CCFP

Question 1

Secondary causes of HTN ABCDES

Answer 1

Atherosclerotic, coarctation of the aorta
Bad kidneys - Renal parenchymal disease
Catecholamines
Drug, Diet
Endrocrine (Hypothyroid, aldosterone, Cushing), EtOH
Fibromuscular dysplasia
sleep apnea, stress

Question 2

Medications that raise BP

Answer 2

Steroids, NSAIDs, amphetamines, many psychiatric meds - SSRIs, SNRIs, carbamazepine, estrogen/progesterone/androgens, sympathomimetic (decongestant), licorice

Question 3

What does a lipid panel include

Answer 3

Chol, HDL, LDL, non-HDL, TG

Question 4

Risks of HCTZ?

Answer 4

Skin cancer non melanoma, possible 4x risk after 3 years

Avoid long acting Chlorthalidone, indapamine b/c of DM2, renal and electrolyte abnormalities

Question 5

Lifestyle interventions for HTN

Answer 5

Lower salt, exercise, weight loss, reduce alcohol, DASH diet, relaxation –> CBT

Question 6

HTN Meds to avoid in HTN

Answer 6

alpha blocker alone
Beta blockers if > 60
ACE if black

Question 7

Risk factors for uterine perforation

Answer 7

breast feeding
grand multiparity
history of csection
nulliparity
inexperienced HCP
uterine abnormalities 
postpartum state in breastfeeding women

Question 8

when should you start various kinds of birth control when removing an IUD?

Answer 8

POP 2 days before, ocp/depo etc 7 days before

Question 9

contraindications to IUD

Answer 9

pelvic TB, pregnancy, uterine/cervical malignancy, puerperal sepsis, post-septic abortion, unexplained vaginal bleeding, gestational throphoblastic disease with persistently elevated betahcg (decreasing beta is relative), distorted uterine cavity, current PID/gonochlam

mirena: breast cancer, hx of ischemic heart disease, antiphospholipid antibodies, migraine with aura, severe cirrhosis
copper: severe thrombocytopenia

Question 10

What does SAD PERSONS stand for

Answer 10

Male sex
Age <19, >45
Depression
Previous attempt
Excess EtOH/substances
Loss of rational thinking
Social supports lackings
organized plan
no spouse
Sickness

Question 11

What else should you r/o with depression

Answer 11

mania, anxiety (does worry get in the way of your life?), OCD (thoughts/rituals you cannot stop), delusions (special powers/plot against you), hallucinations

Question 12

when to consider bipolar?

Answer 12

age <25
>= 5 episodes
family hx
hypersomnia
hyperphagia/increased weight
lability of mood/irritability

Question 13

first line meds/treatments for PTSD

Answer 13

fluoxetine, paroxetine, sertraline
venlafaxine
CBT
group therapy

Question 14

first line meds/treatments for OCD

Answer 14

escitalopram, fluoxetine, paroxetine, sertraline
CBT
exposure with response prevention

Question 15

mimics for depression

Answer 15

hypothyroid, adrenal insufficiency, grief/adjustment disorder, drug use, bipolar, tumor, delirium

Question 16

SPIKES

Answer 16

setting up
perception
invitation
knowledge
emotion
strategy, also SAFETY.

Question 17

SNOPQRST

Answer 17

Safety
Next visit
Offer
Prevention
Quit 
Refer
Start
Teach

Question 18

Osteoporosis risk factors

Answer 18

Age > 65
Sex - female
post menopausal
Alcohol 
Chronic disease i.e. RA
Chronic steroid use
Previous fragility fracture
Malabsorption/eating disorder
Hypogonadism
low body weight <60kg
for <50yo, fragility #, prolonged use of CS, high risk meds, hypogonadism/premature menopause, malabsorption syndrome, primary hyperparathyroidism, other d/o associated with rapid bone loss and/or fracture

Question 19

Chronic bronchitis criteria

Answer 19

Chronic bronchitis is defined as a cough with sputum expectoration for at least 3 consecutive months for at least
2 consecutive years

Question 20

Thalassemia regions

Answer 20

Southeast Asia
Africa
South America
Middle East
Carribbean 
Mediterranean

Question 21

Broad differential? VINDICATE

Answer 21

Vascular
Infectious
Neoplasm
Drugs
Idiopathic
Congenital
Autoimmune
Trauma
Endocrine

Question 22

COPDE

Answer 22

cough, purulence, dyspnea, CRP >40

Early warning score i.e. NEWS2

Question 23

Common ear bugs? what about (complicated) COPD? what about PNA?

Answer 23

Hemophilus influenza
Moraxella catarrhalis
Strep pneumonia
(same as for COPD; if complicated add on klebsiella, gram negatives, pseudomonas; same for pneumonia, if comorbid add on staph aureus, if not comorbid, atypicals - mycoplasma and chlamydophila)

Question 24

COPD Adjunctive Treatment

Answer 24

Flu/pneumonia shots
Action plan to reduce hospital use
CPAP?
Daily macrolide (azithro, erythro) to decrease exacerbations
Exercise
Quit smoking
Pulmonary rehab
Puffers - SABA, LAMA, 
Respiratory therapy
Teach inhaler technique

Question 25

SNOPQRST

Answer 25

``` Safety Next visit Offer Prevent Quit Refer Start Teach ```

Question 26

Criteria for dx asthma in <6 yo

Answer 26

Wheeze that reverses | it's not something else

Question 27

What are the criteria for asthma dx

Answer 27

FEV1/FVC pre <0.75 FEV1 post increases 12% vs. COPD; post <0.70 and not reversible

Question 28

Asthma rx pyramid for pre-schoolers

Answer 28

mild - saba mod - saba + ICS severe - saba, ICS, oral steroids

Question 29

Asthma rx pyramid for 6+

Answer 29

mild - LABA + ICS (symbicort) as needed mod - saba + daily ICS OR as-needed ICS/LABA- formeterol (LTRA as alternative) mod + - low dose ICS/LABA plus as needed SABA, OR low dose ICS/LABA plus as needed ICS/LABA mod ++ - med dose ICS/LABA plus as needed SABA, OR low dose ICS/LABA plus as needed ICS/LABA next! refer for phenotypic investigations + add-on treatment severe - saba, ICS, LABA, LAMA, LTA, theophylline **if uncontrolled, saba +/- ICS/LABA on demand

Question 30

Good asthma control

Answer 30

<1 night time symptoms <4 use of prn puffer no activity restrictions, no missed school/work

Question 31

Risk factors for asthma exacerbations

Answer 31

ICS not prescribed, poor adherence, GERD, obesity, previous ICU/intubation for asthma, irritants - smoking/allergen/pollution, allergic rhinitis, food allergy, depression, anxiety, pregnancy, FEV1<60% NSAIDs, betablockers

Question 32

Frequency of asthma f/up? in pregnancy?

Answer 32

1-3 months after starting treatment then 3-12 months after that; in pregnancy, every 4-6 weeks

Question 33

Testicular cancer BALLS CFP

Answer 33

Bhcg Alpha fetoprotein Lop it off Cryptorchidism Family hx Personal hx

Question 34

Lung cancer screening

Answer 34

age 55-74, 30pk/yr smoke, current or quit <15 years ago. CT annually up to 3 times

Question 35

Cervical cancer screening

Answer 35

``` 25-69 every 3 years unless - never sexually active - weakened immune system - symptoms of cervical ca - previous abnormal results - those who do not have a cervix - immunosuppressed CAN stop at age 70 if 3 normal in last 10 years ```

Question 36

Skin cancer risk factors

Answer 36

``` Nevi > 15 older white skin, red hair hx of skin cancer, sun exposure family history multiple sunburns actinic skin damage --> refer if hi risk, skin checks q6 months ```

Question 37

skin cancer ABCDE

Answer 37

Asymmetry Border - gradual, indistinct vs. sharp cut off Colour variation Different dermatoscopic structures - pigment network, homogeneous areas, streaks, dots, globules Evolving size/shape/colour

Question 38

Colorectal screening

Answer 38

50-74 | flex sig q10 or FIT q2 years

Question 39

Breast Ca screening (5)

Answer 39

``` 1. Screen with mammography every 2-3 y if aged 50-74 y 2. Do not routinely screen those aged 40-49 y 3. Do not screen with magnetic resonance imaging 4. Do not perform clinical breast examination 5. Advise patients not to perform self breast examination ```

Question 40

Management for Feb neut?

Answer 40

early antibiotic treatment, look for source and consider fungal stabilize and assess severe sepsis --> ICU

Question 41

H Pylori quad therapy

Answer 41

PPI Bismuth salicylate Metronidazole Tetracycline

Question 42

what is Barrett's esophagus? prevention,

Answer 42

columnar cells replace squamous; | prevention - high dose PPI and ASA

Question 43

long term risks of PPIs

Answer 43

fractures b12 deficiency dementia c diff

Question 44

gallstone RF

Answer 44

female forty fat fertile -- on OCP

Question 45

pancreatitis RF

Answer 45

``` septra, flagyl HCTZ, ACE progesterone atorva estrogen gall stones ETOH ``` I = idiopathic (also known as the fancy medical way of saying, “I dunno.”) G = gallstones (one of the two most common causes of acute pancreatitis) E = EtOH (the other common cause of acute pancreatitis) T = trauma S = steroids M = mumps/malignancy A = autoimmune S = scorpion stings … though this probably shouldn’t be your first guess for why your patient has pancreatitis H = hypertriglyceridemia/hypercalcemia E = (post) ERCP D = drugs. Most commonly: thiazides, sulfa drugs, and didanosine

Question 46

admission criteria - UN

Answer 46

uncontrolled symptoms unstable undiagnosed pain esp in elderly, immunocompromised undischargable i.e. poor social support

Question 47

fluid for peds

Answer 47

``` 20 mg/kg maintenance 4/2/1 - 4 ml/kg for the first 10kg - 2ml/kg for 11-20 - 1 ml/kg 20+ ```

Question 48

measures to monitor for severe dehydration

Answer 48

``` weight gfr/creatinine na, k glucose urea ```

Question 49

c diff risks

Answer 49

``` abx esp fluoroquinolones previous infxn recent hospitalization older age immunocompromised ```

Question 50

c diff pitfalls, who not to test? and rx

Answer 50

not just hospital acquired don't test kids <1 rx: vanco po

Question 51

Crohn's medications

Answer 51

start with sulfasalazine if mild, otherwise steroids thiopurines - not for induction methotrexate biologics

Question 52

celiac testing

Answer 52

TTG/IGA plus total IGA +/- upper endoscopy, small intestine biopsy OR endomysial IGA (but this is +++expensive) if IGa deficiency, DGP IgA and IgG

Question 53

IBS rx

Answer 53

``` r/o celiac psyllium probiotics, peppermint oil FODMAP CBT colonoscopy if >50/alarm features antispasmodics anti depressants eluxadoline - diarrhea predominant lubiprostone - constipation predominant linaclotide - " ```

Question 54

Restless legs rx, rx and non rx

Answer 54

``` non rx iron, mg stretch calves avoid caffeine massage, heat exercise rx non ergot dopamine agonists - pramipexole, ropinirole alpha-2-delta calcium channel ligand - gabapentin, pregabalin ```

Question 55

restless legs dx

Answer 55

sensation or urge to move legs worse with rest, improves with activity worse in evening

Question 56

restless legs risk factors

Answer 56

▪ Highly heritable – often family history (↑young age onset) ▪ Pregnancy ▪ Low ferritin (can be with or without anemia) ▪ Medication induced –Caffeine, Alcohol, Antihistamines, Dopamine agonists, Antidepressants, Lithium ▪ Associated diseases –ADHD, Parkinsons disease, Anxiety, Depression, Anemia with iron deficiency, Obesity, Diabetes, Renal disease

Question 57

Dx hyperthyroid

Answer 57

Radioactive iodine uptake (NOT for ladies who are preggers), unless 100% sure it's graves B block for symptoms nodule? >1cm = FNA don't treat subclinical hyperthyroid

Question 58

suspicious features of thyroid nodule

Answer 58

>1cm Taller than wide irregular surface calcifications within

Question 59

Treating thyroid storm - BLOCK x 5

Answer 59

Beta blocker - propanalol Block synthesis - methimazole, propylthiouracil Block conversion T4 --> T3 propylthiouracil Block release - iodine Block Bile - cholestyramine

Question 60

Treating graves, 3 Rs

Answer 60

Rx - First 4 Blocks - beta blocker, block synthesis, block conversion, block release Radiation Removal

Question 61

Meds to stop when sick/at risk of dehydration | SADMANS

Answer 61

``` SFU ACE Diuretics Metformin ARBs NSAIDs SGLT2 ```

Question 62

Three reasons people develop DKA

Answer 62

- acute illness, - drugs: clozapine, terbutaline, cocaine, lithium, SGLT2 - non compliance

Question 63

Diabetes complications, micro/macro

Answer 63

micro - retinopathy, neuropathy, nephropathy | macro - atherosclerosis --> CVD, CVA, PVD

Question 64

Biguanide

Answer 64

metformin

Question 65

SGLT2 inhibitors

Answer 65

flozins - empagliflozin, canagliflozin

Question 66

GLP-1R agonists

Answer 66

glutide - semaglutide, liraglutide

Question 67

DPP4 inhibitors

Answer 67

saxagliptin

Question 68

sulfonylureas

Answer 68

gliclazide, glyburide

Question 69

driving 2-4-6 rule

Answer 69

test BS every 2 hours - if hypoglycemia unawareness test BS every 4 hours - treat and wait 40 min keep 6 lifesaver candies in the car for lows

Question 70

risk factors for hep B

Answer 70

``` IVDU sex with partner with hep B child born to mother with hep B tattoos blood transfusions living in crowded conditions unimmunized multiple sexual partners MSM occupation prison hx of STIs breastfeeding OK if skin is in intact ```

Question 71

medications to treat chronic gout

Answer 71

allopurinol prboenecid febuxostat

Question 72

how to test for Hep C?

