Cardio-Resp-ER-Derm Flashcards
1
Q
Hyperkalemia Tx
- Ca gluconate IV
- ……..
- ………
A
Insulin + D50W
NS + Furosemide +|- bicarbonate +|- salbutamol
2
Q
ACS
Four newer Medications in PCI
- Abciximab
- Bivalirudin
A
- Tirofiban
- Eptifibatide
3
Q
GCS
Verbal=5 Scores
2=?
3=?
4=?
A
2: sounds
3: words
4: confusion
4
Q
Dyslipidemias
Fibrates CIs
- Hepatic disease
- ……………
- …………….
A
- Renal disease
- Biliary disease
5
Q
Intermittent Claudication
Importance of ABI
A
If <0.4 (severe) Then: Surgery or Pentoxifylline
If 0.4-0.9 Then: RDLE or Pentoxifylline
6
Q
Intermittent Claudication
Nonpharma tx (1)
A
Regular Dynamic Leg Exercises (RDLE)
5 times/week for 8 weeks
7
Q
COPD: Steps in management:
Step 1………….
Step 2…………
A
- SABD (PRN) = SABA and Ipratropium
- Add LAMA (used regularly)
= Tiotropium Or Glycopyrronuim (new)
8
Q
Intermittent Claudication
1st line?
2nd line?
A
- Pentoxifylline (Trial: 4-8w, Max: 24w)
- Ramipril
9
Q
Stable Angina
3 advices for taking SL NTG in acute phase:
- Max 3 tablets
- ………….
- ………….
A
- Intervals= 5 minutes
- Sit down to avoid syncope
10
Q
Chronic Cough: UACS Tx?
(Upper Airway Cough Syndrome)
A
1st Gen H1 blocker + Decongestant
(UACS= PND: Post Nasal Drip)
11
Q
CHF
The only safe anti arrhythmic in CHF
A
Amiodarone
12
Q
DOC
- Post MI arrhythmia?
- Post MI LV thrombus?
A
- Beta blocker
- Warfarin
(Warfarin is ok with Plavix but not with Prasugrel or Ticagrelor)
13
Q
SVTs
Two differences in management of A Flutter vs AFib
A
- Flutter responds to ablation >95%
- Rate control in Flutter is more difficult
14
Q
Intermittent Claudication : Pentoxifylline CIs
- Liver disease
- Renal disease
- ………….
- …………
- ………….
A
- MI
- Bleeding
- PU
15
Q
Chronic Cough In Pregnancy:
H1 blockers?
Decongestants?
A
H1: Safe
Dec: Not safe in 1st trimester
16
Q
SVTs
Cardioversion in A.Flutter or AFib
- Electrical?
- Chemical?
A
- Poor response
- Better response: Amiodarone IV or Procainamide IV
17
Q
Dyslipidemias
Monitoring for Niacin:
- LFT
- ……
- ……
A
- Uric Acid
- FBS
18
Q
Dyslipidemias
Niacin CIs:
- Severe Gout
- ………
- ………
A
- Severe Hyperglycemia
- Severe PUD
19
Q
Near Drowning Tx
ABC, Close monitoring, O2, ………. , ……………
A
NG suction
+|- SABA or CPAP or BIPAP
20
Q
Frost Bite Tx
Oxygen, IV fluids, Wound care
………………, …………….., ……………..
A
Immersion in 40-42 degress water,
Analgesics,
Tetanus Prophylaxis
21
Q
Insect bite If severe
ABCs + ……………..
A
Epinephrine 0.1 mg IV
+|- CS or beta2 agonists
22
Q
Age Related Macular degeneration
Prophylaxis
Smoking Cessation, Controlling HTN
Vit C, Vit E
………….., ……………, ……………
A
Zinc,
Copper,
Beta Carotene
23
Q
COPD Management
Indications for CS:
- Inhaled?
- Oral?
- IV or IM?
A
- ICS: step 4 in chronic management
- Oral: AE of COPD
- IV or IM: No indications!
24
Q
Prevention of Stroke,
DOC:
- If the cause is Cardiac…..
- If the cause is non Cardiac…….
A
- Warfarin or newer alternatives
- Plavix
25
Syncope
DOC for vasovagal
Fludrocortisone
26
Red Eye
Acute Glaucoma (ER)
Topical beta blocker + Consult/Refer
27
SVTs
AVRT, AVNRT, FAT
If asymptomatic: No tx
If occasional: ............
If frequent: ...........
