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CCFP > OTHERS > Flashcards

OTHERS Flashcards

1
Q

Oral exam station snowflake mnemonic

A

S - Safety (ie. no driving)
N - Next visit/FU
O - Offer (I will be your GP, I will get your old records, I will perform a physical)
P - Prevention
Q - Quit (ie. smoking)
R - Refer (I would refer to ___ if it’s not improving)
S - Start (ie. meds, physio, etc.)
T - Teaching (ie. pamphlets, info sheets, etc)

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2
Q

Epi dose for anaphylaxis

A

Adults: 0.5mg IM into lateral thigh (0.5mL of 1:1000)
Peds: 0.01mg/kg of 1:1000 (1mg/mL) to max of 0.3-0.5mg IM

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3
Q

Glucocorticoid side effects, chronic use

A 
Fragile skin
Easy bruising
Weight gain
HTN 
Osteoporosis
Myopathy 
GI perforation
Increased risk of infections (ie. oral thrush or pneumocystis jiroveci PNA)
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4
Q

Classic ages for croup

A

6mo-3y

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5
Q

Croup common viruses

A 
Parainfluenza virus types 1** (most common) and 3 
Rhinovirus
RSV 
Influenza
Adenovirus
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6
Q

Croup ddx

A

Epiglottitis
Anaphylaxis
Foreign body aspiration or ingestion
Retropharyngeal/peritonsillar abscess

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7
Q

Croup dx

A

Clinical

Don’t routinely do XR but if you do, neck XR should show narrowing in subglottilc region (steeple sign)

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8
Q

Croup tx

A

Gold standard - dex 0.6mg/kg PO as single dose (works within 2-3h and persists for 24-48h)
Severe: Dex + neb 2.25% racemic epinephrine +/- neb budesonide (may opt deg once)
Adjuncts - cool air, popsicles, humidifier, sitting in bathroom with steam
Observe for ~4h to see improvement before d/c

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9
Q

Typical croup course

A

Symptoms typically last 3d (peak at 24-48h) but may persist for up to 1wk
Symptoms often worse at night
FLUCTUATING course
If >1wk, return for reassessment
Beware of secondary bacterial infection - pt gets better but then suddenly gets worse

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10
Q

Ear exam acronym

A

COMPT

  • Colour (Gray, white, red, yellow)
  • Other (bubbles, air/fluid interface, scarring, perforation)
  • Mobility (absent, reduced, normal, hyper mobile)
  • Position (Normal, retracted, bulging)
  • Translucency (opaque, translucent)
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11
Q

Primary otalgia ddx

A 
OM 
OE 
Trauma
Foreign body
Impacted cerumen
Eustachian tube dysfunction
Perichondritis
Barotrauma
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12
Q

Secondary otalgia ddx

A 
Odontogenic causes
TMJ disorders
Upper cervical spinal dysfunction
Parotitis 
Lymphadenitis 
Pharyngeal disorders
Tonsillitis
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13
Q

Primary otalgia not to miss ddx

A 
Neoplasms
Skull-base osteomyelitis
Herpes zoster
Acute mastoiditis 
Cholesteatoma
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14
Q

Secondary otalgia not to miss ddx

A

Trigeminal neuralgia
Glossopharyngeal neuralgia
Head and neck malignancies
Temporal arteritis

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15
Q

Common bacterial causes for Otitis media (4)

A

Strep pneumo
H-influenza
Moraxella catarrhalis
Streptoccocus pyogenes

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16
Q

Common viral causes for OM (3)

A

RSV
Influenza
Rhinovirus

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17
Q

When to use abx for OM

A

All children 6mo-2y with BILATERAL AOM
Toxic appearing child
Persistent ear pain for 48h
Fever >39C within past 48h

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18
Q

If not giving abx for OM, f/u plan

A

Consider if mild ear pain, temp <39C in past 48h

F/U in 48h

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19
Q

OM treatment (incl duration)

A

High dose amox (75-90mg/kg/d split into 2 or 3 doses)
- x10d if 6mo-2yr or recurrent OMs
- x5d if >/=2yr
Adults: amox/clav 875/125 BID
If tympanovstomy tubes - ciprodex 4 drops BID x 7d
Symptoms should resolve within 48h
Re-evaluate at 10d if symptoms not resolved

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20
Q

Recurrent acute otitis media

A

> /= 3 distinct and well-documented episodes of AOM within 6mo or >/= 4 episodes within 12mo

  • Refer to ENT, hearing test
  • May require prophylactic abx, tympanostomy tubes, adenoidectomy or adenotonsillectomy
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21
Q

Ped UTI oral abx tx

A 
NOTE: If <2mo, Amp + Gent IV x 10d 
Keflex (good E.Coli coverage and other gram neg rods) 
Septra 
Macrobid (only for cystitis)
Amox-clav (not first choice)
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22
Q

Ped UTI IV abx tx

A

CTX
Cipro (if >1yo)
Amp + Gent

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23
Q

Anaphylaxis

A

Need any ONE of the following

  • Acute onset (min-hrs) involving skin/mucosa and at least 1 of respiratory compromise and/or drop in blood pressure
  • 2 or more organ systems – skin/mucosa, respiratory, CVS, or GI rapidly after exposure
    - Drop in BP after exposure to a known allergen
    - Infants and children: Low systolic BP (Age specific) or >30% drop in systolic BP
    * <70mmHg for 1mo to 1 year
    * <70mmHg + (2 x age) for 1-10yo
    - Adults: Systolic BP <90mmHg or 30% drop from baseline
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24
Q

Which peds patients should get kidney/bladder U/S following UTI/pyelo?

A
  • Children < 2y.o. with first febrile UTI
  • Children of any age with recurrent febrile UTIs
  • Children of any age with UTI who have fam hxof renal or urologic disease, poor growth, hypertension
  • Children who do not respond as expected to appropriate antimicrobial therapy
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25
Q

Which peds patients should get a renal technetium scan following UTI/pyelo?

A

4-6mo after acute infection for children with atypical or recurrent UTIs
Generally not required if responded well to tx

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26
Q

Which peds patients should get voiding cystourethrogram following UTI/pyelo?

A
  • Children of any age with ≥ 2 febrile UTIs OR
  • Children of any age with first febrile UTI AND abnormality on renal U/S OR
  • Fever ≥ 39C and pathogen other than E. coli OR
  • Poor growth or hypertension
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27
Q

Peds PNA tx

A

Amox 40-90mg/kg/d divided TID
Ampicillin IV
CTX IV

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28
Q

HEADSS

A 
Home 
Education/employment
Activity
Drugs/diet
Safety
Sexuality/suicide
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29
Q

Asthma dx in patients <6yo

A
  1. Hx (Recurrent wheezing, cough, difficulty breathing, chest tightness)
  2. P/E (Confirming airway obstruction/wheeze that improves with SABA)
  3. AND absence of alternative explanation
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30
Q

Asthma therapeutic trial

A

Daily moderate dose of ICS and SABA PRN
Trial 8-12wks
Discuss with fam in advance expected clinical improvements
Symptom diary

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31
Q

Asthma dx in patients 6-18yo

A
  1. Compatible clinical hx (recurrent wheezing, cough, difficulty breathing and chest tightness)
  2. Documented evidence of reversible obstruction or bronchial hyperactivity with LFT
  3. If LFT is not available, a p/e finding of wheezing or signs of increased WOB that DEFINITIVELY Improves with SABA can be used as surrogate marker of reversible airway obstruction
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32
Q

