CCFP Flashcards
Secondary causes of HTN ABCDES
Atherosclerotic, coarctation of the aorta
Bad kidneys - Renal parenchymal disease
Catecholamines
Drug, Diet
Endrocrine (Hypothyroid, aldosterone, Cushing), EtOH
Fibromuscular dysplasia
sleep apnea, stress
Medications that raise BP
Steroids, NSAIDs, amphetamines, many psychiatric meds - SSRIs, SNRIs, carbamazepine, estrogen/progesterone/androgens, sympathomimetic (decongestant), licorice
What does a lipid panel include
Chol, HDL, LDL, non-HDL, TG
Risks of HCTZ?
Skin cancer non melanoma, possible 4x risk after 3 years
Avoid long acting Chlorthalidone, indapamine b/c of DM2, renal and electrolyte abnormalities
Lifestyle interventions for HTN
Lower salt, exercise, weight loss, reduce alcohol, DASH diet, relaxation –> CBT
HTN Meds to avoid in HTN
alpha blocker alone
Beta blockers if > 60
ACE if black
Risk factors for uterine perforation
breast feeding grand multiparity history of csection nulliparity inexperienced HCP uterine abnormalities postpartum state in breastfeeding women
when should you start various kinds of birth control when removing an IUD?
POP 2 days before, ocp/depo etc 7 days before
contraindications to IUD
pelvic TB, pregnancy, uterine/cervical malignancy, puerperal sepsis, post-septic abortion, unexplained vaginal bleeding, gestational throphoblastic disease with persistently elevated betahcg (decreasing beta is relative), distorted uterine cavity, current PID/gonochlam
mirena: breast cancer, hx of ischemic heart disease, antiphospholipid antibodies, migraine with aura, severe cirrhosis
copper: severe thrombocytopenia
What does SAD PERSONS stand for
Male sex Age <19, >45 Depression Previous attempt Excess EtOH/substances Loss of rational thinking Social supports lackings organized plan no spouse Sickness
What else should you r/o with depression
mania, anxiety (does worry get in the way of your life?), OCD (thoughts/rituals you cannot stop), delusions (special powers/plot against you), hallucinations
when to consider bipolar?
age <25 >= 5 episodes family hx hypersomnia hyperphagia/increased weight lability of mood/irritability
first line meds/treatments for PTSD
fluoxetine, paroxetine, sertraline
venlafaxine
CBT
group therapy
first line meds/treatments for OCD
escitalopram, fluoxetine, paroxetine, sertraline
CBT
exposure with response prevention
mimics for depression
hypothyroid, adrenal insufficiency, grief/adjustment disorder, drug use, bipolar, tumor, delirium
SPIKES
setting up perception invitation knowledge emotion strategy, also SAFETY.
SNOPQRST
Safety Next visit Offer Prevention Quit Refer Start Teach
Osteoporosis risk factors
Age > 65 Sex - female post menopausal Alcohol Chronic disease i.e. RA Chronic steroid use Previous fragility fracture Malabsorption/eating disorder Hypogonadism low body weight <60kg for <50yo, fragility #, prolonged use of CS, high risk meds, hypogonadism/premature menopause, malabsorption syndrome, primary hyperparathyroidism, other d/o associated with rapid bone loss and/or fracture
Chronic bronchitis criteria
Chronic bronchitis is defined as a cough with sputum expectoration for at least 3 consecutive months for at least
2 consecutive years
Thalassemia regions
Southeast Asia Africa South America Middle East Carribbean Mediterranean
Broad differential? VINDICATE
Vascular Infectious Neoplasm Drugs Idiopathic Congenital Autoimmune Trauma Endocrine
COPDE
cough, purulence, dyspnea, CRP >40
Early warning score i.e. NEWS2
Common ear bugs? what about (complicated) COPD? what about PNA?
