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CCFP Exam Flashcards

1
Q

3 things that can precipitate Hyperparathyroidism

A
  • thiazides
  • lithium
  • Multiple Endocrine Neoplasia 1 & 2
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2
Q

3 Symptoms of Hyperparathyroidism

A 
bone pain
fragility #
psychosis
nephrolithiasis
gout
constipation
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3
Q

2 Management options for Hyperparathyroidism

A

Parathyroidectomy

Volume replete for high calcium

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4
Q

List components of CHADs Score

A
  • CHF hx
  • HTN hx
  • age >75
  • DM hx
  • Stroke/TIA symptom hx
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5
Q

2 medication classes for GIB Prevention?

A
  • H2 receptor antagonist

- Proton Pump Inhibitor

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6
Q

10 Symptoms of Hyperthyroidism

A
  • tremor
  • anxiety
  • palpitations
  • heat intolerance
  • hair thinning
  • goitre
  • exophthalmos
  • weight loss
  • anemia
  • lid lag
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7
Q

What test should be ordered if High TSH & High fT4?

A

MRI

think secondary hyperthyroidism from TSH secreting pituitary adenoma

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8
Q

What test should be ordered if Low TSH & High fT4?

A

Thyroid Uptake Scan

- look for Graves/Nodular vs. Thyroiditis

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9
Q

List 3 treatments for Hyperthyroidism?

A

Beta-Blockers
Methimazole
Subtotal Thyroidectomy

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10
Q

3 Symptoms of Thyroid Storm

A

Fever
CNS Agitation
Precipitant Trigger

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11
Q

How to treat thyroid storm?

A
  • slow thyroid synthesis –> methimazole 60-120mg
  • inhibit hormone release –> potassium iodide drops
  • lower HR –> propranolol 60-80mg q4h
  • support circ –> glucocorticoids, fluids, cooling & O2
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12
Q

3 Risk Factors for Hypothyroidism

A

Female trying to conceive or >45 yo
Postpartum
Medications - Amiodarone/Lithium/Iodine

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13
Q

10 Symptoms of Hypothyroidism

A
  • weight gain
  • cold intolerance
  • hair thinning
  • constipation
  • depression
  • goitre
  • edema
  • fatigue
  • myalgia
  • dry skin
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14
Q

Definition of subclinical hypothyroidism

A

TSH <10, Normal fT4, not pregnant, asymptomatic

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15
Q

When to treat Hypothyroidism

A 
TSH >10 + symptomatic 
OR
TSH 5-10  AND: 
- increased TPO antibodies
- goitre
- fam hx of autoimmune disease
- pregnant
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16
Q

How often do we titrate Synthroid?

A

q4-6w until target range

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17
Q

What are the diagnostic values for Diabetes?

A

8hr FPG >7.0
2hr 75g OGTT >7.0 or 2hr >11.1
Random Glucose >11.1
HgA1c >6.5%

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18
Q

What are the target FPG levels pre & post prandial?

A

pre 4-7

post 5-10

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19
Q

What yearly investigations should be done in a patient with DM?

A 
optometry
fasting lipids
Albumin/Cr ratio
Monofilament/foot exam
ECG
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20
Q

10 Risk Factors for DM?

A
  • abdominal obesity
  • asian/african
  • low SES
  • 1st relative with T2DM
  • HTN
  • smoking
  • PCOS
  • statins, steroids, atypical antipsychotics
  • hx of pre-diabetes
  • hx of GDM
  • hx of delivering macrosomic infant
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21
Q

Who IS eligible for tPA?

A

age =/> 18
clinical dx of ischemic stroke causing neurological deficit
time of onset <4.5 hours

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22
Q

Absolute Contraindications for Thrombolysis?

A
  • intracranial hemorrhage on Head CT
  • clinical presentation suggests Subarachnoid hemorrhage
  • NeuroSx, head Trauma or Stroke in last 3 months
  • Uncontrolled hypertension (>185 mmHg SBP or >110 mmHg DBP)
  • Hx of intracranial hemorrhage
  • Known intracranial arteriovenous malformation, neoplasm, or aneurysm
  • Active internal bleeding
  • Suspected/confirmed endocarditis
  • Known bleeding risk (INR >1.7, etc.)
  • Abnormal blood glucose
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23
Q

Relative Contraindications for Thrombolysis?

A
  • Only minor or rapidly improving stroke symptoms
  • Major surgery or serious non-head trauma in the previous 2 weeks
  • History of gastrointestinal or urinary tract hemorrhage within 3 weeks
  • Seizure at stroke onset
  • Recent arterial puncture at a non-compressible site
  • Recent LP
  • Post myocardial infarction pericarditis
  • Pregnancy
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24
Q

Red Flag Symptoms for Back Pain

A 
B - bowel/bladder dysfunction
A - anesthesia (saddle)
C - constitutional symptoms (fever)
K - chronic dz (cancer/OP)
P - paresthesia
A - age >65
I - immunosuppressed/IVDU
N - neurological deficit
>12 weeks
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25
Q

Cervical Cancer screening

A

ages 25-69, q3years

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26
Q

Colorectal Cancer screening

A

FIT ages 50-74 q2years
OR
Flexible Sigmoidoscopy q10years

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27
Q

Breast Cancer screening

A

mammogram q2-3years ages 50-74 IF average risk

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28
Q

Pancreatic Cancer screening

A

ONLY if high risk:

  • family hx
  • peutz-Jeghers syndrome
  • BRCA1 with affected relative
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29
Q

H Pylori Treatment & Duration

A

14 day QUAD treatment:

  • PPI
  • Bismuth
  • Metronidazole
  • Tetracycline
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30
Q

Long term PPI side effects?

A
  • Clostridium Difficile
  • Pneumonia
  • Dementia
  • Fractures
  • B12 Deficiency
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31
Q

Greatest risk factor for barrett’s esophagus?

A

reflux

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32
Q

How to prevent barrett’s esophagus?

