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COPY 23 May > Cardio-Resp-ER-Derm > Flashcards

Cardio-Resp-ER-Derm Flashcards

1
Q

Hyperkalemia Tx

  1. Ca gluconate IV
  2. ……..
  3. ………
A

Insulin + D50W

NS + Furosemide +|- bicarbonate +|- salbutamol

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2
Q

ACS

Four newer Medications in PCI

  1. Abciximab
  2. Bivalirudin
A
  1. Tirofiban
  2. Eptifibatide
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3
Q

GCS

Verbal=5 Scores

2=?

3=?

4=?

A

2: sounds
3: words
4: confusion

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4
Q

Dyslipidemias

Fibrates CIs

  1. Hepatic disease
  2. ……………
  3. …………….
A
  1. Renal disease
  2. Biliary disease
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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

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6
Q

Intermittent Claudication

Nonpharma tx (1)

A

Regular Dynamic Leg Exercises (RDLE)

5 times/week for 8 weeks

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7
Q

COPD: Steps in management:

Step 1………….

Step 2…………

A
  1. SABD (PRN) = SABA and Ipratropium
  2. Add LAMA (used regularly)

= Tiotropium Or Glycopyrronuim (new)

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8
Q

Intermittent Claudication

1st line?

2nd line?

A
  1. Pentoxifylline (Trial: 4-8w, Max: 24w)
  2. Ramipril
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9
Q

Stable Angina

3 advices for taking SL NTG in acute phase:

  1. Max 3 tablets
  2. ………….
  3. ………….
A
  1. Intervals= 5 minutes
  2. Sit down to avoid syncope
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10
Q

Chronic Cough: UACS Tx?

(Upper Airway Cough Syndrome)

A

1st Gen H1 blocker + Decongestant

(UACS= PND: Post Nasal Drip)

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11
Q

CHF

The only safe anti arrhythmic in CHF

A

Amiodarone

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12
Q

DOC

  1. Post MI arrhythmia?
  2. Post MI LV thrombus?
A
  1. Beta blocker
  2. Warfarin

(Warfarin is ok with Plavix but not with Prasugrel or Ticagrelor)

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13
Q

SVTs

Two differences in management of A Flutter vs AFib

A
  1. Flutter responds to ablation >95%
  2. Rate control in Flutter is more difficult
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14
Q

Intermittent Claudication : Pentoxifylline CIs

  1. Liver disease
  2. Renal disease
  3. ………….
  4. …………
  5. ………….
A
  1. MI
  2. Bleeding
  3. PU
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15
Q

Chronic Cough In Pregnancy:

H1 blockers?

Decongestants?

A

H1: Safe

Dec: Not safe in 1st trimester

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16
Q

SVTs

Cardioversion in A.Flutter or AFib

  1. Electrical?
  2. Chemical?
A
  1. Poor response
  2. Better response: Amiodarone IV or Procainamide IV
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17
Q

Dyslipidemias

Monitoring for Niacin:

  1. LFT
  2. ……
  3. ……
A
  1. Uric Acid
  2. FBS
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18
Q

Dyslipidemias

Niacin CIs:

  1. Severe Gout
  2. ………
  3. ………
A
  1. Severe Hyperglycemia
  2. Severe PUD
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19
Q

Near Drowning Tx

ABC, Close monitoring, O2, ………. , ……………

A

NG suction

+|- SABA or CPAP or BIPAP

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20
Q

Frost Bite Tx

Oxygen, IV fluids, Wound care

………………, …………….., ……………..

A

Immersion in 40-42 degress water,

Analgesics,

Tetanus Prophylaxis

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21
Q

Insect bite If severe

ABCs + ……………..