Answer 72

anti - HCV (unless known previous hep C) HCV RNA serum genotype and subtype --> spontaneous clearance in 20-45%

Question 73

how to test for Hep b?

Answer 73

``` HbsAg Anti HBS Anti HBC --> IgM, total if +ve HBeAg HBV DNA Anti HBe ```

Question 74

Mgmt and monitoring hep B

Answer 74

``` Refer to hepatology Anti virals if severe, cirrhosis U/S q6-12 months for HCC scope every 1-3 years for varices Cirrhosis/fibrosis - fibroscan, Child Pugh ``` The current approved treatments for HBV are interferon injections (standard or pegylated interferon) or oral nucleoside/nucleotide analogues (entecavir, lamivudine, tenofovir). As oral antivirals are excreted by the kidney, dose adjustments are required in renal failure. Not all patients with chronic HBV infection need to be treated. The decision to treat depends on several factors including age, serial ALT and HBV DNA levels, and severity of liver disease. Co-infection, particularly with HIV and HCV, needs to be considered when deciding on which medications to use. HBsAg (surface antigen) indicates infection. Persistence of HBsAg for 6 months or more indicates chronic infection. However, up to 50% of people with extended chronic infection will eventually clear HBsAg. By contrast, those with resolving acute HBV will clear HBsAg several months after initial infection. Anti-HBs (surface antibody) is a protective antibody produced with recovery from infection or in response to immunization. Over time, titre may decline to undetectable levels. Note: There is a gap of several weeks to months between the disappearance of HBsAg and the appearance of anti-HBs; during this period, anti-HBc total is detectable as a marker of HBV infection. Anti-HBc IgM (core antibody - IgM) appears early in acute HBV infection and persists for about 6 months. It may also be seen in chronic infection during flares of activity, so clinical/epidemiological correlation is required for interpretation. Anti-HBc total (total core antibody - IgM and IgG) is a marker of past exposure or current infection. IgG usually persists for life. In low prevalence populations, a finding of isolated anti-HBc may signify a false positive result. HBeAg (e-antigen) is a marker of viral replication; its presence indicates high infectivity. Implications for liver injury vary with stage of infection (see Module 7 for significance). Anti-HBe (e-antibody) appears with recovery from acute infection. In chronic infection, the presence of anti-HBe is generally a marker of reduced viral replication, indicating a less infectious state. The implications for liver injury vary with stage of infection (see Module 7 for significance)

Question 75

Mgmt and monitoring hep C

Answer 75

``` Refer to hepatology Treat: interferon or new regimens U/S q6-12 months for HCC scope every 1-3 years for varices Cirrhosis/fibrosis - fibroscan, Child Pugh ```

Question 76

NAFL vs NASH, and treatment?

Answer 76

NASH = NAFL + hepatitis (increased ALT/AST) = signs of inflammation NAFL - no inflammation or fibrosis = STEATOSIS Rx - stop EtOh, weight loss, lipid control, DM control, if fibrosis >2 consider vitamin E

Question 77

Ankylosing Spondylitis features

Answer 77

low back/SI pain stiffness worse w/ rest, improves w/ movement worse at night 30 minutes + for morning stiffness to recede weight loss, fatigue chest pain -- from insertion into sternum enthesis i.e. plantar fasciitis, achilles tendonitis anemia uveitis aortitis heart block

Question 78

what is Schober's test

Answer 78

find L5, measure 10cm above and 5cm below = 15cm | if <20cm when bending forward = restrictive

Question 79

investigations for Ankylosing Spondylitis

Answer 79

ESR, CRP HLA b27 spine xray or MRI for early changes

Question 80

mgmt AS

Answer 80

``` nsaids steroids for flares - oral, IM, into joint anti TNF monoclonal antibody physio no smoking bisphosphonates if osteoporosis ```

Question 81

Back pain physical exam

Answer 81

ALWAYS: numbness, weakness, pedal pulses, neuro exam

Question 82

Lower limb Myotomes memory aid

Answer 82

L1/L2 buckle my shoe - hip flexion L3/L4 kick the door - knee extension C5/6 pick up sticks - biceps C7/8 - shut the gates

Question 83

Dermatomes memory aid

Answer 83

L4 down on all 4s - knees to first toe L5 middle toes S1 pinky toe

Question 84

joint red flags

Answer 84

``` hot boggy AM stiffness PM night pain extra-articular symptoms? think genital infection, vasculitis, systemic illness ```

Question 85

ADHD medication classes

Answer 85

Stimulants - methylphenidate (concerta, biphentin, ritalin), amphetamine (vyvanse, adderall) SNRI - Atomoxetine Alpha receptor antagonist - Guanfacine

Question 86

ADHD meds -- Consider DATER before changing medication to 2nd/3rd line

Answer 86

Dosage All - trial of all 1st line Time - enough time given for response/side effects to resolve Examine - what are the targets? what standardized measures Review - comorbidity, lifestyle

Question 87

ADHD non rx management

Answer 87

patient and family education psychological treatment education accommodations driving -- restrict cell phone use, recommend manual transmission

Question 88

ODD vs conduct disorder

Answer 88

ODD children do not show aggressions towards peope/animals; destroy property; pattern of theft and deceit

Question 89

Bedwetting management

Answer 89

``` make toilet accessible pee before bed including in morning cleanup training pants avoid fluids/caffeine/chocolate before bed do not punish, introduced diapers enuresis alarms desmopressin for short-term ```

Question 90

Well baby care counselling HONEY 'n' guns

Answer 90

``` No honey Choking hazards Vitamin D Breast/fed is best button battery ingestion No guns Carbon monoxide detector Cover electric plugs Hot water heater car seats Storage and poison control ```

Question 91

Milestones

Answer 91

``` 2 months - two = coo, smiles 4 months - hold object - four fingers and hold head, laughs 6 - sit at six with support 8 - pincer grasp 1 year - walk, 1 word; responds to name 15 months- stranger danger 2 - run, 2 word sentence, 1-2 step directions 3 - 3 step instructions 5 - adult like sentences ```

Question 92

Breastfeeding guideline

Answer 92

>=2 years | 400IU daily vitamin D

Question 93

circumcision, pros and cons

Answer 93

pros - decreased infection - phimosis (rx with topical steroids), uti, hpv, cancer cons - pain, stenosis, damage to surrounding tissues

Question 94

undescended testes cause

Answer 94

``` torsion trauma tumor inguinal hernia infertility ```

Question 95

torsion TWIST score

Answer 95

``` absent cremasteric reflex nausea/vomiting testicle swelling testicle hard high riding testicle ```

Question 96

4 nots for nuts

Answer 96

refer if - not descended at 6 months - not there anymore - not there - not positioned properly

Question 97

AIDS defining illnesses

Answer 97

``` Kaposi’s sarcoma Pneumocystis jirovecii pneumonia (PCP) Cytomegalovirus Candidiasis (oesophageal or bronchial) Lymphomas (excluding Hodgkins) Tuberculosis ```

Question 98

when to give Tdap to pregnant ladies

Answer 98

>13, ideally 27-32 weeks

Question 99

which vaccines can you NOT give if someone is breastfeeding?

Answer 99

BCG, yellow fever, japanese encephalitis

Question 100

which vaccines do you need to delay if someone is ill?

Answer 100

lots of congestion -- don't give nasal flu acute GI -- defer cholera, dukoral mod to severe -- defer rotavirus

Question 101

who gets flu vaccine?

Answer 101

kids > 6 months everyone, but esp adults with neurologic/developmental conditions, work in health care, work with poultry > 65 yo

Question 102

vaccines in person with egg allergy

Answer 102

flu, MMR ok | do not give yellow fever, tick-borne encephalitis or rabies

Question 103

make vaccine less painful?

Answer 103

``` breastfeed skin to skin most painful last sugar tylenol after, otherwise blunts immune response topical anesthetic don't aspirate ```

Question 104

what are the two shingles vaccines? | what kind, how often, how $$$, how effective?

Answer 104

zostavax = live attenuated 1 dose, $170, >60 yo shingrix = non live recombivant, adjuvanted 2 doses, 2(-6) months apart 2x as effective, 2x as much >50yo

Question 105

HPV vaccine - # of doses, #-valent

Answer 105

2 doses, 9-valent, all genders

Question 106

who do you give meningitis C to? (5)

Answer 106

``` all travellers to Hajj meningitis belt of africa military recruits asplenia and sickle cell all canada adolescents ```

Question 107

vaccines for the immunocompromised? keep 3 things in mind

Answer 107

- no polio, varicella, MMR - close contacts: avoid giving or avoid contact for 2 weeks - consult public health/ID

Question 108

vaccines contra-indicated in... | pregnancy? TB? severe asthma/medical wheeze in last 7 days? uncorrected GI malformation? HIV?

Answer 108

pregnancy: live vaccines (polio, varicella, MMR), BCG --> flu ok active TB: MMR, varicella, herpes zoster, BCG asthma: live attenuated influenza GI malformation: rotavirus (risk of intussception) HIV: all live vaccines

Question 109

Common cold treatment? (5)

Answer 109

NSAIDs, honey (> 1 year), intranasal ipratropium, nasal decongestant/anti-histamine (>5 year), zinc (not intranasal)

Question 110

sinusitis risk factors? (4) which bugs?

Answer 110

``` allergic rhinitis asthma anatomy smoking ear bugs ```

Question 111

red flags on sinusitis? (9)

Answer 111

``` fever > 39 periorbital edema cranial nerve palsies abnormal EOM proptosis vision changes severe headache altered mental status meningeal signs ```

Question 112

what are the meningeal tests?

Answer 112

Brudzinski - flexed neck --> flexed extremities | Kernig - with hips flexed cannot extend knee

Question 113

PODS acute sinusitis

Answer 113

``` pressure/pain obstruction (nasal) dischage - thick, purulent smell, loss of 2 or more -- persists for >7-10 days ```

Question 114

mgmt of acute sinusitis

Answer 114

``` ct/xr only if red flags amox 500 TID 5-10 days nasal steroids! nasal rinse decongestants analgesics anti-inflammatories mucolytics ```

Question 115

why give abx for GAS? what does it NOT prevent?

Answer 115

``` prevent... AOM rheumatic heart disease sinusitis decrease illness <1 day peritonsillar abscess does NOT prevent glomerulonephritis ```

Question 116

mono - how does it spread? symptoms? labs? recommendations re: spleen?