Hemophilus influenza
Moraxella catarrhalis
Strep pneumonia
(same as for COPD; if complicated add on klebsiella, gram negatives, pseudomonas; same for pneumonia, if comorbid add on staph aureus, if not comorbid, atypicals - mycoplasma and chlamydophila)
COPD Adjunctive Treatment
Flu/pneumonia shots Action plan to reduce hospital use CPAP? Daily macrolide (azithro, erythro) to decrease exacerbations Exercise Quit smoking Pulmonary rehab Puffers - SABA, LAMA, Respiratory therapy Teach inhaler technique
SNOPQRST
Safety Next visit Offer Prevent Quit Refer Start Teach
Criteria for dx asthma in <6 yo
Wheeze that reverses
it’s not something else
What are the criteria for asthma dx
FEV1/FVC pre <0.75
FEV1 post increases 12%
vs. COPD; post <0.70 and not reversible
Asthma rx pyramid for pre-schoolers
mild - saba
mod - saba + ICS
severe - saba, ICS, oral steroids
Asthma rx pyramid for 6+
mild - LABA + ICS (symbicort) as needed
mod - saba + daily ICS OR as-needed ICS/LABA- formeterol (LTRA as alternative)
mod + - low dose ICS/LABA plus as needed SABA, OR low dose ICS/LABA plus as needed ICS/LABA
mod ++ - med dose ICS/LABA plus as needed SABA, OR low dose ICS/LABA plus as needed ICS/LABA
next! refer for phenotypic investigations + add-on treatment
severe - saba, ICS, LABA, LAMA, LTA, theophylline
**if uncontrolled, saba +/- ICS/LABA on demand
Good asthma control
<1 night time symptoms
<4 use of prn puffer
no activity restrictions, no missed school/work
Risk factors for asthma exacerbations
ICS not prescribed, poor adherence,
GERD, obesity, previous ICU/intubation for asthma, irritants - smoking/allergen/pollution, allergic rhinitis, food allergy, depression, anxiety, pregnancy, FEV1<60%
NSAIDs, betablockers
Frequency of asthma f/up? in pregnancy?
1-3 months after starting treatment then 3-12 months after that; in pregnancy, every 4-6 weeks
Testicular cancer BALLS CFP
Bhcg
Alpha fetoprotein
Lop it off
Cryptorchidism
Family hx
Personal hx
Lung cancer screening
age 55-74, 30pk/yr smoke, current or quit <15 years ago. CT annually up to 3 times
Cervical cancer screening
25-69 every 3 years unless - never sexually active - weakened immune system - symptoms of cervical ca - previous abnormal results - those who do not have a cervix - immunosuppressed CAN stop at age 70 if 3 normal in last 10 years
Skin cancer risk factors
Nevi > 15 older white skin, red hair hx of skin cancer, sun exposure family history multiple sunburns actinic skin damage --> refer if hi risk, skin checks q6 months
skin cancer ABCDE
Asymmetry
Border - gradual, indistinct vs. sharp cut off
Colour variation
Different dermatoscopic structures - pigment network, homogeneous areas, streaks, dots, globules
Evolving size/shape/colour
Colorectal screening
50-74
flex sig q10 or FIT q2 years
Breast Ca screening (5)
1. Screen with mammography every 2-3 y if aged 50-74 y 2. Do not routinely screen those aged 40-49 y 3. Do not screen with magnetic resonance imaging 4. Do not perform clinical breast examination 5. Advise patients not to perform self breast examination
Management for Feb neut?
early antibiotic treatment, look for source and consider fungal
stabilize and assess
severe sepsis –> ICU
H Pylori quad therapy
PPI
Bismuth salicylate
Metronidazole
Tetracycline
what is Barrett’s esophagus? prevention,
columnar cells replace squamous;
prevention - high dose PPI and ASA
long term risks of PPIs
fractures
b12 deficiency
dementia
c diff
gallstone RF
female
forty
fat
fertile – on OCP
pancreatitis RF
septra, flagyl HCTZ, ACE progesterone atorva estrogen gall stones ETOH
I = idiopathic (also known as the fancy medical way of saying, “I dunno.”)
