angel23
Forum Guru
Topics: 83
Posts: 1,731
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done with dermatology ques....scored 68 %
and ophthalmology ques....78%
now will head to ENT ques....
not writing any explanations....just marking them in qbank n will write them first thing in the morning tomorrow when i m sleepy
will start in 10mins
coffee break
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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did ENT ques...70 %
now will do some peds ques
i m not going according to plan  but still doing
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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did 1 block of peds of 29 ques....got 75 % ....i think today's day is good n my concentration is also good
another block of 29 ques in peds before i go back to home
n that will be all for today
will try to start early tomorrow
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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i think this is enough for today
will read some pages from psychiatry n will work on application on getting home
will see u all tomorrow with a new energy
take care all
n happy studying
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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wanted to start early but then i slept for 3 hours....
then some things did upset me....
but now anyhow i m back for study
will report later after study
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| npng
Forum Junior
Topics: 1
Posts: 57
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your scores are awesome, angel... you definitely ace it!
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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thanks npng...i think the day was good
dint study almost anything today....wasted my whole day
i dont know y but i kind of idiopathically upset in my mind....dnt know how to be normal
thinking of going to gym n doing some workout
i think i m growing fat thats y feel kind of low....used to be so thin 2 years back... still remember those days
i think i m too much preoccupied with weight than studies....
i will have to find a solution to eat healthy n eat less
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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back with energy
starting with GIT from MTB and ck
will complete in 2 hours
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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did not read GIT instead did one timed block of GIT ques which i did earlier about a week /10 days back
wanted to assess how much i know the stuff.....bcoz tht time did in tutor mode
n guess what i got 93 %
even its a surprise for me....
i think if we read theory nicely n make every weak subject your strength .....u can achieve ur goals
Praise the Lord!!
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| npng
Forum Junior
Topics: 1
Posts: 57
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good afternoon, angel... you will get 100% correct in the exam if you keep doing like this!
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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| simon73
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Topics: 7
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Great job angel23, You are doing good. Keep at it.
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| angel23
Forum Guru
Topics: 83
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good morning everyone
my today's goal is mainly to cover questions and explanations....
cardio ques
hemat ques
ENT, eye ques
dermat
GI and hepatology ques
all from UW
total of 297 ques out of 1372
do them and write explanations in book
starting first with cardio ques
will update my progress once i finish them
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| angel23
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Topics: 83
Posts: 1,731
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did not do cardio ques....
instead did GIT n hepatology ques
now doing some review of ccs...need to get hold of it too
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| angel23
Forum Guru
Topics: 83
Posts: 1,731
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1. femur neck#--ER
2. Advanced maternal age
3. Snake bite
4. HEPATIC ENCEPHALOPATHY
5. Post-op atelectasis.
6. Septic Abortion-
7. Incomplete abortion with heavy bleeding and acute PID.
8. Infected peripheral IV access
9. atrophic vaginitis
10. polycystic ovarian syndrome
11. gono
12. AGN
13. BPH
14. acute psychotic disorder
15. spontaneous abortion
16. malrotation
17. child with rash
18. obesity in adolescent
19. CTS
20. teenager comes for a pre-employment
21. JRA
22. kawasaki disease
23. Osteomyelitis
24. Hypoglycemia
25. Dilated cardiomyopathy
26. Down's Syndrome neonate
27. Preeclampsia
28. MM
29. Hypercalcemia-office
30. Hypercalcemia-ER
31. MS
32. HELLP
33. Endometrial Hyperplasia without Atypia
34. Gastric cancer
35. TURP-HYPONATREMIA
36. testicular pain-acute unilateral, child—ER
37. hypertensive crisis with SAH
38. Hypertension-secondary
39. fever unknown origin – adult
40. septic shock
41. Alcohol withdrawal
42. retained placenta
43. Chronic renal failure
44. Acute renal failure
45. RAPE
46. HUS
47. New onset DM-42 yr old c polydipsia & polyuria
48. Fever Unknown origin-child
49. Cx ca
50. Failure to Thrive
1-femur neck#--ER
Hx- 55 female post meno
Exter. Rot. & shorten Right LL
VS- stable
P/E
general
skin
heent look for hematoma
heart
lung
abd
cns
extr
Orders
IVA
oxy sat
Pulse oxy
cardiac monitor
bp monitor
EKG
nss
cbc
bmp
ua
pt
ptt
inr
fobt
blood type,crossmatch
Ca,phoph,pth,mg
x ray –chest,hip(ap/lat) ,knee
morphin-pain
consent form
orthopedic consult ; reason hip fracture
admit to wd
interval+rest ex
cefazolin IV on time
npo
bed rest ,bathroom
urine output
foley
ranitidine
cbc/d
bmp/d
h&H
ptt-4h
heparin sq
pneumatic
surgery done-
post-sx
morphi
ambulate early
calcium
vit d
if shows patient improves,
discharged and f.u after 2wks
Counseling
mobilization
exercise
alendronate
medicine comp
stop smoking
limit alcohol
seat belt
calcium rich diet
Dexa scan
colonoscopy
lipid
mammography
---------------------------------
2-Advanced maternal age
office:
PE--complete.
urine HCG (+ve)
CBC
BMP
UA
urine culture
LFTs
lipid profile
blood type & cross
type and Rh
pt/ptt
EKG
pap smare
USG trans vaginal
mammography
gonorrhea
chlymydia
RPR
Hep B antibody
HIV ELISA
toxo
rubella titer
Educate patient pregnancy
pregnant mother counseling
no smoking, safe sex, seat belt, safety plan
diet (high calory,High protein)
iron oral
folic acid oral
multi vitamins-prenatal
follow up after 1 month in 1st trimester
2nd visit
full physical
vital(BP check)
Weight
UA
Fetal heart monitoring
fundal height
do triple screen --serum HCG, AFP, estradiol [MS AFP], if high amniocentesis
Triple marker screen-TRIPLE TEST
Valproic acid level
send her home..
counsel about the vit and folic and RATED SEX
further diagnostic plan
continue Valproic acid
Genetic counseling
Genetic Sonogram
Amniocentesis
Karotyping of the fetal amniocytes....cells found in the amniotic fluid
---------------------------------
3-Snake bite
ER Location
25 y young guy – 30min after hx of snake bite.
Haven’t brought snake,
order-
vitals/hr
IV Access
NS
Pulse oxi
O2
Abg
Cont BP moniter
Cardiac moniter
cbc
bmp
ua
pt
ptt
Bleeding time
ECG
CXR
Blood type and cross match.
