1.

If a patient has a fever, give acetaminophen (unless it is contraindicated)

2. If a patient is on a statin or you order a statin, get baseline LFTs and check
frequently
3. If a patient is found to have abnormal LFTs, get a TSH
4. If a patient is going to surgery (including cardiac catheterization), make them
NPO
5. All NPO patients must also have their urine output measured (type "urine
output")
6. If a woman is between 12 and 52 years old and there is no mention of a very
recent menses (that is, < 2 weeks ago), order a beta-hCG
7. Don't forget to discontinue anything that is no longer required (especially if
you are sending the patient home)
8. When a patient is stable, decide whether or not you should change locations
(if you anticipate that the patient could crash in the very near future, send the
patient to the ICU; if the patient just needs overnight monitoring, send to the
ward; if the patient is back to baseline, send home with follow-up)
9. In any diabetic (new or long-standing), order an HbA1c as well as continuous
Accuchecks.
10. If this is a long-standing diabetic, also order an ophthalmology consult (to
evaluate for diabetic retinopathy)
11. In any patient with respiratory distress (especially with low oxygen
saturations), order an ABG
12. In any overdose, do a gastric lavage and activated charcoal (no harm in
doing so, unless the patient is unconscious or has risk for aspiration)
13. In any suicidal patient, admit to ward and get "suicide contract" and "suicide
precautions"
14. Patients who cannot tolerate Aspirin get Clopidogrel or Ticlopidine
15. Post-PTCA patients get Abciximab
16. In any bleeding patient, order PT, PTT, and Blood Type and Crossmatch (just
in case they have to go to the O.R.)
17. In any pregnant patient, get "Blood Type and Rh" as well as "Atypical
Antibody Screen"
18. In any patient with excess bleeding (especially GI bleeding), type "no
aspirin" upon D/C of patient
19. If the patient is having any upper GI distress or is at risk for aspiration, order
"head elevation" and "aspiration precautions"
20. In any asthmatic, order bedside FEV1 and PEFR (and use this to follow
treatment progress)
21. Before you D/C a patient, change all IV meds to PO and all nebulizers to MDI
22. In any patient who has GI distress, make them NPO
23. All diabetic in-patients get Accuchecks, D/C oral hypoglycemic agents, start
insulin, HbA1c, advise strict glycemic control, recommend diabetic foot care
24. All patients with altered mental status of unknown etiology get a "fingerstick
glucose" check (for hypoglycemia), IV thiamine, IV dextrose, IV naloxone, urine
toxicology, blood alcohol level, NPO
25. If hemolysis is in the differential, order a reticulocyte count
26. If you administer heparin, check platelets on Day 3 and Day 5 (for heparininduced thrombocytopenia), as well as frequent H&H
27. If you administer coumadin, check daily PT/INR until it is within therapeutic
range for two consecutive days

28. Before giving a woman coumadin, isotretinoin, doxycycline, OCPs or other

teratogens, get a beta-hCG
29. If you give furosemide (Lasix), also give KCl (it depletes K+)
30. All children who are given gentamycin, should have a hearing test
(audiometry) and check BUN/Cr before and after treatment
31. Don't forget about patient comfort! Treat pain with IV morphine, nausea with
IV phenergan, constipation with PO docusate, diarrhea with PO loperamide,
insomnia with PO temazepam
32. All ICU patients get stress ulcer prophylaxis with IV omeprazole or ranitidine
33. If you put a patient on complete bed rest (such as those who are pre-op),
get "pneumatic compression stockings"
34. If fluid status is vital to a patient's prognosis (such as those with
dehydration, hypovolemia, or fluid overload), place a Foley catheter and order
"urine output"
35. If a CXR shows an effusion, get a decubitus CXR next
36. If you intubate a patient you also have to order "mechanical ventilation"
(otherwise the patient will just sit there with a tube in his mouth!)
37. With any major procedure (including surgery, biopsy, centesis), you MUST
type "consent for procedure" (typing consent will not reveal any results)
38. With any fluid aspiration (such as paracentesis or pericardiocentesis), get
fluid analysis separately (it is not automatic). If you don't order anything on the
fluid, it will just be discarded.
39. With high-dose steroids (such as in temporal arteritis), give IV ranitidine,
calcium, vitamin D, alendronate, and get a baseline DEXA scan.
40. In all suspected DKA or HHNC, check osmolality and ketone levels in the
serum.
41. In alcoholic ketoacidosis, just give dextrose (no need for insulin), in addition
to IV normal saline and thiamine
42. All patients over 50 with no history of FOBT or colonoscopy should get a
rectal exam, a FOBT, and have a sigmoidoscopy or colonoscopy scheduled.
43. All women > 40 years old should get a yearly clinical breast exam and
mammogram (if risk factors are present, start at 35)
44. All men > 50 years old should get a prostate exam and a PSA (if risk factors
are present, start at 45)
45. If a patient has a terminal disease, advise "advanced directives"
46. In any patient with a chronic disease that can cause future altered mental
status, type "medical alert bracelet" upon D/C
47. Any patient with diarrhea should have their stool checked for "ova and
parasites", "white cells", "culture", and C.diff antigen (if warranted)
48. Any patient on lithium or theophylline should have their levels checked
49. All patients with suspected MI should be given a statin (and check baseline
LFTs)
50. All suspected hemolysis patients should get a direct Coombs test
51. Schedule all women older than 18 for a Pap smear (unless she has had a
normal Pap within one year)
52. Pre-op patients should have the following done: NPO, IV
access, IV normal saline, blood type and crossmatch,
analgesia, PT, PTT, pneumatic compression
stockings, Foley, urine output, CBC, and any
appropriate antibiotics

