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PLAN / CAT Flashcards

1
Q

CAT OPEN FRACTURE

A 
STAND
Splint
Tetanus shot
Atb: cephalo 1 + aminoglyc
Neurovasc status
Dressings
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2
Q

Cat acute contusion/ sprain

A 
RICE
Rest
Ice
Compression
Elevation
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3
Q

When not to suture laceration

A
  1. Delayed presentation (>6-8h)
  2. Puncture wound
  3. Mammalian bite
  4. Crush injury or retained foreign body
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4
Q

Evaluation comatose patient

A 
5 N
Noggin
Neck
eNt
Needles
Neuro
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5
Q

Asthma attack

A 
ASTHMA
Adrenergics (beta-ago) +- Anti-cholinergic
STeroids
Hydration
Mask O2
Atb (if infection)
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6
Q

Universal antidotes

A 
DONT
Dextrose
O2
Naloxone
Thiamine
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7
Q

Tx IUT non-compliqué

A

3 JOURS

  • TMP-SMX (septra) 1 co BID = 1ere ligne sauf si resistance >20%
  • Quinolone -> Cipro 250 mg BID

7JOURS

  • Nitrofurantoin -> Macrobid 100mg bid
  • Beta-lactame
    • > clavulin 500mg bid
    • > cefadroxil (duricef) 500 mg bid
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8
Q

Tx PNA ET IUT COMPLIQUÉS

A 
Oral x 14 jours*
- Quinolone 
   -> cipro: 500 mg bid 
   -> levofloxacine (levaquin) 500 mg die
R/O grossesse**

IV (cas graves = Hospit)
- Quinolone
   -> Cipro 400 mg IV Bid
   -> Levaquin 500 mg IV bid
- Aminoside/cephalo + ampicilline
Switch PO des possible**
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9
Q

Bilan dx demence

A
  • FSC, E, creat,
  • Ca, albumine
  • bilan hepatique
  • TSH, B12

Selon FR

  • VDRL, VIH
  • RXP, Tropo
  • A/c urine
  • Scan cerebral
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10
Q

HyperK

A

C BIG K Drop

  • Ca gluconate (stabilise)
  • Bicarb de Na ou Insuline c glucose ou albuterol (intracell)
  • Kayexalate
  • Dialyse
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11
Q

Tx Bronchite aigue

A

1 support

ATB si toux > 10 jr
**jamais 2 x ATB -> hyperteactivite bronches
-Azithro (Biaxin) 500 mg jour #1 puis 250 mg x 4 jr
-clarithro (Zithromax) 500 mg Bid x 7 jr
** cible = atypiques

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12
Q

Investigations poussée HTA

A

E/p: coeur, poumon, FO, neuro

Labo: FSC, creat, BUN,
ECG
A/U

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13
Q

Tx TSVP crise aigue

A
  1. Manoeuvres vagales
    2.Adenosine 6 mg push + salin + lève bras
    Puis 12 mg
    Puis 18 mg
  2. Bb
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14
Q

Tx OAP

A 
LMNOP
Lasix
Morphine
Nitrate
O2 
Positive pressure, Position assise
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15
Q

Tx PAR

A
  1. AINS
  2. Biphosphonate + Cortico (temporaire)
  3. DMARDS : Hydroxychloroquine, Sulfasalazine, leflunomide, Mtx
    * echec -> ADR ciblé (Tofacitinib) ou tx bio c anti-TNF (infiximab), anti-IL6 (tocilizumab), CTLA4 Ig (Abatacept), anti-CD20 (Rifuximab)
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16
Q

Critères de dialyse

A 
AEIOU
Acidose
Electrolytes - hyperK
Intox (Clairance lente: ASA, lithium, ROH, tout Rx)
Overload
Uremie (Sx)
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17
Q

Tx sialolithiase

A

Bonbons surettes

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18
Q

Tx pharmaco TDAH

A

1ere ligne

  • Psycho stim lge actn
    • > Amphetamines: Adderall, Vyvansd
    • > Methylphenidate: Biphentin, Concerta, novo-methylphen.
  • non-psychostin lge actn
    • > Atomoxetine : Strattera
    • > Guanfacine: Intuniv