Foley
Urine output
NPO
PE-(complete)
shows local cellulitis, noticed 2 fang sites on his ankle Neuro xam shows drowsiness
order-
Polyvalent snake antivenom -SNAKE
Shift to ICU
interval hx+rest Ex
Bedrest
Vitalsq2h
Pulse Oximetry q2h
Neuro exam q2h
Monitor Bleeding time, PT, PTT, Platelet counts (Can develop DIC)
H&H-6h
Ranitidine
Inj TT
Ampicillin/Cloxacillin IV
ABG q8h
cbc/24
Bmp/24
If Neuroparalyis symptoms---- (Atropine + Neostigmine IV)
If devloping resp failure---- intubate and mech ventilation
D/C ASV when Bleeding time/PT/PTT parameters normal and neuro symptoms subside,
D/c IV antibiotics; make oral
When pt ok—to wd Later send home
counselling
-----------------
4-HEPATIC ENCEPHALOPATHY
pt presented with altered state of mind... had h/o of cirrhosis of liver already. was given oxycodone my dentist following which he devleloped symptoms..HEP C cirrhosis
LOOK FOR-alkalosisi,low k,SBP,HIGH PROT diet,…..
ER
routine (IV access, pulse oximetry, cont bp, cont cardiac moniter)
fingers stick glu
Thiamine inj
50% dxt
NGT suction (to look for variceal bleeding)
EKG
CXR
CBC, BMP, S.NH3
NPO
NSS
GPE( signs of cirrhosis, confused patient, asterixis)
LFT, PT, PTT, urine r/e, toxicology, blood alcohol level ,Mg
URINE culture
BLOOD culture
(pt marginally raised, lft deranged as for cirrhosis serum NH3 sky high)
admit ICU
urine output, bed rest, continue thiamine and dextrose normal saline drip,
propranolol to control portal HTN./ spironolactone
PARACENTESIS-SEND FLUID
LEVOFLOXACIN----IF PARACENT+VE{>250CELL) CHANGE TO CEFTRIAXONE
.Lactulose oral
[ampicillin po or neosporin po/ neomycin]
enemas to evacuate stool
Moniter PT/PTT/ cbc/bmp/ammo daily .
Pt improves –ADD diet salt restriction
.shift to wards in 24 hrs or when better
Case usually ends after 6 hrs of pt getting better.
rehab
5-Post-op atelectasis.
[after 36 hr of Surgery]...
DD's were:
Pneumothorax
PE
Pneumonia
CXR--it showed Atelactasis
It is one of the first cause of Fever, High WBC and shortness of breath...
So..
I did..blood culture
Removed the Foley Catheter and put a new one
UA culture
And Started..
IV Antibiotics
Acetaminophen Per Rectal
And Incentive Spirometry...
Patient become stable...I transferred him to Inpatient Unit..
----------------
6-Septic Abortion-
Do cultures
IV Antibiotics
Call OBGYN
When patient is accepeted by OBGYN for D&E
Just do medical Management in ICU
7-Incomplete abortion with heavy bleeding and acute PID.
Do cultures
IV Antibiotics
Call OBGYN
When patient is accepeted by OBGYN for D&E
Just do medical Management in ICU
--------------
8-Infected peripheral IV access
iva (if central line, dc cental line and new central line)
oxy
vitals q1h (qday when stable temp)
cardiac monitor (risk of septic shock)
fingerstick stat
b-hcg
cbc stat
bmp stat
focused pe
pt/ptt stat
ua/uc+s
blood cx
cxr
esr
crp
xray site
doppler arm
remove iv line
cath tip for c+s, gm stain, fungal cx
clinda + zosyn (if admitted >48 hrs)
tylenol
ekg
2 d echo
full pe
elevate arm
bed rest
iv nss
iv heparin if signs of cord-like thickening/bluish discoloration
(new iv access already done in beginning to give empiric abx)
when cx back:
iv naf for 2-3 days (until improvement)
dc zosyn and clinda
in this case do not worry abt dc'ing patient or po meds and patient has iv line for a reason.
5 min:
repeat cbc, chem in 3-4 days
counsel
screen
----------------
9-atrophic vaginitis
62 yo
vaginal itching
clear discharge
painful intercourse
vulvar erythema
mucus bleed during exam
dd
atrophic vag
bacterial vagi
candidial vagi
vulvar ca
cervicitis
tricho
office work up
cbc cmp lipid profile as a health maintainance exam-safer to do bu no credit
wet prep
trich
gono
chly
pap
may need emb colpo etc if finding in cervix or pap
if pap positive story goes further
otherwise
cou
vaginal gelly for lubrication
local hrt
estrogen cream
follow up as needed
-----------------
10-polycystic ovarian syndrome
21 yo f
beard
excessive hair
weight gain
menstrual irregularity
darkening axillry thickened skin
normal vitals
dd
polycystic ovarian syndrome
congenital late onset adrenal hyperplasia
adrenal tumour
drug effects like minoxidil phenytoin
ovarian neoplasm
cushing syndrome
idiopathic hirsutism
cbc lft
bmp
endocrine--dhea
lh fsh ratio
prolactin
tsh
dhea
testerone
blood glucose
insulin level
serum 17 hydroxyprogesterone
us pelvis
result - testerone increse
lh fsh ratio increase
insulin fasting glucose ratio increse
urine pregnancy test -do it anyway --
rx
ocp
exercise
metformin
spirolactone
smoking cesation
fu 6 month
----------------
11-gono-male
21 m
unprotected sex
urethral discharge fever
sickness
burning sensation during urination
o/e
urethral discharge
red urethra
suprapubic tender
d/d
-acute cystitis
epidymitis
forign body
nephrolithiasis
orchitis
prostitis
pyelonephritis
reiter's syndrome
urethritis
--gono
chlymydia
office w/u
ua culture urethral gram stain
urethral discharge for gono
chlymydia
vdrl
cbc
finding -- gram stain gram neg
culture awited
rx
azithromycin 1 gram stat
ceftrixone 250 mg stat
coun safe sex practice
smoking
alcohol
safe driving
drug
culture --
fu 4 week
pt coun
treat patner
-------------
12-AGN
10 m
tea urine
priorbit edema
had fever with hx of sore thrat 3 wk bak
bp 140/85
ankle edema
dx
-cryoglobunemia
iga nephropathy
membranoprliferative gn
post streo gn
er work
cbc chem 8
ua
no need of cs he does not have fever
24 hour urine protein
aso titer
complement -low
ua--proteinuria
wbc cast
rbc cast
rx
lasix
captropril
penicillin
office work up
us renal
throat culture
office rx
furosemide
captropril
nephrology consult -
fu 3 week
family couns
dietary consult
low sodium diet
fluid restriction
seat belt
----------
13-BPH
70m sono need of pregnancy test?
