These are the notes I made for ccs:

For online cases:

Foreign body aspiration: Methyl prednisone. Cefazolin. Rigid bronchoscopy

COPD exacerbation: Albuterol, Ipratropium, methyl prednisone, lovefloxacin (PEFR q1)
Bronchiolitis: Albuterol,nasotracheal suction,nss,epinephrine (one time). Observe.
Croup: neck xray. Epinephrine. Dexamethasone. Humidified air.
Acute bacterial Sinusitis: No test needed. Amoxicillin oral, Acetaminophen, Pseudoephidrine, Oral hydration
PCP: ABG, PCP (sputum). BACTRIM (TMP-SMX), prednisone, LDH, G6PD. HIV western blot, viral load, CD4, Vaccine, HIV support.
Pulmonary Embolism: ABG, D-dimer, Cancel OCP, Spiral chest, Lovenox (if creatinine normal), Warfarin, monitor with INR, platelet. No smoking.
DVT: Lower extremity Doppler USG, D-dimer, Enoxaparin SQ, Warfarin, Percocet oral, medication side effect, no smoking, PT/INR each visit. Stop heparin if platelet drops below 100,000.
Hemophilia: Factor VIII. PTT. Genetic consults.
Cellulitis: Clindamycin IV, percocet, leg elevation. When improve change clindamycin to oral.
Septic arthritis: Knee xray, Morphine (one time), acetaminophen,ceftriaxone,vancomycin. Ortho consult, Arthoscopy later cancel IV ceftriaxone after synovial gm stain says staphylococcus
Acoute gout: Indomethacin oral. No aspirin, no alcohol, low protein. Esr, pt, ptt, foot xray, synovial fluid (gram, crystals, c and s, viscosity)
Temporal arteritis: Urine Culture, Blood culture, ESR, head CT, Prednisone, Temporal artery biopsy, Aspirin oral, Pantoprazole oral, Calcium, Vit D.
Polymyalgia Rheumatica: ANA, CRP, RF, CPK, CXR, ESR. Prednisone, Calcium, Vit D. Later ESR, CRP, CBC, Dexa Scan.
Bacterial Meningitis: Head CT, Head Elevation, Ceftriaxone, Vancomycine, Dexamethasone, Phenergan, Acetaminophen, all IV. Cancel HCTZ. LP with CSF (dont forget bacterial antigen), 1-2 days later patient
improves, case ends.
Cryptococcal meningtitis: Serum cryptococcal antigen, HIV elisa, head CT, LP, CSF, India ink, fungal culture, Amphotericin B IV, flucytosine oral, after 2 weeks fluconazole, HIV western blot, CD4, viral load, HIV support
group.
Herpes simplex encephalitis: Head CT, LP, blood culture, CSF (dont forget PCR for HSV), Head elevation, Phenergan, Acetaminophen IV, Acyclovir.
Major depression: Fluoxetine, suicide contract, pt education

Alzheimers disease: Donepezil, Vit E, cognitive rehab, occupational therapy, support group, good nutrition, medication alert

Panic attack: alprazolam sl once. No caffeine

Bipolar I, acute mania: Olanzapine IM, lithium oral, suicide contract, psychiatry consult, psychotherapy, medication side effects.
TIA: Aspirin, Carotid Doppler, Cefazolin, CEA
Essential HTN: Low fat, low salt, exercise, if lifestyle fails after 6 months, medication on 3rd high BP reading.
Hypertensive emergency: Nitroprusside. Arterial line
Unstable angina: Aspirin. Nitroglycerine. Metoprolol. Heparin. Later oral metoprolol, simvastatin eptifibatide (iv) cardiac catheterize, coronary angioplasty.
Acute pericarditis: Ibuprofen,colchicine,echocardiogram
Ruptured abdominal aortic aneurysm: Cancel metoprolol, aspirin. Morphine, phenergan, Abdominal USG, Vascular surgery consult, cefazolin, Repair AAA.
Constipation: metamucil. High fiber,low fat.
Irritable bowel syndrome: Lactose free diet, high fiber diet, loperamide, biofeedback

Acute appendicitis: Morphine.phenergan. Cefoxitin. Laparoscopy.