If spirometry is normal but asthma dx still suspected…

A

Methacholine challenge or exercise challenge (typically require respirologist referral)

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33
Q

Asthma symptom control checklist

A 
In the past 4 wks has the patient had:
-daytime asthma symptoms >2x/wk
-any night symptoms due to asthma 
-reliever needed for symptoms >2x/wk
-any activity limitation due to asthma
-FEV1 or peak flow <80% of personal best?
If 0 pts = well controlled asthma 
If 1-2 pts = partly controlled asthma 
If >/= 3 pts = uncontrolled asthma
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34
Q

Asthma general tx plan

A
  1. SABA reliever
  2. Low-dose ICS + SABA reliever
  3. Med/high dose ICS + SABA inhaler OR Low dose ICS/LABA combo (ie. Symbicort)
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35
Q

Symbicort

A

Budesonide/Formoterol (ICS/LABA)

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36
Q

Advair

A

Fluticasone/Salmeterol (ICS/LABA)

Diskus or MDI

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37
Q

Zenhale

A

Mometasone/formoterol (ICS/LABA)

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38
Q

Breo Ellipta

A

Fluticasone/vilanterol

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39
Q

Pulmicort

A

Budesonide

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40
Q

Alvesco

A

Ciclesonide (ICS)

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41
Q

Flovent

A

Fluticasone

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42
Q

Drugs which can trigger or exacerbate asthma

A

Beta blockers
Aspirin and NSAID drugs
ACEi

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43
Q

Typical age for bronchiolitis

A

<2yo

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44
Q

Most common cause of bronchiolitis

A

RSV

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45
Q

2 recommended tx for bronchiolitis

A

Oxygen (to keep sat >90%, typically via nasal cannula or blow-by) and hydration (Promote PO, NG or IV if needed)

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46
Q

Eating d/o SCOFF questions

A

Do you make yourself Sick b/c you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone (14lbs) in 3mo?
Do you believe you’re Fat when others say you’re thin?
Would you say that Food dominates your life?

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47
Q

Wellbutrin and eating disorder

A

C/I due to increase in sz risk

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48
Q

Potential complications from eating disorder

A

Amenorrhea
Cardiac dysfunction secondary to myocardial wasting (bradycardia, prolonged QTc, ST elevation, arrhythmias, pericardial effusion, orthostatic BP changes, poor peripheral circulation)
Osteopenia/osteoporosis
Sick euthyroid syndrome (TSH normal but decreased T4 –> T3 conversion = hypothyroid symptoms)
Abnormal liver enzymes
Electrolyte disturbances (hypoglycaemia, hypophosphatemia, hypokalemia)

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49
Q

Pharmacotherapy for eating disorder

A

SSRI - Fluoxetine

Esp helpful for binging

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50
Q

Screen time recommendations for peds

A

<2yo: not recommended
2-5yo: <1h/d
Avoiding screens at least 1h before bedtime

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51
Q

Typical 1st line pharmacotx for ADHD

A

Methylphenidate/Ritalin

Concerta (Methylphenidate XR)

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52
Q

2nd line tx for ADHD

A

Dextroamphetamine (ie. dexedrine, Vyvanse)

Dextroamphetamine and amphetamine salt combos (ie. adderrall)

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53
Q

F/U of pt on stimulant medication

A

q3mo, P/E annually

Height, weight, BP, pulse

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54
Q

Questionnaire for ADHD

A

SNAP IV - usually get parent and teacher to complete

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55
Q

Ddx for ADHD to explore

A 
Hearing impairment 
Developmental delay 
Learning disorder
Mood disorder
Conduct disorder 
Other psych issues
Psychosocial - fam stress, relationship issues, abuse, parental expectations
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56
Q

C/I to ADHD meds

A 
Tx with MAOI
Symptomatic CV dz 
Glaucoma
Advanced arteriosclerosis 
Untreated hyperthyroidism
Known hypersensitivity or allergy to the products
Mod-Severe HTN
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57
Q

ADHD dx

A

Inattention and/or hyperactivity-impulsivity that interferes with functioning/development
Present PRIOR to age 12
present in 2 or more settings (ie. school, home, work, friends/fam)
Persist >/= 6mo

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58
Q

Common comorbid dx with ADHD

A 
Oppositional defiant disorder (up to 50%) 
Conduct d/o
Anxiety
Depression
Learning disabilities
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59
Q

P/E for ADHD

A 
Dysmorphic features (ie. FAS) 
Growth rate
BP 
Cardiac exam (if meds to be considered)
Other potential causes for behaviour - vision loss, hearing loss, enlarged tonsils/OSA
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60
Q

Anxiety dx

A 
AND I C REST 
Anxious, nervous or worried 
No control over worry
Duration >6mo of 3 or more of:
Irritability
Concentration impairment
Restlessness
Energy decreased
Sleep impairment
Muscle tension
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61
Q

Anxiety diagnoses

A 
GAD
Panic d/o 
Social phobia
Specific phobia 
Social anxiety
Agoraphobia
PTSD
OCD
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62
Q

SSRI S/E

A
  • Sexual dysfunction
  • Drowsiness
  • Dizziness
  • Headache
  • Dry mouth
  • Blurred vision
  • Rash/itching
  • GI abnormalities (nausea and diarrhea)
  • Insomnia
  • Withdrawal on discontinuation
  • Weight gain
  • ALWAYS DISCUSS RISK OF INCREASED SUICIDALITY AT START OF MEDICATION (increase energy before improving mood)
    • Ultimate risk factor for suicidality is untreated depression/anxiety!
  • TAKES ABOUT 6 WKS TO TAKE EFFECT
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63
Q

SSRI you have to worry about high doses with QTc

A

Citalopram/escitalopram

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64
Q

Anxiety medical ddx

A

Hyperthyroid
Pheochromocytoma
R/O causes for panic attack symptoms (ie. PE, MI)
SUBSTANCE ABUSE

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65
Q

MSE acronym

A 
ASEPTIC 
Appearance and behaviour
Speech
Emotion (Mood/affect)
Perception
Thought content and process
Insight and judgement
Cognition
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66
Q

Anxiety workup to exclude medical cause

A

CBC
Fasting glucose
TSH
Urine toxicology

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67
Q

Anxiety pharmacotherapy

A

1st line : SSRI, SNRI

2nd line: TCA, benzo

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68
Q

Depression ddx

A

Disruptive mood dysregulation disorder
MDD
Persistent depressive d/o (Dysthymia)
Premenstrual dysphoric disorder
Substance/medication-induced depressive disorder
Depressive d/o due to another medical condition (ie. hypothyroid, hypoadrogenism)

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69
Q

Depression diagnostic criteria

A 
SIGECAPS 
Sleep changes
Interest loss
Guilt (worthless)
Energy (lack)
Cognition/concentration
Appetite (wt loss)
Psychomotor (agitation or lethargic) 
Suicide/death preoccupation
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70
Q

MDD pharmacotherapy

A

1st line: SSRIs, SNRIs

2nd line: TCAs, MAOs

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71
Q

Seroquel

A

Quetiapine

Atypical antipsychotic

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72
Q

Canadian low risk drinking guidelines

A

Women: 10 drinks per wk, no more than 2 drinks/d
Men: 15 drinks per wk, no more than 3 drinks/d
Plan non-drinking days every week to minimize tolerance and habit formation
Special occasions: No more than 3 drinks (for women) and 4 drinks (for men) on a single occasion

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73
Q

Alcohol use in youth

A

<19 not recommended

Never more than 1-2 drinks at a time, never more than 1-2x per week

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74
Q

Standard drink

A

12oz beer
12 oz cooler/cider
5oz wine
1.5oz distilled alcohol

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75
Q

CAGE questionnaire for alcohol use

A

Have you ever felt you need to CUT down on your drinking?
Do you feel ANNOYED by others complaining about your drinking?
Do you ever feel GUILTY about your drinking?
Do you ever drink an EYE OPENER in the morning to relieve the shakes?