night urin
frequency urgency hesitency
terminal dribbling
double micturation
weak stream
sensation of incomplete evacuation
vita wnl
prostate normal but enlarged
office
cbc
bmp-urea creatinine normakl
ua
cs
us prostate
psa
esr
residual urinary volume
rx
finesteride
prazocin which is a selecting short acting alpha blocker
second visit
urology consult
urodynamic study
fu six month
for dre and psa
dietary consult
seat belt smoking
alcohol
patient counseling
-----------
14-acute psychotic disorder
dd
mania
bipolar 1
stress
malingering
panic
scizophrenia
drug
delirium
vital s -wnl
so pe
meds-
olazapine
valproic acid
we should give a antipsychotic and mood sabliser- lithium or valproic acid
order-cbc bmp no need of lft pt ptt order tsh uds no need of ua no need of ekg xray cardiac enzymes
do psychotherpy
psychiatry consult
coun med compliance
suicide contract
regular exercise
patient education
send home
appointment - one week
agin exam
if not allright -vdrl hiv sle
ect can be given
monitor cbc with antipsychotic
-------------
15-spontaneous abortion
27 yo f
lmp 6 week ago
lower abdominal crmp
vag bleed
cervix - open
blood in vault
vitals tachy bp wnl
dd
ectopic
abortion
polyp
cancer inflammation or cervicitis
normal menstration with dysmenorrhoea
er work up
cbc
pregnancy test
qualitative
then quantiatative
us
blood group rh
iv saline
no cervix tenderness - no pap gono cz now
hb -9 no bllod transfusion now pt is stable
us -- fetus dead - fetal pole uterine pregnancy
gyn consult for d and c
d and c
admit to ward
iv saline
pneumatic compression
methylprednisolone
doxy
cbc folow up
grief counselling
counsel pt rebirth control
follow up 3 week
-------
16-malrotation VOLVULUS
1 dy old m bilious vomi
poor feed
lethargy
rectal bleed
oe-
distension
170 pulse
89 sat
dd
duodenal atresia
intestinal atresia
malrotation with volvulus
meconium plug
necrotising enterocolitis
will do gi series to r/o duodenal
will do plain xray
will r/0 infections
transfer to er
iv aceess
iv normal saline
o2
abg
cbc
bmp
lft
abdominal xray
cxr
BLOOD C/S if fever
abg-metabolic acidosis- means something in the intestine
cbc leucocytosis-
axr-airless rectum
large gastric bubble- means some obstruction
rx as intestinal obst
rx--NPO
ng tube suction
iv bicarb if ph less than 7
pediatric surgery consult
ward -
upper gi sries -
barium enema
ng tube suction
upper gi -- bird beak
corkscrew proximal jejunum
barium enema cecum in RUQ
rx ng tube suction
iv normal saline bmp
fu 48 hours
family counselling
----------------------
17-child with rash
ruleout drug reactin??
rule out lyme if suspected
Office W/U
Complete PE
CBC, stat
BMP, stat
Pulse oximetry
ESR, routine
blood culture
UA, urine culture
CXR, stat
EKG, 12 lead, stat
Neck x ray, stat
culture of scraping from rash
No aspirin
send the patient home and F/U in 4 days
-------------
18-obesity in adolescent
Complete PE
Measure Height
Measure Weight
Calculate BMI -- you have to do this manually...not in the CCS software
cbc
BMP
LFT
Fasting Plasma Glucose
Fasting Lipid Profile
Serum TSH
UA
24 hour urinary cortisol
If the age of the PT is 2-7 years old and BMI with 95 percentile......or more without complication, the goal should generally be maintenance of baseline weight,
For children 2–7 years old with BMI at the 95th percentile or above and secondary complications, weight loss is indicated
For children older than 7 years with BMI between the 85th and 95th percentile, without complications, weight maintenance is an appropriate goal.
I guess this patient's BMI >95th percentile
so,
Weight Loss diet
Counsel Patient for Exercise Program
Counsel Patient
Counsel Family
Follow-up visit in 4 months
If no change...
Sibutramine or Orlistat, po
Follow up in 6 weeks
If morbid obesity, BMI more than 45
Consider Bariatric surgery
-------------
19-CTS
pe
xray
cbc
esr
crp
tsh
ra
ana
ca
magnesium
bmp
lipid
hcg
fu 3 days
night splint-SPLINT EXTREMITY
nerve conduction study
nsaid
usual counselling
another visit
carpal tunnel confirmed
another cou
3 month
not better
ortho consult for surg
20-teenager comes for a pre-employment
she is 5ft 2 inches and weighs 180 lbs. Bp 155/90
pt eats fast food..
it is all about weight loss....
bmp show no Potasium drop
abdominal exam ...no striae.... PE does not point towards high cortisol
for her BP
do urinanalysis
chest x ray
ekg
bmp
for her bmi
lipid profile fasting
FBS
TSH
cbc
follow up one week
bp in both arm
counselling life style -
low sodium low fat low cholesterol
weight mange
oreder calorie count and exercise
folow up three month
better
not better add hctz
it is not secondary hypertension bmp normal no cushing no coarctation
----------------
21-JRA
7 yr old girl with fever, rash and polyarthritis
PE: Complete
Order:
cbc ( stat )
bmp or may be just BUN and Creatinine (stat)
ESR
ANA
RF
UA
LFTs
Xrays of the joints involved
PT/PTT ( if planning to do arthrocenthesis )
athrocenthesis can be done as well....
CULTURE-URINE/BLOOD/THROAT
Tylenol
CXR
12 Lead EKG
Echo
d-dimers and fibrinogen ( i do not know the indication ..maybe coz it's a vasculitis)
will pretend the child does not have a high fever...so send him home. see in next 4-5 days with the lab results..
Results:
Cxr of joint without erosive changes...( so no methorexate)
ANA positive
such pts get eye involvement, thus eye exam q 3mths
RF positive
BUN nad CR wnl
ASPIRIN
MTX-SECOND LINE
Interval hx: improved
Order
Rheumatology consult
Eye consult
Physical therapy consult
EXERCISE
Med compliance
Multi-Vits
Calcium supplements/ diet rich in calcium
Educate family
MRI and Dexa--?
then do RATED SEX...mneumonic counsellin...whatever is applicable
22-kawasaki disease.....