Answer 116

saliva lymphadenopathy, fatigue, sore throat, splenomegaly, headache lymphocyte count, serume AST/ALT, monospot NO abx no contact sports min. 3 weeks, can last up to 8 weeks

Question 117

Jaundice beyond two weeks, order:

Answer 117

``` hemoglobin serum conjugated bili coomb's test group and screen peripheral smear ```

Question 118

Symptoms of down syndrome - rule of 1s

Answer 118

1st toe web space 1 palmar crease 1% recurrence

Question 119

Hip dysplasia risks, ffff

Answer 119

``` first born feet -- breech family history fluid -- oligo female ```

Question 120

full septic workup in kids

Answer 120

CBC LP CXR urine/blood cx

Question 121

pediatric LIMPSS cannot miss

Answer 121

``` Legg calves perthe Infectious Malignancy - ewing's sarcoma, osteosarcoma Pain from a fracture - abuse? Slipped capital femoral epiphysis Something else above/below ```

Question 122

Classes and examples of constipation meds

Answer 122

Stool softeners – docusate (colace) Osmotic laxatives – lactulose, Mg salts, sorbitol, PEG Bowel stimulants (motility agents) – senna, bisacodyl, cascara, prune juice Bulking agents – psyllium, bran (Metamucil ok) Bowel lubricants – mineral oil, castor oil, glycerine Enemas – tap water, saline, sodium phosphate (fleet), oil

Question 123

Counselling pts for HCV - 4

Answer 123

Discussion of avoidance of alcohol Monitoring of progression (ALT/AST, annual AFP) Counsel on risk of transmission Screening sexual partners

Question 124

HCV treatments

Answer 124

``` Pegylated Interferon Ribavirin Telaprevir Simeprevir Sofosbrevir Harvoni (ledipasvir/sofosbuvir) Holkira Pak (dasabuvir, ombitasvir, paritaprevir, ritonavir) velpatasvir daclatasvir ```

Question 125

Mechanism of scaphoid #

Answer 125

Extreme dorsiflexion of the wrist with compressive force to the radial side of the palm Fall on outstretched hand/arm Forceful radial deviation and dorsiflexion of wrist Direct axial compression or hyperextension of the wrist

Question 126

Physical exam for snuffbox tenderness

Answer 126

Anatomic snuffbox tenderness Scaphoid tubercle tenderness (extend the patient’s wrist with one hand and apply pressure to the tuberosity at the proximal wrist crease with the opposite hand) Positive results on the scaphoid compression test (axially/longitudinally compressing a patient’s thumb along the line of the first metacarpal) Swelling on the dorsoradial side of wrist or over the anatomical snuffbox Pain in the snuffbox with pronation of the wrist followed by ulnar deviation Reproduction of pain when patient pinches tips of their thumb and index finger together

Question 127

Scapholunate disruption on xray

Answer 127

A gap of more than 3 mm between the scaphoid and lunate bones (the Terry Thomas sign)

Question 128

Scaphoid #, reasons to refer to ortho

Answer 128

``` open fractures neurovascular compromise displacement of 1 mm or more angulated fractures associated tilt of the lunate bone associated carpal instability evidence of nonunion or displacement during follow up osteonecrosis possible scapholunate dissociation proximal pole fractures oblique fractures unwillingness or inability of the patient to wear a cast for up to 3 months ```

Question 129

Why does scaphoid have higher rates of fracture complications?

Answer 129

The scaphoid bone has a tenuous blood supply running from distal to proximal. RATIONALE: The blood supply comes from the radial artery, feeding the bone on the dorsal surface near the tubercle and scaphoid waist with no direct blood supply to the proximal portion. Thus, there is an increased possibility of nonunion or osteonecrosis with fractures, particularly those of the proximal pole.

Question 130

Symptoms of hypercalcemia

Answer 130

``` mental status change confusion poor concentration abdominal groans (e.g. abdominal pain) nausea vomiting anorexia fatigue/lethargy renal colic dehydration polyuria polydipsia constipation bone pain muscle weakness anxiety depression ```

Question 131

Rx for hypercalcemia

Answer 131

Hydration with normal saline Calcitonin Bisphosphonates

Question 132

Medications that cause hypercalcemia

Answer 132

``` ationale: Thiazide diuretics (class or specific drug name of any thiazide acceptable) Lithium Teriparatide Abaloparatide Theophylline Excessive vitamin A Excessive vitamin D ```

Question 133

1st blood test to order with dx of hypercalcemia

Answer 133

PTH

Question 134

Risk factors for neonatal jaundice

Answer 134

Prematurity Vacuum delivery leading to cephalohematoma Asian background Possible dehydration (poor weight gain)

Question 135

Blood tests in neonatal jaundice

Answer 135

``` Blood type (ABO and Rh status) of infant Direct antiglobulin test (direct Coomb’s test) ```

Question 136

Inherited disorder that cause hyperbilirubinemia

Answer 136

Glucose-6-Phosphate Dehydrogenase Deficiency Pyruvate Kinase deficiency Crigler-Najjar syndrome Hereditary spherocytosis or elliptocytosis Hemoglobinopathies (sickle cell, thalassemia, Hemoglobin H disease)

Question 137

Side effects from phototherapy?

Answer 137

Dehydration Bronze baby syndrome / bronze discolouration of the skin skin rash over or under heating of infant / temperature instability loose stools/diarrhea electrolyte disturbance (hyponatremia or hypokalemia) interference with maternal –infant interactions Ocular damage

Question 138

Causes of hyperbilirubinemia in babies <24 hrs

Answer 138

hemolytic disease of the newborn (Rh or ABO incompatibility, spherocytosis, G-6PD deficiency, Kell Congential hemolytic states) Maternal autoimmune hemolytic anemia (e.g. lupus) Type 1 – usually by day 3 Concealed hemorrhage/hematoma Vitamin K deficiency

Question 139

Treatment for ABRS

Answer 139

amox, nasal steroids

Question 140

Classic sites for infantile eczema

Answer 140

Cheeks Face Scalp Extensor surfaces (elbows and knees would count as 2 answers) 1/2 point for Flexor surfaces (flexor surfaces can be found in any age, however, extensor surface involvement is more classic for infantile eczema) Trunk

Question 141

Risk factors for infantile eczema

Answer 141

``` Positive family history of atopy (give ½ point for either “allergy” or “asthma”) Weather changes (cold, dry) Chemical irritants (scented soaps, detergents) ```

Question 142

strategies to prevent/treat eczema

Answer 142

``` Reducing frequency of baths Unscented products (soap, detergents) Minimize soaps Emollients Barrier creams Use luke warm water for baths Avoiding triggers or irritants Exclusive breastfeeding (although some small studies are refuting this) Parental education Topical steroids Antibiotics in severe cases ```

Question 143

when to treat asymptomatic BV?

Answer 143

Pregnant women with history of a high-risk pregnancy (previous preterm delivery) Prior to IUD insertion Second trimester even if asymptomatic (check this) Prior to gynecologic surgery/therapeutic abortion/genitourinary instrumentation Immunocompromised patient

Question 144

abx to treat trich? what else can be used for BV?

Answer 144

metronidazole | clinda, doxy

Question 145

Pediatric Limps LIMPSS

Answer 145

``` Leg Calve Perthes Syndrome - boys, age 4-10, white Infection/inflammation Malignancy - Ewing's Sarcoma (small round blue cells - pelvis, thigh, lower leg, upper arm, and rib), Osteosarcoma (Osteosarcoma usually develops at the edges of the long bones, in the “metaphysis” esp. the knee) Pain from a fracture - abuse? Slipped Capital Femoral Epiphysis - obese, adolescent, black/latino Something above or below? ```

Question 146

HEADSS

Answer 146

``` Home environment - smokers, smoke alarms Education - bullying Activities - helmets Drugs - prescription drugs Sexuality/sex Suicide ```

Question 147

Kawasaki's CRASH

Answer 147

``` Conjunctivitis Rash Adenopathy Strawberry tongue Hands and feet swollen/rash/peeling if you CRASH call the CAA --> coronary artery aneurysm treat with ASA and IVIG kawASAkI ```

Question 148

Violent/aggressive patient? Think of other causes | DIM FACES

Answer 148

Drugs/dehydration Infection Metabolic/medication change ``` Failure Anemia/alcohol Cardiac/stroke/bleed Electrolytes Structural/seizure disorder/psychiatric ```

Question 149

Which vaccines should you consider for travel?

Answer 149

General - Hep A and B, rabies Country specific - typhoid, meningitis, yellow fever, encephalitis routine - flu, shingrix, pneumococcal, tetanus, pertussis

Question 150

Anti malarial medications and their pros/cons?

Answer 150

Malarone - only for 7 days after exposure daily, expensive Doxy - cheap but photosensitivity rash. daily dose, need for 30 days after exposure Mefloquine - frequent side effects, vivid dreams. once weekly primaquine - only for 7 days after exposure; daily dose need test for G6Pd chloroquine - cheap, safe, widespread resistance so check first, skin and corneal side effects

Question 151

Rx for traveller's diarrhea and how to prevent

Answer 151

``` Azithro oral rehydration solution loperamide bismuth subsalicylate boil, peel; avoid ice cubes, salads, uncooked veggies use bottle water, wash hands often ```

Question 152

medications for altitude sickness?

Answer 152

``` acetazolamide - carbonic anhydrase inhibitor dexamethasone nifedipine sildenafil/tadalafil prophylactic salmeterol ```

Question 153

AAA screening

Answer 153

men 65-80 one time ultrasound

Question 154

calculate sensitivity specificity ppv npv

Answer 154

``` sens = true pos / true pos + fals neg spec = true neg / true neg + fals pos ppv = true pos / true pos + false pos npv = true neg / false neg + true neg ```

Question 155

DM screening

Answer 155

1. Screen every 1-5 y depending on risk determined using a calculator, other risk factors, or age ≥40 y 2. HbA1c level is the preferred screening test (FPG level or OGTT are acceptable alternatives) 3. HbA1c level of ≥6.5%, FPG level of ≥7 mmol/L, or 2-h plasma glucose level in an OGTT of ≥11.1 mmol/L are diagnostic

Question 156

DLP screening

Answer 156

1. Screen fasting lipid profile in men aged ≥40 y, women aged ≥50 y (or postmenopausal), or earlier if at increased risk 2. Screen with Framingham risk assessment every 3-5 y if 10-y risk is <5%, or every y if 10-y risk is ≥5%, until age 75 y 3. Framingham risk should be doubled if positive family history for premature cardiovascular disease 4. Discuss “cardiovascular age”

Question 157

Colon Ca screening

Answer 157

1. Screen with FIT or FOBT every 1-2 y, or flexible sigmoidoscopy every 10 y, if aged 50-75 y 2. Consider individualized opportunistic screening with FIT or FOBT, flexible sigmoidoscopy, or colonoscopy up to age 85 y

Question 158

HPV recommendations

Answer 158

``` 1. Recommended for women up to age 45 y even if already sexually active and regardless of past infection 2. Recommended for men up to age 26 y 3. Recommended for men who have sex with men ```

Question 159

Immigrant health, four areas - infection

Answer 159

HIV, Hep C, TB | mantoux skin test is intradermal

Question 160

TB rx, RIPE

Answer 160

Rifampin Isoniazid Pyrazinamide Ethambutol

Question 161

Common parasitic infections? Ss

Answer 161

strongyloides | Schistosomiasis

Question 162

Unconscious patient? DONT

Answer 162

dextrose oxygen Narcan Thiamine

Question 163

Rx for new psychosis?

Answer 163

``` start med 1st gen = 2nd gen maintain for 18 months oral = depo if depression, treat that too. ```

Question 164

neuroleptic malignant syndrome FARM and treatment (5) and meds (3)

Answer 164

Fever Autonomic - BP, HR, sweating Rigidity Mental status changes stop the rx; IV NS; cooling blankets; ice packs; DVT prophylaxis benzos if agitation; bromocriptine; dantrolene for muscle relaxation

Question 165

qSOFA

Answer 165

resp rate >22 aMS SBP < 100

Question 166

STI abx

Answer 166

cefixime + azithro or doxy OR | ceftriaxone + doxy if PID

Question 167

sinusitis abx

Answer 167

amox or amox-clav

Question 168

bronchitis abx

Answer 168

none

Question 169

diverticulitis abx

Answer 169

none if CT confirmed with no abscess/free air | cipro + flagyl or amox clav

Question 170

sepsis abx

Answer 170

ceftriaxone or pip tazo +/- vanco

Question 171

yeast vaginitis rx

Answer 171

fluconazole oral

Question 172

pneumonia abx

Answer 172

macrolide or fluoroquinolone

Question 173

meningitis bugs and abx

Answer 173

TB, LEGS - listeria, e coli, GBS, meningococcus = neisseria meningitis < 1mo - amp + gent Group B Streptococci E. coli Listeria spp ``` 1-3 mo amp + cefotaxime Group B Streptococci E. coli Listeria spp S. pneumoniae N. meningitidis H. influenzae ``` ``` > 3 months cef + vanco S. pneumoniae N. meningitidis H. influenzae ``` ``` Adult > 50 years or Immunocompromised (including AIDS), Alcohol abuse, Debilitating illness, Pregnancy cef + amp + vanco S. pneumoniae Listeria monocytogenes N. meningitidis Enterobacterales ``` REMEMBER... contact public health! contact prophylaxis! vaccinate!

Question 174

cellulitis abx? MRSA?

Answer 174

with pus = ?mrsa = doxy, septra, clinda | w/o = strep = amox clav, cephalexin

Question 175

uti abx? what if complicated? severely ill? peds?

