CCFP Qs Flashcards
1
Q
Criteria for Delerium
A
- Acute change in mental status with fluctuating course
- Innattentive
- Disorganized Thinking
- Altered LOC
2
Q
Causes of Delirium
A
Urinary retention
Dehydration
Constipation
Drug interactions
Infection
Electrolyte imbalances
3
Q
DIMS-PLUS5
A
Drugs
Infection
Metabolic
Structura
Pain
Liquids and solids
Urine and bowels
Senses
Sleep
Setting
Stasis - restraints
Stress
4
Q
AAA Screening
A
One time abdo US for men 65-80
5
Q
TB treatment
A
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
6
Q
Latent TB investigations
A
Tuberculin skin test
IGRA
7
Q
Active TB investigations
A
Microbiology with acid fast bacilli
Nucleic acid amplification tests
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
9
Q
Side effects of digoxin
A
10
Q
Side effects of warfarin
A
11
Q
Side effects of carbamazepine
A
12
Q
Side effects of Levothyroxin
A
13
Q
Side effects of HIV ARVs
A
14
Q
Side effects of steroids
A
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
16
Q
Sx of serotonin syndrome
A
Autonomic dysfunction - mydriasis, diaphoresis, tachycardia, tachypnea
Neuromuscular - tremor, hyperreflexia
Altered mental statis - agitated, confused, excited, delerius
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
18
Q
Causes of postural hypotension with compensatory tachycardia
A
- Deconditioning
- Dysfunctional heart - myocard or AS
- Dehydration - disease (diarrhea, adrenal insuff), dialysis, drugs (diuretics, digoxin, cholinesterase inhibitors)
- Drugs - anti-HTN, anit-anginal, anti-parkinsonian, anti-depressants, anti-BPH
19
Q
Causes of postural hypotension WITHOUT compensatory tachycardia
A
Autonomic dysfunction:
- low B12
- DM autonomic neuropathy
- Parkinsons
- EtOH
- Amyloid
Beta blockers
20
Q
Conditions associated w/ Aortic Dissection
A
HTN
GCA
Bicuspid aortic valve
Cocaine
Trauma
PCKD
SLE
Ehlers-Danlos
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
22
Q
Cholesterol lowering meds
A
Statin ->Ezetimibe ->PCSK9 inhibitors
23
Q
Bisphosponate side effects
A
Osteonecrosis of the jaw
Subtrochanteric and diaphyseal femur fractures
Eg,. Alendronate
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
25
PE findings for osteoporosis
- 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
26
Labs for Suspected Osteoporosis
Calcium
Albumin
CBC
Creatinine
ALP
TSH
SPEP
25-hydroxy vitamin D
27
Indications for BMD testing 50+
1. All women and men 65 and older
3. 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
28
Indications for BMD <50y
- Fragility #
- Prolonged steroid use (3+months in last year of 7.5mg + daily)
- Malabsorption syndrome
- High risk meds
- Hypogonadism, prematrue menopause
- primary hyperparathyroidism
29
Fracture risk assessment (10-year fracture risk)
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
30
Basic bone health
Regular WB exercise
Calcium 1200mg daily (diet and supp)
Vit D 800-2000IU daily after age 50 and 400-1000IU less than age 50
31
Labs for monitoring 2nd gen anti-psychotic meds
1. Total cholesterol, fasting LDL, fasting HDL, fasting TG
2. FPG
3. ALT
4. AST
5. Prolactin
6. Amylase
32
Physical findings of thyroid CA
1. Dyphonia
2. Dysphagia
3. Dyspnea
4. Fixed nodule
5. Regional lymphadenopathy
33
4 steps to trauma informed care
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
34
Treatment for Restless Leg Syndrom
Iron replacement
Dopamine agonists (Pramipexole)
Gabapentin/Pregabalin
35
Risk factors for RLS
- iron deficiency
- fam hx
- renal failure causing uremia
- neuropathy
- pregnancy- MS
- parkinsons
- Meds (anti-emetics, anti-histamines, anti-convulsants, anti-depressants)
36
Eligibility criteria for MAID
1. 18+
2. Capable of making decision and consenting
3. Grievous and irremediable medical condition in an advanced stage or leading to intolerable suffering.
3. Advanced state or irreversibl decline making death reasonably foreseeable
4. No external pressure/request was voluntary
37
Low FODMAP diet
- Onion, garlic, wheat, rye, legumes
- Milk, yogurt, soft cheest
- Mangos, honey
- low cal sweetener
38
ER+ breast CA meds
Selective estrogen receptor modulators (SERM)- eg. Tamoxifen
Aromatase inhibitors - eg. Anasterole (switch to this when hit menopause)
GNRH agonis - eg Gosrelin
39
Leprosy is endemic to:
Endemic to: - India
- Indoneisa
- Brazil
- Democratic Republic of Congo
40
RF for leprosy
Low SES
Genetics
Exposure to affected household contacts (droplet contact spread and nasal mucosa spread)
41
Myalgic Encephalitis Chronic Fatigue Syndrome (ME/CFS)
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
42
Myalgic Encephalitis Chronic fatigue syndrome treatment
Manage chronic diseases
Antidepressants
CBT
Exercise
Improve sleep hygiene
43
Fibromyalgia Diagnostic Criteria
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
44
Fibromyalgia Treatment
- 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
45
What is the name of the condition that makes you pee when you laugh?