G = gallstones (one of the two most common causes of acute pancreatitis)
E = EtOH (the other common cause of acute pancreatitis)
T = trauma
S = steroids
M = mumps/malignancy
A = autoimmune
S = scorpion stings … though this probably shouldn’t be your first guess for why your patient has pancreatitis
H = hypertriglyceridemia/hypercalcemia
E = (post) ERCP
D = drugs. Most commonly: thiazides, sulfa drugs, and didanosine
admission criteria - UN
uncontrolled symptoms
unstable
undiagnosed pain esp in elderly, immunocompromised
undischargable i.e. poor social support
fluid for peds
20 mg/kg maintenance 4/2/1 - 4 ml/kg for the first 10kg - 2ml/kg for 11-20 - 1 ml/kg 20+
measures to monitor for severe dehydration
weight gfr/creatinine na, k glucose urea
c diff risks
abx esp fluoroquinolones previous infxn recent hospitalization older age immunocompromised
c diff pitfalls, who not to test? and rx
not just hospital acquired
don’t test kids <1
rx: vanco po
Crohn’s medications
start with sulfasalazine if mild, otherwise steroids
thiopurines - not for induction
methotrexate
biologics
celiac testing
TTG/IGA plus total IGA +/- upper endoscopy, small intestine biopsy
OR endomysial IGA (but this is +++expensive)
if IGa deficiency, DGP IgA and IgG
IBS rx
r/o celiac psyllium probiotics, peppermint oil FODMAP CBT colonoscopy if >50/alarm features antispasmodics anti depressants eluxadoline - diarrhea predominant lubiprostone - constipation predominant linaclotide - "
Restless legs rx, rx and non rx
non rx iron, mg stretch calves avoid caffeine massage, heat exercise rx non ergot dopamine agonists - pramipexole, ropinirole alpha-2-delta calcium channel ligand - gabapentin, pregabalin
restless legs dx
sensation or urge to move legs
worse with rest, improves with activity
worse in evening
restless legs risk factors
▪ Highly heritable – often family history (↑young age onset)
▪ Pregnancy
▪ Low ferritin (can be with or without anemia)
▪ Medication induced –Caffeine, Alcohol, Antihistamines, Dopamine agonists, Antidepressants, Lithium
▪ Associated diseases –ADHD, Parkinsons disease, Anxiety, Depression, Anemia with iron deficiency, Obesity, Diabetes, Renal disease
Dx hyperthyroid
Radioactive iodine uptake (NOT for ladies who are preggers), unless 100% sure it’s graves
B block for symptoms
nodule? >1cm = FNA
don’t treat subclinical hyperthyroid
suspicious features of thyroid nodule
> 1cm
Taller than wide
irregular surface
calcifications within
Treating thyroid storm - BLOCK x 5
Beta blocker - propanalol
Block synthesis - methimazole, propylthiouracil
Block conversion T4 –> T3 propylthiouracil
Block release - iodine
Block Bile - cholestyramine
Treating graves, 3 Rs
Rx - First 4 Blocks - beta blocker, block synthesis, block conversion, block release
Radiation
Removal
Meds to stop when sick/at risk of dehydration
SADMANS
SFU ACE Diuretics Metformin ARBs NSAIDs SGLT2
Three reasons people develop DKA
- acute illness,
- drugs: clozapine, terbutaline, cocaine, lithium, SGLT2
- non compliance
Diabetes complications, micro/macro
micro - retinopathy, neuropathy, nephropathy
macro - atherosclerosis –> CVD, CVA, PVD
Biguanide
metformin
SGLT2 inhibitors
flozins - empagliflozin, canagliflozin
GLP-1R agonists
glutide - semaglutide, liraglutide
DPP4 inhibitors
saxagliptin
sulfonylureas
gliclazide, glyburide
driving 2-4-6 rule
test BS every 2 hours - if hypoglycemia unawareness
test BS every 4 hours - treat and wait 40 min
keep 6 lifesaver candies in the car for lows
risk factors for hep B
IVDU sex with partner with hep B child born to mother with hep B tattoos blood transfusions living in crowded conditions unimmunized multiple sexual partners MSM occupation prison hx of STIs breastfeeding OK if skin is in intact
medications to treat chronic gout
allopurinol
prboenecid
febuxostat
how to test for Hep C?
anti - HCV (unless known previous hep C)
HCV RNA serum
genotype and subtype
–> spontaneous clearance in 20-45%
how to test for Hep b?