A

Epinephrine 0.1 mg IV

+|- CS or beta2 agonists

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22
Q

Age Related Macular degeneration

Prophylaxis

Smoking Cessation, Controlling HTN

Vit C, Vit E

………….., ……………, ……………

A

Zinc,

Copper,

Beta Carotene

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23
Q

COPD Management

Indications for CS:

  1. Inhaled?
  2. Oral?
  3. IV or IM?
A
  1. ICS: step 4 in chronic management
  2. Oral: AE of COPD
  3. IV or IM: No indications!
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24
Q

Prevention of Stroke,

DOC:

  1. If the cause is Cardiac…..
  2. If the cause is non Cardiac…….
A
  1. Warfarin or newer alternatives
  2. Plavix
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25
Q

Syncope

DOC for vasovagal

A

Fludrocortisone

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26
Q

Red Eye

Acute Glaucoma (ER)

A

Topical beta blocker + Consult/Refer

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27
Q

SVTs

AVRT, AVNRT, FAT

If asymptomatic: No tx

If occasional: …………

If frequent: ………..

A

Occasional: Pill in the pocket (BBlocker or CCB)

Frequent: BBlocker or CCB

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28
Q

Glaucoma Tx 1st line:

Topical beta blockers: Timolol

And/or ……….

A

Carbonic Anhydrase Inhibitors: Dorsolamide (Topical)

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29
Q

Dyslipidemias

DOC in Pregnancy or Breastfeeding?

DOC in Children >10 y?

A

Both:

Resins Like Cholestyramine

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30
Q

Dyslipidemias

Monitoring for Statins

  1. ………….
  2. …………
A

LFT

CPK

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31
Q

Dabigatran (Direct thrombin Inhibitor)

Three Cautions

  1. Caution in elderly
  2. …………….
  3. …………….
A
  1. Monitor Plt
  2. CI in Renal Failure
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32
Q

Glaucoma

Open angle surgeries (2)

A

Laser Trabeculoplasty

Filtration process surgery

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33
Q

Ophthalmology

Retinal Artery Occlusion

1.Globe massage

2,3,4 ?

A

Topical beta blocker

IV Mannitol

Mix O2+CO2

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34
Q

Asthma in Children,

Safety:

LRTAs? Omalizumab?

A

L: Safe

Om: above 12 yo only

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35
Q

Toxicity With Cyanide (Antidote)

A

Hydroxycobalamine

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36
Q

Chronic Cough

NAEB Tx?

(Non Asthmatic Eosinophilic Bronchitis)

A

Inhaled ICS

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37
Q

Dyslipidemias

Monitoring for Fibrates

1.CPK

2,3 ?

A

LFT

Renal

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38
Q

Raynaud’s Phenomenon

DOC in Pregnancy?

DOC in Breastfeeding?

A

P: Nifedipine XL 30 mg

B: Only nonpharmacologic

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39
Q

GCS

Eye=4 Scores

2=? 3=?

A

2: Opens in response to pain
3: Opens in response to sound

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40
Q

Asthma: A good control means:

Daily symptoms, less than……

Nighttime symptoms, less than……

SABA use, less than……

A

D: 4 times/week

N: 1 times/week

S: 4 times/week

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41
Q

VT and VF DOC

  1. For Electrical Storm (Recurrence of VT or VF)
  2. For long term prophylaxis of VT
A

Both: Beta blocker, like Metoprolol

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42
Q

Quinidine SEs

(Cinshonism)

  1. N/V, Vertigo
  2. Flushing, Tinnitus

3,4 ?

A

Lichenoid reaction

Hemolysis

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43
Q

Dyslipidemias

Statins Myopathy:

  1. If CPK is NL
  2. If CPK is elevated but <10 times NL
A

Both: stop statin

  1. Monitor in 6w
  2. Monitor in 3w
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44
Q

Prasugrel 3 Limitations:

  1. Not the best choice if ACS without PCI
  2. …………….
  3. …………….
A

Not in Hx of stroke or TIA

Not in Patients who take Warfarin

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45
Q

Hemorrhagic stroke: SAH

DOC after diagnosis is confirmed

A

Nimodipine For 3w

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46
Q

Stable Angina

DOC in long term Management

A

Beta blocker

or Long Acting Nitrates

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47
Q

COPD

Two Criteria in Spirometery that are mandatory for diagnosis

A
  1. FEV1 < 80% of predicted value
  2. FEV1/FVC ratio below 0.7
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48
Q

HTN

Two good indications for CCBs

(Preferably Nifedipine XL)

  1. African American patients

2 ?

