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95. Give sickle cell disease children prophylactic penicillin continuously until they
turn 5 years old
96. Any patient with a recent anaphylactic reaction (for any reason), should get
skin test for allergens (to help prevent future disasters) and consult an
allergist
97. Do not give cephalosporins to any patient with anaphylactic penicillin
allergies (there is a 5% cross-reactivity)
98. Order Holter monitor on patients who have had symptomatic palpitations.
99. Any patient with a first-time panic attack gets a urine toxicology
screen, a TSH, and finger stick glucose
100. All renal failure patients get: nephrology consult, calcium
acetate (to decrease the phosphorus levels), calcium supplement,
and erythropoietin
Step by step guide to CCS cases: I don't know if this has been posted
before, I found it on the net and it should make the CCS cases easier to
approach.
Select 'Start Case' button to begin.
You will see the case introduction. Wait! Note on the erasable board:
Setting
Age of the patient
Race of the Patient
Sex of the patient
Then click 'OK' and you will see the initial vital signs. Wait! Note on the erasable
board:
Stable or unstable?
Then click 'OK' and you will see the initial history. Wait! Think and write on the
erasable board:
Differential Diagnosis :
Allergies
Habits smoking , alcohol , drugs , etc. Anything worrisome?
Then ask:
Is the patient stable or is it an emergency? A clue to this would be in the history - for
emergency cases, you will see only the basic history of present illness and not the
detailed history (social, past, etc). All other history will be 'unobtainable'.
If the condition has improved, move the patient to the next location in the order ER
--> ICU --> Ward --> Office/Home.
If the condition has worsened, move the patient to the next location in the order
Home/Office --> Ward/ER or Ward/ER --> ICU.
If you are changing location from inpatient (ER/ICU/Ward) to outpatient
(Office/Home):
Stop unnecessary medications and change IV medications to oral.
Discontinue IV fluids.
Remove tubes.
Remove IV access.
Schedule followup visit in 1 or 2 weeks as relevant.
Patient education or counseling or diet specific and vital to this case. Type 'patient
education' and 'counsel' and see if anything is relevant to this specific case. Type
'Diet' and see if anything is relevant to this specific case.
By this time, the 5 minute screen will appear!
Then type 'counsel' and choose the relevant things. You can choose multiple things at
a time. See your erasable board for any worrisome habits like alcohol or smoking!
Type 'patient education' and choose the relevant things. You can choose multiple
things at a time.
Patient education / Counseling options :
Every adult person - Drive with seat belt, Exercise program, No illegal drug use.
Every person taking long-term medications - Medication compliance, Side effects of
medication.
Every person who takes alcohol - Limit or stop alcohol intake.
Every person who smokes - Smoking cessation.
Every person of reproductive capacity - Safe sex techniques.
Every person with long-term conditions, life-threatening allergies, chronic illnesses Medic Alert Bracelet.
Female requesting contraception or practicing unsafe sex - Birth control,
Contraception, Safe sex techniques.
Cancer case - Cancer diagnosis.
117-Rx intertrochanteric Fx of femur : internal fix with sliding screw and plate ,
early mobilization
118-Rx Cholangitis : Drain biliary tree with ERCP
119-Rx Lambert Eaton : plasmapheresis + immunosuppression
120-Rx Emphysematous cholecystitis : Imm fluid + electrolyte correction +
antibiotics + early surgical cholecystectomy
121-Rx Acute exacerbation of MS: Steroides
122-Rx Umblical hernia : mostly Observe ( look for few indection of intervention)
123-Rx Cholestoma: surgical removal
124-Rx GBS: IVIg, plasmaphresis
125-Rx Hordeoulum/stye : warm compress no answer after 48 hours
incision and drainage
126-Rx Erysipelas : Peni
127-Rx Fever in neutropenic pt : Cetazidime / Cefepime
128-Rx MG crisis: plasmapheresis
129-Rx Sarcoidosis : systemic steroids.
130-Rx for prevention of recurrence of renal stone : know them well and also
remember that Ca intake must be NORMAL or even INCREASED.