Answer 175

nitrofurantoin, septra, cephalexin, fosfomycin if complicated... fluoroquinolone, 3rd gen cephalosporins, broad spectrum, of severely ill i.e. pip-tazo, ertapenem peds - cefixime 7-10 days and image if febrile <2 yrs, recurrent or complicated (sepsis, obstruction, retention, impacted stone, pyelo)

Question 176

pyelo abx

Answer 176

ceftriaxone | then cefixime or septra or cipro or amox-clav

Question 177

remember your TOCC hx

Answer 177

travel occupation contacts critters

Question 178

4 strategies to minimize statin effects on muscles

Answer 178

lower dose rink lots of fluids stop interacting medications alternative day dosing

Question 179

rx for molluscum contagiosum

Answer 179

cantharidin topical

Question 180

Describe arterial ulcer

Answer 180

Punched out full thickness ulcer with smooth wound edges often on lateral ankle or distal digits

Question 181

Describe karposi sarcoma

Answer 181

Red-purple lesions/patches/nodules

Question 182

Describe scabies

Answer 182

intensely pruritic and pimple like rash at the wrists and Intertriginous areas

Question 183

describe herpes labialis

Answer 183

small grouped blisters/sores on lips that can coalesce into an ulcer that heals with 2-3 weeks

Question 184

describe hand foot and mouth

Answer 184

lesions on oral mucosa, tongue, palms, soles and buttocks, grey-white vesiculo pustules

Question 185

describe venous ulcers? risk factors?

Answer 185

shallow and superficial ulcers with irregular margins usually on the lower leg and ankle rf: obesity, immobility, pregnancy, DVT, CHF, varicose veins, conditions with poor musculature

Question 186

describe herpes zoster

Answer 186

grouped, unilateral vessicles in dermatomal distribution +/- pain and prodromal symptoms. anti virals with in 48-72 hours --> do not confuse with eczema herpeticum

Question 187

indications for shingrix vaccine

Answer 187

over 50 years, diabetes, heart disease, renal disease, immunosuppresion

Question 188

describe BCC, treatment options

Answer 188

shiny, pearly nodule located on sun exposed area of skin with telangectasia rx: excision, cryotherapy, topical chemo

Question 189

describe roseola infantum

Answer 189

high fever then rash on chest that turns into a pink maculopapular eruption lasting 1-2 days. 6th disease, HHV 6/7, supportive care

Question 190

describe erythema infectiosum

Answer 190

macular erythema on face on day 1, then erythematous maculopapular eruption for up to 7 days on proximal extremities, then a reticulated or lacy erythema on extensor extremities up to 3 weeks. parvovirus/5th disease

Question 191

Dx of HTN, work-up

Answer 191

AOBP > 135/85 or non-AOBP >140/90 Lipid panel (HDL, LDL, chol, trig, non-HDL) Na, K, Creat, urinalysis, HbA1C, EKG CPAP does not decrease morbidity/mortaliity

Question 192

Recommendations for HTN lifestyle

Answer 192

``` reduce salt - diet - DASH <1800mg reduce weight reduce stress - CBT increase exercise 30-45 min, 3x/week reduce alcohol <2.7 drinks/day ```

Question 193

Fever? keep the ddx broad (11) and don't forget the most dangerous things

Answer 193

``` sepsis meningitis steven's johnston syndrome PE GCA medication cancer/feb neut serotonin syndrome neurleptic malignant syndrome endocarditis rheum -- still's disease unclear? back to basics, serial exams/ekgs/imaging ```

Question 194

DLP screening. When should it be fasting?

Answer 194

>40 and <75 consider earlier in at risk groups: South/East asians and First Nations, gestational HTN Fasting if TG > 4.5 no evidence of mortality benefit of statins if >75

Question 195

DLP management - who to start on statin? | what other things can you do?

Answer 195

Statin based on Framingham > 10 OR if CHD, CAD, PAD, AAA, DM2, CKD Optimize renal, HTN, and CVD rx dietician (med diet), counselling, stop smoking, kinesiology, cardiology, endocrinology (if familial)

Question 196

Vertigo Exam (4)

Answer 196

Orthostatic BP Gait Hints Dix-Hallpike

Question 197

Vertigo ddx

Answer 197

``` BPPV orthostatic meniere's migraine neuritis stroke ```

Question 198

HINTS exam

Answer 198

Pt looks at nose; head impulse to one size continues looking at you = normal (central vertigo) corrective saccades = abnormal (peripheral vertigo)

Question 199

Acute situatuation - ABC MOVIES and cereal

Answer 199

``` monitors oxygen vitals IV large bore x 2 ECG sugars serial ekgABCs/vitals ```

Question 200

GI Bleed rx

Answer 200

PPI infusion Erythromycin prior to scope because it increases GI motility Hgb only if <70 IF varices, give ceftriazone + octeotride (somatostatin)

Question 201

what's the reversal agent for... warfarin? heparin? dabigatran?

Answer 201

vit K protamine, fresh frozen plasma praxbind

Question 202

what are the drug classes for anxiety?

Answer 202

``` benzodiazepines buspirone selective serotonin reuptake inhibitors selective norepinephrine reuptake inhibitors tricyclic antidepressants monoamine oxidase inhibitor atypical anti-psychotics ```

Question 203

after SIGECAPS, r/o other conditions by asking about

Answer 203

- excessive worry, panic, PTSD - hallucinations? - rituals/compulsions that you cannot stop? - mania -- feel better than good? - delusions - do you have special powers? is there a plot against you?

Question 204

Bipolar II, criteria and dx | Bipolar meds

Answer 204

- hypomania, no psychosis quetiapine is first line Acute: abilify, paliperiodone, risperidone Maintenance: quetiapine, lamotrigine, lithium, divalproe

Question 205

1st gen antipsychotics - D2 antagonism, higher risk of neurological side effects

Answer 205

haldol | chlorpromazine

Question 206

2nd gen antipsychotics "atypicals" 5HT2A/D2 antagonism | higher risk of metabolic side effects

Answer 206

``` abilify olanzapine paliperidone quetiapine risperidone clozapine ```

Question 207

Tourette syndrome rx

Answer 207

Tetrabenazine or Risperidone (dopamine blockers) Botox - neuromuscular blocade Habit reversal training

Question 208

PICA rx

Answer 208

methylphenidate - CNS stimulant olanzapine Treat the complications -- radiography for a bezoar

Question 209

Scabies rx

Answer 209

permethrin, invermectin

Question 210

Mastitis rx

Answer 210

continue BF NSAIDs, abx (cloxacillin, cephalexin) usually staph warm/cold compresses

Question 211

Melanoma dx

Answer 211

``` Asymmetry Border irregularity Color not uniform Diameter > 6mm Evolving shape/size/colour ```

Question 212

Measles description, symptoms

Answer 212

purplish red, maculopapular rash starting on the scalp/face/neck and spreading downwards Four Cs: cough, coryza, photophobia, conjunctivitis, koplik spots on buccal mucosa

Question 213

describe Alopecia areata? what conditions is it associated with? what is the treatment?

Answer 213

circular lesion on scalp/body with no hair, may have characteristic exclamation mark hairs. Focal, non scarring ddx: trichotillomania associated with SLE, thyroid, family hx <50% hair loss - steroids either topically or injected, minoxidil >50% hair loss - oral steroids 8 week taper while minoxidil while awaiting referral

Question 214

Marjolin ulcer

Answer 214

non healing ulcer or growth on the edge of a chronic wound - type of SCC

Question 215

Pityrasis rosea

Answer 215

single lesion followed by all over body rash. Oval, dull pink colour involving the trunk and upper arms and legs. Christmas tree distribution

Question 216

Head lice rx

Answer 216

permethrin or pyrethrin, repeat in 7-10 days

Question 217

Rx for androgenic alopecia

Answer 217

stop offending meds minoxidil finasteride hair transplant

Question 218

Rosacea

Answer 218

superficial, dilated blood vessels and papules/pustules/swelling on the face

Question 219

stevens-johnson syndrome

Answer 219

``` painful red or purplish rash involving the skin and mucous membranes stop med/avoid drug class in future ```

Question 220

Koebner's phenomenon

Answer 220

formation of psoriasis in areas of trauma

Question 221

Rx for post herpetic neuralgia

Answer 221

``` topical capsaicin NSAIDs gabapentin TCAs glucocorticoids paracetamol topical lidocaine ```

Question 222

investigations to order for dx osteoporsis (7)

Answer 222

``` hgb TSH ionized Ca Alk Phos Creatinine SPEP if vertebral # Vit D --> after 3 months of Vit D supplementation ```

Question 223

Osteoporosis rx - 3 options + 2 for high risk | When can you stop it?

Answer 223

Bisphosphonates - jaw osteonecrosis - esophageal ulcers - atypical fractures Raloxifene --> selective estrogen receptor modulator - VTE/PE HRT for high risk Teriparatide - PTH analogy - hypercalciuria, hypercalcemia - usually transient - angioedema Denosumab - monoclonal ab vs. RANKL - joint muscle pain - jaw osteo - CI in pregnancy Stop after 3-5 years if low risk take holiday

Question 224

HIV med complications

Answer 224

DLP hyperglycemia BMD loss Renal disease

Question 225

HIV meds to know

Answer 225

Truvada for PREP Zidovudine - peripartum and neonate PEP - truvada, raltegravir

Question 226

Opioid guidelines

Answer 226

maxmimum 50mg MED start taper down to 90mg MED if they are above that only use if no other options - TCAs, nabilone, NSAIDs, CBT, exercise, physio

Question 227

ADL - DEATH

Answer 227

``` Dressing Eating Ambulating Toileting Hygiene ```

Question 228

IADLS - SHAFT

Answer 228

``` Shopping Housework Accounting Food and meds Telephone, transportation ```

Question 229

Frail elderly checklist

Answer 229

``` vision hearing skin - ulcers mobility cognition pain medications rx monitoring abuse driving incontinence falls teeth ```

Question 230

Post phlebitic syndrom

Answer 230

horse chestnut seed extract for venoconstriction

Question 231

DVT w/up and treatment

Answer 231

if low Pre test prob/Wells < 2 -- D-dimer. if +ve, proximal leg compression ultrasound or CTPA if you suspect PE if high Pre test prob/Wells >2 -- ultrasound. if -ve, d dimer if suspicion is high and testing will be delayed, treat first! 1 dose of oral Xa inhibitor or 1 dose of LMWH/IV heparin

Question 232

Bell's palsy, dx and treatment

Answer 232

Stroke spares forehead lubricant eye drops steroids eg prednisone add antivirals if severe

Question 233

Ramsay Hunt Triad

Answer 233

aka Herpes Zoster reactivation - ipsilateral facial paralysis - ear pain - vesicles in the auditory canal

Question 234

Ischemic vs hemorrhagic findings

Answer 234

ischemic 80% - early, focal | Hemorrhagic 20% - late focal deficits, compression effects (headache, vomiting)

Question 235

Acute stroke management

Answer 235

1. ABCs, MOVIEs 2. Stroke scale 3. Labs: Na, K, Hgb, INR, aPTT, creatinine, troponin, glucose 4. Head CT non contrast --> if 4.5-6 hours adter symptoms add CT angiogram from vertex to arch OR CT perfusion. If 6-24 hours after symptoms add CT angiogram AND CT perfusion 5. Treat fever and severe hypertension >220/120

Question 236

Acute stroke treatment options

Answer 236

1. Bust clot - alteplase, tenecteplase - treatment within 3-4.5 hours, >18 yo 2. Yank clot 6-24 hrs- endovascular thrombectomy, aspiration/vacuum/removal stent - acute ischemic stroke, anterior circulation, large vessel

Question 237

Stroke w/up (cause - 4)

Answer 237

- Holter monitor - Carotid doppler/duplex ultrasound - manage A fib if found - ECHO

Question 238

Stroke prevention ABCDEs

Answer 238

``` A Fib BP CVD DM2 Ethanol ```

Question 239

cephalosporins

Answer 239

1st gen - cephalexin (keflex) PO, cefazolin (ancef) IM/IV 2nd gen - cefuroxime IM/IV 3rd gen - cefixime PO, ceftriaxone IV no activity against LAME = listeria, atypicals, MRSA, enterococci Good against gram +ves, increasing gram -ves as you progress at expense of gram +

Question 240

Macule

Answer 240

flat lesion less than 1 cm, without elevation or depression

Question 241

Patch

Answer 241

flat lesion greater than 1 cm, without elevation or depression

Question 242

Plaque

Answer 242

flat, elevated lesion, usually greater than 1 cm

Question 243

Papule

Answer 243

elevated, solid lesion less than 1 cm

Question 244

Nodule

Answer 244

elevated, solid lesion greater than 1 cm

Question 245

Vesicle

Answer 245

elevated, fluid-filled lesion, usually less than 1 cm

Question 246

Pustule

Answer 246

elevated, pus-filled lesion, usually less than 1 cm

Question 247

3 indications for using cannabinoids ? which product for which indications?

