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CCFP Flashcards

1
Q

Secondary causes of HTN ABCDES

A

Atherosclerotic, coarctation of the aorta
Bad kidneys - Renal parenchymal disease
Catecholamines
Drug, Diet
Endrocrine (Hypothyroid, aldosterone, Cushing), EtOH
Fibromuscular dysplasia
sleep apnea, stress

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2
Q

Medications that raise BP

A

Steroids, NSAIDs, amphetamines, many psychiatric meds - SSRIs, SNRIs, carbamazepine, estrogen/progesterone/androgens, sympathomimetic (decongestant), licorice

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3
Q

What does a lipid panel include

A

Chol, HDL, LDL, non-HDL, TG

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4
Q

Risks of HCTZ?

A

Skin cancer non melanoma, possible 4x risk after 3 years

Avoid long acting Chlorthalidone, indapamine b/c of DM2, renal and electrolyte abnormalities

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5
Q

Lifestyle interventions for HTN

A

Lower salt, exercise, weight loss, reduce alcohol, DASH diet, relaxation –> CBT

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6
Q

HTN Meds to avoid in HTN

A

alpha blocker alone
Beta blockers if > 60
ACE if black

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7
Q

Risk factors for uterine perforation

A 
breast feeding
grand multiparity
history of csection
nulliparity
inexperienced HCP
uterine abnormalities 
postpartum state in breastfeeding women
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8
Q

when should you start various kinds of birth control when removing an IUD?

A

POP 2 days before, ocp/depo etc 7 days before

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9
Q

contraindications to IUD

A

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

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10
Q

What does SAD PERSONS stand for

A 
Male sex
Age <19, >45
Depression
Previous attempt
Excess EtOH/substances
Loss of rational thinking
Social supports lackings
organized plan
no spouse
Sickness
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11
Q

What else should you r/o with depression

A

mania, anxiety (does worry get in the way of your life?), OCD (thoughts/rituals you cannot stop), delusions (special powers/plot against you), hallucinations

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12
Q

when to consider bipolar?

A 
age <25
>= 5 episodes
family hx
hypersomnia
hyperphagia/increased weight
lability of mood/irritability
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13
Q

first line meds/treatments for PTSD

A

fluoxetine, paroxetine, sertraline
venlafaxine
CBT
group therapy

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14
Q

first line meds/treatments for OCD

A

escitalopram, fluoxetine, paroxetine, sertraline
CBT
exposure with response prevention

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15
Q

mimics for depression

A

hypothyroid, adrenal insufficiency, grief/adjustment disorder, drug use, bipolar, tumor, delirium

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16
Q

SPIKES

A 
setting up
perception
invitation
knowledge
emotion
strategy, also SAFETY.
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17
Q

SNOPQRST

A 
Safety
Next visit
Offer
Prevention
Quit 
Refer
Start
Teach
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18
Q

Osteoporosis risk factors

A 
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
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19
Q

Chronic bronchitis criteria

A

Chronic bronchitis is defined as a cough with sputum expectoration for at least 3 consecutive months for at least
2 consecutive years

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20
Q

Thalassemia regions

A 
Southeast Asia
Africa
South America
Middle East
Carribbean 
Mediterranean
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21
Q

Broad differential? VINDICATE

A 
Vascular
Infectious
Neoplasm
Drugs
Idiopathic
Congenital
Autoimmune
Trauma
Endocrine
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22
Q

COPDE

A

cough, purulence, dyspnea, CRP >40

Early warning score i.e. NEWS2

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23
Q

Common ear bugs? what about (complicated) COPD? what about PNA?

A

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)

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24
Q

COPD Adjunctive Treatment

A 
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
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25
Q

SNOPQRST

A 
Safety
Next visit
Offer
Prevent
Quit
Refer
Start
Teach
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26
Q

Criteria for dx asthma in <6 yo

A

Wheeze that reverses

it’s not something else

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27
Q

What are the criteria for asthma dx

A

FEV1/FVC pre <0.75
FEV1 post increases 12%

vs. COPD; post <0.70 and not reversible

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28
Q

Asthma rx pyramid for pre-schoolers

A

mild - saba
mod - saba + ICS
severe - saba, ICS, oral steroids

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29
Q

Asthma rx pyramid for 6+

A

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

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30
Q

Good asthma control

A

<1 night time symptoms
<4 use of prn puffer
no activity restrictions, no missed school/work

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31
Q

Risk factors for asthma exacerbations

A

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

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32
Q

Frequency of asthma f/up? in pregnancy?

A

1-3 months after starting treatment then 3-12 months after that; in pregnancy, every 4-6 weeks

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33
Q

Testicular cancer BALLS CFP

A

Bhcg
Alpha fetoprotein
Lop it off

Cryptorchidism
Family hx
Personal hx

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34
Q

Lung cancer screening

A

age 55-74, 30pk/yr smoke, current or quit <15 years ago. CT annually up to 3 times

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35
Q

Cervical cancer screening

A 
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
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36
Q

Skin cancer risk factors

A 
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
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37
Q

skin cancer ABCDE

A

Asymmetry
Border - gradual, indistinct vs. sharp cut off
Colour variation
Different dermatoscopic structures - pigment network, homogeneous areas, streaks, dots, globules
Evolving size/shape/colour

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38
Q

Colorectal screening

A

50-74

flex sig q10 or FIT q2 years

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39
Q

Breast Ca screening (5)

A 
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
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40
Q

Management for Feb neut?

A

early antibiotic treatment, look for source and consider fungal
stabilize and assess
severe sepsis –> ICU

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41
Q

H Pylori quad therapy

A

PPI
Bismuth salicylate
Metronidazole
Tetracycline

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42
Q

what is Barrett’s esophagus? prevention,

A

columnar cells replace squamous;

prevention - high dose PPI and ASA

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43
Q

long term risks of PPIs

A

fractures
b12 deficiency
dementia
c diff

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44
Q

gallstone RF

A

female
forty
fat
fertile – on OCP

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45
Q

pancreatitis RF

A 
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

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46
Q

admission criteria - UN

A

uncontrolled symptoms
unstable
undiagnosed pain esp in elderly, immunocompromised
undischargable i.e. poor social support

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47
Q

fluid for peds

A 
20 mg/kg
maintenance 4/2/1
- 4 ml/kg for the first 10kg
- 2ml/kg for 11-20
- 1 ml/kg 20+
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48
Q

measures to monitor for severe dehydration

A 
weight
gfr/creatinine
na, k 
glucose
urea
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49
Q

c diff risks

A 
abx esp fluoroquinolones
previous infxn
recent hospitalization
older age
immunocompromised
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50
Q

c diff pitfalls, who not to test? and rx

A

not just hospital acquired
don’t test kids <1
rx: vanco po

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51
Q

Crohn’s medications

A

start with sulfasalazine if mild, otherwise steroids
thiopurines - not for induction
methotrexate
biologics

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52
Q

celiac testing

A

TTG/IGA plus total IGA +/- upper endoscopy, small intestine biopsy
OR endomysial IGA (but this is +++expensive)
if IGa deficiency, DGP IgA and IgG

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53
Q

IBS rx

A 
r/o celiac
psyllium 
probiotics, peppermint oil
FODMAP
CBT
colonoscopy if >50/alarm features
antispasmodics
anti depressants
eluxadoline - diarrhea predominant
lubiprostone - constipation predominant
linaclotide - "
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54
Q

Restless legs rx, rx and non rx

A 
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
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55
Q

restless legs dx

A

sensation or urge to move legs
worse with rest, improves with activity
worse in evening

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56
Q

restless legs risk factors

A

▪ 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

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57
Q

Dx hyperthyroid

A

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

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58
Q

suspicious features of thyroid nodule

A

> 1cm
Taller than wide
irregular surface
calcifications within

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59
Q

Treating thyroid storm - BLOCK x 5

A

Beta blocker - propanalol
Block synthesis - methimazole, propylthiouracil
Block conversion T4 –> T3 propylthiouracil
Block release - iodine
Block Bile - cholestyramine

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60
Q

Treating graves, 3 Rs

A

Rx - First 4 Blocks - beta blocker, block synthesis, block conversion, block release
Radiation
Removal

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61
Q

Meds to stop when sick/at risk of dehydration

SADMANS

A 
SFU
ACE
Diuretics
Metformin
ARBs
NSAIDs
SGLT2
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62
Q

Three reasons people develop DKA

A
  • acute illness,
  • drugs: clozapine, terbutaline, cocaine, lithium, SGLT2
  • non compliance
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63
Q

Diabetes complications, micro/macro

A

micro - retinopathy, neuropathy, nephropathy

macro - atherosclerosis –> CVD, CVA, PVD

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64
Q

Biguanide

A

metformin

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65
Q

SGLT2 inhibitors

A

flozins - empagliflozin, canagliflozin

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66
Q

GLP-1R agonists

A

glutide - semaglutide, liraglutide

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67
Q

DPP4 inhibitors

A

saxagliptin

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68
Q

sulfonylureas

A

gliclazide, glyburide

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69
Q

driving 2-4-6 rule

A

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

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70
Q

risk factors for hep B

A 
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
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71
Q

medications to treat chronic gout

A

allopurinol
prboenecid
febuxostat

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72
Q

how to test for Hep C?

A

anti - HCV (unless known previous hep C)
HCV RNA serum
genotype and subtype
–> spontaneous clearance in 20-45%

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73
Q

how to test for Hep b?

A 
HbsAg
Anti HBS
Anti HBC --> IgM, total
if +ve
HBeAg
HBV DNA
Anti HBe
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74
Q

Mgmt and monitoring hep B

A 
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)

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75
Q

Mgmt and monitoring hep C

A 
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
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76
Q

NAFL vs NASH, and treatment?