A

high dose PPI AND ASA

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33
Q

When a pt presents with abdominal pain, what 1 test and 1 exam are commonly missed by the MD?

A
  • BHCG

- Pelvic exam

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34
Q

Definition of acute vs. chronic diarrhea

A

acute <14 days

chronic >4 weeks

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35
Q

What are the pediatric resuscitation guidelines in Pediatrics?

A

bolus - 20ml/kg NS or LR

hourly maintenance 4:2:1 rule

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36
Q

Risk factors for C. Diff?

A
  • elderly
  • immunocompromised
  • Healthcare associated
  • recent course of antibiotics (Esp. fluoroquinolones i.e. Ciprofloxacin)
  • previous C. Diff infection
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37
Q

1st line treatment for C. Diff?

A

Vancomycin PO as of 2018 - no longer Metronidazole

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38
Q

Workup for chronic diarrhea?

A

Test Blood AND Stool:

  • Hgb, Ferritin, TSH, TTG
  • C. Diff, O&P, Calprotectin
  • dont do FIT –> straight to colonoscopy
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39
Q

List 4 Crohns Tx:

A
  • sulfasalazine
  • steroids
  • MTX
  • Biologics
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40
Q

IBS Therapies to try

A
  • TTG
  • FODMAP diet
  • Psyllium
  • Peppermint oil
  • Probiotics
  • CBT & hypnotherapy
  • Colonoscopy if >50 OR if alarm features
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41
Q

What NOT to do for IBS?

A
  • CRP, Calprotectin, Food Allergy Testing
  • GF Diet
  • Wheat bran
  • Herbal therapies
  • Acupuncture
  • Colonoscopy if <50 & no alarm features
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42
Q

IBS Medications

A 
Antidepressants (TCAs, SSRIs)
Antispasmodics
NOT loperamide (imodium)
NOT osmotic laxatives
NOT cholestyramine
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43
Q

Restless Leg Syndrome Non-prescription Treatments:

A
  • Iron
  • Magnesium
  • stretch calves
  • exercise
  • massage
  • heat
  • avoid caffeine
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44
Q

Restless Leg Syndrome Prescription Tx:

A
  • non-ergot dopamine agonist: pramipexole

- alpha 2 delta calcium channel ligand: gabapentin

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45
Q

Questions to diagnose Obstructive Sleep Apnea?

A 
STOP
S - snoring
T - tired
O - observed apnea
P - high blood pressure
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46
Q

How to treat OSA?

A

Positive airway pressure (CPAP)

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47
Q

List 3 strategies in CBT

A
  • goalification
  • scalification
  • reward chart
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48
Q

How do we treat subclinical hypothyroidism?

A

we don’t

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49
Q

What are the 2 treatment options for Hyperthyroid on labs, or having a thyroid nodule and then finding hyperthyroidism on labs?

A
  • RAIU

- Beta-Blocker

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50
Q

What investigation do you order 1st after finding a thyroid nodule?

A

TSH & Thyroid US

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51
Q

What size of thyroid nodule is high risk?

A

> 1 cm

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52
Q

What investigation do you do after Thyroid US if high risk?

A

Fine needle aspiration for cytology

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53
Q

What are features of a suspicious thyroid nodule that would lead you to biopsy?

A

> 1cm
irregular surface
taller than wide
calcifications within

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54
Q

What are the treatments for Thyroid storm?

A
  • Block synthesis (methimazole, PTU)
  • block release (iodine)
  • beta blocker (propranolol)
  • block bile (cholestyramine)
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55
Q

What are the treatments for Graves Disease?

A
  • block synthesis (methimazole/PTU)
  • block release (iodine)
  • beta blocker (propranolol)
  • radiation
  • removal of thyroid gland
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56
Q

What is the starting dose of Insulin in T2DM?

A

10 units NPH @ HS

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57
Q

Things to consider re: SGLT2 inhibitors

A
  • don’t use in T1DM
  • can cause vaginitis/balinitis
  • can lower eGFR
  • used in Heart failure without DM
  • watchout for normoglycemic DKA
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58
Q

Diabetes Driving Guidelines?

A

2-4-6 rule
check blood sugar q2hours if hypoglycemic unawareness
check sugar q4h, if low, treat & wait 40 min
keep 6 lifesaver candies in the car for lows

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59
Q

Management of Hepatitis B?

A
  • refer to hepatology
  • treat if severe (cirrhosis, fibrosis, HBV DNA >2000 IU/mL & ALT elevated for 3-6months
  • Tx with Tenofovir or Interferon
  • Monitor
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60
Q

Management of Hepatitis C?

A
  • refer to hepatology
  • treat if severe
  • Tx with Interferon or Antiretroviral Meds (Sofosbuvir)
  • Monitor & Quit risks
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61
Q

Monitoring for Hep B/C

A
  • liver US q6-12 months
  • monitor varices with scope q1-3 years
  • alcohol use, monitor by taking hx
  • cirrhosis/fibrosis; no single blood test
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62
Q

4 important parts of exam for Back Pain?

A
  • pedal pulses
  • neurological exam
  • weakness?
  • numbness?
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63
Q

Recommended Therapies for Back Pain?

A
  • not drugs
  • teach lifting habits
  • quit smoking & IVDU
  • yoga
  • acupuncture
  • CBT
  • osteopathy
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64
Q

4 joint pain alarm features?

A
  • night pain
  • boggy (soft) joint
  • hot (fever, warm joint)
  • AM stiffness >30 minutes
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65
Q

Who should I refer a child with behavioural problems to?

A
  • pediatrics, SLP, psychology
  • autism clinic
  • hearing & vision assessment
  • occupational therapy
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66
Q

List 3 things on the differential for autism?