53. If a patient requires epinephrine (such as in anaphylaxis), and he/she is on a

beta-blocker, give glucagon first
54. If lipid profile is abnormal, order a TSH
55. All dementia and alcoholic patients should be advised no driving
56. To diagnose Alzheimers, first rule out other causes. Order a CT head,
vitamin B12 levels, folate levels, TSH, and routine labs like CBC, BMP, LFT, UA.
Also, if the history suggests it, order a VDRL and HIV ELISA as well
57. Also rule out depression in suspected dementia patients
58. For all women who are sexually active and of reproductive age, give folate.
In fact, you should give ALL your patients a multivitamin upon D/C home
59. All pancreatitis patients should be made NPO and have NG suction so that no
food can stimulate the pancreas
60. Send patients home on a disease-specific diet: diabetics get a diabetic
diet, hypertensives get a low salt diet, irritable bowel patients get a
high fiber diet, hepatic failure patients get low protein diet, etc
61. Do not give a thrombolytic (tPA or streptokinase) in a patient with unstable
angina
62. Patients who are having a large amount of secretions, order pulmonary
toilet to reduce the risk of aspiration
63. Every patient should be advised to wear a seatbelt, to
exercise, and advised about compliance
64. In any patient who presents with an unprotected airway (as in overdoses,
comatoses), get a CXR to rule out aspiration
65. In any patient with one sexually transmitted disease (such as Trichomonas),
check for other STDs as well (Gonorrhea, Chlamydia, HIV, syphilis, etc.) and do a
Pap smear in all women with an STD
66. Remember to treat children with croup with a mist tent and racemic
epinephrine
67. Any acute abdomen patient with a suspected or proven perforation, give a
TRIPLE antibiotic: Gentamycin, Ampicillin, Metronidazole
68. Get iron studies in patients with microcytic anemia if the cause is unknown.
Order iron, ferritin, TIBC
69. Women with vaginal discharge should get a KOH prep, saline (wet) prep,
vaginal pH, cervical gonococcal, chlamydia culture
70. If a woman is found to have vaginal candida, check her fasting glucose
71. All suspected child abuse patients should be admitted and you should order
THREE consults: consult child protection services, consult
ophthalmology (to look for retinal hemorrhages), consult
psychiatrist (to examine the family dynamics)
72. When a woman reaches her menopause, she should have a fasting lipid
profile checked (because without estrogen, LDL will rise and the HDL will
drop), a DEXA scan (for baseline bone density), FOBT and colonoscopy (if she is
over 50
73. When the 5 minute warning screen is displayed, go through the following
mnemonic
Recreational drugs & Reassurance
Alcohol
Tobacco
Exercise
Diet of high protein, no lactose, low fat

Seat belt, Safety plan & Suicide precautions

Education
X for safe sex
74. If colon cancer is suspected, order a CEA; if pancreatic cancer, order CA 199; if ovarian cancer, order CA 125.
75. Remember to give phototherapy to a newborn with pathologic
unconjugated bilirubinemia (it is not helpful if it is predominantly conjugated).
Also, with phototherapy, keep the neonate on IV fluids (the heat can dehydrate
them), and give erythromycin ointment in their eyes
76. Before giving a child prednisone, get a PPD
77. If a patient is found to have high triglycerides, check amylase and
lipase (high triglycerides can cause pancreatitis)
78. Remember that any newborn under 3 weeks of age who develops a fever is
SEPSIS until proven otherwise. Admit to the ward and culture EVERYTHING:
blood culture, urine culture, sputum culture, and even
CSF culture. And give antibiotics to cover EVERYTHING.
79. If you get a high lead level in a child, you have to check a venous blood
lead level to confirm. If the value is > 70, admit immediately and begin IV
dimercaprol and EDTA. Order lead abatement agency and
lead pain assay upon discharge.
80. If you perform arthrocentesis, send the synovial fluid for gram stain
and the 3 Cs: crystals, culture, and cell count
81. If a patient has exophthalmos with hyperthyroidism, it is not enough to just
treat the hyperthyroidism (as the eye findings may worsen). You should give
prednisone.
82. If any patient has cancer, get an oncology consult.
83. In a patient with rapid atrial fibrillation, decrease heart rate first. Then use a
CCB (diltiazem) or a beta-blocker (metoprolol) for rate control.
84. In any patient with new-onset atrial fibrillation, make sure you check a TSH
85. In any patient with suspected fluid volume depletion, order postural
vitals to detect orthostasis
86. Before a colonoscopy or a sigmoidoscopy, you should prepare the bowel:
make the patient NPO, give IV fluids (if necessary) and order polyethylene
glycol.
87. Any patient with Mobitz II or complete heart block gets an immediate
transcutaneous pacemaker. Then order a cardiology consult to implant a
transvenous pacemaker
88. If calcium level is abnormal, order a serum magnesium, serum
phosphorus, and PTH
89. Treat both malignant hyperthermia and neuroleptic malignant syndrome with
dantrolene
90. All splenectomy patients get a pneumovax, an influenza
vaccine, and a hemophilus vaccine if not previously given.
91. If you give INH (for Tb), also give pyridoxine (this is vitamin B6)
92. If you give pyrazinamide, get baseline serum uric acid levels
93. If you give ethambutol, order an ophthalmology consult (follow optic
neuritis)
94. If you perform a thoracocentesis (lung aspirate), send the EFFUSION as well
as a peripheral blood sample for: LDH and protein (to help differentiate a
transudate versus an exudates) and pH of the effusion