Answer 247

Muscle spasm 2/2 SCI, MS - nabiximol Neuropathic pain refractory to standard therapies- nabilone or nabiximol N/V from chemo - nabilone

Question 248

4-6-8 rule for driving after cannabinoid

Answer 248

don't drive less than 4 hours less than 6 hours for oral ingestions and less than 8 if you experience euphoria

Question 249

managing opioid withdrawal

Answer 249

treat type of pain - neuropathic vs other clonidine if BP >150/90, HR >50; for nausea/vomiting/sweating/tremor diarrhea - start loperamide, stop stool softeners abdo cramping - buscopan (hyoscine), pinaverium muscle cramping - quinine sweating - oxybutynin (anti-cholinergic)

Question 250

what are the domains for major neurocognitive disorder? 5 W's

Answer 250

WHO you are, WHAT you say, WHERE you go, WHY you do things, WHEN you remember ``` learning and memory complex attention executive function language, perceptual motor social cognition Alzheimer's is any one PLUS memory affected mild = 1 domain major = 2 or more plus impair function/decline ```

Question 251

how to assess competency?

Answer 251

explain your treatment options? WHAT reasoning? WHY choice? WHAT ELSE

Question 252

investigations for MNCI d/o?

Answer 252

TSH Hgb/ferritin B12 Na, Ca, glucose | Do a CT Head if last done less than 2 years ago/looking for something else

Question 253

Management for MNCI

Answer 253

- cholinesterase inhibitors --> donepezil - glutamatergic --> memantine exercise cognitive stimulation avoid antipsychotics

Question 254

Parkinson's symptoms TRAP SSSS

Answer 254

``` Tremor Rigidity Akinesia Postural instability Shaky Stiff Slow Steps ```

Question 255

DDx for Parkinson's

Answer 255

tremor improves with EtOH? better at rest? --> Essential tremor On an antipsychotic? - extrapyrimidal side effects falls, slow vertical gaze - progressive supranuclear palsy no L-dopa improvement, symmetric - Multi-systems atrophy

Question 256

Parkinson treatment, things to avoid (5), treat other features

Answer 256

first line - carbidopa/levidopa 30% don't respond, 20% who do have another dx second line - 1. Dopamine agonists, non ergot - pramipexole, warn about impulse control d/o i.e. gambling, binge eating avoid ergot derived i.e. bromocriptine 2. MAO inhibitors - selegiline, rasagiline Avoid... anti psychotics (except quetiapine, clozapine); abruptly stopping meds; amantadine early on; genetic testing/PET scanning; vit E/coenzyme q10 Also look for/treat: constipation, drooling, ED, hypotension

Question 257

Rx for postural hypotension

Answer 257

quit - large meals, EtOH, warmth, medications start - compression stockings, increase salt intake, bed tilt, elastic stockings, midodrine (alpha 1 agonist) or corticosteroid

Question 258

headache -- serious causes to r/o

Answer 258

``` GCA SAH Stroke meningitis Tumour ```

Question 259

red flags for headache SNOOP

Answer 259

``` systemic features neuro symptoms older pt/onset other red flags pattern change ```

Question 260

ottawa SAH tool r/o tool must meet criteria (4), C/I (5) Rule: if any of the following 6...

Answer 260

``` alert patients >15 years old new severe atraumatic headache maximum intensity in 1 hr do NOT USE if: neuro deficits, prior aneurysm, prior SAH, known brain tumour, chronic recurrent headache require investigations if: 1. neck pain or stiffness 2. => 40 yo 3. witnessed LOC 4. peak during exertion 5. thunderclap headache -- immediate peak intensity 6. limited neck flexion on exam ```

Question 261

Migraine Rx - acute, chronic, lifestyle management

Answer 261

Migraine medications: A) Acute migraine medications. B) Prophylactic migraine medications. A) Type ACUTE MEdications First line Ibuprofen 400 mg, ASA 1000 mg, naproxen sodium 500-550 mg, acetaminophen 1000 mg Second line Triptans (oral wafer/nasal spray/IM) Antiemetics: domperidone 10 mg or metoclopramide 10 mg for nausea Third line Naproxen sodium 500-550 mg in combination with a triptan Fourth line Fixed-dose combination analgesics (with codeine if necessary; not recommended for routine use) also consider -- sphenopalatine ganglion block B) Prophylactic Medications First line • propranolol/metoprolol - avoid in asthma • ami/nottriptyline - Consider if patient has depression, anxiety, insomnia, or tension-type headache ``` Second line • topiramate • candesartan • gabapentin Few drug interactions Botox for chronic ``` Lifestyle management: - decrease caffeine, improve sleep, increase exercise, relaxation, CBT

Question 262

ABCs of fractures

Answer 262

``` Antibiotics? Analgesia Brace/splint Consult ortho? Compartment syndrome? Stick them with Tetanus -- Tetanus immunoglobulin if dirty wound/not vaccinated or immunocompromised ```

Question 263

Fractures of abuse (8)

Answer 263

``` multiple multiple, many healing non ambulatory femur <12-18 months humerus <18 months skull metaphyseal - bucket handle rib posterior ```

Question 264

Salter-Harris

Answer 264

``` Slipped Type I Above Type II Lower Type III Through or transverse Type IV Rammed Type V ```

Question 265

causes of Afib (6)

Answer 265

``` ischemic valvular alcohol hyperthyroid HTN pulmonary - COPD, pulmonary embolism ```

Question 266

Afib rx, anticoagulate?

Answer 266

convert IF unstable, symptomatic/poor QOL, cardiomyopathy otherwise bblockers or ccb if unstable/low clot risk -- anticoagulate now and cardiovert now if hi clot risk, OAC for 3 weeks or TEE rate control if old, longstanding, asymptomatic, other disease rhythm control if young, new dx, symptomatic, no other disease

Question 267

CHADS2

Answer 267

``` CHF HTN Age >65 DM2 Stroke/TIA/embolism ```

Question 268

Bleed risk management HAS BLED

Answer 268

HTN SBP>160 Abnormal liver/kidney fxn Stroke Bleeding Labile INR Elderly >65 Drugs/EtOH

Question 269

Which anticoagulant for -- CKD? pregnancy? cancer? valvular afib?

Answer 269

UFH - renal disease CKD LMWH - pregnant, cancer Warfarin.- valvular

Question 270

Systemic Exertional Intolerance

Answer 270

``` Functional impairment > 6 months Non exertional new fatigue Post exertion malaise Rest does not refresh At least 1 of cognitive impairment or orthostatic intolerance ```

Question 271

Panic attack symptoms

Answer 271

``` Students Fear CCCs Sweating Trembling Unsteadiness Dyspnea Excessive sweating Nervousness Tachycardia/tachypnea Sensation weird Fear of death Choking Chills Chest pain ```

Question 272

Lupus | MD SOAP BRAIN

Answer 272

Mallar rash Discoid Rash Serositis - pericarditis, pleuritis Oral ulcers ANA +ve Photosensitivity Blood - thrombocytopenia, hemolytic anemia Renal - GN Arthritis Immune - anti phospholipid, anti dsDNA, anti rho, C3/C4, anti smith Neurological disorders, including psychiatric disorders - psychosis, seizures

Question 273

Symptoms/presentation of Thyroid Storm?

Answer 273

``` Altered mental status Tachy Fever Dyspnea/orthopnea Chest pain Hypertension Profuse sweating ```

Question 274

IBD systemic features APIESAC

Answer 274

``` Apthous ulcers Primary sclerosis cholangitis, pyoderma gangrenous Iritis/uveitis Erythema nodosum Sacroilitis Arthritis Clubbing ```

Question 275

Pro-thrombotic states

Answer 275

``` Protein c and s deficiency - like renal disease because you lose protein Nephrotic syndrome Hormonal meds Pregnancy Cancer IBD, CHF Factor V leiden Anti phospholipid syndrome ```

Question 276

Upper Arm DVT

Answer 276

CONSTANS score — upper arm DVT 1 point each, -1 if other dx more likely Unilateral pain Edema Hx of central line/pacemaker placement “trauma”

Question 277

Risk factors for AOM

Answer 277

maternal smoking pacifiers day care bottle feeding

Question 278

Ear bugs? 5

Answer 278

``` strep pneumo moraxella catarrhalis hemophilus influenza staph aureus group a strep ```

Question 279

rx for AOM? if failure?

Answer 279

amoxicillin - high is BID, low if TID 40-90mg/kg if failure? clavulin or ceftriaxone tylenol 10mg/kg advil 15 mg/kg

Question 280

what are the indications for ear ventilation tubes? (3)

Answer 280

``` >6/yr or 4 per 6 months or Chronic OM with effusion, "glue ear" > 3 months with hearing loss or retracted TM ```

Question 281

CATCH2 for pediatric head injury, AVPU?

Answer 281

Minor head injury and any one of the following GCS <15 (can also use AVPU for younger children --> Awake - Verbal - Responds to Pain - Unresponsive) worsening headache Suspected open/depressed skull fracture irritability Sign of basal skull fracture Large, boggy scalp hematoma Dangerous mechanism >4 episodes of vomiting (common pain response in kiddos)

Question 282

types of SHOCK

Answer 282

``` septic hypovolemic obstructive cardiac AnaphylacticK ```

Question 283

Burns - formulas? special sites?

Answer 283

>10% resuscitate - Brooke formula: 2mls x body surface areas burned (BSAB) x weight Rule of 9s adult - legs 18% x 2, arms 9% x 2, head 9%, chest 18%/back 18%, groin 1% infant - legs 14% x 2, arms 9% x 2, head 18%, chest 18%/back 18%, groin 1% special sites: face, hand, foot, genital, perineum, joint

Question 284

Frostbite rx - 5 steps

Answer 284

``` rapid rewarming - water bath possible thombolysis and heparin and iloprost sterile wound care consult surgery tetanus ```

Question 285

MAPLE hx

Answer 285

``` medications allergies past medical history last meal events leading up to ```

Question 286

GCS

Answer 286

4 - eye response; 4 spontaneous - 3 sound - 2 pressure 5 - verbal; 5 oriented - 4 confused - 3 words - 2 sounds 6 - motor; 6 obeys - 5 localizes pain - 4 withdraws from pain 3 - flexion to pain 2 - extension to pain 1 - no movement

Question 287

ATLS updates

Answer 287

give blood early! after 1L crystalloids smaller chest tubes 28-32 french needle decompression 4th/5th intercostal space laterally use massive transfusion protocols tranexamic acid 1g for 10 min and 1g for 8 hours e-fast for pneumothorax

Question 288

Trauma in pregnancy

Answer 288

``` Mom then fetus Chest tube 1-2 spaces higher NG tube Left lateral decubitus No vag exam until previa ruled out Anti D immune globulin if Rh negative Tetanus vaccine is safe Document domestic violence ```

Question 289

Treatments for acute seizure in adult? pregant? pediatric? 1st and 2nd line.

Answer 289

Adult - 1st benzo 2nd phenytoin, valproate Pregnant - 1st Mag Sulf 2nd benzo Peds - 1st benzo 2nd phenytoin, phenobarb

Question 290

Reversible causes of LOC

Answer 290

``` Hyperopioidemia Seizure Hypovolemia HyperCa Hyperthermia Hypoglycemia Hypoxia Hyponatremia ```

Question 291

Red eye red flags (5)

Answer 291

``` Pain Decrease visual acuity Aniscoria Photophobia Metal work ```

Question 292

Clinical ft of acute angle closure glaucoma (5), physical exam (6), and treatment?

Answer 292

``` Headache N/v Halos around lights Eye pain Decreased vision ``` Physical Exam: Visual acuity, Evaluation of the pupils, Intraocular pressure (IOP), Slit-lamp examination of the anterior segments, Visual field testing, Undilated fundus examination Rx: - pressure lowering eye drops - IV acetazolamide repeat eye pressures 30-60 minutes after meds administration

Question 293

What to do before prescribing eye steroids?

Answer 293

measure eye pressure!

Question 294

Management for premature rupture?

Answer 294

steroids and antibiotics

Question 295

Management for preterm labour?

Answer 295

fetal fibronectin steroids tocolysis magnesium sulfate <32 weeks

Question 296

active labour? labour dystocia? abnormal FHR?

Answer 296

active = >4 cm dilation dystocia = <2cm in 4 hours abnormal fhr = <110 or >160

Question 297

post partum Bs (11)

Answer 297

``` breasts bottom belly baby breast feeding bowels bladder bleeding blues birth control boinking ```

Question 298

Approach to medical abortion

Answer 298

- confirm GA - exclude ectopic - assess for CI: uncontrolled asthma, chronic adrenal failure, chronic corticosteroid use, hematologic disorders - remove IUD Ordering lab tests: bHCG if using for monitoring completion GC/CT testing Rh status Hgb if reason to suspect anemia Advise of risks. Surgical evacuation may be required in the event of retained products of conception or heavy bleeding (5%) or ongoing pregnancy (<1%). Heavy bleeding requiring transfusion is rare (0.1%). Infection is rare (1%) and severe infection/sepsis extremely rare (.01%).

