Toronto Notes FAMILY MED Flashcards
Benign Prostatic Hyperplasia
- Increased prostate specific antigen (PSA) in younger men more often cancer than BPH (**FHx, black men higher risk)
- LIFE MANAGEMENT: fluid restriction, bladder retraining
- MEDICATION:
1. a-receptor agonists (relax smooth muscle around prostate and bladder neck)
2. 5 a-reductase inhibitors: if prostatic enlargement —> reduce growth
3. Antimuscarinic and beta-3 agonists: if storage symptoms, avoid if bladder and outlet obstruction
3. Desmopressin: for nocturia
Bronchitis (acute)
- 80% viral (rhinovirus, coronavirus, adenovirus, influenza, parainfluenza, RSV), 20% bacterial (M, S & C. pneumoniae)
- INVESTIGATION: CXR if suspect pneumonia (cough >3wks, abnormal vital signs, localized chest findings)
- MANAGEMENT: rest, fluids, humidity, analgesics, antitussives, bronchodilators
Chest pain RED FLAGS
Loss consciousness
Severe pain
Pain for >20min
New onset pain at rest
Severe SOB
Cyanosis
Tachycardia
Bradycardia
Hypotension
Influenza vs Cold Symptoms
FLU COLD
Onset Sudden Slow
Fever High fever None
Exhaustion Severe Mild
Cough Dry, hacking +/-
Throat Fine Sore
Nose Dry, clear Runny
Head Achy None
Appetite Decreased Normal
Muscles Achy Fine
Chills Yes No
Cough differential diagnosis
Upper airway cough syndrome (post nasal drip)
Asthma/COPD
GERD
Non-asthmatic eosinophilic bronchitis
ACEi
Diabetes related symptoms
HYPERGLYCEMIA: polyphagia, polydipsia, polyuria, weight change, blurry vision, yeast infections
DIABETIC KETOACIDOSIS: fruity breath, anorexia, fatigue, abdominal pain, Kussmaul breathing, dehydration
HYPOGLYCEMIA: hunger, anxiety, tremors, palpitations, sweating, headache, fatigue, confusion, seizures, coma
**most common cause of new-onset blindness and renal dysfunction
HbA1c diabetes test
ADVANTAGES: convenient, single sample, predicts microvascular complications, low day-to-day variability, reflects long term glucose concentration
DISADVANTAGES: cost, misleading in various medical conditions (hemoglobinopathies, iron deficiency, hemolytic anemia, severe hepatic or renal disease), altered by ethnicity and aging
Dizziness
VERTIGO (vestibular)
**worse with head movement or eye closure
- Objective: external world seems to revolve around
- Subjective: individual revolves in space
- Central: 15%; brainstem, cerebellar -> neurologic associated symptoms
- Peripheral: 85%; inner ear, vestibular nerve -> audiologic associated symptoms
NONVERTIGINOUS (nonvestibular)
**no change with head movement and eye closure
- Psychogenic
- Vascular: VBI, basilar migraine, orthostatic HTN, arrhythmia, CHF, aortic stenosis, vasovagal episodes, metabolic causes
- Ocular: decreased visual acuity
Dyspepsia
- Indigestion; epigastric pain or discomfort
- Fullness, belching, bloating, heartburn, food intolerance
- COMMON ETIOLOGIES: functional, peptic ulcer disease, GERD, gastritis
- MANAGEMENT: gastric acid suppression (H2 blockers, PPIs)
Differential diagnosis for dyspnea
PULMONARY
- COPD
- Asthma
- Restrictive lung disease
- Pneumothorax
- Congenital lung disease
- PE
CARDIAC
- CHF
- Coronary artery disease
- MI
- Cardiomyopathy
- Valve dysfunction
- Pericarditis
- Arrhythmia
- Hypertrophy
MIXED/OTHER
- Deconditioning
- Trauma
- Pain
- Neuromuscular
- Metabolic condition
- Functional: anxiety, panic attack, hyperventilation
Fatigue differential diagnosis
PPSS VINNNDICATE
Psychogenic : depression, anxiety, fibromyalgia
Physiologic : pregnancy, caregiving demands
Sleep : apnea, sleep disorder, BPH, work, pain
Sedentary : lifestyle
Vascular : stroke
Infection : viral (mono, HIV), bacterial (TB), fungal
Neoplastic : any malignancy
Nutrition : anemia (Fe, B12 deficiency)
Neurogenic : myasthenia gravis, MS, parkinson’s
Drugs : B-blockers, antihistamines,
anticholinergics, benzos, antiepileptics,
antidepressants
Idiopathic
Chronic illness : CHF, COPD, sarcoid, renal failure, liver
Autoimmune : SLE, RA, mixed connective tissue disorder
Toxin : substance misuse (alcohol), lead
Endocrine : hypothyroid, DM, Cushing’s, adrenal
insufficiency, pregnancy
Differential Diagnosis Fever
INFECTION CANCER MEDS OTHER
- Bacteria - Leukemia - Allopurinol - IBS
- Viral - Lymphoma - Captopril - DVT
- Fungal - Other - Cimetidine - Collagen
- Heparin vascular
- Nifidipine disease
-Phenytoin
- Diuretics
- Barbiturates
- Antihistamines
Migraine screen
POUND
Pulsatile quality
Over 4-72hr
Unilateral
Nausea and vomiting
Disabling intensity
> /= present then diagnosis likely
Headache RED FLAGS
SNOOP
Systemic symptoms
- Fever
- anticoagulation
- Pregnancy
- Cancer
Neurologic symptoms
- Impaired mental status
- Neck stiffness
- Seizures
- Focal neurological deficits
Onset
- Sudden and severe
- New headache after age 50
Other associated conditions
- Following head trauma
- Awakens patient from sleep
- Jaw claudication
- Scalp tenderness
- Worse with exercise, sex, valsalva
Prior headache history
- Different pattern
- Rapidly progressing in severity/frequency
HTN
HTN : BP > 140/90 mmHg
Isolated systolic : sBP >140 and dBP <90 (associated with progressive reduction in compliance)