< 5yrs of age
fever, rash, conjunctival injection, cervical lympphadenitis, inflammation of lips and the oral cavity, redness and swelling of the hands and feet.
coronary arteries aneurysm
unknown etiology.
PE ; complete
Orders:
pulse ox
oxygen
cbc
bmp
lfts
esr
ua
12 lead ekg
bld cxs
LP
Urine cx
CXR
IVA
results:
thrombocytosis
elevated ESR
sterile pyuria
EKG=ST seg depression and T-wave flattening
mild hypoalbuminemia
ORDER:
2-D echo
Coronary angiogram....maybe???
Aspirin ( untill pt is afebrile for several days)
IVIG
Consult Peads Cardiologist (like Dr. Fisher says on CCS always Consult; it wont harm U)
should continue 3-5mg/kg/day, d/c after 6-8 weeks if no signs of coronary involvement and practically indefinitely if there is a coronary problem.
Influenza vaccine before starting aspirin to prevent REYE'S Syndrome
MMR and Varicella to be delayed till 11 months
INTERVAL HX: PT HAS DEFERVESCED
I do not know what to do now....maybe...
ORDER:
d/c home on aspirin
f/u in 7 days
cbc on follow up may be in 30 days to look for platelets
esr follow up
repeat ECHO. 6-8 weeks out
counselling...
23-Osteomyelitis
PE; complete..except breast, genitalia and rectal
* Orders:
admit
iv acess
iv saline
blood cs
urine ua and cs
cbc
bmp
pt
ptt
ESR
C-reactive protiens
X-ray of the involved leg
~Results...x-ray wnl... ESR 90.....
*Order
MRI or Bone scan( if MRI is... C/I)..........MRI more specific!
Bone Biopsy
~Results ..... MRI= Mild destruction fo tibia... Bone Bx=GM shows neutrophils & Stph aureu grows on cxs!
* Admit to ward
diets
bedrest with bathrm privilages
cbc for day #2
Empiric coverage with Oxacillin & Cipro ...OR.... Ofloxacin & ceftriaxone....treatment for 6 -12 wks....IV...
Gram negative osteomyelitis treated with Cipro orallay.
* 5 minute screen
RATED SEX
age appropriate tests...
-----------------
24-Hypoglycemia
27 yrs old female nurse found unresponcsive, daiphoretic and tachycardic. Prior to this she wa sc/o headache and tremors. Pupils are wnl. PmHx is insignificant.
diffrential includes
Insulinoma
Exogenous Insulin
SU overdose
Prolonged fasting
O2
pulse ox
IVA
Vitals Q 1 HR
BP
Cards
ekg
CXR
Accuecheck
Beta Hcg urine
thiamine
dextrose 50
naltrexone- if pupil constricted
then iv infusion-5%dex
~PE : HEENT, LUNGS, HEART AND ABDOMEN
*Result BS 50 and pupils are wnl
~ORDERS:
cbc
bmp
cal
mag
phos
lfts
UA
abg
C-peptide
Insulin serum
Insulin antibodies
Bld alcohol level
Urine tox
SU urine screen
TSH
Cortisol level
Lipid panel
~PE: come back and finish the exam now.
* Interval histoyr...pt is a little awake
~Results: C-peptide rasied and SU urine tscreen +ve for glyburide!
~Order: Octreotide SC x 1 bolus
do ct/ABD to see insulinoma
gastroenterology surgeon consult for surgey
* Interval Hx and VItals: improving
~Orders:
Transfere to ICU
Octreotide sc q 8hrs
Accue check q 1hrs
NPO
Urine output
teds
bedrest
cbc in AM
bmp in AM
Psychiatyr consult
* Interval History/vitals check...
* improved.. d/c npo, bedrest and octreotide and dextrose.when BS in the range of 85-90
* Move to the ward....
~ "5 MINUTE SCREEN"
PAP
Rated SEX ..whatever is applicable
screening (mamo if age >40)
colono if age>50
counsel (I select as many counsellings for all patients as poss)
diet consult
suicide contract if OD
resched visit in another 4 wks
f/u in 2 weeks after the discharge...
=======================================================
If insulinoma is suspected..then CT abdomen or USG abdomen..
DEBULKING i.e surgery is the treatment then.....
anyone still feels the need to add something...lol...be my guest..
this is an exhausting one, for sure!
25-Dilated cardiomyopathy
55 yr old pt presents w bilateral LE edema, sob on exerction, no cough. h/o drinking 5 quarts of wine every day. PE bibasilar wet crackles and evidence of moderate ascites!!!
Casuses of dialted CM
alcohol
adriaamycin
radiation
viral myocarditis
amyloidosis
sarcoidosis
hemachromatosis
Thiamine deficiency
~ Order: put thme in as STAT
O2
Pulse OX
EKG
CXR
Cards
Vitals q 2
CBC
BMP
IVA
Fingerstick
PE ; COMPLETE
Cal
Mag
Phos
Lfts
Amylase
Lipase
UA
PT
PTT
lipid
tsh
e cho
B12
FOLIC
BLOOD ALCOH
HEAD ELEV
* Results : CXR=Enlarged heart w Kerley B llines + EKG= ST-T waves non-specific abnl
~ Admit to floor ~
~Order
IVA
Low Na diet
Bedrest w bath rm privilages
TEDS
Hepari SC
Lasix IV
KCL
MORPHI
Foley
Strict Input and Output
Daily weights
Cardiac Echo ...now!
CXR Q day
BMP q day
* interval hx...pt hope meds will help
~Result: echo shows dilated heart w EF 25%
~Order
iv carvedilol
iv spirono
iv lisino
iv digi
Anticoagulation...consider in longterm .... if evidence of thrombosis
strict daily wt, i/o (foley for strict uo)
daily mvi, thiamine and folate (commonly deficient)
bed rest
low salt diet
fluid restriction
statin if abn lipids
cards consult
D/C ALCOHOL
ACE receptor blockers for those who cannot tolerate ACEI
when stable:
dc all iv meds-->po—day3
f/u in 1 wk with another bmp and ekg
echo in 2-3 wks
screen
counsel
dietician consult
~ 5 Minute Screen
alcohol anonymous
alcohol abstienance
lipid
colonospcopy
Rated SEX
RPT ECHO-3MONTHS
CARD REHAB
Maybe you will have to manage the pt for 2-3 days in the simulated time...on the software...