Question 299

Management for STEMI

Answer 299

CODE STATUS! - PCI < 120 minutes - Morphine - only if severe pain, increases mortality in NSTEMI - O2 only if O2 <90% otherwise increases free radicals - Nitrates -- use for analgesia, no mortality benefit - ASA - 27% mortality benefit - B blocker - antiplatelet therapy - ACE - statin 80

Question 300

DDx for chest pain

Answer 300

lung - pneumothorax, PE, infection, blood heart - valves, endocarditis, pericarditis/Dressler's syndrome (post MI) esophagus - inflammation, acid, spasm, foreign body, rupture, tear aorta - dissection, aneurysm, infection chest wall - costochondritis, muscle, contusion, fracture, zoster psychiatric abdomen

Question 301

Management for PE

Answer 301

Do WELLS first; if low risk, do PERC to rule out. YEARS for pregnant women

Question 302

Rx for HFrEF

Answer 302

``` mineralocorticoid receptor antagonist i.e. spironolactone ACE beta blocker lasix + SGLT2 inhibitor even if no DM2 ```

Question 303

Breast Cancer risk factors

Answer 303

``` Estrogen exposure Early menarche Late menopause Nulliparity Postmenopausal HRT, obesity Radiation exposure Alcohol Sedentary lifestyle ``` Non modifiable Age > 50 sex past hx, family hx

Question 304

Red flags in breast lump and when to monitor (4 each(

Answer 304

Peau d'orange Firm fixed lymph nodes Inverted nipple Risk factors Monitor if: smooth, rubbery, mobile, cyclic

Question 305

BMI formula and ranges

Answer 305

``` kg/m^2 <18.5 underweight 18.5-25 normal 25-30 overweight 30-35 class I obesity 35-40 class II >40 class III ```

Question 306

treatments for obesity?

Answer 306

``` bupropion-naltrexone (Contrave) orlistat - lipase inhibitor GLP-1 receptor agonist (Victoza) rx underlying factors or illness surgery: gastric bypass, sleeve gastrectomy, adjustable gastric band ```

Question 307

Smoking Cessation medications and CI

Answer 307

Bupropion - avoid if seizure d/o, eating d/o, EtOH w/d, MAOI use, allergy Varenicline (partial nicotine agonist) - now ok in psychiatric conditions

Question 308

AUD rx

Answer 308

1st line naltrexone (not in liver disease, OUD) others: acamprosate, gabapentin refer to counselling, set goals, eat when drinking

Question 309

OUD rx

Answer 309

OAT! side effects = constipation, amenorrhea, decreased testosterone treatment agreements UDS harm reduction - lock box, naloxone, don't use alone avoid cannabinoids, benzos, EtOH/sedatives

Question 310

Nexus C-spine rule | Exclusions (6)

Answer 310

Exclusions: acute paralysis, known vertebral disease, previous C-spine surgery, non trauma patients GCS <15, unstable vital signs, <16 ``` NO neuro deficit spinal tenderness midline alertness intoxication distracting injury ```

Question 311

Test for cervical radiculopathy

Answer 311

Spurling test - The Spurling test is a medical maneuver used to assess nerve root pain (also known as radicular pain). The examiner turns the patient's head to the affected side while extending and applying downward pressure to the top of the patient's head.

Question 312

Causes of unconjugated hyperbilirubinemia

Answer 312

``` ABC BILI ABO hemolysis Breast milk Conjugation defect - Gilbert’s syndrome Breastfeeding (dehydration) Infection Loss of blood Idiopathic (physiologic) ```

Question 313

Causes of conjugated hyperbilirubinemia?

Answer 313

BAD-C Biliary atresia Ductal stenosis Cystic fibrosis

Question 314

Modified CENTOR criteria

Answer 314

``` Cough absent Tonsils red or exudative Cervical lymph nodes Fever <14 +1 14-45 0 45+ - ```

Question 315

Causes of abnormal uterine bleeding

Answer 315

``` PPALMCOEIN Pregnancy ruled out Polyp Adenomyosis Légion Yona Malignancy and hyperplasia Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic ```

Question 316

Features of renal artery stenosis

Answer 316

``` New HTN <30 or >55 Abdominal bruit Creatinine increases more than 30% with ACE or ARB HTN resistant to 3 or more meds Récurrent pulmonary derm with HTN surges ```

Question 317

Bipolar medications in pregnancy advice

Answer 317

``` Lowest effective dose Avoid valproate Monotherapy Psychosocial preferred over meds in 1st trimester Restart medications after childbirth ```

Question 318

Classes of pharmacological treatment for endometriosis

Answer 318

GNRH antagonists (CI: postmenopausal or <18) Aromatase inhibitors NSAIDS hormonal contraception

Question 319

The Menopause 5

Answer 319

Quit: smoking, alcohol, caffeine Start: exercise, weight loss Fan, layers, cool environment, no hot drinks, optimize sleep

Question 320

Menopause - 4 medication classes

Answer 320

``` SSRIs HRT -- safe for 5 yrs w/in 10 years of LMP, transdermal is best. No uterus? No progesterone OCP Progestin TCAs Anticonvulsants ```

Question 321

C/I to estrogen

Answer 321

``` migraine with aura smoker >35 CVD/valvular disease liver disease diabetes w/ end organ damage malignancy uncontrolled HTN ```

Question 322

Cat bite!

Answer 322

Amox-Clav if pen allergy - doxy or septra/flagyl don't close the wound dog bite less risk but consider in immunocompromised

Question 323

Rabies Rx

Answer 323

Dog/cat/ferret - observe for 10 days, at first sign of rabid, give Rabig and four doses of HDCV or PDECV and test animal Dog/cat/ferret/skunk/bat/fox/coyote/raccoon/carnivores that is suspected rabid - Rabig + fours doses of HDCV or PCECV, immediately test animal

Question 324

sedation of peds lac repair?

Answer 324

intranasal midazolam | IV/IM ketamine

Question 325

sutures # of days

Answer 325

face - 5 joint, scalp 10-14 everything else -7

Question 326

``` Toxidromes for... Stimulant Anticholinergic Cholinergic Opioids Sedative-Hypnotics Benzos ```

Answer 326

Stimulant -- BIG pupils, use benzos Anticholinergic: TCAs, tegretol, anti-Parkinson's, antipsychotics, jimson weed -- use physostigmine. NO sweating Mad as a hatter, dry as a bone, red as a beet, hot as a hare, blind as a bat, full as a flask Cholinergic: mushrooms, organophosphates/insectiticides, nerve agents / sarin gas -- atropine, pralidoxime. Tiny pupils, increased sweating. SLUDGE = salivation, lacrimation, urinary incontinence, diarrhea, GI upset, emesis, miosis Opioids Sedative-Hypnotics: anti-epileptics, barbiturates, muscle relaxants. Depressed vitals. Benzos - give flumazenil (seizure risk)

Question 327

Antidotes for ... beta blockers? iron? Aceminophen?

Answer 327

BB - glucagon & CABs iron - deferoxamine & ABCs acetaminophen - N-acetylcysteine & ABCs

Question 328

If UTI 1st line abx fail...

Answer 328

reinfection vs. relapse treat 7-14 days reconsider dx/refer - upper tract imaging, cystoscopy, urodynamics

Question 329

causes and mgmt for epistaxis... mild? severe? Posterior?

Answer 329

``` 90% are anterior causes TIME to stop BLEED Trauma/tumor Infection Meds - nasal steroids Exogenous - foreign body BLEEDing disorders ``` Mgmt - mild: - blow nose - 2 sprays oxymetazoline - pinch x 10 minutes Severe: - ABCs, MOVIES, labs - tranexamic acid - freeze and cauterize or freeze and pack. Don't cauterize both sides! (Septal perforation) Posterior - identify by packing; if still bleeding, call ENT. Nasal baloon/foley.

Question 330

Prophylaxis for those in close contact to bacterial meningitis?

Answer 330

Rifampin or ceftriaxone or ciprofloxacin

Question 331

Croup management steroid dose? ddx? fup instructions for parents?

Answer 331

Mild - ABCs, treat fever, PO fluids, reassure parents Dexamethasone 0.15 (mild)-0.6mg/kg If severe, inhaled racemic epinephrine (if receives this, fup <24 hours post discharge) if given dex, should get better! If not, consider ddx: influenza, RSV, adenovirus, metapneumovirus, foreign body, tracheomalacia fever persistiting past 24-48 hours fluid intake or output not adequate fatigued/listless decreased LOC, respiratory distress

Question 332

Meningitis management, CSF findings

Answer 332

Start IV abx right away! They are a resuscitation drug. Steroids only if H flu and <2 hours from antibiotics Normal CSF findings: Bacterial: WBC >500 - neutrophils, low in glucose, protein >100 Aseptic, often viral i.e. syphillis: WBC 10-1000 - lymphocytes, normal glucose, protein <200 SAH: xanthochromia, normal glucose, elevated protein Fungal: WBC 10-500, cloudy, low glucose, elevated protein TB: 50-500 clear to opaque, low glucose, elevated

Question 333

Contraindications to LP

Answer 333

- blood pressure - shock - brain herniation - bleeding - coagulopathy - blisters - rash at site

Question 334

Anaphylaxis treatment

Answer 334

0.01 mg/kg 1:1000 IM ABC MOVIES SUPINE (unless seizure, pregnant, decreased LOC) EPI Allergy alphabet, rule of 5 Adrenaline 0.5mg Breathing - O2 5L nasal or 15L non rebreather Corticosteroid - methylprenisolone 125mg Diphenhydramine 50mg Epi again? Fluids - treat hypotension 2/2 vasodilation 500c Glucagon if on B-blocker H2 blocker - ranitidine 150mg Inhaled salbutamol - if wheezy observe for at least 4-8 hours, can have rebound in 23%; steroids don't help reduce this

Question 335

Eating d/o - SCOFF screening tool

Answer 335

Made yourself SICK because you felt uncomfortably full? Lost CONTROL over how much you eat? Recently lost more than ONE stone (14 lbs) in a 3 month period? Do you believe yourself to be FAT when others say you are too thin? Would you say that FOOD dominates your life?

Question 336

BMI in eating disorders

Answer 336

>17 mild 16+ moderate 15+ severe <15 extreme

Question 337

The new Female Athlete Triad

Answer 337

Relative Energy Deficiency in Sport RED-S

Question 338

Signs on exam of eating disorder

Answer 338

``` Bradycardia Slow cap refill Postural tachycardia Postural hypotension Decreased core temperature Pressure sores ```

Question 339

Emergency Contraception (4)

Answer 339

OCP Ullipristal Levonorgestrel Copper IUD

Question 340

Counselling after sexual assault, pregnancy, when to retest?

Answer 340

``` HIV post-exposure prophylaxis Hep B immune globulin, vaccinate within 8 hours Retest at 6, 12 weeks Azithro + cefixime/ceftriaxone Preg test in 4 weeks Reporting = voluntary unless <18 ```

Question 341

1st trimester bleeding

Answer 341

missed abortion? expectant vs. D&C vs. misoprostol Always remember your WinRHO if threatened, serial ultrasound/serial beta ectopic - pain, <7 weeks, tubal risk factors - expectant, medical or surgical

Question 342

Tests and managemnet for AUB

Answer 342

tests: Endometrial biopsy, colposcopy, Pap Management: Levonorgestrel IUS, OCP, progestin, NSAIDs(??), TXA Surgical - ablation, hysterectomy, polypectomy, myomectomy

Question 343

Test for vaginitis

Answer 343

``` Swabs/culture KOH Wet mount PH Biopsy ```

Question 344

To PSA or not to PSA And how to interpret RFs for prostate cancer

Answer 344

Discuss it if life expectancy >10 years Start at 50, or 45 if high risk PSA < 10 low risk, routine PSA 10-20 semiurgent PSA > 20 high risk, urgent PSA > 10 and abnormal prostate = urgent RFs: age, high risk race, family hx, smoking, obesity

Question 345

Physical exam/investigations for suspected BPH?

Answer 345

ABDO and rectal exam Midstream urine culture + sensitivity and analysis, GC/CT screening PSA if >10 year life expectancy

Question 346

BPH management Stop (7) Start (2)

Answer 346

1. Stop antihistamines, decongestants, NSAIDs, saw palmetto, excess fluid, caffeine, alcohol 2. Start 5-Alpha reductase inhibitor - Finasteride Alpha blocker - Tamsulosin (or both) Phosphodiesterase type 5 inhibitors - tadalafil Anti-muscarinics

Question 347

Risk factors for tubal dysfunction

Answer 347

Endometriosis, ectopic, surgery, Crohn's, PID, chlamydia, ruptured appendix

Question 348

Causes of infertility / workup | bloodwork to r/o hyperangronism

Answer 348

Anovulation Tubal dysfunction Uterine abnormalities - adhesions (surgery), septate/arcuate uterus, intracavitary fibroids Ovulation --> Day 3 FSH (ovarian reserve), Estrogen (ensure FSH not being suppressed), TSH, prolactin, midluteral progesterone Anti Mullerian hormone for women > 35 or with risk factors for low ovarian reserve: single ovary, ovarian surgery, poor response to FSH, chemo/radiation, unexplained infertility Hyperandrogenism --> DHEA-S, 17-OH progesterone, total testosterone Structural, tubal --> ultrasound, hysterosalpingogram Partner --> semen analysis Male Testicles - trauma, torsion, surgery, infection Sperm - tobacco, marijuana, hypogonadism

Question 349

When to refer for ?infertility

Answer 349

12 months if no risk factors 6months if risk factors or <35 immediately if >40 start exercise!

