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Priority Topics Flashcards

1
Q

ACLS steps for shockable rhythm

A

Give O2
Attach defib
Vent fib or pulseless ventricular tachycardia
SCREAM
Shock
CPR - 30:2 ratio for 2 min
Rhythm - check q2m and shock if indicated
CONTINUE CPR
Epinephrine q3-5m 1 mg IV/IO OR can give vasopressin in place of 1st or 2nd dose of epi
AM - Antiarrhytmic medication - give Amiodarone, lidocaine or mag sulfate

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2
Q

Shockable rhythms

A

Ventricullar fibrillation
Pulseless ventricular tachycardia
Pulseless

EMERGENCY

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3
Q

Medications that cross into breast milk

A

Antimetabolites, chloramphenicol, diazepam, ergots, golds, metronidazole, tetracycline, lithium, cyclophosphamide

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4
Q

Absolute contraindications to breastfeeding

A

HIV, HTLV type 1 and 2, infant galactosemia

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5
Q

Safest SSRI in pregnancy and breastfeeding

A

Sertraline

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6
Q

Common issues when breast feeding

A

Inadequate milk (consider domperidone), breast engorgement (cool compresses, manual expression), nipple pain (clear milk off after feeds, moisturizer, topical steroids), mastitis (treat with cloxacillin or cephalexin), inverted nipples, maternal medication

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7
Q

What is in Pediacel?

A

Six-in-one needle that protects against pertussis, diphtheria, tetanus, polio, Hib (Haemophilus Influenzae type B) meningitis/epiglottitis

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8
Q

When should children get DTap IPV Hib

A

2, 4, 6, 18 months

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9
Q

When should influenza vaccine be started in children?

A

6 months and annually thereafter

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10
Q

Side effect of rotavirus vaccine

A

Intussusception
Meckle’s diverticulum

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11
Q

Side effects of TdaP IPV vaccine

A

Possible seizure on same day (rare)

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12
Q

What vaccine causes ORS as a side effect?

Oculo respiratory syndrome

Bilateral red eyes AND cough/wheezing/hoarseness/sore threat/tightness/difficulty breathing/swallowing

A

Influenza

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13
Q

What vaccine should be avoided in preganancy?

A

Live - polio, MR, varicella
Oral typhoid

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14
Q

What vaccine should be avoided in preganancy?

A

Live - polio, MR, varicella
Oral typhoid

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15
Q

Side effect of DTaP

A

Large swelling can occur with 4-5th dose
Self limiting
Not an allergy sign, future doses remain safe

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15
Q

Side effect of MMR

A

Rare but thrombocytopenia is possible
Orchitis (mumps)
Parotitis (mumps)
Arthralgia (rubella)

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16
Q

What is hypotonic hyporesponsive episode and what vaccine is it associated with?

A

Sudden onset of reduced muscle tone, hyporesponsiveness, pallor/cyanosis within 12 hours of immunization
Rag doll reaction
Associated with pertussis vaccine

Not a CI to further doses

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17
Q

What is the only vaccine given at birth?

A

Hepatitis B

2nd dose given at 2 months

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18
Q

What medical exams should be done on new immigrants to Canada?

A
  • chest xray and report for > 11 yo
  • urinalysis > 5 yo
  • syphilis serology > 15 yo
  • HIV testing > 15 yo or those who have an HIV mother, identified risk or received blood products
  • serum creatinine > 15 yo and children with h/o HTN, DM, kidney disease
  • psychosocial support
  • develop immunization catch up schedule
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19
Q

What immunization should pregnant woman have?

A

Tdap every pregnancy between 27-32 weeks or earlier if risk of preterm labor
Rubella for all non immune mothers

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20
Q

What should be asked at each well baby visit?

Rourke

A

Parent and caregiver concerns
Breastfeeding up to 2-3 yo + Vitamin D 400 IU/d

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21
Q

What education and advice should be discussed at 1 week?

Rourke

A

Car seat, safe sleep position (avoid bed sharing, crib safety, position, room share), firearm safety

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22
Q

What education and advice should be discussed at 1 month?

Rourke

A

Second hand smoke, supervised tummy time, no OTC cough/cold meds

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23
Q

What education and advice should be discussed at 2 months?

Rourke

A

Car seat, safe sleep, poisons, firearm safety

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24
Q

What education and advice should be discussed at 4 months?

