Asters Notes III

USMLE step 3 CCS cases list

• Step 3 CCS cases part 1

• Step 3 CCS cases part 2

• Unorganized list of CCS cases

Other step 3 CCS resources

• Asters Notes I

• Asters Notes II

• Asters Notes III

Asters Notes for USMLE step 3

Aster's Notes 91 of 111

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Factor V Leyden: Lifelong Warfarin Prophylaxis

beta-blockers in stable CHF: decrease mortality

DVT with h/o UGIH: no prophylaxis (?IVC Filter)

Critical Aortic Stenosis: Mx – Valve Repair (Valvulopalsty only for high risk cases)

Esophageal Varices: BANDING

TIPS is for portal decompression before Transplant. Not used as a primary procedure

only for Eso. Varices

Chronic Malabsorption in Pancreatitis: Mx – non-enteric coated Pancreatic enzyme with

H2 blockers

Child < 2 years with symp. Inguinal Hernia:

Contralateral Exploration indicated

GERD:

Œnon-pharmacological measures

Œemperical pharmacological measures (H2 / PPI)

Œif fail, do Esophageal 24 hr. pH monitoring

probe kept 5 cm proximal to LES

pH<4 for >5 minutes or >9% of total time

Œfollowed by UGIE & Surgical Mx if needed

Irritable Bowel Syndrome is a Dx of exclusion

12 weeks of GI symp. In preceding 12 months

Gilbert's: jaundice may only be noticed in the times of stress / infection or fasting

(Unconj.)

Anal Fissure: Steroid Cream & Sitz Bath

Stress is a trigger of IBS, not cause

Biliary colic: RUQ pain following meals

Cholecystitis: RUQ Pain / Murphy's / Fever / Leuko.

Cholangitis: RUQ Pain / Fever / Jaundice

False (+) Guaiac stools: meats & vegetables containing peroxidases (Inorganic Iron.

Aster's Notes 92 of 111

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does NOT cause False (+))

F/H Duodenal Ulcers with Hypercalcemia:

MEN I

HNPCC: Mx – subtotal colectomy with TAHBSO

Child with Constipation: Mx prune / pear juice (sorbitol)

Rectum devoid of stool: Hirschsprung's

Rectum full of hard stool: Fecal Impaction

Graves': Cigarette smoking increases ophthalmic involvement (advise patients to quit

smoking)

Smoking Cessation:

1.success usually takes 5-6 attempts

2.associated with weight gain

3.counsel patients at each visit

4.pharmacotherapy should be offered to all

5.relapse rates decrease after 6m of abstinence

suspected Phaeo: first step is alpha-blockade with phenoxybenzamine (before Bx /

FNAC)

1. 1 side effect of radioactive Iodine: hypothyroidism

Glitazones – asociated with liver toxicity (LFT's)

Hypothyroidism with macrocytosis & hyperlipidemia:

1 st step is THYROID hormone replacement

(might correct macrocytic anemia & decrease lipid levels)

Infection in suppressed adrenal axis due to chronic use of exogenous steroids

(refractory hypotension) :

administer stress dose of i/v steroids

Cholesteatoma: CT scan of temporal bone (Mx: Sx)

CN III palsy with pupillary involvement: MRI

Child attending day care with viral conjunctivitis:.

Aster's Notes 93 of 111

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remove from daycare till symptoms subside

Fifth Disease: child is infectious before onset of rash

Mx of epistaxis: pressure, no need to tilt head upwards

Alk. Phosphatase is norally increased in pregnancy

Med. Mx of Ectopic: MTX

(b-hCG sample on Day 4 & 7, 15% decrease in level)

LGSIL = CIN I (most lesions resolve spontaneously)

Newborns can lose upto 10% of their weight in 1 st wk

Breast – Cystic Mass

clear : discard

bloody : send for cytology

Delayed age at 1 st preg: increased risk of Ca. Breast

Polycystic Ovaries: 1 st step: OCP's

Churg-Strauss: (+) pANCA

1. 1 extra-renal manifestation of adult PCKD:

Colonic Diverticular Disease

(not Intracranial Berry Aneurysms: seen in 15%)

Nephrotic Syndrome in adult with recurrent hematuria:

IgA nephropathy

HSP: self limiting. Do urinanalysis (r/o kidney involv.)

