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Clinical pearls and targets from lectures clerkship rotations > Med FAM > Flashcards

Med FAM Flashcards

1
Q

In patients with hemoglobinopthies (ex. sickle cell anemia), recent blood loss or recent drastic change in diet (or extremely low carbs diet) how should we assess diabetes?

A

Obtaime the serum fructosamine levels

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2
Q

What is the HbA1c target to assess that a patient is DB?

A

6.5% or more

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3
Q

What is the value of the HbA1c to assess that a patient is pre-DB?

A

6-6.4%

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4
Q

What is the HT target for DB patient?

A

130/80

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5
Q

What is the target value of the HbA1c for most people with DB I et II?

A

Less than or equal to 7%

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6
Q

What is the mechanism of action of Sulfonylureas (Glyburide –> Diabeta)

–> Oral therapy

A

Sulfonylureas bind to and close ATP-sensitive K+ (KATP) channels on the cell membrane of pancreatic beta cells, which depolarizes the cell by preventing potassium from exiting. This depolarization opens voltage-gated Ca2+ channels. The rise in intracellular calcium leads to increased fusion of insulin granules with the cell membrane, and therefore increased secretion of mature insulin

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7
Q

What is the MA of metformine/ biguanide (Glucophage)?

–> Oral therapy

A

Metformin is a biguanide anti- hyperglycemic agent. It works by decreasing glucose production in the liver, increasing the insulin sensitivity of body tissues, and increasing GDF15 secretion, which reduces appetite and caloric intak

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8
Q

What is the MA of GLP-1 receptor agonist (Ozempic, exanide )

–> IV injection twice daily

A

Decreased glucagon concentrations
Improved insulin sensitivity
Decreased A1C
Slowed gastric emptying
Increased satiety
Decreased free fatty acid concentrations
Decreased body weight

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9
Q

What is the MA of DPP-4 inhibitors (Gliptins)

–> Oral therapy once daily

A

DPP-4 inhibitors increase the levels of GLP-1 and GIP, which in turn increase beta-cell insulin secretion in the pancreas, thereby reducing postprandial and fasting hyperglycemia.

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10
Q

What is the MA of Glucosidase inhibitors?

A

work by preventing the digestion of carbohydrates (such as starch and table sugar). Carbohydrates are normally converted into simple sugars (monosaccharides) by alpha-glucosidase enzymes present on cells lining the intestine, enabling monosaccharides to be absorbed through the intestine. Hence, alpha-glucosidase inhibitors reduce the impact of dietary carbohydrates on blood sugar.

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11
Q

How to manage hypoglycemia if the person is conscious?

A

Give juice, soda, candy or other sugar containing product can rapidly alleviate the sx on a temporary basis.

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12
Q

How to manage hypoglycemia if the person is unconscious?

A

Give glucacon

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13
Q

In girls < 24 mois what is the rule for ruling out UTI?

A

age <12 months, white race, temperature >39°C, fever for >2 days and absence of another source of infection. When there are no more than one of these features, the risk for UTI is <1%.

https://cps.ca/en/documents/position/urinary-tract-infections-in-children

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14
Q

If you suspect a UTI in a child for urinalysis and he is not toilette train how do you obtain it?

A
  • urethral catheterization*
  • suprapubic aspiration (SPA*),
  • use of a paediatric urine collection bag
  • leaving the child with the diaper off and obtaining a clean-catch urine when the child voids.

Only valid methods for urine culture

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15
Q

In UTI/ urinalysis interpretation what does Nitrite tell us?

A

positive nitrite test makes UTI very likely (Table 1), but the test may be falsely negative if the bladder is emptied frequently or if an organism that does not metabolize nitrate (including all Gram-positive organisms) is the cause of infection.

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16
Q

What is the most common virus that causes bronchiolitis in infants and young children?

A

respiratory syncytial virus (RSV)

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17
Q

What is Roseola?

A

Roseola infantum and s caused by the B variant of human herpesvirus 6

Appears mostly before 3

Abrupt fever (can go up to 41.1) followed by rash (It starts on the neck and trunk and spreads to the extremities.)

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18
Q

What are the manifestations of the Kawasaki disease?

A

Diagnosis is based upon evidence of systemic inflammation (eg, fever) in association with signs of mucocutaneous inflammation, conjunctivitis, erythema of the lips and oral mucosa, rash, extremity changes, and cervical lymphadenopathy

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19
Q

How to diagnose Kawasaki Disease?

A

Requires the presence of fever lasting ≥5 days with 4 of these following:

●Bilateral bulbar conjunctival injection
●Oral mucous membrane changes
●Peripheral extremity changes, including erythema of palms or soles, edema of hands or feet (acute phase) or periungual desquamation (convalescent phase)
●Polymorphous rash
●Cervical lymphadenopathy (at least one lymph node >1.5 cm in diameter)

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20
Q

How do you treat Kawasaki Disease?