Rourke

A

Night walking, healthy sleep habits, parent bonding, postpartum depression, assess home visit need, family healthy active living, screen time, social status (making ends meet, food insecurity)

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25
Q

What education and advice should be discussed at 6 months?

Rourke

A

Second hand smoke, supervised tummy time, dental cleaning with fluoride, no OTC cough or cold meds

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26
Q

What education and advice should be discussed at 12-13 months?

Rourke

A

Night walking, parenting, making ends meet, high risk infants needing home visits, family healthy active living, avoiding juice or beverages high in sugar

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27
Q

What education and advice should be discussed at 18 months?

A

High risk children, making ends meet, active family, second hand smoke

Rourke

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28
Q

What education and advice should be discussed at 2+ years?

Rourke

A

Avoid juice and high sugar drinks, car seat, bike helmet, discipline, depression, making ends meet, second hand smoke, dental health, no OTC cough/cold meds, health sleep habits

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29
Q

How do you monitor growth according to the Rourke record?

A

Measure length, weight and head circumference and plot on graph up until 2-3 yo then do height, weight and BMI

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30
Q

When ocular assessments should be done in a child according to the Rourke record?

A

Red reflex all visits
Start visual acuity at 2 years
Do corneal light reflex from 6 months onward

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31
Q

At what point in the Rourke record should tonsil size and sleep disordered breathing be assessed?

A

1 year onwards

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32
Q

When can you start introducing solids?

Pediatrics

A

6 months
Give iron containing foods - iron fortified cereals, meat, tofu, legumes, poultry, fish, whole eggs
Discuss allergenic food - eggs and peanuts
Avoid high sugar food and drink

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33
Q

What is a Broselow tape?

A

Broselow Tape relates a child’s height as measured by the tape to their weight to provide medical instructions including medication dosages, the size of the equipment that should be used, and the level of energy when using a defibrillator

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34
Q

Neurologic symptoms that are possible after vaccination

A

Persistent crying, seizure, paraesthesia, paralysis, guillain barre, subacute sclerosing panencephalitis, meningitis

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35
Q

System reactions that can occur after vaccination

A

Adenopathy, anaphylaxis, allergic reaction, erythema multiforme, rash, hypotonic hyporesponsive episode, arthralgia, severe diarrhea or vomiting

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36
Q

Other reactions that are possible after vaccination

A

Parotitis, orchitis, thrombocytopenia, narcolepsy, ORS, bell’s palsy, intussusception

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37
Q

Indicators of good CPR

A
  • Push hard >2 inches (5 cm) and fast (100-120/min) and allow complete chest recoil
  • Minimize interuptions
  • Avoid excessive ventilation
  • Rotate compressors every 2 minutes or sooner if tired
  • If no airway then 30:2 compression ventilation ratio
  • If PETC02 < 10 mmhG attempt to improve the quality
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38
Q

Drug therapy in ACLS

A

Epinephrine
Amiodarone
Lidocaine

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39
Q

Advanced airway in ACLS

A
  • Endotracheal intubation or supraglottic advanced airway
  • Waveform capnography or capnometry to confirm and monitor ET placement
  • Once in place give breath nce every 6 seconds (10/min) with continuous chest compressions
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40
Q

How to you confirm ROSC

Return of spontaneous circulation

A

Pulse and blood pressure
Abrupt sustained increased in Petc02 > 40 mmHg
Spontaneous arterial pressure waves with intra arterial monitoring

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41
Q

Reversible causes cardiac arrest

A

– Hypovolemia
– Hypoxia
– Hydrogen ion (acidosis)
– Hypo-/hyperkalemia
– Hypothermia
– Tension pneumothorax
– Tamponade, cardiac
– Toxins
– Thrombosis, pulmonary
– Thrombosis, coronary

H’s and T’s of ACLS is a mnemonic used to help recall the major contributing factors to pulseless arrest including PEA, asystole, ventricular fibrillation, and ventricular tachycardia. These H’s and T’s will most commonly be associated with PEA, but they will help direct your search for underlying causes to any of arrhythmias

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42
Q

What are indicators of inappropriate resuscitation?

A

Asystole, long code times, poor pre code prognosis, living wills, DNR

43
Q

What are indicators of inapproriate resucitation?

A

Asystole, long code times, poor pre code prognosis, living wills, DNR

44
Q

What is important to remember in a code?