Cisplatin: nephrotoxic

Never prescribe prescription drugs over the phone, especially if the patient is “new”

(call for evaluation)

F/H (+) of HTN: ? Adult PCKD

Biopsy has no role for Diagnosis of RCC. If suspected, refer for Sx management (Bx

only if e/o metastasis present).

Aster's Notes 94 of 111

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Nephrotic Syndrome with HTN: start ACEI's

(no role of high-protein diet in nephrotic syndrome)

DEXA:

T-score: cf. Normal healthy young population

Z-score: cf. Age matched conrols

Osteoporosis is defined by the T-score

Rx (HRT + Bisphosphonates) indicated if:

ŒT < 2.5 or

ŒT < 1.5 with presence of risk factors

Smallpox Rx: Cidofovir

Smoking cessation: Mortality reduced to ½ in first year and smoking caeses to be a risk

factor 15 years after quitting

Infants: always rear facing on backseat

< 12y: always on rear seat

Fertility returns as early as 1-2 weeks after cessation of OCP use.

Tinea capitis: KOH prep (Ix)

not Wood's lamp, all species don't show fluorescence

Postherpectic neuralgia: Mx – TCA

(Acyclovir decreases PHN when given prophylactically)

Toxic megacolon in U/C:

Œhigh mortality rate

ŒIx: AXR

ŒMx: NPO/NG/Rectal Tube/Antibiotics

ŒSx if doesn't resolve in 2-5 days

Peptic Ulcer disease with Gout: acute Rx – colchicine

(NSAIDs can not be used)

Necrobiosis Lipoidal Diabeticorum: DM

plaques with depressed atrophy on anterolateral leg

Parkinson's patients hould be referred to neurologist

Anosmia: r/o neoplasm/#/sinusitis (CT/MRI).

Aster's Notes 95 of 111

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Endometriosis:

Œabdominal pain

Œdyspareunia

Œpainful defecation

Œdysuria

ŒGI upset with periods

ŒIx: Laparoscopy

Influenza vaccine is indicated in healthcare workers @ any age

alpha-1-AT def.: avoid smoking & alcohol

(to prevent emphysema & cirrhosis)

PUPPP:

Pruritic Urticarial Papules & Plaques of Pregnancy

Œno umbilical involvement

ŒMx: conservative

Impetigo herpetiformes:

rare form of pustular psoriasis

Œacute onset

Œfebrile

Œerythematous plaques surrounded by sterile pustules

Herpes Gestationis:

Œautoimmune

Œ2 nd or 3 rd trimester onset

Œinvolves umbilicus

Œrecurs in subsequent pregnancies

Routine rectal examination does not lead to elevation of PSA (levels can be done on the

same visit as DRE)

Uncomplicated varicella in preg., Conservative Mx

Hematuria without UTI: next step – contrast study

LiCO3 can excacerbate psoriasis

TT in past 5y: No Rx reqd..

Aster's Notes 96 of 111

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TT in past 5-10y:

prone wound: T toxoid

clean wound: No Rx

TT > 10y ago

prone wound: T toxoid

clean wound: No Rx

Post-PE: maintain INR between 2.0 & 3.0

If > 3.0 (no e/o ICH):

admit / give Vit. K (heparinize if INR falls to 2.0)

If e/o ICH: give FFP to replenish clotting factors

Thioridazine: prolongation of QT interval

PPD(+): obtain CXR to r/o active infection before starting INH prophylaxis

Chronic Steroid Use:

Œosteopenia

ŒAvascular Necrosis of Femoral Head (not due to osteopenia) avoid trauma, slow taper

of steroids

Relapsing Polychondritis

ŒEar (Painful external ear)

ŒNose

ŒLarngeal Inflammation (focal narrowing) with airway obstruction

Œcan be associated with aortic aneurysms

ŒMx: STEROIDS

Avascular Necrosis of Scaphoid: Sx Pinning

(X-Ray: sclerosis)

1. 1 cause of U/L vocal cord paralysis: Lung Ca.

