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Clerkship (CC3) > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

Describe the NYHA criteria for functional assessment of HF

A

Class I - no impairment Class II - some limitation by SOB / fatigue during moderate exertion Class III - symptoms with minimal exertion that interfere with normal daily activity Class IV - inability to carry out any physical activity

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2
Q

What is an example of a disease that follows this trajectory?

A

Organ failure e.g. HF or COPD with exacerbations.

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3
Q

What is the surprise question and how predictive is it?

A

Would you be surprised if this patient died in the next 12 months?

Crap sensitivity, moderate specificity.

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4
Q

What kinds of illness have this course?

A

Progressive neuromuscular diseases, dementia.

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5
Q

How do you use the paliative prefromance scale?

A

Start from the left; ambulation and then move down until you reach their level of function and then work across down to the lowest score in each category. Left-sided categories are “more important” as predictors. Lower scores are more prognostic.

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6
Q

What is the difference between pacemakers & ICDs and CRT?

A

Pacemaking sends gentle electrical signals to maintain a minimum heart rate above a minimum bradycardia.

ICDs defibrillate VFib or VTach. When someone is in advanced decline / comfort, these can be uncomfortable.

CRT can resynch the ventricles to get more effective pumping.

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7
Q

What are some examples of nociceptive pain? What would you use to treat it?

A

Well-localized constant achy or throbbing pain: OA, mecahnical back pain, injuries & surgical pain.

Treat with: non-opioids, acetaminophen, NSAIDs or opioids

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8
Q

What are some examples of neuropathic pain? What do we use to treat it?

A

Burning, shooting pain e.g. dysthesia

Spontaneous pain or allodynia

Hyralgesia or hyperpathia

1st line: TCA or SNRI, gabapentin or pregabalin, lidocaine, nerve block

2nd line: opioids

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9
Q

What can methadone also be used for in additions to substance use disorder?

A

Chronic pain.

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10
Q

What is an appropriate starting dose for hydromorphone or morphine?

A

0.5mg-1mg PO hydromorphone q4h

or 2.5-5mg PO q4h

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11
Q

What can you use for breakthrough pain?

A

10% of their total daily dose q1-2h PRN.

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12
Q

What is the dosage to convert PO opioids into SQ or IV?

A

Divide dose by half.

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13
Q

What information must be provided on a prescription for an opioid?

A

You must spell out in letters the exact number of tablets to be dispensed.

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14
Q

What are some side effects of opioid use?

A

1: overdosing
2: side effects: N/V, pruritis, constipation, sedation
3: toxicitiy: kidney failure, delirium, seizures, myoclonus, seizures and respiratory depression.

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15
Q

When do we suggest moving someone to PCU or hospice.

A

When home supports are maxed out (4h / day of care). For patients in their last 3 months of life, a palliative care unit (in a hospital) or hospice (standalone building), with round-the-clock nuring and PSWs there to try to help them be comfortable.

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16
Q

What diseases would be “good” candidates for tube feeding or TPN? What are the complications of tube feeding or TPN.

A

Neuromuscular disease or bowel obstruction or cancer where functional status is otherwise ok and intake would be life-limiting are “better candidates”.

With other life-limiting disease, there is no good evidence for tube feeding or TPN. Complications include electrolyte abnormalities, infection, aspiration (with tube feeding), liver faiilure, blood clots.

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17
Q

What are some signs of immenent death?

A

Cool, mottled extremities

Irregular HR, weak pulse, irregular breathing (both rate & depth)

Lots of secretions in upper airway due to saliva pooling.

Unable to swallow / rattling sound

Periodically unresponsive

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18
Q

How do you pronounce the patient dead?

A

Let family know what you want to do, say that they can leave the room or be present.

Auscultate heart for 1 minute, lungs for 1 minute, no pulses, no respiration, fixed pupils. Need at least 2 organ systems failed.

Fill out the death certificate.

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19
Q

How do you fill out the immediate, antecedent and underlying cause of death? What do you do for MAID? If you have a suspicious death what do you do?