RE: family

A

Speak to the family

45
Q

Examples of autosomal recessive conditions

A

cystic fibrosis - deficiency in the chloride channel CFTR
inborn errors of metabolism
PKU, von Gierke’s, Pompe’s, glycogen storage diseases, sphingolipidoses (except Fabry’s), and mucopolysaccharidoses (except Hunter’s)
sickle cell anemia
thalassemias
albinism
ARPKD
hemochromatosis

1/4 of offspring affected when both parents are carriers

Must have 2 defective copies of the gene

46
Q

Examples of autosomal dominant conditions

A

von Willebrand disease (most common)
Huntington’s disease
osteogenesis imperfecta
achondroplasia
Marfan syndrome
neurofibromatosis type I
acute intermittent porphyria

Only one copy of the defective gene is required to express the disease phenotype

47
Q

What medications are used for rate control in atrial flutter?

A

Beta blocker, diltiazem, verapamil, digoxin

48
Q

What medications are used for chemical cardioversion in atrial flutter?

A

Sotalol, amiodarone, type 1 antiarrhythmics

49
Q

First line treatment for depression in youth

A

Fluoxetine

Paroxetine is not recommended for youth

Blocks serotonin reuptake. Can cause sexual dysfunction, headache, GI upset, weight loss, tremors, increased QT interval

50
Q

First line oral medication for HTN in pregnancy

A

Labetalol, methyldopa, nifedipine, other beta blockers

AVOID ACEi and ARBs, PRAZOSIN OR ATENOLOL

51
Q

First line treatment for PMS

A

Exercise, CBT vitamin B6
Can try SSRI (citalopram or escitalopram) continuously or during luteal phase (day 15-28)
Combined hormonal contraception

52
Q

First line treatment for suspected endometriosis

A

Combined hormonal contraception ideally continuous or progestin alone (oral, IM, SC)

53
Q

First line IV antihypertensive in a hypertensive emergency

A

Labetalol except in CHF
Nitroglycerine - used in coronary ischemia and HF
Hydralazine - used in eclampsia

54
Q

First line medication in a high risk bite

A

Amoxicillin + clavulanate (Augmentin)
Alternatves: Doxycycline (in children older than 9) or ceftriaxone

55
Q

First line pharmaceutical treatment for chronic pelvic pain

A
  1. NSAIDs (ibuprofen, ASA< naproxen)
    Second line: Opioids
  2. Combined OCPs
  3. GnRH agonists
  4. Progestins
56
Q

First line therapy for generalized neuropathic pain

A

Gabapentin, pregabalin, TCA, SNRI

57
Q

First line treatment for post herpetic neuralgia

A

Lidocaine patch
Capsaicin
Gabapentin, pregabalin
TCA
Anticonvulsant

58
Q

First line treatment for trigeminal neuralgia

A

Carbamazepine
Phenytoin
Baclofen

59
Q

Treatment for giant cell arteritis

A

Treat promptly with glucocorticoids if suspected
Diagnostic biopsy can be done later
Can lead to blindness if not prompty treated

60
Q

Signs of endometriosis on laparoscopy

A
  • Mulberry spots: dark blue or brownish-black implants on the uterosacral ligaments, cul-de-sac,
    or anywhere in the pelvis
  • Endometrioma: “chocolate” cysts on the ovaries
  • “Powder-burn” lesions on the peritoneal surface
  • Early white lesions and clear blebs
  • Peritoneal “pockets”
61
Q

Who should have urgent undelayed antibiotic treatment?

A

Meningitis, septic shock, febrile neutropenia

62
Q

Common causes of chest pain

A

Angina/MI, GERD, anxiety, pulled muscle, costochondritis

63
Q

Presentation of typical angina

A
  1. Substernal pressure (may radiate to neck, jaw, shoulders, left arm)
  2. Occurs with exertion or stress
  3. Relieved with rest (5-10 min) or nitro (immediate)

If 2/3 then atypical angina
If 0 or 1/3 then noncardiac pain

64
Q

Definition of unstable angina

A

New or rapidly worsening pattern of typical angina that severely limits usual activities or occurs at rest

Chest discomfort or pain caused by poor blood flow and oxygenation of the heart that is unpredictable and can occur at rest.