Prostatic Mets.: respond to andrigen deprivation for the first 2-3 years and then

become resistant

>6m with exclusive b.f. : Iron Supple.

Breast Feeding (Hormonal Contra.): Progestin-only

minimal effect on milk quality & quantity.

Aster's Notes 97 of 111

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Uterus & Cx reach normal size:

6 wks post-partum (IUCD & Diaphragm can be used)

If one FBS > 126, send another sample (Dx of DM)

MMR immunization is assoc. with simple febrile reaction. Can be associated with

seizures too.

Gingko biloba used with warfarin:

severe bleeding tendency

Give MMR to children with egg allergy (contains cross-reacting egg protein but in

very small quantity)

Varicella vaccine @ 12 months

suspected Giardiasis: send stool for ova/parasite before starting treatment

Shell fish intake: associated with Hep. A

Rx of Clostridial infection: Penicillin & Clindamycin

Neonatal Sepsis: Ampicillin + Cefotaxime

Meningococcal disease with persistent hypotension: Give I/V hydrocortisone

(Waterhouse-Frederickson)

SBP prophylaxis: Levofloxacin

Acute post-infectious cerebellar ataxia:

Œataxia / nystagmus

Œpost varicella infection (1m later)

Œacute onset, resolves

ŒMx: conservative

Pulmonary Coccidiomycosis:

Pap smear of fresh expectorate is diagostic

Meningococcal prophylaxis:

Rifampin/Ceftriaxone/Ciprofloxacin

Immunosuppressed: increased risk of fungal sinusitis

(high mortality rate, intracranial compli., Ampho-B).

Aster's Notes 98 of 111

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After toilet, wipe front to back (decreases UTI inci.)

Candida Diaper Rash: Topical Nystatin

Primary Irritant Dermatitis: Zinc Oxide

Rx of viral pericarditis: NSAIDs

Rotavirus vaccine is no longer FDA approved (due to incidence of intussusception in

recipients)

Ant-HCV is (+) 18 weeks after infection

Newborn with (+) TB contact should be given

INH prophylaxis for 3 months irrespective of CXR/PPD status.

If at 3 months PPD(+), continue for 6 more months (else stop INH)

Pruritus ani: E.vermicularis (Mebendazole)

Mandatory seat belt laws decrease MVA mortality

Smoking cessation counseling should be provided to all patients regardless of age,

duration, previous attemps. (decreases cardiovascular mortality)

HSV transmission may not be prevented by condoms: skin-to-skin transmission occurs

too.

G(-) diplococci in Otitis: Moraxella

(usually Penicillin resistant, use penicillinase resistant antibiotics)

MMR is not contra-indicated in AIDS

Dog Bite infection

Rx with Amox-clav for puncture wounds or bites on hand (for non-infected wounds: local

care)

Home air humidifiers favor growth of house dust mite

Post GA Sx hoarseness of voice:

evaluate by ENT

Mx aspiration pneumonia:

Clindamycin (anaerobic cover).

Aster's Notes 99 of 111

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Breastfeeding mother with Trichomoniasis:

Give MNZ one dose stat, discard milk for 24 hours

Air Travel: decreased cabin pressure

Œdecreased pO2 can cause hypoxemia, CAD patients have increased risk of MI

Œdecreased pressure leads to expansion of gases. (problematic for patients with

volvulus, GI surgery, recent intestinal obstruction)

Female patients with CF may be infertile (plugging of fallopian tubes)

Inpatient Rx for community acquired pneumonia:

Malignancy, AIDS, cardiopulmonary/renal/liver disease

PSA is not present in ejaculate. Butejaculation can increase PSA levels transiently for

48 hours

Hemoptysis workup:

ŒChest X-Ray

ŒBronchoscopy

ŒHRCT

Chlamydial/Gono. Epidydimitis can be treated with a 10 day course of Ofloxacin

PSA > 4.0ng/mL: required prostatic biopsy

(esp. with F/H prostatic Ca.; 30% risk of Prostatic Ca. When PSA levels are >

4.0ng/mL). But no evidence that screening with PSA is beneficial

suspected esophageal perf.:

esophagoscopy with water soluble contrast

Anabolic Steroids:

Acne/Testicular Atrophy/Liver Dyfn./Depression

IV contrast is contra-indicated in renal dysfn.

