CCFP flash cards.txt
Card Set Information
CCFP flash cards.txt
CCFP family medicine exam 2012
CCFP 2012 Exam Prep
What are 8 physical symptoms at the end of life?
Pain, nausea, dyspnea, fatigue, anorexia/cachexia, delirium, depression, dehydration
How do we manage fatigue?
SLEEP hygiene, decrease/increase ACTIVITY, D/C MEDS, improve PAIN control
What are Sx of opioid toxicity?
What are common side effects of opioids?
DNSP - DO NOT START PANICKING
Somnolence (transient), Pruritis
What are signs of substance abuse in adolescents?
SIB (Substance IBuse)
School failure, Isolation, Behavioral change
What is substance abuse?
- 12 month duration
- Never met criteria for dependence
- LORD ( legal problems, ongoing use despite substance related problems, responsibilities unmet, dangerous use)
What is substance dependence?
- 12 month duration
- WTOMCAT (Weaning TOM from being a killer CAT)
Withdrawal, tolerance, ongoing - prob, more/longer than intend, cut down attempts, activities 0, time spent obtaining/using/recovering.
What are the components of CIWA?
GI, NEURO, PSYCH, HALLUCINATIONS
: n/v; NEURO: (TSH) tremor, headache, sweats; PSYCH: (AA) anxiety, agitation; HALLUCINATIONS: (VATO) orientation/clouded/delirium, tactile/visual/auditory hall.
What are the 4 types of hypersensitivity rxn?
: IgE immediate reaction (anaphylaxis, atopy, asthma)
: cytotoxic Immune mediated (ITP)
: immune complexes (GN, arthritis)
: delayed reaction(poison ivy)
What are the pituitary hormones?
Go Find The Adenoma Please And Oxygenate
(GH, FSH/LH, TSH, ACTH, Prolactin, ADH, Oxytoxin)
POSTERIOR pit = OA (oxytocin, ADH)
Who is immune compromised?
(Suppressants, AIDS, Diabetes, Malnutrition, Ig deficiency, Solid organ dysfunction, Tumor)
What are the causes of bloody diarrhea?
YES just a SEC, gotta bloody poo!
Yersinia, ETEC/EHIC, Salmonella, Shigella, Enteroamoeba, Campylobacter
What are the 3 symptoms of Reiters Syndrome?
Can't pee, can't see, can't climb a tree
urethritis, then Conjunctivitis, then arthritis
What are the exclusion criteria for lysis with stroke?
CHILl don't lyse!
(Clinical, Hx, Imaging, Labs)
CLINICAL: refractory HTN >185/110, ?SAH, ?mimic
: (SHIPS Bleed with Lysis): Stroke<3mo, head="" spine="" injury="" ich="" puncture="" at="" arterial="" site="" 7d="" surgery="" recent="" condition="" risk="" d="" bleed="" with="" lysis="" br="">
: stroke>1/3 MCA territory, any hemorrhage
- glucose <2.7, >22
: INR>1.7, Plt <100, elev aPTT
What does HAS BLED stand for?
Hypertension, Abnormal Liver/Renal, Stroke, Bleeding hx, Labile INRs, elderly (>65), Drugs/Etoh
What is wernickes syndrome
Ataxia, confusion, opthalmoplegia
What's the CAM?
Has to have:
1. Acute, fluctuating course
2. In attention
ONE of the following:
3. Disorganized thinking
4. Altered LOC
What is seen in Korsakoff's syndrome
Air Canada PAID
Preservation of LT memory & cog skills
Denial of Illness
How do to diagnose Alzheimer's Dementia?
4 A's and 1 D
Apraxia (losing learned skill with normal muscle function
Agnosia (sensory function normal but doesn't recognize things)
Disturbance of exec. F'n
What are the symptoms of menopause?
HOT LATE NIGHT SUV MOOD
Hot flashes, libido decreased night sweats, sleep disturbance, urinary incontinence, vaginal dryness & decreased libido, mood-depression
How do you manage domestic violence?
Risk assessment, educate about course, Safety plan, counseling (sw)/community resources, CAS,
What are common causes of chronic cough?
PND:post nasal drip
How do u manage opioid withdrawal?
Cut the GSP high!
1. Decrease Catecholamines
: clonidine 2. GI (diarrhea): ondanseteon, peptol bismol
: trazodone 4. Pain: NSAIDs
How do you assess ABCs in Peds?
Breathing (BAR RV)
- body position (sniff, tripod)
- airway sounds
- Resp effort
- Visible movement
- skin color
What are common extraintestinal manifestations of IBD?
