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CCFP - Missed Q's > CCFP Qs > Flashcards

CCFP Qs Flashcards

1
Q

Criteria for Delerium

A
  1. Acute change in mental status with fluctuating course
  2. Innattentive
  3. Disorganized Thinking
  4. Altered LOC
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2
Q

Causes of Delirium

A

Urinary retention
Dehydration
Constipation
Drug interactions
Infection
Electrolyte imbalances

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3
Q

DIMS-PLUS5

A

Drugs
Infection
Metabolic
Structura
Pain
Liquids and solids
Urine and bowels
Senses
Sleep
Setting
Stasis - restraints
Stress

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4
Q

AAA Screening

A

One time abdo US for men 65-80

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5
Q

TB treatment

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

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6
Q

Latent TB investigations

A

Tuberculin skin test
IGRA

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7
Q

Active TB investigations

A

Microbiology with acid fast bacilli
Nucleic acid amplification tests

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8
Q

Side effects of lithium

A

N/V
Diarrhea
Confusion
Hypothyroid signs
Weight gain
Myoclonic jerks
Ataxia
Calcium abnormalities due to effect on parathyroid gland

Therapeutic range 0.6-1.2

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9
Q

Side effects of digoxin

A
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10
Q

Side effects of warfarin

A
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11
Q

Side effects of carbamazepine

A
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12
Q

Side effects of Levothyroxin

A
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13
Q

Side effects of HIV ARVs

A
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14
Q

Side effects of steroids

A
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15
Q

Differential diagnosis of fever and possible seratonin syndrome

A

Neuroleptic malignant syndrome (happens over days rather than hours)
Malignant hyperthermia
EtOH withdrawal
Antidepressant discontinuation
Anticholinergic toxicity
Alcohol w/d
Benzo w/d
Drug OD
Thyroid storm
Infection - Meningitis, encephalitis
Space occupying lesion

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16
Q

Sx of serotonin syndrome

A

Autonomic dysfunction - mydriasis, diaphoresis, tachycardia, tachypnea
Neuromuscular - tremor, hyperreflexia
Altered mental statis - agitated, confused, excited, delerius

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17
Q

Limping child differential

A

L - Leg Calves Perthes
I - Infection (osteomyelitis)
M - Malignancy (Ewing sarcoma and osteosarcoma)
P - Pain from fracture
S - SCFE (overweight teens, boys, Black and Hispanic patients)
S - something else above or below

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18
Q

Causes of postural hypotension with compensatory tachycardia

A
  1. Deconditioning
  2. Dysfunctional heart - myocard or AS
  3. Dehydration - disease (diarrhea, adrenal insuff), dialysis, drugs (diuretics, digoxin, cholinesterase inhibitors)
  4. Drugs - anti-HTN, anit-anginal, anti-parkinsonian, anti-depressants, anti-BPH
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19
Q

Causes of postural hypotension WITHOUT compensatory tachycardia

A

Autonomic dysfunction:
- low B12
- DM autonomic neuropathy
- Parkinsons
- EtOH
- Amyloid

Beta blockers

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20
Q

Conditions associated w/ Aortic Dissection

A

HTN
GCA
Bicuspid aortic valve
Cocaine
Trauma
PCKD
SLE
Ehlers-Danlos

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21
Q

Indications for medical marijuana

A

IF 1st and 2nd lines failed:
1. End of life/palliative
2. Chemo induced nausea/vomiting
3. Refractory neuropathic pain
4. Spasticity in MS and spinal cord injuries
**Trial of nabilone first

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22
Q

Cholesterol lowering meds

A

Statin ->Ezetimibe ->PCSK9 inhibitors

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23
Q

Bisphosponate side effects

A

Osteonecrosis of the jaw
Subtrochanteric and diaphyseal femur fractures
Eg,. Alendronate

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24
Q

Osteoporosis Risk factors

A
  • prior fragility #
  • parentla hip #
  • glucocorticoid use
  • current smoking
  • RA
  • > 3 EtOH per day
  • Falls in last 12 months
  • Gait/balance
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25
Q

PE findings for osteoporosis

A
  • Loss of >10% of weight since age 25
  • loss of >2cm of height annually or >6cm total
  • less than or equal to 2 fingerbreadths rib to pelvis
  • occiput to wall distance for kyphosis of >5cm
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26
Q

Labs for Suspected Osteoporosis

A

Calcium
Albumin
CBC
Creatinine
ALP
TSH
SPEP
25-hydroxy vitamin D

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27
Q

Indications for BMD testing 50+

A
  1. All women and men 65 and older
  2. Menopausal women and men aged 50-64 with clinical risk for#:
    - fragility # after 40
    - prolonged steroid use 3+months in prior year at dose of more 7.5mg or more daily
    - high risk med use (aromatase inhibitors, androgen deprivation rxn)
    - current smoking
    - high etoh intake
    - RA
    - Low body weigth (<60kg)
    - T1DM
    - Osteogenesis imperfecta
    - Primary hyperpara
    - Cushings
    - Malabsorptive dz
    - COPD
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28
Q

Indications for BMD <50y

A
  • Fragility #
  • Prolonged steroid use (3+months in last year of 7.5mg + daily)
  • Malabsorption syndrome
  • High risk meds
  • Hypogonadism, prematrue menopause
  • primary hyperparathyroidism
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29
Q

Fracture risk assessment (10-year fracture risk)

A

Low = <10% - reassess in 5 years, no meds

Moderate = 10-20% - Lateral thoracolumbar x-ray or vertebral fracture analysis - treat if:
- T-score is less than or = to -2.5, - wrist fracture after age 65
- rapid bone loss
- pts on aromatase inh or androgen deprivation rxn
- 2+ falls in last year

High = >20% OR prev fragility # of hip or spine OR >1 frag fracture - pharmacotherapy

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30
Q

Basic bone health

A

Regular WB exercise
Calcium 1200mg daily (diet and supp)
Vit D 800-2000IU daily after age 50 and 400-1000IU less than age 50

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31
Q

Labs for monitoring 2nd gen anti-psychotic meds

A
  1. Total cholesterol, fasting LDL, fasting HDL, fasting TG
  2. FPG
  3. ALT
  4. AST
  5. Prolactin
  6. Amylase
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32
Q

Physical findings of thyroid CA

A
  1. Dyphonia
  2. Dysphagia
  3. Dyspnea
  4. Fixed nodule
  5. Regional lymphadenopathy
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33
Q

4 steps to trauma informed care

A
  1. Bear witness to the patient’s trauma experience
  2. Create a physically and emotionally safe space
  3. Include patients in healing process
  4. Believe in patient strength and resilience
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34
Q

Treatment for Restless Leg Syndrom

A

Iron replacement

Dopamine agonists (Pramipexole)

Gabapentin/Pregabalin

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35
Q

Risk factors for RLS

A
  • iron deficiency
  • fam hx
  • renal failure causing uremia
  • neuropathy
  • pregnancy- MS
  • parkinsons
  • Meds (anti-emetics, anti-histamines, anti-convulsants, anti-depressants)
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36
Q

Eligibility criteria for MAID

A
  1. 18+
  2. Capable of making decision and consenting
  3. Grievous and irremediable medical condition in an advanced stage or leading to intolerable suffering.
  4. Advanced state or irreversibl decline making death reasonably foreseeable
  5. No external pressure/request was voluntary
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37
Q

Low FODMAP diet

A
  • Onion, garlic, wheat, rye, legumes
  • Milk, yogurt, soft cheest
  • Mangos, honey
  • low cal sweetener
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38
Q

ER+ breast CA meds

A

Selective estrogen receptor modulators (SERM)- eg. Tamoxifen

Aromatase inhibitors - eg. Anasterole (switch to this when hit menopause)

GNRH agonis - eg Gosrelin

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39
Q

Leprosy is endemic to:

A

Endemic to: - India
- Indoneisa
- Brazil
- Democratic Republic of Congo

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40
Q

RF for leprosy

A

Low SES
Genetics
Exposure to affected household contacts (droplet contact spread and nasal mucosa spread)

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41
Q

Myalgic Encephalitis Chronic Fatigue Syndrome (ME/CFS)

A
  1. 6 month hx of the following:
    - Fatigue
    - Post-exertional malaise or fatigue
    - Sleep dysfunction and pain
  2. Two or more of neuro/cog manifestations:
    - Confusion
    - Impaired concentration
    - Information processing or word finding issues
    - Disorientation
    - Perceptual and sensory disturbance
  3. At least one symptom from either autonomic, immune or neuroendocrine cateogries
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42
Q

Myalgic Encephalitis Chronic fatigue syndrome treatment

A

Manage chronic diseases
Antidepressants
CBT
Exercise
Improve sleep hygiene

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43
Q

Fibromyalgia Diagnostic Criteria

A

Diffuse body pain present for at least 3 months who may also have symptoms of:
- fatigue
- sleep disturbance
- cognitive changes
- mood disorder
- other somatic sx

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44
Q

Fibromyalgia Treatment

A
  • physical activity
  • PT
  • Sleep habit improvement
  • Diet (low-inflammatory diet)
  • CBT
  • Trigger point injections
  • TCAs (amitryptiline, nortriptyline, cyclobenzabrine)
  • Anticonvulsants (pregabalin, gabapentin, topiramate)
  • SNRIs (venlafaxine, duloxetine)
  • Cannabanoids (Nabilone)
  • Low dose naltrexone

**No NSAIDs or Opioids unless acute injury

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45
Q

What is the name of the condition that makes you pee when you laugh?

