pelvic ultrasound,
Tx: OCs, Iron sulfate

25
Q

Pericarditis

A

CBC, BMP, troponin,ESR, CK-MB, blood cultures, amylase/lipase,
Dx: ECG, CXR, echo,
Tx: NSAID + colchicine, consider steroid if refractory, consider pericardiocentesis

26
Q

Trauma

A

First: C-spine immobilization, oxygen, pulse ox, IV access, NS, BP/Cardiac monitoring

CBC, BMP, LFTs, ABG, type and screen, UA, INR/PTT, urine pregnancy test, amylase/lipase, urine drug screen

Dx: Full physical, , CXR, Abdominal CT/Ultrasound (depending on stability),, ECG, Spine x-ray,

Tx: Supportive unless requiring splenectomy, IV analgesia/anti-emetics, foley, surgical consult

27
Q

Cellulitis

A

CBC, BMP, Blood culture, wound culture
Dx: X-ray,
Tx: Outpatient: Clinda; Inpatient: IV access, NS, elevation, Vanc (MRSA) or Cefazolin-> Keflex, PO analgesic

28
Q

Gout

A

, CBC, BMP, ESR, INR/PTT, Uric acid
Dx: Joint aspiration, X-ray
Tx: Indomethacin, consider colchicine if can’t tolerate NSAIDS

29
Q

AIDS with PCP

A

Dx: CBC, BMP, Sputum culture, pulse ox, ABG, LDH, ELISA followed by western blot then CD4 and viral load,
CXR
Tx: Bactrim + steroids, oxygen, vaccinations, HAART i.e. Efavirenz/Tenofovir/Emtricitabine

30
Q

Renal Cell Carcinoma

A

Dx: CBC then iron studies (ferritin, transferrin, TIBC), INR/PTT BMP, LFTs, UA, cystoscopy, abdominal CT, chest CT, FOBT
Tx: Nephrectomy (pre-op care i.e. Cefazolin, type and cross, NPO)

31
Q

Duodenal Ulcer

A

First: IV Access, oxygen, Cardiac/BP monitoring, ECG

CBC, BMP, FOBT, amylase, lipase, UA
Dx: CXR or AXR,

Tx: Laparoscopy (NPO, PPI, NG tube, INR/PTT, Type and cross, NS), IV Zosyn

32
Q

Turner Syndrome

A

FSH, LH CBC, TSH, BMP, fasting glucose, lipid profile, UA
Dx: Full exam, Karyotype*,Psych consult for IQ, hearing test, skeletal survey, renal ultrasound, pelvic ultrasound, echo,
Tx: Calcium, vitamin D, OCs, growth hormone, diet, ophthalmology consult

33
Q

Essential HTN

A

Dx: CBC, BMP, LFTs, UA, lipid, ECG. Then have return in 1 month for repeat BP
Tx: start with lifestyle management. If no change in 3-5 month period start on medication management. ACE if standard. CCB if AA

34
Q

Diverticulitis

A

CBC, BMP, LFTs, UA, Blood culture
Dx: FOBT, Abdominal CT,
Tx: Zosyn -> augmentin. NS, NPO, morphine, anti-emetics. Colonoscopy 3 weeks post recovery.

35
Q

Child abuse

A

CBC, INR, PTT, bleeding time
Dx: Skeletal Survey, consider ophthalmologic exam, if bruising
Tx: CPS Consult, Psych consult, admit, DO NOT RETURN HOME

36
Q

Menopause

A

CBC
Dx: FSH, prolactin if worried,
Tx: Counseling, estrogen/progestin replacement??

