Week 1 Flashcards
low back pain - ddx
cord compression
infectious
cancer mets
vertebral fracture
ruptured AAA
spondyloarthritis
radicular pain - disc herniation
neurogenic claudication - stenosis - buttock/leg pain
non-specific/mechanical
non lumbar spine - gyne, renal stones, GI, hip
low back pain - ix if concern ankylosing spondylitis
xray or CT SI joints
HLA B27 antigen
low back pain - risk factors for red flags
IVDU
recent surgery
osteoporosis
steroid use
morning stiffness, pain at night - spondyloarthritis
low back pain - ix cauda equina
MRI
low back pain - physical exam red flags
vertebral tenderness
spine abnormalities
saddle anesthesia
sphincter tone low
straight leg raise
motor weakness
sensory loss dermatomal, reflexes
obesity - south asian BMI criteria for overweight and obese
overweight >= 23
obese >= 25
obesity - lifestyle recommendations
goal 5-10% weight loss for health benefit
nutrition
decrease calories by 500-1000 daily
exercise
minimum 30m daily mod intensity
increase to 1h daily
obesity BMI >30 if lifestyle tx failed
or BMI >27 w risk factors
how would you treat?
structured behavioural weight loss programs
meds
orlistat (lipase inhibitor) - stop if wt loss <5% in 3mo
GLP1 (ozempic) if wt loss in diabetes and metformin
obesity
BMI >40
BMI >35 w comorbidity - OA, OSA etc
treatment?
consider bariatric surgery
reduce chronic disease RR 25%
child - BMI cut offs for overweight and obese
overweight >85th percentile
obese >97th percentile
palliative
treatment for dyspnea
O2 in - oxygen, fans
CO2 out - bronchodilators
SOB sensation - opioids, benzo
secretions - scopolamine (anticholinergic), anxiety, sitting up
palliative
treatment for constipation
osmotic - PEG, lactulose
stimulant - senna, bisacodyl
surfactant/lubricating - docusate, glycerine supp
palliative
treatment for nausea/vomitting
tx
metoclopramide - prokinetic
ondansetron - 5HT3 antagonists
dimenhydramine - antihistamine
scopolamine - antichlinergic
haloperidol - antipsychotics
cannabinoids
drug induced - tx - opioid rotation, haloperidol, metoclopramide, ondansetron
constipation tx
gastritis tx
oral candida tx
palliative
pronouncement of death
check id bracelet
no spontaneous respiration, absent breath sound
absent heart sounds, carotid pulse
fixed pupils, non reactive to light
no response to tactile stimulation and pain (pressure on nail bed)
time of death
palliative
tx for confusion/delirium
haloperidol 1-2mg q2h SC PRN
methotrimeprazine
midazolam 1mg SC q1h PRN
palliative
noisy respiratory secretions tx
glycopyrrolate 0.2-0.4 SC q4h PRN
scopolamine if unconscious 0.4-0.6 SC q4h PRN or patch
atropine opthalmic drops 103 drops SL q2-4h
counselling
readiness to change stages
pre-contemplation
contemplation
preparation-action
maintenance
relapse (learning)
counselling - health risk behaviour questions
5 As
ask - would you mind if we spoke about your smoking
advise - i recommend
assess - are you ready to quit smoking in the next 30d
assist - offer tx, supports
arrange a follow up
lifestyle - decrease these activities
smoking/alchol/rec drugs
diet - salt, fat, sugar, calories
screentime TV
stressful activities/work
exposure to triggers (allergies)
lifestyle - increase these activities
injury prevention - helmet, belts
exercise
diet
relaxation - breathing etc.
hypertension urgency dx
dBP > 130
sx
confusion - HTN encephalopathy, ICH
chest pain - aortic dissection, LV failure, ACS
low urine - AKI
pre-eclampsia/eclampsia
catecholamine associated HTN
HTN physical exam
cardiac - s4 hs, apical pulse, displaced apex
resp
fundoscopy
bruits - abdo
peripheral pulses
labs
HTN dx cut offs
automated office BP >135/85
non automated office BP >140/90
out of office
ambulatory/home BP >135/85
24h auto BP 130/80
start meds immediately >160/100
how to take home BP diary
7 days
2 x before breakfast
2x 2h after dinner
eliminate day 1 reading
avg 6 days
HTN BP targets
<140/90 (including elderly, CKD)
diabetes <130/80
high risk <120 - CKD, CV, FRS >15%
