CCFP Exam Flashcards
(295 cards)
1
Q
3 things that can precipitate Hyperparathyroidism
A
- thiazides
- lithium
- Multiple Endocrine Neoplasia 1 & 2
2
Q
3 Symptoms of Hyperparathyroidism
A
bone pain fragility # psychosis nephrolithiasis gout constipation
3
Q
2 Management options for Hyperparathyroidism
A
Parathyroidectomy
Volume replete for high calcium
4
Q
List components of CHADs Score
A
- CHF hx
- HTN hx
- age >75
- DM hx
- Stroke/TIA symptom hx
5
Q
2 medication classes for GIB Prevention?
A
- H2 receptor antagonist
- Proton Pump Inhibitor
6
Q
10 Symptoms of Hyperthyroidism
A
- tremor
- anxiety
- palpitations
- heat intolerance
- hair thinning
- goitre
- exophthalmos
- weight loss
- anemia
- lid lag
7
Q
What test should be ordered if High TSH & High fT4?
A
MRI
think secondary hyperthyroidism from TSH secreting pituitary adenoma
8
Q
What test should be ordered if Low TSH & High fT4?
A
Thyroid Uptake Scan
- look for Graves/Nodular vs. Thyroiditis
9
Q
List 3 treatments for Hyperthyroidism?
A
Beta-Blockers
Methimazole
Subtotal Thyroidectomy
10
Q
3 Symptoms of Thyroid Storm
A
Fever
CNS Agitation
Precipitant Trigger
11
Q
How to treat thyroid storm?
A
- slow thyroid synthesis –> methimazole 60-120mg
- inhibit hormone release –> potassium iodide drops
- lower HR –> propranolol 60-80mg q4h
- support circ –> glucocorticoids, fluids, cooling & O2
12
Q
3 Risk Factors for Hypothyroidism
A
Female trying to conceive or >45 yo
Postpartum
Medications - Amiodarone/Lithium/Iodine
13
Q
10 Symptoms of Hypothyroidism
A
- weight gain
- cold intolerance
- hair thinning
- constipation
- depression
- goitre
- edema
- fatigue
- myalgia
- dry skin
14
Q
Definition of subclinical hypothyroidism
A
TSH <10, Normal fT4, not pregnant, asymptomatic
15
Q
When to treat Hypothyroidism
A
TSH >10 + symptomatic OR TSH 5-10 AND: - increased TPO antibodies - goitre - fam hx of autoimmune disease - pregnant
16
Q
How often do we titrate Synthroid?
A
q4-6w until target range
17
Q
What are the diagnostic values for Diabetes?
A
8hr FPG >7.0
2hr 75g OGTT >7.0 or 2hr >11.1
Random Glucose >11.1
HgA1c >6.5%
18
Q
What are the target FPG levels pre & post prandial?
A
pre 4-7
post 5-10
19
Q
What yearly investigations should be done in a patient with DM?
A
optometry fasting lipids Albumin/Cr ratio Monofilament/foot exam ECG
20
Q
10 Risk Factors for DM?
A
- abdominal obesity
- asian/african
- low SES
- 1st relative with T2DM
- HTN
- smoking
- PCOS
- statins, steroids, atypical antipsychotics
- hx of pre-diabetes
- hx of GDM
- hx of delivering macrosomic infant
21
Q
Who IS eligible for tPA?
A
age =/> 18
clinical dx of ischemic stroke causing neurological deficit
time of onset <4.5 hours
22
Q
Absolute Contraindications for Thrombolysis?
A
- intracranial hemorrhage on Head CT
- clinical presentation suggests Subarachnoid hemorrhage
- NeuroSx, head Trauma or Stroke in last 3 months
- Uncontrolled hypertension (>185 mmHg SBP or >110 mmHg DBP)
- Hx of intracranial hemorrhage
- Known intracranial arteriovenous malformation, neoplasm, or aneurysm
- Active internal bleeding
- Suspected/confirmed endocarditis
- Known bleeding risk (INR >1.7, etc.)
- Abnormal blood glucose
23
Q
Relative Contraindications for Thrombolysis?
A
- Only minor or rapidly improving stroke symptoms
- Major surgery or serious non-head trauma in the previous 2 weeks
- History of gastrointestinal or urinary tract hemorrhage within 3 weeks
- Seizure at stroke onset
- Recent arterial puncture at a non-compressible site
- Recent LP
- Post myocardial infarction pericarditis
- Pregnancy
24
Q
Red Flag Symptoms for Back Pain
A
B - bowel/bladder dysfunction A - anesthesia (saddle) C - constitutional symptoms (fever) K - chronic dz (cancer/OP) P - paresthesia A - age >65 I - immunosuppressed/IVDU N - neurological deficit >12 weeks
25
Cervical Cancer screening
ages 25-69, q3years
26
Colorectal Cancer screening
FIT ages 50-74 q2years
OR
Flexible Sigmoidoscopy q10years
27
Breast Cancer screening
mammogram q2-3years ages 50-74 IF average risk
28
Pancreatic Cancer screening
ONLY if high risk:
- family hx
- peutz-Jeghers syndrome
- BRCA1 with affected relative
29
H Pylori Treatment & Duration
14 day QUAD treatment:
- PPI
- Bismuth
- Metronidazole
- Tetracycline
30
Long term PPI side effects?
