Medicine 2 Flashcards
What is the definition of arthritis?
Inflammation in the joints
Name 4 signs and symptoms of arthritis?
- joint swelling: effusion / synovial thickening
- pain
- warmth
- erythema
What is the definition of arthralgia?
Joint pain without swelling, redness or warmth
What is the definition of true syncope?
Loss of consciousness 2° to impaired cerebral perfusion
Name 4 general causes of true syncope.
- reflex mediated
- inadequate circulating volume
- obstruction to blood flow
- arrhythmia leading to sudden loss of CO
Name 4 types of reflex mediated syncope.
- vasovagal
- situational
- autonomic dysfunction
- postural hypotension
In what kinds of situations can you have “situational” reflex mediated syncope?
- micturition
- cough
- carotid hypersensitivity
Name 5 causes of loss of consciousness that are NOT due to impaired cerebral perfusion.
- seizure
- hypoglycemia
- severe hypoxia or hypercarbia
- psychiatric
- head trauma
Name 4 causes of generalized edema driven by increased hydrostatic pressure / fluid overload.
- heart failure
- pregnancy
- drugs (e.g. CCBs)
- iatrogenic (too much IV fluids)
Name 3 causes of generalized edema driven by decreased oncotic pressure / hypoalbuminemia.
- liver cirrhosis
- nephrotic syndrome
- malnutrition
Name a cause of generalized edema driven by increased interstitial oncotic pressure.
Myxedema
Name a cause of generalized edema driven by increased capillary permeability.
Sepsis.
Name 4 hormonal causes of generalized edema.
- hypothyroidism
- exogenous steroids
- pregnancy
- estrogens
À St-Jean, où peut-on référer en physio périnéale?
À ActiSport ou chez Kinatex.
Name 5 systemic causes of sinus tachycardia.
- fever
- inflammation
- infection
- neoplasm
- autoimmune condition
Name 3 endocrine causes of sinus tachycardia.
- thyrotoxicosis
- pheochromocytoma
- hypoglycemia
Name 2 classes of drugs that can cause sinus tachycardia.
- stimulants
- anticholinergics
Name 3 psychiatric causes of sinus tachycardia.
- panick attacks
- GAD
- somatization
Name 4 causes of pathologic tachycardia.
- supraventricular tachycardia (SVT)
- a fib
- atrial flutter
- ventricular tachycardia
Name 2 causes of SVT (supraventricular tachycardia).
- reentrant SVT
- atrial tachycardia
What is the usual paper speed on an ECG?
25 mm/s
On an ECG, what does 1 small square (1 mm) represent on the horizontal axis?
40 msec
On an ECG, what does 1 large square (5 mm) represent on the horizontal axis?
200 msec
On an ECG, what does 1 small square (1 mm) represent on the vertical axis?
0.1 mV
On an ECG, what do 2 large squares (10 mm) represent on the vertical axis?
1 mV
What are the standard limb (bipolar) leads on a 12-lead ECG?
I, II, II, aVL, aVR, aVF.
What are the standard precordial (unipolar) leads on a 12-lead ECG?
V1-V6:
- V1-V2 (septal)
- V3-V4 (anterior)
- V5-V6 (lateral)
What are the additional leads you can ask for on an ECG?
Right-sided leads or posterior leads.
On an ECG, what leads represent the lateral wall?
I, aVL, V5, V6.
On an ECG, what leads represent the inferior wall?
II, III, aVF.
On an ECG, what leads represent the anterior wall?
V1-V4.
What is the normal duration of the PR interval?
120 to 200 msec.
What is the normal duration of the QRS interval?
< 120 msec.
What is the normal duration of the P wave?
120 msec.
What is the treatment effect of statins?
It lowers LDL by about 30-40%.
What is the treatment effect of ezetimibe?
It lowers LDL by about 18%.
Quels sont les 3 classes de médicaments pour la dyslipidémie?
- les statines
- l’ézétimibe
- les inhibiteurs de la PCSK9 (PO ou injections SC, médicament d’exception)
What is the treatment effect of PCSK9 inhibitors?
It lowers LDL-C by about 50%.
Name 3 clinical signs of hyperlipidemia.
- xanthelasma
- xanthoma
- arcus cornealis
What is a xanthoma?
Xanthomas are depositions of yellowish cholesterol-rich material that can appear on the skin anywhere on the body.
What is a xanthelasma?
It is the most common type of xanthoma. It appears on or by the corners of the eyelids, close to the nose.
What is arcus cornealis?
The deposition of lipids on the cornea, around the iris. It forms an arc and can eventually form a ring around the iris.
What are the high-risk ethnicities for dyslipidemia? (2)
South Asians and Indigenous peoples.
