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CCFP Exam 2021 > Practice Exam Questions! > Flashcards

Practice Exam Questions! Flashcards

1
Q

Side effects of antipsychotics in elderly?

A 
BLACK BOX: ALL cause mortality!
Adverse cardiac events
Gait
UTIs
Edema
Somnolence
Falls
Anticholinergic side effects
Orthostatic hypotension
Weight gain
Diabetes
Dyslipidemia
Sedation
EPS
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2
Q

How long is AP trial in geris?

A

Deprescribe if for insomnia!

Also deprescribe if had adequate trial (3 mo) or if unresponsive/stabilized!

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3
Q

BASELINE BLOODWORK FOR ANTIPSYCHOTIC MED INITIATION?

A 
Fasting blood glucose
HDL, LDL, TChol/triglycerides (lipid panel is INCORRECT)
AST, ALT
Prolactin
Amylase
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4
Q

Clinic physical exam for initiation of antipsychotics?

A

Height
Weight
Waist circumference
Blood pressure

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5
Q

45 yo F with neck lump. What are RF’s for Thyroid CA on history?

A

Constitutional symptoms
Rapid growth
Radiation (head/neck OR total body for Bone Marrow transplant)
Familial thyroid carcinoma
Thyroid cancer syndromes (MEN 2, Cowden’s dz, familial adenomatous polyposis)

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6
Q

Physical exam findings in neck mass are concerning for malignancy?

A 
Lymphadenopathy
Fixated to surrounding tissue
Dysphonia
Dysphagia
Dyspnea
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7
Q

You find a SINGLE FIXED nodule on the thyroid. What is the SINGLE MOST important blood test to order now?

A

serum TSH

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8
Q

What are the four steps to trauma informed care?

A
  1. Bear witness to patient’s trauma experience
  2. Create a safe space
  3. Include patient in healing process
  4. Believe in the patient’s strength and resilience
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9
Q

What do you call when patient’s hurt themselves but don’t want to kill themselves?

A

Nonsuicidal self-injury (NSSI)

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10
Q

What conditions are associated with nonsuicidal self-injury?

A

Depression
Borderline Personality Disorder
Higher risk of suicidal behaviour
Childhood sexual abuse

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11
Q

What are three things on your differential when somebody presents with restless legs at bed?

A 
Periodic limb movement disorder
Leg pain
Akathisia
Nocturnal leg cramps
Volitional movements
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12
Q

What are 4 risk factors for restless leg syndrome

A 
Iron deficiency
Pregnancy
Uremia
Neuropathy
Multiple sclerosis
Parkinsons
Medications (antiemetics, antihistmines, antidepressants and anticonvulsants)
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13
Q

How do you treat restless leg syndrome?

List 3

A 
Iron replacement
Dopamine agonist (pramipexole)
Gabapentin, pregabalin
Benzodiazepines
Exercise/stretching
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14
Q

What are three ways to remove a cast safely?

A 
Use a guard
Cut from both sides
Stop patient if patient says stop
Mark the cast prior to cutting
Display that the cast does not cut skin
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15
Q

What diagnosis are you worried about with pain in cast?

A

Compartment syndrome

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16
Q

Does early introduction of allergens increase the risk of allergy?

A

No. It lowers it. Introduce allergens no earlier than 4 months.

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17
Q

What two conditions put children at higher risk for having a peanut allergy?

A

Severe eczema

Egg allergy

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18
Q

List 6 conditions that would be associated with intellectual disabilities

A 
Dementia/Diabetes
Infectious conditions
Menopause
Addictions
Psychiatric conditions
Epilepsy
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19
Q

What are additional psychosocial steps in caring for developmentally disabled?

A 
Support in community
Educating family
Ensuring follow-up
Engaging with inter professional services
Monitoring for drug reactions
Monitoring for abuse
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20
Q

What are three of the essential eligibility requirements for MAID?

A

Capacity
18 years old
Irremediable medical condition that causes suffering
Ab advanced state of irreversible decline and death is reasonably foreseeable
Decision not made as a result of external pressure

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21
Q

If patient’s are having difficulty with BGMs, what management do you offer?

