ccfp Flashcards
1
Q
acute blood loss vs occult bleed on MCV?
A
microcytosis is occult bleed, normocytosis= acute bleed
2
Q
iron study results in IDA?
A
ferritin and total Fe low, TIBC elevated (only really elevated in IDA)
3
Q
ddx macrocytic anemia
A
ABCDEF: alcohol, B12, compensatory retics (acute blood loss or hemolysis), drugs (), endo (thyroid), folate
4
Q
normocytic anemia work up?
A
retics, LDH, haptoglobin, bili
5
Q
when to check Hgb/iron studies again after starting iron supp?
A
2-4 weeks. looking for 10 pt increase in HgB/ 4 weeks if compliant and abrosbing iron
6
Q
ddx normocytic anemia
A
ABCD: acute blood loss, bone marrow issue, chronic dz, destruction (hemolysis)
7
Q
preferred iron supp?
A
all similar, probably ferrous fumarate (palafer). if not tolerating, try ferrous gluconate (less elemental iron)
8
Q
how long to continue oral iron
A
monitor q2-4 weeks, then once Hgb and ferritin normal, continue for an additional 3 months and stop (if underlying cause reversed)
9
Q
apart from INCS, what other meds or allergic rhinitis?
A
INAH (4 weeks max), eg olopatidine
10
Q
Medical w/u for anxiety d/o
A
Consider: CBC, BG, lytes, lfts, bili, urinalysis, tsh b12. Lipids and ecg if age appropriate
11
Q
Length of med tx in GAD and PTSD
A
Gad=1 yr, ptsd 8 months, then taper gradually for both.
12
Q
All anxiety histories must include:
A
Substance use Hx, suicidal it hx screen for other comorbid psych d/o which are v common
13
Q
Peds MH history pneumonic
A
HEADSSS:
Home,
Eduction and eating!
Activities
Drugs
Sexuality/sex
Suicide
Strengths
14
Q
meds for chronic pain based on etiology?
A
PEER table
15
Q
Walk through SPIKES
A
setting, perception (“what is your understanding of xyz”, invitation (how much would yo like to know?), knowledge (give a warning shot, “I’m afraid I have some bad news”, “i’m afraid the results were not what we were hoping for”) and give info in small chunks, emotions (acknoledge them), summary (arrangefollow up)
16
Q
Health mod behaviors in afib
A
Alcohol/tobacco, weight , exercise DM, BP
17
Q
Score for anti coag in afib
A
Chads-65
18
Q
Dx of Binge eating D/o
A
Large amounts of food in discrete amounts of time (1-2 hrs) without compensatory behavior
19
Q
Who to screen for BED in particular
A
Metabolic syndrome, weight gain T2DM
20
Q
Indications for hospitalization for eating disorder
A
Unstable vitals, unstable bw concerning ecg, suicidality
21
Q
Breast cancer screening
A
50-74, q2-3 yrs
22
Q
2 common breast mass “fibros”
A
Fibrocystic—> cyclical, hormone driven
Fibroadenoma —> hormone drive mass
23
Q
Palpable breast mass under and over 30 gets—>
A
< 30 u/s
>| 30 u/s and diag mammo
24
Q
Breast mass from trauma
A
Fat necrosis
25
Asthma triggers
Cold air, exercise, allergens, irritants, resp infections, meds, strong emotion
26
Spirometry criteria for asthma dx:
Fev1/fvc <0.8. (Children), <0.75 (adults)
And improvement of at least 12% of fev1 with bronchodilator
27
Good control of asthma =
2 or fewer prn doses/week
Infrequent exacerbation
28
Common a/e to counsel for ICS
Dysphonia, thrush, decreased growth velocity total growth within a cm.
Adrenal suppression in kids on high dose >6m
29
What is a yellow zone asthma exacerbation?
Sits and talks in phrases, RR<30, pulse < 120, sats above 90. (Note I’m anyone under 6 use PRAM score
30
Astham exacerbation: Yellow zone tx?