95. Give sickle cell disease children prophylactic penicillin continuously until they
turn 5 years old
96. Any patient with a recent anaphylactic reaction (for any reason), should get
skin test for allergens (to help prevent future disasters) and consult an
allergist
97. Do not give cephalosporins to any patient with anaphylactic penicillin
allergies (there is a 5% cross-reactivity)
98. Order Holter monitor on patients who have had symptomatic palpitations.
99. Any patient with a first-time panic attack gets a urine toxicology
screen, a TSH, and finger stick glucose
100. All renal failure patients get: nephrology consult, calcium
acetate (to decrease the phosphorus levels), calcium supplement,
and erythropoietin

Step by step guide to CCS cases: I don't know if this has been posted
before, I found it on the net and it should make the CCS cases easier to
approach.
Select 'Start Case' button to begin.
You will see the case introduction. Wait! Note on the erasable board:
Setting
Age of the patient
Race of the Patient
Sex of the patient
Then click 'OK' and you will see the initial vital signs. Wait! Note on the erasable
board:
Stable or unstable?
Then click 'OK' and you will see the initial history. Wait! Think and write on the
erasable board:
Differential Diagnosis :
Allergies
Habits smoking , alcohol , drugs , etc. Anything worrisome?
Then ask:
Is the patient stable or is it an emergency? A clue to this would be in the history - for
emergency cases, you will see only the basic history of present illness and not the
detailed history (social, past, etc). All other history will be 'unobtainable'.

If unstable, do a EMERGENT physical exam. No emergency case should get a full

physical exam - it's an emergency!!
For the EMERGENT physical, choose the 'general appearance' and the relevant
system. If needed, add one or two relevant systems.
After you note the results of the EMERGENT physical, stabilize patient immediately:
Airway Intubation?
Breathing Oxygen mask? Chest tube?
Circulation IV fluids? Dopamine?
Drugs Naloxone? Dextrose? Thiamine?
IV Access?
Then ask:
Does the patient's condition correlate to the setting?
Emergency or unstable patient in office needs to go to the ER immediately!! Change
location if necessary.
After the patient is stable and in the right setting, proceed to 'Interval/follow-up
history' and a more detailed RELEVANT physical exam.
If the patient is already a stable case in the right setting, proceed straight to the
RELEVANT physical exam.
Then ask:
Is the case limited to one particular system? Like Asthma or MI?
Choose the particular system and a few related systems, based on the most likely
diagnosis.
Is the case not limited to one particular system?
Choose a COMPLETE physical exam. This option is available on the top of the physical
exam choices. Examples of such cases include Case for Annual Physical Exam, Child
Abuse, Depression, Asymptomatic Hypertensive for Office Management, etc.
Note the significant findings on the physical exam and go back to your erasable
paper and revise your Differential Diagnosis. Strike out those which are less likely
and add those are more likely.
Then keeping the Differential Diagnosis in mind, consider the labs to be done.
When considering labs use this mnemonic:
IBUOP
I Imaging > X-Rays, CT, USG, MRI, Echo, Scopy, VQ Scan, etc.
B Blood > CBC, Basic Metabolic Panel, Lipid Profile, LFT, Smears, Cultures, etc.

U Urine > Urinalysis, Toxicology Screen, Ketones, etc.

O Others > Other tests which do not fall under IBU, like EKG, PEFR for Asthma,
Pulse Oximetry, Biopsies, etc.
P Pregnancy test > For any female of reproductive age presenting with abdominal
or pelvic symptoms, or trauma.
When ordering labs, consider:
Is this test time-effective/time-consuming? Choose time-effective.
Is this test initial screening/confirmatory? Choose initial screening.
Is this test cheap/expensive? Choose cheap.
Is this test non-invasive/invasive? Choose non-invasive.
Then ask:
Will this test tell me anything useful? Tests like CBC, ESR, Chem 7, etc might satisfy
the above criteria but will not tell you anything useful.
Are there any specific tests for this condition? Examples are Cardiac Enzymes for MI,
Sweat Chloride test for Cystic Fibrosis, etc.
Are the tests in the right order? Example Pulse Oximetry before ABG, CT before
Spinal Tap, etc.
Order the labs using the Order button.
Then advance clock to the 'Next Available Result'.
Understand the results. Ask:
Is the diagnosis clear or do I need any confirmatory tests?
If diagnosis is clear, start treatment.
If confirmation is needed, order confirmatory tests and then start treatment.
Treatment :
Determine if the patient is in the right setting. If patient is in office and needs to be
admitted, change location to ward. If patient is in ward and is in a serious condition,
change location to ICU.
If case is admitted, order:

IV access (unless IV drugs are not indicated) Type 'IV Access'.