A

Do not use vague terms. Use the actual medical conditions no abbreviations, even if best guess. For MAID write the underlying disease that cause them to seek MAID & you need to call the coroner)

Immediate - what caused them to die…NOT “old age”

Antecedent - anything that directly contributes to the immediate cause of death (in reverse chronological order)

Can add other comorbidities in part II.

Can call the coroner if you are unsure,

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20
Q

What are 3 domains that impact aging well?

A

Psychological factors, outlook on life

Physical factors

Connections

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21
Q

What is the overall approach to the older patient?

A

Understand (What’s changed? Are there any new safety concerns? Prioritize (urgent/emergent vs routine)?)

Reflect (What is the most likely explanation, context? Common gorund? Priorities?)

Act (What do you need to do NOW? What needs to be investigated or monitored? Who do I need to contact/collaborate?)

Follow-up (when do we need to reconnect with patient/family? Who will do what? What red flags are there?)

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22
Q

When there is a change in behaviour or an older adult, what do you want to consider on the differential?

A

Stressors, depression, delirium/psychosis or dementia, or substance use. Functional status, elder abuse.

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23
Q

How is frailty defined?

A

Functional dependence, multiple comorbidities with limited comorbidities

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24
Q

How does the clinical frail scale correlate with mortality?

A

CFS 7-9 is correlated with mortality within 6 months

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25
Q

Which vaccines are covered in the older adult?

A

Influenza, shingrix and pneumovax.

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26
Q

What are important factors for health maintenance and health promotion?

A

May continue cancer screening, encourage exercise and bone health, screen for hearing loss and vision changes, keep doing BPs.

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27
Q

What are important predictors of frailty?

A

Low income, psychosocial support, physiologic reserve.

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28
Q

What is the approach to multimorbidity in older adults?

A

Provide continuity of care with a central provider.

Focus on functional optimization and common risk factors.

Extended appointment times

Multidisciplinary care; combine visits

Patient centred care.

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29
Q

What is the frailty five checklist?

A

Feelings (mood, cognition & pain)

Flow (incontinence and constipation)

Farmacy (med rec, go over how they’re taking, what they’re taking, what they’re not taking).

Function & Falls

Future & Family

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30
Q

How do you ask about mood / depression in the older adult?

A

Ask about mood generally?

Ask about loss of interest in activities?

Ask “have you felt sad or blue in the last 2 weeks?”

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31
Q

How do you diagnose dementia?

A

Take hx family & close caregiver’s concerns seriously.

Need objective evidence of memory loss

Need functional loss

Focus physical, labs +/- imaging.

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32
Q

How do you ask about incontinence and constipation?

A

“Do you ever leak urine and get wet?”

“Do you have painful bowel movements or trouble moving your bowels?”

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33
Q

What is the concern for SSRI use in the elderly? How should you manage deprescribing?

A

Falls risk, GI bleed, hyponatremia. Make sure you taper and plan follow up and do one at a time.

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34
Q

What are the STOP / START criteria

A

STOP high risk drugs: anticholinergic, opiate, CV drugs, psychotropics, insulin, NSAIDs and PPI.

STOP drugs for inappropriate targets or unecessary drugs

START drugs with known benefits eg. vitamin D, A fib.

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35
Q

What are the risk factors for falls in the elderly?

A

Previous fall, balance impairment or decreased strength, medications/polypharmacy, gait impairment, visual impairment, arthritis, cognitive impiarment, pain, depression. dizziness / orthostatic hypotension, functional limitation, advanced age, female sex, low BMI, incontinence diabetes.

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36
Q

What is an appropriate physical exam for falls?

A

Orthostatic vitals, height, vision, balance / gait e.g. timed up and go, chair rise, focused neurologic, MSK and Cardiovascular exam.

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37
Q

How do you send a request for a home assessment from OT

A

Contact LHIN, request home safety assessment and gait assessment for gait aid – request report copied to MD.

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38
Q

how do we manage falls?

A

Recommend strength and balance assessment (PT) + exercise program as well as home hazard assessment (OT).

Vision assessment and referral

Med rec, add vitamin D and calcium; may want bone density, treat osteoporosis.

Discuss future / family: SDM and patient’s wishes and values. Normalize advance care planning.