Giggle micturition
46
Whooping cough facts
- 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
47
IBS Rome Criteria
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
48
IBS Treatment
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
49
Meningitis pathogens and rxn
0 - 1 mo
1 - 23 mo
2 - 50 y
> 50y
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
50
LP findings in viral vs. bacterial meningitis
Viral: WBC 10-500, lymphocytes, moderately increased protein
Bacterial: WBC 500-10,000, decreased glucose ration <0.4, increased protein, 80-95% neutrophils
51
GAD diagnosis
>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?
52
Panic Disorder DSM 5
Recurrent unexpected panic attacks without situational trigger and concern about them or maladaptation x >1 month
53
PTSD DSM-5
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
54
OCD DSM-5
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
55
Agoraphobia
1. Fear of a situation and the avoidance or the situation due to fear
56
Social anxiety Disorder
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
57
GAD-7 scores and components
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
58
Secondary causes of HTN
A - atherosclerosis
B - Blocked kidneys
C- Catecholamines
D- Drugs, diet, supplemental, licorice, NSAIDs, OCP
E - endocrine (aldosterone, thyroid, ETOH)
S - sleep apnea, stress, salt
59
Lifestyle interventions for HTN
Decrease sodium
Decrease weight
DASH diet
Alcohol
Exercise
CBT/relasation
60
HTN targets
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
61
When to avoid ACEi
If black or pregnant patients
62
HCTZ possible risk
Possible increased risk in skin cancer 4x after 3yrs. Dose dependent. Consider switch if light skin, personal/fam hx or immunosuppression
63
HTN Urgency
Not necessary to treat rapidly
- Start treatment in office not in ED
64
HTN Emergency
Diagnose if:
- Asymptomatic but DBP 130+
- EOD - Acute heart, brain, aorta, renal
- Pre-eclampsia
- Pheo
65
Safe HTN drugs in pregnancy and breastfeeding
BF: Labetolol, methyldopa, nifedipine
AVOID ACEi & ARB
66
HTN in children
- 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
67
Non-sepsis causes of fever
- Pregnancy
- Meningitis
- PE
- Cancer
- Febrile neutropenia
- SJS
- Endocarditis
- GC arteritis
- ?Serotonin syndrome
- NMS
68
Fever of unknown origin w/normal initial labs. Next steps:
- 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)
69
What exam not to do with febrile neutropenia
Avoid rectal temp or DRE
70
Fever in the returning traveler
Malaria until proven otherwise
71
Hyperlipidemia screening guidelines
Men and women 40+
- Consider if South Asian or First Nations
- CV dz or fam hx
- Smoker
- Exam findings like obesity and xanthelasma
72
Validated Risk score
- 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.
73
What to screen for in HTN-sive pregnant patients?
Hyperlipidemia
74
Hyperlipidemia tests other than usual lipid panel?
Apo-B
Lipoprotein A (Order once in a lifetime)
CRP
75
New non-statin agents
PCSK9i (often used in familial hypertrigliceridemia)
Ezetimibe
76
Coronary Artery Calcium Score
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
77
When would you order fasting lipids
If Triglycerides are over 4.5
78
OMEGA-3
- Reduces TG levels by up to 20% but do not improve CV outcome
79
TiTrATE
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
80
Criteria for dx of CKD
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%
81
Monitoringin CKD
eGFR, ACR, electrolytes, urinalysis q6mo
82
CKD Mgmt
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
83
Renal adjustment drugs
S - Sulfonylureas and secretagogues
A - ACEi
D - Diuretics
M - Metformin
A - ARBs
N - NSAIDS
S - SGLT2
84
AKI causes
Pre-renal: Dehydration, hypovolemia
Renal: ATN, Glomerular, AIN, IgA Nephropathy etc.
Post-renal: Prostate, stone etc.
85
Fever in a peritoneal dialysis patient
Spontaneous Bacterial Peritonitis until proven otherwise
86
C/I to Triptans
CVD (CVA/TIA/MI/PVD/coronary spasm/angina)
WPW
Pregnancy
Basilar migraine
Ergot in last 24h
87
Non-pharma migraine treatment
1. Avoid triggers
2. Headache diary
3. Regular sleep
4. Regular diet
5. Stress reduction
6. Avoid caffeine
7. Avoid analgesia overuse
88
When to use prophylaxis for migraines
- >3 migraines per month
- rebound migraines
- C/I to acute migraine meds
- Increased frequency
- migraines for 15d/month x 3 months
89
Migraine prophylaxis medication classes
Betablockers
TCAs
Anticonvulsants
SNRI (Venlafaxine)
Vitamins/supplements (Mg, coenzyme Q, riboflavin)
Flunarizine
Botos
ARB
ACEi
90
Suspected hyperlipidemia
Total cholesterol
LDL-C
TG
HDL-C
A1c or FPG
eGFR
Lipoprotein A - once in lifetime
ApoB
Urine ACR
91
6 risk factors for dyslipidemia screening earlier than age 40
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
92
Components of FRS
Age
Sex
Total cholest
HDL-C
SBP
Treated BP
Smoking
DM
93