Perforated Duodenal Ulcer: Cancel Ibuprofen, NG suction, UO, Morphine, Phenergan, Pantoprazole, BACTRIM (TMP-SMX).
Acute diverticulitis: Abdominal XRAY, CT, Blood culture, BACTRIM, Morphine, Phenergan, After 12-24 hours, if pt improves, dc all iv, d/c iv bactrim, give oral percocet, oral Metronidazole, oral Ciprofloxacin. High fiber.
Sigmoid Volvulus: Abdominal xray, GI consult, IV morphine, Flexible sigmoidoscopy, rectal tube, 12-24 hours, pt improves then IV Cefazolin, IV Metronidazole, Elective Laparotomy.
Acute Cholecystitis: Abdominal xray, Abdominal USG, NG tube, Piperacillin-tazobactum, ketorolac IM, Phenergan, Pt improves, Laparoscopic cholecystectomy.
Intussusception: Morphine, Phenergan, Ngtube, Abdominal Xray, Abdominal USG, Surgery consult, Barium enema.
Renal Cell Carcinoma: (Dont forget:Serum Iron, Ferritin, TIBC), Abdominal CT, Chest CT, Cefazolin, Nephrectomy.
Splenic hematoma: Cervical spine immoblization,morphine,phenergan,get ct result.
Colon Cancer: Polyethylene glycol before colonoscopy, abdominal CT, CXR, CEA, Iron sulfate, Metronidazole, Ciprofloxacin, Hemicolectomy. No smoking, no alcohol.
Child abuse: CXR, or Xray of involved injury, CPS, Ibuprofen, chest physiotherapy, Psychiatry consult, if retinopathy ophthalmology consult. Parent counsel.
Pregnancy tests: A BB CC HH P RR UU

Uncomplicated cystitis with pregnancy: Nitrofurantoin

Ectopic pregnancy: Methotrexate, (3.5cm or bhcg >5000 laparoscopy), Morphine

Vaginal Candidiasis: Vaginal Miconazole/clotrimazole 14 days or one time oral fluconazole
Fibroadenoma of breast: Mammogram/USG. FNA Pap. 3-6 m f/u
PID: Morphine. Phenergan. Cefoxitin. Doxycycline. Acetaminophen
Later dc all iv and give oral doxycyclin

DUB (16year): Prolactin,tsh,pap then ocp(low estro low prog), iron.

Menopause: Estrogen-progesterone, vit D, calcium, low salt diet, high calcium diet, exercise, pap, mammography, dexa, colonoscopy, lipid profile, f/u 3-6 months.
Simple Ovarian Cyst with torsion: Pelvic USG, IV Morphine, Phenergan, Laparoscopy.
Ovarian Cancer: Pelvic USG, Abdominal CT, CA 125, Colonoscopy, Mammogram, Pap, CXR, Cefazolin, LMWH SQ, TAH-BSO by laparotomy.
Turners Syndrome: Karyotype, FSH, LH, TSH, Fasting glucose, Skeletal Survey, Pelvic USG, Renal USG, Hearing test, Echocardiogram, Growth hormone, Estrogen-progesterone, Vit D, Calcium, Dietary Consult,
Psychiatry for IQ test.


For read out cases of uw:
Atrial fibrillation: Pulse ox, IVA, EKG, Metoprolol or Cardizem IV bolus, (if copd), CBC, BMP, CXR, Cardiac enzyme q8*2, UA, LFT, TSH, Free T4, PT/INR, PTT, Admit, Telemetry, vitals and pulse ox q4, order old records,
Consistent carbohydrate diet, HbA1C stat, Accuchecks Q6, Echocardiogram, Cardizem IV continous drip, Heparin IV continous, PTT Q6, Daily CBC, Urine C & S, Bactrim, After 2 hours hx, monitor telemetry strip,
repeat ekg, check in 6 hours, once hr 1 cm, need thoracocentesis), Consent, Thoracocentesis, Pleural fluid analysis (Gram stain, AFB, C & S), Protein, Glucose, LDH, Cell count, Cytology, pH), Serum LDH, Serum
Protein, Rheumatology consult, Prednisone oral, safe sex, contraception counseling (AVOID OCPs), exercise, Low fat, high fiber diet. [C/I to thoracocentesis: PT or PTT >twice normal, platelet count 6], Pleural fluid pH


