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RCPEM > PEM Notes Q2 > Flashcards

PEM Notes Q2 Flashcards

1
Q

5 findings in infantile glaucoma

A 
Unilateral pain
Cloudy cornea
Ciliary flush
Epiphoria / photophobia
poorly reactive pupil
Enlarged eye
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2
Q

causes of sudden vision loss

A 
central retinal aa occlusion
retinal detachment
stroke
optic neuritis
glaucoma
complicated migraine
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3
Q

causes of red painful eye

A 
conjunctivitis
retained foreign body
traumatic iritis
uveitis/keratitis
globe rupture
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4
Q

CF in neurogenic shock

A
  1. hypotension + relative bradycardia
  2. flaccid extremities
  3. incontinence
  4. loss of bulbocavernous reflex
  5. decreased rectal tone
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5
Q

ddx bullous impetigo

A
  1. rhus dermatitis
  2. varicella
  3. HSV infection
  4. staph scalded skin syndrome
  5. Hand-foot-mouth dz (coxsackie)
  6. lupus
  7. drug mediated reaction
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6
Q

ddx blistering rash s/p canoe trip

A
  1. poison ivy / rhus dermatitis
  2. cercarial dermatitis (swimmer’s itch)
  3. dyshidrotic eczema
  4. bullous impetigo
  5. friction blisters
  6. bullous cellulitis (vibrio vulnificus)
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7
Q

bacteria that cause soft tissue infxn from water exposure

A 
A- aeromonas
E - erysipelothrix
E - edwardsiella
V - vibrio vulnificus
M- mycobacterium marinum
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8
Q

Electrolyte changes in CAH

A

hyponatremia, hypochloremia
hyperkalemia
hypoglycemia
metabolic acidosis

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9
Q

RF for cerebral edema in DKA

A
  1. new onset DM
  2. age < 3 years
  3. Elevated BUN
  4. Decreased PCO2
  5. tx with bicarb
  6. failure of Na+ to rise w/ treatment
  7. admin of insulin w/in 1st hr of fluid
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10
Q

how do you differentiate between SIADH and cerebral salt wasting?

A

Both have LOW Na, LOW Sosm and LOW Uosm

CSW = polyuria, dec BP and volume depletion, vasopressin decreased

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11
Q

5 causes of gynecomastia

A
  1. hyperthyroidism (Graves disease)
  2. primary or secondary hypogonadism
  3. prolactin secreting tumor
  4. drugs: THC, antipsychotics, reglan
  5. testicular neoplasm
  6. physiologic
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12
Q

what meds can u use to tx HTN w/ pheochromocytoma

A
  1. alpha blocker: phentolamine (1-5 mg)
  2. sodium nitroprusside
    - do not use BB (unopposed alpha stimulation worsens HTN)
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13
Q

tx of thyroid storm

A
  1. IVF
  2. BB - propranolol
  3. lower body temperature / cooling measures
  4. methimazole
  5. steroids - inhibit TH release
  6. iodide - dec TH prod in 24 hrs
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14
Q

Tx. necrotizing fasciitis

A

Tx. PCN (Nafcillin) + Clindamycin (Vancomycin if MRSA)
IVF
Surgical debridement

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15
Q

MOA and CF of Tetanus

A

Neurotoxin –> uses retrograde axonal transmission to enter brain/spinal cord –> descending mm spasms that start at neck /jaw and progress to chest/abdomen

  • flexion/abduction of arms with extension of legs
  • risus sardonicus
  • resp failure due to mm spasm in chest wall
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16
Q

Tx of tetanus

A 
TIG - neutralizes unbound toxin
Metronidazole
Sedation w/ benzos
Paralysis - pancuronium
Baclofen
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17
Q

Kocher criteria for septic arthritis

A
  1. WBC > 12000
  2. ESR > 40
  3. Fever > 38.5 (101.3)
  4. Non-weight bearing
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18
Q

Abx for septic arthritis

A

< 3 mos: Amp + Cefotaxime

> 3 mos: Ancef, Clinda, Nafcillin, Vanco (either one)

19
Q

Dx criteria for toxic shock syndrome

A 
High fever
Erythroderma
Abnormal VS
Atleast 3 organ systems involved:
- NVD or increased LFTs
- myalgias or inc CPK
- elev BUN/Cr
- Plt < 100 000
- altered mental status
20
Q

Tx toxic shock syndrome

A

Vancomycin + Ceftriaxone

mild: ancef + clinda

21
Q

3 findings in exudative pleural effusion

A
  • pleural fluid: serum protein ratio > 0.5
  • pleural fluid: serum LDH ratio > 0.6
  • pleural LDH > 2/3 UNL for serum
22
Q

RF for MRSA

A 
crowded living conditions
MSM 
Prisoners
poor hygeine
cuts/abrasions
close skin/skin contact with MRSA (+) person
23
Q

When do you tx with abx for abscess?

