All Subjects Flashcards
Presbycusis is . . .
Age related hearing loss - bilateral symmetric
What are the two crises of sickle cell anemia
Aplastic crisis = low retic count without splenomegaly
Splenic sequestration crisis = normal retic count with splenomegaly
Side effect of high dose niacin therapy is . . .
Cutaneous flushing and generalized pruritus due to peripheral vasodilation
Rubella signs are (beware rubella in the unvaccinated child)
Aphalocaudalrash with localized lymphadenopathy and athralgias
Who boo sicker rubella or measles
M eagles! Similar symptoms but measles has prodrome of cough and conjunctivitis
What are the signs of autoimmune hepatitis
Abnormal hepatic cellular lab pattern (increased AST and alt ) otherwise asymptomatic w mo other identifiable aetiology
Alcohol hepatitis expect what lab pattern
AST to ALT of 2 to 1
What are the best predictors of postoperative lung resection outcomes
FEV1 and DLCO
What does hypoosmolality in stool indicate
Addition of dilutants to stool osmolality generally remains constant in organic GI disease
Elevated Mg or phosphate in stool electrolytes suggests what
Overuse of saline osmotic ( laxatives)
What are the CSF findings in aseptic viral meningitis
Lymphocytosis mildly elevated protein and normal glucose
Common court of viral meningitis in adults
Enterovirus but also HIV (in sexually active)
Vitiligo creates _____________ macules due to _________
Flat, white macules due to melanocyte destruction often associated with (autoimmune disease (type 1 dm)
What is the tumor antigen pattern for cholangiocarcinoma and hepatocellular carcinoma
Cholangiocarcinsma increased CA-19-9/CEAwith normal AFP
Hepatocellular carcinoma normal CA-19-9/CEA and increased AFP sometimes
Acute organ rejection is in what timeframe
6 worths of transplant (T cell mediated response)
Describe acute, unilateral cervical lymphadenitis
Children with recent respiratory infection present with enlarged markedly tender worm erythematous cervical nodule with but well-appearing
Treatment for acute unilateral cervical lymphadenitis in children
Clindamyain
Describe group b streptococci
Gram positive cocci in pairs and chains called streptococcus agalactiae
While GBs is most common cause of early neonatal sepsis in the first week it can also cause late onset infection de to
Horizontal transmission in the home
How des hyperthyroidism cause A. Fib
Increased beta adrenergic receptor expression that’s why treat with beta blockers
What does beta blocker toxicity look like
Hypotension bradycardia bronchospasm aLOC Hypoglycemia
Antipsychotics cause side effects because they block the blockage of dopamine so we see
Hyperprolactinemia girecomastia galactorrhea menstrual cycle dysfunction decreased libido
Why do adolescents who recently started menstruating have regular cycles and heavy or prolonged seeding
Docto immaturity of the pituitary ovarian axis can cause duration takes awhile to mature and regularized
Prepubertal boy with soft coiled rightsided scrotal mass that fails to decompress when supine Diagnosis is
Secondly varicocele _ look for source of venous compression
Symptoms of increased intracranial pressure
Headache. (Worse at night) nausea and vomiting mental status change SoCal neurological signs (vision changes unsteady gait)
Signs and symptoms of Kawasaki disease
Fever for more than five days, conjunctivitis, mucositis (strawberry tongue), cervical lymphadenopathy rashs erythema Edema of hands/feet increased WBC and platelets decreased hemoglobin
Describe the celiac stool
Foul smelling greasy abating stool (steatorrhea)
Tuberous sclerosis signs and symptoms
Derm stuff, neurological (enslestons, epilepsy, autism, intellectual disability)
Tumor factors for ovarian vs. Colorectal
Ovarian ca-125
colorectal CEA
Discuss pCO2 in acute asthma exacerbation (normal, elevated?)