A
  1. Isolated systolic BP in elderly
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49
Q

Prevention of Stroke,

DOC: If recurrent…….

A

Plavix Or Dipyridamole/ASA

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50
Q

Age Related Macular Degeneration

1st line Tx

A

VEGF Inhibitors Like Bevacizumab

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51
Q

Dyslipidemias

Target LDL

A

Half of the baseline

Or <2 mmol/L

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52
Q

Asthma in Children

Delivery method:

If < 5 yo ?

If > 5 yo ?

A

<5 pMDI+Spacer+Mask

>5 DPI or pMDI

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53
Q

Hypercalcemia Tx

Initial?

then?

A

Initial: NS + Furosemide

Then: +/- Calcitonin +/- Bisphosphonates

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54
Q

Dyslipidemias

Statins CIs:

  1. Hepatic disease

2,3 ?

A
  1. High Alcohol intake
  2. Pregnancy
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55
Q

Apixaban, Rivaroxaban (Direct Inhibitors of Xa)

3 Cautions

  1. Caution in elderly
  2. …………
  3. …………
A

Monitor Plt

CI in Renal Failure

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56
Q

Stable Angina

If heart rate is low, which beta blockers are recommended?

A

Acebutolol or Pindolol

(Intrinsic Sympathetic Activity)

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57
Q

Asthma

3 indications for Ipratropium (Inhaled)

  1. Acute Exacerbation
  2. ……. 3……..
A
  1. BBlocker induced asthma
  2. Intolerance to LABA or SABA
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58
Q

CHF

Best beta blocker in CHF (Canadian Guideline)

A

Carvedilol

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59
Q

COPD

Acute Exacerbation: What Antibiotic?

A

If simple: Amoxi or Macrolide

If complicated: CoAmoxi or Fluoroquinolone

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60
Q

Dyslipidemias

Monitoring for Cholestyramine:

  1. LFT

2,3 ?

A

TG

Electrolytes

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61
Q

SVTs

When do we choose: Rate Control vs Rhythm Control?

A

If above 65 yo: Rate control

If below 65 yo: first, Rhythm, then Rate

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62
Q

Dyslipidemias Statins Myopathy:

If CPK is elevated >10 times NL

A

Stop statin

+ Check Renal, Urine Myoglobin now

63
Q

ACS, PCI/Stent, CABG

Plavix (Clopidogrel)?

Ticagrelor?

Prasugrel?

A

PCI/Stent: All are good.

ACS: Either Plavix or Ticagrelor (No Prasugrel)

CABG: 5-7 days interval is needed

64
Q

Age Related Macular degeneration

2nd line Tx

A

PDT + Verteporfin

65
Q

COPD Acute Exacerbation:

Main tx

  1. ………………
    • |- Antibiotics
  3. ………………..
A

SABD

+|- Oral Prednison

66
Q

Age Related Macular degeneration

Two SEs Of VEGF Inhibitors

A
  1. Endophthalmitis
  2. Subconjctival hemorrhage
67
Q

Inhalation Injury Tx

A

100% O2 (Humidified Oxygen)

+|- hyperbaric O2 (controversial)

68
Q

COPD

Home Oxygen therapy (15 h/day)

Target PO2 ?

A

65-80 mm Hg at rest

69
Q

Renal Colic

Two treatments

A

Ketorolac + Alpha blockers

70
Q

SVTs

DOC for Rate control in A.Flutter or AFib

A

Beta blocker or CCB

71
Q

HTN

DOC in DM is ACEIs (and avoid ……)

A

Thiazides (hyperglycemia)

72
Q

Dyslipidemias

Monitoring for Ezetimibe

1,2 ?

73
Q

COPD

Home Oxygen therapy (15 h/day)

Indications

  1. SaO2 below 88%

2,3 ?