Cardiac tamponade from MVA: NSS, Pericardiocentesis, Elevate
legs, EKG, CXR portable, TTE, Pericardial fluid for cell count, ABG,
CVTS consult, Shift to ICU, Swan-Ganz catheter, Foley, UO q2, PT,
PTT, Omeprazole oral, Percocet, Type and screen, If Hb 92, wean
oxygen, Pt education, Cardiac rehabilitation, Smoking cessation,
Regular exercise, f/u 2 weeks.

DKA: Finger stick Glucose, CBC, BMP, Calcium, EKG, Amylase,
Lipase, UA, ABG, Serum Osmolality, Serum Ketones qualitative,
Regular Insulin iv, Phenergan once, Admit to ICU, NPO, Urine
Output, KCL IV continuous, HbA1C, Serum Phosphorus, BMP q4
then q12, ABG q2*2, After 4 hours, stop NS give NS, monitor
serum potassium, once nausea decreased oral fluid, At discharge,
NPH insulin sq, regular insulin, diabetic diet, diabetic teaching,
diabetic foot care, home glucose monitoring.

ARF: oxy, iva, nss, foley catheter, EKG, ABG, CBC, BMP, Magnesium,
Phosphorus, UA, Urine C & S, Urine Na and Creatinine, FeNa, D/C
lisinopril, d/c ibuprofen, transfer to ward, vitals q2, 24 hour urine
protein, Heparin sq, Renal usg routine, daily weights, strict input &
output, Accucheck q6, HbA1C routine, insulin, if pt does not respond
to fluid lasix to increase urine output, if cause of renal hypoperfusion
is heart failure start dobutamine and dopamine, once pt improves,
d/c bedrest, out of bed to chair, d/c foley, continue renal diet, plenty
of oral fluids, if fever blood culture.

Nephrotic Syndrome: UA, BMP, CBC, LFT, Lipid panel, PT/INR, PTT,
Complement 3 and 4, Input/Output, Consult Nephrology, Albumin,
Furosemide, KCL, CMP in am, No salt added, High protein diet,
Prednsone oral 4-6 wks, Repat albumin and lasix.


ADPKD: CBC, BMP, UA, USG of kidneys, EKG, (Renal failure can
cause metabolic acidosis, hyperkalemia, hypocalcemia, anemia, EKG
change (peaked T wave), Calcium gluconate IV bolus, D50 and
insulin iv bolus, sodium bicarbonate oral continuous, kayexalate oral
continuous, UO, Nephrology consult, Serum potassium, BMP every
12 hours, serum phosphorus, serum iron, ferritin, TIBC, Amlodipine
oral continuous, Calcium acetate? Not in software, Erythropoietin
SQ routine.

Jaundice (G6PD def anemia): CBC, BMP, LFT, PT, Admit to floor,
IVA, NSS, Regular diet, ambulate at will, Reticulocyte count,
Haptoglobin, LDH, UA, Type and cross, PRBC (2 units), G6PD blood
quantitative, Coombs test direct stat, limit alcohol, f/u in 2 months.

Cystic Fibrosis: Admit, Sputum (gram, C&S), Blood cultures, CBC,
BMP, CXR, Sinus xray, Sweat Chloride, 72 hour fecal fat, Augmentin,
Albuterol, Multivitamin, Chest physiotherapy, D5NS, Regular diet,
Ambulation at will, D/C all iv, Influenza vaccine, Pneumococcal
vaccine, Consult dietician, Pancreatic enzyme oral, Genetic
counseling, high protein, high calorie diet.

