Vital FM 5 Flashcards
What are 4 nonpharmacologic treatments for vasovagal syncope?
Avoid triggers
Identify prodromes
Water & Salt
Protective maneuvers
What t medications do we give for vasovagal syncope?
Fludrocortisone Midrodine Beta Blockers > 42 years SSRIs Droxidopa
What vasovagal syncope would warrant a 1 month driving ban?
Unexplained
Frequent
No prodrome
Who do you screen for esophageal cancer?
Nobody.
What are two diabetic drugs that have reduced CV mortality even if the patient doesn’t have diabetes?
SGLT2 inhibitors (empagliflozin) GLP-1 Agonist (liraglutide)
What 4 management tests do you order for known pulmonary hypertension?
Annual Echo
Annual DLCO (diffusing capacity for carbon monoxide)
Cardiac MRI
Right heart catheterization
What are 3 types of pulmonary hypertension who need warfarin?
Idiopathic
Heritable
Drug/toxin-induced
What are three prescriptions for pulmonary HTN?
PDE5i
Endothelin receptor antagonist
Soluble guanylate cyclase stimulators
What are 4 lifestyle management steps for patients with MS
Decrease smoking
Decrease weight
Increase exercise
Vitamin D
What would make you stop MS treatments?
Patient wanting to conceive!
What two pharmacologic treatments have some evidence in eating disorders?
SSRIs
Antipsychotics
Which medications have no evidence or are contraindicated in eating disorders?
SNRIs
Mood stabilizer
Bupropion
What medication can you start in ED for opioid use disorder?
Buprenorphine/Naloxone
Which children are at highest risk of food allergy?
Severe eczema
If sibling had an allergic reaction should you delay allergens?
No.
DELAY increases risk.
What are two alternatives to latex condoms?
Polyurothane
Polyisoprene
What sub-clinical hypothyroidism do you treat?
Wanting to conceive
>4 TSH
>4 weeks apart
List 5 things that would make you at moderate risk of neural tube defects?
Family history
Diabetes
Malabsortion (bypass, IBD, celiac)
Folate-inhibiting meds (cholestyramine
List 2 things that would put patients at high risk of neural tube defects
Personal history
Previous pregnancy
What are the doses of folic acid for neural tube defects?
How soon do you start it?
0.4
1
4
Start 3 months before
What additional imaging test do you order for moderate/high risk neural tube defects?
1st trimester U/S
What is the abnormal amount of fluid for urinary retention?
> 150 cc’s
What are 4 non-pharm medications for urinary incontinence
Pelvic floor muscle training
Pessary
Weight loss
Stop caffeine
What is the target uric acid level for gout?
None
What are the components of the fever pain score?
Fever > 24hr
Pus
Severly inflamed
No cough/coryza
What are the four types of fecal incontinence?
Urge
Passive
Involuntary
Seepage
What are 4 treatments for fecal incontinence?
Diet
Antimotility
Neuromodulation
Surgery
Who do you screen for dementia?
None.
What are 3 treatments for alopecia aerata
Steroids (topical, SC)
Minoxidil
Bimatoprost
What do you treat molluscum with?
Cantharridin
q3-4 weeks 90% resolve
What are effects associated with tetracyclines, macrocodes and clinda?
Short-term
Hypersensitivity (photo)
Autoimmune
How to avoid side effects of abx for acne?
Shortest course possible
What are three reasons not to use cannabis during pregnancy/breastfeeding?
Harm to mom
Harm to fetus
Harm while breastfeeding
What are benefits of low carb diets?
Reduce A1c
Reduce weight
What are the benefits of keto diet?
Reduction in seizures.
List 5 side effects of antibiotics?
GI (N/V/diarrhea/abdo pain)
Derm
What medication is best for alcohol abstinence? What is next best?
Acamprosate NNT 12
Naltrexone NNT 20
What is the most effective treatment you use to reduce IUD insertion pain?
Lidocaine-prilocaine cream
List 3 things to reduce IUD insertion pain.
Lidocaine-prilocaine cream
Misoprostol 600
Viscous lidocaine 4%
What are 3 treatments that do not reduce IUD insertion pain?
Misoprostol 400
Lidocaine 2%
Ibuprofen
What is the screen time limits for children as per CPS?
None.
What are 5 things to consider as alternatives to ADHD?
Learning disorder, sleep, ODD, substances, mood
What is first line treatment for age 4-6 ADHD?
Behavioural management
Which visits for well baby should be in person?
Vaccines
What anti-seizure has the highest risk of birth defects?
Valproic acid
How long do patients need to be seizure free before conceiving?
9 months
Screening questions for pediatric nutrition
Did the food not last and didn’t have money?
OR
Within the past 12 months did you work that your food would run out before you got money to buy more?
What are 5 things that would place a child at high risk of dental issues?
Dental hygiene Exposure to fluoride Socioeconomic Feeding practices Visual appearance of Caries
What are 4 components of the EUA prostate score?
Age
Prostate volume
PSA level
Spermine level
What are three serologic tests for syphilis?
Enzyme immunoassay (+ve for life)
Rapid plasma reagin
Treponema palidum particule aggregation
What % of IUD’s will be expelled after pregnancy if placed within 3 days?
33%
When is the ideal time to place an IUD after delivery?
4 weeks
What 2 occupation parameters are associated with poorer pregnancy outcomes?
Dose response with respect to number of hours worked
Physically demanding jobs
What are 4 things that would make you high risk for penicillin reaction?
Less than 5 years
Anaphylaxis/angioedema
Severe cutaneous reaction
Treatment required
PEN-F.A.S.T. rule
What are 5 benefits of bariatric surgery?
Decreased CV mortality Decreased all cause mortality Reduces T2DM Reduces HTN Reduces Ischemic Heart Disease
What test has improved sensitivity over the lachman/anterior drawer test
Lever test
What numerical value on investigation would make you suspicious for caudal equina?
Post void residual > 200cc
What are 5 red flags for headache?
Sudden onset Systemic symptoms Neurologic findings Old age Positional
What test do you order if a patient has GCA?
CT-A chest
What medication must you start if you suspect GCA?
Steroids
What test confirms GCA?
Temporal artery biopsy
What two physical exam findings would you make you order an MRI for tinnitus?
Visualized pathology in outer ear
Pulsatile
What is the single best lab test to diagnose pneumonia?
CRP
What are the cutoffs for EF for HFrEF, HFmEF, HFpEF
HFrEF < 40
HFmEF 41-49
HFpEF >50
What are 5 risk factors for ruptured AAA?
Connective tissue disease Aortic valve disease Family history Known AAA Recent aortic surgery
What are 5 findings on physical exam that would be suggestive of ruptured AAA
Hypotension Pulse deficit Neurologic deficit Aortic regurgitation mumur Aortic aneurysm
How do pupils affect GCS?
Subtract 1 from GCS if 1 pupil is non-reactive
Subtract 2 from GCS if 2 pupils are non-reactive
What are three areas to apply stimulation to rouse patients?
Supraorbital notch
Fingertips
Trapezius
What is one similar treatment for both NMS and serotonin syndrome?
Stop offending agent.
What are three lifestyle interventions for acne?
Decrease dairy
Stop smoking
Low GI Diet
What are 1st, 2nd and 3rd line topical steroids?
Hydrocortisone (start at sea level)
Betamethasone
Clobetasol
With psoriasis, what are four other places to ask about other than skin?
Scalp
Nails
Genitals
Joints (Knee)
What is the single best treatment for actinic keratuosis
5-FU
What household product will increase a child’s risk of asthma?
Cleaning products