A

Immunoglobuline and ASA

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21
Q

What complication are you trying to avoir in Kawasaki Disease?

A

cardiovascular complications, particularly coronary artery (CA) aneurysms. These, in turn, can lead to coronary occlusion and cardiac ischemia and result in significant morbidity or even mortality.

22
Q
A
23
Q

What is the presentation of varicella?

A

Typical case of chicken pox in children begin with a rash in cluster followed by malaise, fever and anorexia.

Typically more in winter and spring.

Rash is described as : papule of vesicles on an erythematous base

24
Q

What is the pathogen responsible for Fifth disease/ slapped cheeks?

A

Parvovirus B19

25
Q

How is the rash in the Fifth disease?

A

Bilateral cheeks, may affect trunk and extremities.

26
Q

What should include evaluation of febrile infants younger than 29 days ?

A
  • Complete blood count with differential
  • Lumbar puncture
  • Blood culture
  • Chest radiography
  • Urinalysis, and urine culture.
  • Stool testing should be performed if diarrhea is present.
27
Q

What should include evaluation of febrile infants older than 29 days but younger than three months?

A
  • urinalysis and urine culture
  • Complete blood count with differential.

Omitting lumbar puncture may be considered in well-appearing, previously healthy young infants with no focal signs of infection, a white blood cell count between 5,000 per mm3 (5 × 109 per L) and 15,000 per mm3 (15 × 109 per L), and no pyuria or bacteriuria on urinalysis.

Stool testing should be performed if diarrhea is present.

28
Q

Is lombar punction appropriate in febrile children younger than 36 months but older than three months?

A

Lumbar puncture is not appropriate unless neurologic signs are present.

29
Q

T/F: Urinalysis and urine culture are recommended as part of the evaluation for all febrile infants 24 months of age or younger with unexplained fever.

A

True

30
Q

What is a clinically significant fever in infant (less than 36 months)?

A

38 taken rectally

31
Q

Name 3 virus that can cause CROUP (laryngotracheobronchitis)

A
  • Para-influenza
  • Adenovirus
  • RSV
32
Q

What is the age range for croup?

A

3 mois - 3 ans

33
Q

Name differential Dx of Croup

A
  1. Acute epiglottitis
  2. Foreign body inhalation
  3. Subglottic stenosis
  4. Angioedema
  5. Retropharyngal abcess
    6 Bacterial tracheitis
34
Q

How do we treat Croup?

A
  • Dex
  • Nebulize adrenaline ?
35
Q

In children what causes acute epiglottitis

A
  • Hemophilus inflluenzae b (Hib)
  • untypable h, influenza, staph, strep
36
Q

What are sx of actue epiglottitis

A

Early: fever and sore throat
late: dysphagia –> drooling, respiratory distress, sitting still leaning foward, inspiratory stridor, inscrease heart rate, muffled voice (potatoe voice),
NO COUGH
-

37
Q

What is the treatment for acute epiglottitis

A
  • ABC
  • Ceftriaxone
  • Dexamethasone
  • Humidified air
  • Oyxgen and IV fluids
38
Q

Name sx of Pertussis

A
  • Cough
  • Audible woop
  • Post-tussive vomiting
39
Q

What should we investigate if patient with abnormal vital signes ( pulse 100 +, FR 24 +, Temperature 38+) examination connsistant with consolidation

A

Pneumonia

40
Q

Name sx of otitis externa (OE)

A
  • Ear pain/ itching
  • Swollen inflamed ear canal
  • Exsudate and discharge
  • Pain when mobilisation
41
Q

Name pathogens of OE

A
  • Staph
  • Strep
  • Pseudomonas (swimmers ear)
42
Q

T/F: patients with DBII are at risk for an invasive external otitis (malignan OE) caused by Pseudomonas

A

True

43
Q

What are the most common bacterial pathogen for OM

A

S. pneumoniae
H. influenzae
M. catarrhalis

44
Q

Name some complication of OM

A
  • Mastoiditis
  • Bacterial meningitis
  • Brain abscess
  • Subdural empyema
45
Q

What is the difference between pneumonia and pneumonitis?

A

Pneumonia: define as an infection of the lung parenchyma.

Pneumonitis: inflammmation of the lung from a variety of non infectious causes: chemical, blood, radiation and AI process.

46
Q

What is the most common mechanism triggering pneumonia?

A

Upper airway colonization

47
Q

What are the 3 bacteria that causes atypical pneumonia?

A

M. pneumoniae
C. pneumoniae
L. pneumophila

on X rays: tend to cause bilat, ,diffuse infiltrates, rather than focal, lobar infiltrates

48
Q

Name the possible complication of pneumonia

A
  • Bacteriemia
  • Parapneumonic pleural effusion
  • Empyema
49
Q

T/F: We should consider the dx of empyema in patients with pneumonia and pleural effusion, especially with patient that continue to have fever despite appropriate atb

A

True

50
Q
A

Clinical pearls and targets from lectures clerkship rotations (1 decks)

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