Reviewed ⅓ : Step 2 CK: Next Step in Management

cafe au lait spots with sensorineural hearing loss: Next Step in Management:

MRI with gadolinium (suspect acoustic neuroma)

fibromuscular dysplasia treatment:

percutaneous angioplasty with stent placement

suspicion in an immigrant man with hypopigmented skin patch with loss of sensation. Had a flu-like illness 1 month prior. Next Step in Management:

perform a skin biopsy -> top ddx is Lepromatous leprosy.

pericardial effusion: Next Step in Management:

pericardiocentesis or pericardial window placement.

What is the next Step in Management for - treatment for scabies:

permethrin

What is the next Step in Management for - acute open-angle glaucoma

1) B-2-antagonist eye drops i.e. timolol, betaxolol 2) carbonic anhydrase inhibitors 3) if medication fails, then a trabeculoplasty or trabeculectomy can improve aqueous drainage

45 yr old woman overdosed on pills comes in with tinnitus, fever, and tachypnea: Next Step in Management:

1. aspirin intoxiciation - supportive care, activated charcoal, IV hydration, bowel irrigation a. moderate intoxication =>IV sodium bicarbonate to alkalinize the urine and promote excretion b. severe intoxication => hemodialysis

What is the next Step in Management for - Pulmonary edema in acute CHF exacerbation:

100% O2 therapy

flu-like illness with cherry red lips; multiple family membersl; carboxyhemoglobin <25% Next Step in Management:

100% oxygen

Palpitations with underlying lung disease i.e. COPD Next Step in Management:

72 hr Holter monitor

What is the next Step in Management for - Hypertension with underlying diabetes type 2:

ACE-inhibitor or ARB

Angina symptoms: Next Step in Management:

Beta-blockers - they increase the threshold of angina

pneumonia, dyspnea, dry cough, fever, chest pain in HIV patient: Next Step in Management:

Bronchoscopy with alveolar lavage

Estimated fetal weight is >4.5kg by sonogram: Next Step in Management:

C-section

Asystole: Next Step in Management:

CPR and epinephrine(lowers defibrillation threshold, increases myocardial and cerebral blood flow) ; defibrillation does not work for asystole

presence of bilateral popliteal artery aneurysms: Next Step in Management:

CT Abdomen -> 25% chance of abdominal aortic aneurysm present.

DVT identified on ultrasound: Next Step in Management:

CT scan of abdomen, chest, and pelvis - search for any embolism

What is the next Step in Management for - chronic sinusitis refractory to medical Tx or - (+) neurological deficits.

CT scan of the face (coronal section)

What is the next Step in Management for - someone that comes in with headaches and shows papilledema in the opthalmic exam.

CT scan of the head non-contrast - r/o mass or bleed.

abscess size >3cm Next Step in Management:

CT-guided percutaneous drainage

dysuria, suprapubic pain, and hematuria continue despite empiric antibiotics for UTI: Next Step in Management:

CT-scan of the abdomen and pelvis

What is the next Step in Management for - Syncope with normal vitals and no previous episodes:

Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and arrythmia

Posterior anterolateral MI and Percutaneous coronary intervention Next Step in Management:

Clopidogrel

a digoxin user with a potassium of 5.5 mg/dL

Digibind (Fab fragment

What is the next Step in Management for - A-fib secondary to hypertension for >48 hours.

Diltiazem; rate control + anticoagulant

What is the next Step in Management for - Asymptomatic aortic stenosis:

Hydrocholorothiazide to reduce preload

perinatal management of gestational diabetes: Next Step in Management:

IV D5w with insulin drip maintain glucose within 80-100mg/dL

how to diagnose hepatorenal syndrome

IV colloid challenge , if no improvement then positive for hepatorenal syndrome

Rhabdomyolysis: Next Step in Management:

IV fluids, mannitol and bicarbonate

acute cholecystitis Next Step in Management:

IV fluids, pain medication, and cholecystectomy within 72 hours

What is the next Step in Management for - Pulmonary edema in acute CHF exacerbation after 100% O2 therapy:

IV furosemide

A patient presents with hypertension and chest pain on exertion: Next Step in Management:

IV nitroglycerin for lowering the blood pressure

shoulder dystocia on observing the Turtle sign(retraction of head back into perineum) Next Step in Management:

McRoberts maneuver - flexion of mother's thighs against her abdomen

What is the next Step in Management for- PR interval=o.3 sinus rhythm normal:

Nothing, no management needed; PR>0.2 is first degree heartblock

Baseline EKG changes on patient with SSx of stable angina Next Step in Management:

Stress echocardiography instead of exercise treadmill stress test -- (echo you need to have a normal EKG reading at rest)

MRI contraindicated in suspicious looking equivocal X-ray: Next Step in Management:

Technetium bone scan

A man with mediastinal widening on chest X-ray and equal blood pressures on both arms and moderate pericardial effusion: Next Step in Management:

Trans esophageal echo

Needlestick from an HIV infected person: Next Step in Management:

Triple HAART therapy for 28 days

4 month old boy with leg-length discrepancy and positive Ortolani test: Next Step in Management:

U/S of the hip followed by Pavlik Harness (splint that holds hip in flexion and abduction) - prevents extension and adduction

What is the next Step in Management for - supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus rhythm:

Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or adenosine

the first test to determine beta-thalassemia anemia in genetic counseling: Next Step in Management:

WHAT IS THE LOGIC BEHIND THESE STEPS? complete blood count in the female (if no abnormality found, then there is no need for hemoglobin electrophoresis testing; if abnormal then test the partner)

vesicles on skin and mucous membranes which erode into ulcers with inguinal lymphadenopathy Tzanck positive Next Step in Management:

acyclovir famciclovir valacyclovir

What is the next Step in Management for - erythematous knee with effusion and fever.

arthrocentesis to tell apart crystal disease (gout) from infection (septic arthritis).

eisenmenger's syndrome in a pregnant woman: Next Step in Management:

avoid hypotension give pressors

infant with symmetric descending paralysis, drooling and constipation, poor suck and gag reflex also seen: Next Step in Management:

botulism immuneglobulin + supportive therapy(respiratory support, NGT feeding)

tracheobronchial rupture: Next Step in Management:

bronchoscopy (flexible or rigid)

prinzmetal angina: Next Step in Management:

calcium channel blockers or nitrates (also for esophageal spasm)

What is the next Step in Management for - osteopenia in an elderly patient:

calcium, vitamin D, and weight-baring exercise

septic arthritis Next Step in Management:

ceftriaxone + vancomycin

What is the next Step in Management for - multiple 2nd trimester spontaneous abortions.

cervical cerclage

single 2cm nodule on Chest X-ray in a 25 yo male: Next Step in Management:

check old Chest-X-ray to compare size or presence of the nodule.

acute viral pericarditis recurrence prevention: Next Step in Management:

colchicine

Lichen sclerosus: Next Step in Management:

corticosteroids

methods of treating genital warts: Next Step in Management:

cryotherapy , lasers, trichloroacetic acid or podophyllin imiquimod(originally for basal cell , acktinic akeratosis) , no side effects

prophylaxis against acute limb ischemia in a person with a-fib

dabigatran

skin lesions in a patient with celiac disease: Next Step in Management:

dapsone (Tx for dermatitis herpetiformis)

ulcer that is not infected and does not involve the bone Next Step in Management:

debridement

Rheumatic mitral stenosis in a pregnant woman: Next Step in Management:

decrease the heart rate to allow time for blood to fill the left ventricle; reduce the IV fluid volume

Non-reactive stress test with fetus and positive contractions: Next Step in Management:

delivery the baby immediately

What is the next Step in Management for - cord compression confirmed with CT-spine:

dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)

What is the next Step in Management for - someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo:

dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere's disease)

acute febrile non-hemolytic transfusion reaction Next Step in Management:

discontinue transfusion, give IV acetaminophen

pregnant woman of 16 weeks gestation with fasting blood glucose of 140 mg/dL: Next Step in Management:

do quadruple marker screen assess for neural tube defects - specifically caudal regression syndrome - she has overt diabetes mellitus. sacral agenesis (or hypoplasia of the sacrum) is a congenital disorder in which there is abnormal fetal development of the lower spine—the caudal partition of the spine. Sacral agenesis syndrome (agenesis of the lumbar spine, sacrum, and coccyx, and hypoplasia of the lower extremities) is a well-established congenital anomaly associated with maternal diabetes mellitus (not gestational diabetes).