HbsAg Anti HBS Anti HBC --> IgM, total if +ve HBeAg HBV DNA Anti HBe
Mgmt and monitoring hep B
Refer to hepatology Anti virals if severe, cirrhosis U/S q6-12 months for HCC scope every 1-3 years for varices Cirrhosis/fibrosis - fibroscan, Child Pugh
The current approved treatments for HBV are interferon injections (standard or pegylated interferon) or oral nucleoside/nucleotide analogues (entecavir, lamivudine, tenofovir). As oral antivirals are excreted by the kidney, dose adjustments are required in renal failure.
Not all patients with chronic HBV infection need to be treated. The decision to treat depends on several factors including age, serial ALT and HBV DNA levels, and severity of liver disease. Co-infection, particularly with HIV and HCV, needs to be considered when deciding on which medications to use.
HBsAg (surface antigen) indicates infection. Persistence of HBsAg for 6 months or more indicates chronic infection. However, up to 50% of people with extended chronic infection will eventually clear HBsAg. By contrast, those with resolving acute HBV will clear HBsAg several months after initial infection.
Anti-HBs (surface antibody) is a protective antibody produced with recovery from infection or in response to immunization. Over time, titre may decline to undetectable levels. Note: There is a gap of several weeks to months between the disappearance of HBsAg and the appearance of anti-HBs; during this period, anti-HBc total is detectable as a marker of HBV infection.
Anti-HBc IgM (core antibody - IgM) appears early in acute HBV infection and persists for about 6 months. It may also be seen in chronic infection during flares of activity, so clinical/epidemiological correlation is required for interpretation.
Anti-HBc total (total core antibody - IgM and IgG) is a marker of past exposure or current infection. IgG usually persists for life. In low prevalence populations, a finding of isolated anti-HBc may signify a false positive result.
HBeAg (e-antigen) is a marker of viral replication; its presence indicates high infectivity. Implications for liver injury vary with stage of infection (see Module 7 for significance).
Anti-HBe (e-antibody) appears with recovery from acute infection. In chronic infection, the presence of anti-HBe is generally a marker of reduced viral replication, indicating a less infectious state. The implications for liver injury vary with stage of infection (see Module 7 for significance)
Mgmt and monitoring hep C
Refer to hepatology Treat: interferon or new regimens U/S q6-12 months for HCC scope every 1-3 years for varices Cirrhosis/fibrosis - fibroscan, Child Pugh
NAFL vs NASH, and treatment?
