Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CCFP Exam 2021 > Review Course Content > Flashcards

Review Course Content Flashcards

1
Q

Fever in returning traveler is ____ until proven otherwise?

A

Malaria - falciparum malaria can kill you in 24-48 hours!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pre-travel history?

A 
When, where, how long are you going and why are you going there?
ie. food tourism = high risk for cholera, GI illness, typhoid fever, parasites
SE Asia (Bankok, Thailand for business meetings) - lower risk profile.
PHx, PMHx, Family Hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management of traveler with fever?

A

More than meds!

Twinrix and ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is typhoid vaccine indicated in Canadian guidelines?

A

Southeast Asia & surrounding region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Biggest risk type of travel for fever in traveler?

A

Visiting relatives!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Antimalarials and comparison as per PHAC 2014?

A
  1. Atovaquone - proguanil - daily x 7 days post exposure. Daily dosing and $$$$
  2. Doxycycline - cheap, daily, photosensitivity rash and need it 30 days post exposure
  3. Mefloquine - once weekly dosing, frequent side effects including wild dreams!! And psychiatric sx. THUS not first line anymore!
  4. Primoquine - need blood test before medication taken -G6PD deficiency test. ONLY 7 days after exposure.
  5. Chloroquine - cheap and long term safety data
    * **WIDESPREAD RESISTANCE (Check before prescribing) also has skin and corneal side effects.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Non-pharmacological management and recommendations for pre-travel counseling

A
  1. PREVENT - Limit high risk activity - night driving (don’t do it), sex tourism (use PREP or condoms)
  2. QUIT - smoking, don’t check meds in luggage!!, risky activity
  3. REFER -travel clinic
  4. Travelers diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

BIGGEST M&M In patients who are travelers?

A

MVA’s!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to prep for travelers diarrhea?

A
  1. Pack: Oral rehydration solution, loperamide*, azithromycin, bismuth subsalicylate** (can take QID for prevention)
  • Take loperamide for mild diarrhea if no dysentry or blood.
  • *Pepto bismol - can take QID for prevention
    2. Boil it, peel it, cook it, or forget it
    3. Ice cubes, salads, uncooked veg
    4. Use bottled water
    5. Wash and sanitize hands often
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to manage altitude sickness?

A 
Acetazolamide 125 mg BID
Dexamethasone 4 mg BID**
Nifedipine
Sildenafil/Tadalafil
Prophylactic salmeterol

**Also treats high altitude cerebral edema AND get em off the mountain!

NOT recommended: ginko biloba

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Aspirin a day?

A

Primary prevention for CV disease? DON’T START IT!
If already taking? Evidence to discontinue less clear. Do risk assessment

Studies: ASPREE, ARRIVE, ASCEND, ACCEPT-D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HCV Screening? Who are the higher risk patients?

A

NOPE.
Unless higher risk:
Hx incarceration, blood products/organ transplant before 1992, recent immigrants, IVDU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AAA Screening?

A

Men 65-80 yo - one time abdo ultrasound

Women - NOPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CFPC Preventive Health Checklist?

A

Learn it. CFP 2020. Get it off bit.ly/vitalfm-checklist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CFPC Preventive Health Checklist?

A

Learn it. CFP 2020. Get it off bit.ly/vitalfm-checklist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

FALL in PM? How can we prevent the hip fractures?

A

Best question: How many falls in the last one year?

FALL: review active health status, screen for FALLS yearly
P: Review pain control
M: Medications?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Immigrants and Refugees Guidelines?

A

Check out Ottawa guidelines from CMAJ 2011 or CPS have good one: caringforkids.ca new to Canada

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Immigrants & Refugee Canadian Practice Recommendations?

A
  1. Infectious Disease - OFFER testing and vaccines, INTERPRETER, Consider RISK LEVEL for country (ex. HIV, TB, HCV
  2. Chronic Disease
  3. Mental Health
  4. Women’s Health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Recommends for Interpreter?

A
  1. Not a family member
  2. Don’t pull someone from waiting room
  3. LOTS of access for interpreters!
  4. Don’t use google translate as not standard of care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do we test for TB?

A

Intradermal (IGRA)-interferon gamma release assay
>95% Specificity for latent TB only
-Don’t use to dx ACTIVE TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

4 meds to tx TB?

A

Rifampin
Isoniazid
P
E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

4 meds to tx TB?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Painless hematuria is

A

CANCER until proven otherwise

ALSO a sx. of schistosomias and consider this for

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If fever and travel test for malaria. If asymptomatic?