A
  • global developmental delay
  • epilepsy
  • hearing impairment**
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67
Q

Define Conduct Disorder

A

repetitive/persistent, violation of rights of others, rule breaking, VIOLENCE against people/animals, running away from home/school

  • **PROPERTY/PEOPLE/ANIMALS DAMAGED
  • **THEFT
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68
Q

Define Oppositional Defiant Disorder

A

irritable, defiant, vindictive

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69
Q

Therapies to try to minimize bed wetting

A
  • make toilet accessible
  • pee before bed
  • training pants
  • use bedwetting alarms
  • can use desmopressin (short term ex. sleepovers)
  • imipramine LAST RESORT
  • no caffeine/chocolate
  • no fluid before bed
  • don’t punish child
  • don’t put child in diapers
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70
Q

Treatment for Phimosis?

A

Topical steroids (Betamethasone)

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71
Q

What can be caused by undescended testes (cryptorchidism)?

A 
torsion
trauma
tumor
infertility
inguinal hernia
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72
Q

How to examine for torsion?

A

TWIST score

  • absent cremasteric reflex?
  • nausea/vomiting?
  • high riding testicle?
  • testicular swelling?
  • hard testicle?
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73
Q

which vaccines can someone get if they are allergic to chicken/eggs?

A

Influenza & MMR

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74
Q

which vaccines should you NOT give if someone is allergic to chicken/eggs?

A

yellow fever, tick borne encephalitis, rabies

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75
Q

Tips on making infant immunizations less painful?

A
  • don’t aspirate
  • do the most painful last
  • breastfeed during
  • skin-to-skin
  • topical anesthetic
  • oral sugar
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76
Q

Shingrix info?

A

non-live recombinant

  • 2 doses
  • 2 months (up to 6 months apart)
  • 2x as effective as Zostavax
  • $150 each shot
  • recommended in patients >50 years old
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77
Q

HPV vaccine info?

A
  • 2 doses
  • 9 valent
  • all genders
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78
Q

Who should get the Meningitis C vaccine?

A
  • ALL canadian adolescents ~12yo
  • military recruits
  • asplenia & sickle cell
  • travelers to Hajj & Meningitis belt of Africa
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79
Q

Which vaccines are live?

A

Polio
Varicella
MMR

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80
Q

Which vaccines can’t immunocompromised people have?

A

live vaccines - polio, varicella, MMR

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81
Q

Which vaccine is contraindicated if pt is pregnant?

A

most live vaccines
BCG
Flu vaccine is OK

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82
Q

Which vaccine is contraindicated if pt has active TB?

A

MMR, varicella, herpes zoster, bcg

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83
Q

which vaccine is contraindicated if pt has severe asthma/wheeze 7d prior?

A

live attenuated flu shot

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84
Q

which vaccine is contraindicated if pt has a congenital GI malformation?

A

rotavirus (risk of intussception)

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85
Q

which vaccine is contraindicated if pt has HIV?

A

live vaccines - varicella, polio & MMR

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86
Q

What are the common organisms causing sinusitis & ear infections?

A

Hemophilus influenza
Moraxella cattarhalis
Strep pneumoniae

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87
Q

Rhinosinusitis Signs & Symptoms

A 
CPODS:
Congestion/fullness
Pain (facial pressure/fullness)
Obstruction
Drainage (purulent)
Smell (anosmia)
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88
Q

Acute vs. Chronic Sinusitis Timeline

A

acute <4w

chronic >12w

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89
Q

When to refer for sinusitis?

A

> 4 episodes in 1 year
refractory to treatment
complications (immunosuppressed, severe pain, fungal)

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90
Q

Acute Sinusitis Management

A
  • saline nasal rinse
  • analgesia/antipyretics
  • decongestant
  • inhaled steam/warm compresses
  • intranasal steroids x 3d (if no improvement, then abx)
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91
Q

When is chronic rhinosinusitis diagnosed?

A

> 2 CPODS for 8-12 weeks + inflammation of sinus mucosa

can confirm with CT (NOT xray)

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92
Q

When is acute sinusitis diagnosed?

A

> 2 PODS for >7d or w/ biphasic fever

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93
Q

Bacterial Sinusitis Treatment:

A
  1. Amoxicillin 80mg/kg or 500mg po TID
  2. Cefuroxime if allergic to PCN

** Amox/Clav 500mg po TID if Amox doesn’t work

Tx for 10-14d
Most are viral and do NOT need antibiotics
consider saline rinse, oral decongestants, IN steroids

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94
Q

Diagnostic Criteria for IBS:

A

recurrent abdo pain at least 1 day/week in the last 3 months associated with >2 of:

  • related to defecation
  • change in frequency of stool
  • change in form of stool
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95
Q

Alarm Symptoms of IBS

A 
unexplained weight loss
vomiting
GIB
abdominal mass
dysphagia
anemia
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96
Q

Imp Hx for IBS:

A
  • family hx of GI Cancer/IBD/celiac
  • new symptoms in pt >45
  • nocturnal defecation
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97
Q

Investigations for IBS:

A
  • CBC, TSH, Stool C&S, lactulose hydrogen breath test, Giardia, albumin, fecal calprotectin, +/-O&P, +/- endoscopy/colonoscopy
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98
Q

IBS Management

A
  • reassurance
  • FODMAP diet
  • Probiotics
  • Peppermint oil/antispasmodic
  • TCA (diarrhea prominent)
  • SSRI (constipation prominent)
  • adequate oral hydration
  • bowel training
  • exercise
  • adequate oral fiber
  • avoid fatty diet/caffeine/etoh
  • CBT/hypnotherapy
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99
Q

S&S peptic ulcer disease

A
  • upper abdo pain, bloating, nausea, early satiety, fullness, dyspepsia, belching, heart burn
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100
Q

Red flags of PUD

A
  • vomiting
  • bleeding/anemia
  • unexplained weight loss
  • abdominal mass
  • dysphagia
  • fam hx of GI cancer
  • previous peptic ulcer
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101
Q

how to prevent peptic ulcer disease?

