Priority Topics Flashcards
(107 cards)
1
Q
ACLS steps for shockable rhythm
A
Give O2
Attach defib
Vent fib or pulseless ventricular tachycardia
SCREAM
Shock
CPR - 30:2 ratio for 2 min
Rhythm - check q2m and shock if indicated
CONTINUE CPR
Epinephrine q3-5m 1 mg IV/IO OR can give vasopressin in place of 1st or 2nd dose of epi
AM - Antiarrhytmic medication - give Amiodarone, lidocaine or mag sulfate
2
Q
Shockable rhythms
A
Ventricullar fibrillation
Pulseless ventricular tachycardia
Pulseless
EMERGENCY
3
Q
Medications that cross into breast milk
A
Antimetabolites, chloramphenicol, diazepam, ergots, golds, metronidazole, tetracycline, lithium, cyclophosphamide
4
Q
Absolute contraindications to breastfeeding
A
HIV, HTLV type 1 and 2, infant galactosemia
5
Q
Safest SSRI in pregnancy and breastfeeding
A
Sertraline
6
Q
Common issues when breast feeding
A
Inadequate milk (consider domperidone), breast engorgement (cool compresses, manual expression), nipple pain (clear milk off after feeds, moisturizer, topical steroids), mastitis (treat with cloxacillin or cephalexin), inverted nipples, maternal medication
7
Q
What is in Pediacel?
A
Six-in-one needle that protects against pertussis, diphtheria, tetanus, polio, Hib (Haemophilus Influenzae type B) meningitis/epiglottitis
8
Q
When should children get DTap IPV Hib
A
2, 4, 6, 18 months
9
Q
When should influenza vaccine be started in children?
A
6 months and annually thereafter
10
Q
Side effect of rotavirus vaccine
A
Intussusception
Meckle’s diverticulum
11
Q
Side effects of TdaP IPV vaccine
A
Possible seizure on same day (rare)
12
Q
What vaccine causes ORS as a side effect?
Oculo respiratory syndrome
Bilateral red eyes AND cough/wheezing/hoarseness/sore threat/tightness/difficulty breathing/swallowing
A
Influenza
13
Q
What vaccine should be avoided in preganancy?
A
Live - polio, MR, varicella
Oral typhoid
14
Q
What vaccine should be avoided in preganancy?
A
Live - polio, MR, varicella
Oral typhoid
15
Q
Side effect of DTaP
A
Large swelling can occur with 4-5th dose
Self limiting
Not an allergy sign, future doses remain safe
15
Q
Side effect of MMR
A
Rare but thrombocytopenia is possible
Orchitis (mumps)
Parotitis (mumps)
Arthralgia (rubella)
16
Q
What is hypotonic hyporesponsive episode and what vaccine is it associated with?
A
Sudden onset of reduced muscle tone, hyporesponsiveness, pallor/cyanosis within 12 hours of immunization
Rag doll reaction
Associated with pertussis vaccine
Not a CI to further doses
17
Q
What is the only vaccine given at birth?
A
Hepatitis B
2nd dose given at 2 months
18
Q
What medical exams should be done on new immigrants to Canada?
A
- chest xray and report for > 11 yo
- urinalysis > 5 yo
- syphilis serology > 15 yo
- HIV testing > 15 yo or those who have an HIV mother, identified risk or received blood products
- serum creatinine > 15 yo and children with h/o HTN, DM, kidney disease
- psychosocial support
- develop immunization catch up schedule
19
Q
What immunization should pregnant woman have?
A
Tdap every pregnancy between 27-32 weeks or earlier if risk of preterm labor
Rubella for all non immune mothers
20
Q
What should be asked at each well baby visit?
Rourke
A
Parent and caregiver concerns
Breastfeeding up to 2-3 yo + Vitamin D 400 IU/d
21
Q
What education and advice should be discussed at 1 week?
Rourke
A
Car seat, safe sleep position (avoid bed sharing, crib safety, position, room share), firearm safety
22
Q
What education and advice should be discussed at 1 month?
Rourke
A
Second hand smoke, supervised tummy time, no OTC cough/cold meds
23
Q
What education and advice should be discussed at 2 months?
Rourke
A
Car seat, safe sleep, poisons, firearm safety
24
What education and advice should be discussed at 4 months?
| Rourke
Night walking, healthy sleep habits, parent bonding, postpartum depression, assess home visit need, family healthy active living, screen time, social status (making ends meet, food insecurity)
25
What education and advice should be discussed at 6 months?
| Rourke
Second hand smoke, supervised tummy time, dental cleaning with fluoride, no OTC cough or cold meds
26
What education and advice should be discussed at 12-13 months?
| Rourke
Night walking, parenting, making ends meet, high risk infants needing home visits, family healthy active living, avoiding juice or beverages high in sugar
27
What education and advice should be discussed at 18 months?
High risk children, making ends meet, active family, second hand smoke
| Rourke
28
What education and advice should be discussed at 2+ years?
| Rourke
Avoid juice and high sugar drinks, car seat, bike helmet, discipline, depression, making ends meet, second hand smoke, dental health, no OTC cough/cold meds, health sleep habits
29
How do you monitor growth according to the Rourke record?
Measure length, weight and head circumference and plot on graph up until 2-3 yo then do height, weight and BMI
30
When ocular assessments should be done in a child according to the Rourke record?
Red reflex all visits
Start visual acuity at 2 years
Do corneal light reflex from 6 months onward
31
At what point in the Rourke record should tonsil size and sleep disordered breathing be assessed?
1 year onwards
32
When can you start introducing solids?
| Pediatrics
6 months
Give iron containing foods - iron fortified cereals, meat, tofu, legumes, poultry, fish, whole eggs
Discuss allergenic food - eggs and peanuts
Avoid high sugar food and drink
33
What is a Broselow tape?
Broselow Tape relates a child's height as measured by the tape to their weight to provide medical instructions including medication dosages, the size of the equipment that should be used, and the level of energy when using a defibrillator
34
Neurologic symptoms that are possible after vaccination
Persistent crying, seizure, paraesthesia, paralysis, guillain barre, subacute sclerosing panencephalitis, meningitis
35
System reactions that can occur after vaccination
Adenopathy, anaphylaxis, allergic reaction, erythema multiforme, rash, hypotonic hyporesponsive episode, arthralgia, severe diarrhea or vomiting
36
Other reactions that are possible after vaccination
Parotitis, orchitis, thrombocytopenia, narcolepsy, ORS, bell's palsy, intussusception
37
Indicators of good CPR
- Push hard >2 inches (5 cm) and fast (100-120/min) and allow complete chest recoil
- Minimize interuptions
- Avoid excessive ventilation
- Rotate compressors every 2 minutes or sooner if tired
- If no airway then 30:2 compression ventilation ratio
- If PETC02 < 10 mmhG attempt to improve the quality
38
Drug therapy in ACLS
Epinephrine
Amiodarone
Lidocaine
39
Advanced airway in ACLS
- Endotracheal intubation or supraglottic advanced airway
- Waveform capnography or capnometry to confirm and monitor ET placement
- Once in place give breath nce every 6 seconds (10/min) with continuous chest compressions
40
How to you confirm ROSC
| Return of spontaneous circulation
Pulse and blood pressure
Abrupt sustained increased in Petc02 > 40 mmHg
Spontaneous arterial pressure waves with intra arterial monitoring
41
Reversible causes cardiac arrest
– Hypovolemia
– Hypoxia
– Hydrogen ion (acidosis)
– Hypo-/hyperkalemia
– Hypothermia
– Tension pneumothorax
– Tamponade, cardiac
– Toxins
– Thrombosis, pulmonary
– Thrombosis, coronary
## Footnote
H’s and T’s of ACLS is a mnemonic used to help recall the major contributing factors to pulseless arrest including PEA, asystole, ventricular fibrillation, and ventricular tachycardia. These H’s and T’s will most commonly be associated with PEA, but they will help direct your search for underlying causes to any of arrhythmias
42
What are indicators of inappropriate resuscitation?
Asystole, long code times, poor pre code prognosis, living wills, DNR
43
What are indicators of inapproriate resucitation?
Asystole, long code times, poor pre code prognosis, living wills, DNR
44
What is important to remember in a code?
| RE: family
Speak to the family
45
Examples of autosomal recessive conditions
cystic fibrosis - deficiency in the chloride channel CFTR
inborn errors of metabolism
PKU, von Gierke's, Pompe's, glycogen storage diseases, sphingolipidoses (except Fabry's), and mucopolysaccharidoses (except Hunter's)
sickle cell anemia
thalassemias
albinism
ARPKD
hemochromatosis
| 1/4 of offspring affected when both parents are carriers
## Footnote
Must have 2 defective copies of the gene
46
Examples of autosomal dominant conditions
von Willebrand disease (most common)
Huntington's disease
osteogenesis imperfecta
achondroplasia
Marfan syndrome
neurofibromatosis type I
acute intermittent porphyria
## Footnote
Only one copy of the defective gene is required to express the disease phenotype
47
What medications are used for rate control in atrial flutter?
Beta blocker, diltiazem, verapamil, digoxin
48
What medications are used for chemical cardioversion in atrial flutter?
Sotalol, amiodarone, type 1 antiarrhythmics
49
First line treatment for depression in youth
Fluoxetine
| Paroxetine is not recommended for youth
## Footnote
Blocks serotonin reuptake. Can cause sexual dysfunction, headache, GI upset, weight loss, tremors, increased QT interval
50
First line oral medication for HTN in pregnancy
Labetalol, methyldopa, nifedipine, other beta blockers
| AVOID ACEi and ARBs, PRAZOSIN OR ATENOLOL
51
First line treatment for PMS
Exercise, CBT vitamin B6
Can try SSRI (citalopram or escitalopram) continuously or during luteal phase (day 15-28)
Combined hormonal contraception
52
First line treatment for suspected endometriosis
Combined hormonal contraception ideally continuous or progestin alone (oral, IM, SC)
53
First line IV antihypertensive in a hypertensive emergency
Labetalol **except in CHF**
Nitroglycerine - used in coronary ischemia and HF
Hydralazine - used in eclampsia
54
First line medication in a high risk bite
Amoxicillin + clavulanate (Augmentin)
Alternatves: Doxycycline (in children older than 9) or ceftriaxone
55
First line pharmaceutical treatment for chronic pelvic pain
1. NSAIDs (ibuprofen, ASA< naproxen)
Second line: Opioids
2. Combined OCPs
3. GnRH agonists
4. Progestins
56
First line therapy for generalized neuropathic pain
Gabapentin, pregabalin, TCA, SNRI
57
First line treatment for post herpetic neuralgia
Lidocaine patch
Capsaicin
Gabapentin, pregabalin
TCA
Anticonvulsant
58
First line treatment for trigeminal neuralgia
Carbamazepine
Phenytoin
Baclofen
59
Treatment for giant cell arteritis
Treat promptly with glucocorticoids if suspected
Diagnostic biopsy can be done later
Can lead to blindness if not prompty treated
60
Signs of endometriosis on laparoscopy
* Mulberry spots: dark blue or brownish-black implants on the uterosacral ligaments, cul-de-sac,
or anywhere in the pelvis
* Endometrioma: “chocolate” cysts on the ovaries
* “Powder-burn” lesions on the peritoneal surface
* Early white lesions and clear blebs
* Peritoneal “pockets”
61
Who should have urgent undelayed antibiotic treatment?
Meningitis, septic shock, febrile neutropenia
62
Common causes of chest pain
Angina/MI, GERD, anxiety, pulled muscle, costochondritis
63
Presentation of typical angina
1. Substernal pressure (may radiate to neck, jaw, shoulders, left arm)
2. Occurs with exertion or stress
3. Relieved with rest (5-10 min) or nitro (immediate)
## Footnote
If 2/3 then atypical angina
If 0 or 1/3 then noncardiac pain
64
Definition of unstable angina
New or rapidly worsening pattern of typical angina that severely limits usual activities or occurs at rest
Chest discomfort or pain caused by poor blood flow and oxygenation of the heart that is unpredictable and can occur at rest.
65
Signs of aortic dissection
HTN, asymmetric BP in upper extemities (>20 mmHg difference), diastolic murmur, hypotension
Widened mediastinum or pleural effusion on CXR
Contast CT: fast, non invasive, highly senstive
66
Gold standard for aortic dissection diagnosis
MRI
Howevere sometimes not readily available and can be time consuming
67
Sudden pleuritic pain (sharp pain that is worse with deep inspiration) with shortness of breath
Tension pneumothorax
Usually unilateral
Look for hyperressonance on percussion and unilateral reduction of breath sounds
68
Sudden pleuritic pain (sharp pain that is worse with deep inspiration) with shortness of breath ± syncope, **tachypnea, tachycardia**
Pulmonary embolism
69
Workup for pulmonary embolism
1 D dimer (if low clinical probability) or go straight to CT pulmonary angiogram
2. CXR - frequently normal
3. VQ scan - sensitive but low specificity
4. ABG - hypoxemia with Aa gradient (no real diagnostic use)
4. VQ scan, contrast chest CT, angiogram to confirm
| If highly suspicious go straight to CT angiography to look for fillling
## Footnote
Pulmonary angiography is gold standard for PE but rarely used and contraindicated if renal dysfunction
70
High risk causes of chest pain
**P**ericarditis
**A**cute corony syndrome (MI)
**P**neumothorax
**P**ulmonary embolism
**A**neurysm
**A**ortic dissection
71
How to screen chest pain patients
**S**ite: ask where the pain is
**O**nset: clarify when the pain first started and if it came on suddenly or gradually
**C**haracter: ask the patient to describe how the pain feels
**R**adiation: ask if the pain moves anywhere else
**A**ssociated symptoms: ask if there are any other associated symptoms
**T**ime course: ask how the pain has changed over time
**E**xacerbating or relieving factors: ask if anything makes the pain worse or better
**S**everity: ask how severe the pain is on a scale of 0-10
**E**xplore the patient’s ideas, concerns, and expectations
**S**ummarise the patient’s presenting complaint
Then screen for other body system symptoms, PMHx, drug hx, FMHx, social hx
72
First line antianginal medications
Beta blockers
73
Ho to exclude ischmic heart disease in chest pain pts
Coronary angiography
74
What vaccine should be given before transplants?
* to all transplant patients: DTaP, pneumococcal, infuenza, hepatitis A and B, COVID-19
* in select patients: MMR, varicella, HPV, herpes zoster
75
Emergent treatment for severe bradycardia
Check for hypoperfusion (LOC, hypotension, severe chest pain)
Try atropine if present
If no resonse then transcutaneous pacing or IV dopamine/epinephrine
Consider hyperkalemia and treat if present
76
Emergent treatment of asystole or pulseless electrical activity
CPR
Epi IV q3-5m
Consider H's and T's
77
Treatment of PE
1. Admit for observation and stratify risk
2. In low risk then send home with anticoagulation
3. O2 to target > 90% sat
4. Anticoagulate ASAP with LMWH or fonaparinux or unfractionated heparin or oral factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) or direct thrombin inhibitors (dabigatran)
5. Give IV thromboyltic for **massive PPE** and no CI
6. May need IVC filter
78
Gold standard to diagnose aortic dissection
MRI
Sensitive and specific but not always readily available and can be time consuming
79
Gold standard to diagnose Hirschsprung's
Rectal biopsy
80
Psychiatric condition that should be included in the differential of fatigue
Depression
81
First line investigations for fatigue
Urinalysis, CBC with differential, blood glucose, HbA1c, TFT
Electrolytes, lipid panel, syphilis, HIV
## Footnote
Possible: ESR/CRP, U&E, LFT, ferritin, calcium, anti endomysial and anti giladin AB
82
Important things to remember to ask in the history taking of fatigue
Complete medication list and history
Sleep disturbances
Lifestyle issues
83
Most definitive test for herpes type 1 and 2
NAAT assay of vesicle fluid or ulcer swab
Can do HSV PCR which is 100% specific but not as sensitive
84
An edematous external auditory cancl with **increased pain when pushing on the tragus or pulling on the pinna**
Otitis externa
85
Erythematous and bulging tympanic membrane
AOM
86
Erythemarous and fluctuance over the mastoid region
Mastoiditis
| Clinical diagnosis not a radiological one
## Footnote
Potentially life threatening complication of AOM that manifests as redness and swelling over the mastoid region immediately posterior to the external ear. **If suspected then administer IV AB urgently and refer to otolaryngology for surgical debridement**
87
MCC pediatric ear pain
Otitis media
| MC S. pneumoniae, H. influenza, M. catarrhalis, viral
## Footnote
Arises from Eustachian tube obstruction secondary to edema from URTI, allergies or inadequate opening that can lead to negative middle ear pressure causing influx of pathogens from nasopharynx
88
First line treatment for acute otitis media
High dose amoxicillin
| Second line = Augmentin or cephalosporin
## Footnote
Recurrent infections may require myringotomy and tube insertion
89
MCC hearing loss in children? Adults?
Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction
90
MCC hearing loss in children? Adults?
Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction
91
MCC hearing loss in children? Adults?
Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction
92
MCC hearing loss in children? Adults?
Childen: acute otitis media or otitis media with effusion
Adults: cerumen impaction
93
Vaccines to give post splenectomy
Ideally 14 days prior to splenectomy or day 14 or on discharge give:
HiB regardless of age or previous immuization history, quadrivalent meningococcal, serogroup b meningococcal, both pneumococcal conjugate and polysaccharide. Hep B indicated for those with repeat transfusions ie: sickle cell or thalassemia
Annual influenza
Boosters every 5 years for bacgerial vaccines
94
Achalasia vs esophageal stricture
**Achalasia** - failure of LES smooth muscle to relax
A/W ilness, cancer, Chaga's, Allgrove's
25-60 yo
Tx myotomy, pneumatic balloon dilation, Botulinum
**Esophageal stricture** - physical narrowing of the esophagus
A/W GERD, swallowing corrosive substance, radiation, damage from NG tube
> 40 yo
Tx balloon dilation, stent, surgery to remove some tissue
| Both present with difficulty with swallow
95
Tests to order in acute abdominal pain
ALP, ALT, AST, bilirubin
Lipase, amylase
Urinalysis
Beta HCG
Troponins
Lactate
96
What are enlarged hard left supraclavicular nodes associated with?
Gastric carcinoma
97
A hypotensive, tachycardic or febrile patient in the setting of abdominal pain is concerning for?
Ischemic bowel, ruptured AAA, sepsis
98
Hyperactive bowel sounds are suggestive of?
Mechnical bowel obstruction
99
SBO signs and treatment
Intermittent, colicky, postprandial pain with recurring cramps q3-10m, vomiting, crescendo descrescendo rushes of high pitched peristalsis sounds and **history of previous surgery**
Do abdo xray and CT to diagnose and urgent referral to surgery to treat. Can try NG tube decompression.
100
Signs and treatment of irritable bowel syndrome
Chronic and recurrent abdominal pain and/or altered bowel habits for at least 6 months with at least two of the following:
1. Defectation increases or improves pain
2. Change in stool frequency
3. Change in stool appearance
Treat with diet and lifestyle changes
101
Clinical signs of pancreatitis
Constant midepigastic pain radiates to left shoulder and back and worsens with laying on back (supine)
102
Fever, RUQ pain and jaundice
Charcot's Triad
Describes the symptoms and presentation of cholangitis
| Reynol's pentad = those sx + hypotension and altered mental status
## Footnote
Cholangitis is inflammation of the bile ducts leading to infection of the gallbladder, liver or biliary system. It is a progression of choledocholithiasis.
103
Extraintestinal manifestations of inflammatory bowel disease
Crohn's: erythema nodosum (red, painful nodules on the shin bilaterally typically), pyoderma gangrenosum (lower extremity ulcers), perianal skin tags, oral ulcers, arthritis, uveitis and episcleritis, gall stones, fatty liver, osteoporosis
UC: erythema nodosum, pyoderma gangrenosum (less common, more often in Crohn's), arthritis, uveitis,
104
Treatment for vaginal candida
Clotrimazole, butoconazole, miconazole, terconazole, fluconazole
| Look for hyphae and spores on wet mount
105
Treatment for bacterial vaginosis
None if non pregnant and asymptomatic unless scheduled for procedure or surgery
Oral: metronidazole (better in preg)
Vaginal: metronidazole, clindamycin, probiotics
| Look for CLUE cells (squamous epithelial cells dotted with coccobacilli)
## Footnote
**INcreased risk of preterm birth**
106
Treatment for trichomoniasis
Metronidazole
| Treat partners too!
## Footnote
Positive whiff test, yellow/green smelly discharge