NASH = NAFL + hepatitis (increased ALT/AST)
= signs of inflammation
NAFL - no inflammation or fibrosis = STEATOSIS
Rx - stop EtOh, weight loss, lipid control, DM control, if fibrosis >2 consider vitamin E
Ankylosing Spondylitis features
low back/SI pain stiffness
worse w/ rest, improves w/ movement
worse at night
30 minutes + for morning stiffness to recede
weight loss, fatigue
chest pain – from insertion into sternum
enthesis i.e. plantar fasciitis, achilles tendonitis
anemia
uveitis
aortitis
heart block
what is Schober’s test
find L5, measure 10cm above and 5cm below = 15cm
if <20cm when bending forward = restrictive
investigations for Ankylosing Spondylitis
ESR, CRP
HLA b27
spine xray or MRI for early changes
mgmt AS
nsaids steroids for flares - oral, IM, into joint anti TNF monoclonal antibody physio no smoking bisphosphonates if osteoporosis
Back pain physical exam
ALWAYS: numbness, weakness, pedal pulses, neuro exam
Lower limb Myotomes memory aid
L1/L2 buckle my shoe - hip flexion
L3/L4 kick the door - knee extension
C5/6 pick up sticks - biceps
C7/8 - shut the gates
Dermatomes memory aid
L4 down on all 4s - knees to first toe
L5 middle toes
S1 pinky toe
joint red flags
hot boggy AM stiffness PM night pain extra-articular symptoms? think genital infection, vasculitis, systemic illness
ADHD medication classes
Stimulants - methylphenidate (concerta, biphentin, ritalin), amphetamine (vyvanse, adderall)
SNRI - Atomoxetine
Alpha receptor antagonist - Guanfacine
ADHD meds – Consider DATER before changing medication to 2nd/3rd line
Dosage
All - trial of all 1st line
Time - enough time given for response/side effects to resolve
Examine - what are the targets? what standardized measures
Review - comorbidity, lifestyle
ADHD non rx management
patient and family education
psychological treatment
education accommodations
driving – restrict cell phone use, recommend manual transmission
ODD vs conduct disorder
ODD children do not show aggressions towards peope/animals; destroy property; pattern of theft and deceit
Bedwetting management
make toilet accessible pee before bed including in morning cleanup training pants avoid fluids/caffeine/chocolate before bed do not punish, introduced diapers enuresis alarms desmopressin for short-term
Well baby care counselling HONEY ‘n’ guns
No honey Choking hazards Vitamin D Breast/fed is best button battery ingestion No guns Carbon monoxide detector Cover electric plugs Hot water heater car seats Storage and poison control
Milestones
2 months - two = coo, smiles 4 months - hold object - four fingers and hold head, laughs 6 - sit at six with support 8 - pincer grasp 1 year - walk, 1 word; responds to name 15 months- stranger danger 2 - run, 2 word sentence, 1-2 step directions 3 - 3 step instructions 5 - adult like sentences
Breastfeeding guideline
> =2 years
400IU daily vitamin D
circumcision, pros and cons
pros
- decreased infection - phimosis (rx with topical steroids), uti, hpv, cancer
cons
- pain, stenosis, damage to surrounding tissues
undescended testes cause
torsion trauma tumor inguinal hernia infertility
torsion TWIST score
absent cremasteric reflex nausea/vomiting testicle swelling testicle hard high riding testicle
4 nots for nuts
refer if
- not descended at 6 months
- not there anymore
- not there
- not positioned properly
AIDS defining illnesses
Kaposi’s sarcoma Pneumocystis jirovecii pneumonia (PCP) Cytomegalovirus Candidiasis (oesophageal or bronchial) Lymphomas (excluding Hodgkins) Tuberculosis
when to give Tdap to pregnant ladies
> 13, ideally 27-32 weeks
which vaccines can you NOT give if someone is breastfeeding?
BCG, yellow fever, japanese encephalitis
which vaccines do you need to delay if someone is ill?
lots of congestion – don’t give nasal flu
acute GI – defer cholera, dukoral
mod to severe – defer rotavirus
who gets flu vaccine?
kids > 6 months
everyone, but esp adults with neurologic/developmental conditions, work in health care, work with poultry
> 65 yo
vaccines in person with egg allergy
flu, MMR ok
do not give yellow fever, tick-borne encephalitis or rabies
make vaccine less painful?
breastfeed skin to skin most painful last sugar tylenol after, otherwise blunts immune response topical anesthetic don't aspirate
what are the two shingles vaccines?
what kind, how often, how $$$, how effective?
zostavax = live attenuated
1 dose, $170, >60 yo
shingrix = non live recombivant, adjuvanted
2 doses, 2(-6) months apart
2x as effective, 2x as much
>50yo
HPV vaccine - # of doses, #-valent
2 doses, 9-valent, all genders
who do you give meningitis C to? (5)
all travellers to Hajj meningitis belt of africa military recruits asplenia and sickle cell all canada adolescents
vaccines for the immunocompromised? keep 3 things in mind
- no polio, varicella, MMR
- close contacts: avoid giving or avoid contact for 2 weeks
- consult public health/ID
vaccines contra-indicated in…
pregnancy? TB? severe asthma/medical wheeze in last 7 days? uncorrected GI malformation? HIV?