2e ligne

  • Psychostim courte/interm duree actn
    • > Amphetamine: Dexedrine
    • > Methylphenidate: Ritalin
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19
Q

EAMPOC simple

Tx atb

A 
Amox 500 mg TID x7jr
ou
Cefuroxime (ceftin) 500mg BID x 7 jr
ou
Clarithro (Biaxin) 500 mg BId x 7jr
ou
Doxycycline (Vibra-tabs) 100 mg bid x10jr
ou
Tmpsmx (Septra) 1 co bid x 10jr
ou
Azithro (Zithromax) 500 mg die jr 1 puis250 mg die x 4 jr

2e ligne

  • clavulin 875 mg bid
  • Levaquin 500 mg die x 7 jr
  • Moxiflo (Avelox) 400 mg die x 5 j
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20
Q

TX EAMPOC COMPLEXE atb

A

1er

  • Levo (levaquin): 500mg die x7 jr
  • Moxi (A elox) 400 mg die x 5jr
  • Clavulin 875 mg bud x 7 jr

2e
-Cipro: 500-750 mg bid x 7-10 jr

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21
Q

PRISE EN CHARGE EAMPOC

A
  1. ABC
  2. Cortico systemique: dim durée hospit
  3. Atb
  4. O2
  5. Bronchodil si pas pris
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22
Q

Prise en charge migraine

A
  1. Non-pharm: eviter declencheur, relaxer, TCC, biofeedback
  2. Prevention: bb, bcc, TCA, Valproate
  3. Pharm:
    - anti-inflam: acetam, ains, narco
    - ago rctr 5HT1: derives de l’ergo, triptans
    - antago rcptr D2
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23
Q

Tx pharmaco IRC

A
  1. IECA
  2. Lasix
  3. BCC
  4. Tx adjoint
    - tx dlp
    - tx db
    - contrôle complications
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24
Q

Tx 1ere ligne ICC

A

Diurétique + IECA + BB
+_ inotrope
+_ VD

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25
Q

Bilan de base HTA

A
  • FSC, E, creat
  • TSH
  • Bilan lipidique
  • HbA1C
  • A/U
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26
Q

Tx local dermatophytes

A
  1. Azolés: ketoconazole ou clotrimazole x 4-6 sem
  2. Crème: Lamisil x 2 sem
  3. Laque: ciclipiroxolamine x 1an
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27
Q

Tx systemique dermatophytes

A
  1. Teigne: Terbinafide (lamisil), Itraconazole, Flucobazole
  2. Ongles: lamisil + sporanox PO
  3. Peau: lamisil
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28
Q

Tx tinea versicolor

A
  1. Local
    - azoles topique: crème ketoconazole ou clotrimazole
  2. Étendue
    -shampoing: nizoral, selsun
    ET
    -itraconazole/fluconazole/pramocazole
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29
Q

Tx folliculite

A
  1. Culture
  2. Savon chlorhexidine
  3. ATB
    - topique: Bactroban, Fucidin
    - PO: cloxacilline, erythromycine
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30
Q

Tx furoncle

A
  1. Culture
  2. Drainage
  3. ATB: sulfa si sévère/cellulite/FR
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31
Q

Tx impetigo

A
  1. Hygiène, non-partage des serviettes
  2. Culture
  3. ATB
    - topique: bactroban, fucidin
    - PO: cloxacilline, clavulin
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32
Q

Tx cellulite

A

ATB po

  • Cephalo 1G
  • Cloxacilline
  • PNC: si infection certaine à strept
  • clavulin: <5 ans
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33
Q

Tx erythrasma

A

ATB topique

  • clinda
  • Erythro (ou PO)
  • Fucidin
  • Peroxyde benzoyle
  • Azoles
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34
Q

Tx rhinosinusite aigue

A
  1. Antipyrétiques, analgésiques
  2. Hygiène nasale >BID
  3. Decongestionnant topique faible dose qd congestion la +imp x10 jr
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35
Q