Men - two yes responses is +ve
Women - one yes response is +ve

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76
Q

CRAFFT questionnaire for teens

A

Have you ever ridden in a CAR driven by someone/including yourself who was high or had been using EtOH or drugs?
Do you ever use EtOH or drugs to RELAX, feel better about yourself or fit in?
Do you ever use EtOH or drugs while you are by yourself ALONE?
Do you ever FORGET things you did while using alcohol or drugs?
Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
Have you ever gotten into TROUBLE while you were using alcohol or drugs?

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77
Q

Signs/symptoms suggesting alcohol use

A 
MCV > 96
Elevated GGT, AST, ALT (esp AST:ALT > 2:1) 
GERD, HTN, diabetes, pancreatitis
Chronic non-cancer pain
Alcohol on breath
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78
Q

3 categories for recovery goals

A
  1. Substance use and tx (ie. reduce use to x days/wk, listen to recovery podcast, 12-step meetings xtimes/wk, etc.)
  2. Exercise or wellness goal
  3. Creative/spirtual/community/relationship goals (ie. reconnect with old friend, call mom once a week, go to church)
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79
Q

Benzo contraindications

A 
Severe respiratory insufficiency 
Hepatic dz 
Sleep apnea 
Myasthenia gravis 
Narrow angle glaucoma
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80
Q

Neuropathic pain tx options

A

Gabapentin
Pregabalin
TCAs
SNRIs

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81
Q

Acute alcohol withdrawal tx options

A

Benzos (CIWA protocol)

Anticonvulsants - gabapentin, carbamazepine, valproic acid

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82
Q

Delirium tremens signs/symptoms

A

Presents 48-72h after last drink, can last btwn 1-5d
Severe confusion, disorientation
Hallucinations
Severe autonomic hyperactivity - ie. tachycardia, HTN, hyperthermia, agitation and sweating
NOTE DIFFERENCE BTWN DT AND ALCOHOLIC HALLUCINOSIS

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83
Q

Alcohol use disorder recovery tx

A

1st line: Naltrexone, acamprosate
2nd line: Topiramate, gabapentin
Not recommended, refractory cases only: Disulfiram

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84
Q

Naltrexone prescribing notes

A

Wait 7d after last opioid use for opioid-dependent patients

Mu-opioid receptor antagonist (will precipitate opioid withdrawal)

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85
Q

Delirium tremens risk factors

A
  • Hx of sustained drinking
  • Hx of EtOH withdrawal sz
  • Hx of DT
  • Age >30
  • Presence of concurrent illness
  • Presence of significant EtOH withdrawal in presence of elevated blood alcohol concentration
  • Longer period since last drink
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86
Q

Nicotine patch prescribing

A

Start 1-4wks before quit date
Peak level 6-12h after
Apply new patch each morning

If >/=10 cigs/d:
21mg/d for 6wks
14mg/d for 2wks
7mg/d for 2 wks

if <10cigs/d or <45kg
14mg/d for 6wks
7mg/d for 2 wks

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87
Q

Common S/E from nicotine patch

A

Skin reaction
Sleep disturbance
Other possible symptoms - heart palpitations, chest pains, N/V, GI complaints, mouth and throat pain, mouth ulcers, hiccups and coughing with oral forms of NRT

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88
Q

NRT treatment regimen

A

Often start with one form of NRT (ie. patch), then choose one short-acting NRT for breakthrough cravings as needed (ie. gum, lozenge, mouth spray or inhaler)

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89
Q

Smoking cessation pharmacotherapy options

A
  1. Varenicline/champix
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90
Q

Varenicline MOA

A

Partial agonist and antagonist at alpha and beta receptors
Partial agonist function –> release of dopamine –> reduces withdrawal and cravings
Partial antagonist function –> reduces reinforcing effect of nicotine b/c no longer able to bind

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91
Q

Varenicline S/E

A

Irritability, restlessness, insomnia, constipation, other GI problems, abnormal dreams, nausea**

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92
Q

Varenicline dosing info

A

Patients choose a quit date
Start Varenicline tx 1-2wks BEFORE this date then completely stop
Can be done with NRTs

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93
Q

Major C/I with Wellbutrin

A

Decreases sz threshold

C/I in pts with hx of seizure d/o

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94
Q

Infertility workup

A 
Day 3 LH, FSH, estradiol
\+/- AMH 
Prolactin
TSH
Pelvic U/S 
Semen analysis 
=/- mid-luteal phase serum progesterone (1wk before expected menses)
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95
Q

Monthly pregnancy %

A

20: 30-40%
25: 25-35%
30: 20-30%
40: 5-7%
45: 1-2%

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96
Q

Ddx for female infertility

A 
PCOS 
Infrequent/absent ovulation 
Endometriosis 
Uterine fibroids 
Cervical factors 
Pelvic adhesions
Tubal blockage 
HyperPRL 
Inherited thrombophilia 
Immune factors
Genetic causes 
Thyroid dz
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97
Q

Assisted reproductive technologies

A 
Intrauterine insemination (IUI) 
IVF
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98
Q

2 main agonist therapies for opioid use disorder

A

Suboxone (buprenorphine/naloxone)

Methadone

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99
Q

Methadone MOA

A

Full opioids agonist

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100
Q

Suboxone MOA

A

Partial opioid agonist
High affinity to mu receptor (quickly alleviates withdrawal) but has LOW intrinsic activity (less euphoria, sedation, nausea, constipation, hypotension, resp depression)

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101
Q

Naloxone MOA

A

Opioid antagonist

ONLY bioavailable if injected

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102
Q

Suboxone initiation

A

Aim for COWS >12 (need to be in slight withdrawal)
Low initial dose (i.e one to two 2mg/0.5mg SL tabs)
Monitor for 2h –> if withdrawal symptoms remain, give additional 2-4mg (max 12mg/3mg on day 1)
Next day, give single dose of total dose received on day 1
Increase in 4mg increments up to max of 16mg total
Most stabilize on 16-25mg/d

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103
Q

Common classes of meds that methadone interacts with

A

Antiretrovirals
Anti-fungals
Rifampin

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104
Q

Methadone and ECG changes

A

Prolongs QTc interval

Consider getting ECG esp when on high doses

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105
Q

Opioid use disorder b/w

A 
CBC 
Liver function panel 
HIV, hepatitis A, B and C 
Syphilis serology 
TB testing when appropriate
Pregnancy test 
ECG if indicates (ie. when escalating dose, fam hx of sudden cardiac death)
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106
Q

Methadone initiation

A

Start at 20-30mg on first day
Titrate up in 5-10mg increments q3-5d over several weeks
Stable dose 60-120mg/d

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107
Q

Common false +ve on urine drug testing

A

Amphetamine

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108
Q

Common false -ve on urine drug testing

A

Clonazepam, lorazepam

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109
Q

Red flags for breast CA

A
  • Breast lumps
  • Nipple discharge
  • Unusual nipple or areolar skin changes (ie. crusting, scaling, dimpling)
  • Nipple inversion
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110
Q