SLE with pleural effusion: Pulse ox, CBC, IV, BMP, UA, CXR, EKG,
ANA, ESR, PT/INR, PTT, Anti-Ds DNA, Complement C3, C4,
Decubitus film (>1 cm, need thoracocentesis), Consent,
Thoracocentesis, Pleural fluid analysis (Gram stain, AFB, C & S),
Protein, Glucose, LDH, Cell count, Cytology, pH), Serum LDH,
Serum Protein, Rheumatology consult, Prednisone oral, safe sex,
contraception counseling (AVOID OCPs), exercise, Low fat, high
fiber diet. [C/I to thoracocentesis: PT or PTT >twice normal, platelet
count 6], Pleural fluid pH

ur wc, these are the rest, I could
not post last night for internet
troubles in usmleforum, if it
helps, pray for me. I need lot of
prayers.
Sickle cell anemia: CBC, BMP,
Blood cultures, UA, urine
culture, sputum gram stain and
culture, cxr, ekg, type and
screen, D5 NSS, morphine,
Cefuroxime, Azithromycin,
Incentive Spirometry, Albuterol
nebulization, Repeat H and H in
4 then 8 hours, CBC, BMP next
day, High calorie diet,
Chronic therapy:Penicillin
prophylaxis ( 4months to 3
years), Pneumococcal vaccine,
Folic acid, hydroxyurea for
recurrent vasoocclusive crisis

GBS Pneumonia: CBC, BMP,
Blood Cultures, CSF (protein,
glucose, cell count, gram stain),
CXR, CRP, D5 NS, Ampicillin,
Cefotaxime, Input/Output, CBC
&BMP daily, Change antibiotic
to oral amoxicillin if sensitive to
it.

Lung Cancer: Pulse ox,
osteoarthropathy indicate lung
ca, oxygen, IVA, NSS, Urine
output q4, CXR, Blood Culture,
Sputum for gram stain, Culture
and Cytology, CBC, BMP,
Levofloxacin, albuterol q2 and
ipratropium q6, Spiral CT scan
of chest, Bronchoscopy, Consult
Pulmonary medicine for
bronchoscopy, CBC and BMP
daily, LFT, PFT, Serum Calcium,
CT of abdomen and pelvis, MRI
brain with and without contrast,
Bone scan, Consult oncology,
consult radiation oncologist,
quit tobacco, Supplement diet
with high protein nutritional
shakes.

Bacterial Meningitis: NPO, Hold
atenolol, Pneumatic, Urine
output q2, Head elevation,
Blood cultures, UA, urine C & S,
CBC qd, BMP qd, PT/INR, PTT,
Phenergan, Acetaminophen, IV
ceftriaxone, Vancomycin, LP,
CSF (cell count, protein,
glucose, gram stain, fungal
stain, culture and sensitivity).

Vertrebral fracture: Toradol,
ESR, CBC, BMP, Serum
Calcium, Spine x-ray,
lumbosacral, SPEP (to r/o mm),
TSH, Naproxen oral, calcium
carbonate, vit D, Fosamax
(Alendronate), calcium enriched
diet. In f/u 7 days, Dexa scan.


TSS: Clindamycin. IV dopamine,
iv phenergan one time, foley.

Acute bacterial prostatitis:
Ampicillin, Gentamicin, later
oral amoxicillin.

Diverticulosis: Anoscopy, CBC,
BMP, LFT, PT, PTT, EKG, Type
and crossmatch, NGT
aspiration, D/C if taking
Glyburide, statin or lisinopril,
PRBC, FFP, H and H Q6, Urine
output, Accucheck Q6, Consult
Gastroenterology for
Colonoscopy, Golytely, High
fiber diet, avoid nuts and fruits.

Infective endocarditis:
Vancomycin, Gentamicin. TEE,
Daily blood culture, later D/C
Vancomycin, add oral Nafcillin.

Angioedema: Epinephrine SQ,
stat, ABG, albuterol,
hydrocortisone,
Diphenhydramine, ranitidine,
dopamine,all iv continous, urine
output, d/c all IV, oral
prednisone, oral
diphenhydramine. At discharge,
EpiPen. After 6 weeks, RAST.
Avoid allergen, Immunology
consult for anaphylaxis.

Folic Acid deficiency: Fobt,
serum folate, serum vit b12, lft,
reticulocyte, iron sulfate
therapy, thiamine oral,
multiviamin oral, iron enriched
diet, folic acid therapy.

All postmenopausal: Cal, Vit D.

Urosepsis: D/C foley, IV
ceftriaxone, after 24 hours, oral
bactrim or ciprofloxacin.