great stuff. thanks.
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.
great stuff. thanks.
1. sub arrachnoid hemorrhage
2. pregnancy (45yo female)
3. pericarditis (this was tricky b'c at first was Severely impaired CHF w/ pericardial effusions, a f/u echo showed mildly impaired CHF... i am not sure if i got this right. Pt had recent h/o URI 30yo male)
4. trichomonas vaginalis (make sure to treat partners)
5. acute viral meningitis (no sure for this one too. 7mo baby... could have been bacterial meningitis, sepsis)
6. small bowel obstruction
7. Acute Tubular necrosis (not sure, pt was 33yo female with s/p ORIF leg, arm 2/2 MVA... c/o decrease urine output and now has become dark colored/bloody)
8. hepatocellular carcinoma (make sure to counsel cancer diagnosis)
9. Maxillary sinusitis
I hope i passed
bad idea to post cases
Last edited by DocSAMMD; 09-13-2010 at 04:08 AM. Reason: edit