A
  1. PO2 below 55 mm Hg
  2. PO2 between 55-59 plus: cor polmonale or HCT >56 or Ankle edema
74
Q

Indications for Anticoagulants

In A.Flutter or AFib

A

Both: recommended

in Paroxysmal, Persistent, Permanente: all recommended

Based on CHADS2

75
Q

ACS management STEMI vs NSTEMI

  1. No rTPA in NSTEMI
  2. ? 3. ?
A
  1. STEMI: Preferably No CCBs
  2. STEMI: Preferably No IV Nitroglycerin
76
Q

DVT, PE Prophylaxis

in Major surgeries DOC ?

A

LMWH (Enoxaparin) For 10-14 days

77
Q

ACS, STEMI

Relative CIs for Thrombolysis (8)

1,2 Poorly controlled HTN, CVA before 3 months

3,4 Internal bleeding 2-4w, Venous Puncture

5,6 ?

7,8 ?

A

Pregnancy, Active PU/CPR>10min

Surgery <3w, Current Anticoagulation

78
Q

GCS MOTOR=6 Scores

2=? 3=? 4=? 5=?

A

2: decerebrated (extension)
3: decorticated (flexion)
4: localizes pain
5: withdraws with pain

79
Q

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 ……

A

FBS > 5.6 mmol/L

TG > 1.7 mmol/L

80
Q

Ischemic Stroke

If you prescribe rtPA: 3 things to monitor

1.BP to be <180/110

2,3 ?

A

BS to be <12

No ASA, No Heparin

81
Q

Ischemic Stroke Which one is recommended in general? Heparin/ rtPA (Alteplase) / ASA

A

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

82
Q

Stable Angina

CCBs Dyhydropyridines?

A

DHP= Vascular (Amlopidipine, Nifedipine)

Non DHP= Verapamil, Diltiazem

83
Q

Asthma: 3 examples of ICS

1.Beclomethasone

2,3 ?

A

Budenoside

Fluticasone

84
Q

Glaucoma

Closed angle surgeries (2)

A

Laser Iridotomy

Surgical Iridectomy

85
Q

HTN

DOC in Pregnancy (4)

Methyldopa, Hydralazine

………………. , ……………….

A

Nifedipine XL

Labetalol IV

86
Q

HTN In general:

DOC if <60 yo

DOC if >60 yo

A

Below 60: beta blocker

Above 60: Diuretic or ACEI

87
Q

Syncope

DOC for Orthostatic Intolerance

A

Fludrocortisone

Or Midodrine (Alpha Agonist)

88
Q

COPD: Steps in management:

Step 3………….

Step 4…………

Step 5: home Oxygen

A
  1. Add LABA (Similar to asthma)
  2. Switch from LABA to combination of LABA+ICS
89
Q

Asthma Steps of chronic management

  1. SABA PRN
  2. Add ICS regular use
  3. Add LABA
  4. …………..
  5. Oral Prednisone or consider Omalizumab
A
  1. Increase ICS dosage

Or Add Montelukast (LTRA)

Or Add Theophylline

90
Q

Asthma: Theophylline SEs

  1. Seizures
  2. Nervousness/Insomnia/Palpitations
  3. …………………….
A

N/V Abdominal cramps/Headache

91
Q

Glaucoma Tx

2nd line (3 groups)

A

PG Analogues: Latanoprost (topical)

Alpha 2 agonists: Brimonidine (topical)

Cholinergics: Pilocarpine (topical)

92
Q

ACS Duration of Heparin therapy

STEMI vs NSTEMI

A

STEMI: 48h

NSTEMI: 2-5 days

93
Q

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 ?

A

6,7,8 Pericarditis/Ao dissection/Active bleeding

94
Q

Acne

Indication for Glycolic Acid or Azelaic Acid

A

If intolerant to Retinoids

95
Q

Acne

Isotretinoin monitoring

1.Beta hCG, Needs contraception

2,3 ?

A

LFT

Lipid Profile

96
Q

Acne: Safe or not in Pregnancy?

Oral Retinoids

Topical Retinoids

Spironolactone

Tetracycline/Doxycycline

A

All are unsafe (All systemic treatments are unsafe during pregnancy)

But: Benzoyl, Glycolic Acid, Topical Erythromycin Are safe

97
Q

Pregnancy Is SMX/TMP safe?

A

1st trimester: unsafe

After 32nd week: unsafe

98
Q

Atopic Dermatitis Nonpharma (4)

  1. Bathing
  2. Wet wrap (If expert)

3,4 ?

A

Emollients like Petrolatum

UVB

99
Q

Atopic dermatitis DOC

1st line: Topical CS

3 different groups/locations?

A

Face and folds: Hydrocortisone

Body: Triamcinolone

Palms and soles: Betamethasone

100
Q

Atopic dermatitis (Eczema)

2nd line tx

A

Tacrolimus or Pimercolimus

101
Q

Tacrolimus in Atopic dermatitis

3 rules:

1.Only 2nd line

2,3 ?

A

Only > 2 yo patients

Only short term

102
Q

Atopic dermatitis

New Tx for refractory and severe forms

A

Alitretinoin

103
Q

Atopic dermatitis

In Pregnancy

A

Topical CS, Tacrolimus, UVB = safe

But: PUVA, Methotrexate are unsafe

104
Q

Impetigo

1st line tx

2nd line tx

A
  1. Topical Mupirocin or Fusidic Acid For 5 days
  2. If No response after 48h, Then Cephalexin oral for 7 days
105
Q

Local Folliculitis

DOC ?

A

Topical Mupirocin or Fusidic Acid

106
Q

Folliculitis DOC if disseminated

A

If hot tub (Pseudomonas) Ciprofloxacin 7-10 d

If Other: Ciprofloxacin or Cephalexin 7-10 days

107
Q

Furuncle or Carbuncle DOC

A

Cloxacillin or Cephalexin

108
Q

Skin infection Associated with edema, erythema And non-clear margins Dx?

A

Cellulitis (If sharp borders: Erysipelas)

109
Q

Cellulitis DOC

A

Mild to moderate: Oral Cephalexin 7-10 days

Severe: Cefazolin IV

110
Q

Erysipelas DOC

A

Mild to moderate: Oral Cephalexin 14 days (not 7-10) Severe: Cefazolin IV

111
Q

Burns

Parkland Formula

A

4 ml x Wt kg x Percentage of burn = total fluid needed in the first 24 h

(In children add maintenance to Parkland)

112
Q

Burns and Sunburns

Two best local anesthetics

1……. 2. Lidocaine

113
Q

Onychomycosis 1st line:

Oral Terbinafine Monitoring?

A

LFT

and remember: Terbinafine is a cytochrome inhibitor

114
Q

Onychomycosis

Duration of tx with Terbinafine

A

Hands: 6w

Foots: 12w

115
Q

Onychomycosis

Terbinafine SEs:

  1. GI, Headache, Rash
  2. Hepatotoxicity

3,4 ?

A

Smelling or Tasting sensory problem

Hearing impairment

116
Q

Onychomycosis

In Pregnancy

A

No systemic treatment is safe

Only local like Ciclopirox or Efinaconazole

117
Q

Pruritis Nonpharma (3)

  1. Hydrating the skin, Mild soaps

2,3 ?

A

Colloidal Oatmeal

Avoiding excoriation and irritants

118
Q

Pruritis

DOC in

Dermatographism, Swimmers itch, Mastocytosis

A

All: H1 blocker

119
Q

Pruritis

Tx in Miliaria (Heat Rash)

A

Cooling + Talcum Powder

120
Q

Pruritis

Local treatments

  1. Calamine
  2. ……………..
121
Q

Indications for topical CS in

  • Pruritis
  • Sunburn
A

Pruritis: ONLY IF there is an obvious inflammation Sunburn: Not indicated!

122
Q

Pruritis

Tx In Pregnancy

A

Either local treatments Or Antihistamines

123
Q

Lice Nonpharma

  1. Pets no tx needed
  2. Close relatives: all need tx

3,4 ?

A

Mechanical removal Vinegar + towel

Washing clothes with hot water or closed bag

124
Q

Lice DOC ?

A

Permethrin 1% for 10 min, then wash

Repeat after 1 week

125
Q

Scabies DOC ?

A

Permethrin 5% for 8-14 h, then wash

Repeat after 1 w

126
Q

Crusted Scabies DOC ?

A

Both Oral Ivermectin and topical Permethrin 5%

127
Q

Lice and Scabies

In Pregnancy

A

DOC: Permethrin (safe)

128
Q

Sunscreens Two groups

A
  1. Physical, like Zinc Oxide
  2. Organic, like Anthralinates
129
Q

Psoriasis of Scalp Tx?

Scale removal is important

1,2 ?

A

Topical Calcipotriol or Betamethasone

Or if severe: Tar based shampoo

130
Q

Psoriasis in the Face Tx?

A

Hydrocortisone 1% (Cream)

If severe: Tacrolimus (Topical)

131
Q

Psoriasis in hand or foot Tx?

A

Locals: Petrolatum Or Betamethasone Or phototherapy (UVB) with Calcipotriol

Systemic:Acitretin

132
Q

Psoriasis in body and extremities Tx?

A

Local: Betamethasone, Calcipotriol, Tar, Tazarotene, Anthraline Or Phototherapy UVB

133
Q

Psoriasis in fold areas Tx?

A

Like Psoriasis in the face: Hydrocortisone 1% Or Tacrolimus

134
Q

Psoriasis

Indications for systemic treatment with Acitretin (3)

A
  • Refractory - Nails - Hands and Feet
135
Q

Psoriasis In Pregnancy

A

Safe: Local treatments like CS, Anthraline, Tar. and UVB (best for severe cases in Pregnancy)

Unsafe: MTX, Acitretin, PUVA

136
Q

Rosacea Ocular subtype Tx?

A

Topical: ABs + Artificial tear

Systemic: Oral Doxycycline

137
Q

Rosacea Phymatous subtype Tx?

A

No topical tx

Systemic: Oral Prednisone or Isotretinoin

138
Q

Rosacea Erythemato-telangiectatic And Papulopustular subtypes Tx?

A

Topical: Metronidazole 2-4 w

Systemic: Oral Doxycycline

139
Q

Rosacea Nonpharma

Avoid: Sunlight, …………… ,Undiluted Liquors, Spicy food, ………….., Hot beverages

A

Topical CS

Vinegar

140
Q

Pressure Ulcers Dressing

for superficial wounds (2)

for deep wounds (2)

A

Sup: Transparent Film, Hydro colloid (Autolytic)

Deep: Xerogel, Hydrogel (Autolytic)

141
Q

Pressure Ulcers

Two dressings for massive slough

A

Xerogel

Foam

142
Q

Tension Pneumothorax:

Needle thoracostomy

A

2nd ICS mid clavicular line

Then Chest tube in 5th ICS AAL (anterior axillary line)

143
Q

Open Pneumothorax (Sucking chest wound)

A

3 way sealed air-tight dressing

Then chest tube

144
Q

Flail chest

A

O2 + Judicious Fluid therapy + Pain control

145
Q

Cholinergic toxidrome

Caused by:

Physostigmine (Anticholinesterase)

Insecticides (Organophosphates)

A

Tx:

Atropine for Muscarinic effects

Pralidoxime for Nicotinic effects

146
Q

Herbal Products Black Cohosh

A

Menopause and PMS

147
Q

Herbal Products Evening Primrose

A

Menopause and PMS

148
Q

Herbal Products Valerian Root

A

PMS Sedative, Anxyolitic

149
Q

Herbal Products Ginkgo Biloba

A

Improves circulation (PAD and Dementia)

150
Q

Herbal Products Ginseng

A

Energy enhancer Adjunct for chemo or radiotherapy

151
Q

Herbal Products Echinacea

A

Common Cold, Flu Wound treatment

152
Q

Herbal Products Flaxseed Oil

A

Laxative Source of Omega 3

153
Q

Herbal Products Ginger

A

Nausea, Motion Sickness Dyspepsia

COPY 23 May (5 decks)

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