: osteoporosis, PMR, arthritis (sacorilitis,AnkSpond)
-Growth dist. In children/adol.
: uveitis, iritis, episcleritis, corneal ulcers
-Skin & Mouth
: Reactive lesions (erythema nodosum, pyoderma gangrenosum, aphthous ulcers), Specific lesions (fissures/fistulas), Nutritional (glossitis, purpura), Related (vitiligo, psoriasis)
: primary sclerosing cholangitis, cholelothiasis, autoimmune hepatitis, fatty liver
What are the high risk criteria for copd/chronic bronchitis?
2. Home o2
3. 4 or more exac/year
4. Chronic oral steroids
5. Abx <3 months
6. Ischemic heart disease
7. Cor pulmonale
What is a complicated UTI?
Who should you order a RBUS in? VCUG
- Recurrent febrile UTI
: Fam hx of renal/uro abN, poor Growth, Htn
- 1st febrile UTI <2yoa
- not responding to tx
- Recurrent febrile UTI
- 1st febrile UTI with any:
: Fam hx of renal/uro abN, poor Growth, Htn
RBUS abN, non-ecoli
What are the 5 categories in the differential for child with behavior issue?
MVP gets PD day
- Medical condition
- Variable of normal dev't
- Psychosocial factors
- Development/Neuro conditions
What are the 6 tiers of therapy for stable vag bleed?
What are red flags in dyspepsia?
Jaundice is A Very BAD PFffft
- Age >55
: anemia, hemoptysis, melena
- Abdominal Mass/LN/wt loss
- dysphasia progressive
- pmhx PUD/gastric Sx
- FamHx gastric Ca
4 step tx for dyspepsia?
1. If GERD/on NSAID?
- stop NSAID / treat with PPI
2. dep on age, EGD/h.pylori
- empiric rx with PPI
- EGD if >55
3.If neg for h. Pylori
- get EGD
4. If all negative = functional
- consider dDx
- consider IBS
What are 3 broad ways of managing osteoporosis?
1. Primary prevention (CASED)
2. Falls prevention
: address mobility, sensory imp, dizziness, home safety
: d/c or, don't prescribe meds that incr risk of falls
What risk factors should lead you to screen for osteoporosis in <50yoa
Drugs - high risk ones
What are the features of PTSD?
Avoidance of stimuli
Unable to fx
What are the 5A's of smoking cessation in or WILLING to quit?
Ask about smoking status
Advise to quit
Assist with quit attempt
Arrange follow up
What are the 5R's in pts UNWILLING to quit?
Relevance to pt (family, health, social)
Risks of smoking (ST, LT, environmental)
Rewards of smoking cessation
Roadblocks to quitting
Repeat motivational interviewing (attempts x 7)
What are common smoking triggers?
- after Sex
- after Meal
- with Alcohol
- morning Coffee
How do you design a quitting plan (for smoking)?
Set quit date (within 2 weeks, phone call <1 wk after quitting, fu monthly x 3)
Tell family/friends for support
Anticipate changes (withdrawal)
Remove tobacco products
What are the symptoms of nicotine withdrawal?
Appetite increased/wt gain
Psychomotor - restless
What are the stages of change and what should you do at each?
-Precontemplation - pt unaware of problem; solicit pros/cons, make more aware
-Contemplation - explore ambivalence, build confidence, gain commitment
-Preparation - choose course of action, strengthen confidence and commitment, ID high risk situations & strategies to avoid
- Action - help design reward system, strategies to avoid relapse, support convictions
-Maintenance - strengthen motivation, review high risk situations and strategies
- Relapse - learning experience not failure, NNF X 7 to quit!
How should NRT be prescribed?
- IF >10/day
: 21 mg x 6wks, then 14 mg x 2 wks, then 7mg x 2 wks
- IF <10/d
: 14mg x 6wk, 7mg x 4wks
- if >25/d, use 4mg, else 2mg
- chew and park
- whenever there is an urge
(1/h) over first 6 weeks, then decrease use
SPRAY (max 80/d, 10/h)
What are the treatments of the common STIs?
: azithro 1g x 1
: cefixime 400 x 1
: flagyl 2g x 1
: acyclovir 200 5x/d x 5-10d
What are things to inquire about in pt with chronic dz?
Chronic Frikkin PMS SupportS:
Compliance with meds/tx (symptom control, side effects)
Mood (include SI)
Social factors (LOANS, F&E)
What are red flags for adult cough
VSA LIST PE contacts
PE risk factors
What are red flags for PEDS cough?
Family hx serious illness
Position (sniffing, drool)
Failure to Thrive
What are autonomic symptoms?
