Review Flashcards
Name 8 investigations for iron deficiency anemia.
- Serum Hemoglobin
- Mean Cell Volume
- Serum Ferritin
- Peripheral blood smear
- Serum iron
- Total iron binding capacity
- Colonoscopy
- Beta-hCG
Thalassemia risk regions (#6)
- Africa
- Middle East
- Mediterranean
- Caribbean
- South East Asia
- South America
Risk factors for vitamin B12 deficiency (#6)
- Gastric surgery
- Strict vegans
- Breastfed children of strict vegans
- Elderly
- Psychiatric
- Pernicious anemia
Investigations for Pernicious Anemia (#2)
- Serum vitamin B12
- Serum anti-intrinsic factor antibody
Forms of iron supplementation (#3)
- Ferrous fumarate (highest iron content)
- Ferrous sulfate (best for children)
- IV iron dextran
Severe anemia investigations [#2]
- Colonoscopy
- Urinalysis
Causes of acute cough (#6)
- Pneumonia
- Heart failure
- Neoplasm
- Foreign body
- Pneumothorax
- ACE inhibitors
Causes of subacute cough (#2)
- Post-viral
- Infectious (bacterial, viral, fungal, mycobacterial)
Causes of chronic cough (#8)
- Asthma
- GERD
- Upper airway cough syndrome
- COPD
- Parasite
- Cystic fibrosis
- Eosinophilic bronchitis
- Bronchiectasis
PERC rule-out criteria for PE (#8)
- Age < 50
- Oximetry >94% (RA)
- Pulse < 100
- No prior PE or DVT
- No recent surgery or trauma (< 4 weeks)
- No hemoptysis
- No estrogen use
- No unilateral leg swelling
Well’s Score for PE (#7)
- Clinical signs & symptoms of DVT
- PE is #1 diagnosis OR equally likely
- HR > 100
- Previous, objectively diagnosed PE or DVT
- Hemoptysis
- Immobilization at least 3 days or surgery in the previous 4 weeks
- Malignancy with treatment within 6 months or palliative
YEARS algorithm to rule out PE if pregnant
- Clinical signs of DVT?
- Hemoptysis?
- PE most likely diagnosis?
0 = rule out PE with D-dimer < 1000 ng /mL
1-3 = rule out PE with D-dimer < 500 ng/mL
Shortness of breath investigations (#7)
- ECG
- Echocardiogram
- Serum Troponin
- Arterial pO2 / pCO2 / pH / HCO3
- Chest x-ray
- Pulmonary function test
- CT chest
Life-threatening causes of dyspnea (#3)
- Foreign body
- Anaphylaxis
- Pneumothorax
Conservative approach to pneumothorax (unilateral, moderate-large, primary spontaneous)
- Observe for 4 hours, discharge if stable on x-ray
Pulmonary / Cardiac zebra causes for dyspnea (#9)
- Recurrent or fungal pneumonia
- Fibrosis
- Post-COVID-19 sequelae
- Pleural effusion
- Occasional arrhythmia
- Cardiomyopathy
- Malignancy
- Mycobacterial
- Aortic stenosis
Non-cardiac/pulmonary causes of dyspnea [#8]
- Anxiety
- Altitude
- Abnormal thyroid
- Acid reflux
- Anemia
- Abdomen
- Allergy
- Anti-aerobic (deconditioning)
Stepwise treatment for mild COPD (#2)
- SABA prn
- LAMA or LABA
Stepwise treatment for moderate/severe COPD with low risk for AECOPD (#3)
- LAMA or LABA
- LAMA+LABA
- Triple
Stepwise treatment for moderate/severe COPD with high risk for AECOPD (#3)
- LAMA+LABA or ICS/LABA
- Triple
- Oral
Oral treatments for COPD (#3)
- Roflumilast
- N-acetyl cysteine (NAC)
- Daily Azithromycin
Recommended COPD treatment if blood eosinophils ≥ 300 cells/uL
Use steroid (ICS+LABA > LAMA+LABA)
Avoid ICS for COPD treatment if (#3)
- Serum eosinophils < 100 cells/uL
- History of mycobacterium
- History of repeated pneumonia
Differential for AECOPD [#6]
- Pneumonia
- Pneumothorax
- Pleural effusion
- Pulmonary embolism
- Pulmonary edema due to heart
- Problem on ECG
When to add antibiotics for COPD
- 2-3 Winnipeg symptoms (sputum purulence, sputum volume, dyspnea)
- CRP > 40
Potential bacteria in complicated COPD infections (i.e., empyema, septic, very sick) [#6]
- H. influenza
- S. pneumoniae
- M. catarrhalis
- Klebsiella
- Gram negatives
- Pseudomonas
Non-medical treatments for COPD [#7]
- Smoking cessation
- Exercise
- Acupuncture
- Active mind-body therapy
- Yoga
- Tai chi
- Opioids (palliative)
Differential for pediatric asthma [#5]
- Croup
- Foreign body
- Infection
- Cystic fibrosis
- Tracheomalacia
Features of well controlled asthma [#5]
- Days with symptoms ≤ 2
- Doses of reliever ≤ 2
- Nights with symptoms < 1
- No interference with work/school/exercise
- Infrequent, mild exacerbations
Asthma diagnosis on spirometry
- FEV1/FVC pre-bronchodilator < 0.75
- FEV1 post-bronchodilator ↑ 12% & reversible
PRAM score for severity of airway obstruction [#5]
- O2 saturation
- Suprasternal retractions present
- Scalene muscle contractions present
- Air entry
- Wheeze