SNOOP mnemonic for dangerous secondary headaches

A

Systemic symptoms: fever, weight loss, night sweats
Secondary risk factors: HIV, cancer, immune compromise
Neurologic symptoms or signs: anything focal? Papilledema? Confusion?
Onset: sudden, maximal at onset
Older >50
Pattern change: first, worst or different
Provocative factors - positional, cough/sex/exertion, pregnancy

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111
Q

Features (signs and symptoms) of headache that make it more worrisome

A 
Age of onset >50
Sudden onset 
Positional nature of headache 
Hx trauma 
New onset HIV 
Hx of any cancer 
Systemic illness
Focal symptoms or signs
Fever
Neck stiffness
Papilledema
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112
Q

Headache ddx

A 
Migraine w/ or w/out aura 
Tension headache 
Cluster headache
Temporal arteritis 
Idiopathic intracranial HTN
SAH 
Bacterial meningitis 
Medication overuse headache
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113
Q

Lifestyle management for headaches

A 
Regular meals 
Sleep
Stress reduction - Meditation, activity pacing 
Reduce caffeine 
Exercise 
Headache diary
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114
Q

Pharmacologic management for headaches

A

Simple analgesia - Acetaminophen 1000mg, ibuprofen 400mg or Naproxen 500mg, Cambia 50mg packet
Triptans (migraine specific) - ie. Sumatriptan, zolmitriptan

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115
Q

Major triptan s/e

A

Chest tightness/discomfort

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116
Q

Headache prophylaxis: when to do it

A

Headache >3d/month, no response to acute rx
Headache >8d/mo, due to risk of medication overuse
Disability despite acute meds

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117
Q

Headache prophylaxis

A 
Tricyclics (ie. amitriptyline) 
BB (ie. propranolol) 
CCB (ie. verapamil)
Anticovulsants (ie. valproate, topiramax) - for severe chronic migraines
Botox
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118
Q

Headache supplements

A

Riboflavin (standard adult dose 400mg daily)
Coenzyme q10
Magnesium

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119
Q

HIV transmission counselling

A
  • Most ppl get HIV by having unprotected vaginal or anal sex with someone who has HIV
  • Can also be passed during unprotected oral sex (low risk)
  • Can be passed through sharing drug equipment (i.e needles)
  • Can be passed to others even if you don’t have symptoms
  • CANNOT be spread by casual contact (ie. kissing, sharing drinking glasses)
120
Q

Most common STI

A

Chlamydia

121
Q

Who to screen for chlamydia

A
  • Symptomatic
  • At-risk asymptomatic patients - women <24yo, pregnant, new or many sexual partners, MSM, sexually active HIV-infected individuals of any age
  • Note - persons who engage in receptive anal intercourse (particularly MSM) warrant screening at both urogenital and rectal sites
  • Any pt with documented gonococcal infix should also undergo chlamydia testing
  • Any pt who has been treated for chlamydia should be rescreened 6mo after tx
122
Q

How long after tx should pts be retested for chlamydia

A

3mo

123
Q

Management of pt with recent known exposure to chlamydia (1-2wks)

A

Treat empirically

124
Q

Components of complete tx of chlamydia

A
  • Pregnancy test
  • Active antimicrobial therapy
  • Directed or empiric tx for concomitant gonococcal infection
  • Testing for other STIs
  • Discussion of need for HIV testing if HIV status is not known
  • Counselling on abstinence of 1wk following tx
  • Counselling to return for persistent or recurrent symptoms
  • Retesting to evaluate for recurrent infection
  • Tx of sexual partners (within 60d prior to infection or last known partner)
125
Q

Chlamydia tx

A

Azithro 1g PO single dose
OR Doxy 100mg PO BID x 7d
Alternatively erythromycin or levofloxacin or ofloxacin

126
Q

Who should receive test of cure for chlamydia tx

A

Pregnant patients
Persistent symptoms
Use of regimen with inferior cure rates (ie. erythromycin, amoxicillin)
Compliance uncertain

127
Q

When to perform test of cure for chlamydia infection

A

No earlier than 3 wks after tx completed

128
Q

Reportable STIs in BC

A

Chlamydia
Gonorrhea
Syphilis
HIV/AIDS

129
Q

Gonorrhea microbiology

A

Gram negative coccus

130
Q

Second most common STI

A

Gonorrhea

131
Q

Sequelae of untreated STIs

A 
PID 
Perihepatitis/Fitz-Hugh-Curtis Syndrome 
Infertility
Higher risk of ectopic pregnancy
Infection during pregnancy can lead to increased risk of PROM, preterm delivery, low birthweight infant
132
Q

Characteristics of fitz-hugh-curtis syndrome

A

Sharp pleuritic pain to RUQ, n/v, fever

133
Q

Female presentation chlamydia/gonorrhea

A

Cervicitis - abN vaginal d/c, intermenstrual vag bleeding, post-coital bleeding
Urethritis - dysuria, pyuria
Proctitis
conjunctivitis, pharyngitis, genital lymphogranuloma venerereum, reactive arthritis

134
Q

Complications of pregnancy from chlamydia/gonorrhea

A

Chorioamnionitis, PROM, preterm birth, low birth weight, SGA, spontaneous abortions

135
Q

Male presentation chlamydia/gonorrhea

A 
Urethritis
Epididymitis 
Prostatitis 
Proctitis 
conjunctivitis, pharyngitis, genital lymphogranuloma venerereum, reactive arthritis
136
Q

Dx for chlamydia/gonorrhea

A

Men - first catch urine, urethral swab
Women - vaginal swab, endocervical swab
NAAT vs culture (culture gives you abx susceptibility)
Culture - urethral swab, cervical specimen, rectal specimen, pharyngeal specimen
Rectal or throat swab if symptomatic

137
Q

Gonorrhea tx

A

Ceftriaxone 250mg IM single dose or cefixime 800mg PO AND azithromycin 1g PO single dose or doxy 100mg PO BID x 7d (chlamydia tx)

138
Q

When to rescreen for gonorrhea tx

A

6mo after tx (all patients)

139
Q

Why perform test of cure for gonorrhea

A

Only for:
* Pt dx with gonococcal pharyngeal infection
* Pt treated with non-recommended regimen
* Tx failure suspected
* Antimicrobial resistance to tx is documented
* Compliance uncertain
* Re-exposure to untreated partner suspected
* PID or disseminated gonoccal infection dx
* Pt is pregnant
2-3 wks after tx if via NAAT
3-7d after tx if via culture (needed for pregnant pts)

140
Q

Plagiocephaly orthosis most effective when initiated at or before age of…

A

6mo

141
Q

Treatment for torticollis

A

Physiotherapy

142
Q

Honey should not be given until age

A

12mo

143
Q

Conditions to always counsel patients on with undescended testicles

A

Testicular torsion

Inguinal hernia

144
Q

Eczema distribution toddlers

A

Scalp, forehead, cheeks, extensor surfaces

145
Q

Eczema distribution older children/adolescents

A

Flexural areas of neck, elbows, wrists, knees, ankles

146
Q

Eczema distribution adults

A

Flexural area, hands, feet, face

147
Q

Alternative treatment to steroid creams for atopic dermatitis

A

Topical calcineurin inhibitors
For pts >2yo
Ie. Tacrolimus ointment (Protopic)