Should be low, if normal or elevated this suggests impending respiratory failure
What is a common cause of pericardial effusion
Malignancy
Low do you treat pericardial effusion
Pericardiocentesis initially then pericardial window or prolonged catheter to prevent reaccumulatlon
PDE-5 inhibitors are contraindicated in patients taking nitrates because
Can head to severe hypotension
Most common organism to cause epiglottitis
Haemophilus influenza B and staph aureus so have to cover both with antibiotics (vancomycin and ceftriaxone)
Treatment for pinworm (enterbius vermicularis)
Pyrantel pamoate or albendazole
What nerve can brachial artery canullation injure
Median
Infective endocarditis following dental procedures is most commonly caused by what bug
Viridian’s streptococci
Nitroprusside is often used in hypertensive emergencies what do You have to watch out for with prolonged infusions or high dose.
Cyanide toxicity because metabolized to nitric oxide and cyanide ions
Symptoms of cyanide toxicity
Altered LOC, lactic acidosis, seizures, coma.
Name the 4 lung cancers and their main differentiating signs
Adenocarcinoma = clubbing
squamous cell carcinoma = hypercalemia cavitation
small cell carcinoma = Cushing syndrome SIADH
large cell carcinoma = gynecomastia galactorrhea
If you suspect-spinal metastasis that are causing cord compression what is first action
Glucocorticoids without delay then imaging
Symptoms of ethylene gland poisoning are
Flank pain, Hematuria with oliguria and cranial nerve palsies and hypocalcemia
Treatment of ethylene glyadl poisoning is
Fomepizole a competitive inhibitor
What test is strongly indicative of patellofemoral pain syndrome
Tonic contraction of quadriceps causing pain (ex. Squatting)
Small painful papules in the beard area diagnosis likely
Pseudofolliculitis barbae
Signs of severe aortic stenosis
Exercise intolerance exertion dysprea, left ventricular hypertrophy on ECG syncope
Best antibiotic for UTI’s in children
Cefixime
What is the big concern with posterior knee dislocation
Popliteal artery injury need thorough vascular exam (ABI, U/S, pulses)
Do VSD’s need treatment usually
No most close-spontaneously worry if hemodynamics instability
Young women with abdominal bruit and other signs of unilateral renal artery stenosis is vary indicative of
Fibromuscular dysplasia
What is the active precursor to T3 and T4 and where is it produced
Thyroglobulin produced by normal or cancerous thyroid tissue (can track as a pseudo tumour marker)
Carbadopa-levodopa can cause what concerning side effect and what do you do
Psychotic symptoms so consider dose lowering
Patients who experience sexual assault are at high risk for developing what 2 psychiatric issues
PTSD and depression with suicidality
Abx safe in pregnancy are
Penicillins cephalosporins (cephalexin) and Fosfomycin
Aspirin exacerbated respiratory disease is characterized by
Asthma, bronchospasm/nasal congestion following ingestion of NSAIDs with chronic rhinosinusitis and nasal polyposis
What is the initial management of neonate with billious emesis peritoneal signs and hemodynamic instability
Emergency exploratory laparstory
Undiagnosed pleural effusion best evaluated by
Thoracentesis
What is gaucher disease
Autosomal recessive disorder of lysosomal storage
Features of gaucher disease
Hepatosplenomegaly anemia, thrombocytopenia, bony pain, failure to thrive delayed puberty
What is the lung complication of neonates with mothers with uncontrolled diabetes
Delayed lung maturation heading to respiratory distress syndrome
Hemi section of the spinal cord (brown-sequard syndrone) presents how
Ipsilateral hemipareisis ipsilateral diminished procisception/vibration/light touch and contralateral diminished pain and temperature sensation
What are the signs of intussusception on ultrasound
“Target’ sign “ colon wall, lumen, and then another structure which is the ilieum - this is diagnostic
Treatment of intussusception
Air or water soluble contrast enema
Most common cause of heavy regular menses in adolescents
Von willebrand disease-will see normal coagulation studies or prolonged PTT
Name 3 bacteria within the viridas gap streptococci
Strep mutants, S mitis S oralis S sanguinis
Viridans grap streptococci common where and what disease do they often cause
Oral mucosa - cause IE following dental procedures with underlying value defects
What are 6 indications for cervical CT
High-energy mechanism, neurological deficit, spinal tenderness, aLOC, intoxication, distracting injury
What is the triad of IgA vasculitis (henoch-scholein Purpura)
Hip arthralggia abdominal pain lower extremity petechial rash
Treatment of massive hemoptysis
Bronchoscopic intervation emobilization or resection
What procedure increases risk of cervical insufficiency
Cervical cone biopsy
Sign and Symptoms of Eustachian tube defects
Ear fullness/discomfort tinnitus conductive hearing loss “popping” sensation
Prophylactic treatment of non-bleeding esophageal varices
Non-selective beta blockers or variceal ligation
What is post streptococcal glomerulonephritis
Immune-mediated disease where immune complexes are deposited in the GBM after a group A strep infection
What is subclavian steal syndrome
Stenosis or occlusion of the proximal subclavian artery and reversal of flow in ipsilateral vertebral artery causing upper extremity ischemia, dizziness, ataxia, and disequilibrium
What bug is associated with nasspharnygeal carcinomas
Reactivation of epstein-barr virus
Manifestations of nasopharyngeal carcinomas
Epistaxis, headaches, cranial nerve palsies, and otitis media
Antibiotics can cause a serum sickness like syndrome in children manifesting as
Low grade fever urticarial rash arthralgia - resolve without sequelae .
