Vital FM 1 Flashcards
List 5 regions Thalassemia is endemic in.
Africa Middle East Caribbean Mediterranean South East Asia South America
Coffee producing regions of the world
What iron formulation has the highest iron content?
Ferrous FUmarate
FULL of Fe
What iron formulation is best for children?
Ferrous ‘S’ulfate
Best for ‘S’mall
What can you do to aid iron absorption
Vitamin C - no Tea
List 5 tests if you are worried about iron deficiency anemia
Hgb MCV Serum ferritin Peripheral Blood Smear Serum Iron TIBC Colonoscopy HCG
What test do you order to diagnosis Thalassemia
Hemoglobin Electrophoresis
Who is at high risk of iron deficiency in anemia?
List 2
Women and children
Think women and children FErst
What are risk factors for B12 deficiency?
Gastric surgery (gastric parietal cells make intrinsic factor) Strict vegans Breastfed kids of strict vegans Elderly Psychiatric
What test do you order if B12 is low to diagnose pernicious anemia?
Anti-intrinsic factor antibody
Schilling test is no longer done
What are 5 causes of anemia?
Low intake (dietary - B12/iron) Loss - menstrual, donations, meds, bleeding disorder Destruction - Marathon running
How does the Canadian Thoracic society divide up cough?
Acute - less than 3 weeks
Sub-acute - 3-8 weeks
Chronic - more than 8 weeks
What can cause acute cough (less than 3 weeks)?
Pneumonia Heart failure Neoplasm Foreign body Pneumothorax Medication
What can cause a sub-acute cough (3-8 weeks)?
Post-viral
Infectious - bacterial, viral, fungal, mycobacterial
Early chronic (asthma, reflux, upper airway cough syndrome(post-nasal drip))
What can cause chronic cough? (more than 8 weeks)
COPD Infection Cystic Fibrosis Eosinophil bronchitis Bronchiectasis
What are 4 causes outside the lung?
Travel
Occupation
Contacts
Critters
“TOCC” to your patients
What are your first, second and third line treatments for Asthma/COPD overlap syndrome?
ICS/LABA (Fluticasone + salmeterol)
LAMA (Tiotropium)
Biologic + Refer
What prophylactic antibiotic will decrease COPD exacerbations?
List 2
Azithromycin
Erythromycin
What is the first line treatment for COPD?
SABA
What medication do you substitute for a LAMA in COPD with high eosinophilic counts?
Inhaled corticosteroid (ICS)
What are 3 other causes of COPD other than smoking?
Alpha 1 antitripsyn
Second hand smoke
Biofuels (immigrants)
What is the risk and benefit of adding an ICS for COPD?
Fewer exacerbations
More pneumonias
What are two non-pharmacologic interventions for COPD?
Quit smoking
Exercise
When do you add antibiotics to steroids for acute exacerbation?
CRP>40
or 2 of 3 of
Dyspnea
Sputum purulence
Sputum Volume
What bugs cause COPD?
H. Influenza
S. Pneumonia
M. Catarrhalis
What bugs cause complicated COPD exacerbations?
Klebisella
Gram -ve’s
Pseudamonas
What can help prevent COPD exacerbations?
Flu vaccine
Pneumonia vaccine
Exercise
What can you refer a COPD patient to?
Respiratory therapy Pulmonary rehab Respirology Smoking counsellor Psychologist Exercise counsellor
How do you diagnose Asthma in less than 6?
Wheeze
Reversable wheeze
Not anything else
What is the diagnostic cutoff for A5THMA?
FEV1/FVC pre < 0.75
Reversible and increase in 12%
What is the diagnostic cutoff for C0PD?
FEV1/FVC < 0.70
What are the first, second and third line treatments for pediatric asthma?
Salbutamol
ICS
Oral steroid
What is the first line treatment for asthma?
As needed ICS-Formoterol combo
slightly better than
ICS whenever SABA is taken
What is the second line treatment for asthma
Daily ICS-formoterol + as releiver
What is the third line treatment for asthma?
Low dose ICS-LABA
What is the fourth line treatment for asthma?
Medium dose ICS-LABA
What is the fifth line treatment for asthma?
Maximum dose ICS-LABA
+ refer
+ additional therapy (tiotropium)
What are 5 risk factors for PE?
Age Prior DVT/PE Recent Surgery/trauma Estrogen use Leg swelling
What intervention do you perform for unilateral spontaneous pneumothorax that does not progress over 4 hours?
Nothing.
List 5 non-pulmonary causes of shortness of breath.
Arrhythmia Cardiomyopathy Malignancy Aortic Stenosis Mycobacterial
List 5 non-pulmonary causes for dyspnea
(5 A’s)
Anemia Anti-aeriobic (reconditioning) Altitude Allergy Acid Reflux Abnormal thyroid Anxiety
How do you diagnose and treat testicular cancer?
beta-hcg
Alpha Fetoprotein
Lop it off
BALLLS
What are 3 risk factors for Testicular Cancer
Cryptorchidism
Family History
Personal History
What screening test can you offer for lung cancer? What are the criteria?
Low Dose CT
55-74
30 pk-yr
Current or quit <15 years
What screening test would you offer for ovarian cancer?
Nothing
What 2 screening tests can you offer for colon cancer and what are their intervals?
FIT q2years
Flex sig q10years
Who do you screen for pancreatic cancer?
Family history
High-risk syndromes (Peutz-Jeghers syndrome)
What are 5 tests you can order for unexplained weight loss
Hemoglboin Na, K, eGFR, Urea, Creatinine PSA FIT CXR
What are four alarm features for abdominal pain?
Severe pain
Blood in stool
Melena
Abnormal labs
What is the treatment for H.Pylori? How long do you treat them for?
PPI
Bismuth
Metronidazole
Tetracycline
14 days
What screening test should you order for esophageal cancer?
None
What is the greater risk factor for Barrett’s esophagus?
Reflux
List 4 long-term PPI risks?
B12, dementia, C. difficile, fractures
What is the bolus fluid amount for kids?
20 ml/kg
What is the maintenance fluid amount for kids?
4-2-1 per hour.
What are 5 risk factors for C. diff?
Admission Older age Immunocompromise Previous C. diff Recent antibiotics
What is the first line treatment for C. diff?
Vancomycin PO
What are five tests to order for chronic diarrhea (> 4 weeks)?
CBC ferritin TSH C. Diff fecal calprotectin Colonoscopy
What test do you order to test for lactose intolerance?
Hydrogen breath test.
What three agents should you avoid in Crohn’s?
5-ASA
Antibiotics
Alternative treatments (probiotics/cannabis)
Name 4 medication classes to treat Crohn’s.
Sulfasalazine
Thiopurines
Methotrexate
Biologics
What are 5 things you can refer for insomnia?
Sleep Medicine Sleep study Psychiatry Auricular Accupuncture CBT-I
What are 5 non-pharm treatments for restless legs?
Iron Magnesium Stretch Massage Heat Exercise
What are 4 pharm treatments for restless legs?
Pramipexole
Gabapentin
Pregabalin
Benzos
What are the 4 steps of trauma informed care?
- Bear witness
- Create safe space
- Collaborate
- Believe in resilience
What is your first treatment class of medications for hyperthyroidism?
Beta-blocker
What 2 tests are you ordering for a thyroid nodule?
TSH
Thyroid ultrasound
What are 4 suspicious features on U/S of thyroid warrant biopsy?
1 cm
Irregular surface
Taller than wide
Calcifications
Think goitre the hedgehog.
What two treatments can you use for pharmacology resistant Grave’s disease?
Radiation
Surgery
What are 5 things common to ME-CFS, fibre and ES-MCS?
Fatigue Pain Sleep Neuro symptoms Cognitive symptoms
What symptoms are specific to ME-CFS?
Chronic, profound fatigue
Not improved by rest
Post-exertional malaise
What symptoms are specific to fibromyalgia?
Diffuse body pain (3 months)
What symptoms are specific to multiple chemical sensitivity?
Provoked by chemical agents
Removal relieves
Respiratory symptoms
What are the 5 steps in pharmacotherapy for diabetes?
Metformin 2nd line OHA qhs basal insulin qam basal insulin bolus insulin
What two oral hypoglycemic agents have cardioprotective effects?
SGLT2 inhibitors (empagliflozin) GLP-1 receptor agonists (liraglutide)
Driving guidelines for diabetes?
Check sugar q2h if symptomatic
Check sugar q4h if asymptomatic
Have 6 lifesavers in the car.
2-4-6 rule
What 5 things should you screen for in somebody with suspected somatization?
Substance use Anxiety IPV Depression Sleeping disorder
THINK SAIDS - like dummies who are on income assistance will have somatization
What are the 5 stages of change?
Pre-contemplation Contemplation Preparation Action Maintenance
List 5 causes of hepatitis.
Infections Medication Alcohol Iron overload Autoimmune
What are four treatments for non-alcohol fatty liver disease?
Exercise
Diet
Weight Loss
EtOH reduction
What test do you order to confirm active HCV infection?
HCV RNA
What are four complications of hepatitis to screen for?
HCC
Varices
Alcohol
Cirrhosis
What are two parts of low back pain history that suggest a non-inflammatory cause?
Less than 30 minutes of morning stiffness
Worse at the end of the day.
What are two parts of low back pain history that suggest an inflammatory cause?
More than 30 minutes of morning stiffness
Better at the end of the day
What are four alarm features for joints?
Hot
Boggy
AM (Stiff > 30 min)
PM (Night pain)
What four diseases should you screen for before starting DMARD/Immune suppressants
HIV
TB
HCV
HBV
What are 5 non-pharm options for treating bedwetting?
Use toilet before bed No fluids before bed No caffeine Training pants Bedwetting alarms
What two drugs can you use to treat bedwetting?
Desmopressin
Imipramine
What are 5 things you can refer for autism?
Hearing assessment Visual assessment Pediatrics Autism support group SLP
What are three co-morbid conditions to screen for in Autism spectrum disorder?
Sleep
Constipation
Anxiety/Depression
What are 5 things on your differential for Autism Spectrum Disorder
Global development delay Hearing impairment Epilepsy OCD ODD Conduct disorder Trisomy 21 Cerebral Palsy
What are 5 things to look for in conduct disorder?
Persistent Violating rights of others Rule breaking Violence against people/animals Running away from home/school
How do you separate ODD from conduct disorder?
ODD does not
Damage people or animals
Damage property
Deceive or thieve
What is one treatment for button battery injection?
Honey
List 5 things to counsel for in safety around the home in kids.
Guns Carbon monoxide Electric plugs Hot water heater Car Seats Pools
What is the most common poisoning to occur in the household?
Shampoo/Soap
What are 4 pros of circumcision?
Phimosis
UTI
Penile cancer
HPV/HIV/HSV
What do you treat phimosis with?
Betamethasone at age 8-10.
What vaccine is given in every pregnancy?
TdaP
What are 5 tips to reduce vaccine pain for children?
Most painful last Breastfeed Skin to skin Topical anesthetic Sugars
What are 4 risk factors for sinusitis?
Smoking
Anatomy (deviated septum etc.)
Allergic rhinitis
Asthma
What are 3 bugs found in sinusitis?
H. flu
S. Pneumonia
M. Catarrhalis
Same as ear bugs
Same as COPD bugs
What are 5 alarm features of sinusitis?
Persistent fever Periorbital edema Cranial nerve palsies Abnormal extra ocular movements Proptosis Vision changes Sever headache Altered mental status Meningismus
What are four features that will point to bacterial sinusitis?
Pain
Obstruction
Discharge
Smell
Greater than 7 days - treat
What is your first line antibiotic treatment for sinusitis?
Amox
What are two second line treatments for sinusitis?
TMP/SMX
Macrolide
What are 5 additional treatments to abx for sinusitis?
Nasal rinse Intranasal steroids Decongestants Analgesics Anti-inflammatories
What is the treatment for strep throat?
Pen V 800 mg QID * 5 days
What are 5 risk factors for neonatal sepsis?
Chorioamniotinits Maternal fever < 37 weeks Rupture > 18 hours GBS +ve
What are the three bugs that cause sepsis?
Listeria
E. Coli
GBS
LEGS
What is the treatment for infant hypoglycemia?
D10W
What are 5 symptoms of hypoglycemia in the neonate?
Jittery Lethargic Hypotonic Sweating Weak cry Tachypnea Seizures
How long is jaundice possible for in neonates?
2 weeks
What is the workup for neonate hypobilirubinemia?
Hemoglobin Group and Screen Conjugated bilirubin Coomb's Peripheral smear
What does a Coomb’s test in neonates?
Looks for maternal antibodies on baby’s red blood cells.
What are 5 risk factors for hip dysplasia
Firstborn Female Family history Fluid (oligo) Feet (breech)
5 F’s
What are 5 thinks to look for with pediatric limp?
Legg-Calve-Perthes Infection Malignancy (Ewing's Sarcoma) Pain from abuse Slipped Capital Femoral Epiphysis
“LIMPS”
Causes of altered mental status?
Drugs Infection Metabolic Failure Anemia/Alcohol Cardiac Electrolyte Structural
DIM FACES