Evidence based lifestyle interventions for CV risk reduction:
Smoking cessation
Mediterranean/DASH diet
150 mins mod-vig activity per week
Decrease EtOH consumption
Moderate sleep
94
Cholesterol lowering meds
Statins
PCSK9 inhibitors
Bile acid sequestrants
Nicotinic acid
Fibrates
Cholesterol absorption inhibitors
95
Conditions to rule out when a diagnosis of dyslipidemia is suspected
Hypothyroidism
Nephrotic syndrome
Cholestatic liver disease
CKD
Anabolic steroid use
96
3 Statin indicated conditions regardless of lipid status for primary prevention
Clinical atheroschlerosis
AAA
DM age >40 OR 15 year duration >30 OR DM1 with microvascular disease
CKD >age50 with GFR <60 or ACR>3
97
Lithium monitoring
12 hour troughs 5 days after dose increase
Creat, Calcium, TSH q3-6mo
98
Divalproex
12h troughs + CBC + LFTs q3-6mo
99
Atypical antipsychotis
BP, FPG, A1c, lipids q12mo
100
Kawasaki
C - conjunctivitis
R - rash
A - adenoopathy
S - strawberry tongue
H - hands and feet swollen/peeling
Rxn ASA, IVIG
Complications: Coronary artery aneurysm
101
Anti-malarial drug
Malarone or Doxycycline (cheaper or if allergy)
*Cholorquine has widespread resistence
102
Treatment of malaria
Atemisinin or quinine combinations
103
Travel tips
- 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
104
Altitude sickness
>2800 prescribe acetazolamide or dexamethasone as first line. Can also use nifedipine or sildenafil as second line
105
qSOFA
RR 22+
Altered mentation
SBP <100
106
Statin myalgia options
Lower dose
Drink more fluids
Alternate day dosing
Stop interacting meds
107
Warfarin reversal agent
Vitamin K
108
Heparin reversal agents
Protamine or fresh frozen plasma
109
Dabigatran reversal agent
Praxbind
110
Dopamine blocker drug names
Anti-psych
Risperidone
Haloperidol
Cloxapine
Loxapine
Quetiapine
Olanzapine
Motility agents
Metaclopromide
Domperidone
111
Treatment of PIKA
Olanzapine
Methylphenidate
Treat the complications - ie Bezoar, consider x-ray
112
Indications for Shingles vaccine
Age >50
DM
CHF
Immunosuppression
Renal disease
113
Alopecia areata treatement
<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.
114
Rosasea treatment
If papules and pustules:
Topicals
- Azelaic acid
- Ivermectin
- Minocycline
- Metronidazole
If persistent erythema:
- Brimonidine gel
- oxymoetazoline
If persistent erythmea and telangectasia:
- lasers
115
Osteoporosis risk factors
- Post menopausal
- Prolonged steroid use
- Family history of osteoporosis
- Eating disorder or malabsorption
- Previous fragility fracture
- Smoking
- Sedentary
- Personal history
- Alcohol
- hypogonadism
116
FRAX score
Age >65
Sex
Previous fracture
Previous hip fracture
Current smoking
Glucocoritcoids
RA
Secondary osteoporosis
EtOH >3u/day
Femeral neck BMD
Treat if >20% risk
117
Height loss in osteoporosis
Loss of height 2cm prospective or 6cm historical
118
Labs to order if osteoporosis diagnosis
Hgb
TSH
Ionized Calcium
ALP
Creatinine
Vit D
SPEP if vertebral fracture
119
Meds for osteoporosis
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
120
Osteoporosis Drug holiday timeline
5 years after drug use.
Stop for 5 years.
Only stop if low risk of fracture
121
Disability Tax Benefit Criteria
One of the following
1. Blindness
2. 1+ ADLs severely impaired
3. 2+ ADLs significantly impaired
4. Needs life sustaining therapy
122
CPP Disability
Mental OR physical AND prolonged AND preventing any work.
123
Registered disability savings
Only if eligible for disability tax credit
Max age 59
Not taxed on withdrawal
124
Things to watch for in patients on HIV meds
Dyslipidemia
Triglyceridemia
BMD loss
Renal impairment
125
What to screen for in HIV patients?
CKD
CVD
ANNUAL PAP
DM
Osteoporosis
126
ARV drugs for HIV prevention
PREP: Truvada
Zidovudine: Peripartum and neonates
127
Opioid dosing for non-cancer pain
Starting max 50mg morphine equivalents, titrate up to 90mg maximum.
128
Prior to opioids try:
NSAIDS
TCA
Nabilone
CBT
Exercise
Physio
Self management
129
Withdrawal Management
- 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
130
Indications for Cannabis
Refractor neuropathic palliative pain, spasticity, chemo induced N/V
**Do not drive prior to 6 hours after inhalation and 8 hours after oral ingestion
131
ADLs acronym
D - dressing
E - eating
A- ambulating
T - toilet
H - hygiene
132
IADLs acronym
S - Shopping
H- Housework
A - Accounting
F - Foods and meds
T - Telephone and transportations
133
Ways to improve function in elderly
Hearing aid
Dentures
Glasses
Walker/Wheel chair
Refer to OT, SW, Geriatrics
134
Post-phlebetic syndrome
- US to ensure no clot
- Compression stockings
- Exercise and elevation
- Topical meds if skin changes
- Vein ablation/excision if vascular changes
135
DVT risk trial
1. Stasis
2. Trauma - central line, pacemaker, surgery
3. Hypercoagulable - cancer, pregnancy, meds (OCP, HRT), IBD, CHR, nephrotic, interited
136
Bell's Palsy Treatment
"Stroke spares forehead"