A

**H2 blockers & PPI

  • no smoking
  • no etoh
  • no NSAIDs/ASA
  • no bisphosphonates or CCB
  • no caffeine or fatty diet
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102
Q

What is treatment if H Pylori test positive?

A

Quadruple therapy:

  • PPI po BID
  • Tetracycline QID
  • Bismuth QID
  • Metronidazole 500mg po BID QID
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103
Q

When do we do a test of cure for PUD?

A

if complicated patient or still symptomatic, 30d after completion of 14d treatment - order repeat urea breath test

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104
Q

Risk factors for Sinusitis?

A
  • anatomy
  • asthma
  • smoking
  • allergic rhinitis
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105
Q

Red Flag Features of Sinusitis

A
  • persistent fever >39C
  • proptosis
  • periorbital edema
  • vision changes
  • cranial nerve palsies
  • severe headache
  • altered mental status
  • abnormal EOM
  • meningismus
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106
Q

Best treatment for GAS Pharyngitis?

A

Penicillin V 800mg po QID x 5 days (NOT 10)

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107
Q

S&S of Mono?

A 
lymphadenopathy
fever
fatigue
pharyngitis
myalgia
headache
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108
Q

What labs to order for Mono?

A

Lymphocyte count, AST/ALT, Monospot

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109
Q

Treatment for Mono?

A

NO ANTIBIOTICS

Hand washing & rest

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110
Q

How long to avoid contact sports after Mono?

A

At least 3 weeks

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111
Q

What can increase risk of neonatal sepsis?

A 
chorioamnionitis
fever
<37w GA
rupture >18 hours
GBS + mother
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112
Q

neonatal sepsis bugs & meningitis =

A

Listeria
E Coli
GBS

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113
Q

Management of Neonatal Sepsis?

A
  • CXR
  • Ampicillin/Gentamicin +/- Acyclovir
  • Consult NICU
  • Blood Cultures/Urine Cultures/CSF
  • Hgb, Lactate, WBC, CRP, Glucose
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114
Q

What is the cutoff for neonatal hypoglycemia?

A

<2.6

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115
Q

S&S of neonatal Hypoglycemia?

A
  • lethargy
  • jittery
  • hypotonic
  • sweating
  • weak cry
  • tachypnea
  • seizures
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116
Q

Investigations for Hyperbilirubinemia?

A 
Conjugated Bilirubin
Hgb
Group &amp; Screen
PBS
Coombs test
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117
Q

Risks of Hip Dysplasia?

A 
First born
feet first
female
fluid (oligo)
family hx
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118
Q

Differential for pediatric limp? (LIMPS)

A
  • leg calve perthes disease
  • infection/inflammation
  • malignancies (Ewings sarcoma/osteosarcoma)
  • pain from a # (abuse?)
  • slipped capital femoral epiphysis (SCFE)
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119
Q

Management of constipation in pediatrics?

A 
start osmotic laxative (PEG 3350/lactulose)
disimpaction
behavioral &amp; dietary modification 
parental education
refer to GI if necessary
120
Q

Reflux in infants?

A
  • modify frequency/thickness/timing of feeds
  • trial formula (hydrolyzed)
  • NO PPIs
121
Q

Reflux in Kids?

A
  • PPI (not for >8 weeks)

- risks = pneumonia & c. diff

122
Q

HEADSS assessment in adolescents?

A 
Home Environment (type of home, who do you live with, who makes the food?)
Education &amp; Employment
Activities
Drugs - access to prescriptions/alcohol?
Sexuality
Suicide/mood
123
Q

When are signs of puberty too early?

A
  • age 8 in girls (thelarche ‘breast buds’)
  • age 9 in boys (genital development)

REFER

124
Q

Travelers Diarrhea prevention & Tx:

A
  • loperamide
  • bismuth
  • oral rehydration
  • antibiotics (azithromycin)
  • boil/peel/cook foods
  • bottled water
  • avoid ice cubes/salads/uncooked vegetables
  • wash hands
125
Q

What is a medication for altitude sickness?

A

Acetazolamide 125mg BID

126
Q

What are the screening guidelines for AAA?

A

1 time Abdominal US for men ages 65-80

127
Q

What to test Immigrants for?

A

HIV/HCV/TB

128
Q

What is the TB test?

A

IGRA (tests for latent TB)

129
Q

What is the treatment for TB?

A 
RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
130
Q

What is the organism causing Scarlet Fever?

131
Q

What condition presents with red scaly ‘sandpaper’ rash and fever

A

Scarlet Fever

132
Q

Treatment for NMS:

A
  • stop neuroleptic agent
  • IV NS, ice packs, cooling blanket
  • DVT prophylaxis
  • DANTROLENE/BROMOCRIPTINE
133
Q

What are the S&S of NMS?

A
  • fever
  • autonomic instability (HR/BP/sweating)
  • Rigidity
  • mental status changes
134
Q

What does a “lipid panel” include?

A

HDL, LDL, triglycerides, non-HDL, total cholesterol

135
Q

Initial HTN workup

A

A1c, Urinalysis, urine albumin, Na, K, Cr, eGFR, ECG, Tchol, HDL, LDL, non-HDL, triglycerides

136
Q

Lifestyle interventions to reduce HTN:

A 
sodium <1800 mg/day
DASH diet
weight loss
exercise
CBT (relaxation)
alcohol <2.7 drinks/day
137
Q

Diagnose & Treat HTN Emergency

A

asymptomatic dBP >130, acute HF, aorta/kidney damage
pre-eclampsia or pheo

Tx with Nifedipine/Hydralazine/Labetalol
Clonidine/Captopril/Nitrates

138
Q

Alopecia Areata Tx?

A
  • steroids (topical/injection)
  • if >50% hair loss, 8 week oral steroid taper
  • Minoxidil
139
Q

Papulopustular Rosacea Tx?