What is the criteria for
>2y of symptoms and never >2 months without symptoms
(in adolescents >1y)
: depressed mood more days than not (adol: irritability)
: numerous periods of hypo mania and depressive Sx (not MDE)
- impairs functioning
2 of FLASHC
- low esteem
- appetite changes
- sleep changes
- concentration impaired
What is the criteria for adjustment d/o?
Onset within 3 months of stressor, subsides within 6 months of stressor going away (unless chronic stressor)
- impaired functioning
- treat with psychotherapy
How many criteria do you need for MDE??
5, 1/5 has to be anhedonia or low mood
How many criteria need to be present for dx of mania? What are they?
3 - DIGFAST
- flight of ideas
- Activites, pleasurable with neg. consequences
- pSychomotor agitation (goal directed activities)
What should you address in elderly patients?
SHELFS MAD Meds (SIN)
- social supports
- eye sight
- living situation
- functional status (death & shaftm)
- meds (side effects, interaction, need it?)
What is the dDx for microcytic anemia?
TAILS: thalassemia, anemia of chronic dz, iron def anemia, lead poisoning, sideroblastic anemia + hemoglobinopathy (spherocytosis, SC, thal, g6pd)
What's the dDx or normocytic anemia?
- anemia of chronic dz
: hemolysis, SC, others
- endocrine dz
- aplastic anemia
- deficiencies, mixed
What's the dDx for macrocytic anemia?
HAD Large Mcv
- hemolytic anemia
- alcohol use
- deficiencies (b12, folate)
- liver dz
Also high PTH
What questions can you ask about domestic abuse?
- do you feel SAFE in your relationship
- have u been in a relationship where you felt threatened, abused or AFRAID?
- do your FAMILY/FRIENDS know you've been hurt? Would you tell them? Would they be supportive?
- EMERGENCY PLAN
: do you have a safe place to go and the resources you need in an emergency?
What are 6 common food/drink triggers for
- aged cheese
What are non food/drink triggers for migraines?
SHE gets migraines
- sensory (lights, sounds, smells)
- hormonal (ocp, cycles)
- environmental (sleep, irreg meals, stress, weather)
What is the PECARN Peds head injury criteria?
Get CT if GS (Gcs<15, skull#)
: Most Hematomas Act Loco
- MOI severe - fall 3 ft
- Scalp Hematoma (non frontal)
- not acting normal
- hx LOC
: Most HA lack vomiting
- MOI Severe - fall 5 ft
- hx loc
- any vomiting
What is the Canadian CT head rule? What is the exclusion criteria?
Get CT with AGFE in AM
HIGH RISK NEUROSX
- age 65+
- Gcs <15
- Fracture (skull, basilar)
- Emesis 2+
MED RISK INJURY ON CT
- amnesia >30 mins
- MOI severe
EXCLUSION (PAY BANS)
- bounce back
- non trauma
What are the 6 vital signs of the eye?
What are dangerous causes for a red eye?
Acute angle glaucoma
What are the Canadian c spine rules? Exclusion?
MAP, DAAS koo, rotate
Mechanism - dangerous
Paresthesias in extremities
: (if any, then rotate)
Delayed onset of pain
Ambulatory at any time
Absent midline tenderness
Sitting in ER
Not stable VS
What should you educated CAD patients & families about
Nitro use, not with PDE-5
Symptom recognition & mgmt
How should you manage pts in crisis?
Coping skills ?unhealthy
Resources ie. counseling
ID pts supports
What things do you want to address in a pt with Anxiety?
Type of anxiety
How many criteria need to be present for GAD dx?
How many criteria need to be present for panic disorder?
(syncope, excess Hr, chills
Tell me about bacterial tracheitis.
: 6 months-8yoa
: s. aureus, s. pneumo, H. Flu
: 2ndary worsening, toxic, no resp to epi
What age group and rx for epiglottitis?
Tell me about diphtheria
Forms a pseudo membrane
Caused by corynebacterium dipteriae
Rx with intubation, pen g, flagyl, or erythro
Tell me about croup
: resolves <48h
: occasional bark
: retractions at rest, frequent bark, stridor with min. exertion
: strider at rest
Ottawa knee rule
Mobility-unable at time and ER 4+ steps
Pain (patellar, fibular head)
Unable to FLEX knee >90deg
What is the criteria for Borderline PD? How many?
