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Clerkship > Ambulatory > Flashcards

Ambulatory Flashcards

1
Q

Medication tx for BPH

A

1st line = alpha blockers (-sin)
2nd line = 5-alpha reductase inhibitor (prevents T –> DHT; DHT causes hyperplasia) ex. finasteride
Combo if prostate large

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2
Q

Symptoms of BPH

A 
Weak stream
Intermittency
Straining
Emptying incomplete 
Hesitency
Post-void dribbling
Nocturia
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3
Q

Indications for BPH surgery

A 
Urinary retention 
Recurrent UTI 
Recurrent or persistent gross hematuria
Bladder stones
Renal insufficiency
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4
Q

Mammogram screening regular risk women

A

Q2-3y 50-74
No routine clinical breast exam alone or in conjunction with mammography to screen for breast CA
No need to recommend routine breast self-exam

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5
Q

Mammogram screening for high risk women

A

Q1 yr 40-74

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6
Q

Colorectal CA screening for average risk individual

A

Begin at age 50
FOBT q1-2yr
Colonoscopy/flex sig q10y
No screening after age 75

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7
Q

Colorectal CA screening for individual with +ve fam hx for HNPCC or FAP

A
  1. Genetic counselling and special screening
  2. HNPCC: colonoscopy q1-2y starting age 20 or 10y younger than earliest case in family (whichever first)
    FAP: Sigmoidoscopy annually, starting age 10-12
    AAPC: Colonoscopy annually starting age 16-18
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8
Q

Colorectal CA screening for individual with 1st degree relative with CA or adenomatous polyp at age <60 or 2 or more 1st degree relatives with polyp or colon CA at any age

A

Colonoscopy q5y

Begin age 40 or 10y younger than earliest polyp or cancer case in family

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9
Q

Colorectal CA screening for individual with one 1st degree relative with cancer or adomatous polyp affected at age >60 or 2 or more second degree relatives with polyps or colon CA

A

Average risk screening

Begin at age 40

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10
Q

Colorectal CA screening for individual with one second degree relative or third degree relative affected

A

Average risk screening

Begin at age 50

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11
Q

Cervical CA screening

A

Pap smear age >/= 25 q3y

Once age >/= 70, if 3 normal tests in a row and no abnormal tests in last 10y, can discontinue screening

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12
Q

Cervical CA screening, inadequate sample

A

Repeat cytology in 3mo

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13
Q

Abnormal squamous cell of unknown significance (ASCUS)

A

<30y.o. = repeat cytology in 6mo
> 30 = HPV DNA testing
If Positive –> colposcopy

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14
Q

Abnormal squamous cells cannot rule out high grade squamous intraepithelial lesion (ASC-H)

A

Colposcopy

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15
Q

Atypical glandular cells of unknown significance (AGUS)

A

Colposcopy +/- endometrial sampling

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16
Q

Low grade squamous intraepithelial lesion (LSIL)

A

Colposcopy OR repeat cytology in 6mo

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17
Q

Important points for cervical screening

A
  • Pregnant women and women who have sex with women should follow routine cervical screening
  • Hysterectomy = total –> only swab vaginal vault if hx of uterine malignancy/dysplasia
    = subtotal –> continue regular screening
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18
Q

Routine prostate CA screening

A

PSA test NOT RECOMMENDED for any age group

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19
Q

Dyslipidemia screening

A

q1-3y in males >40y.o. and females >40y.o. or who are menopausal
OR at any age with additional dyslipidemia risk factors

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20
Q

Framingham Risk Score

A

10yr mortality risk
<10% = low risk
10-19% = Moderate risk
>20% = High risk

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21
Q

Target for dyslipidemia tx

A

=2mmol/L LDL-C or >/= 50% decrease

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22
Q

When to tx dyslipidemia

A

High risk –> tx all
Moderate risk –> tx if LDL >/= 3.5mmol/L, ApoB >1.2g/L or Non-HDL-C >4.3; or men >/=50 or women >/= 60 with one additional RF (ie. low HDL, impaired fasting glucose, high waist circumference, smoker, HTN)
Low risk –> tx if LDL >/= 5 or familial hypercholesterolemia
Monitor lipids q6-12mo if adequate response on statin

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23
Q

Statin MOA

A

HMG-CoA reductase inhibitors

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24
Q

Other dyslipidemia tx option

A

Ezetimibe (cholesterol absorption inhibitor) - post-ACS, combine with statin for reduced mortality benefit

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25
Q

Conditions that automatically require statins

A 
DM (age >40 or >30 with 15yr duration or microvasc complications)
CKD 
AAA
Clinical atherosclerosis 
Very sig LDL or cholesterol fam hx
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26
Q

Contraindications to inactivated vaccines

A

Hx of anaphylaxis to previous dose of vaccine, or to component of vaccine

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27
Q

Contraindications to live vaccines

A

Hx of anaphylaxis to previous dose of vaccine, or to component of vaccine, severely immunocompromised pts (ie. HIV with CD4 <200), pregnant patients

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28
Q

ADLs

A 
DEATH
Dressing
Eating 
Ambulating 
Toileting 
Hygiene
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29
Q

IADLS

A 
SHAFT
Shopping
Housekeeping 
Accounting
Food prep 
Telephone/Transportation
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30
Q

Geriatric giants

A

Immobility
Instability
Incontinence
Intellectual impairment

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31
Q

2 month immunizations

A
  1. DTaP, Hep B, Hib, Polio (IPV)
  2. Pneumococcal
  3. Rotavirus
  4. Men conjugate C
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32
Q

4 month immunizations

A
  1. DTap, Hep B, Hib, IPV
  2. Pneumococcal
  3. Rotavirus
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33
Q

6 month immunizations

A
  1. DTaP, Hep B, Hib, IPV

2. Hep A (offered to Aboriginal patients)

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34
Q

12 month immunizations

A
  1. Pneumococcal
  2. Men conjugate C
  3. MMR
  4. Varicella
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35
Q