A
  • Ivermectin
  • Doxycycline
  • Minocycline
140
Q

Risk factors for osteoporosis:

A
  • hx of fragility fractures
  • prolonged steroid use
  • age >65
  • rheumatoid arthritis
  • malabsorption (Eating disorder)
141
Q

Tests to order for Osteoporosis once diagnosed:

A 
Hemoglobin
TSH
Ionized Calcium
ALP
Creatinine
Vitamin D (after 3 months of treatment)
SPEP (if vertebral #)
142
Q

Osteoporosis Tx

A

calcium 1200mg qd
vitamin D 1000 IU qd
quit smoking
weight bearing exercise

143
Q

What are some side effects of Bisphosphonates?

A

esophageal ulcer
jaw osteonecrosis
atypical fractures

144
Q

What is the best test for DVT?

A

Low Pretest probability or Wells score <2 = D Dimer; otherwise, proximal leg compression US

145
Q

What increases risk of clot?

A

trauma, stasis, hypercoagulable state

146
Q

causes of hypercoagulable state?

A 
cancer
pregnancy
meds (hormonal)
IBD
CHF
Inherited
147
Q

Symptoms of CKD

A 
fatigue
pruritus
restless leg syndrome
anxiety/depression
pain
148
Q

What could a fever in peritoneal dialysis patients mean?

A

spontaneous bacterial peritonitis

149
Q

causes of pancreatitis?

A 
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Tumors
Scorpion stings
Micro (TB, mumps, rubella, varicella, hepatitis, CMV, HIV)
autoimmune (SLE, Crohns)
surgery/trauma
hyperlipidemia, hypercalcemia, hypothermia
emboli
drugs (furosemide, estrogen, H2 blockers, valproate, antibiotics, asa)
150
Q

What tests to order in the male for infertility?

A

sperm analysis

r/o STI

151
Q

What tests to order in the female for infertility?

A 
r/o STI
day 3 LH/FSH/Estradiol/TSH/Prolactin/Testosterone
day 21 Progesterone
Pap
Rubella &amp; Varicella immune levels
152
Q

absolute contraindications to systemic estrogen supplementation

A 
cancer
breast cancer
pregnancy
unexplained vaginal bleeding
stroke
migraine with aura
liver disease
hyperlipidemia
acute CVD
recent VTE
immobility
153
Q

risk factors for DVT/PE

A 
immobility
recent surgery/trauma/ICU
air travel >6 hours
1st degree relative with VTE
prior DVT/PE
malignancy
obesity
pregnancy
postpartum
estrogen
dehydration
age >60
154
Q

Wells score for DVT

A 
cancer
immobility >3d or surgery in past 4w
previous DVT
tender along deep vein system
unilateral entire leg swollen
calf swollen >3cm relative to other leg (10cm below tibial tuberosity)
other dx as likely as DVT?
superficial collateral veins on symptomatic leg?

<2 unlikely
>2 likely

155
Q

Wells score for PE

A 
S&amp;S of DVT?
HR >100
immobility >3d or surgery in past 4w
hemoptysis
malignancy
previous DVT/PE

<4.5 unlikely - do PERC to r/o
>4.5 likely

156
Q

PERC rule

A 
age <50
HR <100
no unilateral leg swelling
no hemoptysis
no recent surgery
no prior DVT/PE
no hormone supplementation
157
Q

Gold investigation for PE?

A

CT pulmonary angiography

158
Q

Gold investigation for DVT?

A

Leg Venous Compression Ultrasound

159
Q

Tx for cat bite?

A

Doxycycline
(treating for pasteurella - don’t close wound!)
give tetanus & rabies vaccines

160
Q

Suture removal timelines?

A

face - 5d
scalp/over joint - 10-14d
everywhere else - 7

161
Q

Tx for bronchiolitis?

A 
O2 if sats <90%
hydration
nasal suctioning
nebulized epinephrine
hypertonic saline nebulizer
162
Q

Tx for Croup?

A

Dexamethasone 0.6mg/kg po x 1 (max 10mg)
Blow by oxygen if sats <90%
Nebulized Epinephrine in moderate-severe

163
Q

Top 4 causes of Croup?

A

Parainfluenza, RSV, Adenovirus, Influenza

164
Q

Risk Factors for HCV

A 
IVDU
region where HCV endemic
blood transfusion/organ transplant before 1992
hx or current incarceration
tattoos/piercings
infant born to mom with HCV
chronic hemodialysis
needle stick injury
sexual contact
sharing sharp instruments
IN &amp; inhaled drug use
homelessness/group home/shelter
higher risk sexual activity
MSM
HIV infection
165
Q

What are 2 treatments for HCV?

A

Ribavirin

Harvoni

166
Q

What CD4 counts have increased risk of certain infections?

A
  • CD4 <0.2 - cough - Pneumocystis Jiroveci Pneumonia
    Tx Septra
  • CD4 <0.1 - encephalitis - Toxoplasma gondii encephalitis
    Tx Septra
  • CD4 <0.05 - disseminated mycobacterium avium complex - cough
    Tx Azithromycin
167
Q

What would you do if someone had an HIV exposure?

A

baseline HIV serology, CBC, Cr
assess source person if possible
start PEP in <72 hours for up to 28d
TENOFOVIR 300mg qdaily

168
Q

What is the trade name for PREP?

169
Q

What vaccines should you give for asplenia?

A

Pneumococcal
Hemofluenza Influenza Type B
Meningococcal
Influenza

170
Q

Management for Meningitis?

A 
3rd generation cephalosporin (ceftriaxone)
\+ 
Vancomycin (if >1 yo)
 \+/- Ampicillin (Listeria)
\+/- Acyclovir (Viruses)
171
Q

How long after having Mono should you avoid contact sports?

172
Q

Risk Factors for Otitis Media

A

maternal smoking
daycare
pacifier use
bottle feeding

173
Q

Definition of dementia

A

unable to function
decline from previous function
NOT delirium or psychiatric
>2 domains

174
Q

Mild cognitive impairment

A

NOT delirium or psych

>1 domain

175
Q

What are the 5 cognitive domains?