What is the difference between a coroner and medical examiner
Medical examiners are pathologists, coroners can be pretty much any professional
What deaths have to be reported to coroner or ME
All provinces have different document but querally sudden or unexpected deaths, or deaths resulting from evidence, accidents negligence misconduct malpractice or self-inflicted
What is the coroners mandate to answer)
Who when where why (cause of death) and by what means (manner of death - by balance of probabilities) - it is fact finding only not fault
Autopsies arc ordered when and done bny
Only ordered when manner of death cannot reasonably be determined conducted by pathologist
Name the 4 ethical pillars
Autonomy beneficence non-maleficence justice
Capacity is dynamic rector each decision determined by the physician but competence is
Competence is a legal term deeded by the courts
Years of Medical car act and Canada health act
1966-federal gov. Pays 50% of medical insurance
1984-imposed conditions on Federal funding
What are the 5 principles of the Canada Health act
Public administration, comprehensiveness, universality, portability, accessibility
What is the process for getting mard approved
Provincial form complete witnessed properly, then 2 clinical assessment it death foreseeable, no extra or waiting not foreseeable more safeguards minimum 90 dayassessment
Canada’s age of consent is and the nuances
16, but 18 if partner in position of power or authority, 14 and 15 year olds can consent to 5 years older and 12 and 13 year olds can consent to 2 years older.
What sexual activity of a minor must you report and where
any sexual activity that is non-consensual either by person report or by age of consent laws and report to MCFD (in BC)
What is the public safety exception of reporting
can break confidentiality and report if there is a clear risk to an identifiable person or group of persons and there is clear, imminent risk to those peoples.
definition of a stillbirth
over 20 wks GA OR weighs more than 500 grams. - all stillbirths must be reported!
What is the RADAR acronym for IPV
Remember to ask Ask directly Document findings Assess for safety Review options after Follow up
What are the five phases of pain
transduction conduction transmission modulation perception
What is morphine equivalence
dose of opioid that will give the same effect as 1mg of morphine
What are the seven common side effects of opioids
nausea constipation drowsiness/confusion dizziness dry skin vomiting sweating
What are 5 complications of prolonged opioid use
hypogonadism sexual dysfunction sleep apnea opioid induced hyper analgesia opioid use disorder
what is an appropriate starting MME dose for opioid naive patient and how do you titrate
30, titrate by no more than 10 mg/day or approx. 25% of total dose, commonly see increase by 10% of total daily dose if need more pain coverage
definition of cultural competence
a set of congruent behaviours attitudes and policies that come together in a system agency or among professionals and enable that system or those professionals to work effectively in cross-cultural situations.
What opioids are okay in pregnancy and which are not so much
morphine and hydro morph are okay
tramadol and fentanyl should be avoided
define gender
cultural constructed roles, behaviours and expressions
define sex (as in male and female)
biological attributes, internal and external genitals and hormones, gene expressions, karyotype. Assigned at birth by appearance of external genitals.
define gender identity and gender expression
identity = sense of who you are and who you perceive yourself to be expression = how we choose to present ourselves to the world.