A

asyx: DON’T Test
Test via: Thick & thin smear
Test for malaria antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
If patient has no vaccine record and is immigrant?
GIVE THESE!!! (50% don't have them on avg.) TDAP-IPV MMR TEST first: HBV Varicella (if over 13 years old)
26
Immigrants Screening?
Dentist Diabetes (use HgbA1C) Vision - optometrist Lead poisoning
27
What mental health like conditions should you NOT screen for in immigrants? What should you screen for?
Don't screen for maltreatment of children, domestic violence or PTSD unless presenting complaints. 2. Are you down, depressed or hopeless? Little interest in doing things? (anhedonia) - This is the PHQ-2 and first 2 questions of PHQ-9.
28
Women's Health in immigrants?
OFFER screening: serum iron or ferritin | women and Children FERST
29
TRAVEL HISTORY? Years later...patient has a cough? Vague GI sx?
TB risk region? | Test for strongyloides if walking barefoot!
30
TRAVEL HISTORY? Years later...patient has a cough? Vague GI sx?
TB risk region? | Test for strongyloides if walking barefoot!
31
SCZ Guidelines - Initial Workup?
Full history | FUNCTION (sexual function - pregnant????)
32
SCZ Guidelines Top 5 Recs?
``` 1st episode: antipsychotic How long? 18 months 1st vs. 2nd gen are equal Oral = Depot (patient preference) -NNT = 7 to avoid patient admission Treat Comorbid depression ```
33
NMS symptoms and treatment?
``` FARM: Fever Autonomic dysregulation Rigidity Mental status changes ``` -Even low dose, any stage of treatment, can be if escalating doses or dose changes. ``` Tx: Stop medication IVNS Ice packs Dantrolene Bromocriptine ```
34
Management of SCZ?
``` Meds Safety first!! -SI and HI Family counseling Vocational rehab Finances? Day hospital? Admission? Detox? Adherence? Pregnant? SUD? ```
35
Adult non resolving pneumonia?
Is it the wrong bug, drug, or diagnosis!? Typical? Atypical? Mycobacterium? Pneumocystis?
36
Non- abx treatment for abscess, sepsis, appendicitis, laceration and nec fasc?
Abscess - drain it, and de-capsulate Sepsis - supportive (fluids, pressors, blood cx) Appendicitis - conservative therapy treatment emerging Laceration - TETANUS BRO Nec Fasc - EMERGENTLY DEBRIDE!
37
Abx Trends?
ORAL after IV? May be non-inferior to prolonged IV
38
Pneumonia Guidelines (2019)
``` DON'T -use term healthcare associated PNA term -DON't use CURB-65 score. -procalcitocin -order sputum C&S or blood culture unless patient is sick! Sick = severe CAP as per PSI score. -prescribe steroids -XRAY not required ``` DO: - use PSI score - Test for influenza (at risk for MRSA PNA) - Treat with antiviral if influenza positive AND abx if PNA expected
39
Non-resolving PNA: 37 M non smoker, low grade fever, SOBOE and occasional cough. Pulse 102 / 22/ 106/68, afebrile Generalized lymphadenopathy Prev got mixofloxacin and hasn't improved WBS of 3.6 and low lymphocytes CXR is normal.
TROC history Vitals Treating the wrong bug? drug? or diagnosis? Repeat CXR: Diffuse interstitial infiltrates, CD4 110, bronchoscopy was PJP!
40
Weird and Wonderful ddx of PNA?
``` PJP - pneumocystis Jirovecii pneumonia Mycobacterium Avium Complex (MAC) TB Influenza Toxoplasmosis ```
41
CXR normal! Clinical picture unclear?
Get SERIAL dude!!! Serial exams, serial ECG's, Serial Imaging *Also relevant for chest pain etc. Imaging evolves over time!
42
What 3 infectious diagnoses should you think about testing together?
HIV-TB-HCV
43
4 factors affect antibiotic choice in pneumonia (and one bonus)?
1. Allergies 2. Drug drug Interactions (ex. warfarin) 3. COPD co-treatment needed? 4. Are we covering for aspiration PNA? (anaerobes!) 5. Outbreak!? (Think legionaires, COVID-19)
44
When do you use antibiotics in COPD?
In exacerbations!
45
COVID-19 CXR imaging?
Interstitial PNA
46
Most common cause for PNA in ALL people?
Strep Pneumoniae!!!!
47
In kids...uncomplicated PNA recommendations?
Amoxicillin - banana flavoured!! is still first-line | Routine X-ray post treatment is NOT recommended unless clinically indicated.
48
Hypertension screening best practice?
Automated> manual Gold standard 24 h ambulatory If chubby or muscly arm? Use wrist device (sit at level of heart) -Take BP when patient relaxed, no coffee, no smoking, feet flat, no gum
49
Out of office measurements of BP recommendations?
- CRITICAL!! - White coat HTN effect is real! - BP cuffs aren't that expensive anymore
50
Diagnosis of HTN?
Automated office BP mean >135/85 Office BP >140/90 Diabetes >130/80 if 3 office measurements on different days If any above: get outpatient BP Amb >135/85 Diabetic 130/80
51
Workup for HTN?
Do a lipid panel Non fasting OK Also K, Na, Creatinine, urinalysis, HbA1c, diabetic patients (urinary albumin), ECG -MAKE SURE NOT PREGO!!
52
% of cases are essential HTN?
90%
53
Secondary HTN?
``` Atherosclerosis Big belly, bruits, bad kidneys Catecholamines (pheo) Drug, diet Endocrine sleep apnea and stress ```
54
CPAP does NOT?
Decrease cardiovascular events | or decrease mortality
55
First line for eHTN?
1. Diet | 2. Lifestyle
56
When do you start treatment for eHTN?
Based on RF's: Low High Diabetes All others
57
HCTZ and skin cancer?
- uncertain and not proven - Possible 4x incr risk after 3 years of: - Non melanoma skin CA - Inform patients and -consider switch if higher risk: light skin personal or fam hx Immunosuppressed
58
HTN ABC's to avoid!?
AVOID: Alpha blocker alone Beta blocker if older than 60 yo ACE or chlorthalidone if black
59
Chlorthalidone in HTN?
Incr risk diabetes, renal, e'lyte abnormalities VS HCTZ (similar CV benefit for both) Prefer LONG acting diuretics (chlorthalidone or indapamide)
60
What does taking antiHTN at bedtime do?
Reduce CV disease risk by nearly half (hazard ratio is ~0.55?)
61
HTN urgency vs. Emergency?
Urgent: Rapid treatment is NOT successful or necessary Emergency: Asymptomatic DBP >130 Acute heart, brain, aorta or kidney damage Pre-eclampsia or PHEO ``` Treat with: Nifedipine Labetolol Captopril Clonidine Nitrates ```
62
Resistant HTN definition? #1 reason?
if on 3 meds REFER! This = resistant 4th agent: Spironolactone has BEST effect to lower BP (monitor kidney fcn) Reason: NOT TAKING THE MEDICATION! Other: not appropriately prescribed? Lifestyle: salt, tobacco, sedentary, obesity, alcohol Other meds: naproxen, NSAID's, contraception, steroids, licorice, OTC medications
63
HTN in kids?
>3yo then measure Check in RIGHT arm because if coarctation of aorta then falsely low BP in LEFT arm Workup = ECHO and CVD risk assessment
64
HTN in pregnancy?
AVOID/CONTRAINDICATED: ACE and ARB pre-conception and in pregnancy BREASTFEEDING: Choose labetalol, methyldopa, nifedipine COUNSELING PRE-CONCEPTION: Look at BMI!
65
Lifestyle treatments of HTN?
Sodium <2000 mg/day (drop 5mmHg) Weight decrease 4.5 kg (drop 7 mmHg) Alcohol -decrease by 2.7 drinks/day (drop 4 mmHg) Exercise Rx - 30-45 mins 3x/week (10 mmHg) Diet - DASH (10 mmHg) Relaxation - CBT (10 mmHg)
66
When do you start treatment for HTN?
``` START treatment if? Low risk: >160/100 (goal: <140/90) High risk: >130 (<120 sys) Diabetes: >130/80 (<130/80) All others: >140/90 (<140/90) ```
67
Febrile neutropenia?
1. Recognize early!!! 2. Stabilize (fluids and ABX) 3. Avoid rectal temp, look in mouth (mucositis), look for source (consider fungal)
68
Fever without cause -when to do tissue biopsy? What other tests?
Full workup previously normal.... ``` Tissue biopsy? Liver Node Temporal artery Bone marrow ``` ``` SPEP Vasculitis/autoimmune ECHO HIV, TB test Dental assessment Viral cultures ```