1. Lubricant eye drops
2. Steroids
3. Antivirals if severe.
137
Ramsay Hunt Triad
Herpes Zoster Reactiviation
1. Ipsilateral facial paralysis
2. Ear pain
3. Vesicles in auditory ear canal
138
Stroke scale
Age >60
BP >140/90
Clinical features
Duration of TIA
Diabetes
139
Acute Stroke
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
6. Treat BP if >220 systolic or >120 diastolic
7. 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)
8. REMEMBER:
- Holter monitor, Carotid dopplers, manage afib, echo, optimize DM, cardiac dz RFs
140
Recurrent migraines prophylaxis
- Beta blockers
- Antidepressants (Venlafaxine, Amitriptyline)
- Anticonvulsants (Valproate, topiramate)
- Calcitonin gene-related peptide agonists (Erenumab)
- Botox
141
Acute migraine treatment
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
142
Migraine tool componenets
P - pulsating
O - hOurs 4-72
U - Unilateral
N - nausea
D - Disabling
If 4/5 = 92% chance of migraine
143
Other things to treat in Parkinsons
1. Constipation
2. Drooling
3. Hypotension (Midodrine, Fluticasone)
4. ED
144
First line for Parkinsons
Trial of carbidopa/levodopa
Other treatments:
- Dopamine agonists (Pramiprexole)
- Ritigotine patch
145
Pt with tremor that improves with EtOH
Essential tremor
146
Pt with tremor on long term psych meds
Extra-pyramidal side effects
147
Pt w/resting tremor
PArkinsons
148
Pt w/falls and slow vertical gaze
Progressive nuclear palsy
149
When to assess competency
1. Any acute change in mental status
2. TBI
3. Psych illness
4. Neurodegenerative disease
5. Cognitive aging
6. Delerium
150
How to assess compentency
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
151
3 anticholinesterase inhibitors
Rivastigmine
Donepazil
Galantamine
152
Dementia diagnosis
Not able to function +
decline from previous function + not delirium or psych + 2+ domains
153
Mild cognitive impairement
Not delerium or psych + 1+ domains
154
Domains to assess for in cognitive decline/dementia
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
Tetanus immunoglobulin if...
Unknown vaccine status or really dirty wound
*Otherwise booster q10 years
156
Hip fracture analgesia
US guided femoral nerve block
157
SALTER HARRIS
S- Slipped (type I)
A- Above (type II)
L- Lower (type III_
T- Through or transverse (Type IV)
R- Rammed (Type V)
158
On children for peds x-rays you can order a:
Comparison film
159
Fractures of abuse
- Fracture but non-ambulatory
- Femur # <18 months
- Humerus # <18 months
- Multiple, many healing stages
- Skull
- Metaphyseal #
- Rib #
160
Big 6 in palliative care
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
CHADS65 - To decide if they need to be anticoagulated
CHF
HTN
Age>65
DM
Stroke (2pts)
If CAD give ASA, in no CAD no ASA
162
HASBLED
HTN >160
Abnormal renal/liver function
Stroke/VTE
Bleeding
Labile INR
Elderly >65
Drugs or alcohol
163
Adenosine dose in SVT
6mg IV then repeat 12mg IV
164
Otitis media RF
Maternal smoking
Daycare
Pacifier use
Bottle feeding
165
Otitis media criteria
Effusion +/- air-fluid levels
Inflammation
Acute symptoms
166
Usual pathogens for otitis media
S. penumo
H. influenza
M. Catarrhalis
GAS
Staph aureus
167
Treatment for otitis media
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
Head imaging for children
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
Modified Brooke formula
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
When to refer burn patients
Face, hands, foot, genital, peritoneum, joint
171
Frostbite
- Rapid rewarming in water bath
- Possible thrombolysis + heparin + iloprost (prostaglandin)
- Sterile wound care
- Consult surgery
- Tetanus
172
Trauma in pregnancy
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
Simple febrile seizure criteria
1. Temp >39
2. Generalized tonic clonic
3. 6months to 5y
4. No history of afebrile seizures
174
Indications for Rhogam
- 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
What do we worry about with patients with pink eye who are contact lens wearers?
Pseudomonas
Acanthomeba
176
What does a perilimbal haze indicate?
Iritis or keratitis (need to do fluorescene for keratits to see punctate epithelial erosions)
177
Halos around lights and severe unilateral headaches
Acute angle closure glaucoma
- IV mannitol, oral meds, 3 kinds of eye drops
- Check intraocular pressure
178
Eye pain when blinking and looking in light
Iritis
Keratitis
Scleritis
Glaucoma
179
A patient with pinkeye and diarrhea
Inflammatory bowel disease until proven otherwise
180
3 pink eye red flags
1. Pain
2. Decreased acuity
3. Anisicoria
181
Preterm labor treatments/invest
Fetal fibronectin
Steroids
Tocolysis
Magnesium
Premature rupture - steroids and antibioitcs
182
TOLAC
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
Labor dystocia definition
Less than 2cm in 4 hours
184
Active labour
4+cm dilation
185
Postpartum B's
Bowels
Bladder
Breastfeeding
Bleeding (lochia)
Baby
Blues
Belly
Birth control
Boinking
186
Abortion medication
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
Acute MI Mgmt
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
Dressler's Syndrome
Def: secondary pericarditis seen after an MI.