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39
Q

What are some examples of mandatory reporting?

A

Child abuse

Unsafe driving

Communicable disease

LTC resident abuse or neglect

Sexual abuse of a patient

Preferential access or health care fraud

Privacy breach

Malpractice

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40
Q

What is motivational interviewing?

A

Person-centered counseling that addresses ambivalence to change.

It is collaborative and goal-oriented.

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41
Q

What does DARN CAT stand for in motivational interviewing?

A

Desire to change

Ability to change

Reasons to change

Need to change

_________________

Commitment

Activation

Taking Steps

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42
Q

What is the side effect profile of the 5 classes of HTN medication.

A

Thiazide diuretics - hypo Na+ hypo K+ worse uric acid/gout

ACE-i: Cough, hyper K+, angeoedemia

ARB: hyper K+, creatinine

CCB: dihydropuridines - less heart effects; verapamil > diltiazem

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43
Q

What are the indications for BP meds in heart disease

A

Recent MI is beta-blocker + ACEi

CVD is ACEi + diuretic

Other heart disease is ACEi or ARB adding beta blocker or CCB for no HF

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44
Q

What are the indications for blood pressure meds for diabetes

A

ACE-i for renal protection

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45
Q

What are important questions on the fatigue history?

A

Malignancy (b symptoms)

Bleeding (from anywhere)

Inflammatory / autoimmune (joints, rashes)

Cardioresp (SOB)

Sleep / sleep apnea

Psychological symptoms / SDOH

New drug drug/interaction

Impact on day to day life

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46
Q

What is a helpful first question for fatigue

A

Is this muscle weakness, sleepiness, low energy?

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47
Q

What physical exam would be appropriate for fatigue?

A

Cardioresp, abdo, thyroid

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48
Q

What investigations are appropriate for fatigue?

A

CBC, TSH, maybe ferritin

Can add creatinine, lytes, liver function, CK, ESR if needed.

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49
Q

How do you approach the patient with substance use, depression and difficulty sleeping?

A

Figure out what the primary problem (what came first?) then focus on treating that.

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50
Q

What is the approach to management of depression?

A

Nonpharm: therapy, lifestyle (exercise, eating well, sleep hygiene)

Pharm: SSRIs - sertraline, escitalopram (better side effect profile), mirtazapine (for older adults, makes you sleepy & hungry), bupropion (don’t give to bulemia or risk of seizures), venlafaxine (can raise BP). People will often add bupropion to the SSRI as an adjunct or for sexual function

Regular follow-up with PHQ-9

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51
Q

At what point after starting a medication should you expect to see improvement?

A

2-3 weeks with some effect - if no effect switch meds.

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52
Q

What are the recommendations for when to discontinue or continue SSRIs?

A

After 6 mos since last depressive episode can taper

If recurrence, stay on for 2 years then taper

If recurrence, then stay on for life.

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53
Q

How do you assess risk for suicide?

A

SAAD persons

Sex: male (more likely to complete)

Age (v. 25-44, 65+)

Depression

Previous attempt

Ethanol abuse

Rational thinking loss

Social support lacking

Organized plan

No spouse

Sickness / intractable pain

(Passive vs active suicidality)

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54
Q

What is the process for bringing in a patient to get assessed on a form 1?

A

If active suicidality and have taken steps for the plan then need to issue Form 1

72 hrs in hospital to be assessed.

If they are not in hospital, then need to get police.

55
Q

What are criteria for earlier BMD screening? When do we usually do it?

A

Hx of fracture, fragility fracture after 40

Smoking, alcohol use

Low body weight

Inflammatory disorders

Steroid use

Screen 50-65s

After 65, can screen anyone.

56
Q

What are some important questions for history for osteoporosis?

A

Risk factors, previous hx of falls and fractures, and lifestyle

57
Q

What are some specific physical tests that can be done in the setting of osteoporosis?

O

A

Timed up and go (15s to get up, walk 3m turn around and sit down)

Occiput to wall distance

two fingers or more between bottom rib and pelvis

58
Q

What is the cutoff for osteoporosis

A

Femoral neck t score < -2.5

59
Q

What is the recommendation for vitamin D and Calcium for bone health?