If on prns only for maintenance consider adding ICS. If already on ICS 3-5 days of pred (50 mg if over 12 or 1mg/kg if under 12). Can also do single dose of dex if under 12!
31
4 major categories of Conduct Disorder symptoms:
1. Aggression towards ppl and animals
2. Destruction of property
3. Deceitfulnes and theft
4. Serious violations of rule
32
2 domains of autism symptoms
1. Social communication impairment
2. Repetitive, restricted patterns
33
When to screen for Autism?
Parental concern, delayed language, limited eye contact, no social smile etc
34
Autism screens?
M-CHAT: age 16-30 months
Infant toddler checklist (ITC): 8-24 m
Symptoms usually onset between 12-24 months
35
ADHD questionnaires
Snap 4- kids
ASRS- adult
36
ADHD prevalence
7% children, half will progress to adulthood
37
Dx of adhd:
6 symptoms of inattention and/OR hyperactivity. Adults only
Need 5. Must be present before age of 12, in more than 1 setting
38
Contraindications to ADHD meds:
Cardiac dz (mod HTN, atherosclerosis, structural dz), history sudden cardiac death, arrhythmia, bipolar, psychosis caution: SUD, epilepsy, anxiety, renal dz,
39
PETMAP for lethal CP?
PE, esophageal rupture, tamponade, MI, aortic dissection, tension pneumothorax
40
Who presents differently with ACS?
Women, diabetics, elderly
41
Breast cancer screening
50-74: q2-3 yrs.
If high risk 30-69: annually, if BRCA, 1st degree relative with BRCA or chest radiation under age 30
42
Ic of breast mass
<30 u/s, over 30 u/s and mammo
43
Follow up interval after breast cancer?
Q3-6 months for 3 yrs then w6-12months for 2 yrs then q1yr.
History and physical
44
RF for cervical ca
Sex before age 20
Multiple partners
Smoking
Immunecomp
45
Pap screening
25-69 q 2-3 yrs
Annual vault paps after total hyst if removed for cancer/hail etc
None if removed for benign reason
Routine screening if subtotal hyst
46
Colorectal sceeen
50-74 q2 with FIT
Or c scope q10
47
Colorectal screening of high risk
>1FDR with colorectal cancer—> scope at 40 or 10 yrs before youngest dx then q5
IBD: scope 8 yrs after pangolins or 12 yrs after left sided colitis then q 1-2 yrs
If >2 FDR with advanced adenoma screen at age 40
48
Initial work up for leukaemia
CBC, lfts, lytes/cr, inr
Peripheral smear if leukocytosis despite tx of potential cause, wbc >20, or leukocytosis with anemia, thrombocytopenia or abnormal exam finding (node etc)
49
Cervical ca s/s
Abn bag bleeding
Irreg spotting
Dyspareunia
Inc discharge
Pelvic pain
Heavier than normal periods
50
Follow up of emergency contraception?
Bleeding in 21 days or preg test
51
Contraindications and dose of emergency contraception
Known preg
Levonorgestrel 1.5 mg x1 —> 95% effective if used with 24 hrs, but can use up to 5 days
Copper IUD: most effective, up to 7dsys post coirus
52
Contraindication to estrogen containing birth control
53
Exam maneuver and test before starting contraceptive?
BP
Preg test
54
Progestin contraindications
Pregnant,
Active breast cancer
Unexplained vag bleeding
Liver dz (relative)
55
Cluster ha criteria
Severe unilateral, orbital/temporal pain, lasting 15-180 mins, 8/d-q2d, with at least one autonomic symptoms and definite circadian and cirrcanual rhythm
56
Tx for cluster HA
Abort: Triptan + O2
Prophylaxis: verapimil, topiramate,
Can bridge with steroids until prophylaxis kicks in
57
When do medication overuse HA start?