Question 350

PID symptoms, counselling

Answer 350

cervical motion tenderness, purulent discharge, fever treat partner contact tracing abstinence x 7 days

Question 351

Ages for abuse

Answer 351

``` 16 if non exploitative 18 if exploitative consenting youth 12-13 -- up to 2 years older 14-15 -- up to 5 years older` ```

Question 352

PreP recommended for :

Answer 352

MSM trans people having condomless anal sex with HIV+/unknown status partners might benefit: - IVDU - hetero people with HIV+ partners with detectable viral loads

Question 353

How to start PREP, counselling?

Answer 353

Truvada one pill per day or on demand Doesn't protect from other STIs, use condoms Baseline labs: STI screen CBC/Hgb Creat HCG urinalysis - q3 montly lab fup

Question 354

Priapasm management

Answer 354

Doppler ultrasound, cavernosal blood gas Non ischemic? watch and wait - finasteride - gonadotropic-releasing hormone agonists - Leuprolide Ischemic - needle drainage - intracavernosal phenylephrine - surgical shunt if >48 hours

Question 355

Bloodwork for ED

Answer 355

Serum glucose Chol HDL LDL Trig non-HDL Testosterone Prolactin TSH LH FSH

Question 356

Semen analysis

Answer 356

Most important results are CONCENTRATION (>15 million/ml) and MOTILITY (>40%) morphology less important

Question 357

Heart failure treatment

Answer 357

``` ACE/ARB Betablocker Mineralocorticoid Lasix AND if HFrEF (EF <40%), add SGLT2 even if no DM2 ``` If HFpEF, add SGLT2 if DM2/CVD, >30yo w/ DM2/CKD, >50yo w/ DM2 and risk of CVD If ongoing symptoms despite triple therapy, add entresto for NYHA II to IV If Heart rate > 70, also add Ivrabradine

Question 358

When to suspect cardiac amyloid and what to order

Answer 358

``` “Frequent” and “underlooked” Occurs in 1 in 4 over 80 yrs old  If HF unexplained, or associated with neuropathy or carpal tunnel (bilateral): Order SPEP, UPEP & serum free light chains Monoclonal protein:  Absent: Tc-99m-PYP SPECT scan  Present: Refer to hematology for biopsy ```

Question 359

Microcytic anemia

Answer 359

``` Thalassemia Anemia of chronic disease Iron deficiency Lead poisoning Sideroblastic anemia ```

Question 360

Macrocytic anemia

Answer 360

M FAT RBC ``` Myelodysplasia Fetal hgb/folate deficiency Alcohol Thyroid Reticulocytosis B12 deficiency Chronic disease ```

Question 361

Normocytic anemia

Answer 361

``` HARPS normocytic Hemolytic anemia Anemia of chronic disease Renal failure Pregnancy/pernicious anemia/pyridoxine deficiency Spherocytosis ```

Question 362

Anemia workup

Answer 362

```  Hemoglobin  Mean cell volume  Serum Ferritin  Peripheral Blood Smear  Serum Iron  Total Iron Binding Capacity  Colonoscopy  HCG ``` Elevated RDW = iron deficiency Low/normal RDW = thalassemia - hgb electrophoresis

Question 363

B12 DEFICIENCY | Risk Factors

Answer 363

``` 1. Gastric surgery Gastric parietal cells make intrinsic factor 2. Strict vegans 3. Breastfed children of #2 4. Elderly 5. Psychiatric ```

Question 364

Iron for peds?

Answer 364

FERROUS SULFATE FOR SMALL ONES

Question 365

Causes of recurrent UTI in peds:

Answer 365

VUR Uretrocele Posterior urethral valves

Question 366

Causes of unconjugated hyperbilirubinemia?

Answer 366

ABC Bili - unconjugated ABO hemolysis Breastmilk Conjugation deficiency Breastfeed, lack of - dehydration Infection Loss of blood, vit K deficiency Idiopathic

Question 367

Causes of conjugated hyperbili?

Answer 367

Bad C Bili - conjugated Biliary atresia Biliary duct stenosis Cystic fibrosis

Question 368

C diff test

Answer 368

Stool PCR For c diff toxin A and B

Question 369

Ottawa Ankle Rule

Answer 369

An ankle X-Ray series is only required if there is any pain in the malleolar zone and... Bone tenderness at the posterior edge or tip of the lateral malleolus (A) OR Bone tenderness at the posterior edge or tip of the medial malleolus (B) OR An inability to bear weight both immediately and in the emergency department for four steps

Question 370

Ottawa Foot Rule

Answer 370

A foot X-Ray series is only required if there is any pain the midfoot zone and... Bone tenderness at the base of the fifth metatarsal (C) OR Bone tenderness at the navicular (D) OR And inability to bear weight both immediately and in the emergency department for four steps

Question 371

Ottawa Knee Rule

Answer 371

knee X-Ray series is only required for knee injury patients with any of these findings: Age 55 or older OR Isolated tenderness of the patella No bone tenderness of knee other than patella OR Tenderness of the head of the fibula OR Cannot flex to 90 degrees OR Unable to bear weight both immediately and in the emergency room department for 4 steps Unable to transfer weight twice onto each lower limb regardless of limping

Question 372

Wells Criteria for DVT

Answer 372

Active cancer Treatment or palliation within 6 months Bedridden recently >3 days or major surgery within 12 weeks Calf swelling >3 cm compared to the other leg Measured 10 cm below tibial tuberosity Collateral (nonvaricose) superficial veins present Entire leg swollen Localized tenderness along the deep venous system Pitting edema, confined to symptomatic leg Paralysis, paresis, or recent plaster immobilization of the lower extremity Previously documented DVT Alternative diagnosis to DVT as likely or more likely

Question 373

Zika counselling

Answer 373

- do not get pregnant if travelling to Zika-risk country - mosquito precaustions If traveler is female: Consider using condoms or not having sex for at least 2 months after travel to an area with risk of Zika (if she doesn’t have symptoms), or for at least 2 months from the start of her symptoms (or Zika diagnosis) if she develops Zika. If traveler is male: Consider using condoms or not having sex for at least 3 months after travel to an area with risk of Zika (if he doesn’t have symptoms), or for at least 3 months from the start of his symptoms (or Zika diagnosis) if he develops Zika.

Question 374

Schizophrenia symptoms

Answer 374

Positive (i.e. hallucinations, delusions, racing thoughts), negative (i.e. apathy, lack of emotion, poor or nonexistant social functioning), and cognitive (disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems)

Question 375

SADMAN drugs

Answer 375

``` Sulfonylureas ACE Diuretics - spironolactone Metformin ARBs NSAIDs SGLT2 ```

Question 376

PE Wells Criteria

Answer 376

Clinical signs and symptoms of DVT PE is #1 diagnosis OR equally likely Heart rate > 100 Immobilization at least 3 days OR surgery in the previous 4 weeks Previous, objectively diagnosed PE or DVT Hemoptysis Malignancy w/ treatment within 6 months or palliative

Question 377

PERC score

Answer 377

Age ≥50 HR ≥100 O₂ sat on room air <95% Unilateral leg swelling Hemoptysis Recent surgery or trauma Surgery or trauma ≤4 weeks ago requiring treatment with general anesthesia Prior PE or DVT Hormone use Oral contraceptives, hormone replacement or estrogenic hormones use in males or female patients

Question 378

Murmur for hypertrophy cardiomyopathy

Answer 378

Significant LVOT obstruction, often due to a combination of LV upper septal hypertrophy and systolic anterior motion (SAM) of the mitral valve, results in a harsh crescendo-decrescendo systolic murmur that begins slightly after S1 and is heard best at the apex and lower left sternal border. An increase in intensity, due to enhancement of obstruction, is seen with the assumption of an upright posture from a squatting, sitting, or supine position; the Valsalva maneuver; during the more forceful contraction that follows the compensatory pause after a PVC; and following the administration of nitroglycerin. ●A decrease in intensity, due to attenuation of obstruction, is heard after going from a standing to a sitting or squatting position, with handgrip, and following passive elevation of the legs.

Question 379

Stevens Johnsons syndrome, presentation and management

Answer 379

- Risk limited to the first eight weeks of treatment. - typical exposure period before reaction four days to four weeks of first continuous use of the drug. - Fever, often exceeding 39°C and influenza-like symptoms precede by one to three days the development of mucocutaneous lesions - Photophobia, conjunctival itching or burning, and pain on swallowing may be early symptoms of mucosal involvement. Malaise, myalgia, and arthralgia are present in most patients. - Signs and symptoms that should alert the clinician to the possibility of SJS/TEN include fever >38°C (100.4°F), mucositis, skin tenderness, and blistering - Nikolsky sign - labs: Complete blood count with differential, metabolic panel (ie, glucose, electrolytes, blood urea nitrogen, creatinine, calcium, total protein, albumin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase), erythrocyte sedimentation rate, and C-reactive protein --> chest xray due to high risk of pneumonia ●Bacterial and fungal cultures should be performed from blood, wounds, and mucosal lesions. Because of the high risk of bacterial superinfection and sepsis in these patients, cultures should be repeated throughout the acute phase of the disease. Management: referral to the most appropriate health care setting (eg, intensive care unit, burn unit, specialized dermatology unit, where present), and initiation of supportive treatment. - wound care, fluid and electrolyte management, prompt withdrawal of offending agent, pain control, prevention/treatment of infections

Question 380

what is sarcoidosis?

Answer 380

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology that affects individuals worldwide and is characterized pathologically by the presence of noncaseating granulomas in involved organs. It typically affects young adults and initially presents with one or more of the following abnormalities: ●Bilateral hilar adenopathy ●Pulmonary reticular opacities ●Skin, joint, and/or eye lesions

Question 381

what is acute aortic syndrome?

Answer 381

It is a clinical spectrum of diagnoses including aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer at any location along the aorta

Question 382

Meniere's disease

Answer 382

Tinnitus, vertigo, hearing loss, nausea/vomiting (clinical dx; rarely may do MRI) From build up of fluid in the ears, occurs in episodes Treatment: symptoms - anti-emetic: promethazine, prochloperazine treat of fluid build up - diuretics (HCTZ, acetazolamide), low salt diet Toxic labyrinthitis -- related to EtOH

Question 383

Signs of advanced HF

Answer 383

2 or more hospitalization or ED for HF visits in the past year progressive deterioration of renal function weight loss without other cause = cardiac cachexia stop ACE due to hypotension or worsening renal failure intolerance of bblockers because of worsening HF or hypotension SBP < 90 NYHA class III or IV need to escalate diuretics to maintain volume status, often reaching furosemide > 160 or supplemental metolazone rx progressive decline in serum sodium frequent implantable cardioverter debrillator shocks

Question 384

Who do you give pneumococcal vaccine to, and which one?

Answer 384

It is recommended that immunosuppressed adults of all ages receive the 13-valent pneumococcal conjugate vaccine (PCV13) all adults aged 65 years and older receive PCV13 on an individual basis, followed by the 23-valent pneumococcal polysaccharide vaccine One dose of Pneu-P-23 vaccine should be administered to all individuals 24 months of age and older who are at high risk of IPD due to an underlying medical condition or who are residents of long-term care facilities. People at highest risk of IPD should also receive 1 booster dose of Pneu-P-23 vaccine. One dose of Pneu-P-23 vaccine is recommended for adults: 65 years of age and older, regardless of risk factors or previous pneumococcal vaccination. at high risk of IPD due to lifestyle factors: smokers, persons with alcoholism, persons who are homeless. Adults who use illicit drugs should be considered for Pneu-P-23 vaccination. Why S. pneumoniae is a common cause of invasive disease, such as bacteremia and meningitis. The case fatality rate of bacteremic pneumococcal pneumonia is 5% to 7% and is higher among elderly persons.

Question 385

What is degenerative cervical myelopathy and how do you treat it?

Answer 385

Degenerative cervical myelopathy occurs when age-related osteoarthritic changes cause narrowing of the cervical spinal canal, leading to chronic spinal cord compression and resultant neurologic disability. The natural course of DCM presents as a stepwise decline, with symptoms ranging from muscle weakness to complete paralysis. All individuals with signs and symptoms should be referred to a spine surgeon for consideration of surgery. Asymptomatic patients with evidence of cord compression on magnetic resonance imaging might need to be referred for assessment; however, surgery is not advised. It is critical to closely monitor asymptomatic individuals or those with mild DCM for neurologic deterioration. Patient presentation can vary broadly, with symptoms ranging from mild dysfunction, such as numbness or dexterity problems, to severe dysfunction, such as quadraparesis and incontinence, as later findings. It is important to note that paresthesia in the extremities is often the first sign, and because it might be mild, it can be easily overlooked by patients and providers.