pregnancy: live vaccines (polio, varicella, MMR), BCG –> flu ok
active TB: MMR, varicella, herpes zoster, BCG
asthma: live attenuated influenza
GI malformation: rotavirus (risk of intussception)
HIV: all live vaccines
Common cold treatment? (5)
NSAIDs, honey (> 1 year), intranasal ipratropium, nasal decongestant/anti-histamine (>5 year), zinc (not intranasal)
sinusitis risk factors? (4) which bugs?
allergic rhinitis asthma anatomy smoking ear bugs
red flags on sinusitis? (9)
fever > 39 periorbital edema cranial nerve palsies abnormal EOM proptosis vision changes severe headache altered mental status meningeal signs
what are the meningeal tests?
Brudzinski - flexed neck –> flexed extremities
Kernig - with hips flexed cannot extend knee
PODS acute sinusitis
pressure/pain obstruction (nasal) dischage - thick, purulent smell, loss of 2 or more -- persists for >7-10 days
mgmt of acute sinusitis
ct/xr only if red flags amox 500 TID 5-10 days nasal steroids! nasal rinse decongestants analgesics anti-inflammatories mucolytics
why give abx for GAS? what does it NOT prevent?
prevent... AOM rheumatic heart disease sinusitis decrease illness <1 day peritonsillar abscess does NOT prevent glomerulonephritis
mono - how does it spread? symptoms? labs? recommendations re: spleen?
saliva
lymphadenopathy, fatigue, sore throat, splenomegaly, headache
lymphocyte count, serume AST/ALT, monospot
NO abx
no contact sports min. 3 weeks, can last up to 8 weeks
Jaundice beyond two weeks, order:
hemoglobin serum conjugated bili coomb's test group and screen peripheral smear
Symptoms of down syndrome - rule of 1s
1st toe web space
1 palmar crease
1% recurrence
Hip dysplasia risks, ffff
first born feet -- breech family history fluid -- oligo female
full septic workup in kids
CBC
LP
CXR
urine/blood cx
pediatric LIMPSS cannot miss
Legg calves perthe Infectious Malignancy - ewing's sarcoma, osteosarcoma Pain from a fracture - abuse? Slipped capital femoral epiphysis Something else above/below
Classes and examples of constipation meds
Stool softeners – docusate (colace)
Osmotic laxatives – lactulose, Mg salts, sorbitol, PEG
Bowel stimulants (motility agents) – senna, bisacodyl, cascara, prune juice
Bulking agents – psyllium, bran (Metamucil ok)
Bowel lubricants – mineral oil, castor oil, glycerine
Enemas – tap water, saline, sodium phosphate (fleet), oil
Counselling pts for HCV - 4
Discussion of avoidance of alcohol
Monitoring of progression (ALT/AST, annual AFP)
Counsel on risk of transmission
Screening sexual partners
HCV treatments
Pegylated Interferon Ribavirin Telaprevir Simeprevir Sofosbrevir Harvoni (ledipasvir/sofosbuvir) Holkira Pak (dasabuvir, ombitasvir, paritaprevir, ritonavir) velpatasvir daclatasvir
Mechanism of scaphoid #
Extreme dorsiflexion of the wrist with compressive force to the radial side of the palm
Fall on outstretched hand/arm
Forceful radial deviation and dorsiflexion of wrist
Direct axial compression or hyperextension of the wrist
Physical exam for snuffbox tenderness
Anatomic snuffbox tenderness
Scaphoid tubercle tenderness (extend the patient’s wrist with one hand and apply pressure to the tuberosity at the proximal wrist crease with the opposite hand)
Positive results on the scaphoid compression test (axially/longitudinally compressing a patient’s thumb along the line of the first metacarpal)
Swelling on the dorsoradial side of wrist or over the anatomical snuffbox
Pain in the snuffbox with pronation of the wrist followed by ulnar deviation
Reproduction of pain when patient pinches tips of their thumb and index finger together
Scapholunate disruption on xray
A gap of more than 3 mm between the scaphoid and lunate bones (the Terry Thomas sign)
Scaphoid #, reasons to refer to ortho
open fractures neurovascular compromise displacement of 1 mm or more angulated fractures associated tilt of the lunate bone associated carpal instability evidence of nonunion or displacement during follow up osteonecrosis possible scapholunate dissociation proximal pole fractures oblique fractures unwillingness or inability of the patient to wear a cast for up to 3 months
Why does scaphoid have higher rates of fracture complications?
