The Washington Manual Internship Survival Guide by unknow

Author:unknow
Language: eng
Format: epub
Tags: Medical, Internal Medicine
ISBN: 9781469830131
Google: zjX3qT3kOuUC
Publisher: Lippincott Williams & Wilkins
Published: 2013-03-21T08:00:00+00:00

• Treatment: Antibiotics should not be withheld if the head CT and lumbar puncture cannot be obtained rapidly. Obtain blood cultures prior to starting antibiotics, as a significant percentage of bacterial meningitis patients will have bacteremia. Antibiotic coverage should include ceftriaxone 2 g IV q12h and vancomycin dosed for weight and creatinine clearance (see Chapter 20). Ampicillin 2 g IV q4h can be considered for patients at risk for Listeria. If viral meningitis is suspected, start acyclovir 10 mg/kg (ideal body weight) q8h empirically while the HSV PCR is pending. The PCR will remain positive for several days after initiating treatment, so acyclovir should not be delayed. See Table 21-2 for additional treatment recommendations.

OBSTETRICS AND GYNECOLOGY

The OB/GYN History and Physical Examination

• Perform a basic GYN H&P prior to calling a consult!

• Gynecologic history:

• Menstrual history:

▪ Last menstrual period (LMP)?

▪ Age at menarche?

▪ Age at menopause? Any postmenopausal bleeding?

▪ If a menstrual problem seems central to the chief complaint, consider asking about menstrual length, inter-menstrual duration, amount of menstrual bleeding (number of pads/day, degree of soilage of pads), and presence of dysmenorrhea.

• Pap history: Date of last pap? Any history of abnormal paps?

• Contraceptive history: Currently using anything to prevent pregnancy?

• Hormone use: Any history of exogenous hormone use (e.g., in postmenopausal women)?

• Sexual history: Currently sexually active? History of any STIs?

• Gynecologic procedure history: Date and type of any gynecologic procedures/surgeries, for example, bilateral tubal ligation (BTL), diagnostic laparoscopy for endometriosis, unilateral or bilateral salpingo-oophorectomy (USO/BSO), loop electrosurgical excision procedure (LEEP)?

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