Topics to regularly reassess at asthma visits [#7]
- Control
- Risk of exacerbation
- Spirometry or PEF
- Inhaler technique
- Adherence
- Triggers
- Comorbidities
Labs & management of Testicular Cancer
- b-hCG
- AFP
- Lop it off (surgery)
Risk factors for Testicular Cancer
- Cryptorchidism
- Family history
- Personal history
Screening for lung cancer
Low dose CT if age 55-74, 30 pk/yr smoker, current or quit < 15 years ago –> annually up to 3 times
Screening for ovarian cancer
No screening indicated if asymptomatic, low risk
Screening for cervical cancer
Screen 25-69 every 3 years
Screening recommendations for cervical cancer do NOT apply if [#6]
- Never sexually active
- Weakened immune system
- Symptoms of cervical cancer
- Previous abnormal screening results
- Does not have cervix
- Immunosuppressed
Melanoma prevention [#3]
- Sunscreen
- Physical UV blocking
- Avoid tanning beds
High-risk features that should consider referral for 6-monthly fully body examination for melanoma [#7]
- Older, male
- Previous skin cancer
- Family history
- # of Nevi (>15)
- Light skin, red hair
- Multiple sunburns
- Actinic skin damage
Screening methods for colorectal cancer [#2]
- FOBT age 50-74 q2 years
- Flexible sigmoidoscopy age 50-74 q10 years
Screening for breast cancer
- Mammogram age 50-74 q2-3 years if average risk
Risk factors for pancreatic cancer [#3]
- Family history
- Peutz-Jeghers syndrome
- BRCA1 with affected relative
Serum investigations for unexplained weight loss [#6]
- Serum hemoglobin
- Serum Na
- Serum K
- Serum Cr / eGFR
- Serum Urea
- Serum PSA
Non-lab investigations for unexplained weight loss [#4]
- Weight
- Height
- Fecal Occult Blood
- Chest x-ray
Alarm features for abdominal pain [#12]
- Severe pain
- Melena
- Weight loss
- Abnormal labs (Hb, CRP, Na, K)
- Age > 55
- Vomiting
- Dysphagia
- Mass
- Family history
- Previous history
- Bilious vomit
- b-HCG (+)
Treatment for H. pylori [#4]
Quadruple therapy x 14 days
- PPI
- Bismuth
- Metronidazole
- Tetracycline
Prevention for esophageal cancer with Barrett’s eosphagus
- Lifestyle
- High-dose PPI
- ASA
Non-abdominal causes of abdominal pain [5]
- Pulmonary embolism
- Myocardial infarction
- Pericarditis
- Zoster
- Testicular
Management of ureteral stone < 5 mm
Conservative management
Management of obstructive ureteral stone
Timely decompression
First-line imaging for ureteral stone
KUB US
Management of ureteral stone 5-10 mm
Medical expulsive therapy
Management of distal ureteral stone
Medical expulsive therapy
Gallstone risk factors [#5]
- Female
- Forty
- Fertile
- Obese
- OCP
Pancreatitis risk factors [#6]
- Septra, Flagyl, HCTZ, ACE inhibitors
- Progesterone
- Atorvastatin
- Estrogen
- Gallstones
- Alcohol
Bolus fluids for Peds
20 mL/kg
Maintenance fluids for Peds
4-2-1 rule
- 4 mL/kg for first 10 kg
- +2 mL/kg for kg 11-20
- +1 mL/kg for every kg above 20
Objective measurements for treating severe dehydration [#6]
- Weight
- Serum glucose
- Serum Na
- Serum K
- Serum Cr
- Serum urea
Non-gastroenteritis differential for diarrhea in elderly [#5]
- Acute ischemic bowel
- Obstruction
- Diverticulitis
- Appendicitis
- Neoplasm
Risk factors for C. Difficile [#5]
- Healthcare-associated
- Older age
- Immunocompromised
- Previous C. Diff infection
- Recent antibiotics (esp. Fluoroquinolone)
Treatments for C. Difficile [#6]
- Vancomycin PO (first-line even if mild)
- Fidaxomicin
- Metronidazole
- Fecal transplant
- Rifaximin
- Bezlotoxumab (monoclonal)
Investigations for chronic diarrhea [#12]
- Serum Hb
- Serum ferritin
- Serum TSH
- Serum ttG
- Stool C. Diff NAAT
- Stool Ova & parasites
- Fecal calprotectin
- FIT / Colonoscopy
- Hydrogen breath (lactose)
- Capsule endoscopy
- Fecal elastase (fat malabsorption)
- MRI abdomen (chronic pancreatitis)
Treatments for Crohn’s Disease
- Sulfasalazine
- Steroids
- Thiopurines
- Methotrexate
- Anti-TNF therapy
IBS investigations
TTG or endomysial IgA
Non-medical management for IBS [#5]
- FODMAP diet trial
- Psyllium
- Peppermint oil, probiotics
- CBT, hypnotherapy
- Colonoscopy if > 50 years OR alarm features
Medical management for IBS [#5]
- Antispasmodics (e.g. Buscopan)
- Antidepressants (e.g., TCAs, SSRIs)
- Eluxadoline
- Lubiprostone
- Linaclotide
Sleep disorders [#8]
- Narcolepsy
- Restless leg syndrome
- Sleep terrors
- Sleep walking
- REM sleep disorder
- OSA
- Central sleep apnea
- Substance/medication-induced
PHQ-2
- Down/depressed/hopeless?