A

1000 IU vitamin D.

1200 mg of calcium from diet + supplementation

60
Q

What is the recommendation for follow-up BMD testing?

A

Low risk 3-5 years

Moderate ??

61
Q

What bloodwork is indicated in a new diagnosis of osteoporosis?

A

ALP, Ca2+ albumin, kidney function, CBC

62
Q

How do you manage moderate or severe falls risk?

A

If moderate - send for thoracolumbar spine Xray to rule out occult fractures and have a conversation

If severe - start bisphosphonates (esophagitis, can perversely increase risk of fracture), Prolia / denosumab (injection, need to stay on it for life), SERMS/estrogen (endo)

63
Q

What are the side effects of bisphosphonate therapy?

A

GI upset, myalgia, acute phase reaction

Esophagitis - need to take with food/water, need to stay upright for an hour

Atypical femur fractures, osteonecrosis of the jaw

64
Q

What are the key questions you have to ask before putting someone on OCP?

A

Contraindications: Stroke, clot, blood pressure, migraine + neuro symptoms, smoking

Sexual history / pap hx, STI history

must do BP

65
Q

How do you start an OCP?

A

1st day of your period

Sunday start - 1st sunday after your period

Or start anytime (no immediate protection against pregnancy, at least a week of backup, can have more side effects / bleeding)

66
Q

What are the medications that are contraindicated with OCPs?

A

Antibiotics, Antivirals, Anticonvulsants

67
Q

When do you follow up after starting cOCP?

A

1-3 months afterwards

68
Q

When do you follow up after inserting an IUD? What do you want to check on?

A

Ask about satisfaction, bleeding, STI / infection

Remind them to still use condoms

69
Q

How do you diagnose hypertension? What are the cutoffs?

A

Any measurement >180/110 is hypertensive emergency and a spot diagnosis

If diabetic, cutoff is >130/80 x3 on different days

If not diabetic

2+ Serial visits > 140/90 or automated measurements with a mean of >135/85 with end-organ damage

or 3+ serial visits >160/100 avg + visit 4/5 average >140/90

70
Q

What investigations should you perform in all patients with a new diagnosis of HTN?

A

U/A

Lytes + creatinine

A1C

Lipid panel

ECG

71
Q

What are the targets for the treatment of HTN?

A

Non-diabetic < 140/90

Diabetic < 130/80

72
Q

What are the non-pharm recommendations for HTN management? When is non-pharm mgmt alone appropriate?

A

30-60 minutes of moderate intensity dynamic exercise 4-7 days / week

Weight loss if BMI >=25 or waist circ >102cm for men or 88 for women

Alcohol reduction if >2 drinks per day (or 14/9 per week M/F)

Reduce salt intake <2000mg/day + increase K+ intake / DASH diet

Stage 1 HTN < 159/99

73
Q

What are the pharmacologic options for BP management? How would you start?

A

Initial therapy can be ACEi (esp if DM or heart disease), Thiazide, Beta blocker if < 60 / recent MI or CCB

ARB if ACEi not tolerated

74
Q

When do we start screening for diabetes and dyslipidemia? How often do we screen

A

routine men @40 and women @50 q3 years unless risk factors including at-risk pop

yearly if elevated Framingham score

75
Q

How do you diagnose diabetes?

A

Fasting glucose >7 or 2hr OGTT >11.1 or A1C >6.5

Must have 2 tests on different days if asymptomatic

76
Q

What are the key side effects for different HTN treatments?

A

Thiazides: low Na+, K+ and hyperuricemia (don’t use if gout)

ACE-i = cough, high K+, high creatinine, angioedema, teratogenic

ARB, similar to ACE-i, minus the cough and the angioedema

beta-blocker: fatigue, contraindicated if asthma

CCB: pedal edema, flushing, HA

77
Q

What is the physical exam for diabetes / metabolic syndrome?

A

HTN (BP, vitals, weight, height and waist circ)

Acanthosis nigricans

Foot inspection

Annual dilated eye exam

eGFR/ ACR annually

ECG every 3-5 years

78
Q

What are the lipid and HbA1C and Post-prandial glucose targets for DM?