69
No idea wtf going on with this weird AF PNA?
Serial exams Serial ECG's Serial imaging
70
Serotonin Syndrome
- GI symptoms and NMS does not | - myoclonus
71
Kid prevents with 5 days of fever and he is 5yo?
KAWASAKI's CRASH ``` Conjunctivitis Rash Adenopathy Strawberry tongue Hands and feet ``` Bad bad bad -CAA: Coronary artery aneurysm ASA and IVIG in KAWASAKI Don't forget about MIS-C!! -Children 0-19 with fever >3 days and COVID 19 positive or close contact, and unexplained ESR/CRP elevation
72
Kid presents with 5 days of fever and he is 5yo?
KAWASAKI's CRASH ``` Conjunctivitis Rash Adenopathy Strawberry tongue Hands and feet ``` Bad bad bad -CAA: Coronary artery aneurysm ASA and IVIG in KAWASAKI Don't forget about MIS-C!! -Children 0-19 with fever >3 days and COVID 19 positive or close contact, and unexplained ESR/CRP elevation
73
Issues with Framingham?
OVER ESTIMATES RISK
74
Screen who for hyper
Men >40yo Women >50 (or post menopauisal) EARLIER: Smoker
75
Screen who for hyperlipidemia? (incomplete)
Men >40yo Women >50 (or post menopauisal) EARLIER: Smoker
76
DO NOT in hyperlipidemia
``` Treat LDL target (CCS disagrees rx. to <2 or 50% reduction or <1.8 if ACS) Use framingham in renal dz make patients fast Order Apo-B, CRP Use ezetimibe for primary prevention ```
77
DO NOTs in hyperlipidemia
``` DO NOT in HYPERLIPIDEMIA: Treat LDL target (CCS disagrees rx. to <2 or 50% reduction reduction or <1.8 if ACS) Use framingham in renal dz make patients fast Order Apo-B, CRP Use ezetimibe for primary prevention ```
78
CAM for high lipids?
O3FA FIRST LINE FOR HYPERTRIGLYCERIDEMIA 25% risk reductions Effective and safe except poor GI sx
79
CAM for high lipids?
O3FA FIRST LINE FOR HYPERTRIGLYCERIDEMIA 25% risk reductions Effective and safe except poor GI sx
80
Dumb Mnemonic for Dizziness that is validated?
TiTrATE (validated tool): Timing a. How long does it last? seconds, minutes, days. When feel dizziness how long does it last? Does it go away? Triggers A thorough exam Don't need to ask med school questions for lightheaded or room spinning? Get a double yes that is UNHELPFUL
81
Dizziness timeline clues? In shower, look up, and dizzy but resolves in 30 seconds? 20-30 mins long ladsting? Constant/days?
BPPV Orthostatic Hypotension Meniere's last longer Migraine, neuritis, stroke
82
Triggers of dizziness?
Medication start or change Trauma (barotrauma) BPPV or orthostatic hypotension
83
Associated symptoms of dizziness?
Migraine aura - think migraine Blood, Blisters, Back of neck pain -Ramsay hunt, trauma, vertebral artery dissection Chest pain - aortic dissection Deafness (1 side) -Meniere's (tinnitus, fullness, dizziness)
84
Vertigo exam includes?
Orthostatic BP GAIT (stroke?) HINTS + loss of hearing exam - head impulse, nystagmus, test of skew Dix-Hallpike
85
Where to REFER for dizziness?
``` ENT Neurology Vestibular rehab Physiotherapy OT Psychiatric comorbidity with vertigo: 37-50% ```
86
Tdap in pregnancy?
EVERY pregnancy at 28-32 weeks to prevent pertussis in the lil infant even if the mom got it recently.
87
YEARS criteria?
Look it up RIGHT NOW!
88
PNA and steroids?
NO (IDSA guidelines)
89
Red or black stool ddx?
IF not blood: beets iron bismuth subsalicylate
90
Deprescribe PPI?
Stop or taper slowly Step down (H2 antagonist) Reduce: on demand, EOD
91
Ddx of Lower GI bleed?
``` ROYAL Family: Kate is always pregnant = Hemorrhoids (statistically) Queen Elisabeth (old AF) = Probably your aspirin (RULE OUT BAD THINGS) ```
92
Treatment for EVERY Acute Situation?
ABC MOVIES Airway Breathing Circulation ``` Monitor Oxygen Vitals IV ECG Sugar check ``` SERIAL ABC's, VITALS, ECGs
93
Acute GI bleed myths and facts?
Increase hemoglobin? Transfuse ONLY if fluids not working and Hb <70 Decrease stomach contents? Decrease acid! PPI bolus (non variceal), Decrease blood/clots? Erythromycin Scope Urgently? Scope by 6 hours does NOT reduce mortality compared to 24 hours. Ceftriaxone? IF cirrhosis or varices? Ceftriaxone and somatostatin NO varices? NO other drugs - don't give transexamic acid as NO benefit and doubles risk of VTE
94
Prevent GI bleed?
PPI and H2RA
95
Anxiety RFs? Don't miss!?!?
``` Family history PHx of mood or anxiety ACEs Female Chronic medical illness Behavioural inhibition ``` Don't MISS: SUICIDE Assessment! -Anxiety is INDEPENDENT RF for suicide completion (controlling for mood disorders)
96
PTSD treatment?
``` VPS + F: Venlafaxine Paroxetine Sertraline Fluoxetine ``` CBT (trauma focused) Group Therapy
97
Debrief all trauma victims?
NO WAY!
98
OCD
- Obsessions and/OR compulsions - time consuming or distressing - Significant impairment in social or occupational functioning OCD: O's are ego dystonic
99
OCD treatment?
SSRI's except citalopram First line augmentation: aripiprazole, risperidone Exposure response prevention (ERP) (Gold standard type of CBT)
100
Generalized anxiety disorder meds? Most effective for GAD?
``` VPS PEAD: Venlafaxine Paroxetine Sertraline Pregabalin Escitalopram Agomelatine Duloxetine ``` MOST effective: Pregabalin, duloxetine, venlafaxine, escitalopram, Also (but smaller): Mirtazapine, sertraline, buspirone, agomelatine AND quetiapine, paroxetine and BZD's.
101
A word on BZD's for anxiety...
- NOT monotherapy - Avoid if on opioids - Consider risk and discuss dependence - Avoid high doses or large quantities - Avoid in elderly!! Increases all cause mortality.
102
Social anxiety treatment?
VPS PEF: Venlafaxine, paroxetine, sertraline, pregabalin, escitalopram, fluvoxamine
103
New SADPERSONS?
``` Precipitating factors: Drugs/alcohol (50% of SA's involve EtOH) Access to means Life events New terminal/chronic dz diagnosis Media effects ``` ``` Predisposing factors: Neuropsychiatric disorders Family history Previous attempts ACEs Socioeconomic status ```
104
CFI-S?
Convergent functional assessment for suicide - good to excellent predictive value - 22 questions
105
Antidepressant efficacy?
AD's effective by 6 weeks? | -Up to 1/3 will not show early response by 6 weeks
106
DSM-5 Mimics of depression
``` Hormones Grief Drugs Bipolar Tumor Delirium ```
107
Bipolar disorder or MDD?
<25 yo >5 episodes -Quick on/off of episodes -Atypical features (hyperphagia, hypersomnia, leaden paralysis, longstanding interpersonal rejection sensitivity) -depression with psychotic features -quick response, but wear off of efficacy.
108
WOW FRAMEWORK for delivering bad news?
Wish we didn't have to discuss this hard topic? Worry convo will be difficult? Wonder if? GOALS are VITAL Recognize Strengths (trauma and violence informed discussion) Recognize abilites Family
109
Teach when breaking difficult news?
Advanced directives (CPR, feeding tubes, intubation) Estate planning? Will? Teach how to break news to family - offer to help
110
When can you terminate a patient-physician relationship?
Check with regulatory body!
111
Cluster A PD's? B? C?
A: Schizoid - Evyn Peters (no emotions, enjoys nothing, likes to be alone) Schizotypal - Willy Wonka Paranoid - suspicious AF B: Borderline - fear abandonment, self harm, identity issues Narcissistic - entitled, no empathy, think they're special Histrionic - Anjena ASPD - No remorse, lies, steals, C: Dependent - can't make any decisions ever Avoidant - extreme version of social anxiety OCPD - all med students ever. Neurotic, controlling, morally scrupulous, perfectionistic
112
URTI's and honey?
Honey works the BEST for kids with URTI's!
113
Side effects of lithium