A 
personality
language
visuo-spatial
judgment/complex tasks
new information

need 2 affected = dementia
need 1 affected = mild cognitive impairment

176
Q

Labs for dementia?

A

TSH
Glucose
B12, Hgb, WBC
Na, K, Ca, Mg

177
Q

Dementia Tx:

A 
cholinesterase inhibitor - donepezil
vitamin E
exercise
cognitive stimulation
avoid antipsychotics
memantidine
178
Q

When to assess for competency?

A 
traumatic brain injury
psychiatric illnesses
neurodegenerative diseases
cognitive aging
delirium
179
Q

Tool for migraine diagnosis:

A 
POUND
pulsating
4-72 hours
unilateral
nausea
disabling
180
Q

Acute Tx of migraine:

A 
NSAIDs
Tylenol
steroid - dexamethasone
tricyclic antidepressants
triptans
antiemetics
sphenopalatine ganglion block
181
Q

Tx for recurrent migraine:

A

metoprolol
antidepressant
anticonvulsant
botox

182
Q

Lifestyle headache management:

A 
headache diary
less caffeine
more exercise
avoid irregular/inadequate sleep
relaxation/CBT
183
Q

Parkinsons symptoms

A 
"TRAP"
tremor (shaky)
rigidity (stiff)
akinesia (slow) 
postural instability (steps)
184
Q

1st line Tx for parkinson

185
Q

Who to refer pt to w/ Parkinsons?

A 
SLP
Dietician
PT
OT
Neurologist
Palliative
Movement Disorders clinic
186
Q

What are the 3 indications for ear ventilation tubes?

A
  • retracted TM
  • chronic OME > 3months with hearing loss
  • recurrent AOM 6/y or 4/6 months
187
Q

Rule of 9s for body surface area

A
  • head & neck = 9%
  • each arm & hand = 9%
  • chest = 9%
  • stomach = 9%
  • upper back = 9%
  • lower back = 9%
  • genital area = 1%
  • each leg & foot = 18%
188
Q

Frostbite Tx?

A
  • rapid wet rewarming
  • possible thrombolysis
  • tetanus
  • sterile wound care
  • consult surgery
189
Q

What is included in trauma imaging?

A 
Bedside POCUS Ultrasound
Chest XR
C-spine XR
Pelvis XR
Chest/Abdo/Pelvis CT
190
Q

GCS Calculation

A

E4
- 4 spontaneous, 3 sound, 2 pressure
V5
- 5 oriented, 4 confused, 3 words, 2 sounds
M6
- 6 obeys, 5 localizes, 4 normal flexion, 3 abnormal flexion, 2 abnormal extension

191
Q

MOVIES

A 
monitors
oxygen
vitals
IV
ECG
Sugar
192
Q

Unconscious pt? DONT

A

dextrose
oxygen
narcan
thiamine

193
Q

1st med given for seizure in kids?

194
Q

1st med given for seizure in pregnant female?

195
Q

1st med given for seizure in adults?

196
Q

What is the parkland formula for burn fluid resuscitation?

A

4ml x % BSA x weight (kg) = X
1/2 of X in first 8 hours
1/2 of X over next 16 hours

197
Q

STEMI PCI Goal time?

A

120 minutes

198
Q

What to send CSF fluid for?

A

Culture & Sensitivity, Gram stain
Cell Count & Differential
Glucose & Protein
Fungal or Viral

199
Q

how to calculate BMI

A

kg/m (squared)

200
Q

Normal BMI?

201
Q

Options for treating Chronic Pain

A
  • tricyclic antidepressants
  • cannabinoid
  • NSAIDs
  • CBT
  • Exercise
  • Physio
  • opioid
  • ibuprofen
  • SNRI (duloxetine)
  • acetaminophen
202
Q

What are 3 indications for cannibis treatment?

A
  • refractory neuropathic/palliative pain
  • chemotherapy induced N/V
  • spasticity
203
Q

What is the rule for cannibis and driving?

A

4-6-8
no driving <4h after inhalation
no driving <6h after ingestion
no driving <8h after euphoria

204
Q

What are the principles of chronic pain?

A
  • reassess regularly
  • relationship & shared decision making
  • reconsider diagnosis
  • refer when appropriate
205
Q

What high risk things on C spine rule indicate a C S XR?

A

age >65
dangerous mechanism
paresthesia

206
Q

What is excluded from the C spine rule?

A
  • acute paralysis
  • known vertebral disease
  • previous C Spine surgery
  • unstable vitals
  • age <16
  • non-trauma patients
  • GCS <15
207
Q

Differential for neck pain:

A 
carotid artery dissection
basilar artery dissection
mass/cancer
lymphoma
MI
polymyalgia rheumatica
ankylosing spondylitis
208
Q

What are the menopause ROS?

A

psychiatric
sex
vasomotor
urogenital

209
Q

What are the menopause 5?

A 
quit smoking
quit caffeine
quit etoh
start losing weight
start exercising
210
Q

4 classes of meds for vasomotor menopause symptom relief:

A

OCP
HRT
SSRI
TCA

211
Q

what to do for intolerable menopause symptoms?

A

HRT
transdermal is best!
within 10 years of LMP
safe for at least 5 years

212
Q

Treatment for Children UTI?

A

Cefixime 7-10 day

213
Q

What can you spray to stop epistaxis?

A

Oxymetazoline

214
Q

Allergy Alphabet

A 
A - adrenaline; 1:1000, 0.01 mg/kg IM
B - breathing O2 - 5L NP or 15L NRB
C - corticosteroid - 125mg methylprednisolone
D - Diphenhydramine - 50mg benadryl
E - epi again or IV instead of IM
F - fluids - 500cc NS
G - Glucagon if on BB
H - H2 blocker - Ranitidine 150 mg
I - inhaled salbutamol
215
Q

Signs of eating disorder:

A 
purging
excessive exercise
weight loss
palpitations
dental erosions
palpitations
216
Q

definition of anorexia

A

does not require amenorrhea

217
Q

bulimia

A

binge & purge once weekly

218
Q

BMI for eating disorders

A

> 17 - mild

<15 extreme

219
Q

Exam after rape

A

STI (HIV post-exposure proph - ribavirin/harvoni) (HBV immune globulin, HBV)
Pregnancy risk
medically pertinent history
does pt want exam?

