CLINICAL CLERKSHIP Cholelithiasis

WA UTZ
SURGERY S. Amylase
S. Alk Phos
FNAB MATERIALS
10 cc syringe
FUNCTIONAL CONSTIPATION
G21 needle
Lactulose 30cc ODHS hold for BM>2x a day
Sterile gloves
OS #10
BREAST MASS
Glass slides #10
Observe for 1 menstrual cycle
Breast UTZ
EXCISION MATERIALS
FNAB
Sterile Gloves #2
s/p excision: Annual mammogram and CBE
Blade 10 #1
Lidocaine #2
SURGICAL SITE INFECTION
10 cc syringe #2
Cefuroxime 500mg/tab 1tab BID x 7days
OS #10
Metronidazole 500mg/tab 1tab TID x 7days
Plaster #1
Specimen cup #1
Betadine #1
Silk 3-0 #1
PNSS 1L for flushing

CP CLEARANCE
CBC, Plt
Blood typing
UA
CT, BT, Protime
FBS, Lipid Profile
Creatinine
SGPT
S. Na, K, Ca
12 leads ECG
CXR PA
If for cholecystectomy: add alk phos
If for thyroidectomy: add T3,FT4, TSH

FOR WOUNDS
Cloxacillin 500 mg/cap 1cap q6h x 7days
Celecoxib 200 mg/cap 1cap BID prn for pain
Daily wound dressing
Facial wounds: Co-amoxiclav 625mg/tab 1tab BID x
7days
For abscess: add Clindamycin 300mg/tab 1tab q6h x
7days
For abrasions: add Mupirocin ointment apply to
abrasions TID

BPH
KUBP UTZ
PSA
Tamsulosin+Finasteride 0.4mg/5mg/tab 1tab OD x 2wks
x 12wks
OB-GYN FETAL KICK COUNTS
At least 10 kicks within 2hrs after meals
1st PRENATAL VISIT
1. Prescribe CLEARANCE LABS
 KY Jelly #1  12 leads ECG
 Surgical Gloves #1  CXR PA
 Glass Slides #4  CBC, ABO/Rh type, CT, BT, Protime
 Cotton Applicator #1  UA
2. Prenatal Record  Crea, BUN, ALT, AST, S. Na, K,
3. Routine Labs  Lipid Profile, FBS, HBSAg
 CBC, ABO/Rh type AOG EXCESS DAYS
 FBS 1/7: 0.14 4/7: 0.57
 UA, FA 2/7: 0.29 5/7: 0.71
 Anti-TP, HBSAg 3/7: 0.43 6/7: 0.86
 GS of vaginal discharge
GRADING OF EDEMA
 Pap smear
Grade 0 Absent or unilateral
 UTZ: <12wks Transvaginal
>12wks Transabdominal Grade 1 Mild: both feet/ankles
Indications: Grade 2 Moderate: both feet and lower legs/
<20 wks: fetal viability, baseline biometry hands, or lower arms
>32 wks: fetal growth monitoring Grade 3 Severe: generalized bilateral pitting edema,
>37 wks: biophysical profile, placental localization, final including both feet, legs, arms, and face
presentation
POSTPARTUM
Using UTZ for Aging: 1. Iron tab OD
<22 wks Early 2. Mefenamic Acid 500mg q6h prn for pain
>22wks Late 3. Oxytocin Ampule
4. Cefuroxime 500mg/tab BID x 7days
4. Prescribe POST-CURETTE
<20 wks >20 wks 1. MTV + Iron
MTV+Iron OD MTV+Iron OD 2. Mefenamic acid 500mg q6h prn for pain
Folic Acid OD Calcium+VitD OD 3. Clindamycin
Calcium+VitD OD Prenatal Milk 1 glass BID
Vit B Complex OD Feminine Wash BID TT/Td SCHEDULE
Prenatal Milk 1 glass BID TT1 First prenatal visit or as early as possible
Feminine Wash BID TT2 At least 4 weeks after TT1
TT3 At least 6 mos after TT2 or at next pregnancy
PRENATAL FOLLOW UP TT4 At least 1 year after TT3
<28wks: q4wks TT5 At least 1 year after TT4
28-36wks: q2wks
>36wks: qweekly PELVIC EXAM
I: Negative
OGTT 75grams: 24-28 weeks SE: Smooth pinkish cervix, (-) masses, (+) minimal
Prescribe: 75g glucose solution bleeding at vaginal vault
Mix ¼ sachet in 200ml water with 1-5 calamansi IE: Admits tip, smooth pinkish cervix, (-) CMT
NPO post-midnight BME: Flat soft nontender abd, small corpus, (-) Adnexal
50g GCT 75g OGTT 100g OGTT masses
Fasting 92 mg/dl 105 mg/dl RVE: GST, (-) masses
1H >140mg/dl 185 185
2H 140 155 FUNGAL INFECTION: Nystatin cream BID x 14days
3H 140
mmol to g/dl: divide by 0.055
OB DIAGNOSIS
Antenatal:
G_P_ (term, preterm, abortions, living children)
__ weeks AOG
By LMP or early/late UTZ
Position: e.g. cephalic, breech, transverse
In labor / Not in labor
Other antenatal dx:
Threatened abortion
PROM x # of hours ruptured
Placenta previa
Abruptio placenta
Arrest or descent/ cervical dilatation

Post-natal:
G_P_
Delivered to a:
Live/stillborn
Full/pre/post term
Male/female neonate
Via: NSVD, breech extraction, outlet forceps, etc.
With APGAR Score of _ at 1min, and _ at 5mins
Other postnatal dx:
Non-institutional delivery
Severe meconium stained
Neonatal sepsis