18 month immunizations

A
  1. DTaP, IPV, Hib

2. Hep A (offered to aboriginal patients)

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36
Q

4 year immunizations

A
  1. DTaP, IPV
  2. MMRV
  3. Hep A (offered to aboriginal patients)
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37
Q

Live vaccines

A 
Rotavirus 
Varicella 
MMR 
Nasal influenza
Shingles/Zoster
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38
Q

Ventolin

A

Salbutamol
SABA
Blue puffer

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39
Q

Atrovent

A

Iptratroprium bromide

SAMA

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40
Q

Salmeterol/SereVent

A

LABA

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41
Q

Aclidinium bromide

A

LAMA

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42
Q

Lumbar strain

A

Acute onset (possibly with injury)
Worse with activity, relieved with rest
Paraspinal spasm/tenderness

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43
Q

Disk herniation

A

Worse with sitting
Radiation to lower extremities in dermatomal pattern
+ve straight leg raise test
MRI if sx >4wks

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44
Q

Degenerative disk disease

A

Worse with flexion/sitting

Chronic

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45
Q

Facet disease

A

Worse with extension, standing, walking

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46
Q

Spondylolisthesis

A

Leg pain > back pain
Worse with extension, better with flexion
Worse with activity

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47
Q

Spinal stenosis

A

Relieved with sitting/flexion
Lower extremity parenthesis
Neurogenic claudication

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48
Q

Ankylosing spondylitis

A 
Younger male 
Morning stiffness, night pain
Relieved by activity 
SI, spinal, hip and shoulder 
Peripheral arthritis (dactylitics)
HLA-B27 
2 forms: ankylosing spondylitis (radiographic evidence of sacroilitis) or non-radiographic asSpA
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49
Q

Reactive arthritis

A

Hx of recent GI/GU infection
Lower extremities commonly infected
Uveitis, arthritis, urethritis

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50
Q

Psoriatic arthritis

A

Asymmetric and distal joint involvement

SI joint involvement

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51
Q

Common viruses associated with common cold

A 
Rhinovirus** 
Coronavirus 
Adenovirus
Respiratory syncytial virus (RSV)
Influenza 
Parainfluenza 
Coxsackie
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52
Q

Mono virus

A

Epstein barr virus

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53
Q

Mono triad of symptoms

A

Fever
Tonsillar pharyngitis
Lymphadenopathy

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54
Q

Mono features that distinguish it from strep

A

Significant fatigue
Posterior cervical chain or generalized adenopathy
Splenomegaly

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55
Q

Mono lab findings

A

Atypical lymphocytosis

Positive monospot test

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56
Q

Centor criteria for GAS

A 
Cough absent 
Exudate on tonsils 
Nodes (anterior cervical chain) 
Temp >38 
young (+1 for <15) OR old (-1 for >45) 
0-2 = no swab, no tx 
3 = swab, no tx until +ve 
4+ = swab, tx with abx prophylactically, stop if -ve
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57
Q

GAS abx choice

A

Penicillin (or erythromycin for its allergic to penicillin)

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58
Q

Common bacterial causes of otitis media

A 
Strep pneumo (50%) 
H influenzae (30%) 
M catarrhalis 
GAS 
S. aureus
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59
Q

Otitis media triad

A

Otalgia
Fever
Conductive hearing loss

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60
Q

1st line medical tx for otitis media

A

Amoxicillin 75mg/kg/d to 90mg/kg/d divided into TID for 10d

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61
Q

2nd tx for otitis media after failed first line (no improvement in 2-3d)

A

Amoxclav: amor 90mg/kg/d + clay 6.4mg/kg/d divided into BID for 10d
If amoxclav fails then consider Ceft 50mg/kg IM/IV OD x3 doses

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62
Q

BMI

A 
< 18.5 = underweight 
18.5-24.9 = normal
25-29.9 = overweight 
30-34.9 = Obesity class I 
35-39.9 = Obesity class II 
40+ = Obesity class III
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63
Q

Normal waist circumference

A 
Men = 102cm (40in) 
Women = 88cm (35in)
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64
Q

Weight loss >___% is clinically significant for reducing CVD risk

A

5

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65
Q

Dyslipidemia: Normal b/w

A

Total cholesterol <5.2
HDL >1
LDL <3.5
Triglycerides <1.7

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66
Q

Gonococcal disease tx

A

Ceftriaxone 250mg IM single dose
Azithromycin 1g orally in single dose
If no risk factors, screen 6-12mo post-tx
If risk factors, test of cure (culture 4d post-tx or urine PCR 2wk post tx)

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67
Q

Non-gonoccocal disease tx

A

Azithromycin 1g PO + Ceftriaxone 250mg IM

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68
Q

Genital herpes tx

A

Acyclovir 200mg PO 5x/d for 5-10d or Valacyclovir 1000mg PO BID x10d
If recurrent:
Acyclovir 200mg PO 5x/d for 5d or 800mg PO TID x2d
OR valacyclovir 500mg PO BID x3d or 1000mg PO OD x3d

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69
Q

Syphillis

A

Benzathine penicillin G IM

Continuous F/U until seroneg

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70
Q

Asthenia

A

sense of weariness, exhaustion

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71
Q

Diabetes screening

A

> 40y.o., screen q3yrs

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72
Q

PID minimal clinical criteria

A
  • Lower abode pain
  • Cervical motion tenderness
  • Adnexal tenderness
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73
Q

PID - Inpt tx regimens

A
  1. Cefoxitin 2g IV q6h + Doxycycline 100mg PO q12h (switch to oral 24-48h after clinical improvement)
    OR 2. Clindamycin 900g IV q8h + gentamicin loading dose 2mg/kg IV then 1.5 mg/kg IV q8h
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74
Q