but d/c home on ace, beta bxs, spironolactone, dig and lasix...with follow up in next 7-14 days... Of course change IV meds to PO befor discharge
-------------------------
26-Down's Syndrome neonate
new born downs most probably presents with vomitting ( duoenal atresia)
telemetry
Pulse oxy
IVA
iv one fourth normal saline
oxygen
BP monitoring
Cardiac MONITOR
NPO
NGT
IV metoclopramide stat
Brief physical
ABG
CBC
BMP
CXR
EKG
AXR acute series
USG abd
UA
urin culture
LFTs
amylase
lipase
USG confirms the Diagnosis
Consult Pediatrics GI surgery
Transfer to ICU
vitals Q 1 hr
NPO
Urin out put
karyotyping
BP check
electrolytes
Karyotype confirms Down's
ECHO
audiometry
TSH
Genetics consult
-------------------------------------
27-Preeclampsia
21 yr 0ld at 33wks gestation, c/o facial and upperextremity edema....
how will you proceed
pulse oxy
IVA
BP monitor
Cardiac Monitor
brief physical
CBC
BMP
LFTs
blood typr n cross match ( if not done already)
pt/ptt
UA
Obtretical USG
DEXAMETH
MGSO4-IM[deli/labo]
IF SEVERE PRE-ecl- Im-MgSO4 stat-cont
IV hydralazine stat-cont
ECL IV MgSO4 stat-cont
IV hydralazine stat-con
Urin creatinine ( it will be included in UA I guess)
Transfer to ward
interval hx-check-neuro
pulse oxy Q 2hrs
Vitals Q 2 hrs
urin output
bp check
complete bed rest
serum Mg Q 4 hrs-if give
Urin 24 hr uric acid
FHR monitoring
fetal doppler
OB consult
observe for 24 hrs
pt gets better
deliver the baby after –term-nvd with oxy
------------------------
28-MM
Multiple Myeloma** patient presenting with Hypercalcemia
CCS: hypecalcemia in a pt who is presenting acutely...... lets say a 45 year old male presents with abdominal pain, wife reports he has been acting a bit strange over the last few days.... how would you proceed.... Presented in emergency.!
Differential will be following:
90% Primary Hyperparathyroidism
Malignancy---
1-* Osteolytic Hypercalcemia due to Myeloma, Lymphoma, Breast carcinoma
2-*Humoral Hypercalcemia-PtHrP – Sq Cell Cacinoma of lungs, head & neck, renal or bladder.
3-*Tumoral Calcitriol production is Hodgkins & Non Hodgkin Lymphomas.
~ORDERS:
Iv Access
Pulse oximetry
Oxygen inhalation continuous
Vitals x 1hr
Focused PE : General, HEENT , Heart , Lung, Abdomen, Extremities
~ORDERS:
cbc- ----- Stat
bmp ------Stat
calcium--- Stat
Mag ---Stat
Phos ---Stat
Lfts ---Stat
UA ---Stat
EKG ---Stat
CXR ---Stat
Move the clock get the result
~*Results show Ca 13.5mg/dl
~*Results show Hb 8.7g/dl . Also BUN and Creatinine slightly Increased
~* EKG shows shortened QT Interval
~ORDER;
Iv 0.9% Saline Continuous
Salmon Calcitonin - SC q 6-12 hours
Or IV Pamidronate Continuos (over 2-6 hours0
PTH assay
24 hr urinary calcium
Sulfosalicylic Acid Test (to detect ~*Bence Jones Protein… coz Normal urine dipsticks will not detect light chain)
Seum Protein Electrophoresis
Urine Protein electrophoresis
Seum alkaline phosphatase (to rule our Hyperparathyroidism & Paget disease)
Serum Ferritin
TIBC
Serum Iron
Ultrasound of Abdomen (to rule out Renal carcinoma)
~*Do Interval and Check for volume overload by focused Heart & lungs
~ORDER;
If Volume overload then give
Iv Furosemide One time only
*******Patients feels better so move the patient to Ward
~ORDER;
Vitals q 2 hours
Iron Enriched Diet
Ambulate at will
Urine output
BMP daily
Sodium Docusate (stool softner)
Calcium Daily
Bone Xrays
Move the clock … get results
~* Results show Bone X ray *Lytic Lesions.
~* Results show SPEP and UPEP *Positive
~* Results show PTH .*Normalâ€
Order *Bone Marrow Biopsy
Consent for Procedure
Move the clock …Get the biopsy result ~* which shows “Plasma cells†in Bone Marrow
~*Call Oncology consult... Patient with Multiple Myeloma needs chemotherapy
~ORDER;
Chemotherapy ---Vincristine, Adriamycin, Dexamaethasone.
Hopefully case ends here
5 minute screen
do all the counselling
and age appropriate test.
Epogen** SC to fix his anemia----- erythropoietin
-------------------------
29-Hypercalcemia-off ice
30 yr old with hyper calcemia on routine tests with h/o renal stones some 2-3 yrs bcak. Serum calcium is 11.5 mg/dl.
PE complete except breast, recal and genitalia
~ORDERS:
cbc
bmp
calcium
Mag
Phos
Lfts
PT
PTT
UA
EKG
CXR
send the pt home..call him when all the lab result return!
Pt returns...do a small PE
Results show ca 11.5mmg/dl
ORDER;
PTH assay
24 hr urinary calcium
Dexa Scan
pt home, call with results of the tests
Results show..PTH 23 mEq/ml
Call general surgery consult...parathyroidectomy.....
as pt fulfills 2 criteria for undergo parathyroidectomy + age less than 50 and h/o Renal stones..
Hopefully case ends here
5 minute screen
do all the counselling
and age appropriate test.
-------------------------
30-Hypercalcemia-ER
a 45 year old male presents with abdominal pain, wife reports he has been ating a bit strange over the last few days....