A

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

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77
Q

Ankylosing Spondylitis features

A

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

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78
Q

what is Schober’s test

A

find L5, measure 10cm above and 5cm below = 15cm

if <20cm when bending forward = restrictive

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79
Q

investigations for Ankylosing Spondylitis

A

ESR, CRP
HLA b27
spine xray or MRI for early changes

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80
Q

mgmt AS

A 
nsaids
steroids for flares - oral, IM, into joint
anti TNF
monoclonal antibody
physio
no smoking
bisphosphonates if osteoporosis
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81
Q

Back pain physical exam

A

ALWAYS: numbness, weakness, pedal pulses, neuro exam

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82
Q

Lower limb Myotomes memory aid

A

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

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83
Q

Dermatomes memory aid

A

L4 down on all 4s - knees to first toe
L5 middle toes
S1 pinky toe

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84
Q

joint red flags

A 
hot
boggy
AM stiffness
PM night pain 
extra-articular symptoms? think genital infection, vasculitis, systemic illness
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85
Q

ADHD medication classes

A

Stimulants - methylphenidate (concerta, biphentin, ritalin), amphetamine (vyvanse, adderall)
SNRI - Atomoxetine
Alpha receptor antagonist - Guanfacine

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86
Q

ADHD meds – Consider DATER before changing medication to 2nd/3rd line

A

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

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87
Q

ADHD non rx management

A

patient and family education
psychological treatment
education accommodations
driving – restrict cell phone use, recommend manual transmission

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88
Q

ODD vs conduct disorder

A

ODD children do not show aggressions towards peope/animals; destroy property; pattern of theft and deceit

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89
Q

Bedwetting management

A 
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
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90
Q

Well baby care counselling HONEY ‘n’ guns

A 
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
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91
Q

Milestones

A 
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
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92
Q

Breastfeeding guideline

A

> =2 years

400IU daily vitamin D

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93
Q

circumcision, pros and cons

A

pros
- decreased infection - phimosis (rx with topical steroids), uti, hpv, cancer

cons
- pain, stenosis, damage to surrounding tissues

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94
Q

undescended testes cause

A 
torsion
trauma
tumor
inguinal hernia
infertility
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95
Q

torsion TWIST score

A 
absent cremasteric reflex
nausea/vomiting
testicle swelling
testicle hard
high riding testicle
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96
Q

4 nots for nuts

A

refer if

  • not descended at 6 months
  • not there anymore
  • not there
  • not positioned properly
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97
Q

AIDS defining illnesses

A 
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus
Candidiasis (oesophageal or bronchial)
Lymphomas (excluding Hodgkins)
Tuberculosis
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98
Q

when to give Tdap to pregnant ladies

A

> 13, ideally 27-32 weeks

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99
Q

which vaccines can you NOT give if someone is breastfeeding?

A

BCG, yellow fever, japanese encephalitis

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100
Q

which vaccines do you need to delay if someone is ill?

A

lots of congestion – don’t give nasal flu
acute GI – defer cholera, dukoral
mod to severe – defer rotavirus

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101
Q

who gets flu vaccine?

A

kids > 6 months
everyone, but esp adults with neurologic/developmental conditions, work in health care, work with poultry
> 65 yo

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102
Q

vaccines in person with egg allergy

A

flu, MMR ok

do not give yellow fever, tick-borne encephalitis or rabies

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103
Q

make vaccine less painful?

A 
breastfeed
skin to skin
most painful last
sugar
tylenol after, otherwise blunts immune response
topical anesthetic
don't aspirate
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104
Q

what are the two shingles vaccines?

what kind, how often, how $$$, how effective?

A

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

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105
Q

HPV vaccine - # of doses, #-valent

A

2 doses, 9-valent, all genders

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106
Q

who do you give meningitis C to? (5)

A 
all travellers to Hajj
meningitis belt of africa
military recruits
asplenia and sickle cell
all canada adolescents
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107
Q

vaccines for the immunocompromised? keep 3 things in mind

A
  • no polio, varicella, MMR
  • close contacts: avoid giving or avoid contact for 2 weeks
  • consult public health/ID
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108
Q

vaccines contra-indicated in…

pregnancy? TB? severe asthma/medical wheeze in last 7 days? uncorrected GI malformation? HIV?

A

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

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109
Q

Common cold treatment? (5)

A

NSAIDs, honey (> 1 year), intranasal ipratropium, nasal decongestant/anti-histamine (>5 year), zinc (not intranasal)

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110
Q

sinusitis risk factors? (4) which bugs?

A 
allergic rhinitis
asthma
anatomy
smoking
ear bugs
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111
Q

red flags on sinusitis? (9)

A 
fever > 39
periorbital edema
cranial nerve palsies
abnormal EOM
proptosis
vision changes
severe headache
altered mental status
meningeal signs
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112
Q

what are the meningeal tests?

A

Brudzinski - flexed neck –> flexed extremities

Kernig - with hips flexed cannot extend knee

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113
Q

PODS acute sinusitis

A 
pressure/pain
obstruction (nasal)
dischage - thick, purulent
smell, loss of
2 or more -- persists for >7-10 days
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114
Q

mgmt of acute sinusitis

A 
ct/xr only if red flags
amox 500 TID 5-10 days
nasal steroids!
nasal rinse
decongestants
analgesics
anti-inflammatories
mucolytics
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115
Q

why give abx for GAS? what does it NOT prevent?

A 
prevent...
AOM
rheumatic heart disease
sinusitis
decrease illness <1 day
peritonsillar abscess 
does NOT prevent glomerulonephritis
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116
Q

mono - how does it spread? symptoms? labs? recommendations re: spleen?

A

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

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117
Q

Jaundice beyond two weeks, order:

A 
hemoglobin
serum conjugated bili
coomb's test
group and screen
peripheral smear
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118
Q

Symptoms of down syndrome - rule of 1s

A

1st toe web space
1 palmar crease
1% recurrence

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119
Q

Hip dysplasia risks, ffff

A 
first born
feet -- breech
family history
fluid -- oligo
female
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120
Q

full septic workup in kids

A

CBC
LP
CXR
urine/blood cx

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121
Q

pediatric LIMPSS cannot miss

A 
Legg calves perthe
Infectious
Malignancy - ewing's sarcoma, osteosarcoma
Pain from a fracture - abuse?
Slipped capital femoral epiphysis
Something else above/below
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122
Q

Classes and examples of constipation meds

A

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

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123
Q

Counselling pts for HCV - 4

A

Discussion of avoidance of alcohol
Monitoring of progression (ALT/AST, annual AFP)
Counsel on risk of transmission
Screening sexual partners

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124
Q

HCV treatments

A 
Pegylated Interferon
Ribavirin
Telaprevir
Simeprevir
Sofosbrevir
Harvoni (ledipasvir/sofosbuvir)
Holkira Pak (dasabuvir, ombitasvir, paritaprevir, ritonavir)
velpatasvir
daclatasvir
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125
Q

Mechanism of scaphoid #

A

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

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126
Q

Physical exam for snuffbox tenderness

A

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

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127
Q

Scapholunate disruption on xray

A

A gap of more than 3 mm between the scaphoid and lunate bones (the Terry Thomas sign)

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128
Q

Scaphoid #, reasons to refer to ortho

A 
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
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129
Q

Why does scaphoid have higher rates of fracture complications?

A

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.

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130
Q

Symptoms of hypercalcemia

A 
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
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131
Q

Rx for hypercalcemia

A

Hydration with normal saline
Calcitonin
Bisphosphonates

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132
Q

Medications that cause hypercalcemia

A 
ationale:
Thiazide diuretics (class or specific drug name of any thiazide acceptable)
Lithium
Teriparatide
Abaloparatide
Theophylline
Excessive vitamin A
Excessive vitamin D
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133
Q

1st blood test to order with dx of hypercalcemia

A

PTH

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134
Q

Risk factors for neonatal jaundice

A

Prematurity
Vacuum delivery leading to cephalohematoma
Asian background
Possible dehydration (poor weight gain)

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135
Q

Blood tests in neonatal jaundice

A 
Blood type (ABO and Rh status) of infant
Direct antiglobulin test (direct Coomb’s test)
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136
Q

Inherited disorder that cause hyperbilirubinemia

A

Glucose-6-Phosphate Dehydrogenase Deficiency
Pyruvate Kinase deficiency
Crigler-Najjar syndrome
Hereditary spherocytosis or elliptocytosis
Hemoglobinopathies (sickle cell, thalassemia, Hemoglobin H disease)

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137
Q

Side effects from phototherapy?

A

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

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138
Q

Causes of hyperbilirubinemia in babies <24 hrs

A

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

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139
Q

Treatment for ABRS

A

amox, nasal steroids

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140
Q

Classic sites for infantile eczema

A

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

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141
Q

Risk factors for infantile eczema

A 
Positive family history of atopy (give ½ point for either “allergy” or “asthma”)
Weather changes (cold, dry)
Chemical irritants (scented soaps, detergents)
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142
Q

strategies to prevent/treat eczema

A 
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
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143
Q

when to treat asymptomatic BV?

A

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

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144
Q

abx to treat trich? what else can be used for BV?

A

metronidazole

clinda, doxy

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145
Q

Pediatric Limps LIMPSS

A 
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?
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146
Q

HEADSS

A 
Home environment - smokers, smoke alarms
Education - bullying
Activities - helmets
Drugs - prescription drugs
Sexuality/sex 
Suicide
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147
Q

Kawasaki’s CRASH

A 
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
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148
Q

Violent/aggressive patient? Think of other causes

DIM FACES

A

Drugs/dehydration
Infection
Metabolic/medication change

Failure
Anemia/alcohol
Cardiac/stroke/bleed
Electrolytes
Structural/seizure disorder/psychiatric
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149
Q

Which vaccines should you consider for travel?

A

General - Hep A and B, rabies
Country specific - typhoid, meningitis, yellow fever, encephalitis
routine - flu, shingrix, pneumococcal, tetanus, pertussis

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150
Q

Anti malarial medications and their pros/cons?

A

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

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151
Q

Rx for traveller’s diarrhea and how to prevent

A 
Azithro
oral rehydration solution
loperamide
bismuth subsalicylate
boil, peel; avoid ice cubes, salads, uncooked veggies use bottle water, wash hands often
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152
Q

medications for altitude sickness?

A 
acetazolamide - carbonic anhydrase inhibitor
dexamethasone 
nifedipine
sildenafil/tadalafil 
prophylactic salmeterol
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153
Q

AAA screening

A

men 65-80 one time ultrasound

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154
Q

calculate sensitivity
specificity
ppv
npv

A 
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
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155
Q

DM screening

A
  1. Screen every 1-5 y depending on risk
    determined using a calculator, other risk
    factors, or age ≥40 y
  2. HbA1c level is the preferred screening test
    (FPG level or OGTT are acceptable
    alternatives)
  3. 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
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156
Q

DLP screening

A
  1. Screen fasting lipid profile in men aged ≥40 y,
    women aged ≥50 y (or postmenopausal), or
    earlier if at increased risk
  2. 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
  3. Framingham risk should be doubled if
    positive family history for premature
    cardiovascular disease
  4. Discuss “cardiovascular age”
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157
Q

Colon Ca screening

A
  1. Screen with FIT or FOBT every 1-2 y, or
    flexible sigmoidoscopy every 10 y, if aged
    50-75 y
  2. Consider individualized opportunistic
    screening with FIT or FOBT, flexible
    sigmoidoscopy, or colonoscopy up to age
    85 y
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158
Q

HPV recommendations

A 
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
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159
Q

Immigrant health, four areas - infection

A

HIV, Hep C, TB

mantoux skin test is intradermal

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160
Q

TB rx, RIPE

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

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161
Q

Common parasitic infections? Ss

A

strongyloides

Schistosomiasis

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162
Q

Unconscious patient? DONT

A

dextrose
oxygen
Narcan
Thiamine

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163
Q

Rx for new psychosis?