PID - Output tx regimens

A
  1. Ceftriaxone 250mg IM single dose + Doxycycline 100mg PO BID for 14d
    IF gonorrhoea not cause: Levofloxacin 500mg PO daily for 14d
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75
Q

Top 3 renal stones

A
  1. Ca-oxalate
  2. Struvite
  3. Uric acid
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76
Q

Beck’s Triad of cardiac tamponade

A
  1. Muffled heart sounds
  2. Elevated JVP
  3. Hypotension
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77
Q

Gold standard imaging for PE

A

Pulmonary angiogram

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78
Q

PE triad of tests for low pre-test probability

A
  1. CXR
  2. ECG
  3. D-dimer
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79
Q

D-Dimer level suggestive of PE R/O

A

If <50: <500 U/mL

If >50: < age x 10

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80
Q

Criteria for outpatient PE management

A

MUST MEET ALL CRITERIA

  1. Vital signs stable
  2. SpO2 >92% on RA
  3. Chest pain resolved
  4. No hx of cardiopulmonary disease
  5. No syncopal event
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81
Q

PE management

A

IV UFH (monitor aPTT q6h, keep within 50-90)

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82
Q

ACA infarct

A

Contralateral leg weakness > arm weakness

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83
Q

MCA infarct

A

Most common stroke
Contralateral weakness/numbness affecting arm > leg
If DOMINANT hemisphere affected (usually left) = aphasia
Homonymous hemianopsia and gaze preference TOWARD side of lesion
If NON-DOMINANT hemisphere affected = inattention, neglect, extinction of simultaneous stimulation

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84
Q

PCA infart

A

Its may be unaware of deficits
Motor minimal
Visual abnormalities - homonymous hemianopsia
Light touch and pinprick may be sig reduced

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85
Q

Vertebrobasilar

A

Crossed neuro deficits (ipsilat CN deficits with contralateral weakness)
Dizziness, vertigo, diplopia, dysphagia, ataxia, CN palsies and limb weakness

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86
Q

Basilar

A

Severe quadriplegia, coma, locked in syndrome

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87
Q

Cerebellar

A

Sudden inability to walk or stand (drop attack)

Vertigo, nausea, vomiting, back pain

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88
Q

Lacunar

A

Pure motor OR sensory deficits

Commonly a/w chronic HTN

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89
Q

TPA absolute contraindications

A 
Intracranial hemorrhage on CT 
Neurosurg, Sig head trauma or prior stroke in prev 3 mo 
Symptoms suggest SAH 
Hx of prev intracranial hemorrhage 
Intracranial neoplasm, AVM, aneurysm 
Activei eternal bleeding 
Suspected/confirmed endocarditis 
Elevated BP (>185SBP or >110DBP) 
Acute bleeding diathesis  (plt <100; heparin within 38h causing elevated aPTT; anticoagulant with INR >1.7 or PT >15s; use of thrombin or factor Xa inhibitors with elevated lab tests)
Blood glucose <2.7
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90
Q

Ischemic stroke treatment

A

tPA within 4.5h if no contraindications + ASA or clopidogrel in 24h
If tPA window missed/CI, ASA or clopidogrel given right away
Thrombectomy in anterior circulation stroke (within 6h of last seen normal); in posterior circulation stroke no time cutoff
If pt candidate for thrombectomy and thrombolysis, do both
No evidence for anticoags unless secondary prevention in fib and embolic strokes

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91
Q

Goal BP in AAA

A

100-120 SBP

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92
Q

Acute elevated BP management

A
  1. Nitroprusside + Propranolol

OR 2. Labetolol

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93
Q

Auscultation sound for pericarditis

A

Friction rub best heard at LLSB

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94
Q

Pericarditis ECG stages

A

1 (hours to days): Diffuse ST elevation in inferior and anterior leads; may have PR depression (pathopneumonic)

2: transiently normal
3: Deep symmetrical T-wave inversion
4: Permanent T-wave inversion or normal

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95
Q

Pericarditis tx

A
  1. Pain management - Indocid 50mg q8h +/- corticosteroid if very severe
  2. Abx +/- surgical drainage
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96
Q

BP d/t pulmonary edema management

A

Nitro SL 0.4mg; 2 sprays q5min
IV morphine 1-3mg
IV furosemide 60-120mg

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97
Q

Eclampsia BP target

A

DBP <100

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98
Q

HTN with stroke symptoms BP target

A

DBP < 115-120

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99
Q

Eclampsia BP tx

A

IV Mg + IV Hydralazine

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100
Q

HTN with CP or MI BP target

A

SBP < 170

DBP <110

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101
Q

Hypertensive urgency

A

Severely elevated BP (sys BP >220 or diastolic >120) with no evidence of target organ damage

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102
Q

Hypertensive emergency

A

Severely elevated BP with target organ damage

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103
Q

Ulnar gutter

A

Prox phalanx #D4-5
Metacarpal #D4-5
Boxer’s #

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104
Q

Radial gutter

A

Prox phalanx #D2-3

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105
Q

Volar slab

A

Metacarpal #D2-3

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106
Q

Thumb spica

A 
Thumb fractures (phalanx or metacarpal) 
UCL tear
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107
Q

1st line tx for otitis media

A

Watchful waiting for 48-72h IF:

  • pt >60mo
  • no hx of immunodeficiency, chronic dz, abnormality of head/neck, hx of complicated otitis media, DS
  • non-severe (fever <39, mild otalgia)
  • capable parents
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108
Q

Reasons to start abx for otitis media

A
  • has had abx in past 90d
  • does NOT attend daycare
  • very unwell (severe otalgia or mod-severe systemic illness)
  • unwell after48h analgesics
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109
Q

Reasons to refer to ENT for otitis media

A

3+ in 6mo or 4+ in 12mo (may require myringotomy & tympanovstomy)
facial paralysis
mastoiditis