Nausea, vomiting, confusion, concentration, hypothyroid, tremor, diarrhea, ataxia, ECG changes (inverted T waves), weight gain
114
Labwork for lithium
Lithium level, creatinine, TSH, beta-HCG, calcium
115
Therapeutic window for lithium
0.6-1.2
116
3 Methods other than injected anethetic
Topical anesthetic, distraction, sedation
117
How to reduce pain of injection
Smallest needle possible, warm anesthetic, bicarb, injecting slowly
118
Alternatives to lidocaine
Tetracaine, procaine, preservative free lidocaine
119
Complications from toe surgery
Cellulitis, ischemia, nec fasc, reperfusion injury, allergic reaction
120
Key features of infection
Proximal migration of the lesion, leukocytosis, bony involvement on x-ray, CRP, Pain with passive stretch, fever
121
Treatment for pediatric asymptomatic bacteriuria
Nothing
122
When do you treat asymptomatic bacteriuria? List 2
Renal transplant, invasive urologic procedures
123
What drugs are most likely to cause serotonin syndrome? List 3
SSRI, SNRI, MaOIs | Also triptans, stimulants.
124
What is on your differential for altered mental status? List 7
``` Drugs - anti-cholinergic toxicity, malignant hyperthermia, NMS, EtOH/benzo withdrawal Infection - meningitis, encephalitis Metabolic - thyroid storm Failure (liver/kidney) Anemia Cerebral infarct/bleed Endocrine Structural/space occupy ```
125
What are the signs and symptoms of serotonin syndrome? List 6
``` Mental status changes (agitation, delirium) Autonomic dysfunction (changes in vitals) Neuromuscular dysfunction ```
126
What is one different symptom in Neuroleptic Malignant Syndrome and not in Serotonin syndrome?
NMS = Rigidity Serotonin syndrome = Gi symptoms and hypereflexia/clonus
127
What is the treatment for a Toddles Fracture (Childhood Accidental Spiral Tibial fracture (CAST))?
Non-surgical. Backslab or boot.
128
What are 5 diagnoses for pediatric limp?
Leg-calves-Perthes Infection/Inflammation Malginancy (Ewing's sarcoma/osteoscarcoma Pain (fracture) Slipped capital femoral epiphysis (Half black/half hispanic obese boy) Something else (referred from above or below)
129
What is the most common organism for pediatric osteomyelitis?
S. aureus
130
What are the cutoff values for postural hypotension
20 systolic, 10 diastolic within 3 minutes of standing.
131
List 8 causes of orthostatic hypotension with compensatory tachycardia.
Dehydration (diarrhea/adrenal insufficiency, dialysis, diuretics, digoxin, antibiotics, cholinesterase inhibitors. Dysfunctional Heart (myocardium, aortic stenosis) Drugs (anti-hypertensives, anti-anginas, anti-parkinsonians, anti-depressants, anti-psychotics, anti-BPH meds) Deconditioning
132
List 2 causes of orthostatic hypotension without compensatory tachycardia.
Low B12, hypothyroidism, EtOH abuse, diabetic neuropathy, parkinsonism, amyloidosis, beta blocker.
133
What are 6 possible treatment options for plantar fasciitis?
Weight loss, NSAIDs, stretching, glucorticoid injection, night splinting, orthotics, hypotension.
134
What is on your differential for anal mass?
``` Colorectal cancer, Rectal porolapse/varices Anal wart Polyp Skin tag` ```
135
What conservative measures are used to treat hemorrhoids? | List 4
``` PEG Weight loss Increase fibre intake Increase fluid intake Increase physical activity Stool softener Cold packs Sitz baths Baby wipes NSAIDs ```
136
When can you start sleep training?
6 months.
137
How do you teach sleep training?
Bedtime routine. Put baby to bed when tired If crying allow for 2-5 minutes then reassure if needed. Then return and increase intervals between consoling
138
Maternal benefits to sleep training.
Better quality maternal sleep Better maternal mood Better maternal energy
139
Differential for fever and diarrhea. List 8
``` Malaria Dengue fever Rickettsial disease (Typhus) Waterborne (Typhoid) Urinary infection Respiratory infection Skin infection Traveler's diarrhea ```
140
What tests to do for stool parasites?
Stool O&P Rectal biopsy Urine examination for parasite eggs
141
What drugs treats trematode flatworms?
Praziquantel
142
What is acute shistosemiasis syndrome?
Katayama fever
143
What office based test for diabetes? List 2
Random glucose | U/A (ketonuria/glysuria)
144
What are important elements of history in new diagnosis of diabetes?
Polyuria Polydyspsia Polyphagia Weight loss
145
What conditions are associated with aortic dissection? List 5
``` Hypertension Marfan's Ehlers-Danlos Bicuspid aortic valve Cocaine/Meth Lupus Polycystic Kidney Disease Trauma Giant Cell Arteritis ```
146
Peak incidence age range for aortic dissection
60-70 | 30-40 (connective tissue diseases)
147
What are 5 indications for medical marijuana?
``` Spasticity secondary to spinal trauma Spasticity secondary to MS Chemotherapy induced N/V Neuropathic pain Palliative pain ```
148
What is the medication given to neonates and what is the dose?
Vitamin K - 1 mg
149
What is an alternative to a vitamin K injection?
PO vitamin K
150
List 4 of the most common reasons for accessing MAID?
``` Suffering/fear of suffering Loss of independence or physical abilities Loss of autonomy Loss of pleasure Unacceptable quality of life Difficulty communicating ```
151
What is the third line treatment for dyslipidemia?
PCSK9 inhibitors
152
What is the mechanism of action of a PCSK9 inhibitor?
PCSK9 inhibitors attack to PCSK9. This prevents them from attaching to the LDL receptors in the liver thus allowing the LDL receptor to not be lysed.
153
Physical exam findings as a result of vertebral compression fractures. List two.
Tenderness to palpation Visible deformity Kaiphosis and height loss
154
What are the conservative treatments for a compression fracture? List 6
``` Rest NSAIDs Acetaminophen Calcium Vit D Smoking cessation Weightbearing exercises Bisphosphonate Short term opiates ```
155
What surgical intervention can be used for compression fractures?
Vertebraplasty
156
What is the t-score cutoff for osteoporosis?
-2.5
157
What are the contraindications for bisphosphonate drug holiday?
Fragility fractures of hip or spine.
158
What are the elements of the FRAX score/what are important elements in history taking for bone health?
``` Age BMI Femoral head t-score Smoking Race Gender EtOH Previous fracture Family history of fracture Glucocorticoid use RA Secondary Osteoporosis ```
159
What clinical features of a hand fracture warrants referral to plastics?
``` Open fracture Rotational deformities Tendon rupture Unstable fracture Intra-articular ```
160
What needs to be documented prior to manipulation?
Neurologic status | Vascular status
161
What are three types of hand tendon injuries that warrant surgical intervention?
Jersey finger Mallet finger Central slip rupture
162
What are the most common treatment options for fingertip amputation? List 3
Secondary intention Reattach fingertip as composite graft Revision amputation.
163
Antenatal care?
Safety U/S Measure mom and baby at each visit LABS
164
Complications
``` Lots more on here - divide into antenatal, in pregnancy, and post-partum Gestational HTN (140/90) PROM TOLAC: labour if no contraindications, but increased risk if <18 mo Labour latent/active 4cm dilation Dystocia (<2cm in 2 hours) Abnormal fetal heartrate Uterine rupture Shoulder dystocia ```
165
Shoulder dystocia?
flip woman over (and other stuff John add please and thanks so much yes yes yes)
166
Postpartum!
``` Breast/chestfeeding bottom bowels bladder bleeding baby belly blues birth control boinking ```
167
Mifeprisone for abortion?