Tx rhinosinusite bacterienne aigue

A

1er:
- Amox 500mg Po TID x5jr

2e:

  • Clavulin: 500/125 mg PO TID x 7jr
  • Levofloxacine: 500 mg po diex10jr
  • Moxifloxacine: 400mg PO die x5 jr
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36
Q

Tx ulcere gastrique perforé

A 
1. Resuscitation 
\+ TNG
\+ laparotomie immédiate une fois stable
2. Analgesique
3. Atb iv large spectre
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37
Q

Tests à demander si abdomen aigu

A

Pour dx:

  • ALT, AST, ALP, BILI
  • Amylase, lipase
  • a/u
  • beta-hcg
  • Tropo, lactate

Pour prep salle d’op

  • fsc, E, bun, Creat, glucose
  • RxP
  • ECG
  • INR/Ptt
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38
Q

Tx RGO

A
  1. IPP(+ efficace), anti-acides, anti-H2
  2. Diete: eviter ROH, cafe, epices, tomate, citrus…
  3. HDV: perte poids, lever tête du lit (sx nocturne)
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39
Q

Investigations RGO

A

1 dx clinique + rps essai therapeutique c IPP

Si echec, ou red flags, ou hx aN => endoscopie

Manimetrie: pre-op fundiplicature (dx peristaltisme aN ou dim tonus LES)

pH metrie 24h: que si echec essai therapeutique et gastroscopie neg

40
Q

Tx candida oral

A
  1. Rince bouche nystatin + avaler

2. Ketoconazole ou fluconazole

41
Q

Tx oesophagite eosinophilique

A
  1. Diete
  2. Avaler CSN (fluticasone)
  3. Avaler cortico visqueux (budenoside + sucralase)
42
Q

Investigations dyspepsie

A
  1. FSC,
  2. Bilan hepatique, amylase, Lipase
  3. E, Creat
  4. Ca, albumine
  5. TSH
  6. EPP
  7. Serologie H. Pylori
43
Q

Approche maladie ulcéreuse peptique

A
  1. D/c AINS, tabac
  2. Neutraliser: IPP
  3. Tx HP: triple therapie
44
Q

Approche suspicion saignement par ulcère peptique

A
  1. ABC + resuscitation
  2. Labo: FSC, E, BUN, Creat, INR, type sanguin
  3. TNG + aspiration
  4. Pantoloc IV: 80 mg + 8 mg/h infusion continue
  5. Endoscopie (prep: Erythromycine 250mg 30 min avant)
45
Q

Tx h pylori

A

Triple therapie x 7-14 jr
= Hp-Pac: IPP bid + amox 1g bid + clarithromycine 500 mg bid

Quadruple tx que si haute resistance clarithro/metronidazole
-IPP bid + bismuth 525 mg qid + tetracyclibe 500 mg qid + metronidazole 250mg qid

46
Q

Investigations diarrhée chronique

A
  1. Analyse selles: toxine c diff, cult, gap osm, gras fecal, Gb
  2. Sang: fsc, E, Crp, Tsg, anti-tTG IgA
  3. Endoscopie haute + basse vs capsule
  4. Tentative d/c produits laitiers
47
Q

Investigations diarrhée chronique

A
  1. Anti-tTG IgA + PSA = la base
    Gold std steatorrhee: collecte selles 24h
  2. Elastase fecale
  3. Carotene srq, B12, Mg, Ca, B9, albumin, ferritine, fer, INR/PTT
48
Q

Investigation suspicion mx chrohn

A
  1. Colo+ biopsies
  2. Ct/IRM enterographie
  3. CRP (rps tx)
    Ddx: culture selle, toxine c diff,
49
Q

Algorithme tx chron

A

Approche graduée

  1. Nutrition, tx Sx (loperamide, tylenol)
  2. 5-ASA (mesalamine), ATB (flagyl, Cipro)
  3. Cortico (budesonide, pred)
  4. Immunosuppression (azathioprine, 6-MP, MTX)
  5. Immunomodulateurs (antago-TNF : infliximab, adalimumab)
  6. Tx/chx experimentale
50
Q