220
Q

is sexual assault/rape reporting voluntary?

A

yes - unless <18

221
Q

is domestic violence reporting voluntary?

A

yes - unless children involved

222
Q

3Es for learning difficulties…

A

eyes - vision impairment
ears - hearing impairment
education - intellectual disability, seizure or sleep disorder, TBI

223
Q

ADHD med classes

A

SNRI - atomoxetine

stimulants - amphetamine, methylphenidate

224
Q

Management of AUB

A 
IUS
OCP
Progestin
NSAID
TXA
Ablation
Hysterectomy
Polypectomy
Myomectomy
225
Q

Protocol for Post Menopausal PV bleeding?

A
  • Pelvic exam
  • PAP
  • endometrial biopsy
  • pelvic ultrasound
226
Q

Differential for vaginitis in children?

A

foreign body
STI
irritant

227
Q

low risk PSA?

228
Q

high risk PSA?

229
Q

When can a PSA of 10 be urgent & high risk?

A

if the prostate gland is abnormal (hard or irregular)

230
Q

Risk factors for Prostate Ca?

A

smoking
obesity
age
family history

231
Q

What tests do we order for BPH?

A

urinalysis
midstream urine culture & sensitivity

& PSA if >10 years life expectancy and would change mgt

232
Q

How to reduce BPH symptoms?

A 
quit antihistamines &amp; decongestants
quit excess fluid
quit caffeine
quit alcohol
quit NSAIDs
quit saw palmetto
233
Q

How to treat BPH symptoms?

A

alpha blocker - tamsulosin
5 alpha-reductase inhibitor - finasteride
antimuscarinic - mirabegron
phosphodiesterase type 5 inhibitor - tadalafil

234
Q

Investigations for Infertility:

A

pap/pelvic/partner
Day 3 FSH/LH/Prolactin/Estradiol/TSH
Day 21 progesterone

DHEA, 17 OH Progesterone, total testosterone

structural/tubal - pelvic US & Hysterosalpingogram

partner semen analysis

r/o STI in both partners

235
Q

Tx for PID?

A

Ceftriaxone & Doxycycline

partner treatment
contact tracing
abstinence for 7 days

236
Q

Contraceptive options

A 
progesterone IUS (mirena)
copper IUD
Pill
Patch
Ring
Depo Provera
Condoms
Diaphragm
Withdrawal
Implant
237
Q

Contraindications for estrogen?

A 
smoking >35, >15 cig/day
migraine with aura
uncontrolled HTN
DVT
malignancy
stroke
CAD/CVD
liver disease
DM with end organ damage
238
Q

Age of consent?

A

16 if non-exploitive
18 if exploitive
12-13, up to 2 years older
14-15, up to 5 years older

239
Q

Priapism management

A 
doppler US
cavernosal blood gas
watch and wait
needle drainage
surgical shunt if >48 hours
240
Q

Labs for Erectile Dysfunction:

A

non-HDL, HDL, LDL, total cholesterol, glucose, testosterone, prolactin, TSH, LH, FSH

241
Q

HIV PREP

A

Truvada
get baseline labs and hepatitis vaccines
bhcg, STI screen, Hgb, WBC, Cr, Urinalysis
q3monthly followup with labs

242
Q

GDM Testing

A

initial 50g glucose test @ 24-28w
if abnormal then 75g OGTT

diagnose based on 1 abnormal value:
>5.3 fasting
>10.6 1 hr
>9.0 2 hr

243
Q

Gestation HTN

A

> 140/90 x 2

labetalol, nifedipine, hydralazine

244
Q

PROM

A

sterile spec exam
steroids
antibiotics <32 weeks

245
Q

Preterm Labour

A

fetal fibronectin +/- serial vag exam
betamethasone x 2
tocolytics
magnesium sulphate for neuroprotection if <32w GA

246
Q

What does GDM put you at increased risk of?

A

macrosomic infant
shoulder dystocia
cesarean section
preeclampsia

247
Q

When to screen for T2DM after delivery and GDM?

A

6 weeks to 6 months post delivery
q3years after
before next pregnancy

248
Q

Dystocia diagnosis:

A

<2cm in 4 hrs of 1st stage of labour

249
Q

definition active labour:

A

3-4cm in nullip

4-5cm in multip

250
Q

risk factors of PPH

A

prior hx of PPH
instrumentation
shoulder dystocia
rapid or prolonged delivery

251
Q

evidence supported analgesia in labour

A 
epidural
self-hypnosis
acupuncture
water immersion
morphine
fentanyl
nitrous oxide
pudendal nerve block
252
Q

PPH diagnosis?

A

tissue
thrombin
trauma
tone

253
Q

PPH management

A 
MOVIE
uterine massage
weigh blood
oxytocin
misoprostol
ergot
hemabate
254
Q

2 main causes of post partum infection?

A

endometritis

septic pelvic thrombophlebitis

255
Q

Diagnostic Criteria for GAD?

A

uncontrollable and excessive worry occurring more days than not for AT LEAST 6 MONTHS. Difficult to control anxiety, + 3 or > symptoms - SIGNIFICANT IMPAIRMENT

  • sleep disturbance
  • irritable
  • poor concentration
  • restless
  • fatigued easily
  • muscle tension
256
Q

Therapy for GAD?

A

CBT + meds

duloxetine, escitalopram, sertraline, paroxetine, venlafaxine

257
Q

Workup for pt presenting with ++anxiety?

A

WBC, Hgb, FBG, lipids, lytes, LFTs, Bili, Cr, TSH, B12
urinalysis
drug screen
ECG if >40

258
Q

What meds should be given in pregnancy for anxiety?

