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YA - Interactive seminars/University lectures > Toronto Notes Gems > Flashcards

Toronto Notes Gems Flashcards

1
Q

6 As of General Anesthesia

A 
Anesthesia
Anxiolysis
Amnesia
Areflexia (muscle relaxation not always required)
Autonomic Stability
Analgesia
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2
Q

Discuss β-blockers (b1 vs. b2) & its cautions

A

• b1 receptors are located primarily in the heart and kidneys
• b2 receptors are located in the lungs
• Non-selective b-blockers block b1 and b2 receptors. Caution is required with non-selective b-blockers, particularly in patients with respiratory conditions
where b2 blockade can result in
airway reactivity

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3
Q

Pre-Anesthetic Checklist

A

SAMMM

  • Suction: connected and working
  • Airways: laryngoscope and blades, ETT, syringe, stylet, oral and nasal airways, tape, bag and mask
  • Machine: connected, pressures okay, all meters functioning, vaporizers full
  • Monitors: available, connected and working
  • Medications: IV fluids and kit ready, emergency medicines in correct location and accessible
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4
Q

Suspect Difficult Bag-Mask Ventilation with:

A

BONES

Beard
Obesity/Obstetrics
No teeth
Elderly
Sleep apnea
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5
Q

Differential Diagnosis of Poor Bilateral Breath Sounds after Intubation

A

DOPE

Displaced ETT
Obstruction
Pneumothorax
Esophageal intubation

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6
Q

Causes of Intraoperative Shock

A

SHOCKED

Sepsis or Spinal shock
Hypovolemic/Hemorrhagic
Obstructive
Cardiogenic
anaphylactiK
Extra/other
Drugs
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7
Q

Discuss Opioid Equivalency for morphine, codeine, oxycodone & hydromorphone

A
  • 10 mg morphine
  • 100 mg codeine
  • 5 mg oxycodone
  • 2 mg hydromorphone
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8
Q

Use NSAIDs with Caution in Patients with:

A
  • Asthma
  • Coagulopathy
  • GI ulcers
  • Renal insufficiency
  • Pregnancy, 3rd trimester
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9
Q

Common Side Effects of Opioids

A
  • Nausea and vomiting
  • Constipation
  • Sedation
  • Pruritus
  • Abdominal pain
  • Urinary retention
  • Respiratory depression

When prescribing opioids, consider:
• Breakthrough dose
• Anti-emetics
• Laxative

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10
Q

Classic Presentation of Dural Puncture Headache

A
  • Onset 6 h-3 d after dural puncture
  • Postural component (worse sitting)
  • Occipital or frontal localization
  • ± tinnitus, diplopia
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11
Q

Differential of ST Segment Changes

A

ST Elevation “I HELP A PAL”

  • Ischemia with reciprocal changes
  • Hypothermia (Osborne waves)
  • Early repolarization (normal variant; need old ECGs)
  • LBBB
  • Post-MI
  • Acute STEMI
  • Prinzmetal’s (Vasospastic) angina
  • Acute pericarditis (diffuse changes)
  • Left/right ventricular aneurysm

ST Depression “WAR SHIP”

  • WPW syndrome
  • Acute NSTEMI
  • RBBB/LBBB
  • STEMI with reciprocal changes
  • Hypertrophy (LVH or RVH) with strain
  • Ischemia
  • Post-MI
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12
Q

Important Contraindications to

Exercise Testing

A

• Acute MI, aortic dissection,
pericarditis, myocarditis, PE
• Severe AS, arterial HTN
• Inability to exercise adequately

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13
Q

Treatment of NSTEMI/Immediate Treatment of Acute MI

A

BEMOAN

β-blocker
Enoxaparin
Morphine
O2
ASA
Nitrates
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14
Q

Complications of MI

A

CRASH PAD

Cardiac Rupture
Arrhythmia
Shock
Hypertension/Heart failure
Pericarditis/Pulmonary emboli
Aneurysm
DVT
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15
Q

Use Ejection Fraction to Grade LV

Dysfunction

A
  • Grade I (EF >60%) (Normal)
  • Grade II (EF = 40-59%)
  • Grade III (EF = 21-39%)
  • Grade IV (EF ≤20%)
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16
Q