Tx colite ulcéreuse

A
  1. Induction Remission
    - 5-ASA (mesalamine): topique vs PO
    - Cortico: PO, IV, suppositoire, topique
    - Immunosuppresseurs: si
    • pas rps cortico apres 3jr et mx severe
    • non-rps/dpdt aux stéroïdes
  2. Maintenance
    - 5-ASA
    - Immunosuppresseurs (qd cortico retirés)
  3. Chx
    - curatif! Colectomie + IPAA
51
Q

Investigations IBS

A

Fsc
Esr, CRP
Anti-tTG
Calprotectine fecale

52
Q

Approche HDH

A
  1. Resuscitation
  2. TNG + NPO
  3. Pre-scopie: IPP IV, octreotide 50 mcg puis 50 mcg/h, erythromycine IV
  4. OGD
53
Q

Tx overdose acetaminophen

A
  1. Lavage gastrique (<2h post-ingestion)
  2. Charcoal activé PO
  3. N-acetylcysteine (NAC, mucomyst)

Appeller centre desintox

54
Q

Investigation foie alccolique

A
  1. Ast/alt > 2
    Augm GGT et CDT
  2. FSC: augm MCV, Gb
  3. U/S
55
Q

Tx foie alcoolique

A

Guider tx selon score de Maddrey et MELD

  • d/c ROH et Protection sevrage (bzp)
  • supplements dont B1
  • Pred 40 mg x28 jr si ictère + MADDREY >32 (CI: HD, pancréatite, IR, infection)
    • eviter Rx métabolisés par foie
56
Q

Investigations NASH

A
  1. AST/ALT <1, +_ ALP
  2. U/S: foie echogene
  3. Biopsie hepatique
57
Q

Tx NASH

A
  1. Perte poids progressive
  2. Controle comorbidités: optimiser tx HTA, DLP, Db
  3. Vit E 800 U po die
58
Q

Plan cirrhose

A
  1. Tx causal
  2. Tx complications
  3. Prevention complications
    • Vo/G: BB
    • CHC: alpha-foetoprot + U/S q6m
    • Vaccin: VHA, VHB, grippe, anti-pneumocoque
  4. Transplant: CHILD C, complication refractaire tx médicale
59
Q

Ddx infections secondaires morsures de chat

A 
Cellulite à progression rapide
Ostéomyélite
Tenosynovite
Arthrite septique
Rares: bactériémie, sepsis, peritonie
60
Q

Tx infection 2r morsure de chat

A
  1. Clavulin 500 mg po q 8h ou 875 mg q 12h
  2. PNC 500 mg po ou iv
  3. Cipro 500 mg po bid
    Levo 400 mg po die

**infection grave -> IV
+- vaccin tetanos + rage!!

61
Q

Indication antibioprophylaxie

A
  1. Trauma severe
  2. Crush injury
  3. Pénétration osseuse ou articulaire
  4. Morsures main/visage/organes genitaux
  5. Hôtes immunosupprimés

*mm ATB que tx x7jr
+- vaccin tetanos + rage

62
Q

ATB empirique + germes meningite <1 ans

A
  • S. Agalactiae, E. Coli, Listeria, K. Pneumoniae

- ATB empirique: Ampicilline + cephalo 3G ou Ampic + aminoglycoside

63
Q

ATB empirique + germes meningite 1-23 mois

A
  • germes: S. Pneumo, N. meningitidis, H. Influenza, E. Coli
  • Vanco + cephalo 3G

** donner vanco avant decadron!!

64
Q

ATB empirique + germes meningite 2-50 ans

A
  • Germes: S. Pneumo, N. meningitidis
  • ATB: Vanco + cephalo 3G

** donner vanco avant decadron!!

65
Q

ATB empirique + germes meningite >50 ans

A
  • Germes: S. Pneumo, N. meningitidis, Listeria
  • Vanco + Cephalo 3G + ampicilline

