LearnFM Cards Flashcards
How should the patient be set up and supported for an accurate office BP measurement?
Back and arm supported
Bladder emptied
Seated comfortably with legs uncrossed x5min
No talking prior to or during measurement
What features of the BP cuff & setup are important for accurate BP measurement?
3cm above elbow crease on a bare arm
At level of right atrium
Width of bladder should be 40% of arm circumference
Length of bladder should be 80% of arm circumference
What should be done before assigning a diagnosis of white coat hypertension?
24h ambulatory BP readings
Even if pt has record of several at-home readings WNL
What is the cutoff for a Dx of hypertension on home BP monitoring?
≥ 135/85 awake average
≥ 120/75 asleep average
≥ 130/80 overall average over 24h
What Ix should be routine on an initial diagnosis of essential hypertension?
Na, K Cr or eGFR; consider albumin-creatinine ratio Fasting blood glucose fasting lipid panel Urinalysis (blood, protein) ECG (for LVH)
Other investigations are guided by clinical concern of end-organ damage, or 2y causes of HTN
What cormorbidities/conditions should people with HTN be monitored for?
Dyslipidemia CKD DM CAD Other end-organ damage
What should you suspect in a young patient with new hypertension?
Secondary hypertension: work up for potential causes
What is one common cause of secondary hypertension in young, active people?
NSAID use (esp after injury)
What is the foundation of HTN management?
Lifestyle changes
- Salt restriction (6g/d)
- reduce EtOH intake
- DASH diet
- BMI/waist circumference reduction
- Exercise
- Smoking cessation
What lifestyle modification has the largest impact on blood pressure?
BMI/waist circumference: 5-20mmHg per 10kg lost
What history is important for an infant presenting with a fever?
Feeding Activity & energy at home Fever, cough, congestion, diarrhea Sick contacts, recent travel PMHx till now Immunizations
What condition must you have a low threshold of suspicion for in infants?
Sepsis
Hx of poor feeding, lethargy, low or high temp all prompt immediate full septic workup and treatment in hospital.
What would you do with an infant presenting to your office with Hx of poor feeding, lethargy, low or high temp?
Send to ED: these features all prompt immediate full septic workup and treatment in hospital.
Name 3 risk factors for infant sepsis
untreated GBS status
maternal fever during delivery
active vaginal lesions during delivery
How do you manage suspected infant sepsis in a rural hospital?
Blood culture as you start an IV
Then up to 3 boluses NS (20mL/kg)
Continue APLS as required
Once stabilized: contact pediatric centre for guidance on empiric Abx, then transfer
What do you try if an infant seems well on exam, is hungry, but has trouble feeding after a few minutes?
Nasal suction & then re-feeding
If a child has an erythematous tympanic membrane, no signs of effusion, and symptoms for <48h, how do you treat?
Supportive care
Followup in 2d if still symptomatic
How do you manage acute OM + fever in 6-24mo?
Treat with empiric Abx, even if symptomatic <2-3d.
Amoxicillin is first line
How do you treat a young child with bronchiolitis?
Rx normally not needed
If irritable, elevated RR, signs of decompensation: consider transfer to ED (pediatric)
If you’re in rural ED, O2 + consult peds ED
What is bronchiolitis?
viral infection caused by RSV (respiratory syncytial virus)
What is the initial workup for peripheral neuropathy?
Diabetic check
B12
When is a cardiac workup indicated for dizziness?
Cardiac features, like arrythmias or chest pain
What is the classic triad of Menière’s disease?
episodic vertigo, aural fullness and hearing loss
What is the workup for Menière’s disease?
Ix: audiometry, MRI of the brain + acoustic meatus
In which patients should you do a CV risk assessment (eg Framingham)?
Assess every 5y for women >50 and men >40
Sooner if any risk factors appear
When should you initiate screening lipids?
All women & men >40 (sooner if risk factors)
Who should have VitD supplementation?
> 50 years: 400-1000IU daily
<50 years 800-2000IU daily
Who should have supplemental calcium?
Dietary always preferred to calcium supplements.
Daily intake should be approx 1200mg from all sources
Name 5 things on the DDx for back pain (7 listed)
Mechanical Muscle strain Disc herniation Discitis Vertebral # Cancer Arthritis
How do vertebral fractures present?
moderate to severe pain reproducible on exam
Usually with obvious trauma, though pt with osteoporosis or malignancies may not have trauma Hx
What are the basic Hx and exam features of ankylosing spondylitis?
20-30 year old age group
Subacute/chronic back stiffness
most pronounced in the morning.
Exam: Lumbar flexion and lateral flexion are reduced.