A

Giggle micturition

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46
Q

Whooping cough facts

A
  • Caused by bordetella pertussis
  • Communicable for 3w after cough onset
  • W/Azithro communicable for 5 days
  • vaccinate pregnant patients >26w and accelerate infant vacc to 42 days if outbreatk
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47
Q

IBS Rome Criteria

A

Recurrent abdo pain at least 1d/wk x 3 months with 2 of the following:
- related to defacation
- associated with change in stool frequency
- associated with change in stool form

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48
Q

IBS Treatment

A

Bloating - peppermint oil or antispasmotic (buscopan)
Diarrhea predom - soluble fibre, low FODMAP, probiotics, CBT, TCAs (amitryptiline)
Constipation predom - soluble fiber, increased fluid, increased exercise, linaclotide first line, ssri second line

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49
Q

Meningitis pathogens and rxn
0 - 1 mo
1 - 23 mo
2 - 50 y
> 50y

A

0-1m: Listeria, E.Coli, GBS | Ampicillin + Cefotaxime
1-23m: S.pneumo, H.flu, N.meningidities | CTX or Cefotaxim + Vancomycin
2-50y: S. pneumo, N. menigitides | CTX or Cefotaxime + Vanco
>50: S.pneumo, N. menigidities, aerobic gram neg bacilli | CTX or Cefotaxime + vanco + ampicillin

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50
Q

LP findings in viral vs. bacterial meningitis

A

Viral: WBC 10-500, lymphocytes, moderately increased protein

Bacterial: WBC 500-10,000, decreased glucose ration <0.4, increased protein, 80-95% neutrophils

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51
Q

GAD diagnosis

A

> 6 months of uncontrollable worry more of the days than not plus at least 3 of the following:
S - sleep disturbance
I - Irritable
C - Concentration issues
K - Keyed up/on edge
F - fatigue
M - muscle tension

Use GAD 7
Q’s have you felt worried or anxious most of the time in the last 4 weeks?
Trouble sleeping, concentrating or irritable/tense?

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52
Q

Panic Disorder DSM 5

A

Recurrent unexpected panic attacks without situational trigger and concern about them or maladaptation x >1 month

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53
Q

PTSD DSM-5

A
  1. Exposure to actual threatened death, serious injury or sexual violence
  2. Presence of intrusive sx assoc w/event; avoidance; alterations in cognition/mood; alteration in response to events

> 1 month

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54
Q

OCD DSM-5

A
  1. Obsessions that are recurrent, persistent, intrusive thoughts causing anxiety/distress. Person tries to avoid or ignore them.
  2. Compulsions - repetitive behaviors in an attempt to avoid the distress caused by the obsessions

Must be present for at least 1h/day or cause significant distress/impairement

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55
Q

Agoraphobia

A
  1. Fear of a situation and the avoidance or the situation due to fear
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56
Q

Social anxiety Disorder

A
  1. Fear of social situations
  2. Fear that one will say or do something that invokes a negative response from others
  3. Social situations almost always provoke anxiety or fear
  4. Avoidance of the situations

> 6 months

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57
Q

GAD-7 scores and components

A

Mild 5-9
Mod 10-15
Severe >15

In last 2 wks (None, several days, >half, almost every day)
1. Feeling nervous/anxious/on edge
2. Uncontrollable worry
3. Worrying too much about different things
4. Trouble relaxing
5. Restless/can’t sit still
6. Easily irritable/annoyed
7. Afraid something awful. might happen

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58
Q

Secondary causes of HTN

A

A - atherosclerosis
B - Blocked kidneys
C- Catecholamines
D- Drugs, diet, supplemental, licorice, NSAIDs, OCP
E - endocrine (aldosterone, thyroid, ETOH)
S - sleep apnea, stress, salt

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59
Q

Lifestyle interventions for HTN

A

Decrease sodium
Decrease weight
DASH diet
Alcohol
Exercise
CBT/relasation

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60
Q

HTN targets

A

Low risk (and no EOD) - <140/90; treat if >160/100
High risk - <120; treat if >130
DM - <130/80; treat if >130/80
All others - <140/90; treat if >140/90

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61
Q

When to avoid ACEi

A

If black or pregnant patients

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62
Q

HCTZ possible risk

A

Possible increased risk in skin cancer 4x after 3yrs. Dose dependent. Consider switch if light skin, personal/fam hx or immunosuppression

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63
Q

HTN Urgency

A

Not necessary to treat rapidly
- Start treatment in office not in ED

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64
Q

HTN Emergency

A

Diagnose if:
- Asymptomatic but DBP 130+
- EOD - Acute heart, brain, aorta, renal
- Pre-eclampsia
- Pheo

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65
Q

Safe HTN drugs in pregnancy and breastfeeding

A

BF: Labetolol, methyldopa, nifedipine

AVOID ACEi & ARB

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66
Q

HTN in children

A
  • Measure over the age of 3
  • Check in R arm (coarctation of the aorta will falsely lower the BP in the left arm)
  • Workup = echo and CVD risk assessment
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67
Q

Non-sepsis causes of fever

A
  • Pregnancy
  • Meningitis
  • PE
  • Cancer
  • Febrile neutropenia
  • SJS
  • Endocarditis
  • GC arteritis
  • ?Serotonin syndrome
  • NMS
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68
Q

Fever of unknown origin w/normal initial labs. Next steps:

A
  • CT
  • LP
  • Tissue biopsies (bone marrow, liver, temporal artery)
  • SPEP
  • Echo
  • Dental assessment
  • ANA
  • HIV
  • TB
  • Viral cultures
  • Mono
  • UTox

*If still unclear do serial exams (ECG, CXR)

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69
Q

What exam not to do with febrile neutropenia

A

Avoid rectal temp or DRE

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70
Q

Fever in the returning traveler

A

Malaria until proven otherwise

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71
Q

Hyperlipidemia screening guidelines

A

Men and women 40+
- Consider if South Asian or First Nations
- CV dz or fam hx
- Smoker
- Exam findings like obesity and xanthelasma

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72
Q

Validated Risk score

A
  • FRS (Calculate every 5 years. Overestimates risk. Includes sex, age, total cholest, HDL, nonsmoker, systolic BP, on BP treatment)
  • CLEM
    **Not validated for South Asian, First Nations, new immigrants.
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73
Q

What to screen for in HTN-sive pregnant patients?

A

Hyperlipidemia

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74
Q

Hyperlipidemia tests other than usual lipid panel?

A

Apo-B
Lipoprotein A (Order once in a lifetime)
CRP

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75
Q

New non-statin agents

A

PCSK9i (often used in familial hypertrigliceridemia)
Ezetimibe

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76
Q

Coronary Artery Calcium Score

A

Score 0 = almost 0% chance of MI or stroke in next 2-5 years. Use if:
- asymptomatic
- over 40, intermediate risk
- fam hx
- premature cardiac event.

Do not order if on a statin, high risk or asymptomatic/lowrisk

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77
Q

When would you order fasting lipids

A

If Triglycerides are over 4.5

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78
Q

OMEGA-3

A
  • Reduces TG levels by up to 20% but do not improve CV outcome
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79
Q

TiTrATE

A
  1. Timing
    - seconds (BPPV or orthostatic)
    - minutes (Menieres)
    - days (Migraine, neuritis, stroke)
  2. Triggers
    - toxins (meds)
    - trauma (barotrauma)
    - turning (BPPV)
    - sTanding (orthostatic)
  3. A Thorough Exam
    - Associated Sx:
    Aura (Migraine)
    Blisters (Ramsay Hunt), blood (trauma), back of neck pain (Vertebral artery dissection)
    Chest pain (Aortic dissection)
    Deafness (Menieres)
  • PE
    Orthostatic BP
    Gait exam
    HINTS+ (the plus is for hearing loss)
    Dix hallpike
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80
Q

Criteria for dx of CKD

A

eGFR <60 and/or ACR >3

Refer to nephro if:
- eGFR <30
- ACR >60
or if:
- eGFR <45 and rapid decline of >5 in 6 months
- BP not at target
- lytes abN
- RBC casts or hematuria
- 5 year KFRE >5%

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81
Q

Monitoringin CKD

A

eGFR, ACR, electrolytes, urinalysis q6mo

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82
Q

CKD Mgmt

A
  1. Reduce CV risk:
    - Lifestyle mods
    - Smoking cessation
    - Statins
  2. Prevent further injury
    - Avoid nephrotoxins
    - Adjust med doses if sick
  3. Slow progression
    - Reduce BP (Goal in CKD is systolic <120)
    - ACEi, ARB (recheck K and creat in 2w)
    - Control DM
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83
Q

Renal adjustment drugs

A

S - Sulfonylureas and secretagogues
A - ACEi
D - Diuretics
M - Metformin
A - ARBs
N - NSAIDS
S - SGLT2

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84
Q

AKI causes

A

Pre-renal: Dehydration, hypovolemia
Renal: ATN, Glomerular, AIN, IgA Nephropathy etc.
Post-renal: Prostate, stone etc.

