Old SAMPS Flashcards
Contraindications of HRT for postmenopausal symptoms
- pregnancy
- unexplained vaginal bleeding
- known or suspected breast CA
- active liver disease
- acute cardiovascular disease
- CAD
- stroke
- recent VTE
- migraine with aura
presentation of temporal/ giant cell arteritis
new-onset headache constitutional symptoms jaw claudication isolated visual changes upper extremity claudication Abrupt-onset headache
Jaw or tongue claudication
Limb claudication or suggestion of large vessel involvement
Prominence, beading, or diminished pulse of the temporal artery
Temporal tenderness
Upper cranial nerve palsies
Visual disturbances
management of giant cell arteritis
- higher dosages of corticosteroids: prednisolone, 40 to 60 mg per day
- urgent referral to a rheumatologist
- anti-platelet therapy: Low-dose aspirin, 81 mg per day (decreases cranial ischemic complications)
diagnosis criteria of polymyalgia rheumatica
Age > 50 years
Bilateral aching of the shoulder and/or pelvic girdle
Duration of symptoms > two weeks
Evidence of acute phase response (elevated erythrocyte sedimentation rate and C-reactive protein level)
Morning stiffness in shoulder and/or pelvic girdle > 45 minutes
symptoms of alcohol withdrawal
Autonomic hyperactivity Increased hand tremor Tongue tremor may be more reliable Insomnia Nausea or vomiting Transient visual, tactile, or auditory hallucinations or illusions Psychomotor agitation Anxiety Generalized tonic-clonic seizures
alcohol withdrawal stages
Symptoms begin within 6-24h of last drink or acute reduction in chronic alcohol
12-48h Alcohol hallucinosis (typically insects/animals in room)
6-48h Withdrawal seizures (typically tonic-clonic convulsions)
Occur in 10-30% of patients with alcohol withdrawal
3-7d (up to 14d) Withdrawal delirium (aka. delirium tremens)
Sudden-onset fluctuating attention/cognition, agitation, autonomic hyperactiviity (fever, tachycardia, hypertension, diaphoresis)
Mortality from cardiovascular complications, hyperthermia, aspiration, fluid/electrolytes disorders
Risk: Previous DT, age>30, sustatined drinking, concurrent illness, longer period between last dirnk and onset of withdrawl (>2 days)
medication drugs to treat anxiety
Tricyclic antidepressants
Tetracyclic antidepressant (Mirtazapine)
Monoamine oxidase inhibitors
Azapirones
DSM-5 symptoms of panic attack
DSM-5 symptoms of panic attack Sweating Trembling Unsteadiness, Derealization/depersonalization Excess Warmth (Hot flashes) and Excess Heart Rate Nausea Tingling, Short of Breath Fear of dying or losing control Chest pain, Chills, Choking
List FOUR of the DSM-5 Anxiety Disorders, other than Generalized Anxiety Disorder and Panic
Disorder
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia
- Social Anxiety Disorder (Social Phobia)
- Panic Disorder
- Panic Attack (Specifier)
- Agoraphobia
- Substance/Medication-Induced Anxiety
Disorder - Anxiety Disorder Due to Another Medical
Condition - Other Specified Anxiety Disorder
- Unspecified Anxiety Disorder
risk factors of suicides
SADPERSONS -
S: Male sex A: Age (<19 or >45 years) - Different from O'Toole D: Depression P: Previous attempt E: Excess alcohol or substance use R: Rational thinking loss S: Social supports lacking O: Organized plan N: No spouse S: Sickness (Think about chronic disease!)
non-pharmacological mgt to prevent suicide
- Cognitive behavioural therapy
- Interpersonal psychotherapy
- Behavioural activation
- Mindfulness-based therapy
- Cognitive-behavioural analysis
- Problem-solving therapy
- Psychodynamic psychotherapy
- Acceptance / commitment therapy
- Motivational interviewing
- Employee family assistance
- Smoking cessation counselling
- Addictions counselling
- Financial counselling
- Family therapy
- Bereavement counselling
pediatric IV bolus amount and maintenance
bolus 20ml/kg
maintenance 4:2:1 ml/hr/kg
(4ml/kg for the first 10kg) + (2ml/kg for kg
11-20) + (1ml/kg for every kg above 20) =
hourly rate
complications of splinting or bracing
- Compartment syndrome
- ischemia
- Neurologic Injury OR Neurapraxia
- Thermal Injury
- Pressure Sores
- Infection
- Pain
- Dermatitis
- Joint stiffness
Red flags of neck pain
- Age > 50 with new symptoms
- Ripping or tearing sensation in the neck
- concurrent chest pain / cardiac history
- Weight Loss, night sweats
- Immunosuppressed
- Intravenous drug use
- Neurological symptoms or signs, eg. severe h/a
- Paresthesias
- Vision changes
- history of malignancy
- recent trauma
specific concern of neck pain in a 40s female with history of juvenile rheumatoid arthritis
atlanto-axial disruption
prep for pediatric trauma at rural ER
Warm IV Fluids Warm the room Warm blankets Chest tube tray Airway cart to the bedside Obtain Broselow Tape Suction on Request Blood Products Mobilize more staff OR Call for help Don Personal protective equipment Notify/Call in lab+xray Prepare Pelvic Binder Prepare Splints Draw up medication
pregnant female resuscitation position