A

incision & drainage for all

- give abx if fever, associated cellulitis or < 3 months

24
Q

Abx choices for abscess

A

< 1 month: vanomycin (clinda if well and < 1 cm)
1-3 mos: Bactrim until cx back, then switch to Keflex
> 3 mos and well: obs
> 3 mos + fever or cellulitis: bactrim + keflex until cx results

25
Q

tx of tinea capitis with kerion

A 
Griseofulvin is not available in canada
Terbinafine x 4 weeks
< 20 kg: 62.5 mg daily
20-40 kg: 125 mg
> 40 kg: 250 mg
26
Q

causes of acute diplopia

A 
trauma (blowout fx)
papilledema
toxins (anticholinergics)
CNS - mass, bleed
myasthenia gravis
refractive error
head trauma
27
Q

findings in orbital fx

A

restricted upward gaze
numbness of I/L malar region
swollen, painful eyelids
diplopia

28
Q

Neuro complications of Varicella (5)

A
  1. acute cerebellar ataxia
  2. meningitis
  3. encephalitis
  4. transverse myelitis
  5. Reye syndrome
29
Q

Ophtho complications of Varicella

A
  1. conjunctivitis
  2. keratitis
  3. uveitis/iritis
  4. acute retinal necrosis
  5. corneal ulcers (dendritic)
30
Q

when can you perform watchful waiting for AOM

A 
> 6 months of age
mild illness (fever < 39)
responsible parents
symptoms < 48 hours
child is otherwise healthy w/ no other underlying conditions
31
Q

3 abx choices for AOM

A
  1. amoxicillin 90 mg/kg/day x 10 days (or 5 days if > 2)
  2. Ceftriaxone 50 mg/kg IM x 3 days
  3. augmentin 45-60 mg/kg/day div TID
  4. cefuroxime 30 mg/kg/day div TID
32
Q

3 stages of pertussis

A
  1. catarrhal: 1-2 wk
  2. paroxysmal: 2-4 wk
  3. convalescent: 2-3 mos “100 d cough”
33
Q

definitive criteria for PID

A
  1. endometrial biopsy
  2. imaging w/ fluid filled/thickened fallopian tubes, TOA abscess or tubal hyperemia
  3. laparoscopic findings
34
Q

3 stages of pertussis

A
  1. catarrhal: 1-2 wk
  2. paroxysmal: 2-4 wk
  3. convalescent: 2-3 mos “100 d cough”
35
Q

DDx purpuric rash

A
  • tickborne illness
  • HSP
  • meningococcemia
  • DIC
  • endocarditis
36
Q

CF of hemolytic uremic syndrome

A 
Hematuria*
Proteinuria*
Elevated BUN/Cr*
decreased plts
microangiopathic anemia
37
Q

Prophylaxis for meningitis

A

Contacts in last 7 days

  • household contacts
  • people sharing sleeping arrangements
  • direct contact with oral/nasal secretions
  • daycare classmates
  • health care workers if no PPE with close contact
  • traveller’s seated next to index pt on flight > 8 hrs
38
Q

Ddx of unilateral cervical LAD

A 
atypical mycobacteria
brucellosis
tularemia
staph aureus
group A strep
EBV
TB
39
Q

CANMEDS - 6

A
  1. communicator
  2. collaborator
  3. manager
  4. health advocate
  5. scholar
  6. professional
40
Q

how can you tell which pupil is abnormal with anisocoria?

A

in LIGHT –> larger pupil is abnormal due to inappropriate pupillary constriction
in DARK –> smaller pupil is abnormal due to inappropriate pupillary dilation

41
Q

CANMEDS - 6

A
  1. communicator
  2. collaborator
  3. manager
  4. health advocate
  5. scholar
  6. professional
42
Q

definition of menorrhagia

A
  1. excessive uterine bleeding at regular intervals

2. prolonged bleeding > 7 days

43
Q

4 things in management of pt w/ menorrhagia and syncope

A
  1. Obtain lab studies including CBC for anemia, iron studies
  2. Obtain pelvic US
  3. Consider beginning hormonal therapy such as OCP
  4. If Hb < 7, consider blood transfusion
  5. Consult gynecology

RCPEM (5 decks)

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