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85
Q

Fever in a peritoneal dialysis patient

A

Spontaneous Bacterial Peritonitis until proven otherwise

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86
Q

C/I to Triptans

A

CVD (CVA/TIA/MI/PVD/coronary spasm/angina)
WPW
Pregnancy
Basilar migraine
Ergot in last 24h

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87
Q

Non-pharma migraine treatment

A
  1. Avoid triggers
  2. Headache diary
  3. Regular sleep
  4. Regular diet
  5. Stress reduction
  6. Avoid caffeine
  7. Avoid analgesia overuse
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88
Q

When to use prophylaxis for migraines

A
  • > 3 migraines per month
  • rebound migraines
  • C/I to acute migraine meds
  • Increased frequency
  • migraines for 15d/month x 3 months
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89
Q

Migraine prophylaxis medication classes

A

Betablockers
TCAs
Anticonvulsants
SNRI (Venlafaxine)
Vitamins/supplements (Mg, coenzyme Q, riboflavin)
Flunarizine
Botos
ARB
ACEi

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90
Q

Suspected hyperlipidemia

A

Total cholesterol
LDL-C
TG
HDL-C
A1c or FPG
eGFR
Lipoprotein A - once in lifetime
ApoB
Urine ACR

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91
Q

6 risk factors for dyslipidemia screening earlier than age 40

A
  1. Clinical evidence of atherosclerosis
  2. AAA
  3. Diabetes
  4. Smoking
  5. HTN
  6. Fhx of early CVD <60
  7. Fhx DLD
  8. CKD
  9. Obesity with BMI >30
  10. COPD
  11. Early menopause
  12. Physical signs
  13. HIV
  14. Hypertensive disorder in pregnancy
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92
Q

Components of FRS

A

Age
Sex
Total cholest
HDL-C
SBP
Treated BP
Smoking
DM

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93
Q

Evidence based lifestyle interventions for CV risk reduction:

A

Smoking cessation
Mediterranean/DASH diet
150 mins mod-vig activity per week
Decrease EtOH consumption
Moderate sleep

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94
Q

Cholesterol lowering meds

A

Statins
PCSK9 inhibitors
Bile acid sequestrants
Nicotinic acid
Fibrates
Cholesterol absorption inhibitors

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95
Q

Conditions to rule out when a diagnosis of dyslipidemia is suspected

A

Hypothyroidism
Nephrotic syndrome
Cholestatic liver disease
CKD
Anabolic steroid use

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96
Q

3 Statin indicated conditions regardless of lipid status for primary prevention

A

Clinical atheroschlerosis
AAA
DM age >40 OR 15 year duration >30 OR DM1 with microvascular disease
CKD >age50 with GFR <60 or ACR>3

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97
Q

Lithium monitoring

A

12 hour troughs 5 days after dose increase
Creat, Calcium, TSH q3-6mo

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98
Q

Divalproex

A

12h troughs + CBC + LFTs q3-6mo

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99
Q

Atypical antipsychotis

A

BP, FPG, A1c, lipids q12mo

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100
Q

Kawasaki

A

C - conjunctivitis
R - rash
A - adenoopathy
S - strawberry tongue
H - hands and feet swollen/peeling

Rxn ASA, IVIG

Complications: Coronary artery aneurysm

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101
Q

Anti-malarial drug

A

Malarone or Doxycycline (cheaper or if allergy)

*Cholorquine has widespread resistence

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102
Q

Treatment of malaria

A

Atemisinin or quinine combinations

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103
Q

Travel tips

A
  • Insurance
  • Do not check meds in luggage
  • Pack oral rehydration, loperamide, pepto bismol QID for prevention, azithromycin to take with you (severe or bloody)
  • Avoid travel if pregnant
  • Boil, peel or cook food
  • Wash hands often
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104
Q

Altitude sickness

A

> 2800 prescribe acetazolamide or dexamethasone as first line. Can also use nifedipine or sildenafil as second line

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105
Q

qSOFA

A

RR 22+
Altered mentation
SBP <100

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106
Q

Statin myalgia options

A

Lower dose
Drink more fluids
Alternate day dosing
Stop interacting meds

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107
Q

Warfarin reversal agent

A

Vitamin K

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108
Q

Heparin reversal agents

A

Protamine or fresh frozen plasma

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109
Q

Dabigatran reversal agent

A

Praxbind

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110
Q

Dopamine blocker drug names

A

Anti-psych
Risperidone
Haloperidol
Cloxapine
Loxapine
Quetiapine
Olanzapine

Motility agents
Metaclopromide
Domperidone

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111
Q

Treatment of PIKA

A

Olanzapine
Methylphenidate
Treat the complications - ie Bezoar, consider x-ray

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112
Q

Indications for Shingles vaccine

A

Age >50
DM
CHF
Immunosuppression
Renal disease

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113
Q

Alopecia areata treatement

A

<50% hair loss: topical or injection steroids and minoxidil

> 50% hair loss: oral steroids for 8 weeks plus minoxidil and referral

Derm may prescribe immunotherapy or JAK inhibitors
Remember to offer hair pieces, wigs.

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114
Q

Rosasea treatment

A

If papules and pustules:
Topicals
- Azelaic acid
- Ivermectin
- Minocycline
- Metronidazole

If persistent erythema:
- Brimonidine gel
- oxymoetazoline

If persistent erythmea and telangectasia:
- lasers

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115
Q

Osteoporosis risk factors

A
  • Post menopausal
  • Prolonged steroid use
  • Family history of osteoporosis
  • Eating disorder or malabsorption
  • Previous fragility fracture
  • Smoking
  • Sedentary
  • Personal history
  • Alcohol
  • hypogonadism
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116
Q

FRAX score

A

Age >65
Sex
Previous fracture
Previous hip fracture
Current smoking
Glucocoritcoids
RA
Secondary osteoporosis
EtOH >3u/day
Femeral neck BMD

Treat if >20% risk

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117
Q

Height loss in osteoporosis

A

Loss of height 2cm prospective or 6cm historical

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118
Q

Labs to order if osteoporosis diagnosis

A

Hgb
TSH
Ionized Calcium
ALP
Creatinine
Vit D
SPEP if vertebral fracture

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119
Q

Meds for osteoporosis

A
  1. Bisphosphonates
    eg Alendronate
    SE: ulcer
    jaw osteonecrosis
    atypical fractures
  2. Selective Estrogen Receptor Modulators
    eg Raloxifene
    SE: VTE/PE
  3. HRT
  4. Parathyroid homrone analogues
  5. High risk think about monoclonal antibodies
    - eg Denosumab (C/I in pregnancy)
    SE: jaw osteonecrosis, joint pain
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120
Q

Osteoporosis Drug holiday timeline

A

5 years after drug use.
Stop for 5 years.
Only stop if low risk of fracture

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121
Q

Disability Tax Benefit Criteria

A

One of the following
1. Blindness
2. 1+ ADLs severely impaired
3. 2+ ADLs significantly impaired
4. Needs life sustaining therapy

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122
Q

CPP Disability

A

Mental OR physical AND prolonged AND preventing any work.

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123
Q

Registered disability savings

A

Only if eligible for disability tax credit
Max age 59
Not taxed on withdrawal

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124
Q

Things to watch for in patients on HIV meds

A

Dyslipidemia
Triglyceridemia
BMD loss
Renal impairment

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125
Q

What to screen for in HIV patients?

A

CKD
CVD
ANNUAL PAP
DM
Osteoporosis

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126
Q

ARV drugs for HIV prevention

A

PREP: Truvada
Zidovudine: Peripartum and neonates

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127
Q

Opioid dosing for non-cancer pain

A

Starting max 50mg morphine equivalents, titrate up to 90mg maximum.

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128
Q

Prior to opioids try:

A

NSAIDS
TCA
Nabilone
CBT
Exercise
Physio
Self management

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129
Q

Withdrawal Management

A
  • Pain - treat type (neuropath vs other)
  • Withdrawal syndrome - Clonidine if BP >90/50 and pulse >50
  • Diarrhea - Stop stool softeners, start loperamide
  • Cramping - Abdo use Buscopan; if muscle use Quinine
  • Sweating - oxybutinin if hydrated
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130
Q

Indications for Cannabis

A

Refractor neuropathic palliative pain, spasticity, chemo induced N/V

**Do not drive prior to 6 hours after inhalation and 8 hours after oral ingestion

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131
Q

ADLs acronym

A

D - dressing
E - eating
A- ambulating
T - toilet
H - hygiene

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132
Q

IADLs acronym

A

S - Shopping
H- Housework
A - Accounting
F - Foods and meds
T - Telephone and transportations

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133
Q

Ways to improve function in elderly

A

Hearing aid
Dentures
Glasses
Walker/Wheel chair
Refer to OT, SW, Geriatrics

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134
Q

Post-phlebetic syndrome

A
  • US to ensure no clot
  • Compression stockings
  • Exercise and elevation
  • Topical meds if skin changes
  • Vein ablation/excision if vascular changes
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135
Q

DVT risk trial

A
  1. Stasis
  2. Trauma - central line, pacemaker, surgery
  3. Hypercoagulable - cancer, pregnancy, meds (OCP, HRT), IBD, CHR, nephrotic, interited
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136
Q

Bell’s Palsy Treatment

A

“Stroke spares forehead”
1. Lubricant eye drops
2. Steroids
3. Antivirals if severe.