Occasional: Pill in the pocket (BBlocker or CCB)
Frequent: BBlocker or CCB
28
Glaucoma Tx 1st line:
Topical beta blockers: Timolol
And/or ..........
Carbonic Anhydrase Inhibitors: Dorsolamide (Topical)
29
Dyslipidemias
DOC in Pregnancy or Breastfeeding?
DOC in Children \>10 y?
Both:
Resins Like Cholestyramine
30
Dyslipidemias
Monitoring for Statins
1. .............
2. ............
LFT
CPK
31
Dabigatran (Direct thrombin Inhibitor)
Three Cautions
1. Caution in elderly
2. ................
3. ................
2. Monitor Plt
3. CI in Renal Failure
32
Glaucoma
Open angle surgeries (2)
Laser Trabeculoplasty
Filtration process surgery
33
Ophthalmology
Retinal Artery Occlusion
1.Globe massage
2,3,4 ?
Topical beta blocker
IV Mannitol
Mix O2+CO2
34
Asthma in Children,
Safety:
LRTAs? Omalizumab?
L: Safe
Om: above 12 yo only
35
Toxicity With Cyanide (Antidote)
Hydroxycobalamine
36
Chronic Cough
NAEB Tx?
(Non Asthmatic Eosinophilic Bronchitis)
Inhaled ICS
37
Dyslipidemias
Monitoring for Fibrates
1.CPK
2,3 ?
LFT
Renal
38
Raynaud's Phenomenon
DOC in Pregnancy?
DOC in Breastfeeding?
P: Nifedipine XL 30 mg
B: Only nonpharmacologic
39
GCS
Eye=4 Scores
2=? 3=?
2: Opens in response to pain
3: Opens in response to sound
40
Asthma: A good control means:
Daily symptoms, less than......
Nighttime symptoms, less than......
SABA use, less than......
D: 4 times/week
N: 1 times/week
S: 4 times/week
41
VT and VF DOC
1. For Electrical Storm (Recurrence of VT or VF)
2. For long term prophylaxis of VT
Both: Beta blocker, like Metoprolol
42
Quinidine SEs
(Cinshonism)
1. N/V, Vertigo
2. Flushing, Tinnitus
3,4 ?
Lichenoid reaction
Hemolysis
43
Dyslipidemias
Statins Myopathy:
1. If CPK is NL
2. If CPK is elevated but \<10 times NL
Both: stop statin
1. Monitor in 6w
2. Monitor in 3w
44
Prasugrel 3 Limitations:
1. Not the best choice if ACS without PCI
2. ................
3. ................
Not in Hx of stroke or TIA
Not in Patients who take Warfarin
45
Hemorrhagic stroke: SAH
DOC after diagnosis is confirmed
Nimodipine For 3w
46
Stable Angina
DOC in long term Management
Beta blocker
or Long Acting Nitrates
47
COPD
Two Criteria in Spirometery that are mandatory for diagnosis
1. FEV1 \< 80% of predicted value
2. FEV1/FVC ratio below 0.7
48
HTN
Two good indications for CCBs
(Preferably Nifedipine XL)
1. African American patients
2 ?
2. Isolated systolic BP in elderly
49
Prevention of Stroke,
DOC: If recurrent.......
Plavix Or Dipyridamole/ASA
50
Age Related Macular Degeneration
1st line Tx
VEGF Inhibitors Like Bevacizumab
51
Dyslipidemias
Target LDL
Half of the baseline
Or \<2 mmol/L
52
Asthma in Children
Delivery method:
If \< 5 yo ?
If \> 5 yo ?
\<5 pMDI+Spacer+Mask
\>5 DPI or pMDI
53
Hypercalcemia Tx
Initial?
then?
Initial: NS + Furosemide
Then: +/- Calcitonin +/- Bisphosphonates
54
Dyslipidemias
Statins CIs:
1. Hepatic disease
2,3 ?
2. High Alcohol intake
3. Pregnancy
55
Apixaban, Rivaroxaban (Direct Inhibitors of Xa)
3 Cautions
1. Caution in elderly
2. ............
3. ............
Monitor Plt
CI in Renal Failure
56
Stable Angina
If heart rate is low, which beta blockers are recommended?
Acebutolol or Pindolol
(Intrinsic Sympathetic Activity)
57
Asthma
3 indications for Ipratropium (Inhaled)
1. Acute Exacerbation
2. ....... 3........
2. BBlocker induced asthma
3. Intolerance to LABA or SABA
58
CHF
Best beta blocker in CHF (Canadian Guideline)
Carvedilol
59
COPD
Acute Exacerbation: What Antibiotic?