iva
pulse oxi stat
vitals q1h
cardiac monitor
cxr
abdo usg
cbc stat
bmp stat
ca, mg, phos stat
ua stat
amylase stat
lipase
lfts
tsh
pt/ptt
morphine iv
full physical
npo
sr. pth
24 hr ur. ca
spep/upep
vit d level
abdo ct
normal saline iv
furosemide iv
calcitonin
if better:
tt ward
vitals q4h
bmp, ca, mg, phos q4h
consult surg if pth for parathoidectomy (blood type and cross match, npo, foley)
dc all iv's
alendronate
send home after 48 hr
f/u in 1 wk with cbc, bmp, ca, mg, phos, sr. pth
5 min screen:
colono
counsel
f/u in 4 wks with same labs
----------------------
31-MS
24 yr F pt comes to your office with blurring of vision in L eye and weakness of right leg. Past history of such weakness episode on R arm prior to 6 months.--ER
PE(complete)
fundoscopy shows blurring of disc margin, disc atrophy;
admit to ward
Pregnancy test
cbc
bmp
ua
tsh
vit b12
pt/ptt
mri brain and spine( shows demylinating lesions)
iv methyl prednisolone
consult neurology
consult opthal
LP( shows oligoclonal bands)
neuro check-2h
baclofen for spasticity
if pain gabapentin
bladder hyperactivity oxybutinin
fatigue amantadine or flouxetine
urinary retention bethanecol
Contracpetive
normal diet/urine output/ambulation at will
r/w after 12 hrs
interval history and PE
symptom free-- on day3
d/c IV methyl pred
Fasting blood sugar
cbc
bmp
calcium
vitaminD
Interferon or Glatimer acetate start
counsel patient
contraception
oral predni
vacc-influ
eye consult
follow up appointment; after 3 months MRI repeat
------------------------
32-HELLP
35 wks getation...bp 170/115, headache, scotoma, epigastic pain-ER
pulse ox
Oxygen
cardiac monitors
Bp continous
IV access
NS
NPO
MgSO4..IV
Latetalol..IV
DEXAmethasone.. IM
P/E
Admit to ICU...
BED
U OUT
PNEU
RANITIDINE-IV
CBC
BMP
Ca, Mg. Phos
LFTs----------------CONSULT OB
PT/PTT
Retic
FSPs
D-Dimers
UA
USS-PELV
Labor monitor
FETAL MONITOR
CULTURE-VAG,GONO,CHLAM
MONITOR—BP,PLT,UA-PROTEIN,PT.PTT,BMP
type and cross 2 units of PRBCs
FFP
Platelet
PENICILLIN G-IV
OXYTOCIN
NVD
5MIN
H&H
ORAL DIET
PT
PTT
OMEPRA
BF
PAP
LFT
----------------------------------
33-Endometrial Hyperplasia without Atypia
hx if imp for age, if she wants childbirth or contraception.
usually presents with abnormal heavy uterine bleed. (if very heavy: send to ER), lets assume here its moderate, no distress, pt now in office.
full PE
CBC
BMP
UA
LFTS
B-HCG
TSH
PT/PTT
BLEEDING TIME
PAP
ENDO BX
USG-PELVIS-ENDO THICKNESS
Call her again in 2 days:
if anemic, order FOBT, RETIC, PERI SMEAR, TIBC, SR. IRON, FERR
RESULTS ALL WNL. BX SHOWS HYPERPLASIA WITHOUT ATYPIA
CYCLIC-
MONOPHASIC OCP'S IF SHE DESIRES CONTRACEPTION
OR
MEDROXYPROGESTERONE ORAL FOR 14 DAYS IF NOT
FESO4
MVI
Call back in 14 days
IMPROVED BLEEDING: NO SYMPTOMS: CAN DC MEDROXY
IF PERSISTENT: CONTINUE MEDROXY FOR 6 MONTHS
Call in 1 month to check
5 min screen:
pap x1 yr
mammo
endo bx x6months
Colono
counsel
IF OLD PATIENT: SEVERE BLEEDING: HYSTERECTOMY
--------
34-Gastric cancer
Weight loss , Abdominal pain , Nausea, presntation was Gastric obstruction
Dysphagia, Melena, Early satiety ,Ulcer-type pain
NPO
NG Tube
IV Fluid
Vitals
Iva
Pulse oxy
ABG
CARDIAC MONITOR
CBC
BMP
UA
CXR
EKG
XRAY-ABD-series
P/E
FOBT
LFT
LIP ID
FBS
PT
PTT
ALBUMIN
CA,MG,PHOS
AMYLASE
LIPASE
PHENERGAN
MORPHINE
WD
OUTPUT
Barium upper GI studies
CONSENT
CONSULT-GASTRO
ENDOSCOPY
BIOPSY-NO OPTIONIN SOFTWARE
COLONOSCOPY
ENDOSCOPY,BX
ADENO CA
ANEMIA-IRON STUDIES,VITB12
FESO4, VITA C
CT-CHEST
CT-ABD
PT
PTT
TYPE
NEXT ORDER
CONSENT
CONSULT –GASTRO-SX
CONSULT-RADIO
CONSULT-ONCO
CONSULT-DIETICIAN
ADVANCE DIRECT
--------------------------------------------
35-TURP-HYPONATRE MIA
Manifestations of the TURP Syndrome:
• - acute hypo-osmolality
• - acute hyponatremia
• - congestive heart failure
• - pulmonary edema
• - hypertension
• - hypotension
• - solutee toxicity:
hyperglycinaemia (glycine)
hyperammonaemia (glycine
if detected intra-operatively bleeding points should be coagulated, surgery
terminated as soon as possible and iv.fluid should be stopped
OXY
VITALS
CARDIO
BP MONIT
OXY
FOLEY
CULTURE-BLOOD/URINE
CBC
BMP
UA
EKG
CXR
DC-NSS
DC-SX
FUROSEMIDE-IV-AFTER LOW Na
ICU
BED
NPO
OUT
PT
PTT
CBC
HandH
TYPE
ABG
PULSE OXY
IF SEIZURE/confusion-
DIAZEPAM
3% NACL
-----------------------------
36-testicular pain-acute unilateral, child--ER
testicular torsion, - the most dramatic and potentially serious of the acute processes
torsion of the appendix testis,-MC
epididymitis.
abrupt onset of severe testicular or scrotal pain.N,V
awaken with scrotal pain in the middle of the night or in the morning
VITALS-FEVER NO
IVA
OXY
CARDIO
BP MONITOR
CBC
BMP
UA/culture
PHENERGAN
MORPHIN
P/E-
GENTAL,ABD†”HORIZONT LEVEL
CREMESTERIC REFLEX-NEG
NPO
TRANSILLUMINATION
USS-SCROTUM--------TEST:TORSION
CX R
amylase
lipase
LFTs
PT
PTT
TYPE
CONSULT-PED SX
Cefazolin
B/L ORCHEOPEXY
Orchiectomy is performed if the testicle is nonviable
IF FEVER+POSITIVE CREMESTER WITH NEG USS---ACUTE EPIDIDYMITIS
frequency, dysuria, urethral discharge –UTI
CULTURE
CHILD WTH UTI-CEPHALEXIN,BACTRIM
GONO- CEFTR+DOXY
scrotal support, rest
----------------------------------------------
37-hype rtensive crisis with SAH
Ischemic stroke or subarachnoid or intracerebral hemorrhage -- Intravenous labetalol Other first-line agents include transdermal nitroglycerin paste and intravenous nicardipine
nitroprusside should be considered second-line therapy
Sublingual nifedipine should be avoided
o Antihypertensive agents previously were advocated for an SBP greater than 160 mm Hg or diastolic BP (DBP) greater than 90 mm Hg.