Ddx: ACS, Pericarditis, Anxeity, PE, Pneumonia
Ix: CRP, echo, CXR
Treat: High dose ASA and NSAIDs
189
Physical exam findings in CHF
Increased Weight
Leg edema
Crackles
S3 (specific)
Elevated JVP (specific)
190
Types of CHF
Preserved EF 50%+
Mid range 41-49%
Reduced 40% or less
191
H2FPEF Score for probability of CHF
H- Heavy (BMI>30)
H - HTN
F - Afib
P - Pulmonary HTN (Pressure >35mmHg)
E - Elder (>60)
F - Filling pressure
192
Quad therapy for HFREF
1. ACEi/ARB/ARNI
2. B-blocker
3. Mineralocorticoid receptor antagonist
4. SGLT2i (even if no DM)
+/- furosemide
193
Breast Cancer RFs
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
Side effects of chemo
Cardiomyopathy
Valvular disease
Fatigue
Secondary malignancy
Ovarian insufficiency
Lymphedema
195
Treatment for obesity if behavioural mgmt fails
Orlistat - (Lipase inhibitor)
Bupropion-naltrexone (Dopamine/norepi reuptake inhibitor)
Semaglutide or Liraglutide (GLP-1 receptor antagonist)
Gastric bypass
Sleeve gastrectomy
Adjustable gastric band
196
Avoid bupropion for smoking cessation if:
Seizure disorder
Eating disorder
EtOH withdrawal
MAOi use
Allergy
197
EtOH use disorder questionnaire
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
Meds for EtOH use disorder
1. Naltrexone (opioid antagonist)
Others: acamprosate, disulfiram
199
SE of OAT
Constipation
Amenorrhea
Decreased Testosterone
200
Canadian C-spine Rule
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
Nexus c-spine rule
For pts <16. Cannot have ANY of the following:
1. Neuro deficit
2. Midline tenderness
3. Alert
4. Intoxicated
5. Distracting injury
202
Cervical radiculopathy definition and imaging
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
Menopause
Psychiatric
Vasomotor
Urogenital
Sex
204
Menopause Lifestyle and Meds Mgmt
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
Pathogen for cat bites
Pasteurella multocida
206
Antibiotic and treatment for cat bites
High risk or in hands - amox clav
Penicillin allergy - Doxy or septra+flagyl
Vaccinate for tetanus and rabies
Do not close wound
207
Rabies common animals and treatment
Dog, cat, ferret, skunk, bat, fox, coyote, raccoon, carnivore
- Call public health
- Give 4 doses of HDCV or PCECV and RabIg
208
When to consider gastric lavage?
1. If within 2 hours
2. No antidote available
3. Potentially lethal ingestion
209
Betablocker overdose antidote
Glucagon
Insulin
210
Iron OD antidote
Deferoxamine
211
Acetaminophen antidote
NAC
212
The only time you treat asymptomatic bacteriuria
Pregnancy
213
UTI meds for pregnant patients
Amox-clav - "according to local resistance patterns"
Macrobid can be used after first trimester
214
UTI treatment for kids
Cefixime 7-10d
Order KUB US if:
Febrile <2y
Recurrent
Complicated
215
Mild epistaxis management
Blow nose
2 sprays of oxymetazoline
Pinch for 10 minutes
216
Severe epistaxis mgmt
ABCs
MOVIES
Labs
Add TXA
Freeze and cauterize (DO NOT cauterize both sides)
Freeze and pack (gauze, rapid rhino, foley)
Abx not necessary
217
Posterior epistaxis
Identify by packing, if still bleeding, call ENT.
- Nasal balloon
- Admit
- Labs for severe bleeds
218
Causes of croup
Parainfluenza
(Influenza, RSV, adenovirus, metapneumovirus)
219
If recurrent croup what do you investigate for?
Bacterial tracheitis
220
Meningitis PE signs
Kernig - Extend KNEE, flex hip
Brudzinksi - Lift BRAIN
Jolt accentuation test
Nuchal rigidity
Blueberry rash
221
Meningitis treatment
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
CSF findings in meningitis
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
Allergy alphabet
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
Pen-Fast Rule for penicillin allergy
0 points = <1% chance of allergy
- <5y since last reaction
- anaphylaxis/angioedema
- severe cutaneous reaction
- treatment required
225
SCOFF Screening tool
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
Bulimia
Binge and purge once weekly
227
Binge eating disorder
Not just overeating
228
Relative energy deficiency in sport
- Formerly 'female athlete triad'
- Calorie deficit due to extreme exercise (?thin, ?no menses)
- Occurs in any gender
229
Sexual assault management
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
ADHD Stimulants
Amphetamine
Methylphenidates
231
SNRIs for ADHD (non-psychostimulants)
Atomoxetine
232
Selective alpha 2a- adrenergic receptor antagonist (non-psychostimulant) for ADHD
Guanfacine
233
Missed abortion Management
1. Surgical Management
2. Medical Management
3. Expectant Management
234
Threatened abortion
- Viable IU pregnancy with cramping or bleeding
- Order serial ultrasounds, serial bHCG, precautions, Cervical suture
235
Complete abortion mgmt
Rhogam if large bleed or >12w
236
AUB Mgmt
2 Non-hormonal
- NSAID
- TXA
3 Hormonal
- LNG IUS
- OCP
- Progestin
4 Surgical
- Ablation
- Hysterectomy
- Polypectomy
- Myomectomy
237
Post-menopausal bleeding mgmt
Pelvic exam
PAP
Endometrial biopsy
Pelvic US
238
Vaginitis investigations
- swabs
- wet mount
- pH
- KOH prep
- Biopsy
239
Other causes of itchy vagina aside from yeast
- 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
PSA Screening
- 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
Prostate CA risk factors
Age
High-risk race (Black)
Family history
Smoking
Obesity
242
Priapism
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
Erectile dysfunction Guidelines
SHIM & Hardness scale
- Offer next visit
- Offer exam
- Offer to interview partner
- Ask about morning erections, contraception, orgasm
- Order A1c, lipids, testosterone
244
Erectile dysfunction second line treatment
- Alprostadil (intraurethral pill or intracavernosal injection_
- Penile pump
- Penile prosthesis
245
Biologic for osteoporosis
Delosumab/Prolia
246
SERM for osteoporosis
Raloxifene
247
Bisphosponates for osteoporosis
Alendronate, Risendronate
248
Gestational diabetes cut offs