A

Reduce BGMs or Stop daily monitoring.

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22
Q

What diet is prescribed for IBS?

A

Low FODMAP

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23
Q

What does FODMAP stand for and give two examples of each

A

Fermented Oligosaccharides - Wheat, rye, onions, garlic
Disaccharides - Milk, yogurt, soft cheese
Monosaccharides - mangos, honey
Polyols - Blackberries, lychie and sugar alcohols

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24
Q

What are the physical exam findings of Leprosy?

A

Painless pale or red lesions without loss of sensation
Extensive sensory loss
Thickening of nerves

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25
List four countries where Leprosy is endemic?
India Indonesia Brazil Congo
26
What are 3 risk factors for leprosy?
Exposure (Droplet/contact) Low - SES Genetic
27
What are three risks of bento receptor agonist (BZRA) in elderly?
Falls Physical dependence Psychological dependence
28
What should you do for elderly patients on benzodiazepines?
Taper. | Not applicable with co-morbid psych disease.
29
Can patients swab themselves for STI screening?
Yes. More sensitive than health care providers.
30
What are three types of urinary incontenence?
Giggle micturition Stress incontenance Urge Incontenance
31
List 4 diseases for abnormal uterine bleeding?
``` Leiomyoma Leiomyosarcoma Clotting disorders - Hemophilia, Von willebrands Endometrial polyp Endometrial carcinoma Endometriosis Endometrial hyperplasia ```
32
Elbow pain in kid following trauma?
Subluxation of the radial head (nursemaid's elbow)
33
What imaging would you order for Nursemaid's elbow?
None.
34
How do you treat nursemaid's elbow?
Hyperpronation maneuver.
35
What is on your differential for a suspected nursemaid's elbow?
Non-accidental injury | Supracondylar fracture of humerous
36
What 5 things do fibromyalgia, myalgic encephalitis-chronic fatigue syndrome and environmental sensitivities have in common?
``` Allodynia Fatigue Sleep disturbance Cognitive symptoms Neurologic symptoms ```
37
What is distinctive about myalgic encephalitis (chronic fatigue syndrome) fatigue?
It does not get better with rest Chronic and profound fatigue Post-exertional malaise
38
What does environmental sensitivity suffer from after exposure? List 3.
Fatigue Neurocognitive depression Relief when inciting agents removed.
39
What tests do you order for somebody with celiac disease?
Vitamin D annually | BMD
40
What do you recommend to celiacs for bone health?
``` Calcium and Vit D supplementation Weight bearing exercises Don't smoke Don't drink Gluten free diet ```
41
What are red flag of back pain? | List 6.
``` Fecal incontenance Urinary retention Saddle anesthesia Fever Weight loss Night sweats Loss of rectal tone ```
42
What imaging do you order for back pain with no red flags?
None.
43
What on history, physical exam or labwork would lead you to believe a patient has appendicitis.
History - migratory pain, nausea Physical exam - Fever, Rosving's, Obturator, Psoas, Cough tenderness Labwork - Leukocytosis with neutrophilia
44
What is one thing you must check in peds patients with suspected appendicitis
Check balls for torsion
45
What organism causes whooping cough?
Bortadella Pertussis
46
How long is whooping cough contagious?
3 weeks
47
How long is an individual contagious of pertussis after receiving antibiotics?
5 days
48
Who do you prioritize vaccines for whooping cough if there is an outbreak?
Pregnant women >26 | Infants
49
What are red flags for tinnitus
Unilateral Pulsatile Abnormal autoscope findings
50
What is best for ruling out a vascular cause for tinnitus?
MRA venogram of brain and neck
51
What are 6 risk factors for plantar fasciitis?
``` Obesity Deconditioning Smoking Male gender Excessive running Flat footed (pes planus) Extra arch in foot Reduced ankle dorsiflexion Leg length discrepancy Foot and calf muscle tightness Occupations requiring prolonged standing or walking. ```