o Keep systolic blood pressure 90-140 mm Hg before aneurysm treatment, then allow hypertension to keep systolic blood pressure less than 200 mm Hg
Acute pulmonary edema -- Nitroprusside or nitroglycerin with a loop diuretic
Drugs that increase cardiac work (hydralazine) or decrease cardiac contractility (labetalol or other beta blocker) should be avoided
Angina pectoris or acute myocardial infarction - nitroprusside and nitroglycerin
Aortic dissection - beta blocker such as propranolol or labetalol. +/- Nitroprusside
Noncontrast brain CT or brain MRI
Electrocardiogram
Complete blood count including platelets
Cardiac enzymes and troponin
Electrolytes, urea nitrogen, creatinine
Serum glucose
Prothrombin time and international normalized ratio (INR)
Partial thromboplastin time
Oxygen saturation
Lipid profile
Lumbar puncture if subarachnoid hemorrhage is suspected and head CT scan is negative for blood Electroencephalogram if seizures are suspected
------------------------------------
38-Hypertension-secondary
youn g man no risk factor
cbc
bmp
lft
pt
ptt inr
lipid
tsh
ua
uds
cxr
ekg
FBS
home
if sodium high potassium lo normal anion gap
give KCL
office
go for aldesterone/rennin activity ratio
if high-24 aldosterone level
spiranolactone
abd/ct
monitor BMp
home
ct-adrenal mass
ward
consent
consult
pt
ptt
type
npo
laparoscopic adrenalectomy
--------------------------------
if cxr show cardimeg
rib notching-MRA
go for coarctation
if ua proteinuria
do ultrasound kidney
mara kidney
do nephro consult
do surgey consult
measure bp in both arm
start meds
beata-2
hctz-1
acei
ccb
smoking
obesity
alcohol
drug hx
coumsel
call back
--------------------------
39-fever unknown origin - adult
h pe
cbc
bmp
lft
pt ptt inr
cxr
ekg
ua
uds if prtinent
blood culture
urine cs
sputum
lp if meningitis suspected or alter mental
ct if necessary
gyn consult -- if gyn cause
surgery if abscess
if lft increse
hepatitis panel
if central lines line culture
if janeway osler roth spot
or bacterial endo--echo
if throat pain lad
mono
atypical lypho in blood
rapid strep test
if viral syndrome
vdrl hiv
if leg pain or sob or pe suspected
vq scan
later -doppler
or low -d dimer
if no improve -
joint lymph node ry eye dry mouth
connective tissue panel
treatwith
abx
iv saline
npo if sepsis suspected
surgical consult and ct if abscess
see the bllod cs report change the abx
no response you may have to add amphotericin
if herpes thing - add acyclovir
-----------------------------------------
40-septic shock
fever
shock
tachy
low bp
left lowe quadrant pain
iv normal saline
iv access
oxygen
pulse oxy
later abg
focus pe
cbc
lft
pt ptt
ua uds
urine culture
blood culture times two
ct abdomen and pelvis with contreast
lactic acid
cxr
echo if bacterial endocarditis suspected--later in floor if he does not improve
can do cardiac enzyme to rule out cardio shock
amylase lipase
xray abdomen - do or dont do because yo do ct anyway
start abx
cefotaxime
genta
intake out put
foley
urine out put 1 hourly
pt get bette -continue
ct reort comes
surgical consult for drainage of abscess
better
dc with cipro
-------------------------------
41-Alcohol withdrawal
tachy,sweating,tremor,agitated
iva
o2
pULSE OX
cARDS MONITORS
bP
Accue check
PE... real quick
HEENT
RESP
CARDS
Labs... STAT..
npo
nss
cbc
bmp
lfts
Blood alcohol level
Urine toxicology
ABG
amylase
lipase
PT
PTT
Thiamine IV
Folic acid Iv
Calcium serum
Mag srum
Phos serum
now come back and Complete the PE...what ever is lfet
librium
transfere to ICU
seizure precaution
aspiration precaution
5 minute screen
counselling
RATED SEX...
alcohol anonymous..
-----------------------------------
42-retained placenta
(ER,3post op D, w fever and abd tenderness)
Pulse Oxymetry
IV Access
IV NSS
Complete PE
CBC with Diff
PT/PTT
Blood Grouping and Cross Match
LFTs
UA and CS
Blood Cultures
Cervical Cultures and gram staining
IV Ceftriaxzone
IV Clindamycin
Consult OBG, for retained placental removal
send the pt to medical ward:
Bed rest
NPO
Vitals Q4H
----------------------------------
43-Chronic renal failure
in office
take complete physical exam
order
vitals
cbc
bmp
ua
cxt
abd ultra sound
abg
ekg
serum lipids
serum albumin
serum calcium
phosphate
vitamin D
pth
lft
if pt in emergency
then we do iva and also see the urnie output
check phosphate lever
and also pt ptt
and do blood typing
as tehre might be anaemia
so we mite need transfusion
or even dialysis if acidosis
calcium
tratment is diet
----------------------------------
44-Acute renal failure
80 yr old man comes to ER with n/v and maliase. PMhx is significant for Htn, DM and osteoarthritis. Pt is on NSAIDS, lisinopril. Also reports making very little urine over the last 24 hrs.
PE : General, heent, LUNGS, ABDOMEN
~ Orders:
iva
nss
pulse ox
vitals Q 2 hrs
cards
ABG
Accue check
ekg and cxr
CBC
BMP
Cal
Mag
Phos
UA
Urine cxs
LFTs
tylenol
~PE: come back and complete the rest of the exam now...
*!* Results..(.pH 7.29, PCO2 20, PO2 80). (BMP NA 138 & HCO3 12)
~Transfere to ward
~Order
low potassium diet/diabetic diet
bed rest with bathroom privilages
d/c NSAIDS
d/c Lisinopril
FOLEY
Strict input/putput
Teds
Urine NA ( NL IS LESS THAN & EQUAL TO 10) and Creatnine
24 hr Urine protien
eosinnophils in urine...(seen in allergic nephritis)
Renal USG ( if BPH...call urology consult)
Hgb A1c
DAILY WEIGHTS
Accue check q 4 hrs
Insulin sliding scale ( if need be )
BMP q 2-4 hrs
hopefully pt starts to improve after d/c nsaids and NSS infusion...
pre-renal RF treated with fluids...if no rsponse...IV lasix....