If simple: Amoxi or Macrolide
If complicated: CoAmoxi or Fluoroquinolone
60
Dyslipidemias
Monitoring for Cholestyramine:
1. LFT
2,3 ?
TG
Electrolytes
61
SVTs
When do we choose: Rate Control vs Rhythm Control?
If above 65 yo: Rate control
If below 65 yo: first, Rhythm, then Rate
62
Dyslipidemias Statins Myopathy:
If CPK is elevated \>10 times NL
Stop statin
+ Check Renal, Urine Myoglobin now
63
ACS, PCI/Stent, CABG
Plavix (Clopidogrel)?
Ticagrelor?
Prasugrel?
PCI/Stent: All are good.
ACS: Either Plavix or Ticagrelor (No Prasugrel)
CABG: 5-7 days interval is needed
64
Age Related Macular degeneration
2nd line Tx
PDT + Verteporfin
65
COPD Acute Exacerbation:
Main tx
1. ..................
2. +|- Antibiotics
3. ....................
SABD
+|- Oral Prednison
66
Age Related Macular degeneration
Two SEs Of VEGF Inhibitors
1. Endophthalmitis
2. Subconjctival hemorrhage
67
Inhalation Injury Tx
100% O2 (Humidified Oxygen)
+|- hyperbaric O2 (controversial)
68
COPD
Home Oxygen therapy (15 h/day)
Target PO2 ?
65-80 mm Hg at rest
69
Renal Colic
Two treatments
Ketorolac + Alpha blockers
70
SVTs
DOC for Rate control in A.Flutter or AFib
Beta blocker or CCB
71
HTN
DOC in DM is ACEIs (and avoid ......)
Thiazides (hyperglycemia)
72
Dyslipidemias
Monitoring for Ezetimibe
1,2 ?
LFT
CPK
73
COPD
Home Oxygen therapy (15 h/day)
Indications
1. SaO2 below 88%
2,3 ?
2. PO2 below 55 mm Hg
3. PO2 between 55-59 plus: cor polmonale or HCT \>56 or Ankle edema
74
Indications for Anticoagulants
In A.Flutter or AFib
Both: recommended
in Paroxysmal, Persistent, Permanente: all recommended
Based on CHADS2
75
ACS management STEMI vs NSTEMI
1. No rTPA in NSTEMI
2. ? 3. ?
2. STEMI: Preferably No CCBs
3. STEMI: Preferably No IV Nitroglycerin
76
DVT, PE Prophylaxis
in Major surgeries DOC ?
LMWH (Enoxaparin) For 10-14 days
77
GCS MOTOR=6 Scores
2=? 3=? 4=? 5=?
2: decerebrated (extension)
3: decorticated (flexion)
4: localizes pain
5: withdraws with pain
78
Metabolic Syndrome
Waist above 94 M or 80 F
HDL below 1.03 M or 1.29 F
BP above 130/85
FBS above ......
TG above ......
FBS \> 5.6 mmol/L
TG \> 1.7 mmol/L
79
Ischemic Stroke
If you prescribe rtPA: 3 things to monitor
1.BP to be \<180/110
2,3 ?
BS to be \<12
No ASA, No Heparin
80
Ischemic Stroke Which one is recommended in general? Heparin/ rtPA (Alteplase) / ASA
H: Not recommended at all !
r: Yes, if between 1-4.5 h
A: ONLY if rTPA is not prescribed, then 160 mg/day
Note: if you prescribe rtPA, do not give ASA for at least 24 hours, then start with 160 mg daily
81
Stable Angina
CCBs Dyhydropyridines?
DHP= Vascular (Amlopidipine, Nifedipine)
Non DHP= Verapamil, Diltiazem
82
Asthma: 3 examples of ICS
1.Beclomethasone
2,3 ?
Budenoside
Fluticasone
83
Glaucoma
Closed angle surgeries (2)
Laser Iridotomy
Surgical Iridectomy
84
HTN
DOC in Pregnancy (4)
Methyldopa, Hydralazine
................... , ...................
Nifedipine XL
Labetalol IV
85
HTN In general:
DOC if \<60 yo
DOC if \>60 yo
Below 60: beta blocker
Above 60: Diuretic or ACEI
86
Syncope
DOC for Orthostatic Intolerance
Fludrocortisone
Or Midodrine (Alpha Agonist)
87
COPD: Steps in management:
Step 3.............
Step 4............