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137
Q

Ramsay Hunt Triad

A

Herpes Zoster Reactiviation
1. Ipsilateral facial paralysis
2. Ear pain
3. Vesicles in auditory ear canal

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138
Q

Stroke scale

A

Age >60
BP >140/90
Clinical features
Duration of TIA
Diabetes

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139
Q

Acute Stroke

A
  1. ABC MOVIES
  2. Stroke scale
  3. Labs: Hgb, Creat, Na, K, aPTT, INR, trop, glucose
  4. 2 x head CTs (first non con then contrast).
    *If 4.5-6h after sx, add CT angiogram from vertex to arch OR CT perfusion
    ** If 6-24h after sx add CT angiogram AND CT perfusion

5..Treat fever

  1. Treat BP if >220 systolic or >120 diastolic
  2. Thrombolytics (stroke dx + deficit + treatment within 3-4.5h + >18years old) OR endovascular thrombectomy (acute ischemic stroke with anterior circulation and large vessel - benefit within 6-24h)
  3. REMEMBER:
    - Holter monitor, Carotid dopplers, manage afib, echo, optimize DM, cardiac dz RFs
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140
Q

Recurrent migraines prophylaxis

A
  • Beta blockers
  • Antidepressants (Venlafaxine, Amitriptyline)
  • Anticonvulsants (Valproate, topiramate)
  • Calcitonin gene-related peptide agonists (Erenumab)
  • Botox
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141
Q

Acute migraine treatment

A
  1. NSAIDs
  2. Acetaminophen
  3. Triptans
  4. Antiemetics
  5. Dopamine receptor antagonists (ie metaclopromide)
  6. Steroids (dexamethasone)
  7. Spenopalatine ganglion block
  8. Calcitonin gene-related peptide receptor antagonist
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142
Q

Migraine tool componenets

A

P - pulsating
O - hOurs 4-72
U - Unilateral
N - nausea
D - Disabling
If 4/5 = 92% chance of migraine

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143
Q

Other things to treat in Parkinsons

A
  1. Constipation
  2. Drooling
  3. Hypotension (Midodrine, Fluticasone)
  4. ED
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144
Q

First line for Parkinsons

A

Trial of carbidopa/levodopa

Other treatments:
- Dopamine agonists (Pramiprexole)
- Ritigotine patch

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145
Q

Pt with tremor that improves with EtOH

A

Essential tremor

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146
Q

Pt with tremor on long term psych meds

A

Extra-pyramidal side effects

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147
Q

Pt w/resting tremor

A

PArkinsons

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148
Q

Pt w/falls and slow vertical gaze

A

Progressive nuclear palsy

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149
Q

When to assess competency

A
  1. Any acute change in mental status
  2. TBI
  3. Psych illness
  4. Neurodegenerative disease
  5. Cognitive aging
  6. Delerium
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150
Q

How to assess compentency

A

Ask patient to:
1. Explain WHAT their treatment options are
2. Explain WHY they have chosen one
3. Describe WHAT ELSE they could choose from

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151
Q

3 anticholinesterase inhibitors

A

Rivastigmine
Donepazil
Galantamine

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152
Q

Dementia diagnosis

A

Not able to function +
decline from previous function + not delirium or psych + 2+ domains

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153
Q

Mild cognitive impairement

A

Not delerium or psych + 1+ domains

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154
Q

Domains to assess for in cognitive decline/dementia

A
  1. WHO you are (Personality)
  2. WHAT you say (Language)
  3. WHERE you go (Visuo-spatial)
  4. WHY you do things (Judgement/complex tasks)
  5. WHEN you remember (New info)
155
Q

Tetanus immunoglobulin if…

A

Unknown vaccine status or really dirty wound
*Otherwise booster q10 years

156
Q

Hip fracture analgesia

A

US guided femoral nerve block

157
Q

SALTER HARRIS

A

S- Slipped (type I)
A- Above (type II)
L- Lower (type III_
T- Through or transverse (Type IV)
R- Rammed (Type V)

158
Q

On children for peds x-rays you can order a:

A

Comparison film

159
Q

Fractures of abuse

A
  • Fracture but non-ambulatory
  • Femur # <18 months
  • Humerus # <18 months
  • Multiple, many healing stages
  • Skull
  • Metaphyseal #
  • Rib #
160
Q

Big 6 in palliative care

A
  1. Hypercalcemia - hydrate, bisphosphonate, calcitonin/steroids
  2. Massive bleeds - bleeding kit: dark towesl, midazolam
  3. Seizure - benzos or phenobarbital
  4. SVC obstruction - Dex, opioid, benzo
  5. Cord compression - Dex, radiation/surgery
  6. Opioid toxicity - hydrate, rotate, treat symptoms
161
Q

CHADS65 - To decide if they need to be anticoagulated

A

CHF
HTN
Age>65
DM
Stroke (2pts)
If CAD give ASA, in no CAD no ASA

162
Q

HASBLED

A

HTN >160
Abnormal renal/liver function
Stroke/VTE
Bleeding
Labile INR
Elderly >65
Drugs or alcohol

163
Q

Adenosine dose in SVT

A

6mg IV then repeat 12mg IV

164
Q

Otitis media RF

A

Maternal smoking
Daycare
Pacifier use
Bottle feeding

165
Q

Otitis media criteria

A

Effusion +/- air-fluid levels
Inflammation
Acute symptoms

166
Q

Usual pathogens for otitis media

A

S. penumo
H. influenza
M. Catarrhalis
GAS
Staph aureus

167
Q

Treatment for otitis media

A

Amoxicillin High dose if BID or Low dose if TID

  • If penicillin allergy (non anaphylaxis) - Cefuroxime or ceftriaxone
  • If penicillin allergy (anaphylaxis) - Clarithromycin(Macrolide)

*If treatment failure Clavulin of Ceftriaxone

168
Q

Head imaging for children

A

PECARN

CATCH2 (CT head if any of these)
GCS<15 2h post injury
suspected open/depressed skull fracture
Worsening headache
Irritability
Signs of basal skull fracture
Large boggy scalp hematoma
Dangerous mechanism
4+ episodes of vomiting

CHALICE

169
Q

Modified Brooke formula

A

For burns instead of the parkland formula if >10% BSA
2ml x BSA x weight
Give half in first 8h then other half in next 16h

170
Q

When to refer burn patients

A

Face, hands, foot, genital, peritoneum, joint

171
Q

Frostbite

A
  • Rapid rewarming in water bath
  • Possible thrombolysis + heparin + iloprost (prostaglandin)
  • Sterile wound care
  • Consult surgery
  • Tetanus
172
Q

Trauma in pregnancy

A

Chest tube 1-2 spaces higher
NG tube
L lateral position
No vaginal exam until previa ruled out
Anti-d immune globulin in Rh-negative
Tetanus vaccine is safe
Document domestic violence

173
Q

Simple febrile seizure criteria

A
  1. Temp >39
  2. Generalized tonic clonic
  3. 6months to 5y
  4. No history of afebrile seizures
174
Q

Indications for Rhogam

A
  • Routinely at 28 weeks gestational age
  • Within 72 hours of birth of a RH + infant
  • Miscarriage
  • Antepartum hemorrhage or vaginal bleeding NYD
  • Ectopic pregnancy
  • Invasive procedures during pregnancy
  • Positive Kleinhauer-Betke test
175
Q

What do we worry about with patients with pink eye who are contact lens wearers?

A

Pseudomonas
Acanthomeba

176
Q

What does a perilimbal haze indicate?

A

Iritis or keratitis (need to do fluorescene for keratits to see punctate epithelial erosions)

177
Q

Halos around lights and severe unilateral headaches

A

Acute angle closure glaucoma
- IV mannitol, oral meds, 3 kinds of eye drops
- Check intraocular pressure

178
Q

Eye pain when blinking and looking in light

A

Iritis
Keratitis
Scleritis
Glaucoma

179
Q

A patient with pinkeye and diarrhea

A

Inflammatory bowel disease until proven otherwise

180
Q

3 pink eye red flags

A
  1. Pain
  2. Decreased acuity
  3. Anisicoria
181
Q

Preterm labor treatments/invest

A

Fetal fibronectin
Steroids
Tocolysis
Magnesium

Premature rupture - steroids and antibioitcs

182
Q

TOLAC

A

Increased risk of rupture if <18 months
Okay if no C/I:
- Vertical C-section
- Previous hysterotomy or myomectomy entering uterine cavity
- Previous uterine rupture
- Any C/I to labour (ie placenta previa or malpresentation)
- Woman declines TOLAC

183
Q

Labor dystocia definition

A

Less than 2cm in 4 hours

184
Q

Active labour

A

4+cm dilation

185
Q

Postpartum B’s

A

Bowels
Bladder
Breastfeeding
Bleeding (lochia)
Baby
Blues
Belly
Birth control
Boinking

186
Q

Abortion medication

A

Mifepristone/Misoprostil
- Confirm gestational age
- Exclude ectopic
- Assess for contraindications (uncontrolled asthma, chronic adrenal failure, chronic corticosteroid use, heme disorders, remove IUD)
- Advise of risks and expected course
- Plan follow up

187
Q

Acute MI Mgmt

A

ABCs - hemodynamic instability
MOVIE
Prep for reperfusion
Pain relief if severe
Anti-thrombotic
Beta-blocker
Anti-platelet
ACE inhibitor
Statin
Oxygen ONLY IF <90%
Code status

188
Q

Dressler’s Syndrome

A

Def: secondary pericarditis seen after an MI.
Ddx: ACS, Pericarditis, Anxeity, PE, Pneumonia
Ix: CRP, echo, CXR
Treat: High dose ASA and NSAIDs

189
Q

Physical exam findings in CHF

A

Increased Weight
Leg edema
Crackles
S3 (specific)
Elevated JVP (specific)

190
Q

Types of CHF

A

Preserved EF 50%+
Mid range 41-49%
Reduced 40% or less

191
Q

H2FPEF Score for probability of CHF

A

H- Heavy (BMI>30)
H - HTN
F - Afib
P - Pulmonary HTN (Pressure >35mmHg)
E - Elder (>60)
F - Filling pressure