All PD, affect function, present in multiple areas of pts life and can be traced back to adol/young adulthood
Impulsivity (sex, food, drugs, driving)
Mood instability (lasts hours)
Paranoid in extreme stress/dissociative (lasts days)
Unstable self image
Inappropriate anger (feel loved ones don't care)
Vulnerable to abandonment
Emptiness - chronic
What do you need to address in all sexual abuse victims?
Affect - depression, anxiety, PTSD
Infections - STI screen & tx, post exposure proph
Refer - community resources, counseling (pt + fam), ID specialist
Evidence - must be collected/frozen within 72h
Complications of mono
PS HUN these are the complications:
: thrombocytopenia, hemolytic anemia, agranulocytosis
: GBS, bells palsy, encephalitis, aseptic meningitis, myelitis, cerebellar ataxia
Who should you do a stool culture in? Treat with abx?
What is the SIRS criteria
Temp <36, >38
WBC <4, >12, or >10% bands
What lab finding in positive >90% of the time in Wegener's?
What are PE findings in gout?
Limited joint mobility
Swollen, red joint
What are the investigations & findings for gout?
Joint aspirate - crystals
X-ray - punched out holes
Why are the risk factors for gout?
Male >45 yoa
Dietary excess (MLS PMS):
What is the treatment for gout?
Early abortive therapy with COLCHICINE (1.2 mg), then 0.6 mg q1-2h until diarrhea (max 6g)
Prednisone 30-50 x5-7 days
What are X-ray findings for OA
Chronic OA Signs:
Assymetric joint space narrowing
What are X-ray findings in RA
Symmetric joint space narrowing
Erosions of subchondral bone
What are the symptoms of RA
3+ joints for >6 months
Morning stiffness >1h
1 joint in hand affected - not 1st CMC
RF in 60-80%
What are the signs of lupus?
MD SOAP BRAIN:
Serositis (GI, pleurisy, pericarditis, nephrosis, hepatosplenomegaly)
Blood (leukopenia, thrombocytopenia, anemia of CD)
Immune abn (autoAb prod'n)
Neuro (psychosis, seizures)
What specific tests can u order to dx SLE?
ANA - 98% of SLE have it
Anti-dsDNA - 50-70%
Anti- SM - 30%
What two lab findings can be Abnormal in a septic joint?
WBC > 12
What is the dDx for monoarticular pain?
What is the dDx in polyarthritis?
Bacterial - Lyme disease, Gonococcus, Endocarditis
Viral - parvo, rubella, hep b/c
Rheumatic fever, reactive arthritis, enteric infections
IBD, psoriatic, ank spond, SLE
: hypothyroid, metabolic bone dz, depression
What are features of sjogren's?
Positive RF & ANA
: non Hodgkin, nephritis, rashes, pulm lesions, SLE, RA, scleroderma
What should you routinely ask about in it with rheumatoid dz before managing them?
liver dz (incl etoh use, OAC)
At what stage of disease are DMARDs indicated in RA?
Early (immediately if mod-severe)
If mild, trial of NSAIDs x 2-3 months, if failed the. DMARD
What are the 1st line DMARDs? Best tolerated? How long do they take to work? When to combine?
Plaquenil 200 bid
MTX - best tolerated
Sulfasalazine - 1g bid-tid
Take 2-3 months to work
Trial x 6 mo, if failed, then consider other/combo
What has good evidence for routine screening
FELT to be good to screen:
Ears - hearing protection
Lungs - smoking cess
What is considered significant weight loss? What's is acceptable?
>5-10% in 6-12 months
Acceptable = 1 pound/year!
What are 4 broad areas that can cause weight loss?
: another q'n
: depression, dementia
: a/e - nausea, dry mouth, anorexiA
: poverty, access, excessive excercise
Differentiate between adequate vs inadequate intake!
What are medical causes of weight loss
intestinal angina, stroke
GI - dysphagia, dysmotility, PUD, celiac/malabsorption, IBD, hep
other end stage dz,
Endo-thyroid, diabetes, adrenal
: RA, sarcoidosis
Withdrawals (antipsychotics, marijuana)
Which bite wounds should you NOT close
Primary Closure BITE:
Time (>12h, or >24h if on face)
Extremity (ie. hand / foot)
How long should sutures remain in eyelids? Face? Neck? Trunk / UE? LE? Scalp?
: 3 days
: 5 days
: 3-4 days
Trunk / UE
: 7 days
: 8-10 days
: 7-14 days
What are common pathogens in bites? Human? Cat? Dog?
Human - eickenella corodens
Cat - bartonella henselae
Dog - capnocytophagia canimorus
What do u treat bites with?
Amox-clav x 5d
Which abx have POOR coverage for pasteurella / eickenella
What are the three most common causes of meningitis in adults?
