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10 Cards in this Set
- Front
- Back
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30yo F with knee, wrist pain, morning stiffness
DDx? Dx? Optimal approach including tx? |
DDx: OA, infectious arthritis, RA, SLE, gout and psoriatic arthritis
Dx: RA Optimal management: PE (extremities, CV, lungs, abd, skin, HEENT and lymph nodes), RF or anti-CCF, CBC, arthrocentesis, ANA, ESR, CRP and joint XRs Rx: NSAID or steroid + DMARD (methotrexate or etanercept) |
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65yo F with L sided CP, HTN, tachycardia w/ bounding central and peripheral pulses, diastolic decrescendo murmur
Dx? Optimal approach? |
Dx: aortic dissection
Optimal approach: ECG 12 lead, portable CXR, stabilize with IV BB + another antihypertensive, IV morphine, continuous cardiac monitor, pulse ox. Once stable - CT chest w/contrast, echo or MRI. W/U: BMP, CBC, CPK, cardiac enzymes, d-dimer and type & crossmatch. Thoracotomy or dissection repair |
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4yo M w/ SOB for 3 days, coughing & wheezing esp after playing outside, h/o pollen allergy and atopic dermatitis
Dx? Optimal approach? |
Dx: asthma
Optimal approach: targeted PE (HEENT, lung, CV and abd), pulse ox, O2 therapy, bronchodilators (albuterol) and steroids (betamethasone) are essential. Include - counseling family on asthma care, med side effects, chest exam after treatment |
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65yo M w/ sharp R-side CP and respiratory distress. No breath sounds on R lung exam.
Dx? Optimal approach? |
Dx: pneumothorax
Optimal approach: focused PE, then needle thoracostomy followed by chest tube. CXR to confirm tube placement. Important to minimize W/U before needle decompression |
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31yo F w/ lethargy, N/V, h/o DM1. On exam, fever, tachypnea, tachycardia and hypotension. No insulin for 24hrs.
Dx? Optimal approach? |
Dx: DKA
Optimal approach: focused PE (lung, CV, abd & neuro/psych), serum random glucose, UA, CBC, IVF (NS or Ringer's), broad spectrum abx (cephalosporin or fluoroquinolone). Once serum glucose is obtained, IV insulin and cardiac monitor. Include ABG, blood cx and BMP. Continue monitoring glucose, electrolytes, pH after treatment |
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25 yo F at 38wks gestation to ED after seizure w/ LOC. Exam shows tachycardia, low-grade fever, and HTN.
Dx? Optimal approach? |
Dx: eclampsia
Optimal approach: focused PE (skin, HEENT, lung, CV, abd, genital, extremities, neuro), CBC, IV mag sulfate, IV antihypertensive (hydralazine or BB). Immediate delivery - vaginally (use oxytocin or misoprostol PRN) or C-section. Measure pt urine output. Include - BMP and PT/PTT. |
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Don't forget about pt comfort. How do you manage pt in pain, nauseous, constipated, with diarrhea or insomnia?
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Pain: IV morphine
Nausea: IV phenergan or ondansetron Constipation: PO docusate Diarrhea: PO loperamide Insomnia: PO temazepam |
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25F with urinary frequency and burning. LMP 24 days ago. No fever, N/V/D, or flank pain.
Optimal approach? |
Focused PE. bhCG (positive), UA (positive nitrite and leukocyte esterase), urine cx
Uncomplicated cystitis - TMP-SMX 3 days Complicated - TMP-SMX 7 days If pregnant, nitrofurantoin PO, prenatal vitamins |
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List prenatal labs
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Blood type, antibody screen, Rh type, CBC with diff, BMP, Pap smear, rubella status, syphilis screen (VDRL or RPR), UA and urine culture, hep B surface ag, HIV counseling and testing, chlamydia testing
Don't forget about counseling, prenatal vitamins, iron sulfate and folic acid |
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28M with bright red blood per rectum; also has colicky abd pain. Older brother has UC. Smoker.
Optimal approach? |
Dx: UC
Focused PE (gen, skin, HEENT, CV, lungs, abd, rectal, extremities). CBC, BMP, stool for O&P/WBC/culture, LFTs, PT/PTT, ESR, sigmoidoscopy and rectal biopsy, Rx: mesalamine, loperamide, dicyclomine (anti-cholinergic), dietary consult, counseling, smoking cessation |