What are the atherogenic particles? (4)
- VLDL
- IDL
- LDL
- lipoprotein A
What is ApoB?
Each atherogenic particle contains one molecule of ApoB. Serum ApoB reflects the total number of particles and may be useful in assessing cardiovascular risk.
What is important to remember to rule out in acute upper abdominal pain?
Thoracic sources:
- MI
- pneumonia
- dissecting aneurysm
Describe the Brief Geriatric Screen using the “5 M’s Framework”.
Mind
Mobility
Medications
Multimorbidity
Matters most
What to explore in the “Mind” part of the 5 M’s Framework (brief geriatric screen)? (4 things)
- dementia
- delirium
- depression
- chronic pain
What to explore in the “Mobility” part of the 5 M’s Framework (brief geriatric screen)? (5 things)
- impaired gait / balance
- exercise
- vision
- home safety assessment
- Ca++ and vitamin D
What to explore in the “Medications” part of the 5 M’s Framework (brief geriatric screen)? (3 things)
- polypharmacy
- deprescribing
- adherence
Name 3 important things to check in “general and vital signs” section of geriatric physical exam.
- weight loss
- height
- orthostatic vitals
Name 5 important things to check in head and neck exam in the elderly.
- visual acuity
- whisper test (hearing screen)
- dentition
- lymphadenopathy
- neck masses
Name 5 important things to check in extremities in a geriatric physical exam.
- arterial insufficiency
- venous insufficiency
- edema
- ulcers
- diminished peripheral pulses
Name 3 important things to check in the dermatologic exam in the elderly.
- premalignant/malignant lesions (sun-exposed areas)
- pressure injuries
- foot wounds
Name 5 parts of the gait assessment in the elderly.
- Romberg for balance
- sit-to-stand test
Consider additional balance tests:
- pull-back test
- forward reach
- tandem stance and gait
Name 3 importants parts of the neurological exam in the elderly.
- signs of parkinsonism
- tremor
- cerebellar testing
What is anisocytosis?
RBCs with increased variability in size (increased RDW).
What is poikilocytosis?
Increased proportion of RBCs of abnormal shape.
Name 4 causes of poikilocytosis.
- iron-deficiency anemia
- hemoglobinopathies
- severe B12 deficiency
- burns
In which condition do you see spherocytes?
In immune hemolytic anemia.
What is a discocyte?
Biconcave disc (normal RBC).
What is a spherocyte?
A spheroidal RBC, due to membrane defect or loss of membrane.
Romberg’s test is a test for what?
Balance
What premise is Romberg’s test based on?
It is based on the premise that a person requires at least 2 of the 3 following senses to maintain balance while standing:
-proprioception
-vestibular function
-vision
How do you perform Romberg’s test?
The patient stands with feet together, eyes open and hands by the sides.
The patient closes the eyes while the examiner observes x 1 minute.
What is a positive Romberg’s test?
Romberg test is + when the patient loses balance with their eyes closed. Loss of balance can be defined as increased body swaying, foot movement in the direction of the fall, or falling.
What is the clinical significance of a positive Romberg’s test?
It denotes sensory ataxia as the cause of postural imbalance.
What is the sit-to-stand test?
The chair is placed against the wall to prevent it from moving.The patient is seated in the chair. Arms are crossed at the wrists and held against the chest.
The patient sits and stands as many times as possible in 30 seconds.
What is the pull back test?
The patient is standing up, feet shoulder width apart. The examiner is behind the patient and pulls the patient off balance from the back (needs to be able to catch the patient if they fall!)
If the patient needs more than 2 steps to catch their balance, it is suggestive of parkinsonism.
Au Québec, quel est le temps d’écran recommandé pour les enfants moins de 2 ans?
Aucun temps d’écran.
Au Québec, quel est le temps d’écran recommandé pour les enfants entre 2 et 5 ans?
Moins d’une heure par jour, supervisé.
Au Québec, quel est le temps d’écran recommandé pour les jeunes de 6 à 17 ans?
Maximum 2 heures par jour.
What is poikilocytosis?
The presence of more than 10% abnormally-shaped RBCs. They can present any kind of abnormal shape (acanthocytes, spherocytes, elliptocytes, etc.)
What is the main local complication of acute limb ischemia?
- compartment syndrome 2° reperfusion injury
What are the possible cardiac complications of acute limb ischemia? (4)
- arrhythmia
- MI
- cardiac arrest
- death
(all du to reperfusion injury)
What is the possible renal complication of acute limb injury?
Renal failure 2° toxic metabolites from ischemic muscle
What is an acute abdomen?
Severe abdominal pain of acute onset which requires urgent medical attention.
What are the 2 most important / frequent dx that would cause an acute abdomen and would require potential urgent surgical intervention?