Vital Signs Type Vitals and click on 'Every 1,2, 4 or 6 hours' depending on the
condition of patient.
Activity Type 'Bed Rest' and choose 'Complete bed rest' or 'Bed rest with bathroom
privileges' or type restrain and choose 'Restrain patient in bed'.
Diet Normal, liquid, NPO, 2 gram Sodium, ADA, etc. Order 'Diet' and you will see
the list of options, choose which is the best for this case.
Tubes NG Tube? Foley's catheter?
Fluids Saline, Ringer, etc. Type 'Fluids' and choose which is the best for this case.
Urine output Type 'Urine Output' and choose frequency. There is no option for
Input/output chart.
Medications :
Stop! Check for allergies on erasable board!
Order standard drugs for this case.
Decide IV or Oral. Decide bolus or continuous. Decide frequency.
Labs :
Additional labs to confirm diagnosis?
Labs to monitor? Cardiac Monitor? Pulse Oximetry?
Consults :
Order consults if necessary. GI, Ophthalmology, Psychiatry, Genetics, Social worker,
etc.
Then move clock!
Depending on severity of case, move by 30 minutes/1 hour/2 hours/3 hours/6
hours/12 hours/1 day/2 days/1 week.
Do Interval/follow-up history.
Understand the results of the labs.
Then ask:
Has the patient's condition changed significantly?
If yes, change locations.

If the condition has improved, move the patient to the next location in the order ER
--> ICU --> Ward --> Office/Home.
If the condition has worsened, move the patient to the next location in the order
Home/Office --> Ward/ER or Ward/ER --> ICU.
If you are changing location from inpatient (ER/ICU/Ward) to outpatient
(Office/Home):
Stop unnecessary medications and change IV medications to oral.
Discontinue IV fluids.
Remove tubes.
Remove IV access.
Schedule followup visit in 1 or 2 weeks as relevant.
Patient education or counseling or diet specific and vital to this case. Type 'patient
education' and 'counsel' and see if anything is relevant to this specific case. Type
'Diet' and see if anything is relevant to this specific case.
By this time, the 5 minute screen will appear!
Then type 'counsel' and choose the relevant things. You can choose multiple things at
a time. See your erasable board for any worrisome habits like alcohol or smoking!
Type 'patient education' and choose the relevant things. You can choose multiple
things at a time.
Patient education / Counseling options :
Every adult person - Drive with seat belt, Exercise program, No illegal drug use.
Every person taking long-term medications - Medication compliance, Side effects of
medication.
Every person who takes alcohol - Limit or stop alcohol intake.
Every person who smokes - Smoking cessation.
Every person of reproductive capacity - Safe sex techniques.
Every person with long-term conditions, life-threatening allergies, chronic illnesses Medic Alert Bracelet.
Female requesting contraception or practicing unsafe sex - Birth control,
Contraception, Safe sex techniques.
Cancer case - Cancer diagnosis.

Asthmatic - Asthma care, medication compliance.

Terminal case - Advance Directive (Family), Advance Directive (Patient) and Living
will.
Every post-operative case - Deep breathing and coughing
Diabetic - Diabetic foot care, Home glucose monitoring, Diet.
Learning disorder kid - Educational remediation.
Osteoporosis - Estrogen replacement therapy.
HIV case - HIV support group, safe sex techniques.
Hypothyroidism or endocrine case - Hormone replacement therapy.
Lactose intolerance - Limit cow's milk intake, Diet.
GI bleeding, peptic ulcer case - No aspirin, Sit upright after meals.
Old age, epileptic, vision defects, narcolepsy - No driving.
Anxiety case - Relaxation techniques, Rebreathing into a paper bag.
Violent psychotic case - Restraining order.
Spousal Abuse - Safety plan.
IV drug use - No illegal drug use, SBE prophylaxis, Safe sex techniques, Stop
alcohol, Smoking cessation.
Pelvic surgery - No intercourse.
STD - Safe sex techniques, Sexual partner needs treatment.
Depression - Suicide contract.
Routine screening : Schedule appropriate screening tests as per age. Type the
relevant test and schedule.
Immunizations : For Pediatrics and Geriatrics as relevant. Type 'Vaccine', choose and
schedule.
At the end of the 5 minutes:
Type the Final Diagnosis.
You are done!!!
For Kids: Add age appropriate vaxine.