For a plaintiff to be successful in a claim against a doctor they must prove what 4 things
Duty of Care
Breach of Duty
Harm or Injury
Causation
What do we prevent with erythromycin at birth
Infant gonococcal conjunctivitis (eyelid swelling, purulent drainage and injection)
What blood thing is a contraindication to OCP
Thrombophilia (factor V Leiden antiphospholipidsyndrome)
With dilated cardiomyopathy and history of alcohol abuse once all other diagnoses have been excluded consider
Alcoholic cardiomyopathy
What is the antibody present in 90% of hashimoto’s thyroid disease
Anti thyroid peroxidase (anti-TPO) and antithyroglobulin
What is antiphospholipid syndrome
Autoimmune disorder can present with recurrent pregnancy loss venous thrombosis and mild thrombocytopenia prolonged PTT
Antiphospholipid syndrome can cause what false positive
VDRL test (syphilis)
What are the H’s and T’s
Hypo volemia, hypoxia, hypothermia, hyper/hypokalemia, hydrogen (acidosis)
Tension pneumothorax, tamponade, toxins, thrombosis (cardiac or pulmonary)
Lacunar strokes of the posterolateral Thalamus present with
Sudden onset contralateral sensory loss and then later a thalamic pain syndrome (paroxysmal burning pain exacerbated by light touch)
Male secondary hypogonadism can be caused by what 3 things
opioids
glucocorticoids
exogenous androgens
symptoms of digoxin toxicity
anorexia N/V abdominal pain fatigue confusion weakness colour vision alterations life threatening arrhythmias
How does Pre-eclampsia precipitate acute ischemic stroke
endothelial cell damage
what does a posterior hip dislocation look like
shortened leg internally rotated with hip held in flexion and adduction
congenital adrenal hyperplasia - what is it
autosomal recessive disorder of 21-hydroxylase deficiency which presents ambiguous genitalia in girls.
CHARGE syndrome =
Coloboma (iris defects) Heart defects Atresia Choanae (nasal blockade) Retardation of growth/development Genitourinary anomalies Ear abnormalities
What is Galactosemia
newborn autosomal recessive GALT deficiency where can’t metabolise galactose to glucose.
clinical findings of Galactosemia
jaundice and hepatomegaly
vomiting/failure to thrive
cataracts
increased risk of E Coli sepsis
U/S findings of epithelial ovarian carcinomas are
solid mass with thick septations
ascites
Systemic arterial pressure normally falls less than 10 mmHg during inspiration an exaggerated from is referred to as pulses paradoxus and is most commonly seen in patients with what
cardiac tamponade
severe asthma
COPD
What precautions are required for measles
airborne
genitourinary symptoms of menopause include:
vulvovaginal dryness, irritation, pruritus, dysparenuria, vaginal bleeding, urinary incontinence, recurrent UTI’s and pelvic pressure.
what is the treatment of ankylosing spondylitis
NSAIDS, COX-2 inhibitors - first line
TNF-alpha inhibitors or Anti-IL-17 antibodies.
Most common cause of an isolated asymptomatic elevation of alkaline phosphatase in an elderly patient is
Paget disease of bone
What is Beckwith-Wiedemann Syndrome
overgrowth disorder due to chromosomal mutation.
what are the signs/symptoms of Beckwith-Wiedemann Syndrome
fetal macrosomia, rapid growth until late childhood, omphalocele or umbilical hernia
macroglossia and hemihyperplasia.
clinical presentation of polycystic kidney disease
asymptomatic until 30-40 then flank pain, hypertension, and palpable bilateral above masses with abnormal kidney labs
Syringomyelia is a disorder where a fluid-filled cavity forms within the spinal cord and symptoms include:
dissociated sensory loss (loss of pain/temp but not vibration), often in a cap distribution, and weakness that affects the upper extremities
What is blepharospasm
form of focal dystonia characterised by recurrent forceful contraction of the eyelid muscles - bright lights can acts as a trigger
what are the most common drug induced haemolytic anemia triggers
NSAIDS, Cephalosporins (ceftriaxone), Penicillins (Pip-Tazo), - mediated by hapten hemoysis
what is erythema multiforme