52
How do you treat plantar fasciitis? Name 6
``` NSAIDs Heel padding Stretching Ice Activity modification Massage Weight loss Glucocorticoid injection ```
53
What are 5 things on your differential for heel pain?
``` Plantar fasciitis Bone spur Calcaneal fracture (acute or stress) Spondyloarthropathies Tumour ```
54
What are 5 pregnancy conditions linked to future cardiovascular disease risk?
``` GDM GHTN Pre-term birth Delivery of IUGR Abruption placental ```
55
What are 4 medications safe to use in treatment of hypertension while breastfeeding?
Captopril Enalapril Labetalol Nifedipine
56
What are features of mono on history (4) and physical exam (2)?
``` Fever Pharyngitis Chest pain Fatigue splenomegaly Head and neck lymphadenopathy ```
57
What is the causative organism of mono?
Epstein-Barr Virus
58
What advice do you give to patient's with enlarged spleens?
No contact sports for 3-6 weeks.
59
What is the chance of curing fungal toe infections with topical treatment alone?
Less than 6-23%
60
What is the oral medication for fungal toe infection?
Terbinafine
61
What is the chance of livery injury with terbinafine?
1 in 50,000 to 120,000
62
What are relevant questions for cannabis history?
``` How much? How frequently? Before noon? Smoke and drive? Smoked alone? Friends or family asking to cut down? Attempts to reduce are unsuccessful? Problems due to cannabis? Type and Delivery method? ```
63
What screening test is good for cannabis risk?
``` Cannabis Abuse Screening Test 93% sensitivity 81% specificity in low EtOH cannabis users ```
64
What are the two screening tests for colon cancer?
FIT q1-2 years | Colonoscopy 10 years earlier than first degree relative diagnosis
65
What are the modifiable risk factors for colon cancer?
``` Smoking Processed meats Soluble fibre Alcohol Weight loss Diabetes ```
66
What are the genetic risk factors for CRC?
``` Familial adenomatous polyposis Lynch Syndrome (HNPCC) ```
67
What are three topical treatments for topical rosacea?
Azelic acid Topical ivermectin Metronidazole
68
What is the definition of pathological weight loss?
10% in 6 months or >5% in 1 month
69
What are 10 modifiable causes of weight loss in elderly patients?
``` Side of Medication Treatment effects (chemos, rads) Other Malignancy Pain control Wandering or repetative behaviour of psychiatric disease Emotional or Psychological problems Impaired condition GI disease Hyperparythyroidism Hypo/hyperthyroidism Hypoadrenalism Taste and Texture Loss of appetite Oral health Swallowing disorders Social factors (low-SES) ```
70
What are you concerned about with professional athletes and excess exercise?
Rhabdomyolysis
71
What are 4 symptoms and 4 complications of rhabdomyolysis?
``` Oliguria Dark urine Back pain Myalgias Renal failure Compartment syndrome End organ failure Death ```
72
What lab test to confirm rhabdomyolysis and what is the cutoff?
CK 5X Upper limit of normal or above 5000.
73
What treatment steps for rhabdo?
IV fluids Rest Restrict exercise Sleep
74
What are 4 side effects of PPI use?
``` Pneumonia CKD Hypomagnesium B12 deficiency Fractures Dementia C. Diff ```
75
What would cause a secondary spasticity?
Spinal cord injury (trauma) M.S. Stroke Cerebral Palsy
76
List 10 causes of increased spasticity in elderly.
``` Discontinuing medications UTI Bladder retention Constipation Pregnancy Post-partum Anxiety Improper wheelchair Temperature Pressure ulcer Tight clothes Ingrown toenails DVT Infection ```
77
When do you introduce allergens? When is the earliest you can do it?
6 months. | Not before 4 months.
78
How do you incorporate breast milk with allergenic foods?
Breastfeed after allergenic foods.
79
Over 65 gets what vaccines?
PPSV - 23 and PSV-13
80
What at-risk or high-risk conditions would you vaccinate with PPSV-23 and PSV-13?
