Vital FM 5 Flashcards by Deleted Deleted

What are 4 nonpharmacologic treatments for vasovagal syncope?

Avoid triggers
Identify prodromes
Water & Salt
Protective maneuvers

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What t medications do we give for vasovagal syncope?

Fludrocortisone
Midrodine
Beta Blockers > 42 years
SSRIs
Droxidopa

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What vasovagal syncope would warrant a 1 month driving ban?

Unexplained
Frequent
No prodrome

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Who do you screen for esophageal cancer?

Nobody.

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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)

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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

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What are 3 types of pulmonary hypertension who need warfarin?

Idiopathic
Heritable
Drug/toxin-induced

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What are three prescriptions for pulmonary HTN?

PDE5i
Endothelin receptor antagonist
Soluble guanylate cyclase stimulators

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What are 4 lifestyle management steps for patients with MS

Decrease smoking
Decrease weight
Increase exercise
Vitamin D

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What would make you stop MS treatments?

Patient wanting to conceive!

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What two pharmacologic treatments have some evidence in eating disorders?

SSRIs

Antipsychotics

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Which medications have no evidence or are contraindicated in eating disorders?

SNRIs
Mood stabilizer
Bupropion

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What medication can you start in ED for opioid use disorder?

Buprenorphine/Naloxone

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Which children are at highest risk of food allergy?

Severe eczema

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If sibling had an allergic reaction should you delay allergens?

No.

DELAY increases risk.

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What are two alternatives to latex condoms?

Polyurothane

Polyisoprene

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What sub-clinical hypothyroidism do you treat?

Wanting to conceive
>4 TSH
>4 weeks apart

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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

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List 2 things that would put patients at high risk of neural tube defects

Personal history

Previous pregnancy

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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

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What additional imaging test do you order for moderate/high risk neural tube defects?

1st trimester U/S

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What is the abnormal amount of fluid for urinary retention?

> 150 cc’s

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What are 4 non-pharm medications for urinary incontinence

Pelvic floor muscle training
Pessary
Weight loss
Stop caffeine

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What is the target uric acid level for gout?

None

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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