Fasting: 5.3
1 hour: 10.6
2 hour: 9.0
249
Normal variability and acceleration size
Normal variability = 5-25 bpm
Accels = 15 beats above baseline for 15 seconds twice in a 20 minute strip
250
Shoulder dystocia managment
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
Pharmacotherapy for PPH
Oxytocin
Misoproste
Ergot
Hemabate (avoid in asthma)
TXA
252
Causes of hemorrhoids
Constipation
Pregnancy
Obesity
HTN
Heavy lifting
253
Symptomatic treatment in Parkinson's
Drooling - botox
Hypotension - Midodrine, fludrocortisone, domperidone
Depression - Tailored to individual
Motor sx - LEvodopa, exercise, deep brain stimulation and gel infusion
254
Indications for allopurinol in gout
1. hx of renal stones
2. Tophi
3. >2 attacks per year
4. CKD stage. or worse
255
Pre-labor RF for shoulder dystocia
1. Prev shoulder dystocia
2. Maternal elebated BMI
3. Gestational Diabetes
4. Macrosomia
5. IOL
256
Intrapartum RF for shoulder dystocia
1. Prolonged stages of labor
2. Use of oxytocin
3. Vacuum delivery
257
Risk factors for celiac disease
Female
Northern european descent
Family history
T1DM
Thyroid disease
Down Syndrome
Turner syndrome
Addison disease
258
Pathophysiology of celiac
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
Penicillin allergy in AOM
Cefuroxime
260
RF for SAH
Smoking
HTN
Moderate to heavy EtOH
Known aneurysm
Fam hx of subarachnoid hemorrhage
Cocaine use
Estrogen deficiency
261
If CT head negative when suspecting SAH what do you do next?
LP
- Elevated opening pressure
- Presence of RBCs
- Xanthochromia
262
APGAR
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
TORCH infections
Toxoplasmosis
Other (syphillis)
Rubella
CMV
HSV
264
RF for low apgar
Opiates in labor
Meconium
Precipitous delivery
Shoulder dystocia
Preterm
265
Two lab tests to assess risk for adverse neuro outcomes in newborns
Umbilical artery cord gasses
Placental pathology
266
Pathognomonic rash in celiac
Dermatitis herpetiformis
267
BMI categories
268
Weight gain in pregnancy
269
VAginal progesterone if...
Cervical length <2.5cm, previous preterm birth
270
Complications. of GDM
LGA
neonatal hypoglycemia
271
Hyperemesis gravida
persistent vomiting, 5% wt loss, abN lytes
272
TSH targets in pregnancy
T1 <2.5
After <3.5
273
ASA in pregnancy indications
Pre-existing HTN
DM
Renal disease
Previous pregnancy with HTN
Mod risk: BMI >35, Age >40 and first preg, fam hx of preeclampsia
274
Treatment of Molloscum contagiosum
- Liquid nitrogen
- Let it be
- Cantharidin
274
HIV med in pregnancy
Truvada
275
Alopecia areata
Clobetasol 0.05% topical
276
Primary varicella described as:
Dew drops on a rose petal
277
Best option for IUD insertion analgesia
Emla cream
278
Pneumothorax in kids mgmt
If not too large - observe and oxygen
If large - small pigtail aspiration
279
Red flags for hearing loss
Sudden hearing loss
Hearing loss after trauma
Unilateral hearing loss with focal neuro signs
280
Lyme disease sx and diagnosis
Target lesions. Treat with doxycycline.
281
Medication classes for acne (name 5)
Antibiotics (Topical clindamycin or erythromycin; Oral Minocycline, doxycycline, tetracycline, erythromycin)
Benzoyl peroxides
Retinoids
Salicylates
Intralesional Steroids
282
Labs before starting isotrentinoin (acutane)
TGs
WBC and differentia
ALT
283
Side effects of isotrentanoin
- dry skin
- sun sensitivity
- birth defects
- joint pain
- epistaxis
- headaches
- abdominal pain
- low mood
- pancreatitis
- psychosis
284
Acne lesion types
Comodomes
Inflammatory papules
Pustules
Nodules
285
Treatment of nausea in pregnancy
Pharma:
Gravol
Promethazine
Chlorpromazine
Metaclopramide
Ondansetron
OTC:
- sea bands
- ginger
- vitamin B6
- pepcid/H2 blocker
- gravol
- antacid
286
Dog attack - rabies questions
- 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
Rabies treatment
1. Rabies vaccine/human diploid cell vaccine (HDCV)
2. Rabies immune globulin
3. Tetanus booster
288
Symptoms of hypercalcemia
Stones
Bones
Groans (abdo pain, N/V)
Thrones (constipation, polyuria)
Psych overtones (confusion, memory loss, fatiuge)
289
Treatment of acute hypercalcemia
IV fluids
Subq or IM calcitonin
IV bisphosphonates (pamidronate/zolendronate)
290
Labs for hypercalcemia
1. SPEP
2. Serum phosphate
3. Vitamin D leve
4. Serum parathyroid hormone
5. Serum creatinine
6. Serum albumin
291
Test to order for sickle cell anemia
Serum hemoglobin electrophoreis
(Autosomal recessive disease)
292
Triggers for blood cells to sickle
1. Hyposxia
2. Dehydration
3. Infection/fever
4. Acidosis
5. Cold temperatures
6. Pregnancy or menses
7. Alcohol
293
Triggers for blood cells to sickle
1. Hyposxia
2. Dehydration
3. Infection/fever
4. Acidosis
5. Cold temperatures
6. Pregnancy or menses
7. Alcohol
294
Mechanism behind anemia in Sickle Cell disease
Abnormally shaped RBCs predisposing them to hemolysis
295
Types of sickle cell crises
. 1. Vaso- occlusive (includes abdo crisis, bone crisis and joint cirsis)
2. Hemolytic crisis
3. Aplastic crisis
4. Acute splenic sequestration crisis
296
Clinical features of epididymitis
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
Investigations to order in epididymitis
1. Color doppler ultrasound of the scrotum
2. Urinalysis
3. Urine C & S
4. WBC
5. urethral swab for Chlamydia and Gonorrhea
298
Risk factors for placenta previa
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
Risk factors for primary nocturnal eneuresis
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
Factors associated with delayed toilet training
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
Scrotal Masses table
302
Scrotal masses algorithm
303
Primary enuresis vs secondary
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
Treatment for enuresis
**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
Causes of torsades
Hypomag
HypoK
HypoCa
Meds
Hypothermia
Give magnesium.