``` Diseases of white blood cells Asplenia Immunosuppressants HIV Renal failure Cochlear implants Asthma COPD EtOH Steroids Liver disease Lung disease Oral steroids Reumatoid arthritis Seizure Lupus Chrohn's Smokers ```
81
Rheumatoid arthritis is a risk factor for? | List 2.
Atherosclerosis CV disease Lymphoma Infection
82
List 8 side effects of steroids
``` Weight gain Osteoporosis Avascular necrosis Cataracts Infection Bruising Acne HTN Hyperlipidemia Hypokalemia Hyperglycemia Mood Swings ```
83
Diagnostic Criteria for SLE
``` Malar rash Discoid rash Serositis Oral ulcers ANA Photosensitivity Blood Renal Arthritis Immune Neurologic ```
84
Describe the Spurling test
Neck extension, lateral flexion, axial loading.
85
What is the treatment for anogenital gonorrhoea?
Cefixime PO 800 mg | Ceftriaxone IM 250 mg PLUS Axithromycin PO 1 g
86
What test do you order for resistant strains of gonorrhoea?
Urine/swab culture.
87
What medication would you prescribe for ceftriazone -resistant gonorrhoea, anaphylactic penicillin allergy and allergy to cephalosporins?
Gentamicin IM 240 mg PLUS | Azithromycin PO 2 g
88
What is on your differential for chronic, non-bloody diarrhea without travel?
``` IBS IBD Celiac Lactose intolerance Bacterial Parasitic ```
89
What agent does gum contain in it that causes diarrhea?
Sorbitol (sugar alcohol)
90
What is the role of loperamide for travellers diarrhea?
Fine with non-bloody diarrhea.
91
What one OTC agent can be taken to prevent traveler's diarrhea?
Pepto bismol
92
What are 4 side effects of pepto bismol?
Black tongue Black stool Tinnitus Constipation
93
What antibiotic do you treat traveler's diarrhea with?
Azithromycin
94
What are 5 indicators of advance heart failure?
``` Symptoms at rest Multiple hospitalizations in a year Weight loss Frequent ICD shock SBP < 90 mm Hg Inability to walk 1 block Decrease in serum sodium ```
95
What are four symptoms of Meniere disease?
Vertigo Aurul fullness Tinnitus Unilateral hearing loss
96
What conservative measures can you treat Meniere disease with? List 4
Dietary salt restriction Stress reduction Betahistine Diuretics
97
Can you drive with Meniere disease?
Yes
98
Red flags for melanoma. List 5
``` Assymetry Irregular borders Multiple colours Diameter > 6mm Evolution of appearance ```
99
What descriptors would you use for seborrheic keratosis?
Verrucous Well defined borders Dull-brown plaque/papule
100
What descriptors would you use for a benign nevus?
Structural symmetry in all axes Light or dark brown No blue or white (scar) areas Gradual fading and thinning towards edges
101
What organism causes warts?
Human papillomavirus
102
Can warts spontaneously resolve in healthy individuals?
Yes
103
What are the elements of using duct tape for warts? | 6 steps
``` Apply directly to the wart Stay on for 4-7 days Remove tape Remove dead skin with emery board Re-apply after 12 hours Repeat for 6 weeks ```
104
What percentage of elderly patients will have side effects with SSRI's?
20%
105
How do falls risk compare in SSRIs vs benzos.
Same
106
How quickly to see changes in mood with SSRIs in elderly?
10-12 weeks
107
What are the two most common treatments for opioid addiction?
Suboxone | Methadone
108
What medication is the cure for opiate overdose?
Naloxone
109
What resources should be provided to those undergoing opioid agonist therapy?
Individual counselling Group support Safe storage Work safety
110
How frequently should individuals with intellectual disabilities have periodic health examinations?
Annually
111
What should be screened for in a periodic health examination in individuals with intellectual disabilities or slowing?
``` Hearing impairments Thyroid disorder Cardiac disorders Vision impairments Respiratory disease Obesity Osteoporosis Mental health ```
112
What conditions could cause behavioural changes in individuals with intellectual disabilities?