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110
Q

Test of choice for pharyngitis

A

Rapid antigen detection test for strep antigens from throat swab

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111
Q

Management of acute asthma exacerbation

A

O2 to keep SpO2 93-95%
Ventolin 5mg neb + Atrovent 0.5 mg neb continuous or q20min for 1h
Methylprednisone IV 40-60mg OR prednisone 60mg PO
Mg Sulfate 2g IV over 20min

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112
Q

D/C instructions for acute asthma exacerbation

A

SABA q4-6h PRN
Pred 40-60mg/d for at least 5 days
Resume/start inhaled GCS

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113
Q

Gonorrhea gram stain

A

Gram negative diplococci

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114
Q

CT head rule

A 
High risk: 
Age >/= 65 
Basilar skull fracture signs (hemotympanum, battle sign) 
Consciousness (GCS <15) 
Depressed or open skull fracture 
Emesis >/= 2

Medium risk:
Retrograde amnesia >/= 30min
Dangerous mechanism (led hit by vehicle, ejected from vehicle, fall from 3ft or 5 stairs)

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115
Q

Canadian C-Spine Rules

A

Paresthesias in extremities
Age >/=65y.o.
Dangerous mechanism (Fall from >/=3ft/5 stairs, axial load injury, high speed MVC, bicycle collision, MVC)

Low risk: 
Sitting upright 
Ambulatory at any point 
Late onset neck pain 
no midline tenderness
Simple rear-ended MVC
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116
Q

Preferred regimens for urethritis/cervicitis

A

Cefixime 400mg PO single dose
Ceftriaxone 125mg IM + doxy 100mg PO BID for 7 days
Azithromycin 1g PO single dose

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117
Q

Preferred regimens for chlamydia/gonorrhea

A

Cefixime 800mg PO single dose + doxy 100mg PO BID for 10d
Ceftriaxone 250mg IM single dose + doxy 100mg PO BID for 10d
Ofloxavin 300mg PO BID for 10d

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118
Q

Meniere’s disease

A

Vertigo, fluctuating hearing loss that eventually results in permanent hearing loss, tinnitus and aural fullness

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119
Q

Trauma IV fluid resuscitation

A

Adult: 2L
Child: 20cc/kg over 10min

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120
Q

Trauma acute hemorrhagic resuscitation

A

Adults: 2U pRBCs
Children: 10cc/kg pRBCs

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121
Q

Cardiac Arrest - VTach or VFib ACLS algorithm

A

Defibrillate (120-200J if biphasic; 360J if monophonic) –> CPR for 2 min –> Epi 1mg q3-5min –> Amiodarone or lidocaine

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122
Q

5Hs and 5Ts of cardiac arrest

A 
Hypoxia 
Hypovolemia 
Hypo/hyperkalemia 
Hypothermia 
Hydrogen ion (acidosis) 
Tamponade 
Tension pneumo
Thrombosis pulmonary (PE)
Thombosis cardiac (MI)
Toxins
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123
Q

ACLS Bradycardia algorithm

A

Look for cause but don’t delay tx –> Airway if needed –> monitor HR and rhythm and BP –> if hypotensive/shock –> atropine 0.5mg q3-5min to 3mg –> if not working, use transcutaneous pacing or dopamine infusion or epi infusion

124
Q

Common causes of altered mental status

A 
TIPS AEIOU 
Trauma 
Infection 
Psych 
SAH, stroke, space occupying lesion, shock 
Alcohol/drugs 
Endocrine, electrolytes, environmental, epilepsy, encephalopathy 
Insulin
Oxygen
Uremia
125
Q

DONT cocktail for coma

A

D50W (50ml of 50%) - give to all unless confirmed glucose is ok with glucometer
Oxygen
Naloxone (if suspected overdose - unresponsive, hypoventilation, pinpoint pupils) - titrate from 2mg to 0.4mg or less IV/SC to avoid precipitating acute withdrawal
Thiamine (100mg IV) for patients at risk for vitamin B1 deficiency (EtOH, malnourished) to tx and prevent acute Wernicke’s encephalopathy

126
Q

Wernicke’s encephalopathy is caused by ____ deficiency

A

Vitamin B1

127
Q

Benzodiazepine antidote

A

Flumenazil (rarely used in OD setting as can cause withdrawal and lower sz threshold)
Mostly used in pt that normally does NOT use benzos

128
Q

Additional therapy for Na+ ch blocker induced dysrhythmia

A

Sodium bicarb

129
Q

Additional therapy for digoxin induced dysrhythmias

A

Digoxin antibodies

130
Q

Additional therapy for theophylline (PDE-I inhibitors) induced dysrhythmias

A

Beta blockers

131
Q

Examples of Na+ ch blocking drugs

A

Tricyclic antidepressants (= most common)
Type Ia antiarrhythmics (quinidine, procainamide)
Type Ic antiarrhythmics (flecainide, encainide)
Local anaesthetics (bupivacaine, ropivacaine)
Antimalarials (chloroquine, hydroxychloroquine)
Dextropropoxyphene
Propranolol
Carbamazepine
Quinine

132
Q

Big 3 causes of bradycardia

A

BB
CCB
Digoxin

133
Q

Toxin-induced seizure management

A

Benzos
Barbiturates
Propofol
Paralyzation and general anesthesia

134
Q

Isoniazid

A

ABx to tx TB

135
Q

Isoniazid seizure antidote

A

Pyridoxine

136
Q

Antiviral drops for herpes simplex keratitis

A

Viroptic 1% drops q1h up to 9/day for 7-14d

Zovirax 800mg 5/day for 10d

137
Q

Classic finding for herpes simplex keratitis

A

Fluorestein staining showing dendritic keratitis

138
Q

Alcohol intoxication treatment

A

Benzos

Thiamine

139
Q

Anticholinergic antidote

A

Physostigmine (inhibits acetylcholinesterase)

140
Q

Anticholinergic toxidrome

A

Altered mental status, hallucinations, tachycardia, dilated pupils, dry/flush skin, decreased bowel sounds, urinary retention