** donner vanco avant decadron!!

66
Q

PAC tx empirique du patient hospitalisé

A

Fluoroquinolone respiratoire ou beta-lactam + macrolide

67
Q

Tx pneumonie a legionella

A

Fluoroquinolone ou macrolide

  • levo 750 mg po x10 jr
  • moxi 400mg po x 10 jr
  • azithro 500 mg IV/PO x7-10 jr (ou clarithro)
  • Rifampin (alt peu utilisér)
68
Q

Maladie à toujours exclure lors d’un retour de voyage

A
  • Entérite bactérienne
  • Dingue
  • Malaria
  • Fièvre typhoïde
69
Q

Bilan retour de voyage et sx GI

A
  • FSC + biochimie
  • Hemoc
  • Frottis malarique + detection d’Ag
  • Recherche parasites dans les selles
  • Recherche C diff dans selles (si a pris ATB)
  • Culture selles
  • Echo abdo
70
Q

Tx empyeme

A

ATB x 4-6 sem
+ drainage complete c tube thoracique
- si loculé -> drainage chx

71
Q

Tx Pneumothorax

A

Petit (<20% + pas d’insuf circ/resp): atoresolutif, O2 100% accelere

Spontané: tube intercostal c tube Heimlich

Large/mx pulmo ssjac: tube avec succion ss H2O

72
Q

Tx ARDS

A
  1. Tx causal
  2. Ventilation Mecanique: + petit VC (<6mL/Kg), utiliser peep optimal
  3. Dc faible: fluide, inotrope
73
Q

Tx apnée sommeil

A
  1. Facteurs modifiables: perte poids, dim ROH/sedatif, décongestionnant nasal, tx cdtn med ssjac
  2. ASO: CPAP nasal, tx postural, application bucodent, amygdalectomie, uvopalatopharyngoplastie
  3. ASC: CPAP/BIPAP nasal, stim respi
74
Q

Mc + Tx insuffisance respiratoire

A

Mc: hypoO2, hyperCO2

Tx: causal, ventilation mécanique, O2

75
Q

MC et Tx insuffisance cardiaque aigue

A

Mc: HypoTA, oligurie, AEC, arythmie, hypoxie

Tx: causal, resuscitation volumique, vasopresseur, inotrope, pompe ballon intra-aortique

76
Q

Mc et tx coagulopathie (contexte organ failure)

A

Mc: augm INR/PTT, hypoPLT, saignement, ecchymoses

Tx: causal, transfusion prod sgn/fctr coag

77
Q

Mc et Tx insuffisance hépatique aigue

A

Mc: transaminite, augm bili, coagulopathie, ictère, AEC (encéphalopathie), hypoglycémie

Tx: causal, transplant, lactulose

78
Q

Mc et Tx IRA

A

Mc: augm creat, oligurie, signes surcharge volemique (icc, effusion)

Tx: causal, corriger anomalies electrolytiques, éliminer toxines, diurétiques, dialyses

79
Q

Choc vs sirs vs sepsis

A

Choc: inadequate tissue perfusion potentially resulting in end organ injury

Sepsis: infection + SIRS

SIRS: generalized inflammatory reaction caused by infectious/non-inf entities, w/ >2

  • T >38 orb<36
  • Fc >90
  • RR > 20 or PaCO2 <32 mmhg
  • Gb >12 or <4 000 or >10% bands
80
Q

Sepsis vs severe sepsis vs septic shock vs syndrome dysfctn multiorg

A

Sepsis: infection + SIRS

Severe sepsis: sepsis c dysfctn organique/hypoperfusion/hypoTA

Shock septique: sepsis c hypoTA malgré resuscitation liquidienne

SDM: sepsis+ alteration fctn organique où homéostasie ne peut pas être maintenue sans intervention

81
Q

EARLY GOAL DIRECTED THERAPY (sepsis)

