CCE specific Flashcards
Differential diagnosis for seizures in a nine month old
Febrile seizure, tumor, stroke, injury, meningitis, epilepsy, electrolyte imbalance, hypoglycaemia
How long does a febrile seizure usually last
Less than 10 minutes
Epilepsy is diagnosed when a patient has had
Two or more unprovoked seizures
Risk factors for febrile seizures include
Previously diagnosed to neurodevelopmental abnormality, epilepsy and a first-degree relative, high fever
Generalized and brief seizure which occurs once in does not require within 24 hours in a young child with a fever
Simple febrile seizure
Focal and prolonged or repetitive seizure in a child with a fever
Complex febrile seizure
Further test order in a child with hypoglycaemia on POC test
Serum glucose to confirm the diagnosis, insulin, C-Peptide, electrolytes, Uriah, creatin, AST, ALT, drug screen, BHB
High insulin level with low C-peptide might mean
Patient has been taking exogenous insulin
Breaking bad news mnemonic spikes stands for
Setting, perception, invitation, knowledge sharing, emotions, strategy in summary.
Five common causes for postmenopausal bleeding
Cancer (endometrial adenocarcinoma or cervical squamous cell), endometrial atrophy due to hypo oestrogenic state, I don’t know meiosis, pull-ups, fibroids.
Risk factors for endometrial adenocarcinoma
Postmenopausal bleeding, endometrial thickness greater than 4 mm, increased age, nulliparity, diabetes mellitus
Common causes of viral gastroenteritis in children
Rotavirus, Norovirus, adenovirus,
Three common causes of bacterial gastroenteritis in children
E. coli, salmonella, CDiff
Most common cause of parasitic gastroenteritis in children
Giardia
Treating mild to moderate dehydration and children
ORT: 90meq/L Na, 20meq/L K, 20meq/L glucose
50-100mL/kg over 2-4 hrs
Treating moderate to severe dehydration/hypovolemic shock in child
20 mL per kilogram bolus of ringers lactate until blood pressure normalizes
Maintenance fluids 421 rule
4 mg per kilogram for the first 10 kg, then 2 mg per kilogram for the next 10 kg, and then 1 mg per kilogram for the remaining weight
Combined oral contraceptive pills work by mimicking which phase of the menstrual cycle
The luteal phase
In addition to mimicking the luteal phase of the menstrual cycle and inhibiting LHFSH an ovulation combined oral contraceptives further reduce the risk of pregnancy by
Thickening the cervical mucus to burnt sperm passage and thinning the endometrium to reduce the chance of implantation 
Medical contraindications to combined hormonal birth control pills
Migraine with aura, current breast cancer, high VTE risk factors
Some high VTE risk factors include
Atrial fibrillation, SLE positive for antiphospholipid antibodies, age 35 and smoking 15 cigarettes daily, history of stroke, history of thrombus, major surgery with prolonged mobilization
Differential diagnosis for a necrotizing soft tissue infection
Cellulitis, pyoderma gangrenosum, gas gangrene, DVT
Risk factors for necrotizing soft tissue infection
Anything that may depress immunity or tissue perfusion such as diabetes, intravenous drug use, alcohol abuse, obesity, chronic steroid use, liver failure or kidney failure
Most common bugs in immuno compromised patient with necrotizing soft tissue infection
Polymicrobial
Most common bug in an average patient with a necrotizing soft tissue infection
Group a strep, gram-positive cocci
Most common gram negative bug in necrotizing soft tissue infection
Typically a marine organism like vibrio
 Asking the patient to inhaled will hook in the fingers under the liver border inspiration causing the gallbladder to send them to the fingers producing pain if the gallbladder is inflamed is called
Murphy’s sign
Location of the appendix 2/3 from the umbilicus and the ASIS
McBurney’s point
Pain in the right lower quadrant with left lower quadrant palpation
Rosvings sign
Increased abdominal pain with extension of the leg at the hip
Psoas sign
Right hypogastric pain when the right hip is flexed knee bent and internally rotated at the hip
Obturator sign
Fever right upper quadrant pain and Murphy’s sign positive
Cholecystitis
Fever right upper quadrant pain Murphy’s sign positive jaundiced an elevated labs
Choledocholithiasis
Shock, fever, jaundice, right upper quadrant pain, altered mental status
Cholangitis 