131-Rx Osgood Schlatter disease: Rest, NSAIDs , brief casting
132-Rx Molluscum : curettage or application of luquid nitrogens
133-Rx Amebic liver abscess: metro
134-Rx Hypochlo met alkalo : 0.9% Nacl , NG suction K supp
135-Rx Anorexia asso w chemotherapy : Megestro acetate
136-Rx Tension pneumothorax : needle thoraco
137-Rx Sensory neuropathy w DM : TCA , Gabapentin , NSAIDs
138-Rx acute pyeloneph : IV ampi + genta ( empiric )
139-Rx VT hemo stable : Lido or Amio
140-Rx prevention of variceal bleeding : beta blocker
141-Rx pul infection if CF : aminoglyco + antipseudomona
142-Rx Hydatid cyst : Surgery under cover of Albendazole ( Plz do not aspirate
these cysts )
143-Rx Reflex sympathetic dystrophy: physical therapy, prednisone , ganglion
block
144-Rx Chorioamnionitis :Ampi+ Genta
145-Rx PCO: combines estro/prog or cyclic prog
146-Rx Perforation of esophagus: primary closure of esophagus , drainage of
mediastinum w/i 6 hours to prevent mediastinitis
147-Rx Rotator cuff tendonitis : Lido injection
148-Rx Megacolon: Iv fluids , Antibiotics , bowel rest , Iv cortico
149-Rx Disseminated histoplasmosis in HIV: IV ampho B + LIFE LONG
itraconazole
150-Rx Pseudomona : cefepim/ceftazidime
151-Rx Dystonia : Anti hista , anti chol
152-Rx AIDS with Dysphagia : 1-2 w of oral fluconazole no answer
biopsy
153-Rx Vipoma : correct dehydration slow diarrhea surgery
154-Rx Ewings sarcoma : radio/chemo surgery
155-Rx Croup : use racemic epinephrine before intubating your pt.
156-Rx Free air under diaphragm : go to OR
157-Rx Abnormal hemostasis due to uremia : DDAVP, Cryoper, conjugated estro
158-Rx Pancreatic pseudocyst : only drain them if persist more then 6W or > 5
cm.
159-Rx Capillary hemangioma: mostly regress by age of 7
160-Rx Acute torsade de points: Mg replacement
161-Rx MgSo4 tox: stop MgSo4, give Ca gluconate
162-Rx CAD + EF<40% : think about Ace I
163-Rx Dec frequency of relapses of MS: INF beta
164-Rx Anemia of prematurity : Iron supp, periodic Hgb checking and blood
transfusion if needed
165-Rx Spinal injuries: think about cortico
166-Rx Ascities in cirrhotic pt : diagnostic paracentesis , salt restricted diet
,spironolactone ,
167-Rx Giant cell tumor : refer it to expert!
168-Rx Nocardia : cotri
169-Rx Clavicle Fx : figure of 8
170-Rx persistent nocturnal enuresis : DDAVP ( not imipiramine , also
know which nocturnal is normal )
171-Rx PCO : think about metformin
172-Rx PH of PF <7.2, PF glucose <60 : chest tube
173-Rx Mediastinal adenopathy on CXR : Med broncho + biopsy
174-Rx bleeding varices : Band ligation is better than sclerotherapy
175-Rx SAH: think about Nimodipine for preventing associated ischemia
176-Rx Tourettes disorder : Haloperidol , pimozide
177-Rx Preventing PCP in transplant pt : cotri
178-Rx ANY gun shot wound to Ant Abd : LAPARATOMY
179-Rx first line for HTN: diuretics/beta blocker
180-( this one is imp) Rx Primary Parathyro : - pt symptomatic : Surgery , Pt
pregnant : surgery, follow up is difficult : surgery , serum Ca > 1 mg/dl over
upper limit : surgery
181-Rx Basal cell carcinoma : excision removal with 1-2 mm clear
margin ( number is imp)
182-Rx erythema margins ( lyme) Doxy / 28 days or Amoxi ( in pregnant )
183-Rx Late lyme disease : IV ceftriaxone
184-Rx Irregular atherosclerotic lesion in carotid + blockage >60% : surgery
185-Rx infant with congenital diaphragmatic hernia : IMMEDIATE orogastric
tube .
186-Rx Reye syn: glucose + FFP and mannitol to dec cerebral edema
187-Rx Cat Scratch disease: Azithro/5days
188-Rx pt with variceal bleeding needs 5 or more units of blood in 24 hours : go
for TIPS
189-Rx intermittent claudication :as pharm therapy go for Ca channel blockers.
190-RX initial drugs in COPD : antichol
191-Rx Isolated LV diastolic dysfunction : beta blocker
192-Rx Colles FX: closed reduction + casting
193-Rx pul emboli with hemo instability or clot in main pul A. : pul embolectomy
194-Rx in ARDS : think about PEEP
195-Rx preg pt w asymptomatic bacteriuria : nitrofuran / 7-10days
196-Rx infectious mono w upper airway obstruction or autoimmune
hemolytic anemia or thrombocytopenia : cortico
197-Rx Fibromyalgia : TCA or Cylobezarpine
243-Rx dirty looking wound in pt w less then 3 doses of tet tox: toxoid +Tig
( only situation which u give pt Tig)
244-Rx uncomplicated Basilar skull fx : head elevation , fluid restriction.
245-Rx Ludwig Angina: IV peni w coverage for anaerobes
246-Rx Meconium plug syn : Water soluble contrast enema
247-Rx Ovarian torsion : surgery
248-Rx Tubo-ovarian abscess: surgery
249-Rx volvulus or malrotation: immediate surgery
250-Rx Transposition of great vessels : keep ductus arteriosus open, go for
surgery.