A

LDL <= 2

A1C < 7

If older 7-7.9, up to 8.5 if frail

5-12 mmol post-prandial

79
Q

When should you screen for lipids?

A

Same as diabetes 40 for men or 50 for women, earlier with CVD risk factors

Re-evaluate q5yrs if not on lipid-lowering therapy

80
Q

At what risk stratification do you start a statin?

A

Secondary prevention

Or primary if 10-year risk > 10%

81
Q

What is the first line treatment pharm for diabetes. What do you add on next?

A
82
Q

When do you screen women with mammography?

A

q2years from 50-74 y old

83
Q

How should you approach the patient presenting with chest pain in the office?

A

Determine if it is likely CAD / unstable angina or MI -> these need to send pt to emerg.

Consider other potential emergencies: PE, Aortic dissection or aneurysm, pericarditis

Non emergent diagnoses include GERD, anxiety disorder and chest wall pain

84
Q

What rule can you use to identify patients with chest pain caused by CAD?

A

5 questions, LR 11.2 if 4-5 YES

Age 55+M or 65+F
Known CAD or cerebrovascular dis

Not reproducible by palpation

Worse during exercise

Patient thinks it’s heart pain

85
Q

What are the red flags on hx that you must watch out for in the patient presenting with headache (9)

A
  1. Recent trauma
  2. Sudden onset
  3. New headache in pt < 5yo or >50 yo
  4. Worst headache of my life
  5. Progressively worse over weeks-to-months
  6. Worse in AM, when supine or when bending over
  7. N/V
  8. Visual changes
  9. Jaw claudication
86
Q

What are the red flags on PE that you must watch out for in the patient presenting with headache?

A
  1. Decreased LOC
  2. Fever
  3. Focal neuro signs
  4. Meningismus (headache + photophobia + nuchal rigidity)
  5. Petichial rash
  6. Papilledema
  7. Red eye or cloudy cornea
  8. Mid-fixed dilated pupil
  9. Tenderness to palpation of temporal artery.
87
Q

In the patient with undifferentiated lower abdo pain, what investigations are indicated?

A

CBC (check for bleeding, leukocytosis), abdo U/S and pelvis and/or scrotal if M, U/A

88
Q

What are risk factors for asthma relapse?

A

Depression, poverty, slow response to treatment in ED, anaphylactic trigger, previous severe asthma attack, admission in last 1 yr, recent ER visit.

89
Q

What are the screening recommendations for colorectal cancer? What are the criteria for colonoscopy?

A

Screeining: FIT test q2 years from 50-74

Colonoscopy at age 50 or 10y prior to earliest diagnosis of relative, q10y thereafter

Previous CRC or adenomatous polyp

IBD

1st degree FHx of CRC

FAP or Lynch syndrome

90
Q

When should you screen for dyslipidemia?

A

Nonfasting lipids (fasting if Hx of triglycerides > 4.5 mmol/L)

Men and women age 40-75 q5 years in concordance with Framingham Risk Score assessment

91
Q

When should you check fasting plasma glucose or HBA1C?

A

Age 40, earlier if high risk, q3years

92
Q

When do you screen with DEXA for bone density?

A

all patients once 65+, earlier if risk factors

Rescreen depending on risk profile

93
Q

When do you stop screening with pap test?

A

70, if 3+ normal results in the last 10 years

94
Q

What is the recommendation for Ca2+ and vitD supplementation to prevent bone loss?

A

1200mg/Day of Ca2+ (either diet or supplements) and 1000 IU vit D

95
Q

What vaccines are recommended by NACI in the older adult?

A

Herpes Zoster vaccine > 60 (currently shingrix funded)

Pneumovax at age 65 (revaccinate if given < 65, offer conjugate vaccine if immunocompromised)

Seasonal influenza yearly (high dose > 65)

Adacel or boostrix once during adulthood, Td q10 years

96
Q

What are the contraindications to patients recieving “live-attenuated” vaccine?

A

Immunocompromise, pregnant or could get pregnant in 1 month, untreated TB, recent blood transfusion or blood product within last 90 days

97
Q

When do you give MMR?