15 days per month OTCs
10 per month for triptans
58
Tension HA criteria
30 min-7days
2 of: pressing/tightening/inhibtiing (not prohibiting), bilateral, not aggravated by activity
Both of: no n/v, only one (or none)of photophobia or phonophobia
59
Tension HA tx:
Tylenol, Advil
Prophylaxis: amitriptyline
60
Snoop for HA red flags
Systemic (infection, cancer, GCA)
Neuro symptoms (including vision)
Onset-sudden
Older -age over 50
Positional/diff from previous
61
Dx of migraine
Think POUND
2 of: unilateral, pulsatile, interferes with daily life, aggravated by activity
One of: n/v, photo/phonophobia
+/- aura
62
Non pharm mgmt migraine
HA journal, avoid triggers (common ones=stress, environmental, caffeine, alcohol)
63
Pharm tx migraine
Triptans
Propranolol, amitriptyline
64
Reasonable empirical abx for meningitis
Dex before abx!
Ctx, vanco
Neonate: amp, gent
65
Time frame for LP in meningitis ?
Within 2 hrs of abx
66
CT before LP?
Immunocomp, history of CNS disease, seizure, ?raised ICP, neuro deficit
67
When to image a cough if not concerning?
8 weeks
68
Croup age?
6m to 3 yrs
69
Dangerous ddx of croup
Bact tracheitis, epiglotitis, RPA, foreign body, anaphylaxis
70
what to explore before offering counselling advice?
stage of change
71
stages of change
pre contemplative
contemplative
preparation/action
maintenance
relapse
72
the 5 A's of health risk behavior
ask, advise, assess, assist, arrange (follow-up)
73
DSM acute stress rxn
Exposure to actual or threatened death, serious injury, or sexual violation
+array of symptoms, 3days-1 month,
sort of a prequel to PTSD
74
adjustment disorder
Emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
Significant impairment or marked distress
75
76
Spirometer dx of COPD
Fev1/fvc <0.7
77
Severity of copd of spirometer
Fev1> 80% = mild
50-79 mod
<50 severe
78
When to consider alpha 1 antitrypsin def
Copd < 65 y/o or < 20 pack yrs
Check AAT levels
79
Vaccines in COPD
Annual influenza, pneumococcal with 5 yr booster, shingles and tdap
80
Puffers in COPD
Mild: prn saba or LAMA (incure)
Mod: LAMA or LAMA/LABA combo (anoro)
Severe: trellegy can add azithro (3 times per week), or another steroid if more needed
81
Asthma vs copd dx and reversibility
Asthma: fev1/fvc <0.8 and 12 % improvement
Copd: fev1/fvc <0.7
Asthma reversible, copd not fully revy
82
Counsel re PSA screening
83
Alarm signs and symptoms for gastric and esophageal cancer
Progressive dysphagia, odynophagia, early satiety, weight loss, anemia, hemetemsis/melena, IDA
84
Minor NCD
measured cog impairement without loss of ADLs or iADLS
85
Ddx of dementia
ALZ 50% , then vasc, then LBD, then FTD.
note PD with dementia diff than LBD (Parkinsonism present for >1 yr independent of cog symptoms)
86
contraindications to donepezil
LBBB, 2nd or 3rd deg heart block, HR <50, sick sinus syndrome
87
MMSE and MoCA scores
mmse <24, moca<26
88
Moca vs mmse
MoCa: more false +, faster, easier. mmse: longer, use if MoCA abn
89
Tx of dementia:
refer to alz society, discuss POA, will etc. anticholinesterase inhibitor for AD, vasc rf for vac dementia, driving safety
90
tests for driving safety in dementia
: trails A and B
91
92
MDD criteria
5 msigecaps, for 2 weeks
93
R/A after starting med for depression
2-4 week f/u, use clinical scales:
>20% improvement—> cont
<20%: inc dose, switch depending on pt preference
94
Maintenance phase for MDD
6-9 months of low risk, 2 yrs of high risk of relapse. Lifelong if long term risk
95
Postpartum depression
MDE during preg or within 4 weeks of delivery
tx: CBT, sertraline
96
Age for once suicide risk with SSRI?