Dobutamine and dopamine (if heart failure)
~famous 5 minute screen
RATED SEX...what ever is applicable.
---------------------------------------------
45-rape
complete physical
orders:
maybe one ste of vitals..
RAPE KIT...
cbc..for baseline
UA
pregnancy test..beta HCG urine
cervical smear
KOH prep
Hanging drop
cervical gram stain and culturegonorrhoe DNA probe testing
Chlamydia DNA probe testing
morning after pill..i think it is LEVONORGESTREL-oral(high dose estrogen) for 2days
Now STD prophylaxis:
Ceftriiaxone 125 mg IM
Azithromax 1gm PO
Probenecid
Metonidazole 2gm po for trichomonas
add vdrl
rape crisis consult
cervical sample for chlamy and gonorr
elisa for HIV
Hep B surface antigen
Social services consult
Psych Consult?
----------------
46- HUS
ER
Focused PE
IVA
NSS
Oxygen
pulse oxymetry
Monitor Blood Pressure
NPO
CBC
BMP
UA, Culture
AXR acute series
Stool leuco, cultu, ova & para
peripheral smear
ldh
haptoglonin
in/output
pt/inr
pt/ptt
blood type cross match
D-DIMER
FIBRIN DEGRADATION PRODUCTS-fdp
results come as low platelet
fragmented RBC
no FDP
no D dimers
PT/PTT are normal
K+ is elevated
treatment with keyexalate
Once stable transfer to ICU
monitor BP
cbc
check BMP again every 1 hr till K+ normalizes followed by every 4hrs
pt/ptt
supporitve for now.
consult hema pediac
counsel pat/fam
If case doesn't improve plasmapheresis
***check for ldh inc. schisto in peripheral, retic increa
BUN & crea are in BMP
----------------
47-New onset DM-42 yr old c polydipsia & polyuria
DD- DM, DI, Factitious Disorder
since it is a clinic setting...no emergency..
Pe: complete
ORDERS:
cbc
bmp
ca, mg, phos
UA
12ekg
ABG
lipid profile
cxr
HgbAIC
lft
Finger stick BS 325mg/dL.—DIAGNOSTIC DM
Admit to inpx service
monofilament skin test,
serum/urine ketones,
serum/urine osmolarity,
urine microalbumin.
UA-CULTURE
-ivf nss,
-sliding scale:bld glucose 100-200-do nothing
bld glucose 200-300-5u insulin
bld glucose 300-400-10u insulin
blood glucose (accucheck or finger stick) q2h,
BMP-2h
-vitals q4h,
Activity prn,
foley's catheter for intake
output,1800 ADA (55-60% cho,less tham 30% fat,15-20% protein,vitamins,minerals,H20),
lisinopril and other anti HTN (if HTN)
-podiatry or chiropody consult
-endocrinilogy consult
-ophthalmology consult
-If insulin 100-200,dc insulin and institute glipizide,
dc ivf
-counsel:weight loss,diet,exercise,
annual ophthalmologic exam,
foot care and protection,medication compliance,
depression couseling,
family counseling,medication side effect counseling,annual health maintenance and flu vaccine couseling.
-follow-ups.
--------------------
48-Fever Unknown origin-child
INFANT-bac,HSV
Child-infect,connective
Cbc
Ua
Bmp
Cu lture-blood,urine,throat
Lft
Ana
Rf
Esr
Cxr
Lp-irritable
Ppd
Hiv
Syph
Ct-abd
Wbc scan-gallium/indium
NO-emp..ABx
--------------------------------------- -----------
49-Cervical cancer
physical exam
cbc
bmp
ua
urine beta hcg
gonorhea probe
chlamydia probe
wet mount
vaginal ph
HIV ELISA
VDRL
pap
move the clock forward
if has come with chlamydial infection/ginorrhea treat that
call in 3 days (pap result comes in 3 days)
Colposcopy
Endocervical curretage(its there in the software but asks for Gynecolgy consult)
Gynecology consult(No Endocervical biopsy on the software so can ask for that also on the Gynec consult)
Move the clock forward
Call her in a week
colpo-cx ca
Interval history
Admit to ward
Bed rest with bathroom previleges
cxr
lft
pelvic ex
IVP
CSYTOSCOPY
SIGMOIDOSCOPY
abdominal ct
pelvic ct
bone scan
RADIO-CONS
oncology consult
ekg 12 leads
blood type cross match
pt
ptt
Serum Iron with TIBC
reticulocyte count
interval history
TAH+BSO(If family done)
Gynecology consult
RADIATION/CHEMO-CISPLATIN
patient education
no smoking
no alcohol
supportive psychotherapy
Iron enriched diet
___________________
I WILL DO IT,,,,,,,,God please help me...
|
| angel23
Forum Guru
Topics: 83
Posts: 1,731
|
50-Failure to Thrive
2yr - below 5th percent
If severe malnutrition/abuse---Hospitalization
dd-
low intake
abuse
chd
infection
endo
genetical
Hx+EX
Head,neck,weight
Cbc
Bmp
Ua
Cxr
Fobt
Lft
Culture-stool/urine
Folic
Vit b12
Stool-ova/fat/
--
HIV
PPD
TSH
Sweat test
Galactose-----
---
Caloric count
Nutrient supp
Cons-dietician
Social service
F/u-q week
___________________
I WILL DO IT,,,,,,,,God please help me...
|
| arundhutik
Forum Senior
Topics: 2
Posts: 176
|
u are amazing and inspirational angel.......
|
| angel23
Forum Guru
Topics: 83
Posts: 1,731
|
thanks arundhutik for ur compliments....
but i study 1 day nicely then waste 2 days....
i should not do this
___________________
I WILL DO IT,,,,,,,,God please help me...
|
| angel23
Forum Guru
Topics: 83
Posts: 1,731
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good morning everyone
hope everyone is studying good
hopefully i can do something productive today
i am aiming at completing 131 ques of gyne obs with explanations
starting with 1st block....
will complete in an hour n brb
___________________
I WILL DO IT,,,,,,,,God please help me...
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| arundhutik
Forum Senior
Topics: 2
Posts: 176
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you will do great. best wishes!
i needed to begin preps but having a painful pharygitis, cant talk or sleep and with all the pain meds a mess...........i need to take the exam in nov........
Angel, you will do great!
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