Five Most Common Causes of CHF

A 
• CAD (60-70%)
• HTN
• Idiopathic (often dilated
cardiomyopathy)
• Valvular (e.g. AS, AR and MR)
• Alcohol (dilated cardiomyopathy)
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17
Q

Precipitants (c.f. exacerbations) of Heart Failure

A

HEART FAILED

  • Hypertension (common)
  • Endocarditis/environment (e.g. heat wave)
  • Anemia
  • Rheumatic heart disease and other valvular disease
  • Thyrotoxicosis
  • Failure to take meds (very common)
  • Arrhythmia (common)
  • Infection/Ischemia/Infarction (common)
  • Lung problems (PE, pneumonia, COPD)
  • Endocrine (pheochromocytoma,
    hyperaldosteronism)
  • Dietary indiscretions (common)
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18
Q

Features of Heart Failure on CXR

A

HERB-B

Heart enlargement (cardiothoracic ratio >0.50)
Pleural Effusion
Re-distribution (alveolar edema)
Kerley B lines
Bronchiolar-alveolar cuffing
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19
Q

Discuss the regime with beta blocker use in acute on chronic HF patients

A

Patients on β-blocker therapy who have acute decompensated heart
failure should continue β-blockers
where possible (provided they are
not in cardiogenic shock or in severe pulmonary edema)

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20
Q

Chronic Treatment of CHF

A
  • ACE inhibitors*
  • β-blockers*
  • ± Aldosterone antagonists* (if severe CHF) e.g. spironolactone
  • Diuretic
  • ± Inotrope
  • ± Antiarrythmic
  • ± Anticoagulant

*Mortality benefit

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21
Q

(4) types of Cardiomyopathy

A

HARD

  • Hypertrophic cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
  • Restrictive cardiomyopathy
  • Dilated cardiomyopathy
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22
Q

(3) Major Risks Factors for DCM

A

Alcohol, cocaine, family history

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23
Q

Acute Pericarditis Triad

A
  • Chest Pain
  • Friction Rub
  • ECG Changes
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24
Q

Ewart’s Sign

A

Bronchial breathing and dullness to percussion at the lower angle of the left scapula in pericardial effusion due to effusion compressing left lower lobe of lung.

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25
Q

Classic Quartet of Tamponade

A
  • Hypotension
  • Increased JVP
  • Tachycardia
  • Pulsus paradoxus
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26
Q

Beck’s Triad in cardiac tamponade

A
  • Hypotension
  • Increased JVP
  • Muffled heart sounds
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27
Q

DDx Pulsus Paradoxus

A
  • Constrictive pericarditis (rarely)
  • Severe obstructive pulmonary disease (e.g. asthma)
  • Tension pneumothorax
  • PE
  • Cardiogenic shock
  • Cardiac tamponade
28
Q

Symptoms of Acute Limb Ischemia

A

6 Ps – all may not be present

  • Pain: absent in 20% of cases
  • Pallor: within a few hours becomes mottled cyanosis
  • Paresthesia: light touch lost first then sensory modalities
  • Paralysis/Power loss: most important, heralds impending gangrene
  • Polar/Poikilothermia (cold)
  • Pulselessness: not reliable
29
Q

Classic Triad of Ruptured AAA

A
  • Pain
  • Hypotension
  • Pulsatile abdominal mass
30
Q

Trousseau’s disease/sign

A

Migratory superficial thrombophlebitis is often a sign of underlying malignancy

31
Q

Antiarrythmic Drug Classification

A

Some Block Potassium Channels

I – Sodium channel blocker
II – β-Blocker
III – Potassium channel blocker
IV – CCB

32
Q

The Cockcroft-Gault Equation (estimate creatinine clearance (CrCl) in adults 20 yr of age and older)

A

• For males CrCl (mL/min) =
[(140 – age in yr) x Weight (kg)] x 1.2 / serum Cr (μmol/L)

  • For females, multiply above equation x 0.85
  • Only applies when renal function is at steady state
33
Q

How many half lives does it need to reach steady state with repeated dosing or to eliminate a drug once dosing is stopped?

A

For most drugs it takes 5 half-lives

34
Q

Keloids vs. Hypertrophic Scars

A 
• Keloids: extend beyond margins
of original injury with claw-like
extensions
• Hypertrophic scars: confined to
original margins of injury
35
Q

DDx of Hyperpigmented Macules

A 
• Purpura (e.g. solar, ASA, anticoagulants,
steroids, hemosiderin
stain)
• Post-inflammatory
• Melasma
• Melanoma
• Fixed drug eruption
36
Q

ABCDE of Melanoma

A 
Asymmetry
Borders (irregular)
Colour (variegated)
Diameter (>6 mm)
Evolution (over time)
37
Q

Triggers for Atopic Dermatitis

A 
• Irritants (detergents, solvents,
clothing, water hardness)
• Contact allergens
• Environmental aeroallergens (dust mites)
• Inappropriate bathing habits (long hot showers)
• Sweating
• Microbes (S. aureus)
• Stress
38
Q

PSORIASIS: Presentation and

Pathophysiology

A
  • Pink papules/Plaques/Pinpoint bleeding (Auspitz sign)/Physical injury (Koebner phenomenon)
  • Silver scale/Sharp margins
  • Onycholysis/Oil spots
  • Rete Ridges with Regular elongation
  • Itching
  • Arthritis/Abscess (Munro)/Autoimmune
  • Stratum corneum with nuclei
  • Immunologic
  • Stratum granulosum absent
39
Q

PSORIASIS: Triggers

A

• Physical trauma (Koebner phenomenon)
• Infections (acute streptococcal
infection precipitates guttate psoriasis)
• Stress (can be a major factor in flares)
• Drugs (systemic glucocorticoids, oral lithium, antimalarial drugs, interferon)
• Alcohol ingestion

40
Q

Drug Hypersensitivity Syndrome Triad

A
  • Fever
  • Exanthematous Eruption
  • Internal Organ Involvement
41
Q

Risk Factors for Melanoma

A

no SPF is a SIN

  • Sun exposure
  • Pigment traits (blue eyes, fair/red hair, pale complexion)
  • Freckling
  • Skin reaction to sunlight (increased incidence of sunburn)
  • Immunosuppressive states (e.g. renal transplantation)
  • Nevi (dysplastic nevi; increased number of benign melanocytic nevi)
42
Q

Initial Management of Any Patient in Shock

A
  • ABCs
  • IV fluids
  • Oxygen
  • Monitor (HR, BP, urine, mentation, O2 saturation)
  • Control hemorrhage
43
Q

NG Tube Contraindications

A
  • Significant mid-face trauma

* Basal skull fracture

44
Q

Unilateral, Dilated, Non-reactive

Pupil, think:

A
  • Focal mass lesion
  • Epidural hematoma
  • Subdural hematoma
45
Q

Signs of Increased Intracranial

Pressure (ICP)

A
  • Deteriorating LOC (hallmark)
  • Deteriorating respiratory pattern
  • Cushing reflex (high BP, low heart rate, irregular respirations)
  • Lateralizing CNS signs (e.g. cranial nerve palsies, hemiparesis)
  • Seizures
  • Papilledema (occurs late)
  • Nausea/vomiting and headache
46
Q

Signs of Basal Skull Fracture

A
  • Battle’s sign (bruised mastoid process)
  • Hemotympanum
  • Raccoon eyes (periorbital bruising)
  • CSF Rhinorrhea/Otorrhea
47
Q

Treatment of Increased ICP

A
  • Elevate head of bed
  • Mannitol
  • Hyperventilate
  • Paralyzing/sedating agents
48
Q

Seatbelt Injuries may Cause:

A
  • Retroperitoneal duodenal trauma
  • Intraperitoneal bowel transection
  • Mesenteric injury
  • L-spine injury
49
Q

Reasons for Emergent Orthopedic Consultation

A
  • Compartment syndrome
  • Irreducible dislocation
  • Circulatory compromise
  • Open fracture
  • Injury requiring surgical repair
50
Q

Vascular injury/compartment syndrome is suggested by “The 6 Ps”:

A
  • Pulse discrepancies
  • Pallor
  • Paresthesia/hypoesthesia
  • Paralysis
  • Pain (especially when refractory to usual analgesics)
  • Polar (cold)
51
Q

Acute Treatment of Contusions

A

RICE

Rest
Ice
Compression
Elevation

52
Q

Where NOT to use local anesthetic with epinephrine:

A

Ears, Nose, Fingers, Toes and Penis

53
Q

Gynecological Causes of Pelvic Pain:

A
  • Ovarian cyst
  • Dysmenorrhea
  • Mittelshmerz
  • Endometriosis
  • Ovarian torsion
  • Uterine fibroids/neoplasm
  • Adnexal neoplasm
  • PID + cervicitis
54
Q

Signs of PE on CXR

A

Westermark’s sign: abrupt tapering of a vessel on chest film.

Hampton’s hump: a wedge-shaped infiltrate that abuts the pleura.

55
Q

Causes of Syncope by System

A

HEAD, HEART, VeSSELS

Hypoxia/Hypoglycemia
Epilepsy
Anxiety
Dysfunctional brainstem

Heart attack
Embolism (PE)
Aortic obstruction
Rhythm disturbance
Tachycardia
Vasovagal
Situational
Subclavian steal!!
ENT (glossopharyngeal neuralgia)
Low systemic vascular resistance
Sensitive carotid sinus
56
Q

Treatment of Asthma

A

ASTHMA

Adrenergics (β-agonists)
STeroids
Hydration
Mask (O2)
Antibiotics (if concurrent bacterial
pneumonia)
57
Q

If patient has Wolff-Parkinson-White and is in AFib use […]. Avoid […] agents as this can increase conduction through bypass tract leading to cardiac arrest

A

use amiodarone or procainamide.

Avoid AV nodal blocking agents (adenosine, digoxin, diltiazem, verapamil, betablockers)

58
Q

Causes of CHF Exacerbation (c.f. precipitants)

A

FAILURE

Forgot medication
Arrhythmia (Dysrhythmia)/Anemia
Ischemia/Infarction/Infection
Lifestyle (e.g. too much salt)
Upregulation of cardiac output
(pregnancy, hyperthyroidism)
Renal failure
Embolism (pulmonary)
59
Q

Acute Treatment of CHF

A

LMNOP

Lasix (furosemide)
Morphine
Nitroglycerine
Oxygen
Position (sit upright), Pressure (BiPAP)
60
Q

Risk Factors for VTE

A

THROMBOSIS

Trauma, travel
Hypercoagulable, HRT
Recreational drugs (IVDU)
Old (age >60)
Malignancy
Birth control pill
Obesity, obstetrics
Surgery, smoking
Immobilization
Sickness (CHF, MI, nephrotic syndrome, vasculitis)
61
Q

Precipitating Factors in DKA

A

The 5 Is

Infection
Ischemia
Infarction
Intoxication
Insulin missed
62
Q

4 Criteria for DKA Dx

A
  • Hyperglycemia
  • Metabolic acidosis
  • Hyperketonemia
  • Ketonuria
63
Q 
HELLP Syndrome (seen only in
preeclampsia/eclampsia)
A

Hemolytic anemia
Elevated Liver enzymes
Low Platelet count

64
Q

Causes of Acute Ataxia

A

UNABLE TO STAND

  • Underlying weakness (mimic ataxia)
  • Nutritional neuropathy (vitamin B12 deficiency)
  • Arteritis/vasculitis
  • Basilar migraine
  • Labyrinthitis/vestibular neuronitis
  • Encephalitis/infection
  • Trauma (post-concussive)
  • Other (rare genetic or metabolic disease)
  • Stroke (ischemia or hemorrhage)
  • Toxins (drugs, toluene, mercury)
  • Alcohol
  • Neoplasm/paraneoplastic syndrome
  • Demyelination (Miller Fisher, Guillain Barré, MS)
65
Q

(3) main types of Kidney Stones

A
  • 80% Calcium
  • 10% Struvite
  • 10% Uric acid
66
Q

High Risk Criteria for Infection of wounds

A 
Wound Factors
• Puncture wounds
• Crush injuries
• Wounds >12 h old
• Hand or foot wounds
• Wounds near joints

Patient Factors
• Immunocompromised
• Age >50 yr
• Prosthetic joints or valves

YA - Interactive seminars/University lectures (87 decks)

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