A

12 months and between 4-6 years

98
Q

How do glycemic targets change in the older adult? What is the theshhold for hypoglycemia in the older adult?

A

Functional dependent <8 A1C or tighter control if insulin or SU

Frail +/- dementia <8.5 A1C

<5 mmol/L is hypoglycemia

99
Q

How do you adjust medications in the older adult with diabetes and falls risk?

A

Remove short-acting insulin, lower dose of long-acting insulin, deprescribe sulfonylureas

Reduce doses of other medications as needed if under target

100
Q

What is the differential diagnosis for orthostatic hypotension?

A

4D-AID

Deconditioning

Dysfunctional heart

Dehydration

Drugs (antiHTN, anti anginals, antiparkison, antidepressants, antipsychotics, anti-BPH meds)

Autonomic dysfunction

Idiopathic

Drugs (beta blockers)

101
Q

What are the statin-indicated conditions?

A

Atherosclerosis

AAA

Diabetes if >40 or >30 + 15y duration or microvascular disease

CKD

LDL-C >5 mmol/L (genetic dyslipidemia)

102
Q

What is the diagnostic criteria for osteoporosis?

A

Fragility fracture (fall from standing height or less)

OR

DEXA BMD of femoral neck T score <=-2.5

103
Q

How should you treat insomnia in the older adult?

A

Do NOT prescribe benzos or Z-drugs as harms outweigh benefits and increased sleep is offset by less restful sleep

1st line is sleep hygiene, CBT

Melatonin may be helpful

104
Q

What are some questions to help you nail down the etiology of urinary incontinence on hx?

A

Stress - does it happen when you cough / laugh / bear down

Urge - how often do you have to go to the bathroom? Have you ever not made it to the bathroom on time?

Toileting symptoms (dysuria, hematuria, constipation)

Fluid intake

Incontinence products & Impact on life

Prior Hx of abdo, pelvic surgeries or OBHx or prolapse

For men WISE: weak stream, incomplete emptying, straining / hesitancy, elevated PSA (indicates prostatic issues)

105
Q

What should be assessed on the PE for urinary incontinence?

A

Mental status, personal hygiene, screening neuro

Abdo exam -> check for distended bladder, bladder pelvic tenderness

Rectal exam in men or pelvic exam in women

106
Q

How do you treat urinary incontinence?

A

Address reversible conditions DRIP

Delirium

Restricted mobilitiy or urinary Retention

Infection Inflammation or fecal Impaction

Pharmaceutical or Polyuria

107
Q

What are some non-pharm approaches to reduce UI?

A

Scheduled / prompted voiding

Pelvic floor physio

Reduce caffeine and alcohol - do not restrict water

Bowl regimen

Weight loss

Pessary for stress UI

108
Q

What medications may be helpful in urge UI or stress UI?

A

Urge UI: anticholinergic medication (use with caution in older adult), mirabegron

Stress UI vaginal estrogen

109
Q

What is the criteria for the modified centor score? How do you use it for management?

A

1 point each if

Fever >38

Tender anterior cervical lymphadenopathy

Tonsillar exudate or swelling

NO cough

if 0-1, no treatment, 2-3 swab and treat if positive, 4 swab and treat

110
Q

How would you distinguish between strep throat and mono?

A

Mono has atypical lymphocytosis, positive monospot, and presents with ++ nodes and fatigue, with splenomegaly or hepatomegaly or liver enzymes

111
Q

What is the 1st line treatment for streptococcal pharyngitis?

A

Penn V 600 mg BID x10 days for adult, pediatric dosing if < 27 kg

112
Q

Does treatment of strep pharyngitis reduce the risk of post-strep glomerulonephritis?

A

No.

113
Q

What are the cutoffs for acute, chronic and recurrent sinusitis?

A

<4 wks is acute

>12 weeks is chronic

recurrent is > 4 episodes per year

114
Q

What are the key symptoms that should be present for a diagnosis of acute bacterial rhinosinusitis?

A

Nasal discharge + at least one of

facial pain, obstruction, discoloured discharge or hyposmia

115
Q

How do you manage sinusitis?