A

SSRI or SNRI

259
Q

what anxiety meds can you take while breastfeeding?

A

paroxetine & sertraline

260
Q

Diagnostic criteria for MDD

A

> 5 of the SIGECAPS nearly every day for >2 weeks

sleep too much or too little
low interest
depressed mood
guilt
low energy
lack of concentration
too low or too high appetite
psychomotor agitation or retardation
SI
261
Q

1st line antidepressant in children/adolescents?

A

fluoxetine (prozac)

262
Q

Serotonin Syndrome S&S

A 
nervousness
insomnia
rigidity/clonus
tremor
sweating
fever >38.5
rhabdomyolysis
hyperreflexia
263
Q

diagnostic criteria for anorexia

A
  • restriction of intake
  • intense fear of gaining weight
  • disturbance of body image

restricting (no binge/purge in >3 months)
binge/purge

264
Q

diagnostic criteria for bulimia

A
  • recurrent episodes of binge eating
  • recurrent inappropriate behaviour to prevent weight gain
  • both of the above at least once/week x 3 months
265
Q

Risk factors for Gout

A 
hyperuricemia
male
obesity
HTN
hyperlipidemia
diuretics
cyclosporine
low dose ASA
meat
seafood
alcohol
high sugar soft drinks
266
Q

Tx for Gout

A

NSAID
naproxen 500mg BID x 1-3d
Colchicine 0.6mg BID-TID x 1-3 days

267
Q

Tx if recurrent Gout

A

if >3 attacks/year that are unexplained and unavoidable:
Allopurinol 50-100mg qdaily
increase by 100mg in 2-4w

wait 2 weeks after resolution of an acute attack to initiate allopurinol

268
Q

workup for SLE

A

CBC, Cr, eGFR, LFTs, CK, CRP, ESR, Vit D, TSH
ANA, Anti-dsDNA, C3/C4, Anti-Ro, anti-smith
Anti-sm, direct coombs
urinalysis
ECG, CXR

269
Q

IPSS criteria

A 
incomplete emptying
frequency
intermittency
urgency
weak stream
straining
nocturia
QOL low due to urinary symptoms
270
Q

antibiotic for AECOPD simple/complicated

A

amoxicillin 500mg po TID x 5d

amoxicillin/clavulanate 500mg po TID OR is risk of pseudomonas ciprofloxacin

271
Q

Abx for OE 7 days)

A

no perforation - polysporin eye & ear drops 1-2 drops QID
perforation - ciprodex 4 drops BID

272
Q

Abx for OM 5 or 10 days)

A

Amoxicillin 500mg po TID or 80mg/kg div BID or TID
10d if <2yo
5d if >2yo

273
Q

Abx or Pertussis (5-7 days)

A

Azithromycin 500mg x 1d, then 250mg qdaily x 4d

274
Q

Abx for Pharyngitis (10 days)

A

Penicillin V 300mg po TID for 10 days

if less than 27kg = 40mg/kg div BID or TID

275
Q

Abx for Sinusitis (10-14d)

A

Amoxicillin 500mg TID or 80mg/kg div BID or TID

276
Q

Abx for pneumonia (14d)

A

Amoxicillin 1g po TID
OR, if complicated in LTC,
Amoxicillin 1g po TID x 14d + Azithromycin x 5d

277
Q

Influenza treatment?

A

Oseltamivir 75mg BID x 5d

278
Q

Influenza post exposure prophylaxis (within 48h)

A

Oseltamivir 75mg qdaily x 10d

279
Q

Impetigo Tx?

A

topical if mild - mupirocin 2% TID for 7d

systemic if severe - cephalexin 250-500mg QID x 10d

280
Q

Tx for Onychomycosis

A

12-16w for toes
6w for finger
Terbinafine 250mg qdaily

281
Q

VZV Shingles

A

initiate within 72h of rash

valacyclovir 1g po TID x 7d

282
Q

Abx in pyelonephritis?

A

Ciprofloxacin 500mg BID

283
Q

Abx in uncomplicated female UTI?

A

macrobid 100mg po BID x 5d

284
Q

Abx in uncomplicated childrens UTI?

A

Septra 5-10mg/kd/d

285
Q

Abx for asymptomatic bacteruria?

A

NONE UNLESS pregnant
then Amoxicillin 500mg po TID x 7d
- same for acute cystitis in pregnant women

286
Q

Abx for C & G/Cervicitis?

A

Ceftriaxone 250mg IM x 1 + Azithromycin 1g po x1

287
Q

Abx for Prostatitis?

A

Ciprofloxacin 500mg po BID x 4-6w

288
Q

Abx for Trich & BV?

A

Metronidazole 500mg po BID x 7d

289
Q

Tx for genital HSV?

A

acyclovir 400mg po TID x 10d

290
Q

Tx for genital warts?

A

imiquimod qhs
cryotherapy q1-2w
podophyllin resin

291
Q

Tx for PID?

A

Ceftriaxone 250mg IM x 1 +

Doxycycline 100mg po BID x 14d

292
Q

Tx for vulvovag candidiasis?

A

clotrimazole PV 500mg x 1
OR
Fluconazole 150mg po x1

293
Q

Tx for traveller’s diarrhea?

A

bismuth (pepto) 2tabs QID
loperamide 4mg x 1 then 2mg after each loose BM (max 8 doses/day)
Azithromycin 1000mg x 1 (if >3 BM day/blood or fever)

294
Q

Prevention of IE?

A

Amoxicillin 2g po x 1

295
Q

CT Head Rule

A
  • not on blood thinners
  • head injury is from trauma
  • GCS >13
  • age >16
  • no skull #

all Yes? —>

GCS >15 2 hours post injury
suspected skull #
signs of basilar skull #
vomiting >2 episodes
age >65
amnesia >30 minutes
dangerous mechanism

CCFP Exam (1 decks)

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