Less than 24
97
Dx criteria of DM
FBG (8hr): >7
A1c > 6.5
Random glc > 11
If symptoms, need 1. No symptoms rot a test another day
98
Monitoring inT1DM and t2DM
Lipids q1
Eyes q1
Urine acr q1
Monofilament q1
Eyes, monofil and urine start after 5 yrs of dx
99
Ketone testing inT1DM
In times of illness, prepaid BG over 14 or symptoms of DKA
100
T1DM BG targets
Pre prand 4-7, post prand 5-10
101
Long acting and short acting insulins
Basaglar = LA
SA: aspart, lispro (humalog)
102
Insulin start in T2DM
Basal: 10 units of LA qhs, inc 2 units q4 days) until morning sugar at target
Bolus: start with 1 meal, 2-4 units or 10% of LA. Titrate 1 unitq4 days
103
General start for basal/bolus
40% is LA and 60 % is SA divided in 3 doses
104
Big contraindications for GLP 1 agonists?
Personal or famhx of thyroid cancer, MEN2 syndrome
105
Which diabetes meds do you hold when I’ll?
Metformin, sulfonylureas, sglt2
Also ace and arb nsaid and diuretics
106
Reasons to terminate physician or relationship
Fraud, theft, threats, abuse to staff
Call CMPA for guidance
107
Acute vs chronic diarrhea timeframe
Acute 2-14 days, chronic > 4 weeks
108
Diarrhea red flags
Age > 50, fever/chills/ns, weight loss, bloody stool, hemetemsis, arthritis, skin rash, anorexia
109
Extended ddx of dizziness
110
Vestibular neuritis presentation
Hours/days of continuous vertigo no tinnitus no hearing loss
111
Menieres
Episodic, tinnitus, hearing loss
112
risk factors for domestic violence
Pregnancy, social isolation, substance abuse, disability, financial stress, work stress, age 18-24
113
mgmt of domestic violence
social supports, counselling, report violence against children
114
physical exam for dyshphagia
CN, motor, reflexes, thyroid, abdo, oropharyngeal
115
first differentiator for dysphagia
initiating swallowing (oropharyngeal) vs foods tops afterwards (esophageal).. comment on ddx for each
116
enhanced primary care pathway for dyspepsia
THIS is sequential: red flags ,meds?, basic bw + abdo u/s, H pylori, PPI trial (OD 4/52, then bid 4/52), domperidone trial then refer
117
Define dyspepsia
Syndrome of epigastric pain +\- bloating that may be triggered by eating
118
Alarm features for dyspepsia
Age > 50 (new), IDA/GIB, progressive dysphagia, persistent vomitting, weight loss, personal hx pud, family history of UGI cancer
119
meds that cause PUD
ASA, NSAIDs, corticosteroids, etoh, nicotine
120
H Pylori, confirm eradication?
yes! 4 weeks after abx and 2 weeks after PPI stopped. all testing to be done after 2 weeks with no PPI
121
122
Duration of tx in AOM
5days if older than 2, 10 days if younger
123
earache ddx
AOM, AOE, reffered from jaw, teeth, parotids, coryza causing eustachoan tube blockage. r/o GCA, mastoiditis
124
when can watchful waiting be used with AOM
less than 48 hours of symptoms, older than 6 months, well appearing, able ot follow up, pain controlled with OTC analgesics.
125
ddx of dysuria
infection: UTI, pyelo, STI (urethritis, cervicitis), vulvovaginitis, prostatitis, epididymo-orchitis
Stones
BPH/urethral stricture
Malignancy
trauma
derm: contact derm, lichen sclerosis, ATROPHIC VAGINITIS
Interstitial cystitis
126
127
G+C tx
Chlamidia: azithro 1g
Gonorrhea: azithro + cefixime 800
128
how to avoid polypharmacy in elderly
periodically review med indications and doses
129
three common and modifiable RF in elderly that can prolong independence
polypharmacy, visual impairment, hearing impairment
130
131
Causes of nosebleed
Local trauma, dry air, iatrogenic (NG, meds), cocaine, coagulopathy, nasal neoplasm
132
Prevention of recurrent epistaxis
Emollient, humidifier, cautery, ?oral propranolol
133
Nasal packing f/u
Within 48 hrs, generally no need for abx
134
When to enquire about family issues
Periodically, at important life cycle junctures (birth of baby, children moving out), when medical issues to responding to appropriate therapy
135
Fatigue ddx
Broad!