A 
start med 
1st gen = 2nd gen 
maintain for 18 months
oral = depo 
if depression, treat that too.
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164
Q

neuroleptic malignant syndrome FARM and treatment (5) and meds (3)

A

Fever
Autonomic - BP, HR, sweating
Rigidity
Mental status changes
stop the rx; IV NS; cooling blankets; ice packs; DVT prophylaxis
benzos if agitation; bromocriptine; dantrolene for muscle relaxation

165
Q

qSOFA

A

resp rate >22
aMS
SBP < 100

166
Q

STI abx

A

cefixime + azithro or doxy OR

ceftriaxone + doxy if PID

167
Q

sinusitis abx

A

amox or amox-clav

168
Q

bronchitis abx

169
Q

diverticulitis abx

A

none if CT confirmed with no abscess/free air

cipro + flagyl or amox clav

170
Q

sepsis abx

A

ceftriaxone or pip tazo +/- vanco

171
Q

yeast vaginitis rx

A

fluconazole oral

172
Q

pneumonia abx

A

macrolide or fluoroquinolone

173
Q

meningitis bugs and abx

A

TB, LEGS - listeria, e coli, GBS, meningococcus = neisseria meningitis

< 1mo - amp + gent
Group B Streptococci
E. coli
Listeria spp

1-3 mo
amp + cefotaxime
Group B Streptococci
E. coli
Listeria spp
S. pneumoniae
N. meningitidis
H. influenzae
> 3 months
cef + vanco
S. pneumoniae
N. meningitidis
H. influenzae
Adult > 50 years or Immunocompromised (including AIDS), Alcohol abuse, Debilitating illness, Pregnancy
cef + amp + vanco
S. pneumoniae
Listeria monocytogenes
N. meningitidis
Enterobacterales

REMEMBER… contact public health! contact prophylaxis! vaccinate!

174
Q

cellulitis abx? MRSA?

A

with pus = ?mrsa = doxy, septra, clinda

w/o = strep = amox clav, cephalexin

175
Q

uti abx? what if complicated? severely ill? peds?

A

nitrofurantoin, septra, cephalexin, fosfomycin
if complicated… fluoroquinolone, 3rd gen cephalosporins, broad spectrum, of severely ill i.e. pip-tazo, ertapenem
peds - cefixime 7-10 days and image if febrile <2 yrs, recurrent or complicated (sepsis, obstruction, retention, impacted stone, pyelo)

176
Q

pyelo abx

A

ceftriaxone

then cefixime or septra or cipro or amox-clav

177
Q

remember your TOCC hx

A

travel
occupation
contacts
critters

178
Q

4 strategies to minimize statin effects on muscles

A

lower dose
rink lots of fluids
stop interacting medications
alternative day dosing

179
Q

rx for molluscum contagiosum

A

cantharidin topical

180
Q

Describe arterial ulcer

A

Punched out full thickness ulcer with smooth wound edges often on lateral ankle or distal digits

181
Q

Describe karposi sarcoma

A

Red-purple lesions/patches/nodules

182
Q

Describe scabies

A

intensely pruritic and pimple like rash at the wrists and Intertriginous areas

183
Q

describe herpes labialis

A

small grouped blisters/sores on lips that can coalesce into an ulcer that heals with 2-3 weeks

184
Q

describe hand foot and mouth

A

lesions on oral mucosa, tongue, palms, soles and buttocks, grey-white vesiculo pustules

185
Q

describe venous ulcers? risk factors?

A

shallow and superficial ulcers with irregular margins usually on the lower leg and ankle
rf: obesity, immobility, pregnancy, DVT, CHF, varicose veins, conditions with poor musculature

186
Q

describe herpes zoster

A

grouped, unilateral vessicles in dermatomal distribution +/- pain and prodromal symptoms. anti virals with in 48-72 hours
–> do not confuse with eczema herpeticum

187
Q

indications for shingrix vaccine

A

over 50 years, diabetes, heart disease, renal disease, immunosuppresion

188
Q

describe BCC, treatment options

A

shiny, pearly nodule located on sun exposed area of skin with telangectasia
rx: excision, cryotherapy, topical chemo

189
Q

describe roseola infantum

A

high fever then rash on chest that turns into a pink maculopapular eruption lasting 1-2 days. 6th disease, HHV 6/7, supportive care

190
Q

describe erythema infectiosum

A

macular erythema on face on day 1, then erythematous maculopapular eruption for up to 7 days on proximal extremities, then a reticulated or lacy erythema on extensor extremities up to 3 weeks. parvovirus/5th disease

191
Q

Dx of HTN, work-up

A

AOBP > 135/85 or non-AOBP >140/90
Lipid panel (HDL, LDL, chol, trig, non-HDL)
Na, K, Creat, urinalysis, HbA1C, EKG
CPAP does not decrease morbidity/mortaliity

192
Q

Recommendations for HTN lifestyle

A 
reduce salt - 
diet - DASH <1800mg
reduce weight
reduce stress - CBT
increase exercise 30-45 min, 3x/week
reduce alcohol <2.7 drinks/day
193
Q

Fever? keep the ddx broad (11) and don’t forget the most dangerous things

A 
sepsis
meningitis
steven's johnston syndrome
PE
GCA
medication
cancer/feb neut
serotonin syndrome
neurleptic malignant syndrome
endocarditis 
rheum -- still's disease
unclear? back to basics, serial exams/ekgs/imaging
194
Q

DLP screening. When should it be fasting?

A

> 40 and <75 consider earlier in at risk groups: South/East asians and First Nations, gestational HTN
Fasting if TG > 4.5
no evidence of mortality benefit of statins if >75

195
Q

DLP management - who to start on statin?

what other things can you do?

A

Statin based on Framingham > 10 OR if CHD, CAD, PAD, AAA, DM2, CKD
Optimize renal, HTN, and CVD rx
dietician (med diet), counselling, stop smoking, kinesiology, cardiology, endocrinology (if familial)

196
Q

Vertigo Exam (4)

A

Orthostatic BP
Gait
Hints
Dix-Hallpike

197
Q

Vertigo ddx

A 
BPPV 
orthostatic
meniere's
migraine
neuritis
stroke
198
Q

HINTS exam

A

Pt looks at nose; head impulse to one size
continues looking at you = normal (central vertigo)
corrective saccades = abnormal (peripheral vertigo)

199
Q

Acute situatuation - ABC MOVIES and cereal

A 
monitors
oxygen
vitals
IV large bore x 2 
ECG
sugars
serial ekgABCs/vitals
200
Q

GI Bleed rx

A

PPI infusion
Erythromycin prior to scope because it increases GI motility
Hgb only if <70
IF varices, give ceftriazone + octeotride (somatostatin)

201
Q

what’s the reversal agent for…
warfarin?
heparin?
dabigatran?

A

vit K
protamine, fresh frozen plasma
praxbind

202
Q

what are the drug classes for anxiety?

A 
benzodiazepines
buspirone 
selective serotonin reuptake inhibitors
selective norepinephrine reuptake inhibitors
tricyclic antidepressants
monoamine oxidase inhibitor 
atypical anti-psychotics
203
Q

after SIGECAPS, r/o other conditions by asking about

A
  • excessive worry, panic, PTSD
  • hallucinations?
  • rituals/compulsions that you cannot stop?
  • mania – feel better than good?
  • delusions - do you have special powers? is there a plot against you?
204
Q

Bipolar II, criteria and dx

Bipolar meds

A
  • hypomania, no psychosis
    quetiapine is first line
    Acute: abilify, paliperiodone, risperidone
    Maintenance: quetiapine, lamotrigine, lithium, divalproe
205
Q

1st gen antipsychotics - D2 antagonism, higher risk of neurological side effects

A

haldol

chlorpromazine

206
Q

2nd gen antipsychotics “atypicals” 5HT2A/D2 antagonism

higher risk of metabolic side effects

A 
abilify
olanzapine
paliperidone
quetiapine
risperidone
clozapine
207
Q

Tourette syndrome rx

A

Tetrabenazine or Risperidone (dopamine blockers)
Botox - neuromuscular blocade
Habit reversal training

208
Q

PICA rx

A

methylphenidate - CNS stimulant
olanzapine
Treat the complications – radiography for a bezoar

209
Q

Scabies rx

A

permethrin, invermectin

210
Q

Mastitis rx

A

continue BF
NSAIDs, abx (cloxacillin, cephalexin)
usually staph
warm/cold compresses

211
Q

Melanoma dx

A 
Asymmetry
Border irregularity
Color not uniform
Diameter > 6mm
Evolving shape/size/colour
212
Q

Measles description, symptoms

A

purplish red, maculopapular rash starting on the scalp/face/neck and spreading downwards
Four Cs: cough, coryza, photophobia, conjunctivitis, koplik spots on buccal mucosa

213
Q

describe Alopecia areata? what conditions is it associated with?
what is the treatment?

A

circular lesion on scalp/body with no hair, may have characteristic exclamation mark hairs. Focal, non scarring
ddx: trichotillomania
associated with SLE, thyroid, family hx
<50% hair loss - steroids either topically or injected, minoxidil
>50% hair loss - oral steroids 8 week taper while minoxidil while awaiting referral

214
Q

Marjolin ulcer

A

non healing ulcer or growth on the edge of a chronic wound - type of SCC

215
Q

Pityrasis rosea

A

single lesion followed by all over body rash. Oval, dull pink colour involving the trunk and upper arms and legs. Christmas tree distribution

216
Q

Head lice rx

A

permethrin or pyrethrin, repeat in 7-10 days

217
Q

Rx for androgenic alopecia

A

stop offending meds
minoxidil
finasteride
hair transplant

218
Q

Rosacea

A

superficial, dilated blood vessels and papules/pustules/swelling on the face

219
Q

stevens-johnson syndrome

A 
painful red or purplish rash involving the skin and mucous membranes
stop med/avoid drug class in future
220
Q

Koebner’s phenomenon

A

formation of psoriasis in areas of trauma

221
Q

Rx for post herpetic neuralgia

A 
topical capsaicin
NSAIDs
gabapentin
TCAs
glucocorticoids
paracetamol
topical lidocaine
222
Q

investigations to order for dx osteoporsis (7)

A 
hgb
TSH
ionized Ca
Alk Phos
Creatinine
SPEP if vertebral #
Vit D --> after 3 months of Vit D supplementation
223
Q

Osteoporosis rx - 3 options + 2 for high risk

When can you stop it?