148
Q

When to treat asymptomatic bacterial vaginosis

A

Pregnancy

Prior to IUD insertion or gone procedure

149
Q

Symptomatic bacterial vaginosis tx

A

Metronidazole 500mg PO BID x 7d
OR Metronidazole gel 0.75% x one applicator (5g) once a day intravaginally x 5d
OR Clindamycin cream 2% x one applicator (5g) intravaginally once a day for 7d
Alternate tx: Metronidazole 2g PO in a single dose OR Clindamycin 300mg PO BID x 7d
Single dose oral flagyl has higher relapse rate at one month
CanesBalance x 7d tx - helps reset vaginal pH

150
Q

Bacterial vaginosis tx in pregnancy

A

Metronidazole 500mg PO BID x 7d or Clindamycin 300mg PO BID x 7d
Systemic rather than intravag tx is recommended in pregnancy

151
Q

BV and pregnancy (screening and risks)

A
  • ROUTINE screening in pregnancy is NOT recommended during pregnancy unless it is high risk pregnancy
  • If high risk, screen at 12-16wks
  • Risk of BV during pregnancy: PROM, chorioamnionitits, PTL, pre-term birth, post-c/s endometritis
152
Q

Trichomoniasis tx

A

Metronidazole 500mg PO BID x 7d or 2g PO x 1d

153
Q

Trichomoniasis symptoms

A

Inflammation (pruritus), frothy yellow d/c and elevated pH

154
Q

Trichomoniasis pregnancy

A

May be a/w PROM, preterm birth, low birth weight
Note ASYMPTOMATIC PREGNANT women do NOT need to be treated
Tx: Metronidazole 2g PO in single dose for symptom relief OR metronidazole 500mg PO BID x 7d

155
Q

Trichomoniasis partner tx

A

Partners always need to be tx regardless of symptoms

156
Q

Causes for hyperprolactinemia

A

Prolactinoma
Hypothyroid (TRH inhibits PRL secretion)
Idiopathic
Drugs (ie. antipsychotics, SSRIs)
Chronic renal dz (inhibits PRL clearance)
Physiologic: pregnancy, nipple stimulation (not significant for non-lactating women/men), stress, food (minimal), chest wall injury

157
Q

Clinical manifestations of hyperprolactinemia

A

Galactorrhea
Irregular menstrual cycles
Poor bone density
Headache/visual disturbances related to prolactinoma
Men: Hypogonadotropic hypogonadism (decreased T), ED, infertility, galactorrhea

158
Q

Investigations for hyperprolactinemia

A

PRL
MRI sella
TSH
Renal function

159
Q

Hyperprolactinemia treatment

A

1st line: Dopamine agonist (ie. cabergoline, bromocriptine)
2nd line: estradiol + progestin
Men: testosterone
Transphenoidal sx

160
Q

Main differential for persistent forceful projectile vomiting in infant

A

Pyloric stenosis

Get U/S!

161
Q

Criteria for uncomplicated vaginal yeast infection

A
  • Sporadic, infrequent episodes (= 3 epis/y)
  • Mild-mod signs/symptoms
  • Probable infection with Candida albicans
  • Healthy, nonpregnant woman
  • Immunocompetent woman
162
Q

Criteria for complicated vaginal yeast infection

A
  • Severe signs/symptoms
  • Candida species other than C. Albicans (ie. C. Glabrata)
  • Pregnancy, poorly controlled diabetes, immunosuppression, debilitation
  • Hx of recurrent (>/=3/y) culture-verified vulvovaginal candidiasis
163
Q

Yeast infection tx

A 
Fluconazole 150mg PO x1 dose 
OR Clotrimazole (Canesten) topical x 7d
164
Q

Yeast infection tx during pregnancy

A

Topical clotramiazole x 7d

165
Q

Age indication for Shingrix

A

> 50yo

166
Q

Time frame after Zostavax to give shingrix

A

At least 1y

167
Q

Time frame after shingles to give shingrix

A

At least 1y

168
Q

Shingrix schedule

A

2 doses at least 2-6mo apart

No booster needed

169
Q

Indications to dose reduce apixaban

A 
Any 2 of: 
1. Age >/= 80yo 
2. Body weight =60kg 
3. Serum creatinine >/= 133
then reduce dose from 5mg BID to 2.5mg BID
170
Q

Don’t miss abdo pain causes in peds

A

Intussusception
Appendicitis
Volvulus
Meckel’s

171
Q

3 most common causes of SBO

A

Adhesions
Bulges (hernias)
Cancers

172
Q

4 most common causes of LBO

A

Cancer
Diverticulitis
Volvulus
Fecal impaction

173
Q

RUQ pain ddx

A 
Hepatitis 
Gallstones
Cholangitis 
Cholecystitis
Liver abscess
174
Q

Epigastric pain ddx

A

Peptic ulcer
Esophagitis
Pancreatitis
Gastric CA

175
Q

LUQ pain ddx

A

Splenic abscess
Splenic rupture
Splenic infarct

176
Q

Flank pain ddx

A

Renal colic

Pyelonephritis

177
Q

Peri-umbilical ddx

A

Early appendicitis
Mesenteric adenititis
Meckel’s diverticulitis

178
Q

RLQ pain ddx

A

Late appendicitis
Crohn’s dz
Ectopic preg
Ovarian cyst

179
Q

Suprapubic pain ddx

A

UTI
Urinary retention
Testicular torsion

180
Q

LLQ pain ddx

A

Diverticulitis
UC
Ectopic pregnancy
Ovarian cyst

181
Q

Red flags for abdo pain

A 
VWBAD 
Vomiting
Weight loss
Bleeding - hematemesis or melena or anemia 
Anorexia (Age > 50) 
Dysphagia
182
Q

Lifestyle GERD management

A 
Weight loss
Smoking cessation
Cut down EtOH, caffeine, spicy foods, foods with high fat content, carbonated beverages, peppermint 
Avoid meals 2h before bed 
Sleep with head of bed elevated
183
Q

Pharmacotx for mild GERD

A 
Anatacids (ie. Tums) 
H2 blockers (ie. Zantac, Pepsid)
184
Q

Pharmacy tx for mod/severe GERD

A

PPI challenge x 8wks

185
Q

Omeprazole standard and low maintenance dose

Brand name

A

20mg, 10mg

Losec

186
Q

Pantoprazole standard and low maintenance dose

Brand name

A

40mg, 20mg

Pantoloc, Tecta

187
Q

Rabeprazole standard and low maintenance dose

Brand name

A

20mg, 10mg

Pariet

188
Q

Risks a/w PPIs

A
  • Risk of C.diff
  • Microscopic colitis
  • Magnesium malabsorption
  • Calcium and # risk
    • If Ca supplementation is needed, suggest Ca Citrate (does not require acid for absorption)
  • Vit B12 malabsorption; absorption of B12 supplements is NOT affected
  • Acute interstitial nephritis
189
Q

Oral abx tx for diverticulitis

A

Tx duration 7-10d
Cipro 500mg PO q12h + metronidazole 500mg PO q8h
OR Levo 750mgPO daily + metronidazole 500mg PO q8h
OR Septra DS q12h + Metronidazole q8h
OR Amox-clav 875mg PO q8h
OR Moxi 400mg PO daily

190
Q

Diverticulitis management counselling

A

Abx
Reassess clinically 2-3d after initiation of abx tx and weekly thereafter until complete resolution of symptoms
Rpt imaging is NOT indicated unless pt fails to improve clinically
Colonoscopy after complete resolution of symptoms

191
Q

Hallmark signs for Crohn’s

A 
Fatigue
Prolonged diarrhea with abdo pain
Weight loss
Fever 
\+/- gross bleeding
192
Q

