Toronto Notes Flashcards

Question 1

Q

Clinical features of Familial Combined Hypercholesterolemia

Answer

A

Premature coronary heart disease, xanthelasma, and obesity

Question 2

Q

Risk factors for Type 1 diabetes mellitus

Answer

A

Personal history of other autoimmune diseases including Graves’ disease, myasthenia gravis, autoimmune thyroid disease, celiac disease, and pernicious anemia Family history of autoimmune diseases

Question 3

Q

Screening for Macrovascular complications of diabetes

Answer

A

A1c every 3 mo BP monitoring Lipid profile every 1-3 yr Resting ECG every 3-5 yr for high-risk patients

Question 4

Q

Etiology of Type 2 Diabetes Mellitus

Answer

A

Pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced

Question 5

Q

Clinical features of autonomic neuropathy

Answer

A

Postural hypotension Tachycardia Decreased cardiovascular response to valsalva maneuver Gastroparesis Alternating diarrhea and constipation Urinary retention and erectile dysfunction

Question 6

Q

Osteoporosis is an age-related disease characterized by:

Answer

A

Decreased bone mass and increased susceptibility to fractures

Question 7

Q

The 5 Ps of the sexual history:

Answer

A

Partners Practices Protection Past history of STIs Pregnancy prevention

Question 8

Q

Sinusitis often presents with PODS symptoms:

Answer

A

Facial pain or fullness Nasal obstruction Postnatal discharge or purulence Changes in smell

Question 9

Q

Sleep apnea is diagnosed using nocturnal polysomnography and first-line treatment is:

Answer

A

Continuous positive airway pressure (CPAP)

Question 10

Q

Group A beta-hemolytic Streptococcus is the most common bacterial cause of:

Answer

A

Sore throat (pharyngitis)

Question 11

Q

List the three categories of benign breast lesions:

Answer

A

Non-proliferative Proliferative without atypia Typical hyperplasia

Question 12

Q

Which finding on mammogram is pathognomonic for fat necrosis:

Answer

A

Oil cysts

Question 13

Q

Which type of hemorrhoids are associated with painless BRBPR, rectal fullness or discomfort, and mucus discharge:

Answer

A

Internal hemorrhoids

Question 14

Q

Characteristic finding of sigmoid volvulus on AXR:

Answer

A

Coffee-bean sign

Question 15

Q

Surgical emergencies focused history:

Answer

A

AMPLE: Allergies Medications Past medical/surgical history (including anesthesia and bleeding disorders) Last meal Events (history of presenting illness)

Question 16

Q

Preoperative stress dose coverage:

Answer

A

For patients with primary adrenal insufficiency (e.g. Addison’s disease) or secondary adrenal insufficiency (e.g. glucocorticoid use)

Question 17

Q

Postoperative fever:

Answer

A

Inflammatory physiological stress (non infectious, POD#1) Atelectasis (POD#1-2) Early necrotizing fasciitis (POD#1-2) Infectious (POD#3-7) Abscess/DVT/drug fever (POD#8+)

Question 18

Q

Approach to critically ill surgical patient:

Answer

A

ABCs IV 2 large bore IVs NS wide open Monitors (O2 sat, ECG, BP) Foley catheter Investigations (bloodwork) +/- NG tube Imaging when stable

Question 19

Q

Patient risk factors surgical site infections:

Answer

A

Age DM Steroids Immunosuppression Smoking Obesity Burn Malnutrition Patient with other infections Traumatic wound Radiation Chemotherapy

Question 20

Q

Mediastinum is bounded by:

Answer

A

Thoracic inlet Diaphragm Sternum Vertebral bodies Pleura

Question 21

Q

6Ss of SSC:

Answer

A

Smoking Spirits (alcohol) Seeds (beetel nut) Scalding (hot liquid) Strictures Sack (diverticula)

Question 22

Q

Lung cancer prevention:

Answer

A

Smoking cessation Avoidance of exposures Early detection

Question 23

Q

Most common bariatric surgery for combination malabsorptive and restrictive:

Answer

A

Laparoscopic Roux-en-Y gastric bypass

Question 24

Q

Lung tumours classified as:

Answer

A

Primary or secondary, benign or malignant, endobronchial or parenchymal

Question 25

Q

Contraindications to Liver Transplantation:

Answer

A

Active alcohol/substance use Extrahepatic malignancy within 5 yrs Advanced cardiopulmonary disease Active uncontrolled infection

Question 26

Q

Define Cholelithiasis:

Answer

A

The presence of stones in the gall bladder

Question 27

Q

Cholelithiasis Risk Factors for Cholesterol Stones:

Answer

A

Obesity Increasing age Female sex (esp females<50 years) Estrogens (female, multipariry, OCPs) Impaired gallbladder emptying (starvation, TPN, DM) Rapid weight loss

Question 28

Q

Cholelithiasis Risk Factors for Pigment Stones:

Answer

A

Cirrhosis Chronic hemolysis Biliary stasis Terminal ileal resection/disease (Crohn’s disease)

Question 29

Q

Cholelithiasis Protective Factors:

Answer

A

Statins Physical Activity Vitamin C Poly- and Monounsaturated Fats/Nuts Coffee

Question 30

Q

Define Acute Cholecystitis:

Answer

A

Inflammation of gallbladder resulting from sustained gallstone impaction in cystic duct or Hartmann’s pouch

Question 31

Q

Define Choledocholithiasis:

Answer

A

Stones in the common bile duct

Question 32

Q

Define Acute Cholangitis:

Answer

A

Obstruction of common bile duct leading to biliary stasis, bacterial overgrowth, suppuration, and biliary sepsis

Question 33

Q

Common causes of constipation in older adults:

Answer

A

Primary impaired colonic and anorectal function Drugs Diet Colo-anorectal disorders (cancer, masses, stenosis, strictures) Neurologic (stroke, dementia, Parkinson’s disease, autonomic neuropathy) Psychiatric (depression, anxiety)

Question 34

Q

Transient causes of incontinence:

Answer

A

(DIAPERS) Delirium Infection Atrophic urethritis/vaginitis Pharmaceuticals Excessive urine output Restricted Mobility Stool impaction

Question 35

Q

Components of delirium prevention:

Answer

A

Orient patient Provide eyewear and hearing aids if needed Mobilization of patient Improve sleep quality Medication reconciliation Adequate nutrition & hydration

Question 36

Q

Risk factors for elder abuse:

Answer

A

Financial exploitation Physical signs (e.g. bruising) Delay in seeking medical attention Disparities in histories Lack of close family ties Dementia Recent deterioration in health Family hx of violence

Question 37

Q

Key items to elicit for fall history:

Answer

A

(SPLATT) Symptoms Previous falls Location of falls Activity at the time of fall Time of fall Trauma

Question 38

Q

Investigations for falls:

Answer

A

CGA CBC Electrolytes BUN Creatinine Glucose Ca2+ TSH Vitamin B12 Urinalysis Cardiac enzymes ECG CT head (as directed by history and physical) Coagulation profile DEXA if >65y

Question 39

Q

Components of a Comprehensive Geriatric Assessment for management of frailty:

Answer

A

Past medical/surgical history Social history Functional history Physical assessment Geriatric review of systems (cognition, mood/mental health, falls, sleep, pain, nutrition, continence) Polypharmacy

Question 40

Q

Key factors to consider in driving competency in older adults

Answer

A

(SAFEDRIVE): Safety record Attention (e.g. concentration lapses, episodes of disorientation) Family observations Ethanol abuse Drugs Reaction time Intellectual impairment Vision/Visuospatial function Executive functions (e.g. planning, decision-making, self-monitoring behaviours)

Question 41

Q

Pharmacokinetic changes in the elderly (absorption, distribution, metabolism, elimination):

Answer

A

No significant changes to absorption Increased distribution of lipophilic drugs Decreased distribution of hydrophilic drugs Increased binding of basic drugs Decreased binding of acidic drugs Reduced phase I reactions by liver Reduced renal elimination of drugs

Question 42

Q

Risk factors for polypharmacy:

Answer

A

Patient level: Age, female sex, cognitive impairment, frailty, mental health conditions, multiple chronic conditions, lack of primary care physician, residing in LTC, use of multiple pharmacies Systems-level: Multiple prescribers, poor documental systems, automated refill systems/lack of systematic medication review

Question 43

Q

Principles for Prescribing in the Elderly:

Answer

A

Caution/compliance Age (adjust dosage for age) Review regimen regularly Educate Discontinue unnecessary medications

Question 44

Q

Etiologies of disseminated intravascular coagulation:

Answer

A

Obstetric complications Malignancy Infection Trauma Shock

Question 45

Q

Vitamin K dependent factors:

Answer

A

X IX VII II Protein C Protein S

Question 46

Q

Heparin therapy is monitored with:

Question 47

Q

Clinical features of DVT:

Answer

A

Unilateral leg swelling Erythema Warmth Tenderness Palpable cord

Question 48

Q

Most useful test to rule out DVT (in the context of low pre-test probability):

Question 49

Q

Initial Investigations for Fever in a returned traveller:

Answer

A

Malaria smears x 3 Blood C&S Routine (CBC & differential, liver enzymes, electrolytes, Cr) Urinalysis (+/1 urine C&S)

Question 50

Q

Risk of transmission after needle stick exposure to blood/infectious fluid (HPB, HPC, HIV): Risk of HIV transmission after mucus membrane exposure:

Answer

A

Hepatitis B (1/3), Hepatitis C (1/30), HIV (1/300). 0.09%

Question 51

Q

Diagnosis of active TB (4 main components):

Answer

A

1) CXR 2) Sputum for direct acid-fast smear 3) Mycobacterial culture & DST 4) NAAT

Question 52

Q

Causes of Nosocomial FUO (BCDE):

Answer

A

Bacterial and fungal infections of Resp tract & surgical sites Catheters Drugs Emboli

Question 53

Q

Drugs that may cause fever:

Answer

A

Antimicrobials Antihypertensives Anti-epileptics Anti-arrhythmics Anti-inflammatories Anti-thrombotics Anti-histamines Anti-thyroid

Question 54

Q

Causes of anion gap metabolic acidosis:

Answer

A

“MUDPILES CAT” Methanol Uremia Diabetic Ketoacidosis Paraldehyde Isopropyl alcohol/iron/ibuprofen/Indomethacin Lactic Acidosis Ethylene Glycol Salicylates Cyanide/Carbon monoxide Alcoholic ketoacidosis Toluene

Question 55

Q

What is Kussmaul breathing a feature of?

Answer

A

Metabolic acidosis

Question 56

Q

What are the general steps in managing hyperkalemia?

Answer

A

a) Stabilize the myocardium (Calcium salts) b) Shift potassium into cells (insulin and IV dextrose) c) Enhance potassium excretion (loop diuretics vs. sodium polystyrene sulfonate)

Question 57

Q

What is a potential complication of rapid correction of hyponatremia?

Answer

A

Osmotic demyelination (of pontine and extrapontine neurons, which may be irreversible)

Question 58

Q

What is a good framework for thinking about the differential diagnoses of acute kidney injury?

Answer

A

Prerenal (e.g. hypovolemia, cardiac performance, NSAIDs/ACEi/ARBs) - Renal (e.g. vasculitis, glomerulonephritis, acute interstitial nephritis, acute tubular necrosis) - Postrenal (e.g. obstructing calculi, ureteric stricture, neuropathy)

Question 59

Q

What are the indications for dialysis?

Answer

A

Think: “AEIOU” Acidosis Electrolyte imbalance (K+) Intoxication (AKI) Overload (fluid) Uremia (encephalopathy, pericarditis, urea >35-50 mM)

Question 60

Q

What are the features of Nephritic Syndrome?

Answer

A

Think: “PHAROH” Proteinuria Hematuria Azotemia RBC casts Oliguria HTN

Question 61

Q

Describe the presentation of Nephrotic Syndrome?

Answer

A

Think: “HELP” Hypoalbuminemia Edema Lipid abnormalities Proteinuria

Question 62

Q

What are the major complications and management principles of CKD? Think of the NEPHRON acronym.

Answer

A

N - Low-nitrogen diet E - Electrolytes: monitor K+ P - pH: metabolic acidosis H - HTN R - RBCs: manage anemia with erythropoietin O - Osteodystrophy: give calcium between meals (to increase Ca2+) and calcium with meals (to bind and decrease PO43-) N - Nephrotoxins: avoid nephrotoxic drugs (ASA, gentamicin) and adjust doses of renally excreted medications

Question 63

Q

What are the extrarenal manifestations of PKD?

Answer

A

Hepatic cysts Mitral valve prolapse Cerebral aneurysms Diverticulosis

Question 64

Q

Functions of the facial nerve “Ears, Tears, Face, Taste”:

Answer

A

Ears: stapedius muscle, sensory around concha of auricle, EAC, and TM. Tears: lacrimation and salivation. Face: muscles of facial expression. Taste: anterior 2/3 of tongue

Answer 63

A

Acute onset Continuous Normal head impulse test Multidirectional nystagmus Skew deviation present

Answer 64

A

Drop attacks Diplopia Dysarthria Dizziness Dysphagia

Answer 65

A

“E COLI”: Eighth cranial nerve Cochlear nucleus superior Olivary nucleus Lateral lemniscus Inferior colliculus

Answer 66

A

Latency ~20 seconds Crescendo/decrescendo vertigo lasting ~20 seconds Geotropic rotary nystagmus (required) Reversal upon sitting up Fatigability

Answer 67

A

All three of 1) Two spontaneous episodes of rotational vertigo > 20 min. 2) Audiometric confirmation SNHL (often low frequency). 3) Tinnitus/aural fullness

Answer 68

A

Totally occlusive cerumen with pain Decreased hearing Tinnitus

Answer 69

A

Active infection Previous ear surgery OOnly hearing ear TM perforation

Answer 70

A

OE, OM, TM perforation Trauma Pain Vertigo Tinnitus

Answer 71

A

Otorrhea Tenderness to pressure over the mastoid Retroarticular swelling with protruding ear

Answer 72

A

Battle’s sign (bruising over mastoid) Racoon eyes CSF rhinorrhea/otorrhea CN involvement (CNV – facial numbness, CNVI – nystagmus, CNVII – facial palsy)

Answer 73

A

(PODS, at least 2 with 1 being O or D): facial Pain/Pressure/fullness nasal Obstruction nasal Discharge hyposmia/anosmia (Smell)

Answer 74

A

Thyroglossal duct cysts

Answer 75

A

Smoking Alcohol use Radiation to the head and neck Oral HPV exposure Personal history of malignancy Family history of malignancy

Answer 76

A

Popular (most common) Palpable lymph nodes Positive I131 uptake Positive prognosis (98% 10 yr survival) Postoperative I131 scan guides further treatment

Answer 77

A

Far away metastases Females (3:1 ratio) not FNA (cannot be diagnosed with FNA) Favourable prognosis (92% 10 year survival)

Answer 78

A

Trismus Uvular deviation Dysphonia (“hot potato voice”)

Answer 79

A

Stridor Subglottic swelling Seal bark cough

Answer 80

A

Thrombocytopenia with normal RBC, WBC

Answer 81

A

ALL AML CML ALL is the most common

Answer 82

A

WAGR syndrome: Wilms tumour Aniridia Genitourinary anomalies mental Retardation

Answer 83

A

Emergent empiric antibiotic therapy based on age (age ≤28 d: ampicillin + cefotaxime, age 29 d-3 mo: ceftriaxone/cefotaxime + vancomycin ± ampicillin, age >3 mo: ceftriaxone + vancomycin). Add ampicillin IV to the above treatments if risk factors for infection with L. monocytogenes present: age >50, alcoholism, immunocompromised

Answer 84

A

1) incubation period<div>2) prodrome</div><div>3) acute neurologic syndrome</div><div>4) coma</div><div>5) death</div>

Answer 85

A

RIPE - rifampin + INH + pyrazinamide + ethambutol x 2 mo (initiation phase), then INH + rifampin x 4 mo in fully susceptible TB (continuation phase), total 6 mo.

Answer 86

A

Steptococcus pneumoniae<div>Moraxella catarrhalis</div><div>Haemophilus influenzae</div><div>Staphylococcus aureus</div>

Answer 87

A

Beta-hemolytic streptococci most commonly group A Streptococcus. Staphylococcus aureus is a notable but less common cause.

Answer 88

A

Pain out of proportion to clinical findings, edema ± crepitus, rapid spread of infection, systemic symptoms

Answer 89

A

Candidiasis, gonococcal infection, HSV

Answer 90

A

FROM JANE (Fever Roth’s spots Osler’s nodes Murmur Janeway lesions Anemia Nail-bed hemorrhages Emboli)

Answer 91

A

(DOC TECH): Drugs (esp. anti-androgens, i.e., spironolactone), Other, Congenital (Klinefelter syndrome), Tumour (esp. germ cell tumours), Endocrine (hyperthyroidism), CHronic disease (cirrhosis, CKD)

Answer 92

A

(DISCKO): Digoxin, Isoniazid, Spironolactone, Cimetidine, Ketoconazole, Oestrogen/anti-testosterone

Answer 93

A

overestimation of survival time ‘from diagnosis’ when the estimate is made from the time of screening, instead of the later time when the disease would have been diagnosed without screening

Answer 94

A

overestimation of the survival time due to screening at one time point including more stable cases than aggressive cases of disease, which may have shorter survival times

Answer 95

A

occurs in a case-control study using hospitalized controls, as they may not be a representative sample of the population due to the complexity that led to their hospital admission

Answer 96

A

at least 3/5 of the following symptoms must be present and persistent/recurrent: behavioural disinhibition; apathy or inertia; loss of sympathy or empathy; preservative, stereotyped, or compulsive/ritualistic behaviour; hyperorality and dietary changes

Answer 97

A

(TRAP): Tremor (resting); Rigidity; Akinesia/bradykinesia; Postural instability

Answer 98

A

anterior communicating artery (Acom) (30%)

Answer 99

A

rupture of middle meningeal artery (85%)

Answer 100

A

(SHAE): Smoking, HTN, Adult Polycystic Kidney Disease, Ehlers-Danlos Syndrome

Answer 101

A

Asymmetry, Border (irregular and/or indistinct), Colour (varied), Diameter (increasing or >6 mm), Enlargement, elevation, evolution (i.e. change in colour, size, or shape)

Answer 102

A

folliculitis, furuncles, carbuncles, acne vulgaris, Crohn’s disease, granuloma inguinale, pyoderma gangrenosum

Answer 103

A

Temporal relation<div>2. Recognized response</div><div>3. Improvement after drug withdrawal</div><div>4. Recurrence on re-challenge with the drug</div>

Answer 104

A

Fever<div>Exanthematous eruption</div><div>Internal organ involvement</div>

Answer 105

A

(DAM HIVES): drugs/foods, allergic, malignancy, hereditary, infection, vasculitis, emotions, stings

Answer 106

A

Rosacea can be differentiated from acne by the absence of comedones, a predilection for the central face, and symptoms of flushing

Answer 107

A

Purple, Pruritic, Polygonal, Peripheral, Papules, Penis (i.e. mucosa)

Answer 108

A

vulgariS = Superficial, intraepidermal, flaccid lesions<div>PemphigoiD = Deeper, tense lesions at the dermal-epidermal junction</div>

Answer 109

A

Admit to hospital, draw blood cultures x 2, perform orbital CT, provide IV antibiotics (ceftriaxone + vancomycin) for 1 wk

Answer 110

A

Bacterial –Mucopurulent discharge, bilateral, no adenopathy<div> <div>Viral –serous discharge, unilateral (initially, often progresses contralaterally within days), adenopathy (preauricular often palpable and tender)</div></div>

Answer 111

A

Phenylephrine 2.5% (Mydfrin®; AK-Dilate®) (will blanch episcleral vessels in episcleritis 10-15 min after application)

Answer 112

A

6-12 mo: 20/120<div>1-2 yr: 20/80</div><div>2-4 yr: 20/20</div>

Answer 113

A

Globe massage; decrease IOP; YAG laser embolectomy; thrombolysis; hyperbaric oxygen therapy

Answer 114

A

sudden-onset; flashes; floaters; curtain of blackness

Answer 115

A

rodent ulcer; indurated base with pearly rolled edges; telangiectasia

Answer 116

A

female; increasing age; family history; smoking; White individuals; blue irides

Answer 117

A

(A FIAT): age; family history; IOP; African descent; thin cornea

Answer 118

A

gradual visual acuity decrease; haloes around lights at night; monocular diplopia; “second sight” phenomenon

Answer 119

A

vitreous hemorrhage; tractional retinal detachment; neovascular glaucoma

Answer 120

A

arterial narrowing; arteriovenous nicking; flame-shaped, dot, and blot hemorrhages; cotton wool spots; hard exudates; optic disc edema

Answer 121

A

sudden monocular vision loss; pain over the temporal artery; jaw claudication; scalp tenderness; constitutional symptoms; history of polymyalgia rheumatica

Answer 122

A

1) Recurrent Thrombosis<div>2) Spontaneous Pregnancy Loss</div><div>3) Antiphospholipid Antibodies</div>

Answer 123

A

1) white (ischemia)<div>2) blue (hypoxia)</div><div>3) red (reperfusion)</div>

Answer 124

A

1) joint space narrowing<div>2) subchondral sclerosis</div><div>3) subchondral cysts</div><div>4) osteophytes</div>

Answer 125

A

1) migrating arthralgia<div>2) tenosynovitis</div><div>3) skin lesions</div>

Answer 126

A

1) palpable purpura<div>2) vesicles</div><div>3) chronic urticaria</div><div>4) superficial ulcers (erosions)</div>

Answer 127

A

1) livedo reticularis<div>2) erythema nodosum</div><div>3) raynaud’s phenomenon</div><div>4) nodules</div><div>5) digital infarcts</div><div>6) ulcers</div>

Answer 128

A

1) atlanto-axial subluxation<div>2) anterior uveitis</div><div>3) apical lung fibrosis</div><div>4) aortic incompetence</div><div>5) amyloidosis (kidneys)</div><div>6) autoimmune bowel disease</div>

Answer 129

A

1) arthritis<div>2) conjunctivitis/uveitis</div><div>3) urethritis/cervicitis</div>

Answer 130

A

scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, trapezium

Answer 131

A

absorbable, non-absorbable, monofilament, multifilament

Answer 132

A

inflammatory phase (Days 1-6)<div>proliferative phase (Day 4 - Week 3)</div><div>Remodeling phase (Week 3 - Year 1)</div>

Answer 133

A

pasteurella multocida, staphylococcus aureus, streptococcus viridans

Answer 134

A

GERD, Asthma, Postnasal drip, ACEi

Answer 135

A

(CADET, face right): CO2, Acid, 2,3-DPG, Exercise, Temperature (increased)

Answer 136

A

Elevated/normal in obstructive, Reduced in restrictive

Answer 137

A

Reticular (interstitial disease)

Answer 138

A

Exudative pleural effusion when any one of the following criteria is met: 1. Pleural protein/serum protein >0.5 2. Pleural LDH/serum LDH >0.6 3. Pleural LDH >2/3 upper limit of normal serum LDH

Answer 139

A

Acute onset - Within 7d of a defined event, such as sepsis, pneumonia, or patient noticing worsening of respiratory symptoms (usually occurs within 72h of presumed trigger) 2. Bilateral opacities consistent with pulmonary edema on either CT or CXR 3. Not fully explained by cardiac failure/fluid overload but patient may have concurrent heart failure 4. Objective assessment of cardiac function (eg. echocardiogram) should be performed even if no clear risk factors

Answer 140

A

hypovolemic, cardiogenic, obstructive, and distributive

Answer 141

A

(FASSTEN): Farmer’s lung (hypersensitivity pneumonitis); Ankylosing spondylitis; Sarcoidosis; Silicosis; TB; Eosinophilic granuloma; Neurofibromatosis

Answer 142

A

Venous stasis; Endothelial cell damage; Hypercoagulable states

Answer 143

A

<0.70 or lower limit of normal

Answer 144

A

6F’s - Fat, Feces, Fetus, Flatus, Fluid, Fatal growth

Answer 145

A

The splenic flexure and rectosigmoid junction are watershed areas and are susceptible to ischemia

Answer 146

A

CHESS – Campylobacter, Hemorrhagic E. coli (e.g. O157:H7), Entamoeba histolytica, Salmonella, Shigella

Answer 147

A

Enteric infections (e.g. Giardia), Lactose intolerance/other disaccharidase deficiency, CD, Celiac sprue, Drug-induced diarrhea, Diet-induced (excess tea, coffee, colas)

Answer 148

A

IBS-D: predominant diarrhea<div>IBS-C: predominant constipation</div><div>IBS-M: mixed, diarrhea AND constipation (each >25%)</div><div>IBS untyped: insufficient abnormality in stool to meet other types</div>

Answer 149

A

(DOPED): Drugs, Obstruction, Pain, Endocrine dysfunction, Depression

Answer 150

A

(CHAND): Colitis (radiation, infectious, ischemic, IBD [UC > CD]), Hemorrhoids/fissure, Angiodysplasia, Neoplasm, Diverticular disease

Answer 151

A

viral infection, alcohol, drugs, immune-mediated, toxins

Answer 152

A

(VARICES) - Varices, Ascites/Anemia, Renal failure (hepatorenal syndrome), Infection, Coagulopathy, Encephalopathy, Sepsis

Answer 153

A

1) Esophageal varices, melena, splenomegaly, ascites, hemorrhoids<div>2) β-blockers, Nitrates, Shunts (e.g., TIPS)</div>

Answer 154

A

(HEPATICS) - Hemorrhage in GI tract/Hypokalemia, Excess dietary protein, Paracentesis, Alkalosis/Anemia, Trauma, Infection, Colon surgery, Sedatives

Answer 155

A

Peritoneal carcinomatosis, peritoneal TB, pancreatic disease, serositis, nephrotic syndrome

Answer 156

A

Charcot’s triad (RUQ pain, fever, jaundice), hypotension, altered mental status

Answer 157

A

Beard 2. Obesity 3. No teeth 4. Elderly 5. Sleep apnea

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Answer 158

A

a patient withsevere systemic disease that limits their activity

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Answer 159

A

Naloxone 2. Atropine 3. Ventolin 4. Epinephrine 5. Lidocaine

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Answer 160

A

Pillars 2. Uvula 3. Soft palate 4. Hard palate

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Answer 161

A

Bradycardia

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Answer 162

A

Esters

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Answer 163

A

Malignant hyperthermia

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Answer 164

A

Triplet repeat expansions

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Answer 165

A

FISH (fluorescence in situ hybridization)

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Answer 166

A

The right that patients have to make decisions according to their values, beliefs, and preferences

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Answer 167

A

The ability to make a specific decision for one’s self as determined legally by the courts

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Answer 168

A

The ability to make a specific decision for oneself as determined by the clinicians proposing the specific treatment

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Answer 169

A

An obligation to provide benefit to the patient, based on what is considered to be their best interests. Consideration of best interests should consider the patient’s values, beliefs, and preferences, so far as these are known. Best interests extend beyond solely medical considerations.

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Answer 170

A

Obligation to avoid causing harm; primum non nocere (“First, do no harm”)

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Answer 171

A

Fair distribution of benefits and harms within a community, regardless of geography, income, or other social factors

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Answer 172

A

Child abuse, Fitness to drive, Communicable disease, Coroner report. All Physicians have a duty to inform/warn.

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Answer 173

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Voluntary, Capable, Specific, Informed

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Answer 174

A

Emergencies, legislation, and special situations

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Answer 175

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A legal document in which one person gives another the authority to make personal care decisions on their behalf if they become mentally incapable

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Answer 176

A

When two objects of the same radiolucency abut, they appear indistinguishable on imaging (i.e. the silhouette expected at an anatomical border disappears)

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Answer 177

A

On lateral films, vertebral bodies should appear progressively radiolucent (dark) as one moves down the thoracic vertebral column; if they appear more radio-opaque, it is an indication of pathology

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Answer 178

A

Branching pattern of air-filled bronchi on a background of opacification/fluid-filled airspaces

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Answer 179

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Space-occupying process resulting in mass effect — growing lesion or contusion causes surrounding areas of tissue to be displaced, compressed and injured
 2. Midline shift — displacement of midline structures due to mass effect
 3. Herniation (tonsilar or uncal) — rising intracranial pressure causes portions of the brain to move from one intracranial compartment to another
 4. Hydrocephalus — expansion of the ventricular system
 5. Hemorrhage — intra- or extra-axial bleeding; acute blood is bright on CT
 6. Edema — hypo-dense areas on CT reflecting blood-brain barrier breakdown
 7. Loss of grey-white matter differentiation — in cases of acute infarction differentiation between grey and white matter is lost due to cell death

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Answer 180

A

non-uniform joint-space narrowing 2. subchondral sclerosis and cyst formation 3. osteophytes

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Answer 181

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uniform joint-space narrowing 2. soft tissue swelling 3. erosions 4. periarticular osteopenia

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Answer 182

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Exercise: Bruce protocol 2. Pharmacologic: Persantine challenge (vasodilator) or dobutamine infusion (chronotropic)

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Answer 183

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A (“mad”): Paranoid, schizoid, schizotypal B (“bad”): Antisocial, borderline, histrionic, narcissistic C (“sad”): Avoidant, dependent, obsessive-compulsive

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Answer 184

A

Women: No more than 2 standardized drinks/day and 10 drinks/week Men: No more than 3 standardized drinks/day and 15 drinks/week

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Answer 185

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Brief Psychotic Disorder: <1 month - Schizophreniform: 1-6 months - Schizophrenia: >6 months

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Answer 186

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GST PAID (3 or more criteria): - Grandiosity - Sleep (decreased need) - Talkative - Pleasurable activities or painful consequences - Activity (increased) - Ideas (flight of) - Distractible

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Answer 187

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Bipolar I Disorder: At least one manic episode has occurred Bipolar II Disorder: At least 1 major depressive episode, 1 hypomanic episode, and no manic episodes

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Answer 188

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RAM: Respiratory depression, Altered mental status, Miosis

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Answer 189

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Pathological onset 2. Presymptomatic stage: from onset to first appearance of symptoms/signs 3. Clinical manifestation of disease: may regress spontaneously, be subject to remissions and relapses, or progress to death

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Answer 190

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Universal screening 2. Selective screening 3. Multiphasic screening

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Answer 191

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Risk reduction: lower the risk to health without eliminating it (e.g. avoiding sun to lower risk of skin cancer) 2. Harm reduction: a set of strategies aimed to reduce the negative consequences of drug use and other risky behaviours (e.g. needle exchange programs)

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Answer 192

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Prevalence: Total number of cases in a period of time Incidence: The number of new cases

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Answer 193

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Linear regression is for a continuous dependent variable, logistic regression is for a binary one.

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Answer 194

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A highly sensitive test helps to rule out (SnOut). A highly specific test helps to rule in (SpIn).

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Answer 195

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<ul><li>10 yr fracture risk >20% OR</li><li>Prior fragility fracture of hip or spine OR</li><li>More than one fragility fracture</li></ul>

Answer 196

A

<ul><li>drugs (especially antiandrogens, i.e.
spironolactone)</li><li>other</li><li>congenital (Klinefelter syndrome)</li><li>tumour (especially germ cell tumours)</li><li>endocrine (hyperthyroidism)</li><li>chronic disease (cirrhosis, CKD)</li></ul>

Answer 197

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<ol><li>Is the patient hypercalcemic?</li><li>Is the PTH high/normal or low?</li><li>If PTH is low, is phosphate high/normal or low?</li><li>If phosphate is high/normal, is the level of vitamin D metabolites high or low?</li></ol>

Answer 198

A

<ul><li>decrease in sperm count is affected to a greater extent than the decrease in serum testosterone level</li><li>likely associated with gynecomastia</li></ul>

Answer 199

A

(Your Stool Smells Extremely Crappy): <ul><li>Yersinia</li><li>Shigella</li><li>Salmonella</li><li>E. coli (EHEC 0157:H7), E. histolytica</li><li>Campylobacter, C. difficile</li></ul>

Answer 200

A

CHESS: <ul><li>Campylobacter</li><li>Hemorrhagic
E. coli (e.g. O157:H7)</li><li>Entamoeba histolytica</li><li>Salmonella</li><li>Shigella</li></ul>

Answer 201

A

autosomal recessive defect in copper elimination

Answer 202

A

<ul><li>metabolic syndrome w/ obesity (T2DM, HTN, hypertriglyceridemia)</li><li>less commonly meds (e.g. tamoxifen, corticosteroids, MTX)</li><li>Wilson’s, TPN, rapid wt loss, etc</li></ul>

Answer 203

A

Serum Ascites Albumin Gradient (SAAG) = serum albumin – ascites albumin. >11 g/L suggests the ascites is due to portal hypertension.

Answer 204

A

Charcot’s triad (result of ascending cholangitis) is comprised of: fever, RUQ pain, jaundice

Answer 205

A

Dementia is insidious in onset with gradual cognitive decline, stable LOC, whereas delirium is acute onset of fluctuating mental status characterized with inattention.

Answer 206

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ADLs: “DEATH” → Dressing, Eating, Ambulating, Toilet, Hygiene. IALDs: “SHAFT” → Shopping, Housework, Accounting, Food, Transport, Telephone, Taking medications.

Answer 207

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<ul><li>new onset > 50</li><li>blood in stool</li><li>unexplained anemia</li><li>weight loss</li><li>obstipation</li><li>severe abdominal pain</li><li>vomiting</li></ul>

Answer 208

A

Flow, Farmacy, Function/Falls, Feelings, Future and Family

Answer 209

A

<ul><li>antidepressants</li><li>neuroleptics</li><li>sedatives/hypnotics</li><li>antihypertensives</li><li>NSAIDS</li><li>diuretics</li><li>B-Blockers</li></ul>

Answer 210

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TAILS <ul><li>Thalassemia</li><li>anemia of chronic disease</li><li>iron deficiency anemia</li><li>sideroblastic anemia</li></ul>

Answer 211

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<ol><li>thrombocytopenia</li><li>microangiopathic hemolytic anemia</li><li>acute kidney failure</li></ol>

Answer 212

A

ABCD <ul><li>Arthralgia</li><li>Bronze skin</li><li>Cardiomyopathy/Cirrhosis of liver</li><li>Diabetes (pancreatic damage)</li></ul>

Answer 213

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<ul><li>Adherence (fimbriae)</li><li>Invasion</li><li>Evasion</li><li>Toxin production</li><li>Intracellular growth</li><li>Biofilm</li></ul>

Answer 214

A

<ul><li>Acute infections (host cell lysis after virion release)</li><li>Chronic infections (>6 mo, chronic virion release)</li><li>Latent infections (viral genome integrated into host cell nucleus, can reactivate)</li></ul>

Answer 215

A

HHAPPPPy <ul><li>Hepadnaviridae</li><li>Herpesviridae</li><li>Adenoviridae</li><li>Papillomaviridae</li><li>Parvoviridae</li><li>Polyomaviridae</li><li>Poxviridae</li></ul>

Answer 216

A

<ul><li>Primary fungal infection (overgrowth, inhalation, traumatic inoculation)</li><li>Toxins</li><li>Allergic reactions</li></ul>

Answer 217

A

<ul><li>Mechanical obstruction</li><li>Competition</li><li>Cytotoxicity</li><li>Inflammatory (acute, delayed, cytokine-mediated)</li><li>Immune-mediated injury (autoimmune, immune complex)</li></ul>

Answer 218

A

<ul><li>Contact</li><li>Droplet/contact</li><li>Airborne</li><li>Food/waterborne</li><li>Zoonotic/vector-borne</li><li>Vertical</li></ul>

Answer 219

A

<ul><li>parasitic (malaria)</li><li>viral (non-specific mononucleosis-like syndrome, dengue, viral hepatitis)</li><li>bacterial (typhoid from Salmonella, rickettsioses)</li><li>diverse (traveller’s diarrhea, RTI, UTI/STI)</li></ul>

Answer 220

A

<ul><li>fever (≥38.3°C/101°F or ≥38.0°C/100.4°F for ≥1 h) AND</li><li>neutropenia: ANC <1.0 (severe neutropenia: ANC <0.5)</li></ul>

Answer 221

A

<ul><li>general (age - very young or elderly, malnutrition)</li><li>immune disease (HIV, malignancies, asplenia, hypogammaglobulinemia, neutropenia)</li><li>DM</li><li>Iatrogenic (Eg. corticosteroids)</li></ul>

Answer 222

A

<ul><li>cell wall inhibitors (Eg. penicillins)</li><li>protein synthesis inhibitors (Eg. macrolides)</li><li>topoisomerase inhibitors (Eg. FQs)</li><li>anti-metabolites (Eg. TMP/SMX)</li><li>anti-mycobacterials (Eg. isoniazid)</li></ul>

Answer 223

A

<ul><li>Impaired lung defenses (poor cough/gag reflex, impaired mucociliary transport, immunosuppression)</li><li>Increased risk of aspiration (impaired swallowing mechanism)</li><li>Mechanical obstruction</li></ul>

Answer 224

A

<ul><li>β-hemolytic streptococci (most common cause of non-purulent cellulitis)</li><li>S. aureus</li><li>S. lugdunensis (occasionally)</li></ul>

Answer 225

A

<ol><li>respiratory rate ≥22/min</li><li>sBP ≤100 mmHg</li><li>altered mentation (GCS <15)</li></ol>

Answer 226

A

2 NRTIs + 1 INSTI or “boosted” PI (combined with ritonavir or cobicistat for improved pharmacokinetics)

Answer 227

A

output greater than 3 L/d. Distinguish from urinary frequency, where urination occurs multiple times per day but the total volume over 24 h is <3 L

Answer 228

A

PHAROH <ul><li>Proteinuria</li><li>Hematuria</li><li>Azotemia</li><li>RBC casts</li><li>Oliguria</li><li>HTN</li></ul>

Answer 229

A

HELP <ul><li>Hypoalbuminemia</li><li>Edema</li><li>Lipid abnormalities</li><li>Proteinuria </li></ul>

Answer 230

A

Diuretics, ACEi/ARBs, NSAIDs

Answer 231

A

C BIG K Drop <ul><li>Calcium gluconate</li><li>B-agonists</li><li>Insulin</li><li>Glucose</li><li>Kayexalate</li><li>Diuretics</li><li>Dialysis</li></ul>

Answer 232

A

<ol><li>Peaking T waves</li><li>Loss of P waves</li><li>Widening QRS</li><li>Sine waves</li></ol>

Answer 233

A

MUDPILES <ul><li>Methanol</li><li>Uremia</li><li>Diabetic/alcoholic ketoacidosis</li><li>Paraldehyde</li><li>Iron/isoniazid</li><li>Lactic acidosis</li><li>Ethylene glycol</li><li>Salicylates </li></ul>

Answer 234

A

<ul><li>Diarrhea</li><li>Renal tubular acidosis</li></ul>

Answer 235

A

AEIOU, if refractory <ul><li>Acidosis</li><li>Electrolyte imbalance</li><li>Intoxication/AKI</li><li>Overload (fluid)</li><li>Uremia</li></ul>

Answer 236

A

Pigmented granular casts

Answer 237

A

8 mmol/L/24h to prevent osmotic demyelination

Answer 238

A

Ischemic renal disease/renal artery stenosis

Answer 239

A

Assess strength of trapezius (shoulder shrug) and sternocleidomastoid muscles (head turn)

Answer 240

A

Post-lumbar puncture headache (5-40%)

Answer 241

A

transient occurrence of signs and/or symptoms due to abnormal hyper-synchronization of neurons

Answer 242

A

<ul><li>Visual hallucinations</li><li>Parkinsonism</li><li>Fluctuating cognition</li><li>REM sleep behaviour disorder</li></ul>

Answer 243

A

Large-amplitude, involuntary, flinging movements that are most commonly unilateral

Answer 244

A

Vitamin B1 deficiency (thiamine)

Answer 245

A

<ul><li>Tachypnea</li><li>Cyanosis</li><li>Tachycardia</li><li>Inability to speak</li><li>Nasal flaring</li><li>Tracheal tug</li><li>Intercostal indrawing</li><li>Tripoding</li><li>Paradoxical breathing</li></ul>

Answer 246

A

<ul><li>Consolidation</li><li>Reticular</li><li>Nodular</li></ul>

Answer 247

A

“CADET face right!” <ul><li>CO2</li><li>Acid</li><li>2,3-DPG</li><li>Exercise</li><li>Temperature (increased)</li></ul>

Answer 248

A

MUDPILESCAT <ul><li>Methanol</li><li>Uremia</li><li>Diabetic ketoacidosis/starvation ketoacidosis</li><li>Phenformin/Paraldehyde</li><li>Isoniazid, Iron, Ibuprofen</li><li>Lactic acidosis</li><li>Ethylene glycol</li><li>Salicylates</li><li>Cyanide, Carbon dioxide</li><li>Alcoholic ketoacidosis</li><li>Toluene, Theophylline</li></ul>

Answer 249

A

DANGERS <ul><li>Daytime Sx ≥3 d/wk</li><li>Activities (physical) reduced</li><li>Night-time Sx ≥1 time/week</li><li>GP visits</li><li>ER visits</li><li>Rescue puffer use ≥3 d/wk</li><li>School or work absences</li></ul>

Answer 250

A

<ul><li>Smoking cessation</li><li>Vaccination</li><li>Home oxygen</li></ul>

Answer 251

A

venous stasis, endothelial cell damage, hypercoagulable states

Answer 252

A

<ol><li>Pulmonary Arterial HTN</li><li>Pulmonary HTN secondary to left heart disease</li><li>Pulmonary HTN due to lung disease and/or hypoxia</li><li>Chronic thromboembolic pulmonary HTN</li><li>Pulmonary HTN with unclear multifactorial mechanisms</li></ol>

Answer 253

A

<ol><li>Protein - Pleural/Serum >0.5</li><li>LDH - Pleural/Serum >0.6</li><li>Pleural LDH >⅔ upper limit of N serum LDH</li></ol>

Answer 254

A

4Ts
 <ul><li>Thymoma</li><li>Thyroid enlargement (goitre)</li><li>Teratoma</li><li>Tumours (lymphoma, parathyroid, esophageal, angiomatous)</li></ul>

Answer 255

A

<ul><li>Low total ventilation</li><li>High dead space ventilation</li><li>High CO2 production</li><li>High inspired CO2</li></ul>

Answer 256

A

reduction in airflow ≥30% from baseline, lasting for ≥10 s, associated with oxygen desaturation ≥3% or EEG arousal

Answer 257

A

<ol><li>Respiratory rate ≥22/min</li><li>Altered mentation</li><li>Systolic blood pressure ≤100 mmHg</li></ol>

Answer 258

A

SHOCK <ul><li>Spinal (neurogenic), Septic</li><li>Hemorrhagic</li><li>Obstructive (e.g. tension pneumothorax, cardiac tamponade, PE)</li><li>Cardiogenic (e.g. arrhythmia, MI)</li><li>AnaphylaKtic </li></ul>

Answer 259

A

disruption of alveolar capillary membranes → leaky capillaries → interstitial and alveolar pulmonary edema → reduced compliance, V/Q mismatch, shunt, hypoxemia, pulmonary HTN

Answer 260

A

<ul><li>genetic predisposition</li><li>advanced age</li><li>obesity</li><li>female</li><li>trauma</li></ul>

Answer 261

A

<ul><li>Breast</li><li>Lung</li><li>Colon</li><li>Ovarian</li></ul>

Answer 262

A

dry eyes, dry mouth, arthritis

Answer 263

A

<ul><li>Palpable purpura</li><li>Vesicles</li><li>Chronic uritcaria</li><li>Superficial ulcers</li></ul>

Answer 264

A

Arthritis, conjunctivitis/uveitis, urethritis/cervicitis

Answer 265

A

<ul><li>Furosemide</li><li>Aspirin</li><li>Alcohol</li><li>Cyclosporine</li><li>Thiazide diuretics</li></ul>

Answer 266

A

ambulation 2. activity and evidence of disease 3. self-care 4. intake 5. consciousness level

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Answer 267

A

Full Code 2. Do Not Resuscitate 3. Comfort Measures 4. Allow Natural Death

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Answer 268

A

S: Setting up the interview P: (assessing) Perspective I: Invitation K: Knowledge sharing E:. Emotions/Empathy S: Strategy and Summary

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Answer 269

A

Life-threatening conditions for which curative treatment may be feasible but can fail 2. Conditions in which premature death is inevitable 3. Progressive conditions without curative treatment options 4. Irreversible but non-progressive conditions causing severe disability

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Answer 270

A

physical concerns 2. social-related concerns 3. psychological concerns 4. spiritual concerns 5. existential concern

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