Confirm gestational age __________ CI: asthma, adrenal failure, steroid use, blood disorders, remove IUD Advise how to take, risks, severe pain (opioids) etc.
168
How to RULE OUT major cardiac events?
``` >18yo CC/ Chest pain NO ECG changes -Troponin and serial at 3 hours. IF negative, home with follow up -LOW risk: 0.9% 30 day MACE ``` ***CLINICAL SUSPICION >> ECG, trops or heart score
169
AVOID MISSING AORTIC DISSECTION by asking WHAT!?
History: Character, onset, duration, quality, radiation ASK about >2 then 94% correct diagnosis. If <2 20% are missed!
170
MONA?
Main goal: PCI <120 mins Morphine (increased mortality for NSTEMI) Oxygen >90% Nitrates for analgesia or pain (no mortality benefit) ASA 27% mortality benefit
171
Non cardiac causes of Chest pain?
LUNG - PE< pneumothorax, infxn, pus, blood Heart - valves, muscle, sac, infection, MI Esophagus - inflam, acid, spasm, foreign body, rupture, ear Viral swab for ZOSTER Hiatus hernia - barium swallor/scope Esophageal spasm
172
Dressler's syndrome is say what?
ddx: ACS, dressler's (pericarditis), Aunxiety or PNA/PE Test: CRP, ECHO, CXR TREAT: High dose ASA and NSAIDS
173
Colchicine for CVD?
Antiinflammatories- trial for effectiveness ongoing. eg. Colchicine after MI = significantly lower risk of ischemic CV events. ONLY WORKS FOR SECONDARY PREVENTION
174
Heart failure mortality?
50% mortality after 5 years
175
2 types of heart failure?
HFpEF - manage rate, volume, risk factors | Reduced EF: modulate neurohormonal pathway, meds, device therapy
176
SLGT2 meds are good for what?
3 places where SLGT2 meds are great: DM and CVdz, DM2+over 50 +risk of CV disease, DM, age >30yo (and something else re: renal dz)
177
Treatment for preserved EF or not in Heart failure
``` HF: ACE or ARB Beta blocker Corticoid antagonist PLUS diuretic ALSO SLGT2 EVEN IF NO DIABETUS! ```
178
Cardiac amyloidosis FUN FACTS?
NEW TREATMENT! 1/4 over 80yo If HF unexplained or associated with NEUROPATHY or CARPAL TUNNEL (bilateral) -Order SPEP, EPEP, and sFLC Monoclonal protein??
179
Heart failure non med treatment?
``` Diet Exercise Smoking Symptom and weight monitoring, vaccines sx control and palliative care early Med adherence Self monitoring symptoms and weight ```
180
Non-modifiable risk factors to breast CA
``` Age >50 PHx Sex FHx CUMULATIVE estrogen exposure!! Radiation ```
181
What affects cumulative estrogen exposure for breast cancer?
``` Estrogen early menarche older menopause Nulliparity Postmenopausal HRT Post menopausal obesity ```
182
Screening for Breast CA?
NO! | No mammogram <50 yo, no breast self exam, no clinician breast exam
183
Breast CA approach
``` RED FLAGS: Risk factors Firm, fixed and lymph nodes Past or family hx ???? more ``` MONITOR: smooth, rubbery, mobile, cystic IF worried and >30 yo: Mammogram, U/S and core biopsy
184
Side effects of treatment for breast CA?
``` CMO Valvular dz fatigue secondary malignancy ovarian insufficiency (not failure) lymphedema ```
185
REFER for breast ca?
``` Nursing breast advocate Breast surgeon Cancer agency Rapid access breast clinic Counselling Physio/massage (lymphatic drainage) Medical genetics (if extensive family history (BRCA?) ```
186
Treatment for obesity (conservative tx failed)?
bupropion - naltrexone Orlistat Liraglutide (3cc/day injection) Sx: gastric bypass, sleeve gastrectomy, gastric band, COUNSEL: major procedure and surgical risk. TREAT: like new patient
187
Obesity
``` ASK ASSESS - MRS SWELPS ADVISE - as your doc, I recommend AGREE ARRANGE ADVOCATE ```
188
Vaping for smoking cessation?
DON'T VAPE! | -vaping related lung injury!
189
Treatment for obesity (conservative tx failed)?
bupropion - naltrexone Orlistat Liraglutide (3cc/day injection) .....1 more Sx: gastric bypass, sleeve gastrectomy, gastric band, COUNSEL: major procedure and surgical risk. TREAT: like new patient
190
Obesity questions? (there are 6 A's lol)
``` ASK ASSESS - MRS SWELPS ADVISE - as your doc, I recommend AGREE ARRANGE ADVOCATE ```
191
M-SASQ?
>8 drinks men, >6 female ??? Finish me!
192
Pharmacological options for smoking cessation?
In order of most-least effective: 1. Varenicline (no black box suicide warning) 2. Bupropion UNLESS: sz d/o, eating d/o, EtOH withdrawal, allergy, MAO-i use 3. Patch, gum, pills, spray, lozenge, inhaler
193
M-SASQ?
Screen better than CAGE for alcohol use disorder: >8 drinks men, >6 female ??? Finish me!
194
Low risk alcohol use guidelines?
Women: 2/day. 10/week | Men 3/day and 15/week
195
Meds for Alcohol use disorder (AUD)
Naltrexone - NNT: 12. Don't use if liver enzymes >3ULN Acamprosate (666mg TID) - 2nd best Disulfiram (antabuse) - only if CLOSE supervision (ie. exam says concerned wife) as can have cardiac issues or choke on their vom and dieeeeee
196
Opioid Assisted Therapy?
Methadone - may have better uptake Buprenorphine-naloxone SE: CAT: constipation, amenorrhea, lower testosterone
197
NSAIDs for acute MSK pain?
Ibuprofen Use 200-400 mg is equivalent to 600-800 mg and NO greater pain relief Don't duplicate treatment Ketorolac: lower dose is better for moderate to severe acute pain in adults. Use 10 mg IV/IM Offer analgesia with investigation
198
Opioid guideline dosing and indication?
-Chronic cancer pain Chronic non cancer pain: New starts: Maximum 50 mg MED Taper to 90 mg if currently higher MED: morphine equivalents/day
199
Non-opioid treatment for pain?
ONLY if no other options: TCA Nabilone NSAIDS ``` Non meds CBT Exercise Physio Self-management ```
200
Opioids in acute pain in elderly?
Morphine = hydromorphone Rx: <3 days, rarely >7 Slow taper: 5% drop every 2-8 weeks Taper rest periods -make agreement with patient so they share your pain in prescribing opiates.
201
Opioid withdrawal?
``` Pain - neuropathic or not? Agitated (clonidine if BP >90/50 and pulse >50 Diarrhea Cramping Sweating - oxybutinin ```
202
Cannabis indications?
Refractory neuropathic, palliative pain, chemotherapy induced nausea and vomiting Spasticity
203
CFPC's position on marijuana?
<25 yo, History of psychotic illness, Avoid in pregnancy Assess for MOOD, ANXIETY, ABUSE
204
Driving and pot?
4-6-8 Don't Drive IF: >4 hours post inhalation >6 hrs post ingestion >8 hours if experienced euphoria
205
Cannabis use in geriatrics?
AVOID if: mental health, SUD, brain or banlance issues, CV dz Assess: CUDIT (cannabis use disorder inventory) screen Falls and driving risk
206
4 R's of chronic pain management long term?
Ressass regularly Relationship and shared decision-making Reconsider diagnosis Refer when appropriate
207
Canadian C-Spine rules?
High risk? Radiography Low risk? ROM Able to ROM neck? Yes? No rads High risk: >65 yo Dangerous mechanism Paresthesia ``` LOW: Simple rearend MVA Sitting in ED Ambulatory at any time Delayed onset of pain Absence of midline tenderness ``` ``` Does NOT apply IF: Acute paralysis Known vertebral disease Previous C-spine injury Outside of trauma Unstable vitals or GCS <15 ``` <16 yo (Use NEXUS) ``` NO C-spine rules for kids No neuro deficit spinal alert intoxicated ?? ```
208
Unstable neck stuff (incomplete)
Jefferson's fracture | Bilateral cervical facet dislocation?
209
C-Spine standard of care?
CT. Skip X-ray.
210
Chronic neck pain imaging indications:
Pain in ONE or BOTH upper extremities Motor/sensory/reflex deficits IMAGING not needed unless: Hx of trauma Persistent symptoms IF >4-6 w treatment Red flags: malignancy, myelopathy, abscess...think about IVDU!
211
Neck pain that isn't neck pain...Name 7!