- Clostridium Difficile
- Pneumonia
- Dementia
- Fractures
- B12 Deficiency
31
Greatest risk factor for barrett's esophagus?
reflux
32
How to prevent barrett's esophagus?
high dose PPI AND ASA
33
When a pt presents with abdominal pain, what 1 test and 1 exam are commonly missed by the MD?
- BHCG
| - Pelvic exam
34
Definition of acute vs. chronic diarrhea
acute <14 days
| chronic >4 weeks
35
What are the pediatric resuscitation guidelines in Pediatrics?
bolus - 20ml/kg NS or LR
| hourly maintenance 4:2:1 rule
36
Risk factors for C. Diff?
- elderly
- immunocompromised
- Healthcare associated
- recent course of antibiotics (Esp. fluoroquinolones i.e. Ciprofloxacin)
- previous C. Diff infection
37
1st line treatment for C. Diff?
Vancomycin PO as of 2018 - no longer Metronidazole
38
Workup for chronic diarrhea?
Test Blood AND Stool:
- Hgb, Ferritin, TSH, TTG
- C. Diff, O&P, Calprotectin
- dont do FIT --> straight to colonoscopy
39
List 4 Crohns Tx:
- sulfasalazine
- steroids
- MTX
- Biologics
40
IBS Therapies to try
- TTG
- FODMAP diet
- Psyllium
- Peppermint oil
- Probiotics
- CBT & hypnotherapy
- Colonoscopy if >50 OR if alarm features
41
What NOT to do for IBS?
- CRP, Calprotectin, Food Allergy Testing
- GF Diet
- Wheat bran
- Herbal therapies
- Acupuncture
- Colonoscopy if <50 & no alarm features
42
IBS Medications
```
Antidepressants (TCAs, SSRIs)
Antispasmodics
NOT loperamide (imodium)
NOT osmotic laxatives
NOT cholestyramine
```
43
Restless Leg Syndrome Non-prescription Treatments:
- Iron
- Magnesium
- stretch calves
- exercise
- massage
- heat
- avoid caffeine
44
Restless Leg Syndrome Prescription Tx:
- non-ergot dopamine agonist: pramipexole
| - alpha 2 delta calcium channel ligand: gabapentin
45
Questions to diagnose Obstructive Sleep Apnea?
```
STOP
S - snoring
T - tired
O - observed apnea
P - high blood pressure
```
46
How to treat OSA?
Positive airway pressure (CPAP)
47
List 3 strategies in CBT
- goalification
- scalification
- reward chart
48
How do we treat subclinical hypothyroidism?
we don't
49
What are the 2 treatment options for Hyperthyroid on labs, or having a thyroid nodule and then finding hyperthyroidism on labs?
- RAIU
| - Beta-Blocker
50
What investigation do you order 1st after finding a thyroid nodule?
TSH & Thyroid US
51
What size of thyroid nodule is high risk?
>1 cm
52
What investigation do you do after Thyroid US if high risk?
Fine needle aspiration for cytology
53
What are features of a suspicious thyroid nodule that would lead you to biopsy?
>1cm
irregular surface
taller than wide
calcifications within
54
What are the treatments for Thyroid storm?
- Block synthesis (methimazole, PTU)
- block release (iodine)
- beta blocker (propranolol)
- block bile (cholestyramine)
55
What are the treatments for Graves Disease?
- block synthesis (methimazole/PTU)
- block release (iodine)
- beta blocker (propranolol)
- radiation
- removal of thyroid gland
56
What is the starting dose of Insulin in T2DM?
10 units NPH @ HS
57
Things to consider re: SGLT2 inhibitors
- don't use in T1DM
- can cause vaginitis/balinitis
- can lower eGFR
- used in Heart failure without DM
- watchout for normoglycemic DKA
58
Diabetes Driving Guidelines?
2-4-6 rule
check blood sugar q2hours if hypoglycemic unawareness
check sugar q4h, if low, treat & wait 40 min
keep 6 lifesaver candies in the car for lows
59
Management of Hepatitis B?
- refer to hepatology
- treat if severe (cirrhosis, fibrosis, HBV DNA >2000 IU/mL & ALT elevated for 3-6months
- Tx with Tenofovir or Interferon
- Monitor
60
Management of Hepatitis C?
- refer to hepatology
- treat if severe
- Tx with Interferon or Antiretroviral Meds (Sofosbuvir)
- Monitor & Quit risks
61
Monitoring for Hep B/C
- liver US q6-12 months
- monitor varices with scope q1-3 years
- alcohol use, monitor by taking hx
- cirrhosis/fibrosis; no single blood test
62
4 important parts of exam for Back Pain?
- pedal pulses
- neurological exam
- weakness?
- numbness?
63
Recommended Therapies for Back Pain?
- not drugs
- teach lifting habits
- quit smoking & IVDU
- yoga
- acupuncture
- CBT
- osteopathy
64
4 joint pain alarm features?
- night pain
- boggy (soft) joint
- hot (fever, warm joint)
- AM stiffness >30 minutes
65
Who should I refer a child with behavioural problems to?
- pediatrics, SLP, psychology
- autism clinic
- hearing & vision assessment
- occupational therapy
66
List 3 things on the differential for autism?
- global developmental delay
- epilepsy
- hearing impairment****
67
Define Conduct Disorder
repetitive/persistent, violation of rights of others, rule breaking, VIOLENCE against people/animals, running away from home/school
* **PROPERTY/PEOPLE/ANIMALS DAMAGED
* **THEFT
68
Define Oppositional Defiant Disorder
irritable, defiant, vindictive
69
Therapies to try to minimize bed wetting
- make toilet accessible
- pee before bed
- training pants
- use bedwetting alarms
- can use desmopressin (short term ex. sleepovers)
- imipramine LAST RESORT
- no caffeine/chocolate
- no fluid before bed
- don't punish child
- don't put child in diapers
70
Treatment for Phimosis?
Topical steroids (Betamethasone)
71
What can be caused by undescended testes (cryptorchidism)?
```
torsion
trauma
tumor
infertility
inguinal hernia
```
72
How to examine for torsion?
TWIST score
- absent cremasteric reflex?
- nausea/vomiting?
- high riding testicle?
- testicular swelling?
- hard testicle?
73
which vaccines can someone get if they are allergic to chicken/eggs?
Influenza & MMR
74
which vaccines should you NOT give if someone is allergic to chicken/eggs?
yellow fever, tick borne encephalitis, rabies
75
Tips on making infant immunizations less painful?
- don't aspirate
- do the most painful last
- breastfeed during
- skin-to-skin
- topical anesthetic
- oral sugar
76
Shingrix info?
non-live recombinant
- 2 doses
- 2 months (up to 6 months apart)
- 2x as effective as Zostavax
- $150 each shot
- recommended in patients >50 years old
77
HPV vaccine info?
- 2 doses
- 9 valent
- all genders
78
Who should get the Meningitis C vaccine?
- ALL canadian adolescents ~12yo
- military recruits
- asplenia & sickle cell
- travelers to Hajj & Meningitis belt of Africa
79
Which vaccines are live?
Polio
Varicella
MMR
80
Which vaccines can't immunocompromised people have?
live vaccines - polio, varicella, MMR
81
Which vaccine is contraindicated if pt is pregnant?
most live vaccines
BCG
Flu vaccine is OK
82
Which vaccine is contraindicated if pt has active TB?
MMR, varicella, herpes zoster, bcg
83
which vaccine is contraindicated if pt has severe asthma/wheeze 7d prior?
live attenuated flu shot
84
which vaccine is contraindicated if pt has a congenital GI malformation?
rotavirus (risk of intussception)
85
which vaccine is contraindicated if pt has HIV?
live vaccines - varicella, polio & MMR
86
What are the common organisms causing sinusitis & ear infections?
Hemophilus influenza
Moraxella cattarhalis
Strep pneumoniae
87
Rhinosinusitis Signs & Symptoms
```
CPODS:
Congestion/fullness
Pain (facial pressure/fullness)
Obstruction
Drainage (purulent)
Smell (anosmia)
```
88
Acute vs. Chronic Sinusitis Timeline
acute <4w
| chronic >12w
89
When to refer for sinusitis?
>4 episodes in 1 year
refractory to treatment
complications (immunosuppressed, severe pain, fungal)
90
Acute Sinusitis Management
- saline nasal rinse
- analgesia/antipyretics
- decongestant
- inhaled steam/warm compresses
- intranasal steroids x 3d (if no improvement, then abx)
91
When is chronic rhinosinusitis diagnosed?
>2 CPODS for 8-12 weeks + inflammation of sinus mucosa
| can confirm with CT (NOT xray)
92
When is acute sinusitis diagnosed?
>2 PODS for >7d or w/ biphasic fever
93
Bacterial Sinusitis Treatment:
1. Amoxicillin 80mg/kg or 500mg po TID
2. Cefuroxime if allergic to PCN
** Amox/Clav 500mg po TID if Amox doesn't work
Tx for 10-14d
Most are viral and do NOT need antibiotics
consider saline rinse, oral decongestants, IN steroids
94
Diagnostic Criteria for IBS:
recurrent abdo pain at least 1 day/week in the last 3 months associated with >2 of:
- related to defecation
- change in frequency of stool
- change in form of stool
95
Alarm Symptoms of IBS
```
unexplained weight loss
vomiting
GIB
abdominal mass
dysphagia
anemia
```
96
Imp Hx for IBS:
- family hx of GI Cancer/IBD/celiac
- new symptoms in pt >45
- nocturnal defecation
97
Investigations for IBS:
- CBC, TSH, Stool C&S, lactulose hydrogen breath test, Giardia, albumin, fecal calprotectin, +/-O&P, +/- endoscopy/colonoscopy
98
IBS Management
- reassurance
- FODMAP diet
- Probiotics
- Peppermint oil/antispasmodic
- TCA (diarrhea prominent)
- SSRI (constipation prominent)
- adequate oral hydration
- bowel training
- exercise
- adequate oral fiber
- avoid fatty diet/caffeine/etoh
- CBT/hypnotherapy
99
S&S peptic ulcer disease
- upper abdo pain, bloating, nausea, early satiety, fullness, dyspepsia, belching, heart burn
100
Red flags of PUD
- vomiting
- bleeding/anemia
- unexplained weight loss
- abdominal mass
- dysphagia
- fam hx of GI cancer
- previous peptic ulcer
101
how to prevent peptic ulcer disease?
**H2 blockers & PPI
- no smoking
- no etoh
- no NSAIDs/ASA
- no bisphosphonates or CCB
- no caffeine or fatty diet
102
What is treatment if H Pylori test positive?
Quadruple therapy:
- PPI po BID
- Tetracycline QID
- Bismuth QID
- Metronidazole 500mg po BID QID
103
When do we do a test of cure for PUD?
if complicated patient or still symptomatic, 30d after completion of 14d treatment - order repeat urea breath test
104
Risk factors for Sinusitis?
- anatomy
- asthma
- smoking
- allergic rhinitis
105
Red Flag Features of Sinusitis
- persistent fever >39C
- proptosis
- periorbital edema
- vision changes
- cranial nerve palsies
- severe headache
- altered mental status
- abnormal EOM
- meningismus
106
Best treatment for GAS Pharyngitis?
Penicillin V 800mg po QID x 5 days (NOT 10)
107
S&S of Mono?
```
lymphadenopathy
fever
fatigue
pharyngitis
myalgia
headache
```
108
What labs to order for Mono?
Lymphocyte count, AST/ALT, Monospot
109
Treatment for Mono?
NO ANTIBIOTICS
| Hand washing & rest
110
How long to avoid contact sports after Mono?
At least 3 weeks
111
What can increase risk of neonatal sepsis?
```
chorioamnionitis
fever
<37w GA
rupture >18 hours
GBS + mother
```
112
neonatal sepsis bugs & meningitis =
Listeria
E Coli
GBS
113
Management of Neonatal Sepsis?
- CXR
- Ampicillin/Gentamicin +/- Acyclovir
- Consult NICU
- Blood Cultures/Urine Cultures/CSF
- Hgb, Lactate, WBC, CRP, Glucose
114
What is the cutoff for neonatal hypoglycemia?
<2.6
115
S&S of neonatal Hypoglycemia?
- lethargy
- jittery
- hypotonic
- sweating
- weak cry
- tachypnea
- seizures
116
Investigations for Hyperbilirubinemia?
```
Conjugated Bilirubin
Hgb
Group & Screen
PBS
Coombs test
```
117
Risks of Hip Dysplasia?
```
First born
feet first
female
fluid (oligo)
family hx
```
118
Differential for pediatric limp? (LIMPS)
- leg calve perthes disease
- infection/inflammation
- malignancies (Ewings sarcoma/osteosarcoma)
- pain from a # (abuse?)
- slipped capital femoral epiphysis (SCFE)
119
Management of constipation in pediatrics?
```
start osmotic laxative (PEG 3350/lactulose)
disimpaction
behavioral & dietary modification
parental education
refer to GI if necessary
```
120
Reflux in infants?
- modify frequency/thickness/timing of feeds
- trial formula (hydrolyzed)
- NO PPIs
121
Reflux in Kids?
- PPI (not for >8 weeks)
| - risks = pneumonia & c. diff
122
HEADSS assessment in adolescents?
```
Home Environment (type of home, who do you live with, who makes the food?)
Education & Employment
Activities
Drugs - access to prescriptions/alcohol?
Sexuality
Suicide/mood
```
123
When are signs of puberty too early?
- age 8 in girls (thelarche 'breast buds')
- age 9 in boys (genital development)
REFER
124
Travelers Diarrhea prevention & Tx:
- loperamide
- bismuth
- oral rehydration
- antibiotics (azithromycin)
- boil/peel/cook foods
- bottled water
- avoid ice cubes/salads/uncooked vegetables
- wash hands
125
What is a medication for altitude sickness?
Acetazolamide 125mg BID
126
What are the screening guidelines for AAA?
1 time Abdominal US for men ages 65-80
127
What to test Immigrants for?
HIV/HCV/TB
128
What is the TB test?
IGRA (tests for latent TB)
129
What is the treatment for TB?
```
RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
```
130
What is the organism causing Scarlet Fever?
GAS
131
What condition presents with red scaly 'sandpaper' rash and fever
Scarlet Fever
132
Treatment for NMS:
- stop neuroleptic agent
- IV NS, ice packs, cooling blanket
- DVT prophylaxis
- DANTROLENE/BROMOCRIPTINE
133
What are the S&S of NMS?
- fever
- autonomic instability (HR/BP/sweating)
- Rigidity
- mental status changes
134
What does a "lipid panel" include?
HDL, LDL, triglycerides, non-HDL, total cholesterol
135
Initial HTN workup
A1c, Urinalysis, urine albumin, Na, K, Cr, eGFR, ECG, Tchol, HDL, LDL, non-HDL, triglycerides
136
Lifestyle interventions to reduce HTN:
```
sodium <1800 mg/day
DASH diet
weight loss
exercise
CBT (relaxation)
alcohol <2.7 drinks/day
```
137
Diagnose & Treat HTN Emergency
asymptomatic dBP >130, acute HF, aorta/kidney damage
pre-eclampsia or pheo
Tx with Nifedipine/Hydralazine/Labetalol
Clonidine/Captopril/Nitrates
138
Alopecia Areata Tx?
- steroids (topical/injection)
- if >50% hair loss, 8 week oral steroid taper
- Minoxidil
139
Papulopustular Rosacea Tx?
- Ivermectin
- Doxycycline
- Minocycline
140
Risk factors for osteoporosis:
- hx of fragility fractures
- prolonged steroid use
- age >65
- rheumatoid arthritis
- malabsorption (Eating disorder)
141
Tests to order for Osteoporosis once diagnosed:
```
Hemoglobin
TSH
Ionized Calcium
ALP
Creatinine
Vitamin D (after 3 months of treatment)
SPEP (if vertebral #)
```
142
Osteoporosis Tx
calcium 1200mg qd
vitamin D 1000 IU qd
quit smoking
weight bearing exercise
143
What are some side effects of Bisphosphonates?
esophageal ulcer
jaw osteonecrosis
atypical fractures
144
What is the best test for DVT?
Low Pretest probability or Wells score <2 = D Dimer; otherwise, proximal leg compression US
145
What increases risk of clot?
trauma, stasis, hypercoagulable state
146
causes of hypercoagulable state?
```
cancer
pregnancy
meds (hormonal)
IBD
CHF
Inherited
```
147
Symptoms of CKD
```
fatigue
pruritus
restless leg syndrome
anxiety/depression
pain
```
148
What could a fever in peritoneal dialysis patients mean?
spontaneous bacterial peritonitis
149
causes of pancreatitis?
```
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Tumors
Scorpion stings
Micro (TB, mumps, rubella, varicella, hepatitis, CMV, HIV)
autoimmune (SLE, Crohns)
surgery/trauma
hyperlipidemia, hypercalcemia, hypothermia
emboli
drugs (furosemide, estrogen, H2 blockers, valproate, antibiotics, asa)
```
150
What tests to order in the male for infertility?
sperm analysis
| r/o STI
151
What tests to order in the female for infertility?
```
r/o STI
day 3 LH/FSH/Estradiol/TSH/Prolactin/Testosterone
day 21 Progesterone
Pap
Rubella & Varicella immune levels
```
152
absolute contraindications to systemic estrogen supplementation
```
cancer
breast cancer
pregnancy
unexplained vaginal bleeding
stroke
migraine with aura
liver disease
hyperlipidemia
acute CVD
recent VTE
immobility
```
153
risk factors for DVT/PE
```
immobility
recent surgery/trauma/ICU
air travel >6 hours
1st degree relative with VTE
prior DVT/PE
malignancy
obesity
pregnancy
postpartum
estrogen
dehydration
age >60
```
154
Wells score for DVT
```
cancer
immobility >3d or surgery in past 4w
previous DVT
tender along deep vein system
unilateral entire leg swollen
calf swollen >3cm relative to other leg (10cm below tibial tuberosity)
other dx as likely as DVT?
superficial collateral veins on symptomatic leg?
```
<2 unlikely
>2 likely
155
Wells score for PE
```
S&S of DVT?
HR >100
immobility >3d or surgery in past 4w
hemoptysis
malignancy
previous DVT/PE
```
<4.5 unlikely - do PERC to r/o
>4.5 likely
156
PERC rule
```
age <50
HR <100
no unilateral leg swelling
no hemoptysis
no recent surgery
no prior DVT/PE
no hormone supplementation
```
157
Gold investigation for PE?
CT pulmonary angiography
158
Gold investigation for DVT?
Leg Venous Compression Ultrasound
159
Tx for cat bite?
Doxycycline
(treating for pasteurella - don't close wound!)
give tetanus & rabies vaccines
160
Suture removal timelines?
face - 5d
scalp/over joint - 10-14d
everywhere else - 7
161
Tx for bronchiolitis?
```
O2 if sats <90%
hydration
nasal suctioning
nebulized epinephrine
hypertonic saline nebulizer
```
162
Tx for Croup?
Dexamethasone 0.6mg/kg po x 1 (max 10mg)
Blow by oxygen if sats <90%
Nebulized Epinephrine in moderate-severe
163
Top 4 causes of Croup?
Parainfluenza, RSV, Adenovirus, Influenza
164
Risk Factors for HCV
```
IVDU
region where HCV endemic
blood transfusion/organ transplant before 1992
hx or current incarceration
tattoos/piercings
infant born to mom with HCV
chronic hemodialysis
needle stick injury
sexual contact
sharing sharp instruments
IN & inhaled drug use
homelessness/group home/shelter
higher risk sexual activity
MSM
HIV infection
```
165
What are 2 treatments for HCV?
Ribavirin
| Harvoni
166
What CD4 counts have increased risk of certain infections?
- CD4 <0.2 - cough - Pneumocystis Jiroveci Pneumonia
Tx Septra
- CD4 <0.1 - encephalitis - Toxoplasma gondii encephalitis
Tx Septra
- CD4 <0.05 - disseminated mycobacterium avium complex - cough
Tx Azithromycin
167
What would you do if someone had an HIV exposure?
baseline HIV serology, CBC, Cr
assess source person if possible
start PEP in <72 hours for up to 28d
TENOFOVIR 300mg qdaily
168
What is the trade name for PREP?
Truvada
169
What vaccines should you give for asplenia?
Pneumococcal
Hemofluenza Influenza Type B
Meningococcal
Influenza
170
Management for Meningitis?
```
3rd generation cephalosporin (ceftriaxone)
+
Vancomycin (if >1 yo)
+/- Ampicillin (Listeria)
+/- Acyclovir (Viruses)
```
171
How long after having Mono should you avoid contact sports?
4 weeks
172
Risk Factors for Otitis Media
maternal smoking
daycare
pacifier use
bottle feeding
173
Definition of dementia
unable to function
decline from previous function
NOT delirium or psychiatric
>2 domains
174
Mild cognitive impairment
NOT delirium or psych
| >1 domain
175
What are the 5 cognitive domains?
```
personality
language
visuo-spatial
judgment/complex tasks
new information
```
need 2 affected = dementia
need 1 affected = mild cognitive impairment
176
Labs for dementia?
TSH
Glucose
B12, Hgb, WBC
Na, K, Ca, Mg
177
Dementia Tx:
```
cholinesterase inhibitor - donepezil
vitamin E
exercise
cognitive stimulation
avoid antipsychotics
memantidine
```
178
When to assess for competency?
```
traumatic brain injury
psychiatric illnesses
neurodegenerative diseases
cognitive aging
delirium
```
179
Tool for migraine diagnosis:
```
POUND
pulsating
4-72 hours
unilateral
nausea
disabling
```
180
Acute Tx of migraine:
```
NSAIDs
Tylenol
steroid - dexamethasone
tricyclic antidepressants
triptans
antiemetics
sphenopalatine ganglion block
```
181
Tx for recurrent migraine:
metoprolol
antidepressant
anticonvulsant
botox
182
Lifestyle headache management:
```
headache diary
less caffeine
more exercise
avoid irregular/inadequate sleep
relaxation/CBT
```
183
Parkinsons symptoms
```
"TRAP"
tremor (shaky)
rigidity (stiff)
akinesia (slow)
postural instability (steps)
```
184
1st line Tx for parkinson
levodopa
185
Who to refer pt to w/ Parkinsons?
```
SLP
Dietician
PT
OT
Neurologist
Palliative
Movement Disorders clinic
```
186
What are the 3 indications for ear ventilation tubes?
- retracted TM
- chronic OME > 3months with hearing loss
- recurrent AOM 6/y or 4/6 months
187
Rule of 9s for body surface area
- head & neck = 9%
- each arm & hand = 9%
- chest = 9%
- stomach = 9%
- upper back = 9%
- lower back = 9%
- genital area = 1%
- each leg & foot = 18%
188
Frostbite Tx?
- rapid wet rewarming
- possible thrombolysis
- tetanus
- sterile wound care
- consult surgery
189
What is included in trauma imaging?
```
Bedside POCUS Ultrasound
Chest XR
C-spine XR
Pelvis XR
Chest/Abdo/Pelvis CT
```
190
GCS Calculation
E4
- 4 spontaneous, 3 sound, 2 pressure
V5
- 5 oriented, 4 confused, 3 words, 2 sounds
M6
- 6 obeys, 5 localizes, 4 normal flexion, 3 abnormal flexion, 2 abnormal extension
191
MOVIES
```
monitors
oxygen
vitals
IV
ECG
Sugar
```
192
Unconscious pt? DONT
dextrose
oxygen
narcan
thiamine
193
1st med given for seizure in kids?
benzo
194
1st med given for seizure in pregnant female?
mgs04
195
1st med given for seizure in adults?
benzo
196
What is the parkland formula for burn fluid resuscitation?
4ml x % BSA x weight (kg) = X
1/2 of X in first 8 hours
1/2 of X over next 16 hours
197
STEMI PCI Goal time?
120 minutes
198
What to send CSF fluid for?
Culture & Sensitivity, Gram stain
Cell Count & Differential
Glucose & Protein
Fungal or Viral
199
how to calculate BMI
kg/m (squared)
200
Normal BMI?
18-25
201
Options for treating Chronic Pain
- tricyclic antidepressants
- cannabinoid
- NSAIDs
- CBT
- Exercise
- Physio
- opioid
- ibuprofen
- SNRI (duloxetine)
- acetaminophen
202
What are 3 indications for cannibis treatment?
- refractory neuropathic/palliative pain
- chemotherapy induced N/V
- spasticity
203
What is the rule for cannibis and driving?
4-6-8
no driving <4h after inhalation
no driving <6h after ingestion
no driving <8h after euphoria
204
What are the principles of chronic pain?
- reassess regularly
- relationship & shared decision making
- reconsider diagnosis
- refer when appropriate
205
What high risk things on C spine rule indicate a C S XR?
age >65
dangerous mechanism
paresthesia
206
What is excluded from the C spine rule?
- acute paralysis
- known vertebral disease
- previous C Spine surgery
- unstable vitals
- age <16
- non-trauma patients
- GCS <15
207
Differential for neck pain:
```
carotid artery dissection
basilar artery dissection
mass/cancer
lymphoma
MI
polymyalgia rheumatica
ankylosing spondylitis
```
208
What are the menopause ROS?
psychiatric
sex
vasomotor
urogenital
209
What are the menopause 5?
```
quit smoking
quit caffeine
quit etoh
start losing weight
start exercising
```
210
4 classes of meds for vasomotor menopause symptom relief:
OCP
HRT
SSRI
TCA
211
what to do for intolerable menopause symptoms?
HRT
transdermal is best!
within 10 years of LMP
safe for at least 5 years
212
Treatment for Children UTI?
Cefixime 7-10 day
213
What can you spray to stop epistaxis?
Oxymetazoline
214
Allergy Alphabet
```
A - adrenaline; 1:1000, 0.01 mg/kg IM
B - breathing O2 - 5L NP or 15L NRB
C - corticosteroid - 125mg methylprednisolone
D - Diphenhydramine - 50mg benadryl
E - epi again or IV instead of IM
F - fluids - 500cc NS
G - Glucagon if on BB
H - H2 blocker - Ranitidine 150 mg
I - inhaled salbutamol
```
215
Signs of eating disorder:
```
purging
excessive exercise
weight loss
palpitations
dental erosions
palpitations
```
216
definition of anorexia
does not require amenorrhea
217
bulimia
binge & purge once weekly
218
BMI for eating disorders
>17 - mild
| <15 extreme
219
Exam after rape
STI (HIV post-exposure proph - ribavirin/harvoni) (HBV immune globulin, HBV)
Pregnancy risk
medically pertinent history
does pt want exam?
220
is sexual assault/rape reporting voluntary?
yes - unless <18
221
is domestic violence reporting voluntary?
yes - unless children involved
222
3Es for learning difficulties...
eyes - vision impairment
ears - hearing impairment
education - intellectual disability, seizure or sleep disorder, TBI
223
ADHD med classes
SNRI - atomoxetine
| stimulants - amphetamine, methylphenidate
224
Management of AUB
```
IUS
OCP
Progestin
NSAID
TXA
Ablation
Hysterectomy
Polypectomy
Myomectomy
```
225
Protocol for Post Menopausal PV bleeding?
- Pelvic exam
- PAP
- endometrial biopsy
- pelvic ultrasound
226
Differential for vaginitis in children?
foreign body
STI
irritant
227
low risk PSA?
10
228
high risk PSA?
20
229
When can a PSA of 10 be urgent & high risk?
if the prostate gland is abnormal (hard or irregular)
230
Risk factors for Prostate Ca?
smoking
obesity
age
family history
231
What tests do we order for BPH?
urinalysis
midstream urine culture & sensitivity
& PSA if >10 years life expectancy and would change mgt
232
How to reduce BPH symptoms?
```
quit antihistamines & decongestants
quit excess fluid
quit caffeine
quit alcohol
quit NSAIDs
quit saw palmetto
```
233
How to treat BPH symptoms?
alpha blocker - tamsulosin
5 alpha-reductase inhibitor - finasteride
antimuscarinic - mirabegron
phosphodiesterase type 5 inhibitor - tadalafil
234
Investigations for Infertility:
pap/pelvic/partner
Day 3 FSH/LH/Prolactin/Estradiol/TSH
Day 21 progesterone
DHEA, 17 OH Progesterone, total testosterone
structural/tubal - pelvic US & Hysterosalpingogram
partner semen analysis
r/o STI in both partners
235
Tx for PID?
Ceftriaxone & Doxycycline
partner treatment
contact tracing
abstinence for 7 days
236
Contraceptive options
```
progesterone IUS (mirena)
copper IUD
Pill
Patch
Ring
Depo Provera
Condoms
Diaphragm
Withdrawal
Implant
```
237
Contraindications for estrogen?
```
smoking >35, >15 cig/day
migraine with aura
uncontrolled HTN
DVT
malignancy
stroke
CAD/CVD
liver disease
DM with end organ damage
```
238
Age of consent?
16 if non-exploitive
18 if exploitive
12-13, up to 2 years older
14-15, up to 5 years older
239
Priapism management
```
doppler US
cavernosal blood gas
watch and wait
needle drainage
surgical shunt if >48 hours
```
240
Labs for Erectile Dysfunction:
non-HDL, HDL, LDL, total cholesterol, glucose, testosterone, prolactin, TSH, LH, FSH
241
HIV PREP
Truvada
get baseline labs and hepatitis vaccines
bhcg, STI screen, Hgb, WBC, Cr, Urinalysis
q3monthly followup with labs
242
GDM Testing
initial 50g glucose test @ 24-28w
if abnormal then 75g OGTT
diagnose based on 1 abnormal value:
>5.3 fasting
>10.6 1 hr
>9.0 2 hr
243
Gestation HTN
>140/90 x 2
| labetalol, nifedipine, hydralazine
244
PROM
sterile spec exam
steroids
antibiotics <32 weeks
245
Preterm Labour
fetal fibronectin +/- serial vag exam
betamethasone x 2
tocolytics
magnesium sulphate for neuroprotection if <32w GA
246
What does GDM put you at increased risk of?
macrosomic infant
shoulder dystocia
cesarean section
preeclampsia
247
When to screen for T2DM after delivery and GDM?
6 weeks to 6 months post delivery
q3years after
before next pregnancy
248
Dystocia diagnosis:
<2cm in 4 hrs of 1st stage of labour
249
definition active labour:
3-4cm in nullip
| 4-5cm in multip
250
risk factors of PPH
prior hx of PPH
instrumentation
shoulder dystocia
rapid or prolonged delivery
251
evidence supported analgesia in labour
```
epidural
self-hypnosis
acupuncture
water immersion
morphine
fentanyl
nitrous oxide
pudendal nerve block
```
252
PPH diagnosis?
tissue
thrombin
trauma
tone
253
PPH management
```
MOVIE
uterine massage
weigh blood
oxytocin
misoprostol
ergot
hemabate
```
254
2 main causes of post partum infection?
endometritis
| septic pelvic thrombophlebitis
255
Diagnostic Criteria for GAD?
uncontrollable and excessive worry occurring more days than not for AT LEAST 6 MONTHS. Difficult to control anxiety, + 3 or > symptoms - SIGNIFICANT IMPAIRMENT
- sleep disturbance
- irritable
- poor concentration
- restless
- fatigued easily
- muscle tension
256
Therapy for GAD?
CBT + meds
| duloxetine, escitalopram, sertraline, paroxetine, venlafaxine
257
Workup for pt presenting with ++anxiety?
WBC, Hgb, FBG, lipids, lytes, LFTs, Bili, Cr, TSH, B12
urinalysis
drug screen
ECG if >40
258
What meds should be given in pregnancy for anxiety?
SSRI or SNRI
259
what anxiety meds can you take while breastfeeding?
paroxetine & sertraline
260
Diagnostic criteria for MDD
>5 of the SIGECAPS nearly every day for >2 weeks
```
sleep too much or too little
low interest
depressed mood
guilt
low energy
lack of concentration
too low or too high appetite
psychomotor agitation or retardation
SI
```
261
1st line antidepressant in children/adolescents?
fluoxetine (prozac)
262
Serotonin Syndrome S&S
```
nervousness
insomnia
rigidity/clonus
tremor
sweating
fever >38.5
rhabdomyolysis
hyperreflexia
```
263
diagnostic criteria for anorexia
- restriction of intake
- intense fear of gaining weight
- disturbance of body image
restricting (no binge/purge in >3 months)
binge/purge
264
diagnostic criteria for bulimia
- recurrent episodes of binge eating
- recurrent inappropriate behaviour to prevent weight gain
- both of the above at least once/week x 3 months
265
Risk factors for Gout
```
hyperuricemia
male
obesity
HTN
hyperlipidemia
diuretics
cyclosporine
low dose ASA
meat
seafood
alcohol
high sugar soft drinks
```
266
Tx for Gout
NSAID
naproxen 500mg BID x 1-3d
Colchicine 0.6mg BID-TID x 1-3 days
267
Tx if recurrent Gout
if >3 attacks/year that are unexplained and unavoidable:
Allopurinol 50-100mg qdaily
increase by 100mg in 2-4w
wait 2 weeks after resolution of an acute attack to initiate allopurinol
268
workup for SLE
CBC, Cr, eGFR, LFTs, CK, CRP, ESR, Vit D, TSH
ANA, Anti-dsDNA, C3/C4, Anti-Ro, anti-smith
Anti-sm, direct coombs
urinalysis
ECG, CXR
269
IPSS criteria
```
incomplete emptying
frequency
intermittency
urgency
weak stream
straining
nocturia
QOL low due to urinary symptoms
```
270
antibiotic for AECOPD simple/complicated
amoxicillin 500mg po TID x 5d
| amoxicillin/clavulanate 500mg po TID OR is risk of pseudomonas ciprofloxacin
271
Abx for OE 7 days)
no perforation - polysporin eye & ear drops 1-2 drops QID
perforation - ciprodex 4 drops BID
272
Abx for OM 5 or 10 days)
Amoxicillin 500mg po TID or 80mg/kg div BID or TID
10d if <2yo
5d if >2yo
273
Abx or Pertussis (5-7 days)
Azithromycin 500mg x 1d, then 250mg qdaily x 4d
274
Abx for Pharyngitis (10 days)
Penicillin V 300mg po TID for 10 days
| if less than 27kg = 40mg/kg div BID or TID
275
Abx for Sinusitis (10-14d)
Amoxicillin 500mg TID or 80mg/kg div BID or TID
276
Abx for pneumonia (14d)
Amoxicillin 1g po TID
OR, if complicated in LTC,
Amoxicillin 1g po TID x 14d + Azithromycin x 5d
277
Influenza treatment?
Oseltamivir 75mg BID x 5d
278
Influenza post exposure prophylaxis (within 48h)
Oseltamivir 75mg qdaily x 10d
279
Impetigo Tx?
topical if mild - mupirocin 2% TID for 7d
| systemic if severe - cephalexin 250-500mg QID x 10d
280
Tx for Onychomycosis
12-16w for toes
6w for finger
Terbinafine 250mg qdaily
281
VZV Shingles
initiate within 72h of rash
| valacyclovir 1g po TID x 7d
282
Abx in pyelonephritis?
Ciprofloxacin 500mg BID
283
Abx in uncomplicated female UTI?
macrobid 100mg po BID x 5d
284
Abx in uncomplicated childrens UTI?
Septra 5-10mg/kd/d
285
Abx for asymptomatic bacteruria?
NONE UNLESS pregnant
then Amoxicillin 500mg po TID x 7d
- same for acute cystitis in pregnant women
286
Abx for C & G/Cervicitis?
Ceftriaxone 250mg IM x 1 + Azithromycin 1g po x1
287
Abx for Prostatitis?
Ciprofloxacin 500mg po BID x 4-6w
288
Abx for Trich & BV?
Metronidazole 500mg po BID x 7d
289
Tx for genital HSV?
acyclovir 400mg po TID x 10d
290
Tx for genital warts?
imiquimod qhs
cryotherapy q1-2w
podophyllin resin
291
Tx for PID?
Ceftriaxone 250mg IM x 1 +
| Doxycycline 100mg po BID x 14d
292
Tx for vulvovag candidiasis?
clotrimazole PV 500mg x 1
OR
Fluconazole 150mg po x1
293
Tx for traveller's diarrhea?
bismuth (pepto) 2tabs QID
loperamide 4mg x 1 then 2mg after each loose BM (max 8 doses/day)
Azithromycin 1000mg x 1 (if >3 BM day/blood or fever)
294
Prevention of IE?
Amoxicillin 2g po x 1
295
CT Head Rule
- not on blood thinners
- head injury is from trauma
- GCS >13
- age >16
- no skull #
all Yes? --->
```
GCS >15 2 hours post injury
suspected skull #
signs of basilar skull #
vomiting >2 episodes
age >65
amnesia >30 minutes
dangerous mechanism
```