A
  1. Ajuster precharge/postcharge cardiaque et contractilité pr rencontrer demande
  2. Si critères SIRS et TA <90 mm hg ou lactate >4
    - O2 +_ intubation et ventilation mecanique
    - Kt arteriel/vnx central
    - garde PVC 8-12 mmhg c crystalloids/colloids IV
    - MAP 65-90 mmhg c agents VC
    - si ScvO2 <70% => tranfusion ad Hct >30%, si pas amélioré => agents inotropes

***debuter en <6h qd reconnait sepsis

82
Q

Tx pharmaco arrêt tabac

A
  1. Support social/communautaire
  2. TRN: dim cravings et sx sevrage, CI: post-IM/angine progressive/arythmie sérieuse
  3. AD
    - Bupropion (Zyban): aussi efficace que TRN, CI: dim seuil convulsif
    - Varenicline (Champix): ago partiel rcptr nicotinique (dim craving) et antago competitif partiel rcptr nicotinique (dim rps nicotine fumée), plus efficace, CI: IRC, cdtn psyc
83
Q

Tx rhinite allergique

A
  1. Conservateur: eviter expo, sinus rince
  2. Pharmaco
    - antihistaminiques PO: 1ere ligne sx leger (Reactine, Allegra, Claritin)
    - CIN: si mod/sev ou sx persistent -> utiliser >1 mo pr résultat
    - Decongestionants IN: max 5 jrs (ES rhinite medicamentosa)
  3. Test allergie si sev/mal contrôlé
    - immunotx
84
Q

Goals tx Db

A
  1. Eviter complications
  2. GS a jeun: 4-7 mm/L
    Vs 2h post-prandial: 5-10 si HbA1C N vs 5-8 si HbA1C aN
  3. HbA1C: <7% ou <6.5 si risque nephropathie,
    Si page/comorb avancees/hypoglycémie sévère ou non senties: 7.1-8.5%
  4. TA <130/80
  5. LDL <2.0 wt Tg <1.5
85
Q

Tx DE

A
  1. Nonpharm: HDV (ROH, tabac, exercice), counselling, vacuum devices
  2. Pharm: PO (inh PDE-5, bloqueur alpha-adr, trazodone, testo (si hypogonadisme)), suppositoire, MUSE, injections
  3. Chzx: implant, reparation vasc, realignement
86
Q

Tx aigue migraine

A

1re ligne: acetaminophen, AINS, ASA +_ caffeine
2e ligne: AINS
3e ligne: ago 5-HT +_ antiémétique

87
Q

Tx prophylactique migraine

A

1er ligne: BB
2e ligne: TCA
3e ligne: anticonvulsivant

88
Q

Tx aigue cluster headache

A

Sumatriptan
Dihydroergotamine
High-flow O2
Lidocaine intranasale

89
Q

Tx prophylactique cluster headache

A

Carbonate de lithium, prednisone, methysergide

90
Q

Tx HTA

A
  1. HDV: DASH diet, 1.5-2.3g Na die, 30-60 min ex 4-7x/sem, d-c tabac, controle stress, <2 cons ROH die, IMC N et circonference N,
  2. Pharm: choix anti-HTA selon autres patho ss jacents, loi 10:5, ABCS
91
Q

Reconnaitre HTA MALIGNE

A

Encephalopathie
Ira
Papilloedeme

92
Q

Reconnaitre urgence HTA

A

Atteinte coeur: OAP, SCA
Atteinte vasc: dissection
Atteinte neuro: hemorragie IC

93
Q

Tx urgence vs poussée hypertensive

A

Poussée = PO vs Urgence = IV

Tx poussée: labetalol #1, clonidine, captopril, BCC

94
Q

Investigations osteomyelitis

A

Fsc, Vs, CRP
Hemoc
Rx (normal 2 premiere sem)
Ct scan/IRM/Scan os

95
Q

Tx osteomyelitis

A
  1. ATB IV empirique: Cefazoline/Cloxa
    - > ajuster selon culture
  2. +- irrigation + debridement chir
  3. Splint + no weight bearing
96
Q

Tx pied perforant diabetique

A

ATB: clinda + cipro ou tazocin +_ vanco (si SARM)

+ debridement agressif

Medicine (16 decks)

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