141
Q

Cholinergic toxidrome

A

SLUDGE

Salivation, lacrimation, urination, defecation, GI upset, emesis

142
Q

Cholinergic antidote

A

Atropine

143
Q

Opiate toxidrome triad

A

Respiratory distress, depressed mental status, small pupils

144
Q

Opiate antidote

A

Naloxone - quick response diagnostic

If no response, consider antipsychotic or clonidine OD (presents similarly)

145
Q

Sympathomimetic toxidrome

A

Hyperactivity, agitation, mydriasis, tacky, HTN, diaphoresis, hyperthermia

146
Q

Sympathomimetic OD treatment

A

Benzos, possibly antipsychotics for sedation
If dehydration and rhabdo, treat with IV fluids
If hyperthermia, require cooling

147
Q

Blood toxicology orders

A 
Acetaminophen
Salicylates 
Electrolytes
AG 
ECG
148
Q

Major ECG changes for Na+ ch blockade OD

A

QRS widening
RAD
Sinus tachy

149
Q

Triad of wernicke’s encephalopathy

A

Altered mental status
Ataxia
Ophthalmoplegia

150
Q

Malignant hyperthermia tx

A

Dantrolene

151
Q

Characteristic symptom of isoniazid OD

A

Seizures

Tx with Pyridoxine

152
Q

Characteristic symptom of Iron OD

A

N/V

153
Q

Acetaminophen antidote

A

N-acetylcysteine

154
Q

Salicylate antidote

A

Sodium bicarb infusion, dialysis

155
Q

TCA antidote

A

Sodium bicarb

156
Q

Enhanced elimination often used for phenobarbital and salicylate

A

urinary alkalization with sodium bicarb in D5 and 20mmol of KCl

157
Q

NAC time window for acetaminophen OD

A

> 4h but <24h
Best if within 8h
Administer regardless if acetaminophen level and AST/ALT elevated

158
Q

Bacterial conjunctivitis treatment

A

Tetracycline 250mg q4h for 2-3 weeks

If pregnant/infant, erythromycin

159
Q

Most common cause of mucopurulent conjunctivitis

A
  1. S. pneumonia
  2. S. aureus
    + Hemophilus, proteus, klebsiella
160
Q

Most common cause of purulent conjunctivitis

A

N. gonorrhoea

161
Q

Treatment for traumatic iritis

A

Cycloplegics

Topical steroids

162
Q

Clinical finding in iritis

A

Positive contralateral photophobia test

163
Q

Acute iritis clinical finding

A

Many cells in anterior chamber and little flares

164
Q

Chronic iritis clinical finding

A

Increased flares and few cells

165
Q

Special note about herpes simplex keratitis

A

AVOID STEROIDS

166
Q

Causes of iritis

A 
Sepsis (TB, H. simplex, H. zoster, adenovirus) 
Inflammatory joint disease 
Malignancy 
Post-trauma 
Idiopathic
167
Q

Normal intraocular pressure

A

10-22mmHg

Needs to be <40mmHg for iris perfusion

168
Q

Timolol MOA

A

Decreases production of aqueous and causes IOP to fall within 30 minutes
Needs to be taken with miotic

169
Q

Diamox MOA

A

Decreases aqueous production

170
Q

Acute closed angle glaucoma immediate tx

A

Timolol (0.25 or 0.5% one drop into affected eye; repeat once in 10min)
Diamox (500mg IV and 250mg q6h)
Pilocarpine (2% for blue eyes-4% for brown eyes, one drop q15min for 1-2h)

171
Q

Drugs that can be treated with dialysis

A

salicylates, lithium, ethylene glycol, methanol

172
Q

Drugs that can treated with whole bowel irrigation

A

Best used for pts ingesting toxins poorly bound to AC (iron, lithium, lead), medications that dissolve slowly (CCB, Lithium, theophylline, or meds that clump in GI tract (enteric coated aspirin)

173
Q

Whole bowel irrigation

A

Polyethylene glycol

174
Q

Wound management

A

Inflammatory - 0-5d phagocytosis of bacteria and dead tissue (help with debridement)
Epithelialization - 0-5d watertight covering forms in 24-48h
Proliferation - 5-15d fibroblasts cause wound contraction (affected by host factors)
Maturation - 15d-18mo (collagen reorganization)

175
Q

Pathognomic injury from shaking trauma

A

Retinal hemorrhage

176
Q

Failure to thrive

A

Decrease in growth parameters >2 STDEV or do not follow normal growth curve

177
Q

Failure to thrive order of losses

A

Weight > height > head circumference

178
Q

Croup AKA

A

Laryngotracheitis

179
Q

Pertussis clinical picture

A

Wheezing, inspiratory/expiratory stridor, SOB, post-tussive emesis, post-jussive whooping

180
Q

Peds bronchitis

A

Wheezing in infant <2yo

Typically RSV

181
Q

Asthma mild, mod severe based on PEFR

A

Mild >80%
Mod 50-80%
Severe <50%

182
Q

Treatment of moderate asthma

A

3 doses of Ventolin + Atrovent MDI
Supp O2 if sat <92%
Prednisone 1mg/kg PO
Cont prednisone for 5d post-d/c

183
Q

Treatment of severe asthma

A

3 doses of ventolin + atrovent MDI
Supp O2
IV access, lytes and blood gases
Admit!