``` MI Carotid artery dissection Basilar artery dissection Mass/cancer Foreign body Lymphoma Polymyalgia rheumatica (typical: Female >50yo) ```
212
Common causes of neck pain (ergonomics)
Occupational (ergonomics!) Driving Neurology - refer
213
QRS approach to neck pain
Quit spine board - remove ASAP Refere - massage, physio, chiro, massage, neurosx if alarm features Start - anesthesia, neck brace, c-collar
214
Menopause conservative treatment start and stops?
STOP: smoking, drinking, caffeine START: exercise and weight loss - Can be managed WITHOUT HRT or meds!! - CAM: Just say NO!
215
Bloodwork for menopause?
Nah. Clinical diagnosis. | Just say NO to FSH!
216
Pharm and non-pharm vasomotor symptoms of menopause?
Vasomotor treatment: Menopause 5? ``` Fan Layers Cool environment No hot drinks Optimize sleep ``` Meds? ``` HRT SSRI Anticonvulsants TCA Progestin OCPs ```
217
Vaginal or internal sx of menopause treatment?
START: Lubricant Non-medicated gel Estrogen tabs (reduce MILD not severe sx), moisture, rings or creams.
218
Hormone sensitive breast CA and topical estrogens?
NO man. Defs not.
219
Psych/Sex symptoms of menopause?
Treat confounders: Sleep Relationship QU sx. of menopause (formerly vag atrophy and urinary sx) SSRI
220
Menopause +/- uterus treatment considerations?
DO they have a uterus? GIVE PROGESTIN or BAZEDOXIFENE No uterus: no progestin
221
HRT for Intolerable menopause symptoms?
SAFE if: Safe for < 5 years (risk increases 2%/y for negative outcome). within 10 years of LMP Transdermal patches work best
222
Who cannot have estrogen for menopause?
``` THINK CLOT RISK!!!! Migraine w aura Smoker >35yo Uncontrolled HTN Malignancy DVT Stroke CAD DM with end organ damage Liver disease FHx. or PHx of clotting dz ```
223
Who cannot have estrogen for menopause?
``` THINK CLOT RISK!!!! Migraine w aura Smoker >35yo Uncontrolled HTN Malignancy DVT Stroke CAD DM with end organ damage Liver disease FHx. or PHx of clotting dz ```
224
Approach to cat bite?
Cat bite: typical pathogen - pasteurella multocida which abx? Amox-clav prophylactic. If pen allergy: ?? how to close it? DON'T Vaccines? Tetanus and rabies lidocaine with epi? OK to use in fingers, nose, ears
225
Rabies guidelines?
Dog, cat and ferret - give RabIg and 4 doses of HDCV or PCECV and test animal
226
Bites tx?
``` Bites: - add abx if closing: stitches loose and drain dog bites? ok to close Cat? Avoid closing ```
227
Peds laceration repair?
Intranasal midazolam or fentanyl IV/IM ketamine Blanket burrito Topical LET (lidocaine, epi, tetracaine)
228
How to close a wound?
Suture for close approximation Staple for scalp or non cosmetic Steri-strip Glue for low tension tears/flaps Deep: absorbable Cosmetic? Doesn't matter
229
DON'T close wound if?
Deep puncture Hi-tension Infected "Smelly Sneaker Syndrome"-pseudomonas and think of osteomyelitis Timing: 18 hours old on face, 24 hours on head, consult plastics
230
When do you remove sutures?
face -5 days over a joint or scalp 10-14d Everything else: 7 days F/U sooner if signs of infection
231
MOST important steps in management of poisonings?
ABC's Consider SECOND or many poisons!!! Call poison control
232
If patient unconscious in the ED and you don't know why???
Dextrose Oxygen Narcan (0.4 mg to start, but up to 10 mg) Thiamine
233
Stimulant vs. Anticholinergic toxidrome....
Vitals high and pupils dilated: Sweating: stimulant (sympathomimetics like coffee, cocaine, amphetamine or ecstacy) Treatment: none really Vitals up and pupils dilated: Flushed and not sweating...Anticholinergic toxidrome! TCA, tegretol, anti-parkinson's, antipsychotic, jimson weed Treatment: physostigmine
234
Antidotes to OD of beta blocker, iron, acetaminophen?
Betablocker OD - use glucagon Iron OD: Deferoxamine Acetaminophen OD - NAC and ABC's
235
Best medicine for poisoning?
Prevention!!!!
236
Recurrent Otitis Media ...refer to ENT when?
>3 episodes in 6 mo | >4 independent episodes that you're sure is acute otitis media in 1 year
237
Conjunctivitis - to treat or not to treat?
65% goes away without antibiotics All antibiotics have equal evidence If wear contacts? Fluoroquinolone tx.
238
Stable vs. unstable fracture?
Stable = Won't displace under normal physiologic circumstance or stress
239
Vitals, pupils and sweating in cholinergic, opioid, benzo and sedative-hypnotic toxidromes? Treatment?
Cholinergic: Normal vitals, pinpoint pupils, diaphoretic Tx: Atropine, pralidoxime Opioid: Decreased vitals, pinpoint pupils, No sweating Tx: Naloxone Sedative hypnotic - decreased vitals, normal pupils Tx: None really Benzo's - normal vitals, pupils and no sweating Tx. Flumazenil (seizure risk!!)
240
What causes a cholinergic toxidrome?
Mushrooms | Organophosphates/insecticides/nerve agents/Sarin gas
241
Causes of Sedative-hypnotic toxidrome?
Anti-epileptics, barbiturates, muscle relaxants
242
Before treatment of UTI what questions
Allergies? Recent UTI? Recent urine cx? | Consult local resistance algorithm
243
Uncomplicated UTI rx?
Septra DS | Nitrofurantoin
244
Complicated UTI rx?
``` Fluoroquinolone 3rd gen cefalosporin Broad if severe: Penem Pip-tazo ``` Get blood cx before ABX!
245
When should I sound alarm for UTI?
``` Pyelonephritis Sepsis Obstruction Impacted stone Retention ```
246
Risks of UTI?
``` Very young Very old Middle age man with BPH (obstructive voiding) Prenatal Chronic pancreatitis ```
247
Reinfection v. relapse of UTI?
Culture Re-treat for 7-14 days Reconsider diagnosis Refer - upper tract imaging, cystoscopy, urodynamics Diagnose recurrent UTI if all this ruled out- consider self treatment or prophylaxis? --> prophylactic daily if menopausal woman, post coital if younger woman. Think of prostate U/S for BPH men.
248
Treatment in children's UTI
Cefixime 7-10 days and is weight based
249
Which kids need bladder U/S post UTI
Febrile and <2yo with UTI Recurrent Complicated MUST be: within 2 week window of UTI because looking for hydronephrosis. This is Positive U/S and THEN you will order VCUG
250
Asymptomatic bacteriuria ALWAYS....EXCEPT....
If prego eggo's as it can increase risk of preterm labour
251
Epistaxis
Anterior are 90% | 90% resolve with pressure and packing.
252
Causes of epistaxis?
``` Trauma/tumor Infection Meds Exogenous (temp, weather Bleeding disorder ```
253
Mgmt MILD epistaxis? SEVERE? Posterior bleed?
Mgmt mild epistaxis: -blow dose 2 sprays oxymetazoline -Pinch x 10 mins ``` Severe: ABC's Movies LABS Tranexamic acid can help! Freeze & cauterize* and pack with gauze, rapid rhino, foley ``` Do NOT cauterize both sides. Posterior - identify by packing and keep bleeding. Call ENT!
254
Next steps management for nosebleeds?
SAFETY - admit for monitoring if posterior Next Visit - follow up w family doctor OFFER labs only if severe. Refer all unless anterior, source clearly identified. NO antibiotics needed.
255
Croup - remember 6! Age of onset and Mild to severe croup pharm and non-pharm
Occurs from 6 mo-36 mo...CAN have up to age 6yo. MILD tx: ABC's, antipyretics, fever, PO fluid, reassure parents, humidified O2. Dexamethasone 0.15 mg/kg MODERATE: Dexamethasone = 0.6 mg per kg. (Likely to be equivalent to prednisolone 1 mg/kg) SEVERE: Inhale epinephrine
256
Bugs of croup!
``` #1 cause: Parainfluenza Influenza RSV Adenovirus (also in pink eye!) Metapneumovirus ```
257
Ddx stridor?
Croup Foreign body (UNTIL PROVEN OTHERWISE!) Tracheo-malacia Safety- protect airway, ensure no foreign ingestion. Next visit - If epinephrine given then see <24h later.
258
Recurrent Croup tx approach?