192
Q

Quad therapy for HFREF

A
  1. ACEi/ARB/ARNI
  2. B-blocker
  3. Mineralocorticoid receptor antagonist
  4. SGLT2i (even if no DM)
    +/- furosemide
193
Q

Breast Cancer RFs

A

Age >50
Sex
Past hx of breast CA
Fam hx of breast CA
Estrogen exposure
Early menarche
Older menopause
Nulliparity
HRT
Postmenopausal obesity
Radiation exposure
Alcohol
Sedentary lifestyle

194
Q

Side effects of chemo

A

Cardiomyopathy
Valvular disease
Fatigue
Secondary malignancy
Ovarian insufficiency
Lymphedema

195
Q

Treatment for obesity if behavioural mgmt fails

A

Orlistat - (Lipase inhibitor)
Bupropion-naltrexone (Dopamine/norepi reuptake inhibitor)
Semaglutide or Liraglutide (GLP-1 receptor antagonist)
Gastric bypass
Sleeve gastrectomy
Adjustable gastric band

196
Q

Avoid bupropion for smoking cessation if:

A

Seizure disorder
Eating disorder
EtOH withdrawal
MAOi use
Allergy

197
Q

EtOH use disorder questionnaire

A

M-SASQ
How often have you had 6 (female) or 8 (male) drinks on a single occasion in the last year?
0 - never
1- Less than monthly
2 - Monthly
3 - Weekly
4 - almost every day
2+ is positive

198
Q

Meds for EtOH use disorder

A
  1. Naltrexone (opioid antagonist)
    Others: acamprosate, disulfiram
199
Q

SE of OAT

A

Constipation
Amenorrhea
Decreased Testosterone

200
Q

Canadian C-spine Rule

A
  1. Age 65+
  2. Dangerous mechanism (axial load, fall from 3+feet, MVC high speed, motorcycle, bicycle or pedestrian struck)
  3. Paresthesias in extremities

IF NO….Any low risk features that allows for ROM testing?

  1. Ambulatory at any time
  2. Sitting in ED
  3. Delayed onset of neck pain
  4. Absence of midline tenderness
  5. Simple rear end MVC (not if high by bus, rollover or pushed into oncoming traffic)

If any present, test ROM 45 degrees.

**does not apply with known vertebral dz, c-spine surgery in past or paralysis, <16y.

201
Q

Nexus c-spine rule

A

For pts <16. Cannot have ANY of the following:
1. Neuro deficit
2. Midline tenderness
3. Alert
4. Intoxicated
5. Distracting injury

202
Q

Cervical radiculopathy definition and imaging

A

Pain in one or both upper extremities AND motor/sensory/reflex deficits

Imaging not required UNLESS:
- Hx of trauma
- Sx persist >4-6w
- Red flags for malig, abscess, myelopathy

Spurling test - axial pressure on the top of the head to reproduce pain

203
Q

Menopause

A

Psychiatric
Vasomotor
Urogenital
Sex

204
Q

Menopause Lifestyle and Meds Mgmt

A

Quit:
- smoking
- EtOH
- Caffeine
- hot clothes

Start:
- exercise
- WL
- cool environment
- optimize sleep

Meds:
SSRIs
TCAs
OCP
HRT
Anti-convulsants
Progestin
LUBRICANT AND ESTROGEN TABLETS/MOISTURIZERS (Must educate that partner must wear a condom within 1st 48h)

205
Q

Pathogen for cat bites

A

Pasteurella multocida

206
Q

Antibiotic and treatment for cat bites

A

High risk or in hands - amox clav
Penicillin allergy - Doxy or septra+flagyl

Vaccinate for tetanus and rabies

Do not close wound

207
Q

Rabies common animals and treatment

A

Dog, cat, ferret, skunk, bat, fox, coyote, raccoon, carnivore
- Call public health
- Give 4 doses of HDCV or PCECV and RabIg

208
Q

When to consider gastric lavage?

A
  1. If within 2 hours
  2. No antidote available
  3. Potentially lethal ingestion
209
Q

Betablocker overdose antidote

A

Glucagon
Insulin

210
Q

Iron OD antidote

A

Deferoxamine

211
Q

Acetaminophen antidote

A

NAC

212
Q

The only time you treat asymptomatic bacteriuria

A

Pregnancy

213
Q

UTI meds for pregnant patients

A

Amox-clav - “according to local resistance patterns”
Macrobid can be used after first trimester

214
Q

UTI treatment for kids

A

Cefixime 7-10d

Order KUB US if:
Febrile <2y
Recurrent
Complicated

215
Q

Mild epistaxis management

A

Blow nose
2 sprays of oxymetazoline
Pinch for 10 minutes

216
Q

Severe epistaxis mgmt

A

ABCs
MOVIES
Labs
Add TXA
Freeze and cauterize (DO NOT cauterize both sides)
Freeze and pack (gauze, rapid rhino, foley)
Abx not necessary

217
Q

Posterior epistaxis

A

Identify by packing, if still bleeding, call ENT.
- Nasal balloon
- Admit
- Labs for severe bleeds

218
Q

Causes of croup

A

Parainfluenza
(Influenza, RSV, adenovirus, metapneumovirus)

219
Q

If recurrent croup what do you investigate for?

A

Bacterial tracheitis

220
Q

Meningitis PE signs

A

Kernig - Extend KNEE, flex hip
Brudzinksi - Lift BRAIN
Jolt accentuation test
Nuchal rigidity
Blueberry rash

221
Q

Meningitis treatment

A
  1. IV Abx immediately.
    Adults - CTX + vanco. Once culture back - if meningococcal then step down to PenG

Peds:
a) Steroids only if H. flu and <2h from abx. ALWAYS LP (C/I - coagulopathy, rash at site, herniation, shock)
b) CTX, vanco + ampicillin

  • If giving steroids, give them before the antibiotics to reduce chance of hearing loss

**You can give family members Rifampin, Cipro or CTX as prophylaxis

222
Q

CSF findings in meningitis

A

Normal = 6 - 25mg H20
Bacterial - “made of protein and eat sugar” so high protein, high WBC, low glucose

Viral - usually normal glucose

T: > 37.5 in kids

223
Q

Allergy alphabet

A

Adrenaline - Peds 0.01mg/kg of 1mg/ml IM | Adult 0.3-0.5mg IM 1mg/ml
Breathing - O2 (5L NP or 15L NRB)
Corticosteroid - Methylprednisilone 125mg
Diphenhydramine - 50mg
Epi again?
Fluids - 500cc NS
Glucagon if on beta blocker
H2 blocker (Ranitidine 150mg)
Inhaled corticosteroid

224
Q

Pen-Fast Rule for penicillin allergy

A

0 points = <1% chance of allergy
- <5y since last reaction
- anaphylaxis/angioedema
- severe cutaneous reaction
- treatment required

225
Q

SCOFF Screening tool

A
  1. Sick - do you make yourself sick because you feel uncomfortably full?
  2. Control - Do you worry that you have lost control over how much you eat?
  3. One - have you lost more than one stone/14lbs in a 3 month period
  4. Fat - do you think you are fat when others say you are thin
  5. Food - would you say food dominates your life
226
Q

Bulimia

A

Binge and purge once weekly

227
Q

Binge eating disorder

A

Not just overeating

228
Q

Relative energy deficiency in sport

A
  • Formerly ‘female athlete triad’
  • Calorie deficit due to extreme exercise (?thin, ?no menses)
  • Occurs in any gender
229
Q

Sexual assault management

A

Pregnancy prevention
Emergency contraception
STI screen - treat for Gonorrhea (Azithro+CTX or Cefixime)
PEP
Medical assessment
Offer counseling
Offer someone in the room
HepB post exposure (Hep B Ig, vaccinate w/in 8h)
Self swab if more comfortable
Assess for safety
Offer forensic exam
STI testing at 6w and 12 weeks
Victim Assistance
Social work

230
Q

ADHD Stimulants

A

Amphetamine
Methylphenidates

231
Q

SNRIs for ADHD (non-psychostimulants)

A

Atomoxetine

232
Q

Selective alpha 2a- adrenergic receptor antagonist (non-psychostimulant) for ADHD

A

Guanfacine

233
Q

Missed abortion Management

A
  1. Surgical Management
  2. Medical Management
  3. Expectant Management
234
Q

Threatened abortion

A
  • Viable IU pregnancy with cramping or bleeding
  • Order serial ultrasounds, serial bHCG, precautions, Cervical suture
235
Q

Complete abortion mgmt

A

Rhogam if large bleed or >12w

236
Q

AUB Mgmt

A

2 Non-hormonal
- NSAID
- TXA

3 Hormonal
- LNG IUS
- OCP
- Progestin

4 Surgical
- Ablation
- Hysterectomy
- Polypectomy
- Myomectomy

237
Q

Post-menopausal bleeding mgmt

A

Pelvic exam
PAP
Endometrial biopsy
Pelvic US

238
Q

Vaginitis investigations

A
  • swabs
  • wet mount
  • pH
  • KOH prep
  • Biopsy
239
Q

Other causes of itchy vagina aside from yeast

A
  • Eczema
  • Contact dermatitis
  • Psoriasis
  • Lichen sclerosis
  • Lichen simplex chronicus
  • Vulvar intraepithelial neoplasia
  • Vulvar cancer
  • Genitourinary syndrome of menopause (aka atrophic vaginitis)
  • Herpes
  • Trichomonas
  • PID
  • BV
240
Q

