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1
Q

How long can a limb tolerate acute occlusion of a peripheral artery before irreversible damage?

A

6 hours

Exception is only acute on chronic occlusion where collaterals provide SOME perfusion

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2
Q

Is abnormal pulse in the unaffected limb a sign of emboli or thrombus?

A

Thrombus

Also look for prior history of claudication, vascular intervention, bypass

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3
Q

Gold standard test for diagnosis and grading of aortic dissection

A

CTA

Tear in intima allowing blood to go into media

MRA if CTA contraindicated

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4
Q

What are conditions that predispose to priapism where PDE inhibitors should not be used?

A

Leukemia, myelofibrosis, polycythemia, sickle cell disease

Contraindicated in patients on nitrates due to severe hypotension

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5
Q

Medications for benign prostatic hyperplasia

A
  1. Alpha blockers (terazosin or doxazosin, tamsulosin, afluzosin, silodosin) - watch for headache, leg edema, presyncope
  2. 5 alpha reductase inhibitors (finasteride, dutasteride) - blockers conversion of test to DHT and reduces prostatic volume - watch for sexual dysfunction
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6
Q

Medications for prostate carcinoma

A
  1. GnRH agonist (leuprolide, goserelin, degarelix) - watch for hot flashes, headaches, decreased libido
  2. Non steroidal antiandrogen (flutamide, bicalutamide, abiraterone, enzalutamide) - watch for hepatotoxicty, high triglycerides, periheral edema
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7
Q

What medications can you give for an overactive bladder?

A
  • Oxybutynin (antispasmodic and anticholinergic)
  • Tolterodine, trospium, solifenacin, darifenacin, fesoterodine, proiverine (anticholingerics)
  • Mitabegron (beta3 agonist)
  • Imipramine (TCA) better for stress incontinence
  • Botulinum injection (neurotoxin)
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8
Q

What should all patients with suspected uretehral injury undergo?

A

Retrograde urethrogram or cystoscopy

Blood at meatus, high riding prostate on DRE, penile/scroal hematoma, distended bladder

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9
Q

What meds are NSAIDs and what are their contraindications?

A

Ibuprofen Advil, diclofenac Voltaren (+- misoprostol Arthrotec), naproxen Aleve, meloxicam

Contraindicared in GI bleeds, renal problems, pregnancy or if pt is anticoagulated

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10
Q

What is tylenol (acetaminophen) contraindicated in?

A

Severe liver disease

It is first line for osteoarthritis though

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11
Q

What needs to be done if you are starting a patient on a newer DMARD biologic (ie etanercept, infliximad, adalimumab, golimumab abatacept, rituximab)?

A

Patients require negative TB skin test, CXR, & negative hepatitis B serology

Be mindful that there is increased risk of: infections, worsened heart failure, multiple sclerosis and positive autoantibodies

Do pneumonia, shingles and hepatitis B vaccines 2 weeks prior ideally

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12
Q

Bronchodilator in acute reversible airway obstruction

A

SABA (short acting beta2 agonist)
Salbutamol or albuterol

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13
Q

Maintenance treatment and prevention of bronchospasm in COPD or asthma

A

LABA
Salmeterol, formoterol, indacterol

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14
Q

Short and long acting anticholinergics used in asthma and COPD

A

Short = ipratropium bromide

Long = tiotropium bromide

Watch for palpations, anxiety, dizziness, fatigue

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15
Q

Medication for status asthmaticus

A

Prednisone or methylprednisolone oral

Can also be used for acuter exacerbation of COPD, bad asthma, PCP pneumo

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16
Q

Medications for community acquired pneumonia

A

Amoxicillin

Macrolide - erythromycin, azithromycin, clarithromycin

Tetracycline - Doxycycline

Fluoroquinolone - levofloxacin, moxifloxacin

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17
Q

Pressor medications

Use for hypotension or intropic support

A

Norepinephrine
Phenylephrine
Dobutamine

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18
Q

Who is dialectical behavioral therapy used in?

A

People with borderline personality disorder

Combined CBT and Buddhist Zen mindfullness practices

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19
Q

What dopamine pathways are affected in schizophrenia?

A

Mesolimbic = high dopamine causes positive symptoms

Mesocortical = low dopamine causes negative symptoms

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20
Q

Medications for the treatment of acute psychosis in the emergency setting

A

Haloperidol IM
Loxapine PO or IM
Olanzapine PO or IM
Risperidone Liqui

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21
Q

Typical antipsychotics

A

Haloperidol, fluphenazine, zuclopenthixol, perphenazine, loxapine, chlorpromazine

Chlorpromazine and haloperidol highest risk of QT prolongation

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22
Q

Atypical antipsychotics

A

Risperidone, paliperidone, olanzapine, asenapine, ziprasidone, aripiprazole, quetiapine, clozapine

Ziprasidone and clozapine highest risk of QT prolongation

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23
Q

Neuroleptic malignant syndrome features

A

FARM (think of going crazy on the farm)

Fever
Autonomic changes (high HR/BP, sweating)
Rigidity
Mental status changes

IF THERE IS SHIVERING, RESTLESSNESS, TWITCHINESS, VOMITING, DIARRHEA OR STOMACH PAIN THINK MORE OF SEROTONIN SYNDROME

More due to antipsychotics causing dopamine disturbances

Young pt with mental health changes, fever, ridigity, autonomic instability over 2-3 days with increased creatine phosphokinase, leukocytosis, myoglobinuria

RX: STOP MED, COOL, DANTROLENE, AMANTADINE OR BROMOCRIPTINE

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24
Q

What meds block the affects of dopamine and what are generalised side effects?

A

Antipsychotics

EPS, galactorrhea, amenorrhea, erectile dysfunction, weight gain

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25
Name the extrapyramidal symptoms
DYSTONIA *sustained abnormal posture, muscle spasms, oculogyric crisis* AKATHISIA *crawling sensation relieved by walking* PARKINSONISM *tremor, rigid, absent arm swing, stooped posture, shuffling gait* DYSKINESIA *purposelessness, involuntary facial and mouth movements, can sometimes show up as hiccups* ## Footnote **RX BENZTROPINE, DIPHENHYDRAMINE (anticholergics but DO NOT GIVE FOR TD AS THESE WORSEN SYMPTOMS - can try clozapine for TD**)
26
How long does it take antidepressants to work?
1-3 weeks for neuro vegetative and physical symptoms 2-6 weeks for emotional and cognitive symptoms **MONITOR FOR SUICIDAL BEHAVIOR FOR FIRST TWO WEEKS**
27
SSRI medications and what they are useful for
Fluxoetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram Good for typical and atypical depression, seasonal, anxiety, OCD and other eating disorders
28
Which SSRI is best in pregnancy and breast feeding
Sertraline
29
SNRI medications and what conditions they are useful for?
Venlafaxine, desvenlafaxine, duloxetine Good for depression, anxiety, neuropathic pain **sad, scared, suffering**
30
What type of medication is bupropion?
NDRI Increases risk of seizures Contraindicated in strokes or head injury Bad for anxiety as it has stimulating effects
31
Which TCA is good in OCD?
Clomipramine **gold standard** Required ECG monitoring, highly lethal in overdose
32
What kind of medications are nortriptyline and desipramine?
TCAs (secondary amines) Prefered because less anticholinergic effects
33
What medication class good for refractory depression? | Hint: cheese
MAO inhibitors such as phenelzine and tranylcypromine
34
What medications are mood stabilizers are what is their main indication?
Divaloproex, lamotrigine, carbamazepine, lithium Use for long term stabilization of bipolar disorder or monotherapy/conjunction with atypical for acute bipolar disorder
35
What mood stabilizer do you need to order LFTs before initiating?
**Diva**lproex and **carb**amazepine ## Footnote Of note they both riase the seizure threshold
36
What drugs increase risk of lithium toxicity?
NSAIDs, thiazides, ACEi, metronidazole
37
Which mood stabilizer is associated with Steven Johnson Syndrome?
Lamotrigine
38
Who are benzos contraindicated in?
Myasthenia gravis, major depression (unless it is an adjunct), drug/alcohol misuse history, caution in pregnancy/breastfeeding | Cause GABA to bind it receptors to decrease neuronal activity
39
Benzos that are safe in impaired liver function
LOT Lorazepam Oxazepam Temazepam | LIVER OK THINGS
40
What is the preferred med for generalized anxiety disorder?
**Buspirone** Non sedating Does not react with alcohol Does not alter seizure threshold Not prone to abuse
41
What are the short acting benzos?
LOAT Lorazepam - high dependency Oxazepam - use for alcohol withdrawl or GAD Alprazolam - As above Temazepam - dont use Triazolam - overnight plane travel but risk of rebound insomnia
42
What is WHO's Pain Relief Ladder steps
Non opioid + adjuvant Then add opioid Then add stronger opioid
43
Pediatric otitis media treatment
Amoxicillin
44
Colic definition
Paroxysms of unexplained irritability and crying for more than 3 hours per day for more than 3 days per week for more than 3 months in an otherwise healthy baby Rx: Relief and reassurance and rest, maybe try changing feeding technique, try eliminating allergens
44
When to initiate treatment in primary enuresis?
Not until 7 years old because there is a high rate of spontaneous cure | Bladder control has never been attained
45
Leading cause of death of 1-12 month old babies
**SIDS** Risks: prematurity, alcohol use, soft bed, low birthweight, Indigneous, no prenatal care, smoking in household, prone sleep position, poverty, bed sharing, drugs
46
MC congenital heart defect in children
VSD
47
Baby who throws up (non bilious) very soon after birth and is drooling, choking, in resp distress, cannot feed and cyanotic ## Footnote Excessive secretions SOON AFTER BIRTH
Think TE fistula On exam you wont be able to advance the NG tube Do upper GI series with contrast
48
Baby who projectile vomits (non bilious) within 30 minutes of feeding, is fatigued and dehydrated and has palpable olive mass in RUQ
Think pyloric stenosis Look for hypokalemic, hypochloremic metabolic acidosis on ABG
49
What is the most common cause of pediatric hearing loss?
Otitis media with effusion 90% resolve in 3 months Surgical rx: myringotomy with tempanostomy
50
What are vesiscles/erosions on the pharynx/tongue caused by vs buccal mucosa/tongue?
Pharynx = posterior = Coxsackie A (Hand foot and mouth) Buccal = anterior = herpes simplex
51
Medical treatment for GAS
Penicillin V or amoxicillin or erythromycin (if penicillin allergy) | PEA ## Footnote Pharyngitis, sclarlet fever, rheumatic fever, PSGN
52
What is piperacillin with tazobactam used to treat?
Pseudomonas coverage Gram + Gram - aerobes
53
What nasal sprays are bad in pts with preexisting HTN?
Decongestants like xylometazoline, oxymetazoline, phenylephrine
54
What medications are used for migraine prophylaxis vs acute migraine
Prophylaxis = topiramate or propanolol Acute = sumatriptan or dihydroergotamine
55
Which medications are loops and what electrolyte changes do they cause?
Furosemide, bumetanide, ethacrynate, torsemide Hypokalemia Hyponatremia Hypocalcemia but hypercalciuria (stones) ## Footnote Precipitate gout
56
Which medication class increases calcium excretion? Which decreases it?
Loops LOSE calcium (increased excretion) Thiazides TIGHTLY hold calcium (decreased excretion - used for hypercalciuria and stones)
57
Features of malignant lymphadenopathy
Firm Non tender Enlarging Immobile Worrisome location like supraclavicular or generalized Abnormal imaging or bloodwork Constitutional symptoms ## Footnote Fluctuance, warmth, or tenderness are more suggestive of benign nodes
58
How many doses of MMR are required?
2 doses of MMR after 12 months and at least 28 days apart
59
Drugs that prolong QT
Normal QTc 350-450 Antiarrhythmics Antipsychotics (hal/zip) Antibiotics (macrolides ery/azi) Antidepressants (cital)
60
Things that decrease QT
Digoxin Hypothyroid Increased calcium
61
Signs of adrenal insufficiency
Fatigue Weight loss GI issues Hypotension Electrolyte disturbance | Do ACTH stimulation test
62
Guillain Barre cause and presentation
MC a/w Campylobacter Acute rapidly evolving demyelinating inflammatory polyradiculoneuropaty that starts in the lower limbs and moves up Look for a child with paresthesias, weird walk, poor propioception and vibration, weakness, areflexia, BP dysregulation and bladder dysfunction Consider CSF to look for HIGH PROTEIN AND NORMAL WBC (albumocytologic dissociation) Treat with IVIG and pain management
63
First line treatment for severe hypercalcemia
FLUIDS THEN furosemide to prevent heart failure from high volume saline THEN Alendronate and/or calcitonin (take 24-48 hours to work)
64
Most common cutaneous malignancy in immunocompromised patients such as organ transplant recipients
Squamous cell carcinoma
65
HTN and hypokalemia
Consider primary hyperaldosteronism Underdiagnosed cause of HTN K could be normal TEST WITH PLASMA ALDOSTERONE TO PLASMA RENIN ACTIVITY RATIO (should be more than 20 in normal)

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