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Preview of Crush Step 3 CCS: The Ultimate USMLE Step 3 CCS Review, 1e PDF
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Additional info for Crush Step 3 CCS: The Ultimate USMLE Step 3 CCS Review, 1e
Chest/Lung Chest wall general. Diaphragm and chest movement both and symmetrically with respiratory. No abnormality on percussion or auscultation. Heart/Cardiovascular S1 and S2 common. No murmurs, rubs, gallops, or additional sounds. crucial and peripheral pulses general. No jugular venous distention. Blood strain equivalent in either hands. stomach Bowel sounds general; no bruits. Bilateral decrease belly tenderness. Liver and spleen no longer palpable. No hernias. Genitalia common labia. Mucopurulent vaginal discharge current. Cervical movement tenderness current. Uterus now not enlarged. Bilateral adnexal tenderness. Rectal Sphincter tone common. No plenty or abnormality. Stool brown; no occult blood. Extremities/Spine Extremities symmetric with no deformity, cyanosis, or clubbing. No edema. Peripheral pulses common. No joint deformity or heat; complete diversity of movement. backbone exam general. what's the suspected prognosis, and what are the following steps in administration? fifty two II—CCS circumstances by way of leader criticism Case #18: Pelvic Inflammatory disorder Keys to analysis n n n Look for a tender girl with abdominal/pelvic soreness, vaginal discharge, dysuria, and soreness or bleeding with sex. historical past might express a number of sexual companions, earlier STI, or loss of condom use. important indicators exhibit a fever. Examination indicates purulent vaginal discharge, adnexal tenderness, or cervical movement tenderness. Order hCG to rule out being pregnant. stomach or transvaginal ultrasound may possibly exhibit fallopian tube dilation or abnormalities within the ovaries. MRI has greater sensitivity than ultrasound yet is extra expensive. Order reviews for sexually transmitted ailments: chlamydia, gonorrhea, Trichomonas, HIV, hepatitis. administration n n n Decide even if to confess: tubo-ovarian abscess, pregnant, immunodeficient, serious disease, noncompliant. Antibiotic therapy may be potent opposed to gonorrhea and chlamydia + anerobes. If inpatient, use cefotetan IV or cefoxitin IV + doxycycline oral. cease IV meds 24 hours after development, yet proceed Doxycycline for 14 days. If tubo-ovaian abscess current, upload Metronidazole, oral for 14 days. If outpatient remedy, use ceftriaxone IM unmarried dose + doxycycline oral for 14 days + metronidazole oral for 14 days. Counseling to prevent intercourse, use secure intercourse suggestions, and deal with companions if wanted. optimum ORDERS prognosis remedy tracking situation TIMING SEQUENCING extra ORDERS • hCG, beta, urine qualitative • CBC • Transvaginal ultrasound • BMP • Vaginal pH • Urinalysis • Vaginal secretion, rainy mount • Urine tradition • Vaginal KOH prep • Hepatitis B floor antigen, serum • Cervical DNA, gonorrhea • Hepatitis C antibody, serum • Cervical DNA, chlamydia • HIV antibody attempt, swift, blood • Intravenous entry • PT/PTT • Cefotetan, IV • NSAID or morphine • Doxycycline, oral • Advise sufferer, secure intercourse • Consult, basic surgical procedure • Advise sufferer, deal with accomplice • Monitor important indicators if wanted. • Emergency division to inpatient unit if sufferer meets standards and wishes parenteral antibiotic treatment or attainable surgical procedure.