A

Bisphosphonates

  • jaw osteonecrosis
  • esophageal ulcers
  • atypical fractures

Raloxifene –> selective estrogen receptor modulator
- VTE/PE

HRT

for high risk
Teriparatide - PTH analogy
- hypercalciuria, hypercalcemia - usually transient
- angioedema

Denosumab - monoclonal ab vs. RANKL

  • joint muscle pain
  • jaw osteo
  • CI in pregnancy

Stop after 3-5 years if low risk take holiday

224
Q

HIV med complications

A

DLP
hyperglycemia
BMD loss
Renal disease

225
Q

HIV meds to know

A

Truvada for PREP
Zidovudine - peripartum and neonate
PEP - truvada, raltegravir

226
Q

Opioid guidelines

A

maxmimum 50mg MED start
taper down to 90mg MED if they are above that
only use if no other options - TCAs, nabilone, NSAIDs, CBT, exercise, physio

227
Q

ADL - DEATH

A 
Dressing
Eating
Ambulating
Toileting
Hygiene
228
Q

IADLS - SHAFT

A 
Shopping
Housework
Accounting
Food and meds
Telephone, transportation
229
Q

Frail elderly checklist

A 
vision
hearing 
skin - ulcers
mobility
cognition
pain
medications
rx monitoring
abuse
driving
incontinence
falls
teeth
230
Q

Post phlebitic syndrom

A

horse chestnut seed extract for venoconstriction

231
Q

DVT w/up and treatment

A

if low Pre test prob/Wells < 2 – D-dimer. if +ve, proximal leg compression ultrasound or CTPA if you suspect PE
if high Pre test prob/Wells >2 – ultrasound. if -ve, d dimer
if suspicion is high and testing will be delayed, treat first!
1 dose of oral Xa inhibitor or 1 dose of LMWH/IV heparin

232
Q

Bell’s palsy, dx and treatment

A

Stroke spares forehead
lubricant eye drops
steroids eg prednisone
add antivirals if severe

233
Q

Ramsay Hunt Triad

A

aka Herpes Zoster reactivation

  • ipsilateral facial paralysis
  • ear pain
  • vesicles in the auditory canal
234
Q

Ischemic vs hemorrhagic findings

A

ischemic 80% - early, focal

Hemorrhagic 20% - late focal deficits, compression effects (headache, vomiting)

235
Q

Acute stroke management

A
  1. ABCs, MOVIEs
  2. Stroke scale
  3. Labs: Na, K, Hgb, INR, aPTT, creatinine, troponin, glucose
  4. Head CT non contrast –> if 4.5-6 hours adter symptoms add CT angiogram from vertex to arch OR CT perfusion. If 6-24 hours after symptoms add CT angiogram AND CT perfusion
  5. Treat fever and severe hypertension >220/120
236
Q

Acute stroke treatment options

A
  1. Bust clot - alteplase, tenecteplase
    - treatment within 3-4.5 hours, >18 yo
  2. Yank clot 6-24 hrs- endovascular thrombectomy, aspiration/vacuum/removal stent
    - acute ischemic stroke, anterior circulation, large vessel
237
Q

Stroke w/up (cause - 4)

A
  • Holter monitor
  • Carotid doppler/duplex ultrasound
  • manage A fib if found
  • ECHO
238
Q

Stroke prevention ABCDEs

A 
A Fib
BP
CVD
DM2
Ethanol
239
Q

cephalosporins

A

1st gen - cephalexin (keflex) PO, cefazolin (ancef) IM/IV
2nd gen - cefuroxime IM/IV
3rd gen - cefixime PO, ceftriaxone IV
no activity against LAME = listeria, atypicals, MRSA, enterococci
Good against gram +ves, increasing gram -ves as you progress at expense of gram +

240
Q

Macule

A

flat lesion less than 1 cm, without elevation or depression

241
Q

Patch

A

flat lesion greater than 1 cm, without elevation or depression

242
Q

Plaque

A

flat, elevated lesion, usually greater than 1 cm

243
Q

Papule

A

elevated, solid lesion less than 1 cm

244
Q

Nodule

A

elevated, solid lesion greater than 1 cm

245
Q

Vesicle

A

elevated, fluid-filled lesion, usually less than 1 cm

246
Q

Pustule

A

elevated, pus-filled lesion, usually less than 1 cm

247
Q

3 indications for using cannabinoids ? which product for which indications?

A

Muscle spasm 2/2 SCI, MS - nabiximol
Neuropathic pain refractory to standard therapies- nabilone or nabiximol
N/V from chemo - nabilone

248
Q

4-6-8 rule for driving after cannabinoid

A

don’t drive less than 4 hours
less than 6 hours for oral ingestions
and less than 8 if you experience euphoria

249
Q

managing opioid withdrawal

A

treat type of pain - neuropathic vs other
clonidine if BP >150/90, HR >50; for nausea/vomiting/sweating/tremor
diarrhea - start loperamide, stop stool softeners
abdo cramping - buscopan (hyoscine), pinaverium
muscle cramping - quinine
sweating - oxybutynin (anti-cholinergic)

250
Q

what are the domains for major neurocognitive disorder? 5 W’s

A

WHO you are, WHAT you say, WHERE you go, WHY you do things, WHEN you remember

learning and memory
complex attention
executive function
language,
perceptual motor
social cognition
Alzheimer's is any one PLUS memory affected 
mild = 1 domain
major = 2 or more plus impair function/decline
251
Q

how to assess competency?

A

explain your treatment options? WHAT
reasoning? WHY
choice? WHAT ELSE

252
Q

investigations for MNCI d/o?

A

TSH Hgb/ferritin B12 Na, Ca, glucose

Do a CT Head if last done less than 2 years ago/looking for something else

253
Q

Management for MNCI

A
  • cholinesterase inhibitors –> donepezil
  • glutamatergic –> memantine
    exercise
    cognitive stimulation
    avoid antipsychotics
254
Q

Parkinson’s symptoms TRAP SSSS

A 
Tremor
Rigidity
Akinesia
Postural instability
Shaky
Stiff
Slow
Steps
255
Q

DDx for Parkinson’s

A

tremor improves with EtOH? better at rest? –> Essential tremor
On an antipsychotic? - extrapyrimidal side effects
falls, slow vertical gaze - progressive supranuclear palsy
no L-dopa improvement, symmetric - Multi-systems atrophy

256
Q

Parkinson treatment, things to avoid (5), treat other features

A

first line - carbidopa/levidopa
30% don’t respond, 20% who do have another dx
second line -
1. Dopamine agonists, non ergot - pramipexole, warn about impulse control d/o i.e. gambling, binge eating
avoid ergot derived i.e. bromocriptine

  1. MAO inhibitors - selegiline, rasagiline

Avoid… anti psychotics (except quetiapine, clozapine); abruptly stopping meds; amantadine early on; genetic testing/PET scanning; vit E/coenzyme q10

Also look for/treat: constipation, drooling, ED, hypotension

257
Q

Rx for postural hypotension

A

quit - large meals, EtOH, warmth, medications
start - compression stockings, increase salt intake, bed tilt, elastic stockings, midodrine (alpha 1 agonist) or corticosteroid

258
Q

headache – serious causes to r/o

A 
GCA
SAH
Stroke
meningitis
Tumour
259
Q

red flags for headache SNOOP

A 
systemic features
neuro symptoms
older pt/onset
other red flags 
pattern change
260
Q

ottawa SAH tool
r/o tool must meet criteria (4), C/I (5)
Rule: if any of the following 6…

A 
alert patients
>15 years old
new severe atraumatic headache
maximum intensity in 1 hr
do NOT USE if: neuro deficits, prior aneurysm, prior SAH, known brain tumour, chronic recurrent headache
require investigations if: 
1. neck pain or stiffness
2. => 40 yo
3. witnessed LOC
4. peak during exertion
5. thunderclap headache -- immediate peak intensity
6. limited neck flexion on exam
261
Q

Migraine Rx - acute, chronic, lifestyle management

A

Migraine medications: A) Acute migraine medications. B) Prophylactic migraine medications.
A)
Type ACUTE MEdications
First line Ibuprofen 400 mg, ASA 1000 mg, naproxen sodium 500-550 mg, acetaminophen 1000 mg
Second line Triptans (oral wafer/nasal spray/IM)

Antiemetics: domperidone 10 mg or metoclopramide 10 mg for nausea
Third line Naproxen sodium 500-550 mg in combination with a triptan
Fourth line Fixed-dose combination analgesics (with codeine if necessary; not recommended for routine use)

also consider – sphenopalatine ganglion block
B)
Prophylactic Medications
First line
• propranolol/metoprolol - avoid in asthma
• ami/nottriptyline - Consider if patient has depression,
anxiety, insomnia, or tension-type
headache

Second line
• topiramate 
• candesartan 
• gabapentin 
Few drug interactions
Botox for chronic

Lifestyle management:
- decrease caffeine, improve sleep, increase exercise, relaxation, CBT

262
Q

ABCs of fractures

A 
Antibiotics? Analgesia
Brace/splint
Consult ortho? Compartment syndrome?
Stick them with Tetanus
-- Tetanus immunoglobulin if dirty wound/not vaccinated or immunocompromised
263
Q

Fractures of abuse (8)

A 
multiple
multiple, many healing 
non ambulatory
femur <12-18 months
humerus <18 months
skull
metaphyseal - bucket handle
rib posterior
264
Q

Salter-Harris

A 
Slipped Type I
Above Type II
Lower Type III
Through or transverse Type IV
Rammed Type V
265
Q

causes of Afib (6)

A 
ischemic
valvular
alcohol
hyperthyroid
HTN
pulmonary - COPD, pulmonary embolism
266
Q

Afib rx, anticoagulate?

A

convert IF unstable, symptomatic/poor QOL, cardiomyopathy
otherwise bblockers or ccb

if unstable/low clot risk – anticoagulate now and cardiovert now

if hi clot risk, OAC for 3 weeks or TEE

rate control if old, longstanding, asymptomatic, other disease

rhythm control if young, new dx, symptomatic, no other disease

267
Q

CHADS2

A 
CHF
HTN
Age >65
DM2
Stroke/TIA/embolism
268
Q

Bleed risk management HAS BLED

A

HTN SBP>160
Abnormal liver/kidney fxn
Stroke

Bleeding
Labile INR
Elderly >65
Drugs/EtOH

269
Q

Which anticoagulant for – CKD? pregnancy? cancer? valvular afib?

A

UFH - renal disease CKD
LMWH - pregnant, cancer
Warfarin.- valvular

270
Q

Systemic Exertional Intolerance

A 
Functional impairment > 6 months
Non exertional new fatigue 
Post exertion malaise
Rest does not refresh
At least 1 of cognitive impairment or orthostatic intolerance
271
Q

Panic attack symptoms

A 
Students Fear CCCs
Sweating
Trembling
Unsteadiness
Dyspnea
Excessive sweating
Nervousness
Tachycardia/tachypnea
Sensation weird
Fear of death
Choking
Chills
Chest pain
272
Q

Lupus

MD SOAP BRAIN

A

Mallar rash
Discoid Rash
Serositis - pericarditis, pleuritis
Oral ulcers
ANA +ve
Photosensitivity
Blood - thrombocytopenia, hemolytic anemia
Renal - GN
Arthritis
Immune - anti phospholipid, anti dsDNA, anti rho, C3/C4, anti smith
Neurological disorders, including psychiatric disorders - psychosis, seizures

273
Q

Symptoms/presentation of Thyroid Storm?

A 
Altered mental status
Tachy
Fever 
Dyspnea/orthopnea
Chest pain
Hypertension
Profuse sweating
274
Q

IBD systemic features APIESAC

A 
Apthous ulcers
Primary sclerosis cholangitis, pyoderma gangrenous
Iritis/uveitis
Erythema nodosum
Sacroilitis 
Arthritis 
Clubbing
275
Q

Pro-thrombotic states

A 
Protein c and s deficiency - like renal disease because you lose protein 
Nephrotic syndrome 
Hormonal meds
Pregnancy
Cancer
IBD, CHF
Factor V leiden
Anti phospholipid syndrome
276
Q

Upper Arm DVT

A

CONSTANS score — upper arm DVT
1 point each, -1 if other dx more likely

Unilateral pain
Edema
Hx of central line/pacemaker placement “trauma”

277
Q

Risk factors for AOM

A

maternal smoking
pacifiers
day care
bottle feeding

278
Q

Ear bugs? 5

A 
strep pneumo
moraxella catarrhalis
hemophilus influenza
staph aureus
group a strep
279
Q

rx for AOM? if failure?