A

Don’t give antibiotics. It will most likely resolve in 10-14 days on its own & it’s most likely viral or allergic. If symptoms are persistent and antiiotics are indicated, amoxicillin 500mg TID x5-10 days.

Try topical decongestants for 3-4 days, saline rinse, or intranasal steroids.

DO NOT use antihistamines

116
Q

When should you refer folks to otolaryngology with sinusitis?

A

Anatomical abnormalities, recurrent or treatment-resistant chronic sinusitis or RED FLAGS?!

Abnormal vision, altered mental status, periorbital / forehead swelling, extraocular muscle dysfunction, meningitis

117
Q

What is recommended in management of acute otitis media? When are antibiotics indicated? What would you treat with?

A

In general, do not treat with antibiotics and wait 24-48 hrs, provide acetaminophen.

Antibiotics if < 6mos, toxic appearance, fever > 39C, severe otalgia or not trustworthy for follow-up.

Amox 80mg/kg/d BID x 10 days.

118
Q

How would you distinguish between bronchitis and pneumonia?

A

Bronchitis = not as sick, afebrile

Pneumonia = consolidation, tachycardia and tachypnea, leukocytosis.

119
Q

How do you manage bronchitis?

A

Don’t give antibiotics, it’s 90% viral.

Counsel to avoid irritants and stop smoking.

120
Q

How do you interpret a dipstick in the context of suspected UTI?

A

If 2 or more of dysuria, leuks or nitrites present, can treat w/o culture.

121
Q

What are the characteristics of complicated UTI?

A

Male, immunocompromise, instrumentation or anatomical abnormalities

122
Q

What is the appropriate management for uncomplicated UTI?

A

Nitrofurantoin 100mg BID x5 days

Trimethoprim 10mg BID 3 days

TMP/SMX 2 tabs BID x 3 days.

123
Q

What do you do about asymptomatic bacteriuria?

A

Don’t treat it unless pregnant or pre-op for GU procedure.

124
Q

How do you treat yeast vaginitis?

BV & trichomonas?

G/C?

A

Clotrimazole or miconazole topically or oral fluconazole

Metronidazole 500mg PO BID 7 days (+treat partner if trichomonas)

Ceftriaxone 250 mg IM + azithromycin 1g PO (one dose)

125
Q

What are the 3 most common causes of chronic benign cough?

A

GERD, asthma and PND

126
Q

How is asthma diagnosed in children and adults?

A

Children <0.9 LLN or <0.8 LLN for adults on FEV1/FVC and increase in FEV1 +12% with ventolin.

OR peak exp flow variability >20% after bronchodilator

OR +ve methacoline challenge test with PC20 <4mg/mL or exercise challenge with >10% increase in FEV1 post ex

127
Q

How do you assess adequate asthma control?

A

<4 days / week with daytime symptoms and <4 doses of SABD/week

Mild, infrequent exacerbation

Normal exercise tolerance

No missed work/school and no nighttime symptoms

128
Q

How do you diagnose COPD? What are the cutoffs for the various levels of severity?

A

Obstructive pattern on PFTs, irreversible

Very severe / 30 / severe / 50 / moderate / 80 / mild

129
Q

What is the management of COPD?

A

Nonpharm: smoking cessation / exercise / education / self-mgmt / pulmonary rehab

Pharm: SABD, inhaled salbutamol, corticosteroid or muscarinic antagonist, oral therapy, long-term O2 therapy and noninvasive respiration, lung transplant.

130
Q

what vaccines are given at 2mos and 4 months

A

pediacell (DTap, IPV, HiB), Pneumococcal C-13, Rotavirus

131
Q

What vaccine is given at 6 months and 18 months (previously also at 2 and 4 months)?

A

DTap/IPV/HiB -> pediacell

132
Q

What vaccines are given at the 12 month and 15 month appis?

A

12 - pneu C-13, men-C, MMR

15 Varicella

133
Q

What vaccines are given between 4-6 yrs?

A

TDap IPV and MMRV

134
Q

What vaccines are given at grade 7

A

Hep B, HPV (2 booster set, 6 months apart)

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