Helmets when Bicycle riding.

water temp<120 degree.
Dental health.
GUn safety.
smoke detector.
Teenage : DOnt drink while drive counsel.
For every one add age appropriate SCREEN.UV protection .Postexposure prophylaxis.
CANCER screen everyone gets it.
Females: think if she neeeds to be PAPed.
Chlamydia screen for a sexualy active with many.
Elderly geriatic *Mamograph if older.
*osteoporosis screen.
*pneumovax and flu vax for elderly.
*elderly fall prevention.
*Hormone replacement.
Screening :
Consider:
Self-breast exam every month after age 20.
Clinical breast exam every year after 40.
Mammography every year after 50 in normal-risk females.
Mammography every year after 40 in high-risk females.
Pap smear - every year (for 3 years) after 18 years or earlier if sexually active. Then,
every 3 years until 65.
FOBT every year after 50 + Sigmoidoscopy every 3 years after 50 years.
OR
Colonoscopy every 10 years after 50 years.
Digital Rectal Exam every year after 40.
PSA every year after 50.
Vaccines :
Geriatrics :
Pneumococcal vaccine once for every person above 65. High-risk patients get earlier.
Influenza vaccine every year for every person above 65. High-risk patients get
earlier.
Pediatrics :
DTaP - 2 months, 4 months, 6 months, between 15 and 18 months, between 4 and 6
years.
IPV - 2 months, 4 months, between 6 and 18 months, between 4 and 6 years.
Hepatitis B - Birth, 2 months, 4 months.

H. influenza B - 2 months, 4 months, 6 months, 12 to 15 months.

Pneumococcus - 2 months, 4 months, 6 months, 12 to 15 months.
Varicella - Between 12 and 15 months.
MMR - Between 12 and 18 months.

1- Rx Webs in plummer vinson : dilation

2- Rx Intimal flap of carotid artery: surgey
3- Rx Ant wall MI : risk of arterial thrombo ; full doses heparin + 3 months of
warfarin.
4- Rx Acute ill and toxic pt with UC : proctosigmo + biopsy
5- Rx Heat stroke : rapid cooling
6- Rx progressive back pain + myelopathy: IV dexa --> MRI --> Rx Metastatic
cord compression : Radiotherapy
7- Rx refractory hydrothorax due to cirrohis : TIPS
8- Rx Ref ascitis : TIPS
9- Rx recurrent variceal bleading not responsive to medical Rx : TIPS
10- Rx TCA poisoning : NaHCO3
11- Rx diabetic cystopathy: 1- oral bethancol , 2- intermittent catheter
12- Rx chlamydia : single dose of Azithromycin OR 7 days doxycyclin
13- Rx neuromalignant syn : Dantrolene or Bromocripten
14- Rx atopic dermatitis : prevention of Rx , take short baths.
15- Rx presbyopia : convex lenses
16- Rx amblyopia : cover better eye
17- Rx hyperopia : convex lenses
18- Rx myopia : concave lenses
19- Rx beta blocker posioning : recent ingestion= emesis , bradycardia :
Atropine--> Isoproterenol--> glucagon-->pace
20- Rx beta blocker poisioning : severe bronchospasm : aminophylline or Beta2
agonist.
21- Rx Isolated duodenal hematoma : NG + parentral nutrition.
22- Rx for preventing recurrence of HBV after liver transplant : HBV Ig +
Lamivudine.
23- Rx Seizure due to INH toxicity : Pyriodoxine
24- Rx hyponatremia due to SIADH : water restriction.
25- Rx Girl infant < 3 months w vaginal bleeding : observation
26- Rx Slow down progression of DM nephropathy : AceI
27- Rx epiglottitis : Fiberoptic laryngoscopy in OR ( not in ER)
28- Rx acute attacks of migrains : Rizatriptan
29- Rx acute attack of migrains lasts for longer than 48 hours or r frequently
recurrent : ergotamine.
30- Rx anorexia nervosa : hospitalization
31- Rx prophlaxy against human bites : Amoxi / calvulanate
32- Rx rhabdomyolysis : osmotic diuresis + bicarbonate
33- Rx Afib + HF : digoxin .
34- Rx acute rejection : high dose IV steroides.

35- Rx bipolar disorder : lithium , valporate, OLANZAPINE.