MI status post CABG post-op day 5 small pericardial effusion with fever, tachycardia, a-fib. Next Step in Management:

drainage, surgical debridement and antibiotics ( acute mediastinitis)

1 month old boy with a harsh holosystolic murmur over the left lower sternal border: Next Step in Management:

echocardiography - he has a VSD

clinical suspicion for abnormal uterine bleeding: Next Step in Management:

endometrial biopsy

pancreatic cancer with elevated direct bilirubin: Next Step in Management:

endoscopic stent to relieve jaundice from extrahepatic cholestasis

reproductive-age woman with widespread pain ,fatigue, poor-sleep, frequent headaches and tenderness to palpation of her neck, shoulders and back. Vitals and labs are normal. Next Step in Management:

exercise program with aerobic conditioning (Tx for fibromyalgia). Medications - duloxetine, TCAs are a secondary measure.

Alcohol withdrawal: Next Step in Management:

fluid resuscitation, thiamine, dextrose, folate, benzodiazepines(diazepam, chlordiazepoxide)

5 day old newborn has lost 7% of their body weight: Next Step in Management:

follow up 10-14 days to see if baby has regained it (normal loss of fluid due to labor and in-utero)

nephrogenic diabetes insipidus:

free water and hydrochlorothiazide

needle-stick and unvaccinated for HepB Next Step in Management:

give HepB IV-IgG and HepB vaccine

teenage patient grunting and blinking many times a day for at least 1 year: Next Step in Management:

haloperidol

carbon monoxide poisoned pregnant lady with carboxyhemoglobin >15%: Next Step in Management:

hyperbaric oxygen (oxygen >100%)

pseudocyst on CT-abdomen: Next Step in Management:

if expanding or pain symptoms, then drain it. otherwise leave it alone.

severe acute pancreatitis >30% necrosis on MRI: Next Step in Management:

imipenem followed by percutaneous needle biopsy

What is the next Step in Management for - stroke outside the 3 hour period but within 6 hours:

intra-arterial tPA administration

abdominal pain out of proportion to clinical findings Next Step in Management:

laparatomy

no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus: Next Step in Management:

measure serum FSH (do not measure estrogen because the lack of breast development already tells you there is a lack of it)

Primary light chain amyloidosis Next Step in Management:

mephalan and prednisone

hepatorenal syndrome

midodrine and octreotide

local baldness: Next Step in Management:

minoxidil

What is the next Step in Management for - 3-hour old infant with poor feeding who vomits green material with a (+) double-bubble on U/S:

nasogastric tube for decompression of the GI tract...

What is the next Step in Management for - mini-mental status exam of <24

neuropsychologic testing to rule-out alzheimer's (other causes of dementia)

What is the next Step in Management for - 3-hour old infant with poor feeding who vomits green material:

next step: U/S --> r/o (+) double-bubble:

central retinal artery occlusion: Next Step in Management:

ocular massage with high flow oxygen

What is the next Step in Management for - (+) clue cells seen in vaginal swab in a fertile woman.

oral metronidazole

admission to inpatient ward with febrile neutropenia: Next Step in Management:

piperacillin-tazobactam

Guillane Barre Syndrome Next Step in Management:

plasmapheresis or IVIG with admission to ICU

pinpoint calcifications in a newborn whose mother owns a cat: Next Step in Management:

pyramethamine and sulfadiazine (Treats toxoplasmosis)

dog bite with suspicion of rabies: Next Step in Management:

quarantine the dog for 10 days; if asymptomatic the whole time, then no need for management (post-exposure prophylaxis)

Lambert Eaton Syndrome Next Step in Management:

radiation and chemotherapy as it is the manifestation of a pre-existing small cell carcinoma of the lung.

What is the next Step in Management for - Scaphoid fracture that is negative on X-ray.

spica cast and re-evaluate in 2~3 weeks

elderly patient with intermediate to high risk factors for coronary artery disease. Next Step in Management:

stress test

What is the next Step in Management for - spontaneous pneumothorax in a tall young man.

supplemental oxygen

peripartum cardiomyopathy - biventricular cardiac failure: Next Step in Management:

supportive care

What is the next Step in Management for - high-grade reflux in females that persists into adulthood with no clear secondary cause.

surgical repair

man comes in with a painless chancre on the penis: Next Step in Management:

swab the exudate and perform dark-field microscopy

Wernicke's Encephalopathy: Next Step in Management:

thiamine, then glucose ( in that order)

non-reactive stress test: Next Step in Management:

vibroacoustic stimulation- wake up the baby because most commonly non-reactive ST due to the baby sleeping