65
Q

Signs of aortic dissection

A

HTN, asymmetric BP in upper extemities (>20 mmHg difference), diastolic murmur, hypotension

Widened mediastinum or pleural effusion on CXR
Contast CT: fast, non invasive, highly senstive

66
Q

Gold standard for aortic dissection diagnosis

A

MRI
Howevere sometimes not readily available and can be time consuming

67
Q

Sudden pleuritic pain (sharp pain that is worse with deep inspiration) with shortness of breath

A

Tension pneumothorax
Usually unilateral

Look for hyperressonance on percussion and unilateral reduction of breath sounds

68
Q

Sudden pleuritic pain (sharp pain that is worse with deep inspiration) with shortness of breath ± syncope, tachypnea, tachycardia

A

Pulmonary embolism

69
Q

Workup for pulmonary embolism

A

1 D dimer (if low clinical probability) or go straight to CT pulmonary angiogram
2. CXR - frequently normal
3. VQ scan - sensitive but low specificity
4. ABG - hypoxemia with Aa gradient (no real diagnostic use)
4. VQ scan, contrast chest CT, angiogram to confirm

If highly suspicious go straight to CT angiography to look for fillling

Pulmonary angiography is gold standard for PE but rarely used and contraindicated if renal dysfunction

70
Q

High risk causes of chest pain

A

Pericarditis
Acute corony syndrome (MI)
Pneumothorax
Pulmonary embolism
Aneurysm
Aortic dissection

71
Q

How to screen chest pain patients

A

Site: ask where the pain is
Onset: clarify when the pain first started and if it came on suddenly or gradually
Character: ask the patient to describe how the pain feels
Radiation: ask if the pain moves anywhere else
Associated symptoms: ask if there are any other associated symptoms
Time course: ask how the pain has changed over time
Exacerbating or relieving factors: ask if anything makes the pain worse or better
Severity: ask how severe the pain is on a scale of 0-10
Explore the patient’s ideas, concerns, and expectations
Summarise the patient’s presenting complaint

Then screen for other body system symptoms, PMHx, drug hx, FMHx, social hx

72
Q

First line antianginal medications

A

Beta blockers

73
Q

Ho to exclude ischmic heart disease in chest pain pts

A

Coronary angiography

74
Q

What vaccine should be given before transplants?

A
  • to all transplant patients: DTaP, pneumococcal, infuenza, hepatitis A and B, COVID-19
  • in select patients: MMR, varicella, HPV, herpes zoster
75
Q

Emergent treatment for severe bradycardia

A

Check for hypoperfusion (LOC, hypotension, severe chest pain)
Try atropine if present
If no resonse then transcutaneous pacing or IV dopamine/epinephrine
Consider hyperkalemia and treat if present

76
Q

Emergent treatment of asystole or pulseless electrical activity

A

CPR
Epi IV q3-5m
Consider H’s and T’s

77
Q

Treatment of PE

A
  1. Admit for observation and stratify risk
  2. In low risk then send home with anticoagulation
  3. O2 to target > 90% sat
  4. Anticoagulate ASAP with LMWH or fonaparinux or unfractionated heparin or oral factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) or direct thrombin inhibitors (dabigatran)
  5. Give IV thromboyltic for massive PPE and no CI
  6. May need IVC filter
78
Q

Gold standard to diagnose aortic dissection

A

MRI
Sensitive and specific but not always readily available and can be time consuming

79
Q

Gold standard to diagnose Hirschsprung’s

A

Rectal biopsy

80
Q

Psychiatric condition that should be included in the differential of fatigue

A

Depression

81
Q

First line investigations for fatigue

A

Urinalysis, CBC with differential, blood glucose, HbA1c, TFT
Electrolytes, lipid panel, syphilis, HIV

Possible: ESR/CRP, U&E, LFT, ferritin, calcium, anti endomysial and anti giladin AB

82
Q

Important things to remember to ask in the history taking of fatigue

A

Complete medication list and history
Sleep disturbances
Lifestyle issues

83
Q

Most definitive test for herpes type 1 and 2

A

NAAT assay of vesicle fluid or ulcer swab
Can do HSV PCR which is 100% specific but not as sensitive

84
Q

An edematous external auditory cancl with increased pain when pushing on the tragus or pulling on the pinna

A

Otitis externa

85
Q

Erythematous and bulging tympanic membrane

A

AOM

86
Q

Erythemarous and fluctuance over the mastoid region

A

Mastoiditis

Clinical diagnosis not a radiological one

Potentially life threatening complication of AOM that manifests as redness and swelling over the mastoid region immediately posterior to the external ear. If suspected then administer IV AB urgently and refer to otolaryngology for surgical debridement

87
Q

MCC pediatric ear pain

A

Otitis media

MC S. pneumoniae, H. influenza, M. catarrhalis, viral

Arises from Eustachian tube obstruction secondary to edema from URTI, allergies or inadequate opening that can lead to negative middle ear pressure causing influx of pathogens from nasopharynx

88
Q

First line treatment for acute otitis media

A

High dose amoxicillin

Second line = Augmentin or cephalosporin

Recurrent infections may require myringotomy and tube insertion

89
Q

MCC hearing loss in children? Adults?