What history raises suspicion for discitis?
new onset back pain
fever
Hx of IV drug use, spine surgery, or recent infection
What history raises suspicion for neoplasm?
Progressive back pain over 6w with unexplained weight loss
What is classic ACS chest pain?
classic L, crushing, radiation to L arm
Exacerbated by exertion, some SoBoE
ø cough or fever or tenderness on palpation
How is costochondritis diagnosed?
Dx of exclusion: w/u for ACS first
Pain is reproducible on palpation, and not worse with exertion
If a pt presented with pleuritic chest pain, tachypnea and tachycardia, what would you suspect?
PE
What drugs should be re-evaluated in an elderly pt with recent falls?
Benzodiazepines
Alpha 1 blockers (may cause hypotension)
What two common medications can worsen CKD when combined?
Ibuprofen
ACEi
Name 6 contraindications to combined hormonal contraception (11 listed)
< 6 weeks postpartum if breastfeeding
smoker over the age of 35 (≥ 15 cigarettes per day)
hypertension (systolic ≥ 160mm Hg or diastolic ≥ 100mm Hg)
current or past history of VTE
ischemic heart disease, history of cerebrovascular accident, cardiovascular disease
migraine with focal neurological symptoms
breast cancer
uncontrolled diabetes or liver disease
What kind of contraception can breastfeeding women have?
Progestin only (not combined)
Which methods of contraception are/can be combined hormonal?
cOCP
Transdermal patch
Ring
What are potential etiologies of worsening menorrhagia?
thyroid issues, fibroids, coagulopathies, polyps or endometrial hyperplasia/cancer
What should a patient do if they miss a pill (of cOCP)?
Take the pill as soon as possible along with backup contraception, then resume regular method
What forms of emergency contraceptive are available in Canada? How long are they effective?
- copper IUD (effective up to 7 days after intercourse)
- high dose combined oral contraceptive (Yuzpe method)
- progestin only emergency contraceptive (ie Plan B)
The hormonal methods are most effective the first 72 hours but can be used up to 5 days. The earlier the intervention the more effective.
What domains of care should be asked about when discussing goals of care?
resuscitation measures (chest compression, intubation) life support measures (mechanical ventilation) life sustaining measures (Abx, transfer to ICU)
True or false: once you’ve had a goals of care conversation, you don’t need to have it again.
False: Remember goals of care can shift, and convo can be had more than once
When should the first postnatal visit take place?
1w
How much of their birth weight is a baby expect to lose in the first week? By when should they regain it? What other features should you assess?
Up to 10%
By 7-10d [other source said 2w]
If they appear well, feed well, and have appropriate stool pattern and urine output
What is the simple formula for estimating a due date?
Naegele’s rule: add 7d and subtract 3mo
E.g. LMP Feb 7 → Nov 15
What recommendations should be given in preconception counselling?
- optimize meds (remove teratogens)
- Folic acid 0.4-5mg
- avoid alcohol
- weight optimization / healthy habits
When is gestational diabetes screening done? What screening should be done before conception?
GDM screening is at 24-26w
No screening for DM is needed prior to pregnancy
What is gold standard for Dx of COPD?
Spirometry: FEV1/FVC <0.7
What is the only intervention that is shown to slow the rate of lung function and decline in COPD?
Smoking cessation
What vaccines are routinely recommended in people with COPD?
Influenza and pneumonia
COPD confers increased risk of complications from influenza and pneumonia
What are the most common causes of chronic cough?
ACEi use asthma environmental triggers gastroesophageal/laryngeal reflux disease upper airway cough syndrome
What is a common mimic of depression, that can be managed by family doctors? Name one clinical feature that can help distinguish it from depression
Hypothyroid
Cold intolerance
What therapy may be effective for patients who present with seasonal (winter) depressive features?
Light therapy
first line, over pharmacotherapy
Who should be screened for diabetes, and how often?
all adults >40 using either a fasting plasma glucose or an A1C every 3 years
If elevated risk, screen more frequently (every 6-12mo)
Reassess risk annually (eg CANRISK calculator)
When should an adult be immediately tested for diabetes?
If they develop symptoms/clinical suspicion (fatigue, polyuria, blurry vision, etc)
What are the risk factors for sleep apnea?
STOP-BANG: Snoring Tired Observed apnea Pressure (HTN) BMI Age > 50 Neck size Gender: male
What is the initial workup for suspected CHF?
ECG
Echo
CXR
In a patient with fatigue, weight loss, a cough, and diminished breath sounds, what would your initial workup be?
Cancer suspected: broad but targeted investigations
CBC: underlying Sx of malignancy
Creatinine: kidney dysfunction
CXR: evidence of adenopathy