184
Q

Fever of unknown origin in child

A

Daily temp >/= 38.5C for >2 weeks without discernible cause

Common: EBV, osteomyelitis, Lyme dz, HIV, malignancy, inflammatory d/o

185
Q

Most common organism a/w occult bacteria in children

A

Strep pneumonia

186
Q

Tx of occult bacteremia in neonates

A

Ampicillin & gentamicin or cefotaxime

187
Q

Tx of occult bacteremia in >1mo

A

Vancomycin & cefotaxime

188
Q

UTI tx for >2mo, non-toxic, well-hydrated child

A

IV ceftriaxone –> 3rd gen oral cephalosporin (ie. cefixime)

189
Q

Highest bacterial risk causing meningitis

A

Strep pneumo

190
Q

Bacterial meningitis LP findings

A

WBC >1000
High protein
Low glucose (<50% serum glucose)

191
Q

Viral meningitis LP findings

A

WBC <300
Normal protein
Normal glucose

192
Q

Ischemic optic neuropathy

A

Swelling of optic disc**
Vision loss**
Visual field loss
Splinter haemorrhages

193
Q

Homonymous hemianopsia

A

Occlusion PCA causing occipital lobe infarction

Always order MRI/CT

194
Q

Cortical blindness

A

Normal pupillary reflexes and normal fundoycopic exam but complete vision loss

195
Q

Acute angle closure glaucoma clinical picture

A

Red, teary eye with hazy cornea and fixed mid-dilated pupil
Pain, nausea, coloured rainbows/halos around light
Eyes feel firm to palpation

196
Q

Examining for glaucoma

A

q2-4yrs for patients >40y.o

African Americans q3-5 yrs between 20-39y.o.

197
Q

P/E of glaucoma

A

Cup:Disc ratio > 0.5
Disc hemorrhages also possible sign of glaucoma
Cup:disc asymmetry of >0.1 between 2 optic nerves

198
Q

Age-related macular degeneration

A

Drusen
Degenerative changes in RPE
Choroidal neovascular membranes
Hemorrhage

199
Q

Tests to identify choroidal neovascularization in wet AMD

A

Fluoroscein angiography

Ocular Coherence Tomography

200
Q

Uveitis clinical picture

A

Blurred vision, pain, photophobia

201
Q

Keratitis clinical picture

A

Blurred vision, pain, photophobia

202
Q

Bacterial conjunctivitis clinical picture

A

Tearing, exudate, eyelids stuck together

203
Q

Viral conjuncitivitis clinical picture

A

Tearing, foreign body sensation, photophobia, may have viral symptoms

204
Q

Rainbow/coloured halos around a point of light should make you think of…

A

corneal adema secondary to abrupt rise in IOP (acute glaucoma)

205
Q

Avoid topical corticosteroids in which eye disease

A

Herpes simplex keratitis

Fungal keratitis

206
Q

Other dangers of topical corticosteroid use in eye diseases

A

Can lead to cataract disease

Can increase IOP –> optic nerve damage

207
Q

Scleritis/uveitis tx

A

Refer to ophtho for steroids

208
Q

Binocular diplopia

A

Trauma –> muscle entrapment or CN palsy
CN palsy
Thyroid eye dz
Orbital inflammation

209
Q

Monocular diplopia

A

Refractive error
Dry eye
Cataract
Intraocular lens subluxation

210
Q

CNIII palsy

A

Eyelid ptosis
Dilated pupil and poorly reactive
Eye loses ability to elevate (SR), depress (IR), and adduct (MR) = eye is turned OUTWARD and slightly DOWNWARD

Undergo MRI/CT imaging

211
Q

Horner’s Syndrome

A

Loss of SNS tone d/t carotid dissection, cavernous carotid aneurysm and apical lung tumour
Small pupil (myosis) + ptosis + anhydrosis
Dx with apraclonidine drops (alpha agonist) –> elevation of eyelid and dilation of pupil
PTs should get MRI

212
Q

Argyll Robertson Pupils

A

Tertiary syphillis affecting midbrain –> small, irregular pupils in response to light, still ok on accommodation

213
Q

CN IV palsy

A

Vertical diplopia, especially on downgaze

214
Q

CN VI palsy

A

Horizontal diplopia

215
Q

INO

A

Slow and weak adduction of one eye and nystagmus of abducting eye in lateral gaze

216
Q

INO causes in adults, young adult, children

A

Adults - brainstem microvascular disease (recovers in weeks or months)
Young adults - trauma, demyelinating dz, brainstem hemorrhage
Children - pontine glioma

Always get MRI and consider myasthenia gravis

217
Q

3 most common forms of nystagmus

A

At extremes of lateral gaze
Pt on nystagmogenic meds (ie. anti-epileptics, barbiturates, sedatives)
Searching/Pendular nystagmus (congenital)

218
Q

Characteristics of ischemic optic neuropathy

A

Sudden, painless, unilateral loss of vision

219
Q

Orbital floor is made up of…

A

Maxilla
Zygoma
Palatine

220
Q

Ophthalmologic changes during pregnancy

A

Lowering of IOP
Transient loss of accommodation
Decreased corneal sensitivity

221
Q

Anterior uveitis

A

Inflammation of iris and ciliary body

222
Q

Posterior uveitis

A

Inflammation of choroid

223
Q

Most common rheumatoid conditions a/w dry eyes

A

SLE
RA
Sjogren’s

224
Q

PPRF lesion

A

Slow/absent horizontal saccades towards side of lesion

225
Q

Topiramate (anticonvulsant) ocular S/Es

A

Closed angle glaucoma d/t ciliary body swelling
near sightedness
Macular folds
Anterior uveitis

226
Q

Ethambutol ocular S/Es

A

TB abx

Optic neuropathy

227
Q

Prenisone ocular S/Es

A

Precipitates ocular HSV
Increased IOP
Open angle glaucoma
Posterior subcapsular cataracts

228
Q

Sildenafil ocular S/Es

A

Colour vision disturbance

Ischemic optic neuropathy

229
Q

Tamsulosin ocular S/Es

A

Floppy iris syndrome - relaxes iris dilator

230
Q

RAPD

A

Optic nerve lesion on the affected side

231
Q

Muscle and innervation that closes eye

A

Orbicularis oculi
CN VII
Affected in Bell’s Palsy

232
Q

Muscle and innervation that opens eye

A

Levator palpebrae

CN III

233
Q

Cone cells

A

Colour vision
Centre of retina (concentrated in fovea)
Function in bright light

234
Q

Rod cells

A

Night vision/peripheral vision
Peripheral of retina
Function in dim light

235
Q

Anticholinergic drops

A

Tropicamide, atropine, homatropine
Causes pupillary dilation, cycloplegia (paralyzes iris sphincter and ciliary body)
Used for ophthalmoscopy, iritis tx