36- Rx PCP : cotri .
37- Rx PCP + PaO2<70 mmhg: cotri + steroides.
38- Rx Bebesiosis : ( quinine, clinda) or ( atovaquone , azithro)
39- Rx IlleoIlleal intussuception due to HSP : Surgery ( in contrast to other
causes of intuss )
40- Rx esophagitis in HIV: itraconazole --> no answer --> esophagoscopy +
cytology + biopsy
41- Rx psuedotumor cerebri : 1-acetazolamide --> no answer --> 2- shunt.
42- Rx struvite stones : eradication of UT infections.
43- Rx persistantly elevated ALT leval w detectable HBs Ag , HBe Ag and HBV
DNA : INF and lamivudine.
44- Rx febrile neutropenic pt : cetazidime or cefepime ( add vanco if pt is
hypotensive or there is high suspiscion of MRSA)
45- Rx Isolated systolic HTN: thiazides .
46- Rx acute attack of cluster headaches : 100% oxygen
47- Rx prevention of cluster headaches : verapamil
48- Rx reversing cardiac effects of ca channel blockers : Ca!
49- Rx Viterous hemorrhage : immediate ophthlamo condsultation.
50- Rx Battery in esophagus : remove it immediatly .
51- Rx Battery in intestine : observe it.
52- Rx acute bleeding in pts with liver failure : FFP.
53- Rx OtoSclerosis : Surgery + Sodium Fluoride .
54- Rx non infalm comedones : topical retionides.
55- Rx mild inflam acne : benzoyl peroxide , topical antibiotics.
56- Rx Refractory mania, severe dep , dep in pregnancy , neuroleptic malig synd,
catatonic schizo : ECT
57- Rx Acute attack of hepatic encephalopathy : All dietary protein withheld ,
oral or rectal lactulose , oral NEOMYCIN.
58- Rx white reflex in infant : refer to ophthalmo
59- Rx ST elevation>1 mm in 2 contiguous leads : thrombolytic therapy OR PTCA
60- Rx New LBBB : thrombolytic therapy.
61- Rx Trachoma : ORAL tetra or erythromycin.
62- Rx diabetic nephropathy : protein restriction ( 0.8 g/kg) , don't use AceI if
Cr> 2,2.5
63- Rx Zenker : excision and frequently cricophayngeal myotomy
64- Rx porcelain gall bladder : cholecystectomy ( risk of carcinoma)
65- Rx conversion disorder : psychotherapy ( long term benefit )
66- Rx Dyspepsia w positve breath test : erad H.pylori
67- Rx Dyspepsia w/o positive breath test : H2 blocker / PPI
68- Rx fibromuscular dysplasia : percutaneous angioplasty w stent placement.
69- Rx prophylaxis against MAC : Azithro or clarithro
70- Rx PBC: ursodeoxycholic
71- Rx Orbital cellulitis : imm admin of IV antibiotics.
72- Rx carcinoid synd : can u remove it?( Remove it ) , u can't remove it ? ( use
octerotide )
73- Rx vaginismus : relaxation, Kegel exercise , insertion training.
74- Rx Hypertrophic dystrophy of Vulva : steroides.
75- Rx lichen scleroris : steroides
76- Rx atrophic vaginitis : estrogen

77- Rx stable angina + HTN : Beta blocker.

78- Rx Tremor and rigidity in parkinson : Antichol ( benzotropines)
79- Rx exercise induced asthma : Beta agon , mast cell stabilizer.
80- Rx Reiter syn : NSAIDS .
81- Rx Chronic HCV ( HCV RNA presents , ALT inc , chornic hepatitis of at least
moderate grade): INF+ Ribaverin.
82- Rx Lactation Suppression: tight fitting bra , ice packs , analgesics.
83- Rx non-complinat schizophrenic pt : long acting injectable antipsychotics like
fluphenazine and haloperidol.
84- Rx TIA due to atherosclrosis: ASA
85- Rx TIA due to emboli from heart : Anticoagulation.
86- Rx Nocardiosis : sulfonamides.
87- Rx prophylaxis of getting UTI after intercourse : voiding after intercourse.
88- Rx met prostate cancer: palliative radiation + anti androgen therapy
( leuprolide )
89- Rx Actinomycosis : high dose penicillin
90- Rx RA with erosive joint disease : DMARDS ( MTX, hydroxychlorquine ,
sulfasalazine , etanercept, azathio)
91- Rx Met brain tumor : surgery + whole brain radiation.
92- Rx Dressker : NSAIDS --> no answer : short course of steroides.
93- Rx PMR : low dose pred
94- Rx Giant cell : high dose.
95- Rx cocaine intox : Benzo + ASA + nitrates.
96- Rx effect of PEEP on CO : inotropic agent or fluids.
97- Rx RMSF: Doxycycline
98- Rx De Quervains tensosynovitis : Long acting steroids.
99- Rx HSV encephalitis : IV acyclo without delay.
100- Rx ALS: Riluzole
101- Rx Subdural hematoma w/o midline shift : head elevation , hyperventilation
, acetazolamide
102- Rx Subdural hematoma w midline shift : craniotomy
103- Rx early syph : Single IM Benz Peni , if allergic Doxy or tetra for 14 days .
in pregnancy use peni with desintizator
104- Rx Acute attack of Gout : use NSAIDs, there may be an option of colchicine
but do not mark this option.
105- Rx prevention of gout attack : allopurinol
106- Rx GAD: Buspirone
107- Rx post-term preg : NST + BPP ( twice/weekly ) oligo or late dece or
>43 w delivery
108- Rx Kawasaki in children : ASA ( the only disease u give child ASA inspite of
fear of Reye syn)
109- Rx massive hemoptysis : RIGID broncho
110-Rx acute vaso-occlusive crisis in sicke cell : Exchange transfusion
111-Rx Acute dystonia : antihistamine or anticholinergic
112-Rx Parkinsonism as a result of antipsychotic: Benzo
113-Rx Akathesia : beta blockers
114-Rx HEAVY UNREMITTING ENDO HEMORRHAGE : high dose conjugated
estrogens
115-Rx Stress Fx : restricting weight bearing + short leg casts (3 to 4 W)
116-Rx Met breast cancer + lytic bone disease : IV pamidronate