PSA Screening

A
  • Discussion with patient (Urology says yes, task force says no)
  • Start at 50 (45 if high risk)
  • If <10 routine, 10-20 semi urgent, >20 urgent referral
  • Do a DRE (if DRE is abnormal, upgrade all patients to urgent)
  • Next step is prostate biopsy
241
Q

Prostate CA risk factors

A

Age
High-risk race (Black)
Family history
Smoking
Obesity

242
Q

Priapism

A

Do doppler US
Cavernosal blood gas

If non-ischemic
- watch and wait
- 5-alpha reductase inhibitors Finasteride
- Gonadotropin releasing hormone agonist

If ischemic
- Needle drainage lateral
- Itracaversonal phenylephrine
- Surgical shunt if >48h

243
Q

Erectile dysfunction Guidelines

A

SHIM & Hardness scale
- Offer next visit
- Offer exam
- Offer to interview partner
- Ask about morning erections, contraception, orgasm
- Order A1c, lipids, testosterone

244
Q

Erectile dysfunction second line treatment

A
  • Alprostadil (intraurethral pill or intracavernosal injection_
  • Penile pump
  • Penile prosthesis
245
Q

Biologic for osteoporosis

A

Delosumab/Prolia

246
Q

SERM for osteoporosis

A

Raloxifene

247
Q

Bisphosponates for osteoporosis

A

Alendronate, Risendronate

248
Q

Gestational diabetes cut offs

A

Fasting: 5.3
1 hour: 10.6
2 hour: 9.0

249
Q

Normal variability and acceleration size

A

Normal variability = 5-25 bpm
Accels = 15 beats above baseline for 15 seconds twice in a 20 minute strip

250
Q

Shoulder dystocia managment

A

ALARMER
- Ask for help
- Lift legs/lower head of bed
- Anterior shoulder disimpaction w/suprapubic pressure
- Rotate shoulders (corkscrew
- Manual removal of posterior shoulder
- Episiotomy
- Roll onto all 4s

251
Q

Pharmacotherapy for PPH

A

Oxytocin
Misoproste
Ergot
Hemabate (avoid in asthma)
TXA

252
Q

Causes of hemorrhoids

A

Constipation
Pregnancy
Obesity
HTN
Heavy lifting

253
Q

Symptomatic treatment in Parkinson’s

A

Drooling - botox
Hypotension - Midodrine, fludrocortisone, domperidone
Depression - Tailored to individual
Motor sx - LEvodopa, exercise, deep brain stimulation and gel infusion

254
Q

Indications for allopurinol in gout

A
  1. hx of renal stones
  2. Tophi
  3. > 2 attacks per year
  4. CKD stage. or worse
255
Q

Pre-labor RF for shoulder dystocia

A
  1. Prev shoulder dystocia
  2. Maternal elebated BMI
  3. Gestational Diabetes
  4. Macrosomia
  5. IOL
256
Q

Intrapartum RF for shoulder dystocia

A
  1. Prolonged stages of labor
  2. Use of oxytocin
  3. Vacuum delivery
257
Q

Risk factors for celiac disease

A

Female
Northern european descent
Family history
T1DM
Thyroid disease
Down Syndrome
Turner syndrome
Addison disease

258
Q

Pathophysiology of celiac

A

Autoimmune condition that results in chronic inflammation in the small bowel causing mucosal tissue damage and villous atrophy in the small intestine secondary to ingestion of gluten leading to malsabsorption

259
Q

Penicillin allergy in AOM

A

Cefuroxime

260
Q

RF for SAH

A

Smoking
HTN
Moderate to heavy EtOH
Known aneurysm
Fam hx of subarachnoid hemorrhage
Cocaine use
Estrogen deficiency

261
Q

If CT head negative when suspecting SAH what do you do next?

A

LP
- Elevated opening pressure
- Presence of RBCs
- Xanthochromia

262
Q

APGAR

A

Appearance (skin color) - Normal/all but extremities/pale
Pulse - >100/<100/absent
Grimace (reflexes) - sneeze cough or cry/grimace/no response
Activity (muscle tone) - active/arms and legs flex/absent
Respirations) - Crying/Gasping/Absent

Total 10. Measured at 1 minute, 5 mins

263
Q

TORCH infections

A

Toxoplasmosis
Other (syphillis)
Rubella
CMV
HSV

264
Q

RF for low apgar

A

Opiates in labor
Meconium
Precipitous delivery
Shoulder dystocia
Preterm

265
Q

Two lab tests to assess risk for adverse neuro outcomes in newborns

A

Umbilical artery cord gasses
Placental pathology

266
Q

Pathognomonic rash in celiac

A

Dermatitis herpetiformis

267
Q

BMI categories

A
268
Q

Weight gain in pregnancy

A
269
Q

VAginal progesterone if…

A

Cervical length <2.5cm, previous preterm birth

270
Q

Complications. of GDM

A

LGA
neonatal hypoglycemia

271
Q

Hyperemesis gravida

A

persistent vomiting, 5% wt loss, abN lytes

272
Q

TSH targets in pregnancy

A

T1 <2.5
After <3.5

273
Q

ASA in pregnancy indications

A

Pre-existing HTN
DM
Renal disease
Previous pregnancy with HTN

Mod risk: BMI >35, Age >40 and first preg, fam hx of preeclampsia

274
Q

Treatment of Molloscum contagiosum

A
  • Liquid nitrogen
  • Let it be
  • Cantharidin
274
Q

HIV med in pregnancy

A

Truvada

275
Q

Alopecia areata

A

Clobetasol 0.05% topical

276
Q

Primary varicella described as:

A

Dew drops on a rose petal

277
Q

Best option for IUD insertion analgesia

A

Emla cream

278
Q

Pneumothorax in kids mgmt

A

If not too large - observe and oxygen
If large - small pigtail aspiration

279
Q

Red flags for hearing loss

A

Sudden hearing loss
Hearing loss after trauma
Unilateral hearing loss with focal neuro signs

280
Q

Lyme disease sx and diagnosis

A

Target lesions. Treat with doxycycline.

281
Q

Medication classes for acne (name 5)

A

Antibiotics (Topical clindamycin or erythromycin; Oral Minocycline, doxycycline, tetracycline, erythromycin)
Benzoyl peroxides
Retinoids
Salicylates
Intralesional Steroids

282
Q

Labs before starting isotrentinoin (acutane)

A

TGs
WBC and differentia
ALT

283
Q

Side effects of isotrentanoin

A
  • dry skin
  • sun sensitivity
  • birth defects
  • joint pain
  • epistaxis
  • headaches
  • abdominal pain
  • low mood
  • pancreatitis
  • psychosis
284
Q

Acne lesion types

A

Comodomes
Inflammatory papules
Pustules
Nodules

285
Q

Treatment of nausea in pregnancy

A

Pharma:
Gravol
Promethazine
Chlorpromazine
Metaclopramide
Ondansetron

OTC:
- sea bands
- ginger
- vitamin B6
- pepcid/H2 blocker
- gravol
- antacid

286
Q

Dog attack - rabies questions

A
  • dog behaviour - did it look rabid
  • dog vaccine status
  • provoked or unprovoked attack
  • rabies prevalence in area
  • wild dog or pet
  • nature of the wound
287
Q

Rabies treatment

A
  1. Rabies vaccine/human diploid cell vaccine (HDCV)
  2. Rabies immune globulin
  3. Tetanus booster
288
Q

Symptoms of hypercalcemia

A

Stones
Bones
Groans (abdo pain, N/V)
Thrones (constipation, polyuria)
Psych overtones (confusion, memory loss, fatiuge)

289
Q

Treatment of acute hypercalcemia

A

IV fluids
Subq or IM calcitonin
IV bisphosphonates (pamidronate/zolendronate)

290
Q

Labs for hypercalcemia

A
  1. SPEP
  2. Serum phosphate
  3. Vitamin D leve
  4. Serum parathyroid hormone
  5. Serum creatinine
  6. Serum albumin
291
Q

Test to order for sickle cell anemia

A

Serum hemoglobin electrophoreis
(Autosomal recessive disease)

292
Q

Triggers for blood cells to sickle

A
  1. Hyposxia
  2. Dehydration
  3. Infection/fever
  4. Acidosis
  5. Cold temperatures
  6. Pregnancy or menses
  7. Alcohol
293
Q

Triggers for blood cells to sickle

A
  1. Hyposxia
  2. Dehydration
  3. Infection/fever
  4. Acidosis
  5. Cold temperatures
  6. Pregnancy or menses
  7. Alcohol
294
Q

Mechanism behind anemia in Sickle Cell disease

A

Abnormally shaped RBCs predisposing them to hemolysis

295
Q

Types of sickle cell crises

A

. 1. Vaso- occlusive (includes abdo crisis, bone crisis and joint cirsis)
2. Hemolytic crisis
3. Aplastic crisis
4. Acute splenic sequestration crisis

296
Q

Clinical features of epididymitis

A
  1. Adolescent onset
  2. Gradual
  3. Moderate to severe pain over epididymis
  4. Dysuria
  5. Fever
  6. Increased frequency of urination
  7. Unilateral
  8. Urethral discharge
297
Q

Investigations to order in epididymitis

A
  1. Color doppler ultrasound of the scrotum
  2. Urinalysis
  3. Urine C & S
  4. WBC
  5. urethral swab for Chlamydia and Gonorrhea
298
Q

