ccknbllr
06-27-2007, 10:43 PM
1: PID - Young female, unprotected sex, multiple partners, the works. No abcess on U/S. Totally blanked on the abx regimen, so I gave her Pen G and Cipro. Amp and Gent or Ofloxacin and Metronidazole are the real choices. Either way she felt better, so hopefully not too many deductions.
2: G6PD deficiency - 3 y/o asian kid with fatigue and hyperbilirubinemia, with signs of hemolysis. Stopped the Bactrim he was taking and switched him to amoxicillin, did fine.
3: STEMI - Typical risk factors, ST elevations, usual management (MONA, heparin gtt, cath, eptifibide gtt post-cath, risk factor reductions).
4: Uncomplicated UTI in an 18 y/o. - Bactrim and you're done.
5: Atelectasis - post-surgical person. I saw the CXR with "free air" and forgot that's normal after laparotomy. Anyway, incentive spirometry and council deep breathing.
6: Pyloric Stenosis - 4 week old, bilious vomiting, U/S showed pyloric stenosis. Surgery and you're out.
7: Aortic Dissection - caught me by surprise; office visit for back pain. CXR showed aortic widening. NO ASA or heparin! Surgical management.
8: OD - 45 y/o alcoholic found comatose with whisky, pill bottles around. I messed up and didn't give thiamine before dextrose (D'oh!), but otherwise do the usual: intubate, FSBS, thiamine, dextrose, naloxone, flumazenil, fluids, tox screen, etc.
9: Whitish vaginal discharge - 71 y/o lady with white plaques and skin breakdown of vagina with bleeding. I did all the cultures, biopsies, etc. After that, gave estrogen cream and empiric Monostat, but pt had no relief. I was really wracking my brain about this one, but when I got home and looked it up all signs pointed to atrophic vaginitis. No idea why she didn't get better.
Good luck!
CNB
2: G6PD deficiency - 3 y/o asian kid with fatigue and hyperbilirubinemia, with signs of hemolysis. Stopped the Bactrim he was taking and switched him to amoxicillin, did fine.
3: STEMI - Typical risk factors, ST elevations, usual management (MONA, heparin gtt, cath, eptifibide gtt post-cath, risk factor reductions).
4: Uncomplicated UTI in an 18 y/o. - Bactrim and you're done.
5: Atelectasis - post-surgical person. I saw the CXR with "free air" and forgot that's normal after laparotomy. Anyway, incentive spirometry and council deep breathing.
6: Pyloric Stenosis - 4 week old, bilious vomiting, U/S showed pyloric stenosis. Surgery and you're out.
7: Aortic Dissection - caught me by surprise; office visit for back pain. CXR showed aortic widening. NO ASA or heparin! Surgical management.
8: OD - 45 y/o alcoholic found comatose with whisky, pill bottles around. I messed up and didn't give thiamine before dextrose (D'oh!), but otherwise do the usual: intubate, FSBS, thiamine, dextrose, naloxone, flumazenil, fluids, tox screen, etc.
9: Whitish vaginal discharge - 71 y/o lady with white plaques and skin breakdown of vagina with bleeding. I did all the cultures, biopsies, etc. After that, gave estrogen cream and empiric Monostat, but pt had no relief. I was really wracking my brain about this one, but when I got home and looked it up all signs pointed to atrophic vaginitis. No idea why she didn't get better.
Good luck!
CNB