37
Q

DVT

A

Dx: admit to ED if PE findings present, Dopplers, d-dimer, CBC, BMP
Tx: LMWH if Cr normal, Warfarin, will need CBC on day 3 to r/o HIT, INR daily until therapeutic, oxycodone

38
Q

PE

A

First: Oxygen, pulse ox, IV, ECG, cardiac monitor
CBC, D-dimer,INR/PTT, BMP, ABG, Cardiac enzymes
Dx: CT spiral, CXR,
Tx: LMWH, Warfarin, discontinue pro-clotting meds (OCs)

39
Q

Colon Cancer

A

Dx: CBC with appropriate workup,
UA, BMP, ESR, TSH, stage with CXR and abdominal CT, CEA**
FOBT, Colonoscopy (don’t forget mechanical bowel prep),
Tx: Hemicolectomy, pre-op orders antibiotics include cipro + metronidazole

40
Q

Bipolar

A

Dx: CBC, BMP, UA, Urine Drug Screen, TSH,
Tx: Atypical antipsychotic + lithium*****, suicide contract, psych consult, admit

41
Q

Bacterial Meningitis

A

Dx: CBC, BMP, Blood culture, Head CT, Vanc + ceftriaxone, LP, UA, CXR CSF gram stain, cell count, glucose, protein, culture, antigens

Tx: Vanc + ceftriaxone, consider gent if gram neg, Dexamethasone for likely s pneumo, NPO, IV, NS, antipyretics

42
Q

Cryptococcal Meningitis

A

Dx: CBC, BMP, Blood culture, UA, LP: CSF gram stain, cell count, glucose, protein, culture, antigens + cryptococcal antigen, India ink, fungal culture (Test for everything with AIDS)
Head CT, CXR
Tx: Amphotericin B, flucytosine

43
Q

HSV Meningitis

A

CBC, BMP, Blood Culture, INR/PTT, UA, Urine Culture
Dx: Head CT, LP with CSF PCR, CXR,
Tx: NPO, NS, IV acyclovir

44
Q

Giant Cell Arteritis

A

CBC, BMP, ESR,UA,blood culture
Dx: Temp artery biopsy, CXR, head CT,
Tx: Oral steroid, if vision loss - IV steroid. With steroids need: PPI, Vitamin D, calcium. Monitor ESR, CBC*

45
Q

Polymyalgia Rheumatica

A

Dx: CBC, BMP, ESR, , ANA, RF, CPK, TSH
CXR
Tx: Oral steroid, With steroid: PPI, Calcium, Vitamin D
Monitor: ESR, CRP, CBC, Focused Exam

46
Q

Ovarian Torsion

A

Dx: CBC, BMP,UA, Urine culture, Blood culture, urine HCG
Pelvic Ultrasound, CXR,
Tx: Laparoscopy, IV access, NS, anti-emetics, analgesia, with pre-op NPO, INR/PTT, Cefazolin

47
Q

Ovarian Carcinoma

A

Dx: CBC, BMP, TSH, LFTs, UA,CA-125 pre-op
CXR, Pelvic Ultrasound, Colonoscopy, Mammography, Abdominal CT for staging,
Tx: Laparotomy with preop orders (ECG, Type and cross, INR/PTT, NPO, IV access, NS)

48
Q

Preventative test for pregnant women?

A

A, BB, CC, HH, P, RR, UU

Atypical antibody
BMP, Blood Type/Rh
Chlamydia, CBC
HBV, HIV
Pap-Smear
RPR, Rubella
Urinalysis, U/A

Treatment: Is For Pregnant Patients

  • Iron
  • Folate
  • Prenatal Vitamins
  • Prenatal Counseling..
49
Q

Preventative test for pregnant women?

A

B-HCG

50
Q

mysthenia gravis

A
  • sign weakness
    full phx, CMP, PT/PTT, UA
    EKG, Telemetry
    TSH, AchR (don’t need to do tensilon test
    CXR, EMG, CT scan(espicially after you find something.
    Presurg lab: CMP, CBC, Type and screen, couags
    tx: pyridostigmine bromide, steroids, surg consult thymectomy,
51
Q

Steroids

A

Prednisolone/prednisone/azathioprine/methylprednisolone

52
Q

Pre surgical labs

A

CMP, CBC, Type and screen, couags

53
Q

UTI

A

uncomplicated uti in pregnancy

1 USMLE Step 3 Main one (37 decks)

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