- peritonitis
- bowel obstruction
Where is the referred pain from biliary colic?
To right shoulder or scapula
Where is the referred pain from renal colic?
Groin
Where is the referred pain from appendicitis?
Periumbilical to RLQ
Where is the referred pain from pancreatitis?
To back
Where is the referred pain from ruptured AAA?
To back or flank
Where is the referred pain from a perforated ulcer?
To RLQ (right paracolic gutter)
Where is the referred pain from the hip?
Groin
Where is the referred pain from an ovarian torsion?
To flank or groin.
What is the most common cause of suden onset severe abdominal pain with a rigid abdomen?
Perforated viscus
What is the most common cause of abdominal pain out of proportion to physical findings?
Ischemic bowel.
What is the most common cause of surgical abdominal pain that presents as waves of colicky pain?
Bowel obstruction.
What is the acute abdominal pain mnemonic?
ABDOMINAL
Appendicitis
Biliary tract disease
Diverticulitis
Ovarian disease
Malignancy
Intestinal obstruction
Nephritic disorders
Acute pancreatitis
Liquor / EtOH
What are the 3 major types of lymphocytes?
- T cells
- B cells
- natural killer (NK) cells
In a CBC, what are blasts?
Immature, undifferentiated precursors of WBCs.
If more than 20% of the total WBC differential consists of blasts, what does it mean?
It means that this is acute leukemia and it is a medical emergency.
What are platelets?
Small, purple, anuclear cell fragments.
Name 3 types of Gram positive cocci?
- Staphylococcus
- Streptococcus
- Enterococus
Name 4 types of bacteria that are not seen on Gram stain.
- Mycobacteria (acid-fast)
- Obligate intracellulars (Rickettsiae and Chlamydia)
- Mycoplasma (no cell wall)
- Spirochetes
Name 2 types of anaerobe Gram positive bacilli.
- Clostridioides difficile
- Clostridium (C. tetani, C. botulinum…)
Name 2 types of Gram negative diplococci.
- Neisseria (N. gonorrhoeae)
- Moraxella (M. catarrhalis)
Name 5 types of Gram negative bacilli.
- Campylobacter
- Enterobacterales
- Hemophilus
- Legionella
- Pseudomonas
Name 5 types of Enterobacterales.
- E. coli
- Klebsiella
- Salmonella
- Shigella
- Yersinia
Name 3 types of Mycobacteria.
- M. tuberculosis
- M. leprae
- M. avium complex
Name 2 types of Chlamydia.
-Chlamydia trachomatis
-Chlamydia pneumoniae
How would you define GFR? (explain)
GFR is the rate of fluid transfer between glomerular capillaries and Bowman’s space, expressed as the sum of the filtration across all nephrons.
What is the RAAS pathway?
Renin-angiotensin-aldosterone pathway.
What organ releases the angiotensin?
The liver.
What hormone converts angiotensin to angiotensin I?
Renin
What hormone converts angiotensin I to angiotensin II?
ACE (angiotensin-converting enzyme)
What are the 2 clinically relevant outcomes of the activation of the RAAS (renin-angiotension-aldosterone system) pathway?
- Net increase in total body water and Na+
- Increased vascular tone
(Therefore –> increased systemic blood volume and pressure)
What is a normal score on the MMSE?
24/30 or more
What is mild impairment on the MMSE?
19-23/30
What is moderate impairment on the MMSE?
10-18/30
What is severe impairment on the MMSE?
< 10/30.
What is a normal score on the MoCA?
26/30 or higher.
What is the 1st cranial nerve?
Olfactory nerve
What is the 2nd cranial nerve?
Optic nerve
What is the 3rd cranial nerve?
Oculomotor nerve.
What is the 4th cranial nerve?
Trochlear nerve.
What is the 5th cranial nerve?
Trigeminal nerve.
What is the 6th cranial nerve?
Abducens nerve.
What is the 7th cranial nerve?
Facial nerve.
What is the 8th cranial nerve?
Vestibulocochlear nerve.
What is the 9th cranial nerve?
Glossopharyngeal nerve.
What is the 10th cranial nerve?
Vagus nerve.
What is the 11th cranial nerve?
Accessory nerve.
What is the 12th cranial nerve?
Hypoglossal nerve.
Name the 12 cranial nerves in order.
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal.
What are the supportive features for restless leg syndrome? (3)
- family hx;
- response to dopaminergic agents;
- the presence of periodic limb movements
What does PERRLA mean?
Pupils are
Equal
Round
Reactive to
Light
and Accommodation
Est-ce qu’il existe un GUO (Guide d’usage optimal) pour le H. pylori?
Oui! (2024)
Quel est le générique du Invega Sustenna?
paliperidone
Quel est le nom de marque de la paliperidone?
Invega Sustenna