The scaphoid bone has a tenuous blood supply running from distal to proximal.
RATIONALE: The blood supply comes from the radial artery, feeding the bone on the dorsal surface near the tubercle and scaphoid waist with no direct blood supply to the proximal portion. Thus, there is an increased possibility of nonunion or osteonecrosis with fractures, particularly those of the proximal pole.
Symptoms of hypercalcemia
mental status change confusion poor concentration abdominal groans (e.g. abdominal pain) nausea vomiting anorexia fatigue/lethargy renal colic dehydration polyuria polydipsia constipation bone pain muscle weakness anxiety depression
Rx for hypercalcemia
Hydration with normal saline
Calcitonin
Bisphosphonates
Medications that cause hypercalcemia
ationale: Thiazide diuretics (class or specific drug name of any thiazide acceptable) Lithium Teriparatide Abaloparatide Theophylline Excessive vitamin A Excessive vitamin D
1st blood test to order with dx of hypercalcemia
PTH
Risk factors for neonatal jaundice
Prematurity
Vacuum delivery leading to cephalohematoma
Asian background
Possible dehydration (poor weight gain)
Blood tests in neonatal jaundice
Blood type (ABO and Rh status) of infant Direct antiglobulin test (direct Coomb’s test)
Inherited disorder that cause hyperbilirubinemia
Glucose-6-Phosphate Dehydrogenase Deficiency
Pyruvate Kinase deficiency
Crigler-Najjar syndrome
Hereditary spherocytosis or elliptocytosis
Hemoglobinopathies (sickle cell, thalassemia, Hemoglobin H disease)
Side effects from phototherapy?
Dehydration
Bronze baby syndrome / bronze discolouration of the skin
skin rash
over or under heating of infant / temperature instability
loose stools/diarrhea
electrolyte disturbance (hyponatremia or hypokalemia)
interference with maternal –infant interactions
Ocular damage
Causes of hyperbilirubinemia in babies <24 hrs
hemolytic disease of the newborn (Rh or ABO incompatibility, spherocytosis, G-6PD deficiency, Kell Congential hemolytic states)
Maternal autoimmune hemolytic anemia (e.g. lupus) Type 1 – usually by day 3
Concealed hemorrhage/hematoma
Vitamin K deficiency
Treatment for ABRS
amox, nasal steroids
Classic sites for infantile eczema
Cheeks
Face
Scalp
Extensor surfaces (elbows and knees would count as 2 answers)
1/2 point for Flexor surfaces (flexor surfaces can be found in any age, however, extensor surface involvement is more classic for infantile eczema)
Trunk
Risk factors for infantile eczema
Positive family history of atopy (give ½ point for either “allergy” or “asthma”) Weather changes (cold, dry) Chemical irritants (scented soaps, detergents)
strategies to prevent/treat eczema
Reducing frequency of baths Unscented products (soap, detergents) Minimize soaps Emollients Barrier creams Use luke warm water for baths Avoiding triggers or irritants Exclusive breastfeeding (although some small studies are refuting this) Parental education Topical steroids Antibiotics in severe cases
when to treat asymptomatic BV?