Think systems based
136
Treatment for non-descript fatigue to implement during work up
CBT, exercise, sleep hygiene, support groups, follow up
137
How to wait before working up fatigue if no red flags and you don’t expect reversible cause?
Consider waiting 4 weeks in lamenting lifestyle advice
138
Fever of unknown origin defn
> 38.3 most days for 3 weeks
139
Antidote for serotonin syndrome
Cyproheptadine
140
NMS mnemonic
Fever, autonomic instability, rigidity, mental status change
Usually fairly acute onset after dose inc or new med (24-72hr)
141
C spine, ankle and knee rules
Go!
142
Ugib vs lgib: frequency and anatomy
2/3= UGIB, anything proximal to ligament of treitz
143
Urea to cr ratio in GIB
If >30 more likely Ugib
144
Implicated grief criteria
Yearning/heartache that is functionally impairing for more than 6. Months post loss with 4 of 8 symptoms
145
Mgmt of complicated grief
Look for and manage psych comorbs (75%prevalence)
Support groups, develop new routines, general lifestyle, repeating death story
146
Non HF causes of elevated bnp
ACS, AF, myocarditis, age, anemia, renal failure , osa, pneumonia, PE, sepsis
147
When to rpt echo in chf
3 months after meds, then q1-3 yrs
148
Bw monitoring in hf
Q 1-3 months, esp if on triple therapy
149
PEP for hep A?
Hep A Ig if not vax and: high risk, infants, cannot have vax
Everyone else: Hep A vax if within 2 weeks from last contact
150
Review hepatitis lecture you made
Do it, it’s good
151
Hep C u/s for HCC
SVR and no cirrhosis: none
svr and cirrhosis: q6m u/s
152
Chronic Hep B HCC screen
Q6m u/s and BW-> should
Be followed by specialist
153
Review course of Hepatitis a,b, c
154
In immigrants always assess?
Vaccines!
155
Immigrants screening tests?
Hep, hiv, TB, DM, IDA, strongyloides and schistosomiasis (serology for the last two)
156
Statin indicated conditions
Familial hyperlipidemia, ldl> 5, ckd, DM (and age > 40, or 30 and diabetic for 15 yrs, or micro vascular dz), ASCVD (cad, pad, Tia/stroke, aaa etc)
157
Familial hyperlipidemia epidemiology
1 in 125
158
Pediatric lipid screen
Ccs recommends screen once between 2-10
159
contraindication to vaccination:
serious reaction (anaphylaxis, GBS) to a vaccine or a component, preg/immuno comp/active TB shoudl not get live vaccine (eg rotavirus, zostavax, MMRV)
160
pneumo vax:
shingles/zoster vax:
pneumo: >65, rpt q5 yrs
shingles: >50, 2 doses 2 months apart
161
HPV vaccine
9-26 m+f, up to 45 in females, but really anyone with ongoing new partners.
162
quality of BP readings
ABPM> HBPM > AOBP >non-AOBP
163
ddx of secondary HTN
164
lifestyle mods for HTN
exercise, etoh, weight loss, dec salt (<2g) aka DASH, inc dietary K
165
BP targets:
- high risk SBP < 120 (CVD, framinghamha high risk or CKD)
- DM ,afib <130/80
-others: <140/90
166
167
Weight loss ddx
So broad!
Think decreased intake/absorption and increased utilization
168
5 s’s of a pt in crisis
Shoulder
Severity (?underlying psych)
Suicide
Safety
Support/services
Generalist infographic
169
Long term meds in IHD
Asa, statin, BB, nitro prn. Ace and plavix considered, often in indefinite
170
Additional consideration in DAPT
ppi
171
Preventation of IE
Who: prosthetic heart valve, prev IE, unrepaired CHD,
Usually amox or keflex 30-60 mins before procedure dose=2g
172
Definition of obesity
Bmi over 30. BMI over 40 is class 3, bmi 35-40 is class 2
173
You need to inform someone they’re obese. How?