Contrast nephropathy can be prevented by prior administration of N-acetylcysteine

Dx of Sarcoidosis: Skin / Transbronchial Bx

[Kveim is obsolete, Ca/ACE levels unreliable]

Postop Sensory loss: EMG (Ix)

Physiotherapy has role in motor weakness only

Occupational Vitiligo: affects persons who work in rubber clothes, rubber gloves or

handle phenolic or antioxidant chemicals.

Aster's Notes 100 of 111

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Seborrheic Keratosis: Stuck-on appearance

100's of Seborrheic keratoses (Leser-Trelat sign)

search for internal malignancy

BZD in OLD patients: Oxazepam (hepatic excretion)

BZD in Liver Disease: Lorazepam (renal excretion)

Severe pain in OA is indication for joint replacement

Hyperpigmented lesions with velvety appearance on nape & axillae: Acanthosis

nigricans

[associated with DM, obesity, Cushing's]

Nursemaid's elbow: Mx – supination of forearm with elbow flexed (No cast

necessary)

Acne

Blackheads: open comedones

Whiteheads: closed comedones

Supraclavicular node: BIOPSY

Axillary node in female: Mammography -> Bx

3-10% of patients with spina bifida are hypersensitive to latex (also to foods like

banana, chestnut, avocado, kiwi): SPINA BIFIDA – LATEX ALLERGY

Osler Weber Rendu: epistaxis, GI bleed

(lesions on lips/nose/tongue/palatepalm/sole)

(chronic blood loss anemia)

Chronic plaque psoriasis: Scale Bx

Mx of autoimmune vitiligo: Steroids+Phototherapy

Time released oxycodone: can be abused by drug-seekers (snorting or injecting

crushed pill)

prevention of recurrent erythema multiforme minor:

ACYCLOVIR

Bullae / Papules on Hand with Naproxen intake:.

Aster's Notes 101 of 111

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r/o Porphyria cutanea tarda / pseudo-porphyria

(order urine porphyrin & hepatic panel)

Kyphosis with thoracic vertebrae wedging:

Scheurmann's Kyphosis

Tracheal deviation with impinging neck mass:

consult thoracic surgery for securing airway

Agitation in Delirium: d/o/c low dose Haloperidol

When giving i/v high-dose Haloperidol, add Benzotropine to prevent Parkinson's

symptoms

Benzotropine is c.i. In Malignant Neurolept Syndrome

(anticholinergic, leads to worsening of hyperthermia)

If a child is to be given long-term salicylates, prior Influenza vaccination is

recommended

(to prevent Reye's syndrome)

Post-MI: chest pain (aggravated by supine posture, relieved by sitting and leaning

forward): Dressler's

(Pericarditis)

Emergent Pericardial Drainage: V5 EKG guided

Postpartum psychosis: increased risk of infanticide

Pt. with A.Fib.:

require anticoagulation before cardioversion

(if anticoag. c.i.: TEE to r/o mural thrombus)

AIDS: primary CNS lymphoma

CSF EBV PCR estimation is highll sensitive & specific

If patient with altered sensorium has no DPAHC:

do not use relatives for consent

Post-SAH deterioration: mediated by vasospasm

(prevent by NIMODIPINE).

Aster's Notes 102 of 111

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diffuse osteoporosis despite HRT / inc. infections

??? Myeloma

MVA with Quadriplegia with h/o recent Sx:

DVT prophylaxis required but anticoag. c.i.

(use IVC Filter)

Post-MI:

absolute bedrest required only for 12 hours.

Patients can begin graded activity after 12 hours.

Submaximal EST @ discharge

Maximal EST @ 2-4 weeks

Sexual activity after 2-4 weeks

1. 1 complication of vascular Sx: MI

No Verapamil / Diltiazem in WPW ass. SVT

(sync. Cardioversion)

tPA use in stroke: monitor neuro. Q1h

(high risk of intracranial h'age)

suspected Conn's in 2º HTN: 1 st step – CT abdo.