Step 5: home Oxygen
3. Add LABA (Similar to asthma)
4. Switch from LABA to combination of LABA+ICS
88
Asthma Steps of chronic management
1. SABA PRN
2. Add ICS regular use
3. Add LABA
4. ..............
5. Oral Prednisone or consider Omalizumab
4. Increase ICS dosage
Or Add Montelukast (LTRA)
Or Add Theophylline
89
Asthma: Theophylline SEs
1. Seizures
2. Nervousness/Insomnia/Palpitations
3. .........................
N/V Abdominal cramps/Headache
90
Glaucoma Tx
2nd line (3 groups)
PG Analogues: Latanoprost (topical)
Alpha 2 agonists: Brimonidine (topical)
Cholinergics: Pilocarpine (topical)
91
ACS Duration of Heparin therapy
STEMI vs NSTEMI
STEMI: 48h
NSTEMI: 2-5 days
92
ACS, STEMI
Absolute CIs for Thrombolysis (8)
1,2,3 Previous-Known IC Hemorrhage/IC Malignancy/Cerebrovascular lesion
4,5 Within last 3 months: Head or face trauma/Ischemic CVA
6,7,8 ?
6,7,8 Pericarditis/Ao dissection/Active bleeding
93
Acne
Indication for Glycolic Acid or Azelaic Acid
If intolerant to Retinoids
94
Acne
Isotretinoin monitoring
1.Beta hCG, Needs contraception
2,3 ?
LFT
Lipid Profile
95
Acne: Safe or not in Pregnancy?
Oral Retinoids
Topical Retinoids
Spironolactone
Tetracycline/Doxycycline
All are unsafe (All systemic treatments are unsafe during pregnancy)
But: Benzoyl, Glycolic Acid, Topical Erythromycin Are safe
96
Pregnancy Is SMX/TMP safe?
1st trimester: unsafe
After 32nd week: unsafe
97
Atopic Dermatitis Nonpharma (4)
1. Bathing
2. Wet wrap (If expert)
3. Emollients like Petrolatum
4 ?
UVB
98
Atopic dermatitis DOC
1st line: Topical CS
3 different groups/locations?
Face and folds: Hydrocortisone
Body: Triamcinolone
Palms and soles: Betamethasone
99
Atopic dermatitis (Eczema)
2nd line tx
Tacrolimus or Pimercolimus
100
Tacrolimus in Atopic dermatitis
3 rules:
1.Only 2nd line
2,3 ?
Only \> 2 yo patients
Only short term
101
Atopic dermatitis
New Tx for refractory and severe forms
Alitretinoin
102
Atopic dermatitis
In Pregnancy
Topical CS, Tacrolimus, UVB = safe
But: PUVA, Methotrexate are unsafe
103
Impetigo
1st line tx
2nd line tx
1. Topical Mupirocin or Fusidic Acid For 5 days
2. If No response after 48h, Then Cephalexin oral for 7 days
104
Local Folliculitis
DOC ?
Topical Mupirocin or Fusidic Acid
105
Folliculitis DOC if disseminated
If hot tub (Pseudomonas) Ciprofloxacin 7-10 d
If Other: Ciprofloxacin or Cephalexin 7-10 days
106
Furuncle or Carbuncle DOC
Cloxacillin or Cephalexin
107
Skin infection Associated with edema, erythema And non-clear margins Dx?
Cellulitis (If sharp borders: Erysipelas)
108
Cellulitis DOC
Mild to moderate: Oral Cephalexin 7-10 days
Severe: Cefazolin IV
109
Erysipelas DOC
Mild to moderate: Oral Cephalexin 14 days (not 7-10) Severe: Cefazolin IV
110
Burns
Parkland Formula
4 ml x Wt kg x Percentage of burn = total fluid needed in the first 24 h
(In children add maintenance to Parkland)
111
Burns and Sunburns
Two best local anesthetics
1....... 2. Lidocaine
Pramoxine
112
Onychomycosis 1st line:
Oral Terbinafine Monitoring?
LFT
and remember: Terbinafine is a cytochrome inhibitor
113
Onychomycosis
Duration of tx with Terbinafine
Hands: 6w
Foots: 12w
114
Onychomycosis
Terbinafine SEs:
1. GI, Headache, Rash
2. Hepatotoxicity
3,4 ?
Smelling or Tasting sensory problem
Hearing impairment
115
Onychomycosis
In Pregnancy
No systemic treatment is safe
Only local like Ciclopirox or Efinaconazole
116
Pruritis Nonpharma (3)
1. Hydrating the skin, Mild soaps
2,3 ?