- Little interest/pleasure?
New medications for Insomnia
- Lemborexant (Dayvigo)
- Eszopiclone (Lunesta)
Non-prescription management for Restless Legs [#5]
- Iron, Magnesium
- Stretch calves
- Avoid caffeine
- Massage, heat
- Exercise
Prescriptions for Restless Legs [#4]
- Pramipexole
- Ropinirole
- Gabapentin
- Pregabalin
STOP-BANG for OSA [#8]
- Snore loudly
- Tired
- Observed apnea
- high blood Pressure
- BMI >35
- Age >50
- Neck circumference > 40 cm
- male Gender
Caregiver burnout management [#4]
CALM
- Counselling
- Appointment (next visit)
- Lifestyle advice
- Mental health support
Thyroid storm management [#5]
Block B’s:
- Block synthesis = Thionamides (Methimazole, Propylthiouracil)
- Block T4 –> T3 = Propranolol, Propylthiouracil
- Block release = Iodine
- Beta Blocker = Propranolol
- Bile acid sequestrant = Cholestyramine
Risk factors for hypothyroidism [#5]
- Age
- Pregnancy
- Personal history
- Thyroidectomy
- Radiation
Treatment for hyperthyroidism
- Propranolol if symptomatic for 6-8 weeks
- RAIU unless 100% sure it’s Graves
Contraindications for RAIU [#2]
- Obvious Grave’s disease
- Pregnant or breastfeeding
Indications for biopsy for thyroid nodule
- > 1 cm
- Irregular surface
- Taller than wide
- Calcifications within
Criteria for Myalgic Encephalomyelitis-Chronic Fatigue Syndrome (ME-CFS) [2]
- Fatigue profound & not improved by rest
- Post-exertional malaise
Criteria for Environmental Sensitivity (ES-MCS) [2]
- Provoked by chemical, biological agents & removal relieves
- Neurocognitive, respiratory symptoms
Criteria for Fibromyalgia [2]
- Diffuse body pain x 3 months with no other explanation
- Fatigue (in 90%), sleep, mood, cognitive symptoms
Treatment for Diabetic Ketoacidosis [#5]
- Insulin
- Saline
- Potassium
- Bicarbonate if overacidic
- D5W once appropriate
5 classes of medications for diabetes besides insulin
- Biguanide
- SGLT-2 inhibitors
- GLP-1 receptor agonists
- Sulfonylureas
- DPP-4 inhibitors
- Thiazolidinediones
Differential for Dyscopia [#6]
SAD-CSS:
- Somatic symptom disorder
- Anxiety
- Depression
- Chronic pain
- Sleeping disorder
- Substance use
Tests to check infectivity for Hepatitis B [#3]
- Serum HBV DNA
- Serum HBeAg
- Anti-HBe
Hepatitis C tests [#3]
- Serum anti-HCV (unless known previous HCV)
- Serum HCV RNA
- Genotype & subtype
Hepatitis A management [#2]
- Supportive
- Report
Treatment indications for severe Hepatitis B [#3]
- Cirrhosis
- Fibrosis
- HBV DNA >2000 IU/mL & ALT elevated for 3-6 months
Medications for Hepatitis B [#2]
- Tenofovir
- Entecavir
Treatment for Hepatitis C [#2]
- Interferon, Peginterferon, Ribavirin
- New regimens (i.e., Sofosbuvir with Ledipasvir, Daclatasvir, Velpatasvir) [Mavyret, Harvoni)
Monitoring for Hepatitis B & C [#4]
- HCC = liver U/S q6-12 months
- Varices = scope q1-3 years
- Alcohol = history
- Cirrrhosis/fibrosis = Fibroscan
Features of non-inflammatory low back pain [#2]
- AM stiffness < 30 mins
- Worse @ end of day
Features of inflammatory back pain [#2]
- AM stiffness > 30 mins
- Better @ end of day
Myotome for L1/2
Hip flexion
Myotome for L3/4
Knee extension
Dermatome for L4
Knees to first toe
Dermatome for L5
Middle toes
Dermatome for S1
Pinky toe
Non-medical management for low back pain [#4]
- Yoga
- Acupuncture
- Osteopathy
- CBT
Alarm features for joints [#4]
- Hot (fever; warm joint)
- Bog (soft & boggy joint)
- AM stiffness > 30 mins
- PM pain (night pain)