A

amoxicillin - high is BID, low if TID 40-90mg/kg
if failure? clavulin or ceftriaxone
tylenol 10mg/kg
advil 15 mg/kg

280
Q

what are the indications for ear ventilation tubes? (3)

A 
>6/yr or 4 per 6 months
or
Chronic OM with effusion, "glue ear" > 3 months with hearing loss
or
retracted TM
281
Q

CATCH2 for pediatric head injury, AVPU?

A

Minor head injury and any one of the following
GCS <15 (can also use AVPU for younger children –> Awake - Verbal - Responds to Pain - Unresponsive)
worsening headache
Suspected open/depressed skull fracture
irritability
Sign of basal skull fracture
Large, boggy scalp hematoma
Dangerous mechanism
>4 episodes of vomiting (common pain response in kiddos)

282
Q

types of SHOCK

A 
septic
hypovolemic
obstructive
cardiac
AnaphylacticK
283
Q

Burns - formulas? special sites?

A

> 10% resuscitate - Brooke formula: 2mls x body surface areas burned (BSAB) x weight
Rule of 9s
adult - legs 18% x 2, arms 9% x 2, head 9%, chest 18%/back 18%, groin 1%
infant - legs 14% x 2, arms 9% x 2, head 18%, chest 18%/back 18%, groin 1%
special sites: face, hand, foot, genital, perineum, joint

284
Q

Frostbite rx - 5 steps

A 
rapid rewarming - water bath
possible thombolysis and heparin and iloprost
sterile wound care
consult surgery
tetanus
285
Q

MAPLE hx

A 
medications
allergies
past medical history
last meal
events leading up to
286
Q

GCS

A

4 - eye response; 4 spontaneous - 3 sound - 2 pressure
5 - verbal; 5 oriented - 4 confused - 3 words - 2 sounds
6 - motor; 6 obeys - 5 localizes pain - 4 withdraws from pain 3 - flexion to pain 2 - extension to pain 1 - no movement

287
Q

ATLS updates

A

give blood early! after 1L crystalloids
smaller chest tubes 28-32 french
needle decompression 4th/5th intercostal space laterally
use massive transfusion protocols
tranexamic acid 1g for 10 min and 1g for 8 hours
e-fast for pneumothorax

288
Q

Trauma in pregnancy

A 
Mom then fetus
Chest tube 1-2 spaces higher
NG tube
Left lateral decubitus 
No vag exam until previa ruled out
Anti D immune globulin if Rh negative
Tetanus vaccine is safe
Document domestic violence
289
Q

Treatments for acute seizure in adult? pregant? pediatric? 1st and 2nd line.

A

Adult - 1st benzo 2nd phenytoin, valproate
Pregnant - 1st Mag Sulf 2nd benzo
Peds - 1st benzo 2nd phenytoin, phenobarb

290
Q

Reversible causes of LOC

A 
Hyperopioidemia
Seizure
Hypovolemia
HyperCa
Hyperthermia
Hypoglycemia 
Hypoxia
Hyponatremia
291
Q

Red eye red flags (5)

A 
Pain
Decrease visual acuity
Aniscoria 
Photophobia 
Metal work
292
Q

Clinical ft of acute angle closure glaucoma (5), physical exam (6), and treatment?

A 
Headache
N/v
Halos around lights
Eye pain
Decreased vision

Physical Exam:
Visual acuity, Evaluation of the pupils, Intraocular pressure (IOP), Slit-lamp examination of the anterior segments, Visual field testing, Undilated fundus examination

Rx:
- pressure lowering eye drops
- IV acetazolamide
repeat eye pressures 30-60 minutes after meds administration

293
Q

What to do before prescribing eye steroids?

A

measure eye pressure!

294
Q

Management for premature rupture?

A

steroids and antibiotics

295
Q

Management for preterm labour?

A

fetal fibronectin
steroids
tocolysis
magnesium sulfate <32 weeks

296
Q

active labour? labour dystocia? abnormal FHR?

A

active = >4 cm dilation
dystocia = <2cm in 4 hours
abnormal fhr = <110 or >160

297
Q

post partum Bs (11)

A 
breasts
bottom
belly
baby
breast feeding
bowels
bladder
bleeding
blues
birth control
boinking
298
Q

Approach to medical abortion

A
  • confirm GA
  • exclude ectopic
  • assess for CI: uncontrolled asthma, chronic adrenal failure, chronic corticosteroid use, hematologic disorders
  • remove IUD

Ordering lab tests:

bHCG if using for monitoring completion
GC/CT testing
Rh status
Hgb if reason to suspect anemia

Advise of risks. Surgical evacuation may be required in the event of retained products of
conception or heavy bleeding (5%) or ongoing pregnancy (<1%). Heavy bleeding requiring
transfusion is rare (0.1%). Infection is rare (1%) and severe infection/sepsis extremely rare
(.01%).

299
Q

Management for STEMI

A

CODE STATUS!

  • PCI < 120 minutes
  • Morphine - only if severe pain, increases mortality in NSTEMI
  • O2 only if O2 <90% otherwise increases free radicals
  • Nitrates – use for analgesia, no mortality benefit
  • ASA - 27% mortality benefit
  • B blocker
  • antiplatelet therapy
  • ACE
  • statin 80
300
Q

DDx for chest pain

A

lung - pneumothorax, PE, infection, blood
heart - valves, endocarditis, pericarditis/Dressler’s syndrome (post MI)
esophagus - inflammation, acid, spasm, foreign body, rupture, tear
aorta - dissection, aneurysm, infection
chest wall - costochondritis, muscle, contusion, fracture, zoster
psychiatric
abdomen

301
Q

Management for PE

A

Do WELLS first; if low risk, do PERC to rule out. YEARS for pregnant women

302
Q

Rx for HFrEF

A 
mineralocorticoid receptor antagonist i.e. spironolactone
ACE
beta blocker
lasix
\+ SGLT2 inhibitor even if no DM2
303
Q

Breast Cancer risk factors

A 
Estrogen exposure
Early menarche 
Late menopause
Nulliparity
Postmenopausal HRT, obesity
Radiation exposure
Alcohol
Sedentary lifestyle

Non modifiable
Age > 50
sex
past hx, family hx

304
Q

Red flags in breast lump and when to monitor (4 each(

A

Peau d’orange
Firm fixed lymph nodes
Inverted nipple
Risk factors

Monitor if:
smooth, rubbery, mobile, cyclic

305
Q

BMI formula and ranges

A 
kg/m^2
<18.5 underweight
18.5-25 normal
25-30 overweight
30-35 class I obesity
35-40 class II
>40 class III
306
Q

treatments for obesity?

A 
bupropion-naltrexone (Contrave)
orlistat - lipase inhibitor
GLP-1 receptor agonist (Victoza)
rx underlying factors or illness
surgery: gastric bypass, sleeve gastrectomy, adjustable gastric band
307
Q

Smoking Cessation medications and CI

A

Bupropion
- avoid if seizure d/o, eating d/o, EtOH w/d, MAOI use, allergy
Varenicline (partial nicotine agonist)
- now ok in psychiatric conditions

308
Q

AUD rx

A

1st line naltrexone (not in liver disease, OUD)
others: acamprosate, gabapentin

refer to counselling, set goals, eat when drinking

309
Q

OUD rx

A

OAT! side effects = constipation, amenorrhea, decreased testosterone
treatment agreements
UDS
harm reduction - lock box, naloxone, don’t use alone
avoid cannabinoids, benzos, EtOH/sedatives

310
Q

Nexus C-spine rule

Exclusions (6)

A

Exclusions: acute paralysis, known vertebral disease, previous C-spine surgery, non trauma patients GCS <15, unstable vital signs, <16

NO
neuro deficit
spinal tenderness midline
alertness
intoxication
distracting injury
311
Q

Test for cervical radiculopathy

A

Spurling test - The Spurling test is a medical maneuver used to assess nerve root pain (also known as radicular pain). The examiner turns the patient’s head to the affected side while extending and applying downward pressure to the top of the patient’s head.

312
Q

Causes of unconjugated hyperbilirubinemia

A 
ABC BILI
ABO hemolysis
Breast milk
Conjugation defect - Gilbert’s syndrome 
Breastfeeding (dehydration)
Infection 
Loss of blood
Idiopathic (physiologic)
313
Q

Causes of conjugated hyperbilirubinemia?

A

BAD-C
Biliary atresia
Ductal stenosis
Cystic fibrosis

314
Q

Modified CENTOR criteria

A 
Cough absent
Tonsils red or exudative
Cervical lymph nodes
Fever
<14 +1 
14-45 0
45+ -
315
Q

Causes of abnormal uterine bleeding

A 
PPALMCOEIN
Pregnancy ruled out
Polyp
Adenomyosis
Légion Yona
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial 
Iatrogenic
316
Q

Features of renal artery stenosis

A 
New HTN <30 or >55
Abdominal bruit
Creatinine increases more than 30% with ACE or ARB
HTN resistant to 3 or more meds
Récurrent pulmonary derm with HTN surges
317
Q

Bipolar medications in pregnancy advice

A 
Lowest effective dose
Avoid valproate
Monotherapy
Psychosocial preferred over meds in 1st trimester 
Restart medications after childbirth
318
Q

Classes of pharmacological treatment for endometriosis

A

GNRH antagonists (CI: postmenopausal or <18)
Aromatase inhibitors
NSAIDS
hormonal contraception

319
Q

The Menopause 5

A

Quit: smoking, alcohol, caffeine
Start: exercise, weight loss
Fan, layers, cool environment, no hot drinks, optimize sleep

320
Q

Menopause - 4 medication classes

A 
SSRIs
HRT -- safe for 5 yrs w/in 10 years of LMP, transdermal is best. No uterus? No progesterone
OCP
Progestin
TCAs
Anticonvulsants
321
Q

C/I to estrogen

A 
migraine with aura
smoker >35
CVD/valvular disease 
liver disease
diabetes w/ end organ damage
malignancy
uncontrolled HTN
322
Q

Cat bite!

A

Amox-Clav
if pen allergy - doxy or septra/flagyl
don’t close the wound
dog bite less risk but consider in immunocompromised

323
Q

Rabies Rx

A

Dog/cat/ferret - observe for 10 days, at first sign of rabid, give Rabig and four doses of HDCV or PDECV and test animal
Dog/cat/ferret/skunk/bat/fox/coyote/raccoon/carnivores that is suspected rabid - Rabig + fours doses of HDCV or PCECV, immediately test animal

324
Q

sedation of peds lac repair?