236
Q

Open angle glaucoma tx

A 
beta blockers --> decreased aqueous production
carbonic anhydrase inhibitors (dorzolamide, brinzolamide, acetazolamide, methazolamide) --> decreased aqueous production 
PG analogues (latanoprost, travaprost, bimatoprost) --> increases uveoscleral outflow
237
Q

Right optic nerve lesion

A

Right monocular vision loss

238
Q

Chloroquine ocular S/Es

A

Corneal deposits and retinopathy
Irreversible
Bull’s eye macular lesions

239
Q

Common fungus in seborrheic dermatitis

A

Malassezia pityrosporum

240
Q

CREST syndrome

A 
Limited cutaneous forms of systemic sclerosis 
Calcinosis 
Raynaud's 
Esophageal dysfunction (acid reflux) 
Sclerodactyly
Telangiectasia
241
Q

Pathognomonic finding in dermatomyositis

A

Gottron Papules

242
Q

Mild acne treatment

A
  1. Cleansing with
    a) Benzoyl peroxide (antibacterial)
    b) salicylic acid (desquamating agent)
  2. Topical retinoids - comedone tx and sebum production
243
Q

Moderate acne treatment

A
  1. Oral abx (max 12 weeks) - tetracycline, doxycycline, minocycline
  2. Oral OCP for females
  3. Oral retinoic acid - accutane
  4. Intralesional steroid injections
244
Q

Severe acne treatment

A

Oral reinoic acid

245
Q

4 different types of rosacea

A
  1. Erythematotelangiectatic rosacea - permanent erythema (vasc dilation)
  2. Papulopustular rosacea - papules, pustules with NO comedones
  3. Rhinophymatous rosacea - sebaceous gland hyperplasia at nose, CT hypertrophy, rhinophyma
  4. Ocular rosacea - conjunctivitis, blepharitis, iritis, keratitis (+/- cutaneous)
246
Q

Rosacea tx

A
  1. Avoid triggers (sun, heat, alcohol)
  2. Telangiectasia/erythema- laser, electrodessication + brimonidine gel (alpha adrenergic agonist)
  3. Papules/pustules - topical metronidazole, azeleic acid (antibacterial), systemic abx or isotretinoin
  4. Phymatous - systemic tetracyclines/isotretinoin, surgical debulking
247
Q

Slapped cheek disease

A

Parvovirus B19

248
Q

DRESS

A

Drug reaction with eosinophilia and systemic symptoms

3rd week after starting medication

249
Q

SJS

A

Steven-Johnson Syndrome
<10% of body surface area
Within 8 weeks after drug onset

250
Q

TEN

A

Toxic Epidermal Necrolysis
>30% body surface area
Within 8 weeks after drug onset

251
Q

SJS/TEN common culprit drugs

A 
SATAN
Sulfa 
Allopurinol
Tetracyclines 
Anticonvulsants
NSAIDs
252
Q

Erythema multiform

A

Target skin lesions typically affecting distal extremities (including palms and soles)

253
Q

Non-Bullous Impetigo

A 
Staph aureus > GAS 
School-aged children
Erythematous papule developing to vesicles/pustules --> honey coloured crust
Topical abx --> mupirocen 
PO Abx --> Cephalexin
254
Q

Bullous Impetigo

A 
Staph aureus 
Neonates 
Thin-roofed bull that slough and leave exposed dermis 
PO abx --> cephalexin
IV abx --> cefazolin 
MRSA-risk --> Vanco
255
Q

Erysipelas

A

GAS of upper dermis, superficial lymphatics
Commonly affects face
PO abx - penicillin, amoxicillin
IV abx - penicillin, cefazolin

256
Q

Cellulitis

A 
GAS of dermis and subcutaneous tissue 
Commonly affects lower extremities 
PO: Cephalexin, penicillin
IV abx: Cefazolin
Complicated: Pip-tazo and vanco
257
Q

MRSA+ skin infection tx

A

IV Vancouver

PO doxy, clinda, septra

258
Q

Facial nerve parasympathetic function

A

Lacrimal gland

Parotid gland

259
Q

Facial nerve sensory function

A

Taste in anterior 2/3 of tongue

Some sensation near pinna

260
Q

Facial nerve motor function

A 
Facial expression
Stapedius muscle (dampens sound to inner ear)
261
Q

Bell’s Palsy Treatment

A

Corticosteroids (Prednisone PO x 10 days)

+/- Valacyclovir (poor evidence)

262
Q

TRAP of parkinsonism

A

Tremor (resting)
Rigidity
Akinesia/Bradykinesia
Postural instability

263
Q

3 types of action tremor

A

Postural
Kinetic
Intention

264
Q

AIDS definition

A
  1. HIV+

2. Either (a) CD4+ T-cell count <200cells/uL OR (b) AIDS-defining opportunistic infection

265
Q

Cervical cancer screening in HIV patients

A

PAP smear at time of diagnosis, repeat in 6 mo

Annually after that if normal

266
Q

Colles #

A

Distal radius #
Beware of shortening, dorsal displacement and dorsal angulation
Dinner fork deformity of wrist
Often a/w ulnar styloid #

267
Q

PCP, Toxoplasmosis, MAC and respective CD4 counts requiring prophylactic abx

A 
PCP = CD4+ <200; Tx = TMP/SMX
Toxoplasmosis = CD4+ <100; Tx=TMP/SMX 
MAC = CD4 <50; Tx = Macrolide (clarithromycin) or rifabutin
268
Q