Dementia Depression Hypothyroidism
113
What are the upper limits of QTC in men and women
Men 450 | Women 460
114
What are risk factors for Torsade de pointes? List four.
``` Low K Low Mg Low Ca Old age Female Bradycardia Prior TdP ```
115
List 4 medications that are linked to Torsade de Pointes.
Domperidone Citalopram/Escitalopram Macrolides Quinolones
116
What is one conservative measure to reduce the incidence of UTI's?
Increase fluid intake by 1.5 L/day.
117
What treatment do you prescribe for pre-menopausal vaginal dryness?
Vaginal estrogens | Vaginal moisturizers
118
What one treatment can you give for simple febrile seizure?
Tylenol
119
What condition causes nervelike distribution of discolouration in fingers in response to the cold?
Raynaud's.
120
What conditions are associated with Raynaud's?
SLE Secondary Raynaud's Systemic sclerosis Sjogren sundrome
121
Who do patient's with Raynaud's get referred to?
Pediatric rheumatology.
122
What is one alarm feature for Raynaud's disease?
Nail fold capillary changes.
123
What is your first line antibiotic for purulent cellulitis in MRSA +ve patients?
SMP/TMX | Clindamycin added increases cure rate.
124
What are risk factors for community acquired MRSA? | List 4
``` Recent abx Contact sports Group housing Low SES IVDU ```
125
Who is PrEP indicated for? | List 3
MSM IVDU Individuals having sex with somebody with detectable virus load
126
What drugs are in PrEP?
Emtricitabine/Tenofovir
127
When is PrEP taken?
Daily | Around the time of sex
128
When can you stop PrEP?
2-28 days after exposure
129
When do you prescribe Dukoral for Traveler's Diarrhea?
Never.
130
What percentage of people who are infected by hepatitis C clear the virus spontaneously?
25-35%
131
What are FOUR risk factors for hepatitis C infection?
``` Low SES IVDU Intra-nasal drugs MSM Sex-workers Prisoners Tattoos Travel or emmigration from endemic nation (China) ```
132
What is the inflammatory reaction associated with treating spirochetes (syphillis)?
Jarisch-Herxheimer reaction
133
How long does the Jarish-Herxheimer reaction take to resolve?
24 hours
134
How do you treat the Jarisch-Herxheimer reaction?
Anti-pyretics
135
What clinical tool do you use to assess concussions?
SCAT-5
136
What are important elements of history to determine readiness for return to play?
Are all symptoms resolved? Has there been unrestricted return to cognitive normal activity without symptoms? Has there been return to physical activities without symptoms? Are there any abnormal neurologic findings?
137
What conditions may be co-morbid with concussion or delay return to normal?
``` Migraines Anxiety Depression Autonomic dysfunction Sleep Dysfunction C-spine trauma ```
138
What are indications for inpatient treatment of anorexia?
``` HR < 45 Weight < 75% ideal Temp <35.5 SBP < 80 Orthostatic change in pulse is >20 BPM Orthostatic change in BP is greater than 10 mm Hg ```
139
What should be screened for with diabetic patients?
Retinopathy Nephropathy Neuropathy
140
Why do patients have different Hgb A1c targets? | List 4
``` Age Comorbidities Cardiac risk Medication cost Frailty Hypertension Side Effects ```
141
What nutrition advice is appropriate for new mothers?
Discourage homemade formula Vit D supplementation Start solids at 6 months (containing iron) Avoid hard, small round, smooth and sticky foods until 3 years of age Promote family meals Avoid all sweetened drinks or juices Early and repeated introduction of allergens at 6 months of age is associated with reduction in risk of food allergies
142
What three injury prevention advice should you give to new parents?
Use rear facing child seat until 2 years of age. Swaddling is not recommended for the first 2 months of life Infants should sleep in a crab without soft objects or loose bedding

CCFP Exam 2021 (11 decks)

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