Pregnant women with history of a high-risk pregnancy (previous preterm delivery)
Prior to IUD insertion
Second trimester even if asymptomatic (check this)
Prior to gynecologic surgery/therapeutic abortion/genitourinary instrumentation
Immunocompromised patient
abx to treat trich? what else can be used for BV?
metronidazole
clinda, doxy
Pediatric Limps LIMPSS
Leg Calve Perthes Syndrome - boys, age 4-10, white Infection/inflammation Malignancy - Ewing's Sarcoma (small round blue cells - pelvis, thigh, lower leg, upper arm, and rib), Osteosarcoma (Osteosarcoma usually develops at the edges of the long bones, in the “metaphysis” esp. the knee) Pain from a fracture - abuse? Slipped Capital Femoral Epiphysis - obese, adolescent, black/latino Something above or below?
HEADSS
Home environment - smokers, smoke alarms Education - bullying Activities - helmets Drugs - prescription drugs Sexuality/sex Suicide
Kawasaki’s CRASH
Conjunctivitis Rash Adenopathy Strawberry tongue Hands and feet swollen/rash/peeling if you CRASH call the CAA --> coronary artery aneurysm treat with ASA and IVIG kawASAkI
Violent/aggressive patient? Think of other causes
DIM FACES
Drugs/dehydration
Infection
Metabolic/medication change
Failure Anemia/alcohol Cardiac/stroke/bleed Electrolytes Structural/seizure disorder/psychiatric
Which vaccines should you consider for travel?
General - Hep A and B, rabies
Country specific - typhoid, meningitis, yellow fever, encephalitis
routine - flu, shingrix, pneumococcal, tetanus, pertussis
Anti malarial medications and their pros/cons?
Malarone - only for 7 days after exposure daily, expensive
Doxy - cheap but photosensitivity rash. daily dose, need for 30 days after exposure
Mefloquine - frequent side effects, vivid dreams. once weekly
primaquine - only for 7 days after exposure; daily dose need test for G6Pd
chloroquine - cheap, safe, widespread resistance so check first, skin and corneal side effects
Rx for traveller’s diarrhea and how to prevent
Azithro oral rehydration solution loperamide bismuth subsalicylate boil, peel; avoid ice cubes, salads, uncooked veggies use bottle water, wash hands often
medications for altitude sickness?
acetazolamide - carbonic anhydrase inhibitor dexamethasone nifedipine sildenafil/tadalafil prophylactic salmeterol
AAA screening
men 65-80 one time ultrasound
calculate sensitivity
specificity
ppv
npv
sens = true pos / true pos + fals neg spec = true neg / true neg + fals pos ppv = true pos / true pos + false pos npv = true neg / false neg + true neg
DM screening
- Screen every 1-5 y depending on risk
determined using a calculator, other risk
factors, or age ≥40 y - HbA1c level is the preferred screening test
(FPG level or OGTT are acceptable
alternatives) - HbA1c level of ≥6.5%, FPG level of
≥7 mmol/L, or 2-h plasma glucose level
in an OGTT of ≥11.1 mmol/L are diagnostic
DLP screening
- Screen fasting lipid profile in men aged ≥40 y,
women aged ≥50 y (or postmenopausal), or
earlier if at increased risk - Screen with Framingham risk assessment
every 3-5 y if 10-y risk is <5%, or every y
if 10-y risk is ≥5%, until age 75 y - Framingham risk should be doubled if
positive family history for premature
cardiovascular disease - Discuss “cardiovascular age”
Colon Ca screening
- Screen with FIT or FOBT every 1-2 y, or
flexible sigmoidoscopy every 10 y, if aged
50-75 y - Consider individualized opportunistic
screening with FIT or FOBT, flexible
sigmoidoscopy, or colonoscopy up to age
85 y
HPV recommendations
1. Recommended for women up to age 45 y even if already sexually active and regardless of past infection 2. Recommended for men up to age 26 y 3. Recommended for men who have sex with men
Immigrant health, four areas - infection
HIV, Hep C, TB
mantoux skin test is intradermal
TB rx, RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Common parasitic infections? Ss
strongyloides
Schistosomiasis
Unconscious patient? DONT
dextrose
oxygen
Narcan
Thiamine
Rx for new psychosis?
start med 1st gen = 2nd gen maintain for 18 months oral = depo if depression, treat that too.