A

Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction

90
Q

MCC hearing loss in children? Adults?

A

Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction

91
Q

MCC hearing loss in children? Adults?

A

Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction

92
Q

MCC hearing loss in children? Adults?

A

Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction

93
Q

Vaccines to give post splenectomy

A

Ideally 14 days prior to splenectomy or day 14 or on discharge give:
HiB regardless of age or previous immuization history, quadrivalent meningococcal, serogroup b meningococcal, both pneumococcal conjugate and polysaccharide. Hep B indicated for those with repeat transfusions ie: sickle cell or thalassemia

Annual influenza
Boosters every 5 years for bacgerial vaccines

94
Q

Achalasia vs esophageal stricture

A

Achalasia - failure of LES smooth muscle to relax
A/W ilness, cancer, Chaga’s, Allgrove’s
25-60 yo
Tx myotomy, pneumatic balloon dilation, Botulinum

Esophageal stricture - physical narrowing of the esophagus
A/W GERD, swallowing corrosive substance, radiation, damage from NG tube
> 40 yo
Tx balloon dilation, stent, surgery to remove some tissue

Both present with difficulty with swallow

95
Q

Tests to order in acute abdominal pain

A

ALP, ALT, AST, bilirubin
Lipase, amylase
Urinalysis
Beta HCG
Troponins
Lactate

96
Q

What are enlarged hard left supraclavicular nodes associated with?

A

Gastric carcinoma

97
Q

A hypotensive, tachycardic or febrile patient in the setting of abdominal pain is concerning for?

A

Ischemic bowel, ruptured AAA, sepsis

98
Q

Hyperactive bowel sounds are suggestive of?

A

Mechnical bowel obstruction

99
Q

SBO signs and treatment

A

Intermittent, colicky, postprandial pain with recurring cramps q3-10m, vomiting, crescendo descrescendo rushes of high pitched peristalsis sounds and history of previous surgery

Do abdo xray and CT to diagnose and urgent referral to surgery to treat. Can try NG tube decompression.

100
Q

Signs and treatment of irritable bowel syndrome

A

Chronic and recurrent abdominal pain and/or altered bowel habits for at least 6 months with at least two of the following:

  1. Defectation increases or improves pain
  2. Change in stool frequency
  3. Change in stool appearance

Treat with diet and lifestyle changes

101
Q

Clinical signs of pancreatitis

A

Constant midepigastic pain radiates to left shoulder and back and worsens with laying on back (supine)

102
Q

Fever, RUQ pain and jaundice

A

Charcot’s Triad
Describes the symptoms and presentation of cholangitis

Reynol’s pentad = those sx + hypotension and altered mental status

Cholangitis is inflammation of the bile ducts leading to infection of the gallbladder, liver or biliary system. It is a progression of choledocholithiasis.

103
Q

Extraintestinal manifestations of inflammatory bowel disease

A

Crohn’s: erythema nodosum (red, painful nodules on the shin bilaterally typically), pyoderma gangrenosum (lower extremity ulcers), perianal skin tags, oral ulcers, arthritis, uveitis and episcleritis, gall stones, fatty liver, osteoporosis

UC: erythema nodosum, pyoderma gangrenosum (less common, more often in Crohn’s), arthritis, uveitis,

104
Q

Treatment for vaginal candida

A

Clotrimazole, butoconazole, miconazole, terconazole, fluconazole

Look for hyphae and spores on wet mount

105
Q

Treatment for bacterial vaginosis

A

None if non pregnant and asymptomatic unless scheduled for procedure or surgery

Oral: metronidazole (better in preg)
Vaginal: metronidazole, clindamycin, probiotics

Look for CLUE cells (squamous epithelial cells dotted with coccobacilli)

INcreased risk of preterm birth

106
Q

Treatment for trichomoniasis

A

Metronidazole

Treat partners too!

Positive whiff test, yellow/green smelly discharge

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