A

intranasal midazolam

IV/IM ketamine

325
Q

sutures # of days

A

face - 5
joint, scalp 10-14
everything else -7

326
Q 
Toxidromes for...
Stimulant
Anticholinergic
Cholinergic
Opioids
Sedative-Hypnotics
Benzos
A

Stimulant – BIG pupils, use benzos

Anticholinergic: TCAs, tegretol, anti-Parkinson’s, antipsychotics, jimson weed – use physostigmine. NO sweating
Mad as a hatter, dry as a bone, red as a beet, hot as a hare, blind as a bat, full as a flask

Cholinergic: mushrooms, organophosphates/insectiticides, nerve agents / sarin gas – atropine, pralidoxime. Tiny pupils, increased sweating.
SLUDGE = salivation, lacrimation, urinary incontinence, diarrhea, GI upset, emesis, miosis

Opioids

Sedative-Hypnotics: anti-epileptics, barbiturates, muscle relaxants. Depressed vitals.

Benzos - give flumazenil (seizure risk)

327
Q

Antidotes for …
beta blockers?
iron?
Aceminophen?

A

BB - glucagon & CABs
iron - deferoxamine & ABCs
acetaminophen - N-acetylcysteine & ABCs

328
Q

If UTI 1st line abx fail…

A

reinfection vs. relapse
treat 7-14 days
reconsider dx/refer - upper tract imaging, cystoscopy, urodynamics

329
Q

causes and mgmt for epistaxis… mild? severe? Posterior?

A 
90% are anterior
causes TIME to stop BLEED
Trauma/tumor
Infection
Meds - nasal steroids
Exogenous - foreign body
BLEEDing disorders

Mgmt - mild:

  • blow nose
  • 2 sprays oxymetazoline
  • pinch x 10 minutes

Severe:

  • ABCs, MOVIES, labs
  • tranexamic acid
  • freeze and cauterize or freeze and pack. Don’t cauterize both sides! (Septal perforation)

Posterior - identify by packing; if still bleeding, call ENT. Nasal baloon/foley.

330
Q

Prophylaxis for those in close contact to bacterial meningitis?

A

Rifampin or ceftriaxone or ciprofloxacin

331
Q

Croup management
steroid dose?
ddx?
fup instructions for parents?

A

Mild - ABCs, treat fever, PO fluids, reassure parents
Dexamethasone 0.15 (mild)-0.6mg/kg
If severe, inhaled racemic epinephrine (if receives this, fup <24 hours post discharge)
if given dex, should get better! If not, consider ddx: influenza, RSV, adenovirus, metapneumovirus, foreign body, tracheomalacia
fever persistiting past 24-48 hours
fluid intake or output not adequate
fatigued/listless
decreased LOC, respiratory distress

332
Q

Meningitis management, CSF findings

A

Start IV abx right away! They are a resuscitation drug.
Steroids only if H flu and <2 hours from antibiotics
Normal
CSF findings:
Bacterial: WBC >500 - neutrophils, low in glucose, protein >100
Aseptic, often viral i.e. syphillis: WBC 10-1000 - lymphocytes, normal glucose, protein <200
SAH: xanthochromia, normal glucose, elevated protein
Fungal: WBC 10-500, cloudy, low glucose, elevated protein
TB: 50-500 clear to opaque, low glucose, elevated

333
Q

Contraindications to LP

A
  • blood pressure - shock
  • brain herniation
  • bleeding - coagulopathy
  • blisters - rash at site
334
Q

Anaphylaxis treatment

A

0.01 mg/kg 1:1000 IM
ABC MOVIES SUPINE (unless seizure, pregnant, decreased LOC) EPI Allergy alphabet, rule of 5
Adrenaline 0.5mg
Breathing - O2 5L nasal or 15L non rebreather
Corticosteroid - methylprenisolone 125mg
Diphenhydramine 50mg
Epi again?
Fluids - treat hypotension 2/2 vasodilation 500c
Glucagon if on B-blocker
H2 blocker - ranitidine 150mg
Inhaled salbutamol - if wheezy

observe for at least 4-8 hours, can have rebound in 23%; steroids don’t help reduce this

335
Q

Eating d/o - SCOFF screening tool

A

Made yourself SICK because you felt uncomfortably full?
Lost CONTROL over how much you eat?
Recently lost more than ONE stone (14 lbs) in a 3 month period?
Do you believe yourself to be FAT when others say you are too thin?
Would you say that FOOD dominates your life?

336
Q

BMI in eating disorders

A

> 17 mild
16+ moderate
15+ severe
<15 extreme

337
Q

The new Female Athlete Triad

A

Relative Energy Deficiency in Sport RED-S

338
Q

Signs on exam of eating disorder

A 
Bradycardia
Slow cap refill
Postural tachycardia
Postural hypotension
Decreased core temperature
Pressure sores
339
Q

Emergency Contraception (4)

A

OCP
Ullipristal
Levonorgestrel
Copper IUD

340
Q

Counselling after sexual assault, pregnancy, when to retest?

A 
HIV post-exposure prophylaxis
Hep B immune globulin, vaccinate within 8 hours
Retest at 6, 12 weeks
Azithro + cefixime/ceftriaxone
Preg test in 4 weeks 
Reporting = voluntary unless <18
341
Q

1st trimester bleeding

A

missed abortion? expectant vs. D&C vs. misoprostol
Always remember your WinRHO
if threatened, serial ultrasound/serial beta
ectopic - pain, <7 weeks, tubal risk factors - expectant, medical or surgical

342
Q

Tests and managemnet for AUB

A

tests: Endometrial biopsy, colposcopy, Pap
Management: Levonorgestrel IUS, OCP, progestin, NSAIDs(??), TXA
Surgical - ablation, hysterectomy, polypectomy, myomectomy

343
Q

Test for vaginitis

A 
Swabs/culture
KOH
Wet mount 
PH
Biopsy
344
Q

To PSA or not to PSA
And how to interpret
RFs for prostate cancer

A

Discuss it if life expectancy >10 years
Start at 50, or 45 if high risk

PSA < 10 low risk, routine
PSA 10-20 semiurgent
PSA > 20 high risk, urgent

PSA > 10 and abnormal prostate = urgent

RFs: age, high risk race, family hx, smoking, obesity

345
Q

Physical exam/investigations for suspected BPH?

A

ABDO and rectal exam

Midstream urine culture + sensitivity and analysis, GC/CT screening

PSA if >10 year life expectancy

346
Q

BPH management
Stop (7)
Start (2)

A
  1. Stop antihistamines, decongestants, NSAIDs, saw palmetto, excess fluid, caffeine, alcohol
  2. Start 5-Alpha reductase inhibitor - Finasteride
    Alpha blocker - Tamsulosin (or both)
    Phosphodiesterase type 5 inhibitors - tadalafil
    Anti-muscarinics
347
Q

Risk factors for tubal dysfunction

A

Endometriosis, ectopic, surgery, Crohn’s, PID, chlamydia, ruptured appendix

348
Q

Causes of infertility / workup

bloodwork to r/o hyperangronism

A

Anovulation
Tubal dysfunction
Uterine abnormalities - adhesions (surgery), septate/arcuate uterus, intracavitary fibroids

Ovulation –> Day 3 FSH (ovarian reserve), Estrogen (ensure FSH not being suppressed), TSH, prolactin, midluteral progesterone

Anti Mullerian hormone for women > 35 or with risk factors for low ovarian reserve: single ovary, ovarian surgery, poor response to FSH, chemo/radiation, unexplained infertility

Hyperandrogenism –> DHEA-S, 17-OH progesterone, total testosterone

Structural, tubal –> ultrasound, hysterosalpingogram

Partner –> semen analysis

Male
Testicles - trauma, torsion, surgery, infection
Sperm - tobacco, marijuana, hypogonadism

349
Q

When to refer for ?infertility

A

12 months if no risk factors
6months if risk factors or <35
immediately if >40
start exercise!

350
Q

PID symptoms, counselling

A

cervical motion tenderness, purulent discharge, fever

treat partner
contact tracing
abstinence x 7 days

351
Q

Ages for abuse

A 
16 if non exploitative
18 if exploitative
consenting youth
12-13 -- up to 2 years older
14-15 -- up to 5 years older`
352
Q

PreP recommended for :

A

MSM
trans people having condomless anal sex with HIV+/unknown status partners

might benefit:

  • IVDU
  • hetero people with HIV+ partners with detectable viral loads
353
Q

How to start PREP, counselling?

A

Truvada one pill per day or on demand
Doesn’t protect from other STIs, use condoms
Baseline labs: STI screen CBC/Hgb Creat HCG urinalysis - q3 montly lab fup

354
Q

Priapasm management

A

Doppler ultrasound, cavernosal blood gas

Non ischemic?
watch and wait
- finasteride
- gonadotropic-releasing hormone agonists - Leuprolide

Ischemic

  • needle drainage
  • intracavernosal phenylephrine
  • surgical shunt if >48 hours
355
Q

Bloodwork for ED

A

Serum glucose
Chol HDL LDL Trig non-HDL
Testosterone Prolactin TSH LH FSH

356
Q

Semen analysis

A

Most important results are CONCENTRATION (>15 million/ml) and MOTILITY (>40%)
morphology less important

357
Q

Heart failure treatment

A 
ACE/ARB
Betablocker
Mineralocorticoid
Lasix
AND if HFrEF (EF <40%), add SGLT2 even if no DM2

If HFpEF, add SGLT2 if DM2/CVD, >30yo w/ DM2/CKD, >50yo w/ DM2 and risk of CVD

If ongoing symptoms despite triple therapy, add entresto for NYHA II to IV
If Heart rate > 70, also add Ivrabradine

358
Q

When to suspect cardiac amyloid and what to order

A 
“Frequent” and “underlooked” Occurs in
1 in 4 over 80 yrs old
 If HF unexplained, or associated with
neuropathy or carpal tunnel
(bilateral):
Order SPEP, UPEP &amp; serum free light chains
Monoclonal protein:
 Absent: Tc-99m-PYP SPECT scan
 Present: Refer to hematology for biopsy
359
Q

Microcytic anemia

A 
Thalassemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia
360
Q

Macrocytic anemia

A

M FAT RBC

Myelodysplasia
Fetal hgb/folate deficiency
Alcohol
Thyroid
Reticulocytosis
B12 deficiency
Chronic disease
361
Q

Normocytic anemia

A 
HARPS normocytic
Hemolytic anemia
Anemia of chronic disease
Renal failure
Pregnancy/pernicious anemia/pyridoxine deficiency 
Spherocytosis
362
Q

Anemia workup

A 
 Hemoglobin
 Mean cell volume
 Serum Ferritin
 Peripheral Blood Smear
 Serum Iron
 Total Iron Binding Capacity
 Colonoscopy
 HCG

Elevated RDW = iron deficiency
Low/normal RDW = thalassemia - hgb electrophoresis

363
Q

B12 DEFICIENCY

Risk Factors

A 
1. Gastric surgery
Gastric parietal cells make intrinsic factor
2. Strict vegans
3. Breastfed children of #2
4. Elderly
5. Psychiatric
364
Q

Iron for peds?