Risk factors for placenta previa

A
  1. Previous previa
  2. Multiple gestaiton
  3. PRior C/S
  4. Prior uterine scar
  5. Maternal age >35
  6. Multiparity
  7. Smoking
  8. Cocaine
299
Q

Risk factors for primary nocturnal eneuresis

A
  1. Developmental delay/neuro immaturity (most common)
  2. Constipation
  3. Genetic predisposition
  4. Sleep disorder or deep sleeper
  5. Low level of night time anti-diuretic hormone
300
Q

Factors associated with delayed toilet training

A
  1. Voluntary witholding of stool
  2. Constipation
  3. Starting toilet training too early or late (ideal start at 27mo)
  4. Conflict at home
  5. First born child
  6. male child
  7. family history of eneuresis
301
Q

Scrotal Masses table

A
302
Q

Scrotal masses algorithm

A
303
Q

Primary enuresis vs secondary

A

Primary = continence has never been acheived
Secondary = continence was achieved for at least 6 months before incontinence reccurs

**only label enurietic if wetting bed more than twice per week and older than 5y

304
Q

Treatment for enuresis

A

**Only treat if bothersome to child.
1. Alarm devices (wake you up when you start to pee)
2. Desmopressin (good for sleepovers or camp - short term)
3. Behavioral:
- set goals
- avoid fluids or caffeine before bed
- empty bladder before bed
- include child in cleanup in non punitive manner
- preserve self esteem

305
Q

Causes of torsades

A

Hypomag
HypoK
HypoCa
Meds
Hypothermia

Give magnesium.
NO PROCAINAMIDE OR AMIODORONE, NO BETA BLOCKERS

306
Q

Rosasea treatment

A
  1. Metronidazole gel or lotion
  2. Azelaic acid
  3. Brimonidine Tartrate (shrinks blood vessels)
  4. Ivermectin (decreases inflamation_
  5. Tretinoin cream
307
Q

Most common pathogens for traveller’s diarrhea

A

Escherichia Coli
Campylobacter jejuni
Salmonella
Shigella
Yersinia
Giardia
Norovirus
Rota virus

308
Q

Post exposure prophylaxis

A

Truvada + raltegravir

309
Q

Post exposure testing for HIV, HBV and HCV

A

HIV - HIV Serum EIA at 3 weeks, 6 weeks and 12weeks

HBV - HBsAg, HBsAb, HBcAb, vaccinate if not immune and repeat serology at 2 months after vaccine series and 12 weeks after exposure

HCV - HCV Ab
Baseline HCV Ab then check HCV RNA 3w after exposure, 12 weeks

310
Q

Syphillis treatement

A

Primary, secondary, and early latent syphilis:
Pen G 2.4 million units IM x1

Late latent (>1y from likely infection) or tertiary (gummatous or cardiovascular disease):
Pen G 2.4 million units IM once weekly x 3 weeks

Tertiary neurosyphilis
Pen G 3-4 million units IV q4h x 10-14d

311
Q

Trichomoniasis

A

Green/yellow malodorous discharge, burning, dyspareunia

Treat with Metronidazole 2g PO once and treat partner

312
Q

Only test for cure of chlamydia if:

A

Persistent sx
Pregnancy
Poor adherence to treatment
Alternate abx use
Re-exposure

Always test for cure in gonorrhea and syphillis

313
Q

Pelvic inflammatory disease features:

A

PAin with adnexal or cervical motion tenderness
- AbN cervical discharge or friability
- Positive for chlamydia/gonorrhea
- T >38.3
- WBC >15 on saline microscopy of vag secretions
- >elevated CRP
- Confirm with US/CT/MRI pelvis
***Remember BHCG

314
Q

Treatment for gonorrhea

A

Azithro PO x 1g AND either CTX 250mg IM or Cefixime 800mg PO

Test of cure 3-7 days after treatment completed

315
Q

PID treatment

A

Outpatient = CTX IM x 1 dose + Doxycycline for 14 days

Inpatient Moderate = CTX IV + Doxy IV/PO + Flagyl Iv/PO
Pen allergy Clinda IV + Gent IV

Inpatient. severe = Piptaz + Doxy

316
Q

Primary features of rosasea

A

Flushing (transient erythema)
Nontransient erythema
Papules
Pustules
Telangiectasia

317
Q

Bacteria that causes acne

A

propionibacterium acnes

318
Q

Factors that make a good screening test

A
  1. detects disease before clinically apparent
  2. detects disease at a curable stage/treatment is available
  3. detects diseases that have a high risk of negative outcome (ie high morbidity/mortality)
  4. is cost effective
  5. low false positives/high specificity
  6. low false negatives/high sensitivity
  7. high negative predictive value
  8. test should be acceptable to vast majority of patients
  9. test should be safe
  10. detects diseases that are common
    accessible: facilities for diagnosis
  11. should be available
319
Q

Number needed to screen for breast CA in age 40-49, 50-59, 60-69

A

40-49: 1700
50-59: 1300
60-69: 1000

320
Q

Acute lithium toxicity

A

Tremor
Nystagmus
Hyperreflexia
Seizures
Confusion/aLOC

321
Q

Treatment of constipation (classes and meds)

A
  1. Osmotic laxatives - Restorolax, lactulose, magnesium salts
  2. Bowel stimulants - Senokot, bisacodyl
  3. Bulking agents - psyllium, bran
  4. Bowel lubricants - glycerine, mineral oil
  5. Enemas - tap water, oil
  6. Prokinetics - Linaclotide
322
Q

Benefits of stopping smoking

A

Decreased PUD risk
Decreased osteoporosis risk
Decreased CVD
Decreased risk of CVA
Decreased risk of COPD
Less sexual dysfunction
Decreased risk of pulmonary infections
Better wound healing
Improved sense of smell
Better health of those around you
Increased exercise tolerance

323
Q

Cancers associated with smoking

A

Lung
Oropharyngeal
Esophageal
Bladder
Cervical
Stomach

324
Q

Meds for smoking cessasion

A
  1. Nicotine replacement products
  2. Nicotinic receptor partial agonists - 3. Varenicline (Champix)
  3. Norepinephrine dopamine receptor antagonists - Bupropion
  4. Alpha 2 adrenergic receptor agonists - Clonidine
325
Q

Interviewing an unmotivated smoker

A

Risks
Rewards
Roadblocks
Repetition (q6-12mo)

326
Q

Mono treatement recommendations

A
  1. Rest
  2. Fluids
  3. Analgesics
  4. Avoid physical activity for 3w
  5. Avoid contact sports until medically cleared
  6. Dsicuss possibility of fatigue for weeks to months
  7. Review transmission
327
Q

Guardasil (HPV-9 vaccine)

A

Females and males age 9-26

328
Q

Treatment of anogenital warts

A
  • cryotherapy
  • surgery
  • laser
  • imiquimod
  • Podofilox solution
  • Trichloroacetic acid
329
Q

Waist circumference measurements

A

Men <102cm
Women <88cm

330
Q

Physical exam signs of end organ damage from HTN

A

Retinopathy
Carotid bruids
Renal bruits
Femoral bruits
S4
Weak/absent peripheral pulses

331
Q

GAS pharyngitis treatment

A

Penicillin VK x 10 days
Amoxicillin x 10 days

Type IV hypersensitivty rxn to Penicillin (rash) - Keflex x 0 days

Type I hypersensitivity to Penicillin (anaphylaxis) - Clinda, Clarithro, Erythro x 3 days.

332
Q

MOCA scores

A

Mild 18-26
Moderate 0-17
Severe <10

333
Q

Do you screen for cognitive impairment

A

NO. No screening recommended in asymptomatic patients.

334
Q

Components of the MOCA

A
  1. Visuospatial
  2. Naming
  3. Attention
  4. Language
  5. Abstraction
  6. Delayed recall
  7. Orientation
335
Q

Risk factors for DM

A

Family history in 1st degree relative
Waist circ >102 in men or >88 in women
BMI >30
Smoking
HTN
Impaired fasting glucose
PCOS
OSA
Age >40
Fasting TG >1.7
History. ofgestational diabetes
HIV infection
History of pancreatitis
HDL < 1 in males. and<1.3 in females

336
Q

Risk factors for carpal tunnel

A

Diabetes
Hypothyroid
Pregancny
Obesity
Rheumatoid athritis
Fracture

337
Q

When is hormonal emergency contraception not effective

A

If taken on the day of ovulation or the day after

338
Q

When can you start hormonal contraception after using emergency contraception?