Recurrent croup: Refer Start antipyretics and analgesia, but NOT abx as ALWAYS viral! Teach that course can fluctuate but symptoms should resolve in 3-4 days. NO dexamethasone if recurrent croup. Must consider if it is more severe: Bacterial Tracheitis
259
Wheeze, stridor, not improving in 1 week, looks bad..what is the black box if NOT croup?
Bacterial Tracheitis.... | DON'T give dex!!!
260
Meningitis tests?
Kernig - extend Knee with hip flex Brudzinski Lift Brain (head) off bed -mod PPV but no NPV.
261
Management for Meningitis?
Do NOT wait for lab Start IV Abx and droplet precautions NOW! Abx are a RESUSCITATION DRUG in meningitis!
262
What type of meningitis needs steroids?
Good for strep. pneumococcal specifically..but won't know that right away. BUT doesn't make others worse! Dex needs to be given 15-20 mins or at same time of Abx. NO VALUE if given afterwards.
263
Meningitis Investigations?
LP: Bloodwork incl cultures CT if indication that is NOT meningitis, worry focal lesion causing. *Consider CT before LP if worried about increased ICP. (has specific risk facters)
264
Who needs a CT before LP?
``` Immunocompromised Hx. CNS dz or lesions New onset sz Papilledema Decreased GCS Focal neuro deficits ```
265
LP results and tx. meningitis
Bacteria: Made of protein and eat glucose. High protein, low glucose, lots of WBC... Once treated will decrease protein, increase glucose, and WBC's Ceftriaxone and vanco Add ampicillin if listeria Add valacyclovir if viral.
266
Peds patients meningitis: Steroids only if H. flu and <2 hours from antibiotics ALWAYS attempt LP
All start with CTX and vanco
267
Contraindications to LP in peds?
ALWAYS attempt UNLESS contraindicated: Bleeding (coagulopathy) Blisters Brain Low BP
268
Peds meningitis
Ecoli and GBS Ceftriaxone, vanco, ampicillin if listeria concern or immunocompromised
269
Prophylaxis timeline and meds for meningitis
Must give if exposed 7 days before sx onset to 24 h post treatment. Rifampin, ciprofloxacin and ceftriaxone REPORTABLE DISEASE!! esp meningitis secondary to neisseria.
270
Anaphylaxis approach
``` Call 911 ABC's Movies Supine UNLESS seizure, pregnant or decreased LOC epinephrine ```
271
Epi dose for anaphylaxis?
Dose: 0.01 mg/kg (1:1000) 1 mg/mL Route: Intramuscular NOT subcutaneous!
272
Allergy alphabet
``` Adrenaline Breathing Corticosteroids Diphenhydramine Epi again or IV fluits Fluids Glucagon if on beta blocker H2 blocker ranitidine Inhaled salbutamol ```
273
Anaphylaxis discharge?
Discharge criteria: Observe for at least 4-8 hours Rebound in 23% - Steroids do NOT help reduce this.
274
Doses for anaphylaxis?
Rule of 5's
275
Gender for eating disorders?
BOTH!
276
Screening tool for EDs? SCOFF!
``` SICK when you are feeling full Lost CONTROL Lost more than 1 stone (14 lbs in 3 mo?) Believe yourself to be fat when others say you are thin Feel food dominates your life? ```
277
Consider eating disorder if...
Weight loss Palpitations Excess exercise Amenorrhea NO LONGER REQ'D for anorexia diagnosis
278
Types of eating disorders?
Anorexia Bulimia Binge Eating
279
ED differential?
``` Anxiety OCD Personality disorder Bullying Poverty/access to food Excessive exercise Depression Substance use ```
280
Ameonorrhea and NO ED?
Relative energy deficiency in sport RED-S Formerly female athlete triad! Occurs in any gender
281
ED non-pharm management
``` Dietitian Psychiatrist Group or individual counseling Psychologist Online training/course CBT School counselor ```
282
BMI in eating disorders?
Mild: <17.5 Mod: 16-16.99 Severe: 15-15.99 Extreme: <15
283
Sexual abuse (rule of 3 not to forget if treatment)
Medical assessment is NOT same as forensic assessment Pregnancy prevention STI counseling / Post exposure prophylaxis
284
Sexual assault medical history/assessment?
- Medically pertinent hx - Pregnancy risk - STI risk - Does patient want exam?
285
Pregnancy prevention post assault
Copper IUD (up to 5 days) Levonorgestrel Ullipristal Combined hormonal contraceptive
286
How do you prevent and support future of sexual assault patient?
Prevent: Mental health ``` COunselling SQ Sexual assault crisis centre Victim assistance Psychiatry if indicated. ```
287
WHen do you report sexual assault?
VOLUNTARY unless under 18yo
288
What do you want to provide education on to patients post sexual assault?
This is sexual assault Not their fault I support your decisions "many people feel" , "it's common to feel"... "It seems to me you are..."
289
Higher risk for interpersonal (domestic) violence?
- Elderly - Pregnant women - Children - Immigrant
290
What MUST you do for patients of domestic violence?
Safety plan!!!! Get detailed! Repeat this at every visit. Warn of escalation Assess danger (first, worst, last) -Write it down (maybe), NUMBERS in their phone (shelters? etc.) -Guns, isolated, cell reception?
291
Learning disabilities ddx?
3E's: Visual impairment Hearing impairment Education - intellectual disability, neurocutaneous disorders, TBI, seizure disorder Sleep disorder
292
ADHD onset? | Adult ADHD...does it exist?
Symptoms before 12 years old. (6/9) | Yes! (5/9)
293
ADHD Med classes?
Stimulants - methylphenidate or amphetamine. First line = long acting NRI - atomoxetine Alpha 2 agonist - guanfacine, clonidine
294
CADDRA - "DATER" mnemonic for considerations of medication not working in ADHD?
Dosage - increase, and duration of effect long enough? All 1st line trialed Time for response and side effects to normalize? Examine targets. Standardized measures? Review como's and lifestyle
295
CADDRA - "DATER" mnemonic for considerations of what to do if medication not working in ADHD?
Dosage - increase, and duration of effect long enough? All 1st line trialed Time for response and side effects to normalize? Examine targets. Standardized measures? Review como's and lifestyle
296
Non-medication treatments for ADHD?
``` Patient and family psychoeducation Psychological treatment Educational accommodations Occupational accomodations Psychoeducational assessment CBT ```
297
Fun fact about bisphosphonates? (Random fact)
Bisphosphonates increase bone density by 3-5% | Bone density readings must be 6-10% apart to be trusted...otherwise, could be due to something else.
298
ADHD treatment if has SUD?
Consider atomoxetine or vyvanse (prodrug) first!
299
Dirty wound?
``` Is there dirt in it? Open wound Crush Tear Burn Frostbite ?vaccinated or <3 tetanus vaccines ```
300
Lipid testing and the elderly?
Canadian: | >75 yo do NOT test lipids
301
Lipid testing and the elderly?
Canadian: | >75 yo do NOT test lipids
302
Vaginal bleeding... get worried IF...
First trimester? Abnormal uterine bleeding? Post menopause?
303
Vaginal bleeding in first trimester ddx?
1. Threatened abortion - viable intrauterine pregnancy Mangement: serial U/S, Serial beta HCG, preautions 2. Missed abortion - no fetal heartbeat or growth failure ``` MGMT: Surgical (96%) Medical Management? (81%) Expectant management (56%) - % = success rate ``` 3. Complete abortion - bleeding, cramping have stopped Mgmt: NOTHING unless major bleed / Rh Neg (WinRHO) 4. Ectopic Pregnancy -Pain, <7 weeks, tubal risk factors Mgmt: Expectant, medical or surgical, serial bHCG and U/S and consult surgical candidate to save the tube!
304
Risk factors for abnormal uterine bleeding?
RF: estrogen exposure, hyperandrogenism
305
Abnormal uterine bleeding (AUB) investigations?
Endometrial biopsy Pap Colposcopy We worry about cancer! So do they!
306
Mgmt of Abnormal Uterine Bleeding?