Extra-intestinal manifestations of Crohn’s disease

A 
Arthritis 
Erythema nodosum 
Pyoderma gangrenosum
Uveitis 
Primary sclerosing cholangitis
Vit B12 deficiency 
Osteoporosis 
Renal stones
Venous/arterial thromboembolism from hyper coagulability
Oral mucosal lesions 
Psoriasis 
Ankylosing spondylitis
193
Q

Investigations for IBD

A 
Hb
ESR
CRP
Folate
B12
Lytes - Na, K 
Albumin 
Fecal calprotectin 
Antibody tests -pANCA, ASCA 
Stool C&S, O&P, c.diff 
Colonoscopy/biopsy
CT abdo (r/o abscess)
AXR (r/o obstruction, perforation, toxic dilatation)
194
Q

Potential complications from IBD

A 
Toxic dilatation
Stricture
Internal fistulae
Abscess
Perianal complications
Gallstones
Renal calculi
Psychological 
Risk of carcinoma (colon CA)
195
Q

Crohn’s treatment - acute exacerbation

A

Prednisone 40mg PO daily

Loperamide, Tylenol

196
Q

Crohn’s treatment - maintenance

A

5-ASA (Mesalazine)
+/- abx (Cipro + Flagyl) in pts who do not tolerate 5-ASA and do not improve within 3-4wks
Immunosuppression (Azathioprine, methotrexate)
Immunomodulators (ie. Infliximab, TNF-antagonist)
Surgery last resort

197
Q

Ulcerative colitis clinical presentation

A 
Rectal bleeding
Diarrhea +/- blood 
Abdo cramps/pain with defecation 
Tenesmus, urgency, incontinence 
Systemic symptoms - fever, anorexia, weight loss, fatigue in severe cases
198
Q

UC treatment - acute

A

Steroids (ie. methylprednisone 30mg IV q12h)

199
Q

UC treatment - maintenance

A

5-ASA (topical suppository or enema, oral)
Immunosupressants for refractory cases (ie. azathioprine)
Biologics (ie. Infliximab)

200
Q

Absolute C/I to OCP

A 
Known/suspected pregnancy
Undx abN vaginal bleeding
Prior thromboembolic events, thromboembolic disorders, active thrombophlebitis 
Cerebrovascular or CAD 
E-dependent tumours (breast, uterus) 
Impaired liver fxn a/w acute liver dz 
Congenital hypertriglyceridemia 
Smoker age >35yo 
Migraines with focal Neuro symptoms (excl aura)
Uncontrolled HTN
201
Q

Thromboembolic d/o C/I in OCP users

A

Factor V Leiden
Protein C or S
Antithrombin III

202
Q

Relative C/I to OCP

A 
Migraines (non-focal with aura <1h) 
DM complicated by vascular dz 
SLE 
Controlled HTN
Hyperlipidemia 
Sickle cell anemia 
Gallbladder dz
203
Q

Syphilis test

A

Treponemal (EIA) - reactive vs nonreactive

vs non-treponemal (RPR, VDRL) - quantitative ab

204
Q

Syphilis tx - early

A

Benzine penicillin G 2.4 million U in single dose

205
Q

Syphilis tx - late or tertiary

A

Benzathine penicillin G 2.4 million U weekly x 3 wks to total of 7.2 million U

206
Q

Gluten found in what types of foods

A 
BROW foods
Barley
Rye 
Oats 
Wheat
207
Q

Genes a/w celiac

A

HLA-DQ2

HLA-DQ8

208
Q

Investigations to order celiac

A 
Serum tTG-IGA 
If +ve --> requires endoscopy with small bowel bx 
Fe
Ca
B12
209
Q

Emergency contraception options

A 
Plan B (Progestin pill) 
Copper IUD 
Ulipristal acetate (Ella)
210
Q

Copper IUD for emergency contraception

A

Most effective

99% effective if inserted up to 5d after unprotected intercourse

211
Q

Plan B for emergency contraception

A

Least effective
Reduces change of pregnancy by ~50% if taken up to 72h after unprotected intercourse
Some efficacy up to 5d after

212
Q

When to take plan B

A

If you forgot to take one of your oral contraceptive pills for more than a 24-hour period and you engaged in unprotected intercourse during the day of the missed pill or within five days before the missed pill, consider taking Plan B® to prevent an unwanted pregnancy

213
Q

When to start contraception after ulipristal acetate

A

5d after

214
Q

C/I to progesterone only contraception

A

Current breast CA
Pregnancy
Hypersensitivity to progesterone

215
Q

C/I to IUD

A 
Pregnancy
Current, recurrent or recent (within 3mo) STI or PID 
Puerperal sepsis 
Immediate post-septic abortion 
Severely distorted uterine cavity 
Unexplained vaginal bleeding 
Cervical or endometrial cancer 
Malignant trophoblastic dz 
Breast CA (Current) 
Copper allergy
216
Q

Combined hormal contraception options

A

OCP
Evra patch
Nuva ring

217
Q

Progesterone only contraception options

A

Micronor
Depo-provera
IUD

218
Q

Evra patch

A

1 patch weekly
Similar s/e to OCP + local skin irritation
May be less effective in women weighing >90kg

219
Q

Vaginal contraceptive ring

A

1 ring monthly

Similar s/e to OCP + vaginitis, leukorrhea, vag discomfort, expulsion

220
Q

Combined contraception MOA

A

Inhibits ovulation
Endometrial effects
Cervical mucus effects
Tubal peristalsis

221
Q

Progesterone only contraception MOA

A

Cervical mucus changes
Impaired sperm motility
Possible inhibition of ovulation

222
Q

Micronor

A

1 pill daily, no pill-free interval

S/E: Irregular bleeding, headache, bloating, acne, breast tenderness

223
Q

Depo provera

A

1 injection IM q12-13wks
Amenorrhea occurs in 55-60% of users at 12mo
S/E: menstrual irregularities, HA, decreased libido, nausea, breast tenderness, weight gain, mood effects (not proven in studies)
Risks: delayed return of fertility, decreased BMD

224
Q

Common S/E from contraception

A

Nausea, breast tenderness, headaches, and unscheduled bleeding
These symptoms are typically mild and resolve within a few cycles.
Unscheduled bleeding can also occur outside of CHC initiation, and amenorrhea can develop as well

225
Q

Don’t miss abdo pain causes in adults

A

Ruptured AAA

Ruptured ectopic pregnancy

226
Q

Dizziness don’t miss dx

A 
ACS 
PE 
Stroke
Dissection
Hypoglycemia
227
Q

Ddx for peripheral vertigo

A 
Idiopathic
Meniere's 
BPPV 
Acoustic neuroma
Trauma
Drugs
Labyrinthitis/Vestibular neuritis
228
Q

HINTS test for vertigo

A

Head Impulse
Nystagmus
Test of Skew

229
Q

Reassuring HINTS exam

A

Abnormal head impulse
Horizontal unidirectional nystagmus
No skew deviation
(all support peripheral vertigo)

230
Q

3 classes of drugs that suppress vestibular system

A
  1. Antihistamines
  2. Benzodiazepines
  3. Antiemetics
231
Q

Tx for BPPV

A

Epley’s maneuver
Pharmacotherapy with antihistamine, benzos, antiemetic or serc
Vestibular rehab
Steroids have no role