Hot Nervous System, HNS:
What are the clinical findings in meningitis?
Altered mental status
Focal Neuro signs
Seizures (add acyclovir)
How can u tell if it's bacterial or viral with CSF glucose, WBC, protein?
Glucose lower in bacterial
WBC higher in bacterial (Neutrophils)
Protein higher in bacterial
Who should receive prophylaxis for meningitis?
Anyone in contact with oral secretions
Household contact not fully immunized
Close contact in past 8h
What do u treat meningitis with in neonates? Adults? Immunocompromised adults? Adults with CSF shunts/Neuro Sx?
: amp & cefotaxime
: ceftriaxone and vanco
: amp + ceftriaxone + vanco
: ceftriaxone + CEFEPIME
When do you consider pharmacotherapy for obesity? Who should you avoid in?
After 6 month trial of increased physical activity, reduced caloric intake and cbt, if has not met goal of 1-2lb/wk x 3-6 months
BMI>30 or >27 with risk factors
Orlistat 120 mg TID (upto 2y)
: steatorrhea, fecal incont, bloating, cramping
: inhibits lipase
AVOID IN PATIENTS WITH:
IBD, inflammatory disorders
Who is a candidate for barbaric surgery?
If other weight loss attempts have failed
BMI>35 with risk factors
What non-cardiac conditions are associated with obesity, that u should screen for?
POMME - shape of obesity
MSK - OA
What are some Components of total pain?
total pain can be a MESs:
Material - financial, functional impairment/dependence
Emotional - mood, family dysfunction
What symptoms can steroids be used for at the end of life?
What are features of total pain?
Pain all over with no systemic disease
Worse when alone
Improves with socialization
No relief with increasing opioids
Hx of somatization under stress
What 3 factors make it difficult to control pain? (at the end of life)
Hx of substance abuse
Also Inquire about coping strategies, previous rx, metabolic abN
How do you start opioid therapy?
Short acting ie. hydro morphine 1 mg po q4h with 0.5 q1h for BTA
Wait until doses are stable after 2-3 days and determine total daily requirements. If pain severe, increase total daily dose by 25%.
Divide by 6 = new dose q4h.
Take 10% daily dose = q1h BTA
Once stable, then take daily dose and split into BID with BTA
How do u manage opioid toxicity?
: haloperidol +/- benzo for seizures
Rotate opioids/reduce dose
How do you rotate opioids
Use equianalgesic table
Reduce by 25% (50% of toxic)
Divide by 6 for q4h dosing with 10% TDD BTA
How do u start a fentanyl patch
Same as switching from other opioids but overlap patch in first 12 h with previous meds&doses
Keep same BTA dose
What age can u give the zoster vaccine? Contraindications?
>60 yoa, CI if immunocompromised (live vaccine), or anaphylaxis to gelatin / neomycin
What are the cardinal symptoms of Parkinson's disease? How many for dx?
2/4, 1 must be bradykinesia
What features suggest another cause for parkinson's?
Poor response to L-dopa
Abrupt onset, rapid progression
: Falls, Cognitive dysfunction, Autonomic dysfunction
What are 4 dopamine agonists?
What agents are used to treat Parkinson's?
COMT inhibitors (entacapone)
What are side effects of dopamine agonists?
Negatives Of Dopamine agonists:
What are signs and symptoms of Parkinson's?
RIM HAD A BBM:
Hypophonia (soft speech)
Aprosody (monotone speech)
Autonomic (late - urinary retention, constipation, sexual dysfunction)
Behavioral changes (personality, sleep dist, depression/anxiety, dec spont speech)
What OD causes physiological excitation?
What drug interaction do fluoroquinolones and macolides cause?
What drugs does amoxicillin interfere with?
What is the criteria for HAP
Family member with drug resistance
Any high level treatment in last month (wound care, dialysis, chemo, iv abx)
2+ days hospitalization in past 3 months
After diagnosing pneumonia, what atypical causes should you consider?
TB HAT: TB, bird exposure, HIV, aspiration, travel
What can cause a false negative CXR?
Early <24 h
When treating pneumonia with abx, they should be better by how many days?
Who is the flu vaccine indicated for
6 months-24 months
Contacts of <6mo
Chronic medical issues/LTC/Healthcare workers
For public health tracing of pathogens causin pneumonia. Who is at risk in terms of time period
1 wk before and 1 day after abx
List 3 types of drugs that can cause ED
Think hypothyroid & depression as well
What features are in keeping with non organic cause of ED
TAME: no Trauma, Abrupt onset, no Med changes, nocturnal Erections