NO PROCAINAMIDE OR AMIODORONE, NO BETA BLOCKERS
306
Rosasea treatment
1. Metronidazole gel or lotion
2. Azelaic acid
3. Brimonidine Tartrate (shrinks blood vessels)
4. Ivermectin (decreases inflamation_
5. Tretinoin cream
307
Most common pathogens for traveller's diarrhea
Escherichia Coli
Campylobacter jejuni
Salmonella
Shigella
Yersinia
Giardia
Norovirus
Rota virus
308
Post exposure prophylaxis
Truvada + raltegravir
309
Post exposure testing for HIV, HBV and HCV
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
Syphillis treatement
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
Trichomoniasis
Green/yellow malodorous discharge, burning, dyspareunia
Treat with Metronidazole 2g PO once and treat partner
312
Only test for cure of chlamydia if:
Persistent sx
Pregnancy
Poor adherence to treatment
Alternate abx use
Re-exposure
Always test for cure in gonorrhea and syphillis
313
Pelvic inflammatory disease features:
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
Treatment for gonorrhea
Azithro PO x 1g AND either CTX 250mg IM or Cefixime 800mg PO
Test of cure 3-7 days after treatment completed
315
PID treatment
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
Primary features of rosasea
Flushing (transient erythema)
Nontransient erythema
Papules
Pustules
Telangiectasia
317
Bacteria that causes acne
propionibacterium acnes
318
Factors that make a good screening test
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
Number needed to screen for breast CA in age 40-49, 50-59, 60-69
40-49: 1700
50-59: 1300
60-69: 1000
320
Acute lithium toxicity
Tremor
Nystagmus
Hyperreflexia
Seizures
Confusion/aLOC
321
Treatment of constipation (classes and meds)
2. Osmotic laxatives - Restorolax, lactulose, magnesium salts
3. Bowel stimulants - Senokot, bisacodyl
4. Bulking agents - psyllium, bran
5. Bowel lubricants - glycerine, mineral oil
6. Enemas - tap water, oil
7. Prokinetics - Linaclotide
322
Benefits of stopping smoking
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
Cancers associated with smoking
Lung
Oropharyngeal
Esophageal
Bladder
Cervical
Stomach
324
Meds for smoking cessasion
1. Nicotine replacement products
2. Nicotinic receptor partial agonists - 3. Varenicline (Champix)
4. Norepinephrine dopamine receptor antagonists - Bupropion
5. Alpha 2 adrenergic receptor agonists - Clonidine
325
Interviewing an unmotivated smoker
Risks
Rewards
Roadblocks
Repetition (q6-12mo)
326
Mono treatement recommendations
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
Guardasil (HPV-9 vaccine)
Females and males age 9-26
328
Treatment of anogenital warts
- cryotherapy
- surgery
- laser
- imiquimod
- Podofilox solution
- Trichloroacetic acid
329
Waist circumference measurements
Men <102cm
Women <88cm
330
Physical exam signs of end organ damage from HTN
Retinopathy
Carotid bruids
Renal bruits
Femoral bruits
S4
Weak/absent peripheral pulses
331
GAS pharyngitis treatment
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
MOCA scores
Mild 18-26
Moderate 0-17
Severe <10
333
Do you screen for cognitive impairment
NO. No screening recommended in asymptomatic patients.
334
Components of the MOCA
1. Visuospatial
2. Naming
3. Attention
4. Language
5. Abstraction
6. Delayed recall
7. Orientation
335
Risk factors for DM
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
Risk factors for carpal tunnel
Diabetes
Hypothyroid
Pregancny
Obesity
Rheumatoid athritis
Fracture
337
When is hormonal emergency contraception not effective
If taken on the day of ovulation or the day after
338
When can you start hormonal contraception after using emergency contraception?