Question 386

What is a tool that uses lab values to predict cirrhosis?

Answer 386

AST to Platelet Ratio Index (APRI) APRI score greater than 1.0 had a sensitivity of 76% and specificity of 72% for predicting cirrhosis. In addition, they concluded that an APRI score greater than 0.7 had a sensitivity of 77% and specificity of 72% for predicting significant hepatic fibrosis. Similarly, the FIB-4 score uses the AST/ALT, age and platelet levels to predict the level of fibrosis using a different equation.

Question 387

Treatment for rosacea

Answer 387

``` Topical - metronidazole azelaic acid invermectin minocycline ``` Oral - doxycycline minocycline tetracycline persistent erythema - brimonidine gel oxymetazoline persistent erythema/telangectasia - laser

Question 388

Questions from the Cannabis Abuse Screening Test?

Answer 388

Have you smoked cannabis before midday? Have you smoked cannabis when you were alone? Have you had memory problems when you smoked cannabis? Have friends or members of your family told you that you ought to reduce your cannabis use? Have you tried to reduce or stop your cannabis use without succeeding? Have you had problems because of your use of cannabis (argument, fight, accident, bad result at school, etc)? Which ones?

Question 389

What is POMI?

Answer 389

Prescription Opioid Misuse Index 1. Do you ever use more of your medication, that is, take a higher dose, than is prescribed for you? 2. Do you ever use your medication more often, that is, shorten the time between doses, than is prescribed for you? 3. Do you ever need early refills for your pain medication? 4. Do you ever feel high or get a buzz after using your pain medication? 5. Do you ever take your pain medication because you are upset, using the medication to relieve or cope with problems other than pain? 6. Have you ever gone to multiple physicians, including emergency room doctors, seeking more of your pain medication?

Question 390

Breastfeeding safe medications

Answer 390

Allergic rhinitis Beclomethasone (Beconase) Fluticasone (Flonase) Cromolyn (Nasalcrom) Cardiovascular Hydrochlorothiazide (Esidrix) Metoprolol tartrate (Lopressor) Propranolol (Inderal) Labetalol (Normodyne) ``` Nifedipine (Procardia XL) Verapamil (Calan SR) Hydralazine (Apresoline) Captopril (Capoten) Enalapril (Vasotec) ``` ``` Use with caution: Atenolol (Tenormin) Nadolol (Corgard) Sotalol (Betapace) Diltiazem (Cardizem CD) ``` Depression Sertraline (Zoloft) Paroxetine (Paxil) Nortriptyline (Pamelor) Desipramine (Norpramin) Use with caution: Fluoxetine (Prozac) Diabetes Insulin Glyburide (Micronase) Glipizide (Glucotrol) Tolbutamide (Orinase) Acarbose (Precose) Use with caution: Metformin (Glucophage) Thiazolinediones Epilepsy Phenytoin (Dilantin) Carbamazepine (Tegretol) ``` Ethosuximide (Zarontin) Valproic sodium (Depakote) ``` Use with caution: Phenobarbital Pain Ibuprofen (Motrin) Morphine Acetaminophen (Tylenol) Use with caution: Naproxen (Naprosyn) Meperidine (Demerol) Asthma Cromolyn (Intal) Nedocromil (Tilade) Fluticasone (Flovent) Beclomethasone (Beclovent) Contraception Barrier methods Progestin-only agents

Question 391

Risks of opthalmic steroids

Answer 391

1. PERFORATION: In the event of herpetic keratitis, steroids can facilitate progression resulting in corneal perforation 2. GLAUCOMA: Ophthalmic steroids can cause chronic open-angle glaucoma if used for a prolonged period of time (i.e. > 2 weeks) 3. CATARACTS: Ophthalmic steroids can cause cataracts if used for a prolonged period of time 4. CORNEAL ULCERS: Ophthalmic steroids have been associated with development of corneal ulcers of a fungal origin.

Question 392

What are the ABCDEF of red eye?

Answer 392

A = ache, B = blob, C = constriction, D = document acuity, E = erythema pattern, F = flourescin

Question 393

Iritis

Answer 393

Remember anatomically what the IRIS is (coloured part of the eye), what the IRIS does (constricts in response to light), and what it surrounds (pupil): It makes sense that if the iris is inflamed… - it will be red around the iris (PERILIMBAL HAZE) - it hurts when the iris constricts (PHOTOPHOBIA) - it can become warped (DISTORTED PUPIL) A • Pain - Photophobia B • Yes, watery C •Miosis / reacts poorly on affected side / distorted pupil (anisocoria) D • Blurred vision E • Perilimbal Haze F •Normal •Not necessary unless FB sensation * Refer for Steroids * R/O systemic cause (i.e. SpA, Behcet's , IBD, Kawasaki's, TINU, JIA, Sjögren's, Polychondritis, Granulomatous Tx) angiitis...) DDx – Unlike Iritis… Conjunctivitis has morning crusting, no pain Sclerits has SEVERE pain & tenderness to palpation Episcleritis is NOT painful Keratitis has corneal opacity, discharge, fluoresces Glaucoma has hazy, nonreactive pupil & headache

Question 394

Scleritis

Answer 394

Remember the sandwich, from superficial to deep: CONJUNCTIVA EPISCLERA SCLERA As the deepest part of the eye, the eye will be will be VERY VERY PAINFUL if the inflammation gets all the way down to the sclera. A • SEVERE CONSTANT BORING PAIN - ++ night, pain w/palpation, + photophobia B • Tears C • PERL D • Decreased - DOCUMENT E • No erythema...but deep red / blue / purple hue F •Normal •Not necessary unless FB sensation •REFER for Steroids •R/O systemic cause (RA, IBD, microscopic polyangiitis, Churg-Strauss, Sjogren's, Polychondritis, Granulomatous angiitis, Tx SLE, infectious)

Question 395

Episcleritis

Answer 395

Remember the sandwich, from superficial to deep: CONJUNCTIVA EPISCLERA SCLERA The episclera is not the deepest part, so there’s no pain & normal acuity. As well, it’s sealed in by conjunctiva so there’s no significant discharge & no A.M. crusting. Focal redness-think Episcleritis. ``` A •Irritation (pain is rare) B •Tears - NO pus, NO a.m. crusting C •PERL D • Normal- DOCUMENT E •FOCAL redness F •Normal •Not necessary unless FB sensation Tx •Artificial Tears ```

Question 396

Keratitis

Answer 396

Keratitis is inflammation of the cornea. Think about how painful a corneal abrasion is and you’ll remember keratitis. These patients are miserable. Also, if the CORNEA is inflamed, ACUITY will obviously be decreased as light passes through the cornea. Don’t forget FLOURESCIN staining as this will give away the diagnosis of keratitis! ``` A •Difficulty keeping eye open •VIRAL - Watery B •BACTERIAL - Possibly Purulent C •PERL but you may notice a haze or branching pattern on the cornea D •Blurred vision •Halos around lights E •Diffuse (maybe perilimbal) •Corneal haze F •+ HSV - Branching pattern •+ Bacterial - Corneal Ulceration ``` Tx •REFER URGENTLY •Ophtho will target instigating bug

Question 397

Conjunctivitis

Answer 397

A No pain just irritation! If it's painful, it's not conjunctivitis B •Viral/Allergic: Watery esp. in AM •Bacterial: PUS esp. in AM C •PERLA. (If abnormal, it's not conjunctivitis) D •Normal -DOCUMENT E •Diffuse •Normal F •Not necessary unless FB sensation •SWABS = USELESS (exceptions: contact lens wearer, painful, failed Tx, immunocompromised) Tx •ABx for Bacterial (cover for Pseudo if contacts)

Question 398

Glacuoma

Answer 398

Remember the rule of thumb: REFER all patients with any PAINFUL EYE. And – look for red eye if your patient has serious headache. If you do this you won’t miss a rare, but serious, glaucoma. A good analogy is the eye is like an overinflated balloon, ready to pop… imagine how PAINFUL that would be. These patients are often IN DISTRESS. As well an overinflated eyeball won’t function normally – pupil FIXED and DECREASED acuity. ``` •Acute, SEVERE Pain, Tender, & firm - these patients are in distress B •Minimal Watery C •Fixed, Hazy, Dilated •Anisocoria D • Decreased - DOCUMENT • Halos around lights E •Ciliary Flush F •Normal •Not necessary unless FB sensation ``` Tx •LOWER PRESSURE within HOURS •IMMEDIATE REFERRAL to ED Acute Angle-Closure Glaucoma Emergent Treatment  Consult Ophthalmology Emergently  Initiate treatment WITHIN 60 MINUTES as recommended by ophthalmology A sample regimen may include:  0.5% timolol maleate  1% apraclonidine, and 1 gtt each, to affected eye, 1min apart  2% pilocarpine  Oral medications may include acetazolamide, two x 250mg tablets in the office  IV medications may include acetazolamide or mannitol

Question 399

Approach to vertigo

Answer 399

Classifying vertigo or dizziness by timing (episodic or continuous) and trigger (positional or not), rather than type (vertigo vs lightheadedness vs unsteadiness, etc) allows for effective clinical identification of both high-risk-for-stroke and low-risk-for-stroke populations.” Consider POSTERIOR STROKE in ANY patient with dizziness, nausea, vomiting. Symptoms can also include swallowing difficulties, facial pain with vertigo or numbness, or gait disturbance

Question 400

Vertigo red flags

Answer 400

``` Red flags: hearing loss, new, unilateral focal neuro headache, new head impulse that suggests central cause (no corrective saccade) ``` Pitfall: Don’t use the Dix-Hallpike Maneuver on patients with continuous vertigo symptoms Only perform this maneuver on patients whose episodes of vertigo last less than 2min, and have no nystagmus at rest. Note that most types of vertigo will be exacerbated by head movements. Even with episodic vertigo, the feeling of nausea can persist, which can be confusing. The key is that BPPV has provoked brief episodes that resolve, and there are no nystagmus present at rest. Peripheral Head Impulse - Catch-up saccade ("abnormal") Nystagmus - unidirectional Test of Skew - No vertical skew Hearing loss absent ``` Central Head Impulse - Normal gaze tracking Nystagmus - bidirectional Test of Skew - Vertical skew present Hearing loss present ``` Pitfall: Don’t use the HINTS Plus exam on patients with BPPV (episodic vertigo without nystagmus at rest) This is only indicated for patients with ongoing, constant vertigo and nystagmus at rest. The results are meaningless and confusing when performed on patients with suspected BPPV.

Question 401

Validated score for Autism?

Answer 401

M CHAT RF

Question 402

How is long QT defined? Risk factors (6) and medications to avoid for TdeP (4)?

Answer 402

MEN QTc > 450, WOMEN QtC > 460 ``` congenital long QT syndrome older age previous TdeP electrolyte abnormalities: low K, low Mg, low Ca bradycardia female ``` ``` Meds: domperidone citalopram macrolides quinolones ```

Question 403

How to reduce recurrent UTIs in premenopausal women

Answer 403

increase daily water consumption by 1.5L/day

Question 404

Reasons to prescribe abx when doing an I+D?

Answer 404

extensive tissue damage, risk of poor healing/complications, immunocompromised, prosthetic device --> if MRSA, add clinda or septra

Question 405

Tool for suspected concussions in sport? | questions to ask before someone can consider return to sport?

Answer 405

SCAT-5 sport concussion assessment tool to return to sport: are all symptoms resolved? unrestricted return to normal cognitive activity achieved? endurance and physical activities performed without symptoms? normal exam of cervical spine and neurologic status? any other health condition/previous concussion/context to justify an additional delay?

Question 406

criteria for admission for anorexia nervosa

Answer 406

``` weight <75% of ideal body weight temp < 35.5 HR 45 SBP <80 orthostatic change in pulse >20 orthostatic change in BP >10 ```

Question 407

Rourke Baby nutritional recommendations

Answer 407

avoid hard/small/round foods until 3 years. Remain seated while eating/drinking Promote family meals with self-feeding avoid all sweetened beverages Vit D supplementation 400IU and 800IU in high risk infants while breastfed early introduction starting at 6 months and repeated ingestion of allergenic foods like egg, fish, peanut

Question 408

Child safety advice

Answer 408

Rear facing car seat until 2 years of age and then booster seat for 40-80 pounds Sleep in crib/cradle/bassinet without soft objects/loose bedding in parents room for 6 months after umbilical stump detaches, should have supervised tummy time vary the direction of the infants head while supine Swaddling not recommended after 2 months