Ask them if it’s ok to talk about
174
Acute, sub acute and chronic lbp
Acute < 4 wks
Sub 4-12
Chronic > 12
175
When to image back pain
In absence of rf, not till 6 wks
176
4 types of LBP and their features
1 discogenic
2 facet
3 sciatica
4 spinal stenosis
177
Common live vaccines
MMR, rabies, intenasal influenza
178
Ddx insomnia
Psych(anxiety, depression, mania,)
Substances -any
Medical- chf, thyroid
Meds- stimulants, bronchodilstors, psych meds
Sleep D/o-RLS, OSA, sleep walking etc
179
Insomnia non pharm mgmt
Sleep hygiene
CBT
Stimulus control
Restriction therapy
Relaxation therapy
(Discuss each)
180
Adolescent HEADSS assessment… need to get parents out of the room too
181
At every adolescent visit…
Directly ask about risky behaviours, do heads assessment
182
Natural progression of whiplash
55 fully recover in 3/12, 80% in1-2 yrs
183
defn of infetrility
12 months of no conception, with regular well timed intercourse
184
ddx of male infertility
testicular (torsion, varicocele, trauma)
iatrogenic (meds/subs (incl marijuana and etoh), radiation)
structural (vasectomy)
185
investigations in male infertility
STI screen, spermanalysis, consider u/s
remained of Ix depends on spermanalysis results
186
general etiology of infertility
30% female, 30% male, 15%mixed, 15% idopathic
187
female infertility work up
STI screen. u/s, day 3 fsh (ovarian reserve), or get AMH, day 21progesterone (did someone ovulate)
if not regular menses: then do amen/oligomen w/u
188
when to refer for female infertility
<35 after 1 yr
35-40 after 6 months
>40 ASAP
189
190
Rheumatoid arthritis symptoms
Symmetric small joint pain and swelling
191
RA blood tests
RF: neg 25% of time
Anti ccp: 95% specific
Crp
192
OA= better with motion, televised with rest? T or F
True!
OA better with rest,
Inflamm = better with motion
193
defintion of fibromyalgia
widespread jt and muscle pains (often burning pain) associated with fatigue
194
how to dx fibromyalgia
no evidence for research questionnaires or tender pts... 3 months of widespread pain and fatigue with normal exam. NEED TO R/O other dx with: xr, bw (tsh crp) and possibly a sleep study
195
tx of fibromyalgia:
CBT, education (non-progressive, non-deforming), exercise, amitriptyline
196
what is Granulomatosis with polyangitis
ANCA + vasculitis,
197
two key things to consider in learning disability
hearing and vision testing
198
what to rule out in learning diability
hearing/vision, psych, genetic and medical causes
199
alcohol recommendations, salt recommendations
2 drinks or less per week (more than 7 is high risk drinking), less than 2 g of salt per day
200
competence vs capacity
competence= legal
capacity= medical
201
4 key's to capacity
-communicate a choice
-understand relevant info
-appreciate situation and consequences
-reason about treatment options
202
3 criteria for consent to be valid
-voluntary
-they must have capacity
-must be properly informed (dx, tx, alternatives etc)
203
204
risks of oral E+P HRT
breast ca, stroke, vte 2-6 per 1000 5 yres use.
benefit 6 all cause mort improved.