A

FERROUS SULFATE FOR SMALL ONES

365
Q

Causes of recurrent UTI in peds:

A

VUR
Uretrocele
Posterior urethral valves

366
Q

Causes of unconjugated hyperbilirubinemia?

A

ABC Bili - unconjugated
ABO hemolysis
Breastmilk
Conjugation deficiency

Breastfeed, lack of - dehydration
Infection
Loss of blood, vit K deficiency
Idiopathic

367
Q

Causes of conjugated hyperbili?

A

Bad C Bili - conjugated
Biliary atresia
Biliary duct stenosis
Cystic fibrosis

368
Q

C diff test

A

Stool PCR For c diff toxin A and B

369
Q

Ottawa Ankle Rule

A

An ankle X-Ray series is only required if there is any pain in the malleolar zone and…
Bone tenderness at the posterior edge or tip of the lateral malleolus (A)
OR
Bone tenderness at the posterior edge or tip of the medial malleolus (B)
OR
An inability to bear weight both immediately and in the emergency department for four steps

370
Q

Ottawa Foot Rule

A

A foot X-Ray series is only required if there is any pain the midfoot zone and…
Bone tenderness at the base of the fifth metatarsal (C)
OR
Bone tenderness at the navicular (D)
OR
And inability to bear weight both immediately and in the emergency department for four steps

371
Q

Ottawa Knee Rule

A

knee X-Ray series is only required for knee injury patients with any of these findings:
Age 55 or older
OR
Isolated tenderness of the patella
No bone tenderness of knee other than patella
OR
Tenderness of the head of the fibula
OR
Cannot flex to 90 degrees
OR
Unable to bear weight both immediately and in the emergency room department for 4 steps
Unable to transfer weight twice onto each lower limb regardless of limping

372
Q

Wells Criteria for DVT

A

Active cancer
Treatment or palliation within 6 months

Bedridden recently >3 days or major surgery within 12 weeks

Calf swelling >3 cm compared to the other leg
Measured 10 cm below tibial tuberosity

Collateral (nonvaricose) superficial veins present

Entire leg swollen

Localized tenderness along the deep venous system

Pitting edema, confined to symptomatic leg

Paralysis, paresis, or recent plaster immobilization of the lower extremity

Previously documented DVT

Alternative diagnosis to DVT as likely or more likely

373
Q

Zika counselling

A
  • do not get pregnant if travelling to Zika-risk country
  • mosquito precaustions
    If traveler is female: Consider using condoms or not having sex for at least 2 months after travel to an area with risk of Zika (if she doesn’t have symptoms), or for at least 2 months from the start of her symptoms (or Zika diagnosis) if she develops Zika.
    If traveler is male: Consider using condoms or not having sex for at least 3 months after travel to an area with risk of Zika (if he doesn’t have symptoms), or for at least 3 months from the start of his symptoms (or Zika diagnosis) if he develops Zika.
374
Q

Schizophrenia symptoms

A

Positive (i.e. hallucinations, delusions, racing thoughts), negative (i.e. apathy, lack of emotion, poor or nonexistant social functioning), and cognitive (disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems)

375
Q

SADMAN drugs

A 
Sulfonylureas
ACE
Diuretics - spironolactone
Metformin
ARBs
NSAIDs
SGLT2
376
Q

PE Wells Criteria

A

Clinical signs and symptoms of DVT

PE is #1 diagnosis OR equally likely

Heart rate > 100

Immobilization at least 3 days OR surgery in the previous 4 weeks

Previous, objectively diagnosed PE or DVT

Hemoptysis

Malignancy w/ treatment within 6 months or palliative

377
Q

PERC score

A

Age ≥50

HR ≥100

O₂ sat on room air <95%

Unilateral leg swelling

Hemoptysis

Recent surgery or trauma
Surgery or trauma ≤4 weeks ago requiring treatment with general anesthesia

Prior PE or DVT

Hormone use
Oral contraceptives, hormone replacement or estrogenic hormones use in males or female patients

378
Q

Murmur for hypertrophy cardiomyopathy

A

Significant LVOT obstruction, often due to a combination of LV upper septal hypertrophy and systolic anterior motion (SAM) of the mitral valve, results in a harsh crescendo-decrescendo systolic murmur that begins slightly after S1 and is heard best at the apex and lower left sternal border.

An increase in intensity, due to enhancement of obstruction, is seen with the assumption of an upright posture from a squatting, sitting, or supine position; the Valsalva maneuver; during the more forceful contraction that follows the compensatory pause after a PVC; and following the administration of nitroglycerin.

●A decrease in intensity, due to attenuation of obstruction, is heard after going from a standing to a sitting or squatting position, with handgrip, and following passive elevation of the legs.

379
Q

Stevens Johnsons syndrome, presentation and management

A
  • Risk limited to the first eight weeks of treatment.
  • typical exposure period before reaction four days to four weeks of first continuous use of the drug.
  • Fever, often exceeding 39°C and influenza-like symptoms precede by one to three days the development of mucocutaneous lesions
  • Photophobia, conjunctival itching or burning, and pain on swallowing may be early symptoms of mucosal involvement. Malaise, myalgia, and arthralgia are present in most patients.
  • Signs and symptoms that should alert the clinician to the possibility of SJS/TEN include fever >38°C (100.4°F), mucositis, skin tenderness, and blistering
  • Nikolsky sign
  • labs: Complete blood count with differential, metabolic panel (ie, glucose, electrolytes, blood urea nitrogen, creatinine, calcium, total protein, albumin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase), erythrocyte sedimentation rate, and C-reactive protein –> chest xray due to high risk of pneumonia

●Bacterial and fungal cultures should be performed from blood, wounds, and mucosal lesions. Because of the high risk of bacterial superinfection and sepsis in these patients, cultures should be repeated throughout the acute phase of the disease.

Management:
referral to the most appropriate health care setting (eg, intensive care unit, burn unit, specialized dermatology unit, where present), and initiation of supportive treatment.
- wound care, fluid and electrolyte management, prompt withdrawal of offending agent, pain control, prevention/treatment of infections

380
Q

what is sarcoidosis?

A

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology that affects individuals worldwide and is characterized pathologically by the presence of noncaseating granulomas in involved organs. It typically affects young adults and initially presents with one or more of the following abnormalities:

●Bilateral hilar adenopathy

●Pulmonary reticular opacities

●Skin, joint, and/or eye lesions

381
Q

what is acute aortic syndrome?

A

It is a clinical spectrum of diagnoses including aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer at any location along the aorta

382
Q

Meniere’s disease

A

Tinnitus, vertigo, hearing loss, nausea/vomiting (clinical dx; rarely may do MRI)
From build up of fluid in the ears, occurs in episodes

Treatment:
symptoms - anti-emetic: promethazine, prochloperazine
treat of fluid build up - diuretics (HCTZ, acetazolamide), low salt diet

Toxic labyrinthitis – related to EtOH

383
Q

Signs of advanced HF

A

2 or more hospitalization or ED for HF visits in the past year
progressive deterioration of renal function
weight loss without other cause = cardiac cachexia
stop ACE due to hypotension or worsening renal failure
intolerance of bblockers because of worsening HF or hypotension
SBP < 90
NYHA class III or IV
need to escalate diuretics to maintain volume status, often reaching furosemide > 160 or supplemental metolazone rx
progressive decline in serum sodium
frequent implantable cardioverter debrillator shocks

384
Q

Who do you give pneumococcal vaccine to, and which one?

A

It is recommended that immunosuppressed adults of all ages receive the 13-valent pneumococcal conjugate vaccine (PCV13)
all adults aged 65 years and older receive PCV13 on an individual basis, followed by the 23-valent pneumococcal polysaccharide vaccine
One dose of Pneu-P-23 vaccine should be administered to all individuals 24 months of age and older who are at high risk of IPD due to an underlying medical condition or who are residents of long-term care facilities. People at highest risk of IPD should also receive 1 booster dose of Pneu-P-23 vaccine.
One dose of Pneu-P-23 vaccine is recommended for adults:
65 years of age and older, regardless of risk factors or previous pneumococcal vaccination.
at high risk of IPD due to lifestyle factors: smokers, persons with alcoholism, persons who are homeless. Adults who use illicit drugs should be considered for Pneu-P-23 vaccination.
Why
S. pneumoniae is a common cause of invasive disease, such as bacteremia and meningitis.
The case fatality rate of bacteremic pneumococcal pneumonia is 5% to 7% and is higher among elderly persons.

385
Q

What is degenerative cervical myelopathy and how do you treat it?

A

Degenerative cervical myelopathy occurs when age-related osteoarthritic changes cause narrowing of the cervical spinal canal, leading to chronic spinal cord compression and resultant neurologic disability.

The natural course of DCM presents as a stepwise decline, with symptoms ranging from muscle weakness to complete paralysis. All individuals with signs and symptoms should be referred to a spine surgeon for consideration of surgery.
Asymptomatic patients with evidence of cord compression on magnetic resonance imaging might need to be referred for assessment; however, surgery is not advised. It is critical to closely monitor asymptomatic individuals or those with mild DCM for neurologic deterioration.

Patient presentation can vary broadly, with symptoms ranging from mild dysfunction, such as numbness or dexterity problems, to severe dysfunction, such as quadraparesis and incontinence, as later findings. It is important to note that paresthesia in the extremities is often the first sign, and because it might be mild, it can be easily overlooked by patients and providers.

386
Q

What is a tool that uses lab values to predict cirrhosis?

A

AST to Platelet Ratio Index (APRI)

APRI score greater than 1.0 had a sensitivity of 76% and specificity of 72% for predicting cirrhosis. In addition, they concluded that an APRI score greater than 0.7 had a sensitivity of 77% and specificity of 72% for predicting significant hepatic fibrosis.

Similarly, the FIB-4 score uses the AST/ALT, age and platelet levels to predict the level of fibrosis using a different equation.

387
Q

Treatment for rosacea

A 
Topical - 
metronidazole
azelaic acid
invermectin
minocycline

Oral -
doxycycline
minocycline
tetracycline

persistent erythema -
brimonidine gel
oxymetazoline
persistent erythema/telangectasia - laser

388
Q

Questions from the Cannabis Abuse Screening Test?

A

Have you smoked cannabis before midday?

Have you smoked cannabis when you were alone?

Have you had memory problems when you smoked cannabis?

Have friends or members of your family told you that you ought to reduce your cannabis use?

Have you tried to reduce or stop your cannabis use without succeeding?

Have you had problems because of your use of cannabis (argument, fight, accident, bad result at school, etc)?
Which ones?

389
Q

What is POMI?

A

Prescription Opioid Misuse Index
1. Do you ever use more of your medication, that is, take a higher dose, than is prescribed for you?