Colloidal Oatmeal
Avoiding excoriation and irritants
117
Pruritis
DOC in
Dermatographism, Swimmers itch, Mastocytosis
All: H1 blocker
118
Pruritis
Tx in Miliaria (Heat Rash)
Cooling + Talcum Powder
119
Pruritis
Local treatments
1. Calamine
2. .................
Menthol
120
Indications for topical CS in
- Pruritis
- Sunburn
Pruritis: ONLY IF there is an obvious inflammation Sunburn: Not indicated!
121
Pruritis
Tx In Pregnancy
Either local treatments Or Antihistamines
122
Lice Nonpharma
1. Pets no tx needed
2. Close relatives: all need tx
3,4 ?
Mechanical removal Vinegar + towel
Washing clothes with hot water or closed bag
123
Lice DOC ?
Permethrin 1% for 10 min, then wash
Repeat after 1 week
124
Scabies DOC ?
Permethrin 5% for 8-14 h, then wash
Repeat after 1 w
125
Crusted Scabies DOC ?
Both Oral Ivermectin and topical Permethrin 5%
126
Lice and Scabies
In Pregnancy
DOC: Permethrin (safe)
127
Sunscreens Two groups
1. Physical, like Zinc Oxide
2. Organic, like Anthralinates
128
Psoriasis of Scalp Tx?
Scale removal is important
1,2 ?
Topical Calcipotriol or Betamethasone
Or if severe: Tar based shampoo
129
Psoriasis in the Face Tx?
Hydrocortisone 1% (Cream)
If severe: Tacrolimus (Topical)
130
Psoriasis in hand or foot Tx?
Locals: Petrolatum Or Betamethasone Or phototherapy (UVB) with Calcipotriol
Systemic:Acitretin
131
Psoriasis in body and extremities Tx?
Local: Betamethasone, Calcipotriol, Tar, Tazarotene, Anthraline Or Phototherapy UVB
132
Psoriasis in fold areas Tx?
Like Psoriasis in the face: Hydrocortisone 1% Or Tacrolimus
133
Psoriasis
Indications for systemic treatment with Acitretin (3)
- Refractory - Nails - Hands and Feet
134
Psoriasis In Pregnancy
Safe: Local treatments like CS, Anthraline, Tar. and UVB (best for severe cases in Pregnancy)
Unsafe: MTX, Acitretin, PUVA
135
Rosacea Ocular subtype Tx?
Topical: ABs + Artificial tear
Systemic: Oral Doxycycline
136
Rosacea Phymatous subtype Tx?
No topical tx
Systemic: Oral Prednisone or Isotretinoin
137
Rosacea Erythemato-telangiectatic And Papulopustular subtypes Tx?
Topical: Metronidazole 2-4 w
Systemic: Oral Doxycycline
138
Rosacea Nonpharma
Avoid: Sunlight, ............... ,Undiluted Liquors, Spicy food, .............., Hot beverages
Topical CS
Vinegar
139
Pressure Ulcers Dressing
for superficial wounds (2)
for deep wounds (2)
Sup: Transparent Film, Hydro colloid (Autolytic)
Deep: Xerogel, Hydrogel (Autolytic)
140
Pressure Ulcers
Two dressings for massive slough
Xerogel
Foam
141
Tension Pneumothorax:
Needle thoracostomy
2nd ICS mid clavicular line
Then Chest tube in 5th ICS AAL (anterior axillary line)
142
Open Pneumothorax (Sucking chest wound)
3 way sealed air-tight dressing
Then chest tube
143
Flail chest
O2 + Judicious Fluid therapy + Pain control
144
Cholinergic toxidrome
Caused by:
Physostigmine (Anticholinesterase)
Insecticides (Organophosphates)
Tx:
Atropine for Muscarinic effects
Pralidoxime for Nicotinic effects
145
Herbal Products Black Cohosh
Menopause and PMS
146
Herbal Products Evening Primrose
Menopause and PMS
147
Herbal Products Valerian Root
PMS Sedative, Anxyolitic
148
Herbal Products Ginkgo Biloba
Improves circulation (PAD and Dementia)
149
Herbal Products Ginseng
Energy enhancer Adjunct for chemo or radiotherapy
150
Herbal Products Echinacea
Common Cold, Flu Wound treatment
151
Herbal Products Flaxseed Oil
Laxative Source of Omega 3
152
Herbal Products Ginger
Nausea, Motion Sickness Dyspepsia