(not Renal Vein Renin Levels), CT yields more info.

Definitive Mx of Hepatorenal Synd.: Liver Transplant

Diverticulitis with Pneumaturia: Mx – Sx

(Colovesical Fistula)

<50y Diverticulitis: Sx after 1 st episode

> 50y Diverticulitis: Sx after 3 rd episode

UGIH: i/v Octreotide (Splanchnic vaso-constriction)

Malignant Otitis Externa: CT scan of temporal bone

(Mx: i/v antibiotics)

Rapid Rx of DKA: risk of cerebral edema

Radio. Dx of Pleural Effusion: X-Ray in decubitus view.

Aster's Notes 103 of 111

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Elderly with Bloody Diarrhea & patchy mucosal depigmentation (with other e/o

atherosclerosis):

Ischemic colitis (Mx - Bowel Rest & Hydration)

Dural Venous Sinus Thrombosis (headache/seizure):

Ix: CT Mx: Anticoag.

Infants of GBS (+) mothers who received <2 doses of ampicillin: Take CBC/Bl.Culture &

observe for 48hrs.

Nephrolithiasis with Hydronephrosis with Urosepsis:

1. 1 step is DECOMPRESSION

Percutaneous Nephrostomy Tube Insetion

(Antibiotics alone will not help)

Mx of Neonatal UTI:

i/v Ampi + Genta

Neonatal Adrenal H'ages (B/L):

sign of birth trauma (F/U with rpt. U/S in 1-2 weeks)

Urinary retention with Renal Dysfn.: Catheterize (Decompress tract)

Competent pregnant female may refuse diagnostic or surgical procedure that may be

therapeutic, even life-saving, for the fetus (Patient autonomy)

Previous abortion & OCP use are not risk factors for ectopic pregnancy

Breast engorgement: Continue breast feeding

(Use warm compresses) – antibiotics not needed

An intact pulse distal to injury DOES NOT R/O compartment syndrome

Ix – measure compartment pressure

Mx – fasciotomy

Lap Chole in Pregnancy: best results in 2 nd trimester

discoloration of synovial fluid indicates infection

Acute onset of renal dysfn. - look at BUN/C

next step: estimate electrolytes.

Aster's Notes 104 of 111

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Children, with delayed passage of meconium, born to mothers who recv'd MgSO4

prepartum:

MECONIUM PLUG SYNDROME

“bubbly” appearance on radiographs

(not synonymous with meconium ileus)

Ix & Mx: Water-soluble contrast

Biliary vomiting in infant: VOLVULUS until proved otherwise (Mx – Sx)

Muddy Brown Casts in urine: ATN

(Contrast nephropathy is a common cause, prevent by prior administration of N-acetylcysteine)

1. 1 Sensitive test for proper intubation:

End-tidal colume CO2 detection (colorimetric)

1 st step after insertion of ETT (>7y):

inflate cuff, auscultate (or check end-tidal CO2)

Any anatomical defect in airway, get thoracic surgery consult before securing airway

Ix for Latent TB: PPD

Ix for Active TB: Sputum AFB Stain

RA+Splenomegaly = Felty's

severe disease, might require immunosuppressive agents like cyclophosphamide /azathiprine for Rx

Patient on ventilator:

acidosis & hypercarbia: increase Tidal Volume

hypoxic respi.failure (ARDS, cardiogenic pulmonary edema): increase PEEP

Apiration penumonia:

Right Lower Lobe, foul smelling, anaerobic cover reqd.

Selective pulmonary vasodilator: NO (Nitric Oxide).