-less risk of vte and stroke if given transdermal
205
non-hormonal meds for menopause
SNRI or SSRI
206
timeline for schizophrenia dx
<1 month = brief pyschotic, <6m = schiprheniform, >6m including prodrome = schz
207
dx criteria for schizo
6 months, 2 of: delusion, hallucinations, negative symptoms, disorganized behavior, disorganized thought/speech
208
209
risk factors for violent pt
young male, low SES, substane use, psych pt, legal history, history of violence
210
Pneumonia duration of tx
5 days and 48-72 hrs afebrile
211
acne treatments
BPO
topical abx + BPO
topical retinoids
oral ABX
isotretinoin
212
213
When does pain become “chronic pain”
12 weeks
214
Type of history in sexual assault case
Medical only! Ask only medically relevant details … do still ask about weapons/restraints/ type of assault, circumstances/location/ age of assailant etc
215
Duration of f/u for STI testing in sexual assault
Initial, 3 week, 6 week, 3 months, 6 months (optional)
216
Pregnancy prophylaxis in sexual assault… aka emergency contraception
Ullipristal, levonorgestrel, copper IUD
217
Mgmt of sexual assault
STI Ix
Manage injuries
Pregnancy proph
STI tx if (I know f/u, or preference, high risk assailant)
Psychosocial
218
Typical vs atypical Parkinson’s features
fm learner list
219
Parkinson’s laterality
Unilateral at presentation but usually progresses to bilateral
220
Tx of long qt and wide are in tox
Qt: mgso4
QRS: sodium bicarbonate
221
Good “go-to” size for surgical chest tube
28F
222
Common non-infectious ethologies of vaginitis
Lichen sclerosis, atrophy, vulvar cancer, contact dermatitis
223
CKD sick day meds
SADMANS (Sulfonylureas, ACEI, Diuretics, Metformin, ARB, NSAIDs, SGLT2i)
224
definition of CKD
>3/12 of GFR <60 OR structural/funtinoal kidney dz (eg significant proteinuria for >3/12)
225
referral to neprho in CKD
lots: generally: ACR over 60, GFR under 30, or GFR under 45 and rapid decline, KFRE over 5%
226
monitoring of GFR in CKD
q3-12 months depending on KDIGO classification
227
peak withdrawl from nicotine and peak relapse
wd: 2-3 days, relapse 2-3 weeks
228
5 A's of smoking cessation
Ask, assess, advise, assist, arrange
229
meds for smokng cessation
Champix (varenacline)
Bupropion
*both the above should be started 1 week before quit date. both are bets combined with nicotine patch!
*should continue both for 3/12
230
smoking cessation STAR strategy
ie what to do when someone is ready to try
-Set a date
-Tell friends and fam
-Anticipate challenges
-Remove nicotine from home
231
number of URTI/year
adult: 4-6
child 6-8
232
when to use Oseltamivir (tamiflu)
influenza a or b and <48 hours of symptoms onset
233
how long does URTI last
on average 10 days, cough can last 4-8 weeks
234
symptoms, Ix and mgmt of mononucleosis... mono age?
age 14-25 give or take
235
Body systems to consider when assessing son
Cardiac, resp, heme, GI, psych, environmental
236
Age to consider OP screening
50
237
indications for BMD >50
age over 65, RA, prolonged glucocorticoids, ++ etoh, current smoker, parental hip #.., high risk med
in practice: only ppl with prev fragility # or mod/high risk frax
238
indications for BMD <50
frag #, high risk med, glucocorticoids, RA
239
general approach to OP
FRAX or BMD (if indication), if mod or high risk FRAX --> BMD. use caroc, if high risk --> tx with alendronate. monitor bmd q3 yrs, consider drug holiday at 5-6 yrs. if remain high risk cont with drug for 10 yrs total.
non pharm mgmt for all
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non pharm mgmt OP
1200 mg calcium daily, vit d 1000 IU, decrease etoh, decrease smoking, weight bearing exercise
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ARR with bisphos
2.5% ARR for symptomatic #, 2% primary, 7% secondary
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indications for surg in BPH
failed dual therapy (flomax, dutasteride), renal issues sec to BPH, reucerrent infection, bladder stones, pt prefernce, recurrent hematuria
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zoster vax age
>50
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pneumovax age
>65
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HPV vax
M/F < 26, females <45
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type A PD
1. paranoid
2.schizoid
3. schizotypal
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Type B pd
1. antisocial
2. borderline
3. narcissistic
4. histrionic
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type C
avoidant, dependent, ocpd
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Quick metabolic that is can’t kiss in seizure
POC glucose!!!