232
Q

Meniere’s triad

A

Vertigo
Tinnitus
Hearing loss

233
Q

Condition for which serc is actually indicated

A

Meniere’s

234
Q

Meniere’s etiology

A

Endolymphatic hydrops (excessive build up of endolymphatic fluid) cause distortion and distention of the membranous, endolymph-containing portions of labyrinthine system

235
Q

Meniere’s dx

A
  • > /=2 spontaneous episodes of vertigo, each lasting 20min-12h
  • Audiometrically documented low-to mid-frequency sensorineural hearing loss in affected ear
  • Fluctuating aural symptoms (reduced or distorted hearing, tinnitus or fullness) in affected ear
  • Symptoms not better accounted for by another vestibular dx
236
Q

Meniere’s tx

A

Dietary triggers (high salt intake, caffeine, EtOH, nicotine, MSG, allergies)
Stress
Vestibular rehab
Pharm: Betahistine 8-16mg PO TID
Diuretics (HCTZ, Lasix)
Benzos
Very severe, unresponsive to lifestyle - systemic glucocorticoids (Prednisone 50mg PO x 7d), intratympanic glucocorticoids weekly up to 3x

237
Q

Vestibular neuronitis/labyrynthitis

A

Viral or post-viral inflammatory disorder affecting CNVIII
Pure vestibular neuritis - auditory fxn preserved
Labyrynthitis: Unilateral hearing loss
Presents - severe vertigo with N/V, gait instability (fall toward affected side)

238
Q

Vestibular neuronitis/labyrynthitis tx

A

Prednisone x 10d taper
Symptomatic tx of N/V
Vestibular rehab

239
Q

Ramsay Hunt

A

VZV reactivation

Triad of ipsilateral facial paralysis, ear pain and vesicles in auditory canal or on auricle

240
Q

Ramsay hunt tx

A

Valacyclovir 1g PO TID x 7-10d AND prednisone 1mg/kg x 56d without taper

241
Q

1st degree AV block

A

Prolonged PR interval (>200ms)
Causes:
-Pts with slow resting HR
-Underlying structural abN of node
-Increase in vagal tone that causes reduction in rate of impulse conduction
-Drugs that impair slow nodal conduction (ie. BB, CCB)
-MI
-Infiltrative and dilated cardiomyopathies
-Certain muscular dystrophies
Tx:
No tx if asymptomatic

242
Q

Wolff-Parkinson White Syndrome

A 
Pre-excitation plus palpitations 
Re-entry rhythm involving AV node, atria, accessory AV pathway (Kent bundle) and ventricles
ECG changes characterized by: 
- Delta wave (slurred slow rise of QRS) 
- Short PR 
- Prolonged QRS
243
Q

Ddx for narrow complex tachycardia

A 
Regular:
-ST 
-SVT 
-AVNRT 
-AVRT 
-Aflutter
Irregular:
-AFib
-Aflutter with variable AV conduction
-Multifocal atrial tachycardia
244
Q

Ddx for wide complex tachycardia

A 
Regular: 
-VTach 
-SVT with aberrancy (BBB) 
Irregular: 
-Afib with BBB
-Aflutter with BBB
245
Q

Pericarditis tx

A

Viral: Combo tx with colchicine and and NSAIDs

Tx duration: Treat while symptomatic then tapering once pt is symptom free for at least 24h. Colchicine continued x 3mo.

246
Q

PE ECG findings

A 
S1QIIITIII 
Present in 10-15% of cases of PE
-Large S wave in lead I 
-Small Q wave in lead III 
-Inverted T-wave in lead III 
Inverted T-waves in anterolateral leads and rightward axis
247
Q

Causes for prolonged QT

A 
Hypothermia
HypoK
HypoMg 
HypoCa
Acute MI 
Elevated intracranial pressure
Drugs with Na channel blocking agents (ie. TCAs,) 
Congenital prolonged WT syndrome
248
Q

Sinusitis PODS

A

Facial Pain/pressure/fullness
Nasal Obstruction
Nasal purulence/discoloured postnasal Discharge
AnoSmia (loss of Smell)

249
Q

Diagnosing bacterial sinusitis

A

> 7d
MUST have nasal obstruction or nasal purulence/discoloured postnasal discharge AND at least one other PODS
Consider if worsening after 5-7d
Symptoms persist >7d without improvement
Presence of purulence for 3-4d with high fever

250
Q

2 most common pathogens associated with sinusitis

A

Strep pneumo

H. influenza

251
Q

5 step sinusitis treatment

A
  1. Intranasal steroids (Nasonex 2 sprays/d)
  2. Nasal saline rinse
  3. Advil
  4. Decongestant (Can use Advil Sinus)
  5. Steam
252
Q

Sinusitis abx

A

1st line: Amox 500mg PO TID or 875mg BID
If beta-lactam allergy: Doxy 100mg PO BID or 200mg PO daily
2nd line: Amox-clav 500mg/125mg PO TID or 875/125mg PO BID
x 5-7d

253
Q

Buckle fracture

A

Occurs at distal metaphysic where bone is most porous
Usually in younger children
Tx: Removable splint for immobilization, possible below elbow vast depending on degree of initial pain/anticipated activity of child, parental preference
Splint x 3wks
Increased risk of break x 6wks
F/U GP
No need for Ortho f/u if uncomplicated
Consider ortho f/u if radius and ulna #, bowing of arm, diminished ROM, continued pain, parental concerns

254
Q

CURB-65

A 
Confusion 
BUN >7 
RR >/= 30
Systolic BP <90mmHg or Diastolic -60mmHg 
Age >/=65yo 
Inpt tx if >1
255
Q

COPDe low risk mgmt (<4 exacerbations/yr and at least 2 of increased sputum purulence, increased sputum volume, increased dyspnea)

A
  1. O2 to keep sat 88-92%
  2. ANTIBIOTICS
    Amox 1g PO TID
    OR
    Doxy 200mg PO once then 100mg PO BID
    OR
    Septra 1DS tab PO BID
    Treat 5-7d
  3. Prednisone 40-60mg PO daily x 5d
  4. SABA +/- SAMA
256
Q

COPDe high risk mgmt (>4 exacerbations/y and at least 2 of increased sputum purulence, increased sputum volume, increased dyspnea) OR failure of first line agents above OR abx in past 3mo

A
  1. O2 to keep sat 88-92%
  2. ANTIBIOTICS
    Amox-clav 875-125mg PO BID x 5-10d
    OR
    Cefuroxime 500-1000mg PO BID x 5-10d
    OR
    Levofloxacin 750mg PO x5d
    OR
    Azithromycin 500mg PO daily x 3d
    OR
    Clarithromycin 500mg PO BID or 1000mg PO XR x 5-10d
  3. Prednisone 40-60mg PO daily x 5d
  4. SABA +/- SAMA
257
Q

Wellen’s sign

A

Biphasic T-wave pattern high specific for large proximal LAD obstructive lesion
Best treated with PCI
Does not respond well to medical management

258
Q

3 red flags of red eye

A
  1. Pain
  2. Decreased acuity
  3. Anisocoria
259
Q

4 risks of eye steroids

A
  1. Corneal perforation
  2. Open angle glaucoma
  3. Cataracts
  4. Corneal ulcers
260
Q

Iritis

A 
Constant photophobia 
Miosis, distorted pupil 
Blurred vision
Perilimbal haze 
Fluoroscein normal
Tx: Referral for steroids (think about systemic cause)
261
Q

Scleritis

A

SEVERE constant boring pain esp at night
Photophobia
PERL
Decreased visual acuity
Whole eye can be DEEP red/blue/purple hue
Fluoroscein normal
Tx: referral for steroids