Aster's Notes 105 of 111

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Evaluation of TMJ: MRI

Heliox: mixture of Helium + Oxygen

(used for oxygen delivery in severe bronchoconstriction, it has better laminar flow)

Cystic Fibrosis with pneumonia:

Aggressive chest physiotherapy to clear secretions

Steroid acne: papules & pustules

Œsteroid induced

Œatypical site

ŒMx: Tretinoin (no need to stop steroids)

Œalso with: anabolic steroids, Iodide, Bromides, Li

If unable to intubate after repeated attempts:

Surgical Airway Access (No Resusci. without airway)

Increased survival with ARDS:

ventilator setting of TV < 6cc/kg bdy weight

Alkali ingestion:

ŒUGI study with water soluble contrast

Œif (-) can be repeated with Barium

ŒEarly endoscopy (endoscopy in acute ingestion might cause perforation)

post-AAA repair, loss of sensation but intact proprioception: Anterior Spinal Artery

occlusion

(posterior cord spared)

Catheter associated sepsis:

Remove catheter, start broad spectrum antibiotics

if still spiking fever (add fungal cover)

Post-heart transplant chest pain / dysnea / fever

? Mediastinitis (Mx: broad-spectrum antibiotics)

Post-thyroidectomy STRIDOR:

? Arterial bleed (call vascular surgeon, will open neck @ bedside – do ot attempt to

open neck yourself)

Post-thyroidectomy hoarseness of voice:

Recurrent Laryngeal Nerve injury.

Aster's Notes 106 of 111

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IJV line: associated with Carotid Bleed (if bleed occurs, and neck is tense, call vascular

surgeon)

Subclavian Line: associated with pneumothorax

Guide wire loss while inserting central line:

1. 1 complication – arrhythmia (call interventional cardiologist or radiologist for guide wire

removal)

post-GI Sx, ileus, LLQ mass, localized tenderness with some air under diaphragm

(Pelvic Abscess)

Œsome air under diaphragm post-op may be normal, does not necessarily indicate

perforated viscus

TURP syndrome: associated with hyonatremia

(aborption of irrigating fluid)

Alcohol withdrawl: Day 3

Fat Embolism: shortly after Long Bone #

DVT: risk increases with duration of immobilization

Nitroprusside : CN toxicity (Mx-Na thiocyanate)

Mx of MethHb: Methylene Blue

Rib #: shallow rapid respiration (due to chest pain): associated with higher incidence

of atelectasis

Patients receiving epidural narcotics should not receive I/V narcotics till epidural

narcotics have stopped

1. 1 cause of wound dehiscence: poor surgical closure

DPL may not reveal retroperitoneal processes

LGV: suppurative inuinal adenitis

(1º lesion: herpetiform vesicle or erosion on glans)

Chancroid: Painful punched out lesion

ŒSyphilitic chancre can appear after appearance of chancroid 'cuz the incubation period

of syphilis is longer than chancroid

ŒMx: Ceftriaxone / Azithromycin.

Aster's Notes 107 of 111

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Granuloma inguinale:

Œseprenginous ulceration of groin/genitalia/anus

Œgranulomatous tissue

Œbeefy red / bleeds easily

Acute suppurative parotitis:

ŒS aureus

Œhigh mortality rate

Œseen in post-op patients with poor oral hygiene

Œfever with preauricular swelling

Fastest way to achieve androgen deprivation (for prostatic mets.) is B/L orchiectomy

(castrate level testosterone in 3 hours) – Leuprolide can take 30 days to achieve

castrate level testosterone

INR > 3.0, dysnea, no fever/leuko, increased Dlco:

Dx is Pulmonary Hemorrhage

AIDS with PML: start HAART (improves survival)

Œno Rx for PML (caused by JC virus)

Post-LP: c/o postural headache

ŒPost-LP headache

ŒMx: remain horizontal

Broca's aphasia: broken speech, comprehension intact

Wernicke's: “word salad”

1 st episode of vasovagal syncope: reassure (get EKG)

recurrent vasovagal syncope: TILT TABLE TEST

Neuro. deficits in hypoglycemia: give I/V Dextrose

SAH: Early CT can be normal, if CT does not agree with clinical suspicion – do CSF

analysis

TIA: 1 st step – auscultate carotid

If bruit (+): do Duplex U/S

If Stenosis > 70% - CEA

TCA overdose: admit to ICU.