Levonogestrel - day after
Ullipristal accetate - 5 days after
339
Anticholinergic toxidrome and drug classes that cause it
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
Cannabanoid hyperemesis treatemtn in hospital
IV fluids
IV haldol
IV/IM lorazepam
Topical capsacin cream
Hot shower
Stop cannabis for cure
Refer to addictions
341
Potential complications of acute bacterial sinusitis
1. Periorbital cellulitis
2. Meningitis
3. Sepsis
4. Intracranial abscess
5. Osteomyelitis
342
Signs of bacterial sinusitis over viral
- Sx lasting >7d
- Sx worsening after 5d
- Pain/pressure over sinuses
- Nasal obstruction
- Smell disorder
- Purulence nasal discharge
PODS - pain, obstruction, discharge, smell
343
Components of cannabinoid hyperemeisis syndrome
1. Episodic pattern of vomiting lasting <7d with asymptomatic periods between
2. Prolonged cannabis use
3. Exclusion of alternative diagnosis
344
Contraindications to stroke fibrinolysis
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
What factors increase number of HSV outbreak
- URTI
- Trauma
- Fever
- Psychosocial stress
- Teroid use
- Immunosuppresion
- Sun exposure
- Surgery
- Menses
346
Risk factors for open angle glaucoma
Family history
Diabetes
Increasing age
Elevated intraocular pressure
African descent
347
ADHD medication classes and examples
- 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
Symptoms of menopause
- vaginal dryness
- dyspareunia
- sleep disturbance
- mood changes
- incontinence
- decreased libido
- memory problems
- joint aches
- new UTIS
349
Thyroid nodule
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
Chorioamnionitis
1. Fever >38
Plus two of:
- uterine tenderness
- maternal or fetal tachycardia
- foul/purulent amniotic fluid
- maternal elevated WBC
351
Complications of CKD
- Fluid retention
- Hyperkalemia
- Metabolic acidosis
- Hypophosphatemia - increasing risk. of#
- Hypertension or worsening HTN
- Anemia
- CAD
- Immune dysfunction
- Sexual dysfunction
352
What x-rays to order for FOOSH
Wrist PA
Wrist lateral
Wrist oblique
Scaphoid views
353
PE of scaphoid fracture
- 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
Scaphoid fracture complications
Non union
AVN of the scaphoid bone
355
Nephrotoxic meds
S - Sulfonylureas
A - ACEi
D - Duretics
M - Metformin
A - ARBs
N - NSAIDs
S - SGLT2 inhibitors
356
Nephrotoxic meds during times. ofillness
S - Sulfonylureas
A - ACEi
D - Duretics
M - Metformin
A - ARBs
N - NSAIDs
S - SGLT2 inhibitors
357
How long can you store breastmilk?
Fridge 7 days
Freezer 3-4 months
358
Non-pharma ways to increase breastmilk
1. Pumping
2. Adequate hydration
3. Adequate nutrition/calories
359
Benefits to baby from breastfeeding:
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
Benefits to mom from breastfeeding
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
Diarrhea red flags
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
Indication for TURP
- Recurrent or refractory urinary retention
- Recurrent UTIs
- Failure of conservative management
- Recurrent hematuria
- Renal dysfunction
- Patient preference
- bladder stones
363
Lifestyle management of BPH
- Avoid fluids before bed
- Fluid restriction
- Avoid caffeine
- Avoid decongestants, antihistamines, diuretics
- Timed/organized voideing
- Avoid constipation
364
Side effects of 5-alpha reductase inhibitors (Dutasteride)
- erectile dysfunction
- retrograde ejaculation
- gynecomastia
- decreased libido
- decreased ejaculate volume
365
Indications for operative delivery
- 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
Checklist before vacuum
Call for help
Maternal consent
Fully dilated
Consider analgesia
Empty bladder
Determine fetal head position
Membranes ruptured
+2 station
367
Benefits of oxytocin for induction/augmentation and risks
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
Risk factors for SIDS
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
Milestone components
Gross motor
Fine motor
Language
Social
370
5 A's of obesity and classes
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
Parent education around simple febrile seizure
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
Symptoms of OSA
Snoring
Daytime fatigue
Choking/gasping in sleep
Morning headache
Labile mood
Poor concentration
Memory loss
Low libido
Erectile dysfunction
373
Risk factors for OSA
- Obesity
- Hx of CAD
- Hx of CVA
- pregnancy
- large tongue
- family history
- nasal septal deviation
- large neck circumference (>43men, >41 women)
374
Treatment for OSA
- CPAP
- Weight loss
- Non supine sleeping position
- Avoid EtOH
- Avoid sedatives
- Mouth guard
- Surgical correction of craniofacial abnormalities
375
Treatment for OSA
- CPAP
- Weight loss
- Non supine sleeping position
- Avoid EtOH
- Avoid sedatives
- Mouth guard
- Surgical correction of craniofacial abnormalities
376
Complex febrile seizure if:
- More than one seizure in 24 hours
- focal seizure
- Lasting more than 15 mins
377
UTI Pathogens - KEEPS
K - Klebsiella
E - Enterobacteriaceae
E - E. Coli
P - Proteus mirabilis
S - Staph saprophyticus
378
MRSA risk factors
- 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
Altitude sickness
- 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
Drugs that don't bind to charcoal
- Lithium
- Alochols
- Potassium
- Lead
- Iron
381
Indications for Dialysis (AEIOU)
A - Acidosis pH<7.1
E - electrolytes Refractory K>6.5
I - Intoxications
O - Overload refractory to diuresis
U - uremia
382
Causes of anion gap acidosis
M - methanol
U - uremia
D - DKA
P - Propylene glycol
I - Isoniazid/Iron
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates