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Precipitate of prev stable seizure d/o
Med compliance, med changes, infection, intox/wd, sleep deprivation
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Seizure ethologies
DIMS + primary seizure
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ddx of bleeding in pregnancy by trimester
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ddx of AUB in non-pregnany
PALM COEIN
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risk factor for suicide
prev attempts
male
hx self harm
sexual mibority
fam hx suicide
hx legal problems
comorbid psych condition (almost all)
active SI
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Test of cure G+C
g 1 week, C 4 weeks (but not necessary)
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Tx if g and c
G -> cefixime 800 po or 250 IM
C-> azithro (1g po) or doxycycline (250 bid 7 days)
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Course of HPV
90% resolve spontaneously in 2 years.
70% of adults have hpv
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Syphillis stages
Primary- < 3/12, painless chancre
Secondary- 2-8 weeks after primary: maculopap (not itchy) rash, comdylomata lata, lumphadenopathy general malaise fevers etc
Latent-> early <1 yr, late/uknown
Tertiary >granuloma, neurosyphillis
Untreated primary/secondary: 1/3 cure, 1/3 latent indefinite, 1/3 tertiary
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Indication for CArotid endsrtercetomy
Stenosis >70 if asymptomatic
50% if symptomatic
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BP mgmt in acute ischemic stroke
TPA: <185/110 for tpa, <180/105 for 24 hrs after
No tpa:permissive htn <220/120
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2 common meds for hyperthyroidism or hypo
Amio, lithium
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What is secondary hyperthyroidism
Elevated TSH, elevated t3/4… pituitary adenoma. It’s very rare, all common causes are primary
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Ethology of hypothyroid
95% primary often hashinotos
5 secondsry, pituitary adenoma or damage
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Subclinical hypothyroid
No tx if tsh <10(or 20) normal t4 and no symptoms (not pregnant)
But check anti tpo ab, and tx if elevated
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When to tx primary hypothyroid
Tsh >10 and symptoms
Tsh 5-10 and getting to conceive, elevated anti-tpo, goitre or strong famhx autoimmune dz
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HypoThyroid monitoring
Check tsh 6-8 weeks after starting and dose change (takes this long to respond)
Once stable rpt yearly
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How to take synthroid and dose
Empty stomach, no other meds
12.5-50 is starting dose, titrate by 12.5 mcg. If young and healthy consider starting at target (1.6 mcg/kg)
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somatic type disorder
1. somatic sypmtom d/o -> somatic sympton
2. illness anxiety d/o _> ++ anxious, no somatic sx
3. body dysmorphic d/0 -->improper perception of body
4. conversion d/o -> SSD, but neuro
5. factitious d/o ->concious somatization for unconcious reasonas
6. malingering --> concious somatization for concious secondary gain
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Malaria endemic areas
Central America, South America, Africa, Russia, china, Middle East
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Drugs for malaria prophylaxis
-Malarone: 1 day before until 1 week after
-other options are hydroxychloroquinr and doxycycline
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When to culture travellers diarrhea
>10-14 days, fever or bloody stool
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acute stress disorder
PRECURSOR TO PTSD
symptoms last 3 days-1 month after event, serious/life threatenting can be witnessed or learned of ie found out a friend was in accident/raped etc
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PTSD
>1 month, same criteria for event as acute stress d/o
symptoms of: hyperarousal, low mood, avoidance, intrusiveness
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adjustment reaction
within 3 months, not longer than 6 months. maladaption to any stressor
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meds for medical abortion
Mife 200, then miso 800 buccally 48 hrs later. LMP <70 days, f/u in 14 days to ensure completion
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Rh mgmt for abortion (medical and spont)
if Rh neg, rhogam 150 IM if GA <12 weeks, 300 IM if GA>12 weeks
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regular cord clamping time
60 s
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stages of labour and corresponding uterus/cervical changes
see chart in o'toole's
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Placental abruption triggers
Trauma, although usually spontaneous!
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Placental abruption triggers
Trauma, although usually spontaneous!
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Baby blues shouldn’t last longer than?
2 weeks
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How long to wait to get pregnant again, esp if c/s
18 months
