The other 105 topics Flashcards
What is the skin sloughing sign associated with blisters?
Nikolsky’s sign.
What two conditions are associated with Nikolsky’s sign?
Toxic Epidermal Necrolysis
Steven’s Johnson’s Syndrome
What are five management steps for SJS/TEN?
Stop offending agent Pain control Wound care Monitor for infection Fluid balance Electrolyte balance
What are three risk factors for pityriasis versicolor?
Activity in hot climates
Corticosteroids
Changes in activity
List three ways to confirm the diagnosis of pityriasis versicolour.
Clinically
Wood’s lamp
Presence of hyphae on KOH prep
Scraping
What are three treatments for pityriasis versicolour?
Ketoconazole shampoo
Topical terbinafine
Systemic fluconazole (severe)
What three things would you tell somebody about the natural course of pityriasis versicolour?
Fungus goes away after two weeks
Not contagious
Pigment comes back slowly
Triggered by warm/humid environments.
List 5 risk factors for CHF.
Smoking Previous myocardial infarction Hypertension Alcohol consumption Hyperlipidemia
What are 5 signs and symptoms of CHF?
PND Orthopnea Edema Ascites Cough Dyspnea Hypotension S3
What are 5 tests you would order to categorize/evaluate CHF?
Chest X-ray ECG BNP Sodium eGFR Potassium Echo
What are 5 investigations you would order if you suspect a flare-up of diverticulitis?
Abdominal CT with oral contrast Lactate Blood glucose White cell count Hgb
What one test must you order prior to getting a contrast CT?
Creatinine
What three diagnoses would you suspect with shortness of breath on a background of wet cough?
Pleural effusion
Pneumonia
Heart failure exacerbation
PE
What one cardiac abnormality would you suspect with a high pitched pan-systolic murmur in heart failure?
Aortic stenosis
What is your first pharmacologic management step for pleural effusion?
Lasix
What are 5 risk factors for DVT?
Smoking Immobility Trauma Surgery Family history of clotting disorder Malignancy
What are three tools for assessing risk of PE?
Which is validated during pregnancy?
PERC
Wells
YEARS - pregnancy validated
What organism should you suspect in a child with sore throat, fever and rash?
Group A beta-hemolytic strep
What are two complications associated with group A strep
Post-streptococcal glomerular nephritis
Rheumatic disease
How do you treat Group A strep?
Penicillin
What diagnose would you suspect in an individual with ++ NSAID use , fatigue and decreased urine output?
Pre-renal AKI
What are 5 physical exam findings associated with pre-renal AKI?
Decreased skin turgor, Dry mucous membranes Tachycardia Orthostasis Edema Elevated JVP S3
Note: kidney failure will have symptoms of both volume deletion and fluid overload
What would cause somebody to scratch in kidney failure?
Uremia
What are five lab findings in a pre-renal AKI?
Elevated urea Elevated creatinine Elevated urea/cr ratio Increased urine osmolality Decreased urine sodium
What are two risk factors for pulmonary hypertension?
Scleroderma
Smoking
What three investigations should you order for suspected pulmonary hypertension
Cardiac MRI
Echocardiogram
Right heart catheterization
What are three supportive management steps for pulmonary hypertension?
Patient education
Cardiology referral
Oxygen
Physical rehabilitation
What are three pathways by which the drugs for pulmonary hypertension work?
Nitric oxide pathway (PDE5i) Endothelin pathway (endothelia receptor antagonist) Prostacyclin pathway (soluble guanalate cyclase inhibitors)
What is the lab test to confirm celiac?
Anti-tissue transglutaminase
What are five non-pharm treatment options for chronic mechanical back pain?
Stretching Heat Ice Massage Yoga
What three things should you document prior to starting opiates?
Pain history Medical history Substance use history Previous analgesia use Opioid treatment agreement
What is the one best tool for assessing risk with opiates?
Opioid Risk Tool
Think OAT/ORT
What three things must you discuss with patients prior to starting opiates?
Benefits
Harms
Risks
What are two other diagnoses you should consider if you are thinking aortic dissection?
Intramural hematoma
Penetrating atherosclerotic ulcer
Think Acute aortic syndrome
What imaging do you order for acute aortic syndrome
ECG gated CT aorta with contrast
By what two metrics do you determine that chronic non-cancer opiates are working?
Improved function
Reduction in pain by 30%
List 5 side effects of opiates.
Nausea Somnolence Pruritus Vomiting Vertigo
What are two medical complications associated with opioid therapy
Sleep apnea
Opioid-induced hyperalgesia
What are three risk factors specific to upper arm DVT?
IV catheters
Pacemaker/ICD
Overhead arm activity
What is the syndrome associated called for upper arm DVT?
Paget-Schroetter
What test should you order if you suspect upper extremity DVT
Arm venous duplex doppler U/S
What is the difference between primary and secondary erythrocytosis?
Primary is when RBCs are produced from an RBC secreting tumour like polycythemia vera
Secondary is when RBCs are elevated due to something else that stimulates RBC production such as EPO secreting tumours
What are 5 tests you would order to distinguish between primary and secondary causes of erythrocytosis?
Hgb Peripheral blood smear Creatinine K Na GGT ALT AST Ferritin
What is the name of the gene mutation associated with the primary form of erythrocytosis (Polycythemia vera)
JAK2
What are 2 conditions that would predispose somebody to erythrocytosis?
COPD
OSA
What are three treatments for erythrocytosis?
Phlebotomy
ASA
Treat underlying cause
What are two definitions of chronic kidney failure?
eGFR < 60
ACR > 3
Either must be present3 months
What is the target BP for CKD?
120/90
How often should somebody with CKD have physical exam and labwork?
q6months
What labwork should be done at CKD checkups?
U/A K Na eGFR Creatinine ACR
What are 5 lifestyle modifications for CKD?
Exercise Weight loss Decrease salt intake Protein restriction Smoking cessation Decrease alcohol intake
What are 5 signs/symptoms that suggest testicular torsion?
What is the screening tool?
TWIST
Absent cremasteric reflex Hard testicle Swollen testicle High riding testicle Nausea/Emesis
What are 5 things to consider on diffential with testicular pain?
Torsion Orchitis Tumour Epidimytis Nephrolithiasis
TOTEN = german for kill
What is a three treatments for fibromyalgia?
TCA’s
SNRI
Gabapentin/Pregabalin
What tool could you utilize to mitigate aberrant drug behaviours when starting opioids?
Opioid contract
What are three ways you can titrate the dosage of opioids for patients who are at increase risk of opioid misuse?
Frequent dispensing
Frequent follow-up
Lower dose/increase frequency
List one long-term complication of endocarditis.
Congestive Heart Failure
What organism is most responsible for endocarditis in IVDU?
S. aureus.
What are four signs of physical exam associated with heart failure.
Elevated JVP
Ascites
Pitting edema
Hepatomegaly
What is the numerical echocardiogram cutoff for heartfailure with reduced EF?
<40%
List 5 conditions associated with high output heart failure.
Hyperthyroidism Obesity Liver disease Lung disease Pregnancy
Think that blood flow forward is HOLLuP
What is one necessary treatment step in all of beriberi, Wernicke’s encephalopathy and Korsikoff syndrome?
Thiamine for two weeks
What are two risk factors and one genetic predisposition for ankylosing spondylitis?
Adolescent
Male
HLA-B27
What diagnosis would you suspect in an adolescent male with A.M. back pain relieved with exercise?
Ankylosing spondylitis
What are three medications to treat ankylosing spondylitis?
NSAIDs
TNF blockers
Methotrexate
Pretibial myxedema (edema with overlying hyperkeratosis) is associated with what disease?
Grave’s disease
What is the pathophysiology of Grave’s disease?
TSH receptor antibodies cause ++ over production of TSH.
What are two treatments for pretibial myxoedema?
Topical steroids
Compression stockings
What is one scoring tool to be able to determine somebody’s chance of organ failure outside of ICU?
qSOFA
What are the three elements of qSOFA?
Altered mental status (GCS <15)
Resp rate > 22
SBP < 100
What are 5 investigations you should order for the sick patient?
Hgb WBC Glucose Blood cultures Chest x-ray ECG U/A
What is the one most likely bug in community acquired pneumonia?
S. pneumonia
What are 5 symptoms associated with anaphylaxis?
Angioedema Wheeze Drooling Emesis Drowsiness Hypotension
What is the dose of epinephrine for ananphylaxis?
0.01 mg/kg
What are 5 other adjuncts to epinephrine?
Antihistamines Steroids Dopamine IV fluids Oxygen
What most you look out for after an anaphylactic reaction?
How do you manage this?
Bi-phasic reaction
Monitor for up to 8 hours.
What are the cutoffs for the stages of kidney disease?
> 90 with kidney damage = stage 1 60-89 = stage 2 30-59 = stage 3 15-29 = stage 4 < 15 = stage 5
What is the target hgb level for somebody with CKD?
110
What are 6 complications of CKD?
Anemia Osteoporosis HTN Hyperkalemia Depression Restless legs
How do you treat anemia associated from CKD?
EPO
Iron supplementation
What might you suspect in a patient with kidney disease and restless legs?
Uremia
What are three indications for referral to nephrologist?
GFR < 30
Rapidly decreasing GFR
ACR > 60
List 5 organs to look at when suspecting sarcoidosis.
Lung Liver Spleen Eyes Skin Lymph nodes Joints Heart Kidneys
What is your second line treatment for otitis media in a child?
Ceftriaxone IM
What three investigations do you order if you suspect sarcoidosis?
Chest X-ray PFTs ECG Creatinine Calcium AST/ALT/GGT Hgb
What key finding would you expect in stage 1 of sarcoidosis?
Bilateral hilar lymphadenopathy
What pulmonary condition are patients with sarcoidosis at risk of developing?
Pulmonary fibrosis
What form of dysfunction does HOCM cause?
Diastolic
What maneuvers will increase a HOCM murmur?
Decrease?
Increase: Valsalva/standing
Decrease: Hand grip, leg raise, squatting
What are 3 complications with HOCM?
Ventricular arrythmias CHF Infective endocarditis Atrial fibrillation Embolic phenomenon
What are 5 diagnoses to consider in LLQ with rebound tenderness and fever
Diverticulitis Bowel obstruction Colorectal cancer Gastroenteritis IBD
What are 4 associated features with diverticulitis?
Anorexia
Nausea
Vomiting
Constipation
What would categorize diverticulitis as complicated?
Abscess Phlegmon Fistula Obstruction Perforation
What are three symptoms associated with endometriosis?
Pain with defecation
Pain with urination
Pain with intercourse
What are 5 classes of medications for endometriosis?
NSAIDs Combined OCPs Progestins IUS Aromatase inhibitors
What are 3 tests to confirm endometriosis?
Physical exam
MRI pelvis
Laparosocpy