117-Rx intertrochanteric Fx of femur : internal fix with sliding screw and plate ,
early mobilization
118-Rx Cholangitis : Drain biliary tree with ERCP
119-Rx Lambert Eaton : plasmapheresis + immunosuppression
120-Rx Emphysematous cholecystitis : Imm fluid + electrolyte correction +
antibiotics + early surgical cholecystectomy
121-Rx Acute exacerbation of MS: Steroides
122-Rx Umblical hernia : mostly Observe ( look for few indection of intervention)
123-Rx Cholestoma: surgical removal
124-Rx GBS: IVIg, plasmaphresis
125-Rx Hordeoulum/stye : warm compress no answer after 48 hours
incision and drainage
126-Rx Erysipelas : Peni
127-Rx Fever in neutropenic pt : Cetazidime / Cefepime
128-Rx MG crisis: plasmapheresis
129-Rx Sarcoidosis : systemic steroids.
130-Rx for prevention of recurrence of renal stone : know them well and also
remember that Ca intake must be NORMAL or even INCREASED.
131-Rx Osgood Schlatter disease: Rest, NSAIDs , brief casting
132-Rx Molluscum : curettage or application of luquid nitrogens
133-Rx Amebic liver abscess: metro
134-Rx Hypochlo met alkalo : 0.9% Nacl , NG suction K supp
135-Rx Anorexia asso w chemotherapy : Megestro acetate
136-Rx Tension pneumothorax : needle thoraco
137-Rx Sensory neuropathy w DM : TCA , Gabapentin , NSAIDs
138-Rx acute pyeloneph : IV ampi + genta ( empiric )
139-Rx VT hemo stable : Lido or Amio
140-Rx prevention of variceal bleeding : beta blocker
141-Rx pul infection if CF : aminoglyco + antipseudomona
142-Rx Hydatid cyst : Surgery under cover of Albendazole ( Plz do not aspirate
these cysts )
143-Rx Reflex sympathetic dystrophy: physical therapy, prednisone , ganglion
block
144-Rx Chorioamnionitis :Ampi+ Genta
145-Rx PCO: combines estro/prog or cyclic prog
146-Rx Perforation of esophagus: primary closure of esophagus , drainage of
mediastinum w/i 6 hours to prevent mediastinitis
147-Rx Rotator cuff tendonitis : Lido injection
148-Rx Megacolon: Iv fluids , Antibiotics , bowel rest , Iv cortico
149-Rx Disseminated histoplasmosis in HIV: IV ampho B + LIFE LONG
itraconazole
150-Rx Pseudomona : cefepim/ceftazidime
151-Rx Dystonia : Anti hista , anti chol
152-Rx AIDS with Dysphagia : 1-2 w of oral fluconazole no answer
biopsy
153-Rx Vipoma : correct dehydration slow diarrhea surgery
154-Rx Ewings sarcoma : radio/chemo surgery
155-Rx Croup : use racemic epinephrine before intubating your pt.
156-Rx Free air under diaphragm : go to OR
157-Rx Abnormal hemostasis due to uremia : DDAVP, Cryoper, conjugated estro

158-Rx Pancreatic pseudocyst : only drain them if persist more then 6W or > 5
cm.
159-Rx Capillary hemangioma: mostly regress by age of 7
160-Rx Acute torsade de points: Mg replacement
161-Rx MgSo4 tox: stop MgSo4, give Ca gluconate
162-Rx CAD + EF<40% : think about Ace I
163-Rx Dec frequency of relapses of MS: INF beta
164-Rx Anemia of prematurity : Iron supp, periodic Hgb checking and blood
transfusion if needed
165-Rx Spinal injuries: think about cortico
166-Rx Ascities in cirrhotic pt : diagnostic paracentesis , salt restricted diet
,spironolactone ,
167-Rx Giant cell tumor : refer it to expert!
168-Rx Nocardia : cotri
169-Rx Clavicle Fx : figure of 8
170-Rx persistent nocturnal enuresis : DDAVP ( not imipiramine , also
know which nocturnal is normal )
171-Rx PCO : think about metformin
172-Rx PH of PF <7.2, PF glucose <60 : chest tube
173-Rx Mediastinal adenopathy on CXR : Med broncho + biopsy
174-Rx bleeding varices : Band ligation is better than sclerotherapy
175-Rx SAH: think about Nimodipine for preventing associated ischemia
176-Rx Tourettes disorder : Haloperidol , pimozide
177-Rx Preventing PCP in transplant pt : cotri
178-Rx ANY gun shot wound to Ant Abd : LAPARATOMY
179-Rx first line for HTN: diuretics/beta blocker
180-( this one is imp) Rx Primary Parathyro : - pt symptomatic : Surgery , Pt
pregnant : surgery, follow up is difficult : surgery , serum Ca > 1 mg/dl over
upper limit : surgery
181-Rx Basal cell carcinoma : excision removal with 1-2 mm clear
margin ( number is imp)
182-Rx erythema margins ( lyme) Doxy / 28 days or Amoxi ( in pregnant )
183-Rx Late lyme disease : IV ceftriaxone
184-Rx Irregular atherosclerotic lesion in carotid + blockage >60% : surgery
185-Rx infant with congenital diaphragmatic hernia : IMMEDIATE orogastric
tube .
186-Rx Reye syn: glucose + FFP and mannitol to dec cerebral edema
187-Rx Cat Scratch disease: Azithro/5days
188-Rx pt with variceal bleeding needs 5 or more units of blood in 24 hours : go
for TIPS
189-Rx intermittent claudication :as pharm therapy go for Ca channel blockers.
190-RX initial drugs in COPD : antichol
191-Rx Isolated LV diastolic dysfunction : beta blocker
192-Rx Colles FX: closed reduction + casting
193-Rx pul emboli with hemo instability or clot in main pul A. : pul embolectomy
194-Rx in ARDS : think about PEEP
195-Rx preg pt w asymptomatic bacteriuria : nitrofuran / 7-10days
196-Rx infectious mono w upper airway obstruction or autoimmune
hemolytic anemia or thrombocytopenia : cortico
197-Rx Fibromyalgia : TCA or Cylobezarpine

198-Rx Benign essential tremor : propranolol

199-Rx Superficial thrombophlebits : Local heat, bed rest, NSAIDs .
200-Rx Atypical mycobacterium infection : Azithro for prophylaxis
201-Rx MAC: Clarithro + ethambutol ( imp)
202-Rx child w legg calve perthes below 5 years of age : NO TREATMENT!!!
203-Rx child w legg calve perthes above 5 years of age: abduction bracing /
surgery
204-Rx IE in IV abusers : Vanco + Genta
205-Rx IE in Non-IV abusers : Nafi + Genta
206-Rx condylomata acuminate: Podophyllin
207-Rx specific phobia : systemic desensitization
208-Rx Tricho : metro for pt + partner
209-Rx ALL pts w BLUNT trauma to abd BUT w signs of peritoneal irritation :
laparatomy.
210-Rx slowing cognitive decline in Alz : Donepezil / Tacrine
211-Rx Pancreatic Abscess : External drainage
211-Rx Pancreatic Abscess : External drainage
212-Rx Granulum Inguinale : Tetra/10-21 days
213-Rx Pertusis : erythro/14 days
214-Rx Pancoast syn: radiation followed by surgery
215-Rx Acute otitis media: Amoxy /10 days , failed Amoxi-Clav
216-Rx Measles : dont forget Vit A
217-Rx chest tube drainage of blood more than 1500cc at first or more than
600cc in 6 hours : surgical thoracotomy
218-Rx RV infarction : immediate volume expansion , failed Dobutamine
219-Rx Vomiting due to chemotherapy: Ondansetron
220-Rx Adjustment disorder: psychodynamic psychotherapy or brief cognitive
psychotherapy
221-Rx Legionella pnumo: high dose erythro or azithro
222-Rx CLL ( w associated symp) : chlorambucil/pred
223-Rx first degree heart block: no Rx!
224-Rx Non displaced scaphoid Fx : cast immobilization of wrist
225-Rx Displaced scaphoid Fx : Internal fixation
226-Rx premature atrial beats: No RX!
227-Rx Hairy cell leukemia : Cladribine
228-Rx Non-Hodgkins lymphoma: CHOP
229-Rx SVC obstruction: Angioplasty w stenting ( imp)
230-Rx Mediastinitis : Thoracotomy for debrid,drain + antibiotic therapy
231-Rx displaced femoral neck in elderly : primary arthroplasty
232-Rx clavicle Fx in infant : no Rx, avoid putting pressure on arm
233-Rx PID in hospitalized pt : cefoxitin/doxy , cefotetan/doxy, clinda/genta
234-Rx PID in non hos pt: cefoxitin/probencid, cetraixone/doxy
235-Rx Androgen insensivity syn: Gonadectomy ( inc risk of test cancer)
236-Rx compartment syn due to eschar of burn wounds: escharotomy
237-Rx Papilloma of breast : Galactogram guided resection
238-Rx shaft of femur Fx: closed intermedullary fixation w/o interrupting skin.
239-Rx scoliosis < 20 degree: observe
240-Rx scoliosis >30: Bracing.
241-Rx Scoliosis >40: surgery
242-Rx Shaft of humerus: closed reduction + hanging cast .

243-Rx dirty looking wound in pt w less then 3 doses of tet tox: toxoid +Tig
( only situation which u give pt Tig)
244-Rx uncomplicated Basilar skull fx : head elevation , fluid restriction.
245-Rx Ludwig Angina: IV peni w coverage for anaerobes
246-Rx Meconium plug syn : Water soluble contrast enema
247-Rx Ovarian torsion : surgery
248-Rx Tubo-ovarian abscess: surgery
249-Rx volvulus or malrotation: immediate surgery
250-Rx Transposition of great vessels : keep ductus arteriosus open, go for
surgery.