A

Levonogestrel - day after
Ullipristal accetate - 5 days after

339
Q

Anticholinergic toxidrome and drug classes that cause it

A

Red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare and full as. aflask

  • Antihistamines
  • Anti-epileptics (Carbamazepine)
  • TCAs
  • Muscle relaxants (Flexeril)
  • Anti-psychotics
  • Anti- parkinsonians
  • Atropine
340
Q

Cannabanoid hyperemesis treatemtn in hospital

A

IV fluids
IV haldol
IV/IM lorazepam
Topical capsacin cream
Hot shower

Stop cannabis for cure
Refer to addictions

341
Q

Potential complications of acute bacterial sinusitis

A
  1. Periorbital cellulitis
  2. Meningitis
  3. Sepsis
  4. Intracranial abscess
  5. Osteomyelitis
342
Q

Signs of bacterial sinusitis over viral

A
  • Sx lasting >7d
  • Sx worsening after 5d
  • Pain/pressure over sinuses
  • Nasal obstruction
  • Smell disorder
  • Purulence nasal discharge

PODS - pain, obstruction, discharge, smell

343
Q

Components of cannabinoid hyperemeisis syndrome

A
  1. Episodic pattern of vomiting lasting <7d with asymptomatic periods between
  2. Prolonged cannabis use
  3. Exclusion of alternative diagnosis
344
Q

Contraindications to stroke fibrinolysis

A

AV Malformation
Aneurysm
CNS tumor
INR >1.7
Plts <100
Suspected aortic dissection
Uncontrolled HTN
Ischemic stroke in last 3 months
Seizure at stroke onset
SAH suspected
Head trauma in last 3 months

345
Q

What factors increase number of HSV outbreak

A
  • URTI
  • Trauma
  • Fever
  • Psychosocial stress
  • Teroid use
  • Immunosuppresion
  • Sun exposure
  • Surgery
  • Menses
346
Q

Risk factors for open angle glaucoma

A

Family history
Diabetes
Increasing age
Elevated intraocular pressure
African descent

347
Q

ADHD medication classes and examples

A
  • Simulants Amphetamines - Adderall Vyvanse

-Stimulants Methylphenidates - Concerta, Biphentin

  • Non-stimulant Selective Norepinephrine Reuptake Inhibitor - Atomoxetine
  • Non-stimulant Selective alpha 2a adrenergic receoptor agonist - Intuniv
348
Q

Symptoms of menopause

A
  • vaginal dryness
  • dyspareunia
  • sleep disturbance
  • mood changes
  • incontinence
  • decreased libido
  • memory problems
  • joint aches
  • new UTIS
349
Q

Thyroid nodule

A

Order TSH and US for all
…THEN:

  • FNA if TSH is normal or high and >1cm or <1cm with RFs
  • Iodine uptake scan if TSH is low (then radioiodine ablation or surgical excision if hyperfunctioning)
350
Q

Chorioamnionitis

A
  1. Fever >38
    Plus two of:
    - uterine tenderness
    - maternal or fetal tachycardia
    - foul/purulent amniotic fluid
    - maternal elevated WBC
351
Q

Complications of CKD

A
  • Fluid retention
  • Hyperkalemia
  • Metabolic acidosis
  • Hypophosphatemia - increasing risk. of#
  • Hypertension or worsening HTN
  • Anemia
  • CAD
  • Immune dysfunction
  • Sexual dysfunction
352
Q

What x-rays to order for FOOSH

A

Wrist PA
Wrist lateral
Wrist oblique
Scaphoid views

353
Q

PE of scaphoid fracture

A
  • snuff box tenderness
  • limitation of wrist flexion and extension
  • pain with axial compression of thumb
  • pain with resisted forearm supination
  • radial and ulnar deviation creates radial sided pain
  • swelling over snuffbox
354
Q

Scaphoid fracture complications

A

Non union
AVN of the scaphoid bone

355
Q

Nephrotoxic meds

A

S - Sulfonylureas
A - ACEi
D - Duretics
M - Metformin
A - ARBs
N - NSAIDs
S - SGLT2 inhibitors

356
Q

Nephrotoxic meds during times. ofillness

A

S - Sulfonylureas
A - ACEi
D - Duretics
M - Metformin
A - ARBs
N - NSAIDs
S - SGLT2 inhibitors

357
Q

How long can you store breastmilk?

A

Fridge 7 days
Freezer 3-4 months

358
Q

Non-pharma ways to increase breastmilk

A
  1. Pumping
  2. Adequate hydration
  3. Adequate nutrition/calories
359
Q

Benefits to baby from breastfeeding:

A

Decreased rate of:
Auto immune
- eczema
- asthma

Infetion
- otitis media
- UTIs
- pneumonia
- meningitis
- bacteremia

Death/Malig
- Neonatal mortality
- SIDS
0 lymphoma
childhood leukemia

GI
- diarrhea
- vomiting
- NEC

Endocrine
- T2DM
- Obesity

360
Q

Benefits to mom from breastfeeding

A

Decrease risk of ovarian cancer
Decreased risk of breast cancer
Lower rates of type 2 diabetes
Quicker return to pre-pregnancy weight
Quicker resolution of post-partum bleeding

361
Q

Diarrhea red flags

A
  1. Constitutional symptoms
  2. Anemia
  3. Blood
  4. Greasy stool
  5. Recent travel
  6. Immunosuppressed
  7. Age>50
  8. Recent antibiotics
  9. Elevated CRP
362
Q

Indication for TURP

A
  • Recurrent or refractory urinary retention
  • Recurrent UTIs
  • Failure of conservative management
  • Recurrent hematuria
  • Renal dysfunction
  • Patient preference
  • bladder stones
363
Q

Lifestyle management of BPH

A
  • Avoid fluids before bed
  • Fluid restriction
  • Avoid caffeine
  • Avoid decongestants, antihistamines, diuretics
  • Timed/organized voideing
  • Avoid constipation
364
Q

Side effects of 5-alpha reductase inhibitors (Dutasteride)

A
  • erectile dysfunction
  • retrograde ejaculation
  • gynecomastia
  • decreased libido
  • decreased ejaculate volume
365
Q

Indications for operative delivery

A
  • maternal exhaustion
  • lack of maternal cooperation
  • inadequate pushing due to analgesia
  • Prolonged second stage. of labor
  • Reason to stop pushing - maternal HTN, cardiac reason
  • abnormal fetal heart rate
  • excessive bleeding
  • abnormal fetal scalp pH
366
Q

Checklist before vacuum

A

Call for help
Maternal consent
Fully dilated
Consider analgesia
Empty bladder
Determine fetal head position
Membranes ruptured
+2 station

367
Q

Benefits of oxytocin for induction/augmentation and risks

A

Benefits:
- shorter labor
- decreased risk of intrapartum infection
- decreased risk of operative delivery
- decreased risk of PPH
- decreased fetal death rates

Risks:
- Uterine tacysystole
- Uterine rupture
- abnormal fetal HR

368
Q

Risk factors for SIDS

A

Maternal:
- Smoking/drugs/alcohol during pregnancy
- Maternal age < 20
- Inadequate prenatal care

Non-maternal
- Preterm
- Low birth weight
- Prone sleeping
- Bed sharing
- Loose bedding/blankets/pads in crib
- Sibling of SIDS victim (no increased risk if other fam members)
- male infant
- Age 2-4 months
- Exposure to 2nd hand smoke

369
Q

Milestone components

A

Gross motor
Fine motor
Language
Social

370
Q

5 A’s of obesity and classes

A

ASK for permission to discuss weight
ASSESS obesity risks and root causes
ADVISE on health risks and treatment options
AGREE on goals
ASSIST in accessing appropriate resources

Class I : 30-34.9
Class II: 35-39.9
Class II: 40+

371
Q

Parent education around simple febrile seizure

A
  1. No brain damage
  2. No increased risk of epilepsy with one febrile seizure
  3. Likely to occur a second time
  4. No need for anti-epileptic medication
  5. Acetaminophen for comfort but won’t prevent. aseizure
  6. No further workup
372
Q

Symptoms of OSA

A

Snoring
Daytime fatigue
Choking/gasping in sleep
Morning headache
Labile mood
Poor concentration
Memory loss
Low libido
Erectile dysfunction

373
Q

Risk factors for OSA

A
  • Obesity
  • Hx of CAD
  • Hx of CVA
  • pregnancy
  • large tongue
  • family history
  • nasal septal deviation
  • large neck circumference (>43men, >41 women)
374
Q

Treatment for OSA

A
  • CPAP
  • Weight loss
  • Non supine sleeping position
  • Avoid EtOH
  • Avoid sedatives
  • Mouth guard
  • Surgical correction of craniofacial abnormalities
375
Q

Treatment for OSA

A
  • CPAP
  • Weight loss
  • Non supine sleeping position
  • Avoid EtOH
  • Avoid sedatives
  • Mouth guard
  • Surgical correction of craniofacial abnormalities
376
Q

Complex febrile seizure if:

A
  • More than one seizure in 24 hours
  • focal seizure
  • Lasting more than 15 mins
377
Q

UTI Pathogens - KEEPS

A

K - Klebsiella
E - Enterobacteriaceae
E - E. Coli
P - Proteus mirabilis
S - Staph saprophyticus

378
Q

MRSA risk factors

A
  • previous MRSA infection or colonization
  • previous hospitalization for SSTI or hospitalization in last 90 days
  • Abx use in last 6 months
  • IVDU
  • Nursing home resident
  • Homelessness
  • Contact sport athlete
  • Dialysis patient
  • MSM
  • Military
  • Prison
  • First nations
  • Age <2 or >65
379
Q

Altitude sickness

A
  • Sx: headache, weakness, fatigue, nausea, restless, SOB, confusion, hemoptysis
  • Caused by pulmonary edema and cerebral edema
  • Spend 2-3 nights at 3000 feet
  • Gradual ascent
  • Avoid alcohol and sedatives
  • Prevent with dexamethasone/acetazolamide
  • Treat with dexamethasone, nifedipine, sildenafil, ventolin
380
Q

Drugs that don’t bind to charcoal

A
  • Lithium
  • Alochols
  • Potassium
  • Lead
  • Iron
381
Q

Indications for Dialysis (AEIOU)

A

A - Acidosis pH<7.1
E - electrolytes Refractory K>6.5
I - Intoxications
O - Overload refractory to diuresis
U - uremia

382
Q

Causes of anion gap acidosis

A

M - methanol
U - uremia
D - DKA
P - Propylene glycol
I - Isoniazid/Iron
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates

CCFP - Missed Q's (1 decks)

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