  1. Do you ever use your medication more often, that is, shorten the time between doses, than is prescribed for you?
  2. Do you ever need early refills for your pain medication?
  3. Do you ever feel high or get a buzz after using your pain medication?
  4. Do you ever take your pain medication because you are upset, using the medication to relieve or cope with problems other than pain?
  5. Have you ever gone to multiple physicians, including emergency room doctors, seeking more of your pain
    medication?
390
Q

Breastfeeding safe medications

A

Allergic rhinitis

Beclomethasone (Beconase)
Fluticasone (Flonase)
Cromolyn (Nasalcrom)

Cardiovascular

Hydrochlorothiazide (Esidrix)
Metoprolol tartrate (Lopressor)
Propranolol (Inderal)
Labetalol (Normodyne)

Nifedipine (Procardia XL)
Verapamil (Calan SR)
Hydralazine (Apresoline)
Captopril (Capoten)
Enalapril (Vasotec)
Use with caution:
Atenolol (Tenormin)
Nadolol (Corgard)
Sotalol (Betapace)
Diltiazem (Cardizem CD)

Depression

Sertraline (Zoloft)
Paroxetine (Paxil)

Nortriptyline (Pamelor)
Desipramine (Norpramin)

Use with caution: Fluoxetine (Prozac)

Diabetes

Insulin
Glyburide (Micronase)
Glipizide (Glucotrol)
Tolbutamide (Orinase)

Acarbose (Precose)

Use with caution:
Metformin (Glucophage)
Thiazolinediones

Epilepsy

Phenytoin (Dilantin)
Carbamazepine (Tegretol)

Ethosuximide (Zarontin)
Valproic sodium (Depakote)

Use with caution:
Phenobarbital

Pain

Ibuprofen (Motrin)
Morphine
Acetaminophen (Tylenol)

Use with caution:
Naproxen (Naprosyn)
Meperidine (Demerol)

Asthma

Cromolyn (Intal)
Nedocromil (Tilade)

Fluticasone (Flovent)
Beclomethasone (Beclovent)

Contraception

Barrier methods

Progestin-only agents

391
Q

Risks of opthalmic steroids

A
  1. PERFORATION: In the event of herpetic keratitis, steroids can facilitate progression resulting in corneal perforation
  2. GLAUCOMA: Ophthalmic steroids can cause chronic open-angle glaucoma if used for a prolonged period of time (i.e. > 2 weeks)
  3. CATARACTS: Ophthalmic steroids can cause cataracts if used for a prolonged period of time
  4. CORNEAL ULCERS: Ophthalmic steroids have been associated with development of corneal ulcers of a fungal origin.
392
Q

What are the ABCDEF of red eye?

A

A = ache, B = blob, C = constriction, D = document acuity, E = erythema pattern, F = flourescin

393
Q

Iritis

A

Remember anatomically what the IRIS is (coloured part of the eye), what the IRIS does (constricts in response to light), and what it surrounds (pupil):
It makes sense that if the iris is inflamed…
- it will be red around the iris (PERILIMBAL HAZE)
- it hurts when the iris constricts (PHOTOPHOBIA)
- it can become warped (DISTORTED PUPIL)

A • Pain - Photophobia

B • Yes, watery

C •Miosis / reacts poorly on
affected side / distorted pupil (anisocoria)

D • Blurred vision

E • Perilimbal Haze

F •Normal
•Not necessary unless FB
sensation

  • Refer for Steroids
  • R/O systemic cause (i.e. SpA, Behcet’s , IBD, Kawasaki’s, TINU, JIA, Sjögren’s, Polychondritis, Granulomatous Tx)

angiitis…)

DDx – Unlike Iritis…
Conjunctivitis has morning crusting, no pain
Sclerits has SEVERE pain & tenderness to palpation
Episcleritis is NOT painful
Keratitis has corneal opacity, discharge, fluoresces
Glaucoma has hazy, nonreactive pupil & headache

394
Q

Scleritis

A

Remember the sandwich, from superficial to deep:
CONJUNCTIVA
EPISCLERA
SCLERA
As the deepest part of the eye, the eye will be will be VERY VERY PAINFUL if the inflammation gets all the way down to the sclera.

A
• SEVERE CONSTANT BORING PAIN -
++ night, pain w/palpation, + photophobia
B • Tears
C • PERL
D • Decreased - DOCUMENT
E • No erythema…but deep red / blue / purple hue
F •Normal •Not necessary unless FB sensation

•REFER for Steroids
•R/O systemic cause (RA, IBD, microscopic polyangiitis, Churg-Strauss, Sjogren’s, Polychondritis, Granulomatous angiitis, Tx
SLE, infectious)

395
Q

Episcleritis

A

Remember the sandwich, from superficial to deep:
CONJUNCTIVA
EPISCLERA
SCLERA
The episclera is not the deepest part, so there’s no
pain & normal acuity. As well, it’s sealed in by
conjunctiva so there’s no significant discharge &
no A.M. crusting. Focal redness-think Episcleritis.

A •Irritation (pain is rare)
B •Tears - NO pus, NO a.m. crusting
C •PERL
D • Normal- DOCUMENT
E •FOCAL redness
F •Normal 
 •Not necessary unless FB sensation
Tx •Artificial Tears
396
Q

Keratitis

A

Keratitis is inflammation of the cornea. Think
about how painful a corneal abrasion is and you’ll remember keratitis. These patients are miserable.
Also, if the CORNEA is inflamed, ACUITY will
obviously be decreased as light passes through the
cornea.
Don’t forget FLOURESCIN staining as this will give away the diagnosis of keratitis!

A •Difficulty keeping eye open
•VIRAL - Watery 
B •BACTERIAL - Possibly Purulent
C •PERL but you may notice a haze or branching pattern on the cornea
D •Blurred vision 
•Halos around lights
E •Diffuse (maybe perilimbal) 
•Corneal haze
F •+ HSV - Branching pattern 
•+ Bacterial - Corneal Ulceration

Tx •REFER URGENTLY •Ophtho will target instigating bug

397
Q

Conjunctivitis

A

A No pain just irritation! If it’s painful, it’s not conjunctivitis
B •Viral/Allergic: Watery esp. in AM
•Bacterial: PUS esp. in AM
C •PERLA. (If abnormal, it’s not conjunctivitis)
D •Normal -DOCUMENT
E •Diffuse
•Normal
F •Not necessary unless FB sensation
•SWABS = USELESS (exceptions: contact lens
wearer, painful, failed Tx, immunocompromised)
Tx •ABx for Bacterial (cover for Pseudo if contacts)

398
Q

Glacuoma

A

Remember the rule of thumb: REFER all patients with any PAINFUL EYE. And – look for red eye if your patient has serious headache. If you do this you won’t miss a rare, but serious, glaucoma.
A good analogy is the eye is like an overinflated balloon, ready to pop… imagine how PAINFUL that would be. These patients are often IN DISTRESS.
As well an overinflated eyeball won’t function normally – pupil FIXED and DECREASED acuity.

•Acute, SEVERE Pain, Tender, &amp; firm - these patients are in distress
B •Minimal Watery
C •Fixed, Hazy, Dilated •Anisocoria
D • Decreased - DOCUMENT 
 • Halos around lights
E •Ciliary Flush
F •Normal 
•Not necessary unless FB sensation

Tx •LOWER PRESSURE within HOURS
•IMMEDIATE REFERRAL to ED

Acute Angle-Closure Glaucoma
Emergent Treatment
 Consult Ophthalmology Emergently
 Initiate treatment WITHIN 60 MINUTES as recommended by ophthalmology
A sample regimen may include:
 0.5% timolol maleate
 1% apraclonidine, and 1 gtt each, to affected eye, 1min apart
 2% pilocarpine
 Oral medications may include acetazolamide, two x 250mg tablets in the office
 IV medications may include acetazolamide or mannitol

399
Q

Approach to vertigo

A

Classifying vertigo or dizziness by timing (episodic or continuous) and trigger (positional or not), rather than type (vertigo vs lightheadedness vs unsteadiness, etc) allows for effective clinical identification of both high-risk-for-stroke and low-risk-for-stroke populations.”
Consider POSTERIOR STROKE in ANY patient with dizziness, nausea, vomiting.
Symptoms can also include swallowing difficulties, facial pain with vertigo or numbness, or gait disturbance

400
Q

Vertigo red flags

A 
Red flags:
hearing loss, new, unilateral
focal neuro
headache, new
head impulse that suggests central cause (no corrective saccade)

Pitfall: Don’t use the Dix-Hallpike Maneuver on patients with continuous vertigo symptoms
Only perform this maneuver on patients whose episodes of vertigo last less than 2min, and have no nystagmus at rest.

Note that most types of vertigo will be exacerbated by head movements. Even with episodic vertigo, the feeling of nausea can persist, which can be confusing. The key is that BPPV has provoked brief episodes that resolve, and there are no nystagmus present at rest.
Peripheral
Head Impulse - Catch-up saccade (“abnormal”)
Nystagmus - unidirectional
Test of Skew - No vertical skew
Hearing loss absent

Central
Head Impulse - Normal gaze tracking
Nystagmus - bidirectional
Test of Skew - Vertical skew present
Hearing loss	 present

Pitfall: Don’t use the HINTS Plus exam on patients with BPPV (episodic vertigo without nystagmus at rest)

This is only indicated for patients with ongoing, constant vertigo and nystagmus at rest. The results are meaningless and confusing when performed on patients with suspected BPPV.

401
Q

Validated score for Autism?

402
Q

How is long QT defined? Risk factors (6) and medications to avoid for TdeP (4)?

A

MEN QTc > 450, WOMEN QtC > 460

congenital long QT syndrome
older age
previous TdeP
electrolyte abnormalities: low K, low Mg, low Ca
bradycardia
female 
Meds:
domperidone
citalopram
macrolides
quinolones
403
Q

How to reduce recurrent UTIs in premenopausal women

A

increase daily water consumption by 1.5L/day

404
Q

Reasons to prescribe abx when doing an I+D?

A

extensive tissue damage, risk of poor healing/complications, immunocompromised, prosthetic device
–> if MRSA, add clinda or septra

405
Q

Tool for suspected concussions in sport?

questions to ask before someone can consider return to sport?

A

SCAT-5
sport concussion assessment tool
to return to sport:
are all symptoms resolved?
unrestricted return to normal cognitive activity achieved?
endurance and physical activities performed without symptoms?
normal exam of cervical spine and neurologic status?
any other health condition/previous concussion/context to justify an additional delay?

406
Q

criteria for admission for anorexia nervosa

A 
weight <75% of ideal body weight
temp < 35.5
HR 45
SBP <80
orthostatic change in pulse >20
orthostatic change in BP >10
407
Q

Rourke Baby nutritional recommendations

A

avoid hard/small/round foods until 3 years. Remain seated while eating/drinking
Promote family meals with self-feeding
avoid all sweetened beverages
Vit D supplementation 400IU and 800IU in high risk infants while breastfed
early introduction starting at 6 months and repeated ingestion of allergenic foods like egg, fish, peanut

408
Q

Child safety advice

A

Rear facing car seat until 2 years of age and then booster seat for 40-80 pounds

Sleep in crib/cradle/bassinet without soft objects/loose bedding in parents room for 6 months

after umbilical stump detaches, should have supervised tummy time

vary the direction of the infants head while supine

Swaddling not recommended after 2 months

CCFP (1 decks)

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