Aster's Notes 108 of 111

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(high risk of arrhythmia)

Bell's palsy: Mx ?Conserv. / Acyclovir & Prednisone

Li levels > 4.0mEq/L – urgent hemodialysis

Bifrontal headache, OK when supine, worse on getting up : Intracranial Hypotension (?

Dural tear – exertion)

Meningitis with Papilledema: No LP

Pt. with A.Fib

on warfarin with increased INR with stroke:

CT Head : if non-h'agic – tPA

CT Head : h'agic – administer FFP & Vit.K

Acute arterial occlusion:

start i/v heparin + prepare for Sx embolectomy

Pt. in ED with asystole: Transcutaneous pacing

severe CAD & brady alternating with tachy:

Sick Sinus Syndrome

Pt. with uncontrolled HTN with chest pain & unequal blood pressure in R & L arm:

Acute Aortic Dissection (Dx: CT)

Mx - 1 st step – lower systolic to < 100-120 mmHg

HbS disease with fever: ADMIT (high risk of sepsis)

CT can detect pericardial effusion, only ECHO can detect cardiac tamponade

Dx of IE: isolation of organism from 2 separate sites

FFP transfusion is also blood group matched

anemia, t'penia, fever, renal dysfn., neuro ab(n):

TTP (Mx: Plasmapheresis)

Sigmoid volvulus: forms an omega loop

can be reduced with sigmoidoscopy.

Aster's Notes 109 of 111

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Abdo exam: 1 st step is AUSCULTATION

eavluation of any acute abdomen: check hernial sites

DM with hearing loss / pain / granulation in external auditory canal: Malignant

Otitis Externa

(Pseudomonas) Mx – I/V Antibiotics

Frontal sinusitis: can lead to a subperiosteal abscess (Pott's puffy tumor)

Adult PCKD: cysts are found in kidneys, aso in liver

PID with severe pain / guarding / mass:

TOA ? Ruptured

Child < 1 m with fever > 100F

send Blood / Stool / CSF to r/o Sepsis

Epiglottitis: Intubate (in OR by Anesthetist)

Avoid NSAID use in renal insufficiency

Acute Gout with PUD / recent Bleed:

Colchicine

Acute Gout with Renal Failure

(NSAIDs and Colchicine are both unsafe)

Intra-articular steroids

HZ Ophthalmicus: ORAL Acyclovir

Rx human bites with antibiotics

Rx rat bites with Penicillin (rat bite fever)

Pain remover: absorbed by skin, metabolized to CO in liver, can lead to CO poisoning

100% O2 vs Hyperbaric Oxygen therapy

Indications for Hyperbaric O2 therapy in

Carbon Monoxide poisoning

ŒCarboxyHb > 40%

ŒCarboxyHb > 25% with neuro. symptoms.

Aster's Notes 110 of 111

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CarboxyHb > 15% in pregnancy (HbF has a high affinity for CO and fetal CO levels are

10-15% higher than maternal levels)

to detect small pneumothoarx: end-expiratory CXR

Radial Head #: heals faster with early mobilization

Clearing Cx Spine: X-Rays and Examination

Clearing involves response from patient. Therefore, a patient in altered sensorium with

suspected Cx spine injury can not have hi Cx spine cleared !!!

Antibiotics improve outcome in COPD flare

A Living Will with DNR orders needs to be verified by the hospital's legal / social work

dept.

Penile chordee: CONGENITAL, fibrosis of tunica albuginea – increased curvature of

penis

Peyronie's disease: ACQUIRED, fibrosis of tunica albuginea – increased curvature &

palpable plaques

evaluation of rotator cuff injuries:

MRI

Diabetic Foot Ulcer: X-Ray to detect air

Mx: Debridement

DVT/PE: start i/v heparin & warfarin. Stop heparin 2 days after attaining therapeutic

INR

Pemphigus: acantholysis, Nikolsky sign (+)

In patients @ high-risk for aspiration, apply cricoid pressure while intubating

Fall from height & landing on feet:

increased incidence of calcaneal & vertebral #'s

Mx of acute prostatitis: Fluoroquinolones / TMP-SMX

Œno prostatic massage / no catheterization.

Aster's Notes 111 of 111

End!

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