262
Q

Top cause of scleritis in BC

A

Syphillis

263
Q

Episcleritis

A 
Irritation but no sig pain
Tears, no pus no AM crusting (sealed in by conjunctiva) 
PERL
Normal VA 
Focal redness
Normal fluorescein
Red area will be mobile if moved with moist q-tip
Tx: Artificial tears
264
Q

Keratitis

A

Inflammation of cornea
Painful & FB sensation, difficulty keeping eye open, miserable
Viral - watery, bacterial - possibly purulent
PERL but may have haze or branching pattern on cornea
Blurred vision, halos around lights
Diffuse erythema, maybe perilimbal
On fluorescein: +HSV - branching pattern, +Bacterial - corneal ulceration
Tx: Refer URGENTLY to ophtho

265
Q

Conjunctivitis

A 
NO PAIN just irritation 
Viral/allergic --> watery esp in AM 
Bacterial --> Pus ESP in AM 
PERLA 
Normal visual acuity 
Diffuse erythema 
Normal fluorescein 
Tx: If bacterial, erythromycin ointment 
If contact lens wearer - copra 0.3% drops 1-2 drops QID x 5-7d
266
Q

Glaucoma

A 
Acute severe pain, tender, firm 
Fixed hazy dilated pupil
Decreased visual acuity 
Ciliary flush 
Normal fluoroscein
Elevated IOP
Reduce pressure NOW and immediate referral 
T.A.P 
-0.5% timolol maleate 
-1% apraclonidine 
-2% pilocarpine 
Oral meds may include acetazolamide, two x 250mg tabs in the office 
IV meds may include acetazolamide or mannitol
267
Q

Cardinal signs for orbital cellulitis

A

Ophthalmoplegia/diplopia
Decreased VA
Pain with EOM

268
Q

Side effects of topical steroids

A
  • Skin atrophy, dyspigmentation, striae, telangiectasia, acne/rosacea, periorificial dermatitis
    • Maximum 4 weeks continuously to same area
269
Q

CURB-65 Score

A 
Confusion
BUN >7 
RR >/= 30 
Systolic BP <90mmHg or Diastolic BP = 60mmHg 
Age >/= 65yo 
Consider inpt treatment once >1
270
Q

Low risk CAP

A

Low risk of macrolide resistance
Have not used abx within last 3mo
Live in area where there is not a high prevalence of macrolide resistant S.pneumo

271
Q

Low risk CAP tx regimens

A

Amox + macrolide (ie. azithro, clarithro)
or monotherapy with amox, doxy or macrolide
x5-7d

272
Q

High risk CAP

A 
Recent abx use 
Major comorbidity (ie. COPD, liver/renal dz, cancer, diabetes, CHF, EtOH, immunosuppression)
273
Q

High risk CAP tx regimens

A

Amox or amox-clav or cefuroxime

AND azithro or clarithro

274
Q

Special inflammatory marker to consider ordering in pneumonia

A

Procalcitonin - rises in bacterial infections usually more for typical (ie. strep pneumonia or H. influenza) than atypical

275
Q

1st degree AV block

A

Prolonged PR interval

276
Q

2nd degree AV Block - Type 1

A

Progressive PR interval prolongation until non-conducted P-wave

277
Q

2nd degree AV block - Type 2

A

PR interval remains unchanged prior to P wave that is not conducted

278
Q

HypERcalcemia ECG changes

A

QT interval shortening
If severe, Osborn/Jwaves may be seen
If extreme, risk of VF arrest

279
Q

Correcting Ca for low albumin

A

Every albumin drop by 10, Ca increase by 0.2

280
Q

Most common cause of hypercalcemia

A

Hyperparathyroidism

281
Q

How does hyperparathyroidism cause hypercalcemia

A

PTH increases Ca reabsorption at distal tubule and bone, decreased PO4 reabsorption at proximal tubule and increased calcitriol

282
Q

HypOcalcemia ECG changes

A

QT interval prolongation through ST interval lengthening

TdP may occur but less common than with hypoK or hypoMg

283
Q

Well’s criteria for DVT

A 
Hx: 
-Active CA 
-Paralysis or casting-
-Bedridden >3d of sx within 3mo 
-Hx of DVT
-Likely alt dx (-2) 
Px: 
-Calf swelling (>3cm)
-Superficial veins
-Unilateral edema
-Swelling of entire leg 
-Localized pain over deep venous system 
Low risk = 0 
Mod risk = 1-2
High risk >2
284
Q

Well’s criteria for PE

A

-Symptoms of DVT (3)
-Other dx less likely (3)
-HR>100 (1.5)
-Immobilization/sx within 4 wks (1.5)
-Previous PE/DVT (1.5)
-Hemoptysis (1)
-Malignancy (1)
PE unlikely =4, PE likely >4

285
Q

PERC score

A 
Do if Well's is low 
HAD CLOTS:
Hormone use 
Age >/=50yo 
DVT/PE hx 
Coughing blood 
Leg swelling
O2 sat <95% 
Tachy >/= 100bpm
Sx or trauma requiring hospitalization last 4wks 
if ANY are +ve, PERC can't be used to r/o pt 
Do a D-Dimer if any are +ve
286
Q

Tumour marker for ovarian CA

A

CA-125

287
Q

Weber #: Type A

A

Fracture of lateral malleolus distal to syndesmosis
Tibiofibular syndesmosis intact
Deltoid ligament intact
Usually stable
Tx: Occasionally requires ORIF esp if medial malleolus #

288
Q

Weber #: type B

A

Fracture of fibula at level of syndesmosis
At level of ankle joint, extending superiorly and laterally up fibula
Tibiofibular syndesmosis intact no widening of distal tibiofibular articulation
Variable stability
Tx: Non-weightbearing, refer to orthodox

289
Q

Weber #: Type C

A

Fracture of fibula proximal to syndesmosis
Above level of ankle joint
Tibiofibular dynesmosis disrupted with widening of distal tibiofibular articulation
Med mall # or deltoid ligament injury present
Tx: UNSTABLE, requires ORIF

290
Q

CHADS65

A 
Age >/= 65 --> OAC 
CHF 
OR HTN 
OR Diabetes 
OR Prior stroke or TIA --> OAC 
If CAD or PAD only --> anti-plt therapy 
If no to all of the above --> no antithrombotic
291
Q

Valvular AF

A

Mechanical heart valve

Rheumatic moderate or severe mitral valve stenosis

292
Q

Non-valvular AF

A 
Mitral regurg
Aortic stenosis
Aortic insufficiency 
Remote (3-6mo) tissue prosthetic heart valve
Remote (3-6mo) surgical valve repair
293
Q

ACS management

A

Stabilize ABCs
Oxygen if O2 <90%
Antiplt - ASA 320mg AND Clopidogrel (if PCI) or Ticagrelor (if invasive), if CABG considered delay until after coronary angiogram
Anticoag - Unfractionated heparin (if PCI) or LMWH/enoxaparin (if fibrinolysis)
Nitro (avoid in right heart infarcts)

294
Q

Modified parkland formula for burns

A

For burns >15% BSA children and >20% BSA adults
Ringer’s Lactate = 2-4mL x % BSA x weight
Give half in first 8h, the other half in next 16h
Titrate to UO of 30-500cc/h or 1cc/kg/h

295
Q

Trigeminal neuralgia tx

A

MRI to r/o vascular compression/brain lesion
1st line: Carbamazepine
2nd line: Gabapentin

CCFP (6 decks)

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