CME questions Flashcards
- S.pneumonia = 71% infx >16yo
- Triad is more common pts >60yo
- poor diagnostic accuracy for physical exam (sensitivity = 5% kernig/brudzinki, 30% nuchal rigidity)
- Only 8% adults with meningitis have a bacterial meningitis but still antimicrobial tx should be started promptly and continued if CSF profile suggest bacterial meningitis. (delay abx>6hours increases mortality 6–>45%, neurological sequelae 10–>70%)
- Can also give dexamethasone to reduce inflam in CSF 2nd abx (reduces mortality in S.pneumonia meningitis but non N meningitis and H influenzae).
Ballon catheters :
- did not cause more c-sections
- did not cause more FTP requiring c-sections
- did not change adverse maternal outcome.
BUT IT DID: lower adverse perinatal outcomes.
Buprenorphine lower fetal abstinence syndrome, preterm births and low birth weight compared to methadone. But no changes on maternal outcomes.
metformin and insulin are preferred, no studies on GLP1/SGLT2
Lorazepam has a shorter half-life so is preferred to clonazepam
granulocyte colony stimulating factors (filgrastim) can be included in management + rectal temperature/exam should be avoided.
Early phase: hair loss, CP, cough, myalgia, respiratory disorders
early + late (180-360 days) phase: palpitations, cognitive impairment, dyspnea
if postural instability occurs early in parkinson, look for other causes as it is unusual early on.
Along with thiazide/loop diuretics, ACEi/ARBs/BBs should be stopped. (ASA will also increase risk of gout)
- Accelerates healing of diabetic foot ulcers
- Decreases anaerobic environment which helps decrease gas gangrene, improvement infx of ulcerations of advanced cutaneous tumours
Only 39% mothers are vaccinated during their pregnancy (26-32 wks) and the main reason was not being aware that Tdap (tetanus, diphteria and acellular pertussis) was recommended during pregnancy).
Tdap significantly reduces incidence pertussis (whooping cough) in first 2 months of life.
Pertussis is caused by Bordella Pertussis and is recognizable with 1) paroxysmal coughing fits + 2) whopping cough + 3) post-cough vomiting. Treated with azythromycin and supportive care.
All infants exposed to monoclonal antibody biologics during the pregnancy should receive inactivated immunizations according to routine schedule, most guidelines recommend avoiding all live vaccines for the first 6-12 months of life (only live vaccine before 12 months is rotavirus at 2 months, otherwise DTaP/Polio/H. influenza B/Hep B + pneumococcal conjugate and influenza are all inactivated and MMR starts is given at 12 months anyway).
Although NAATs (nucleic acids amplification tests) are highly sensitive and accurate, they can remain positive for weeks to months after infection.
In persons with exposure to SARS-CoV-2, testing is generally not useful in the first 48 hours after exposure since the virus will not have achieved a sufficient viral load.
Lubricants (artificial tear + ointments) = 1st line therapy for dry eye disease (DED). Not more than 4-6 times/day other risk of toxic conjunctivitis 2nd preservatives (the ones preservative-free can be used more frequently but can still cause toxic conjunctivitis).
Some artificial tears have vasoconstrictors (tetrahydrozoline), avoid regular use 2nd risk rebound redness from vasodilation due to tachyphylaxis (=rapid response decrease to a drug).
Non-pharmaco for DED is light exercise (increases tear secretion) and low glycemic index diet.
Pts with DED that does not respond to over-the-counter medication should be referred to an ophtalmologist.
Paxlovid contra-indicated with amiodarone and midazolam (other highly CYP3A dependent drugs are statins, CCBs, tacrolimus, benzos, methadone/fentayl but they weren’t explicitly named by CFPC like amiodarone/midazolam)
Combination therapy is more effective and same tolrance as monotherapy for acute depression, most notably when applied as first-line treatment + to non-responders.
Paricularly the combination of monoamine reuptake inhibitors (SSRIs, SNRIs, TCAs) with antagonists of presynaptic a2-autoreceptor (mirtazapine, trazodone).
Covert brain infarctions are focal lesions detected on brain imaging consistent with ischemia in the absence of a history of overt stroke or neurologic dysfunction. They are the most common incidental finding on brain imaging, with a prevalence of 10% to 30% in elderly populations. Covert brain infarctions are associated with an increased risk of future stroke. Stroke prevention interventions such as further diagnostic testing and risk factor modification are indicated in these patients according to the current guidelines.
The 4.7-mm Hg difference in BP, greater than the study was powered to detect, might be expected to translate to ˜20% more cardiovascular events during any period of chronic treatment.
Of the two options in pregnant pts with chronic HTN:
1) treating with target <140/90
2) not treating unless >=160/105
No 1 showed reduced risk of pre-eclampsia with severe features, medically indicated preterm birth <35wks, placntal abruption or fetal/neonatal death.
The RR for cardiac dysrhythmia and MSK pain were significantly higher among patients aged 18–64 years.
Other incident conditions were higher in >65yo (renal failure, thromboembolic events, cerbrevasc disease, mental/neurologic disorders, etc.)
Test-of-cure is generally not needed for non-pregnant patients who are treated for chlamydia with a recommended or alternative regimen.
** Pregnant women should be tested 4 weeks after treatment is completed. **
All patients should be tested for reinfection 3 months (6 months in Canada) after completing treatment.
Vyvanse is the only medication indicated for Binge Eating Disorder.
SiADH produces too much ADH stimulating aquaporines to reabsorb too much water causing hyponatremia by hemodilution. It can be treated by tivolptan and you can combine with desmopressin to avoid overly rapid correction (which can cause acute water intoxication that does not have a high risk of osmotic demyelination).
Finkelstein is 100% specific.
23
The CCS guidelines consider Lp(a) a risk modifier and recommend Lp(a) testing once in a person’s lifetime with earlier and more intensive health behaviour modifications in those with Lp(a) levels 500 mg/L (50 mg/dL) or greater.
28
For patients with severe renal impairment (CrCl < 30 ml/min), unfractionated heparin, warfarin, or apixaban is recommended for treatment of VTE.
29
Tamoxifen is a medication that belongs to the class of selective estrogen receptor modulators (SERMs). It is primarily used in the treatment and prevention of hormone receptor-positive breast cancer which stops/slows growth of breast cancer cells. (but acts as estrogen agonist in the uterus, increasing risk of uterine cancer. Also risks for DVT/PE.