Blue or gray appearance to the abdomen and the flanks
Gray Turner side
Echinosis in the Peri umbilical area around the belly button
Cullen sign
Two signs for ascites
Shifting dullness, Fluid wave test
History of diabetes, nausea and vomiting, thirsty, abdominal pain
DKA
Treat DKA with
Fluid bolus normal saline one later, DKA protocol involves IV insulin slowly with potassium
Inflammation of the pouches in the intestine is called
Diverticulitis
Left lower quadrant pain, diarrhea, maybe bloody, nausea, vomiting, older patient
Diverticulitis
Treat diverticulitis with
Metronidazole and ciprofloxacin
Three viruses that cause otitis media
RSV, para influenza, influenza
Three bacteria that causes bacterial acute otitis media
Strep pneumonia, H flu, moraxella catarrhalis
Risk factors for ear infections
Bottlefeeding, caretaker smoking, daycare attendance, pacifier use
Treatment of bacterial otitis media inpatient younger than two years, high risk, very ill appearing
High-dose amoxycillin
Treatment for severe croup
Nebulized epinephrin and steroids
Which bug causes bacterial tracheitis
Staph aureus
Which bug causes epiglottitis
H flu
Treatment for a group a strep pharyngitis
Penicillin times 10 days
Positive Monospot test or heterophile antibody
Infectious mononucleosis
First phase of whooping cough
Catarrhal phase 1 to 2 weeks of low-grade fever, cough, coryza
Second phase of pertussis
Paroxysmal phase which includes intent spasms of coughing followed by a sudden inhalation which produces a whoop sound
Risk factors for endometrial cancer
Advanced age, unopposed estrogen, tamoxiphen therapy, early menarche or late menopause more periods, nulliparity, PCOS, obesity, diabetes
Causes of postmenopausal PV bleed
Atrophy of the vagina or endometrium, cancer, I don’t know meiosis, polyps, fibroids
Two questions to ask about paranoia
Do you think that anyone is trying to harm you? Do you think that someone is following you?
Questions for thought insertion
Are your thoughts your own? Is there anyone putting thoughts into your head that you know we’re not your own
Questions for thought Broadcasting
Can anyone else hear your thoughts when you aren’t speaking
Mania questions
Have you ever felt like you haven’t needed to sleep? Have you felt like you have unlimited energy? Do you feel like you’ve accomplished a lot in a very short amount of time?
Parts of the mental status exam
Appearance, behavior, speech, mood, affect, thought content and process , perception, cognition, insight
Psychosis that lasts from one day to one month
Brief psychotic disorder
Psychosis that lasts from one month to less than six months
Schizophreniform
To diagnose schizophrenia psychosis must be present for more than
Six months
First line therapy for schizophrenia or other psychotic disorders
Second-generation antipsychotics such as Abilify, quetiapine, olanzapine
Common side effects to second-generation antipsychotics are
Metabolic, weight gain, extra Piramidal side effects
Differential diagnosis for psychosis
Schizoaffective disorder, mood disorder with psychotic features, delusional disorders
Treat bipolar type 2 with
Lithium, mood stabilizers
Cluster headache treatment
High-dose oxygen, Triptans
PR interval normal length
0.12-20
QRS interval normal length
<0.12
QTC interval normals for male and female
Male less than 460 female less than 480
m shaped P-wave can be indicative of
P-mitrale, left atrial enlargement
Peaked p-wave can be indicative of
Right atrial enlargement or p pulmonale
Septal leads
V1 and V2
Anterior wall leads
V3 and V4
Lateral wall leads
I, aVL, V5, V6
Inferior wall leads
II, III, avF
Carpopedal spasm when blood pressure cuff is inflated over arm for 2 to 3 minutes
Trousseau sign for hypocalcaemia
Facial spasm when facial nerve is tapped over the parotid
Chvosteks sign for hypocalcemia
Next best test for hypocalcaemia or hypercalcaemia
PTH
Drugs that can cause hypercalcaemia
Thiazide diuretics, lithium, vitamin D
A lipid profile includes
Total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides
COPD with decreased DLCO
Emphysema
COPD with normal DLCO
Broncholitis
Restricted PFT pattern with decreased DLCO
Interstitial lung disease, congestive heart failure
Red/brown Granular casts in urine
ATN
Left anterior chest line at the level of the lower intercostal space is called
Castells point. Percuss here for splenomegaly during inspiration