Neutropenic febrile of unknown origin

A

Neutrophils <500

269
Q

Epididymitis

A

Most common cause of testicular pain

Cefixime 800mg PO single dose + Doxy 100mg PO BID for 10d

270
Q

Anterior nosebleeds

A

90% of nosebleeds
Kisselback’s Plexus or Little’s Area
Tx = cauterize with silver nitrate +/- 4% cocaine
If brisk bleed, pack nose with vaseline gauze
If diffuse ooze, apply gel foam or avitene to pack nose and remove in 24-48h

271
Q

Posterior nosebleeds

A

Woodruff’s plexus
Tx = foley catheter to balloon tamponade, inflate with 10-15mL saline
Place anterior pack to complete procedure

272
Q

3 symptoms and 2 signs to dx sinusitis

A

3 symptoms:

  1. Maxillary tooth ache
  2. Poor response to nasal contestants
  3. History of coloured nasal discharge

2 signs:

  1. Purulent nasal discharge
  2. Abnormal transillumination
273
Q

Most often location of sinusitis

A

Maxillary

274
Q

Sinusitis tx

A

Amoxicillin for 10 days

TMP-SMX for penicillin allergies

275
Q

Peak ages of otitis media

A

6-36mo, and again in 4-7yrs

276
Q

Ethylene glycol antidote

A

Ethanol

Fomepizole

277
Q

Pernicious anemia

A

AI disease where parietal cells do not produce intrinsic factor needed to bind to B12 in duodenum for absorption in TI

278
Q

Grade 6 vaccinations

A

HPV

Varicella

279
Q

Grade 9 vaccinations

A

TdaP booster

MenC

280
Q

Tetanus booster required…

A

q10y

281
Q

Petrus booster required…

A

Once over age 25

282
Q

Age range for live nasal influenza vaccine

A

2-59y.o.

283
Q

Immunocompromised patient vaccines

A 
Pneumo 13 if >50 and immunocompromised
Pneumo 23 if >65, or earlier if immunocompromised (incl DM, CKD, liver dz, asthma, EtOH/drug/smoker) 
HiB 
Hep A 
Meningococcal quadrivalent
284
Q

Shingles vaccine and C/I

A 
>60 (can get >50 but may not protect for long enough) 
Live attenuated
C/I: 
- Immunodeficiency (incl transplant)
- Breastfeeding 
- Pregnancy or planning pregnancy within 3 mo 
- Severe neomycin allergy
- Active untreated TB
285
Q

Diphtheria booster required

A

q10y

286
Q

Aspirin use recommendations

A

The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.

287
Q

A1c monitoring

A

q6mo if stable and reaching goals

q3mo if therapy changing/unstable

288
Q

Diabetic nephropathy workup

A

eGFR and ACR
If eGFR<60mL/min and/or ACR >2mg/mmol, repeat eGFR in 3 months and order 2 repeat random urine ACRs over the course of the next 3mo. If findings reconfirmed (eGFR <60 and/or 2/3 ACRs >2) = CKD

289
Q

Triglyceride levels

A

> 10-11 = risk of pancreatitis and correlation with CVD risk
Start treating when TG >11.3
Isolated hypertriglyceridemia does NOT increase CV risk

290
Q

Elevated triglyceride treatment

A

Fibrate (do not use with statin)
Fish oil
Nictonic acid

291
Q

Dog bite common bacteria

A 
Beta hemolytic strep 
Staph
Eikenlla corrodes 
Pasturella canis 
Capnocytophagia Canimorsus
292
Q

Cat bite common bacteria and treatment

A 
Pasturella multocida (gram neg cocobacillus) 
Penicillin, clavulin, 2nd and 3rd gen cephalosporins, tetracycline, cipro
293
Q

Cat scratch fever bacteria and treatment

A

Bartonella Henelae

Tx = Doxy

294
Q

Wound risk stratification

A

Crush > puncture > laceration > abrasion
Hand/foot > legs/arms > trunk > head/neck
Cats > humans > dogs

295
Q

Most important factor in animal bite care

A

High pressure syringe irrigation

296
Q

Prophylactic animal bite abx

A

Amox-clav

Doxy if penicillin allergy

297
Q

Rabies prophylaxis only required for _____ in BC

A

Bat bites (+/- skunks, racoons, foxes, coyotes)

298
Q

Most important venomous insect in BC

A

Hymenoptera stings (ie. bees, wasps, sawflies, ants)

299
Q

Zones of thermal burn injuries

A

Zone of coagulation
Zone of stasis
Zone of hyperaemia or inflammation

300
Q

Key distinguishing features from heat stroke vs heat exhaustion

A
  1. Core body temp >40.6 (not essential)

2. Neuro symptoms (essential) - confusion, delirium, seizures, coma

301
Q

Tissue resistance to electricity

A

Nerves < blood vessels < muscles < skin < tendon < fat < bone
Water LOWERS resistance so wet skin is more vulnerable

302
Q

Alternating current vs direct current

A

Alternative current MORE dangerous than direct
AC causes tetany = increased time of contact; can cause VFib
DC = single strong flexion that thrusts victims away from source; can cause systole

303
Q

Virchow’s triad

A

Stasis
Hypercoagulation
Vascular injury

304
Q

Characteristic ECG pattern for PE

A

S1Q3T3

Deep S in 1, Q in 3, inverted T in 3

305
Q

Stages of hemorrhagic shock

A

I: Up to 750cc, <15% blood loss, HR <100, normal BP, RR 14-20
II: 750-1500cc, <30% blood loss, HR100-120, normal BP, RR 20-30
III: 1500-2000cc, <40% blood loss, HR 120-140, low BP, RR 30-35
IV: >2000cc, >40% blood loss, HR >140, low BP, RR >35

306
Q

Fluid resuscitation for burns

A

Ringers lactate

2-4cc x kg x %TBSA

307
Q

Cushing reflex

A

Irreg respiration, bradycardia, increased systolic BP

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