LEFT Lateral decubitus with wedge to remove
pressure off of the inferior Vena Cava
Don’t forget!! - Rhogam OR WinRHO
pathogen of cat bite
Pasturella Multocida
empiric Abx for cat bites
Amoxicillin–Clavulanate
Doxycycline
Septra + Metronidazole
post-menopausal syndrome
- changes in periods
- hot flashes
- Vaginal dryness
- vaginal pain
- sexual dysfunction
- Bladder/incontinence issues
- Sleep quality and quantity
- Mood
HRT should be started within how many years of LMP
within 10 years
- < 60y/o
- < 10 yrs past maunopause
- bothersome vasomotor symptoms
- no contraindications
- with primary ovarian insufficiency or premature menopause without contraindications
COPD causes except for smoking
Alpha 1 antitrypsin deficiency Second-hand smoke exposure Gas fume exposure Dust exposure ? repeated lower respiratory tract infection
Abx to treat COPD exacerbation
A - Penicillins (Amoxicillin, Piperacillin-tazobactam
B - Bactrim/ Septra (Trimethroprim /sulfamethoxazole)
C - Cephalosporins (Ceftriaxone, Cefotaxime, Cefepime, Ceftazidime)
D - Tetracyclines (Doxycycline)
E - Extended-Spectrum Macrolides
(Clarithromycin, Azithromycin)
F - Fluoroquinolone (Moxifloxacin),
levofloxacin) or Amoxicillin / Clavulanate if
complicated
Hypothyroidism symptoms
General:
Fatigue
Weight gain
Cold intolerance
CNS:
Depression
decreased memory
HEENT:
enlarged tongue
hoarseness
CVS and resp Bradycardia pericardial effusion CHF + angina Shortness of breath
GI:
Constipation
weight gain
decreased appetite
Neuro
Delayed reflex relaxation
Myalgia, muscle cramps
carpel tunnel syndrome
Derm: peri-orbital Edema eyebrow thinned brittle nails Dry skin hair loss
Menorrhagia
Anemia
Symptoms of hyperthyroidism
Diaphoresis Anxiety Heat intolerance Tachycardia Weight loss Goiter Increased Bowel movements Tremor Anemia Thinning of hair Lid lag Exophthalmos
Diagnostic criteria of chronic fatigue syndrome/ systemic exertional intolerance disease
1) Functional impairment >6 months
("Substantial reduction / impairment in pre-illness levels of occupational, educational, social, or personal activities")
2) Non-exertional new fatigue
3) Post-exertional malaise
4) Rest does not refresh
5) AND at least 1 of Cognitive impairment OR
orthostatic intolerance
harms of over-screening (e.g. past age limit for colon cancer screening )
Overdiagnosis Death from follow-up testing Hospitalization or medical intervention (such as emergency visits) False positives and consequences Negative consequences of incidental findings Anxiety Quality of life Infection Bleeding
risk factors of type 2 DM
- Age ≥40 years
- History of prediabetes (lGT, lFG or A1C 6.0–
6. 4%) - History of GDM
- History of delivery of a macrosomic infant
> > Presence of end organ damage associated
with diabetes:
- Microvascular (retinopathy, neuropathy,
nephropathy)
- CV (coronary, cerebrovascular, peripheral)
>> Presence of vascular risk factors: - HDL-C <1.0 mmol/L in males, <1.3 mmol/L in females - TG ≥1.7 mmol/L - Hypertension - Overweight - Abdominal obesity - Smoking
>> Presence of associated diseases: - History of pancreatitis - Polycystic ovary syndrome - Acanthosis nigricans - Hyperuricemia/gout - Non-alcoholic steatohepatitis - Psychiatric disorders (bipolar disorder, depression, schizophrenia†) - HlV infection - Obstructive sleep apnea - Cystic fibrosis
> > inheritable causes.
- Member of high-risk population (e.g.,
African, Arab, Asian, Hispanic, Indigenous or
South Asian descent, low socioeconomic
status)
- First-degree relative with type 2 diabetes
- Drugs?
Medications causes diabetes (drug-induced DM)
- Glucocorticoids
- Atypical antipsychotics
- Statins
- Highly active antiretroviral therapy (protease inhibitors) - HAART
- Anti-rejection drugs (calcineurin inhibitors: cyclosporine, tacrolimus)
- antibiotics: quinolones, levofloxacin
1) Corticosteroids
2) Thiazide diuretics
3) Beta-blockers
4) atypical Antipsychotics
5) Statins
- Highly active antiretroviral therapy (protease inhibitors) - HAART
- Anti-rejection drugs (calcineurin inhibitors: cyclosporine, tacrolimus)
- antibiotics: quinolones, levofloxacin
DM-related sequelae that may warrant reporting patients to ministry of transportation
- Hypoglycemia during driving in 12 months, or severe hypoglycemia event in 6 months
- Peripheral neuropathy (unable to work the
rudder pedals) - Stroke
- Diabetic retinopathy
- Myocardial infarction
chest pain DDx
Heart
- Angina (unstable)
- myocardial infarction
- pericarditis
- arrhythmia
- aortic dissection
Lung
- Pulmonary embolism
- pneumonia
- pneumothorax
Others
- GERD / PUD
- Musculoskeletal (costochondritis)
modifiable and non-modifiable cardiac risk factors
non-modifiable
- Age (female until menopause)
- ethnicity (South Asian, African-Caribbean, Aboriginal)
- family history (MI, < 55 in male, < 65 in female)
- previous MI
modifiable RF
- obesity
- alcoholism
- smoking
- sedentary lifestyle/ physical inactivity
- stress
- OSA
- DM
- HTN
- dyslipidemia
- depression