Hormonal - LNG, IUS, OCP, progestin Non-hormonal: NSAIDs and tranexamic acid Surgical - ablation, hysterectomy, polypectomy, myomectomy
307
Who do you investigate when post-menopausal vaginal bleeding? What tests?
Everyone with a uterus!!! Pelvic exam, pap, U/S or endometrial biopsy, REFER!
308
Vaginitis diagnosis?
1. History - LMP, G's and P's 2. Look at the skin / vagine 3. Do some tests! What tests? ``` Swabs Wet mount pH test KOH prep Biopsy ```
309
Ddx of itchy vag?
Not all that itches is yeast Not all discharge is yeast Not all yeast much be treated Ddx: Eczema, psoriasis, lichen sclerosis, or simplex, neoplasm - VIN, vulvar cancer GU syndrome of menopause (atrophic vaginitis) Rashes - contact dermatitis Bugs: HSV, Trich, PID, BV
310
Vagine discharge with normal tests and normal skin?
Normal Variant!! Physiological discharge. Can be thin, thick, more often discharge...can change with hormones or pregnancy
311
Screen for vaginitis?
Don't screen Even if pregnant Not even for BV Only if symptomatic vaginitis
312
Vaginitis in kids?
Foreign body STI ...REPORTABLE!!!! Irritant UNLIKELY yeast!
313
67 yo Male w nocturia, frequency, urgency. Screen?
NOT ONE IF THERE ARE SYMPTOMS!!!
314
PSA?
One recommendation: Don't use for screening Uro recs: If > 10 years life expectancy then DISCUSS PSA. Start at 50 yo if lower risk and 40 yo if higher
315
PSA test comes back elevated (22ug/L). Next step?
CFP 2015 guideline Think 10-20 rule: If PSA is 10-20 it's semiurgent <10 is low risk >20 is hi risk / urgent Physical exam IF abnormal and PSA >10 then URGENT IF normal and PSA <10 non urgent Then REFER TO UROLOGY FOR PROSTATE BIOPSY URGENTLY!
316
What is high risk for prostate CA?
``` Age Hi-risk race Family Hx Smoking Obesity ```
317
BPH Management?
Dx with hx and physical - don't forget abdominal exam (urinary retention) and rectal exam. U/A and midstream C/S PSA if alive for >10 years Treat ONLY IF BOTHERSOME. Use IPSS (international prostate symptom score
318
Non pharm mgmt and pharm mgmt for BPH?
D/C NSAIDs, saw palmetto, antihistamines, decongestants, and excess fluid, caffeine, alcohol Start: 1. Alpha blocker (tamsulosin) 2. 5 alpha reductase inhibitor 3. 1 & 2 4. Antimuscarinics 5. 1 & 4 6. PDE 5 inhibitors REFER: If suspect prostate CA If bothered +/- meds ineffective for surgery considerations
319
Prostatitis
If no fevers, chills, myalgia or malaise? More likely UTI or STI... they would look shitty if had prostatitis as systemic.
320
Most common bugs for prostatitis?
UTI bugs (which are???)
321
Infertility?
(An)ovulatory? Variable menstrual interval and flow? Tubal dysfcn (?scarring) Inflammation - endometriosis, ectopic, surgery, crohns Infection - STI's, PID, ruptured appendix Anatomic Adhesions Tx: Pelvic U/S
322
Infertility don't forget the....
``` MAN! -Sperm Partner Underwear Work environment? ``` Also think of: Erectile dysfunction Coital frequency and timing Dysparenuia
323
Freeze the eggs? Risks?
Thawed oocyte survival rates are 80-90% Live birth rates likely similar to fresh Age of freezing matters RISKS: Infection, anesthesia, Controlled ovarian stimulation, oocyte retrieval and pregnancy at advanced maternal age
324
Ovarian reserve testing?
Consider Anti mullerian hormone for women aged: >35 y ``` <35 y with RF for decreased ovarian reserve? single ovary ovarian surgery poor response to FSH Chemo/radiation Unexplained fertility ```
325
Infertility tx beyond referral
Referral (ya but what else...) Testing Treatment options Adoption
326
Investigations in infertility?
Pelvic Pap Partner Ovulation - Day 3 FSH, Estrogen, TSH, prolactin, midluteal progesterone Hyperandro DHEA-S, 17-OH progesterone, total Pelvic us or hysterosalpingogram Semen analysis
327
Prevention of infertility?
Screen and treat for STI Counsel re risk of tubal damange Quit smoking, MJ, optimize BMI
328
Referral for infertility?
12 mo if no RFs 6 mo if RF's or >35 yo IMMEDIATELY if >40y
329
What % of people conceive in 12 months?
90%
330
If unexplained infertility what do you NOT treat with?
Do not offer if unexplained infertility: Natural - cycle intrauterine insemination Clomiphene citrate alone Aromatase inhibitors alone
331
Consider further investigations/tx with infertility?
IF: No pregnancy after 12 mo, regular intercourse, normal ovulator fcn, normal semen, 1 patent tube Laparoscopy only if tubal/pelvic pathology suspected, invitro fertilization etc.
332
PID tx?
1. Antibiotics: Cefoxitin and docycycline Ceftriaxone and doxy Clindamycin and gentamycin 2. Treat partner, 3. contact tracing, 4. NO SEX x 7 days
333
Contraindications, risk, side effects
Start OCP on sunday and won't get period on weekend
334
Who can't have estrogen?
``` Migraine w aura Smoker >35y >15 cigs uncontrolled HTN Malignancy DVT Stroke CAD DM with end organ damage Liver disease ```
335
Conception counseling...START...
folic acid Iron Vaccines QUIT: smoking, teratogenic meds, alcohol, drugs
336
Sex PLUS...
``` History is the ABC's: Abuse Babies/contraception Cancer s: STI's ```
337
Gender diversity history taking?
``` What is(are) your partner(s) genders? What kind of sex do you have? How do you refer to your genitals? ``` "anything you'd like me to know about your gender identity?"
338
Age of consent?
Age of consent: 16 yo if non-exploitative 18yo if exploitative sex (power differential, porn, prostitution) Consenting youth? Youth: 12-13 yo - up to 2 years older Age 14-15yo -up to 5 years older
339
Contraception questions
Last menses? Contraception types? Adherence? Infertility? OFFER contraception and EMERGENCY contraception
340
HPV vaccine?
HPV vaccine = cancer prevention vaccine!
341
STI history taking?
Do you use internal or external condoms? Prev STI? Trade sex for money or drugs? Discuss prevention, offer testing, treatment, and contact tracing/treatment, report to public health
342
Erectile dysfunction hx taking?
``` ASK... Morning wood sexual preferences Contraception age of partner(s) ```
343
Erectile dysfunction hx taking?
``` ASK... Morning wood sexual preferences Contraception age of partner(s) ```
344
Priapism?
Foreverection!!! 1. Ischemic or not? Doppler US Cavernosal blood gas NON ISCHEMIC: watch & wait, 5 alpha reductase inhibitor - finasteride GNRH agonist- leuprolide ISCHEMIC: Needle drain Intracavernosal phenylephrine Surgical shunt if >48h
345
Sexual dysfunction in females?
Topical estrogen for vaginal sx Testosterone - short term only Sildenafil - inconsistent results
346
Referrals in sexual dysfunction?
``` Refer for counseling (individual or couples) CBT Mindfulness Pelvic floor physio Body image counseling ``` REFER to doctors: Urology, sexual medicine, endocrinology, psychiatry
347
Investigations in sexual dysfunction?
Glucose Chol/ HDL/LDL/Trig/non HDL Testosterone +/- PRL, TSH, LH FSH
348
HIV pre-exposure prophylaxis
>90% reduction in HIV acquisition!!! 1 pill x __days?
349
PREP labs?
bHCG Hepatitis labs Renal functions Screen STI's (q3mo) swab every site!! TALK ABOUT CONDOMS....
350
PREP labs?
bHCG Hepatitis labs Renal function Screen STI's (q3mo) swab every site!! TALK ABOUT CONDOMS....
351
lil guy OR elder abuse consideration?
- Speak to patient without caregiver | - Check competence....
352
PSA and DRE?
Post DRE can have transient PSA elevation...wait 3 days and should go back to normal
353
BPH tx...make sure you pre- and post- measure?
Blood pressure before and after as treatment can lower BP

CCFP Exam 2021 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions