Vital FM 4 Flashcards
What would make a UTI complicated and what test must you order?
Functional or structural abnormality
Male
Pregnancy
You must order and adjust with culture
What are 3 abx choices to treat uncomplicated UTIs?
Septra
Nitrofurantoin
Amox/Clav
What are two choices of antibiotics for complicated UTI?
Fluorquinolone
3rd generation cephalosporin (ceftriaxone)
What are two choices of antibiotic for severely ill patients with UTI?
Piptaz
Ertapenem/Meropenem
Who is at high risk of complications of UTI?
Very young
Very old
Pregnant
Pancreatitis
What management if somebody relapses UTI treatment?
Culture/re-culture
Re-treat for longer (7-14)
Reconsider diagnosis
Imaging
If determine recurrent - prophylaxis
What do you treat pediatric UTI with?
Cefixime 7-10 days PO
What test do you order for febrile UTI in under 2?
U/S KUB
What 3 things would make you U/S KUB in pediatric UTI?
Fever under age 2
Recurrent
Complicated
What is the only time you treat asymptomatic bacteriuria?
Pregnant ladies.
Can also consider upcoming urologic procedure
Increases risk of pre-term labour
What are the three initial steps for mild epistaxis?
Blow nose
Oxymetalazone - 2 sprays in both nostril
Pinch for 10 minutes
What is the most common age for croup? Max usual age?
6-36 months
6 years
What is your management for mild croup?
ABCs
PO fluids
What is the medication and dose of croup in kids?
Dexamethasone
0.6 mg/kg
What are 5 other causes of stridor in kids other than croup?
Parainfluenza Adenovirus RSV Foreign body Tracheomalacia Foreign body
What diagnosis would you think of a patient treated for croup returns with similar symptoms within a week?
Bacterial tracheitis
What are two special tests for Meningitis? Describe them
Kernig - extend Knee with hip flexed
Brudzinski - lift Brain off bed
NO negative predictive value
Indications for CT in suspected meningitis?
Focal neurologic deficits Immunocompromised History of CNS disease New seizure Papillidema Decreased GCS
What are your treatments in meningitis?
Ceftriaxone and
Vancomycin
Ampicllin - Listeria or immunocompromised
Valacyclovir - viral
Acute management mnemonic?
Airway
Breathing
Circulation
Monitor Oxygen Vitals Intravenous ECG Sugar check
What is the dose for epinephrine for anaphylaxis?
0.01 mg/kg IM
What are 9 treatments for anaphylaxis?
Adrenaline - 0.5 mg Breathing (02) - 5L Corticosteroid - Methylprednisolone 125 mg Diphenhydramine - 50 mg Epi again! Fluids - 500cc Glucagon H2 blocker (ranitidine) 150 mg Inhaled albutamol
Allergy alphabet
Rule of 5’s
What is a good screening tool for eating disorders?
Made yourself SICK from feeling full Lost CONTROL over eating Lost more than ONE stone 14lbs in 3 months Believed yourself to be FAT Felt FOOD dominates your life
SCOFF tool
Do you require amenorrhea for diagnosis of anorexia?
No
How many binge/purge cycles do you need for diagnosis of bulimia?
Once weekly
What are 5 things to screen for with eating disorders?
Anxiety Depression OCD Personality Disorder Bullying Poverty
What diagnose to you attribute to athletes who cannot consume as many calories as they burn?
Relative Energy Deficiency in Sport
RED-S
Who should you refer to eating disorders to?
Dietician Psychiatrist Group counselling Individual counselling Psychologist CBT School counsellor
What are the three main parts of sexual assault management?
Pregnancy prevention
STI post exposure prophylaxis
Trauma informed care
What are three treatments for pregnancy prevention following rape?
Copper IUD
Levonorgestrel
Ullipristal
Combined OCP
What are the treatments for post-exposure prophylaxis?
PrEP
Hepatitis B immunoglobulin
TEST @ 6/12 weeks
Treatment of Gonorrhea
Azithromycin 1g PO AND ONE OF
Cetriaxone 250mg IM
OR
Cefixime 800 mg PO
Abx treatment for Chlamydia?
Azithromycin or Doxy 100 mg PO BID * 7 days
When do you have to report sexual assault/rape?
Under the age of 18.
Otherwise it is voluntary.
Who is at high risk of domestic violence?
Kids
Elderly
Pregnant
Immigrants
What is the age of onset for ADHD?
12
What are 4 treatments for ADHD?
Amphetamine
Methylphenidate
Atomoxetine (SNRI)
Guanfacine (Alpha 2a receptor agonist) - good if diverting
What are things to consider before changing to 2nd or 3rd line ADHD medication such as atomoxetine or guanfacine?
Dosage/Duration All - trial all 1st line Time for response Examine targets Review - comorbidities
What are some risks associated with ADHD?
How do you fix this?
2-4X as many motor vehicle collisions
Recommend standard vehicle
What two management steps do you order for 1st trimester bleeding?
Serial ultrasound
Serial bHCG
What four things are on your differential for 1st trimester bleeds? Which of these is life threatening?
Threatened abortion
Missed abortion
Complete abortion
Ectopic
What are 5 risk factors for ectopic pregnancy?
Previous ectopic pregnancy Abnormal fallopian tubes Endometriosis History of tubal surgery STI Smoking Advanced maternal age
What are risk factors for AUB?
Estrogen exposure
Hyperandrogenism
What are three tests you would consider for AUB?
Endometrial biopsy
Pap
Colposcopy
What are three hormonal managements for AUB?
IUS
OCP
Progestin
What are two non-hormonal treatments for AUB?
NSAID
TXA
What are 4 surgical treatments for AUB?
Ablation
Hysterectomy
Polypectomy
Myomectomy
What are four tests or exams for post-menopausal bleeding?
Pelvic
PAP
Ultrasound
Endometrial biopsy
What are 4 tests to do for vaginitis?
Swabs
Wet mount
KOH
pH test
What are 5 things that could cause vaginal itch other than STIs?
Eczema Psoriasis Lichen sclerosis Lichen simplex chronicus Vulvar cancer Genitourinary syndrome of menopause Contact dermatitis
What are 4 infectious things that can cause vaginal itch?
Herpes
Trichomonas
Pelvic inflammatory disease
Bacterial vaginosis
What are three things to think about with pediatric vaginal itch?
Foreign body
Irritant (soaps/clothes)
STI (REPORTABLE)
Unlikely to be yeast
When can you consider PSA screening? At what age?
If patient has > 10 years of life expectancy. Age 50.
What is the next step after finding an elevated PSA?
If less than 10 low risk
If 10-20 medium risk
If greater than 20 high risk
Refer to urology for prostate biopsy
How does physical exam findings on DRE effect referrals for prostate CA?
If PSA < 10 and abnormal prostate, non-urgent
If PSA > 10 and abnormal prostate, urgent
What are risk factors for prostate cancer?
Age Family Hx Smoking Obesity Hi risk race
What tests do you order for suspected BPH?
Urinalysis and
Midstream culture & sensitivity
PSA if life expectancy > 10 years
What are 5 non-pharmacologic interventions for BPH?
Antihistamines Decongestants NSAIDs Saw palmetto Caffeine Alcohol
What are 2 classes of medication for BPH?
Alpha blocker (tamsulosin) 5 alpha-reductase inhibitors (finasteride)
What are 2 second line treatments for BPH?
Antimuscarinics
PDE5 inhibitors
What 4 symptoms would you associate with prostatitis that would not be present with UTI or STI?
Systemic symptoms of illness such as:
Fevers, chills myalgia, malaise
What is the most common bug for prostatitis?
E. coli.
Define hypertensive emergency
180/120
Asymptomatic
Define hypertensive emergency
Elevated BP WITH Generalized neurological symptoms (agitation, delirium, seizure, visual disturbances) Focal neurological symptoms Nausea/Vomiting Chest discomfort Dyspnea Pregnancy Recreational drugs
What are five causes of tubal dysfunction that may lead to infertility?
Endometriosis Ectopic pregnancy Surgery Crohn's PID Chlamydia Ruptured appendix
What are 4 structural uterine problems that may lead to infertility?
Surgery/Instrumentation
Septate uterus
Arcuate uterus
Intracavitary fibroids
What are 5 things that may lead to infertility in men?
Trauma Torsion Surgery Infection Tobacco Cannabis Cycling Laptops
What are 5 tests you will order for infertility in relation to ovulation?
Day 3 FSH Estrogen TSH Prolactin Midluteal progesterone
What are 3 tests you would order with suspected hyperaandrogenism?
DHEA-S
17 OH Progesterone
Total testosterone
What are two imaging tests to look for structural causes of infertility in women?
Pelvic ultrasound
Hysterosalpingogram
What are three indications for referral with infertility?
12 months if no risk factors
6 months if risk factors and over 35
Immediately if over 40
What % of healthy individuals conceive by 12 months?
90%
What 5 things would make you consider intrauterine insemination?
No pregnancy after 12 months Regular intercourse Normal ovulary function Normal semen analysis 1 patent Fallopian tube
What two abx do you treat PID with?
Cefoxitin + Doxycycline (Foxy Doxy)
or
Clindamycin + Gentamicin (in hospital)
What are three things you are doing in addition to treating an STI?
Treat partner
Contact tracing
Abstinence * 7 days
When and why should you start on OCP?
Start your pills on a Sunday. That way you will never get period on weekend.
List 5 contraindications to OCPs
Migraine with aura Smoker >65 or >15 cigs/day Uncontrolled HTN Malignancy DVT Stroke Valvular disease Diabetes with end organ damage Liver disease
What is the age of consent in Canada?
16 if non-exploitative (i.e. no power differential)
18 if exploitative
12-13 Up to 2 years older
14-15 Up to 5 years older
What cancer consideration do you have with sexually active individuals? How do you manage and prevent this?
Cervical/Anal cancer
Pap smear
HPV vaccination
What do we do for priapism?
Doppler ultrasound
Cavernosal blood gas (Ischemic vs. Non-ischemic)
If we have non-ischemic priapism what are the management steps?
Watch & Wait
5a-reductase inhibitors (finasteride)
What are the management steps for ischemic priapism?
Needle drainage
Intracavernosal phenylephrine
Surgical shunt if > 48 hours
What 5 investigations should you offer for erectile dysfunction?
Glucose Cholesterol Hdl Ldl Triglycerides Testosterone
What 5 places could you refer somebody with erectile dysfunction?
Counseling Urology Sexual medicine Endocrinology Psychiatry
Who gets PrEP?
MSM
Anyone having sex with somebody with a detectable viral load
Anybody sharing needles for IVDU
What labs do you order for somebody starting PrEP?
HIV test b-HCG Hepatitis labs Renal function STI screening q3months
