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What are 8 physical symptoms at the end of life?
- PND FADDDS
- 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?
- Allodynia/HyperAlgesia, Delirium/hallucinations
What are common side effects of opioids?
- DNSP - DO NOT START PANICKING:
- Dry mouth,
- 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
- GI: 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?
- Type 1: IgE immediate reaction (anaphylaxis, atopy, asthma)
- Type 2: cytotoxic Immune mediated (ITP)
- Type 3: immune complexes (GN, arthritis)
- Type 4: 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
- HX: (SHIPS Bleed with Lysis): Stroke<3mo, head="" spine="" injury="" ich="" puncture="" at="" arterial="" site="" 7d="" surgery="" recent="" condition="" risk="" d="" bleed="" with="" lysis="" br="">
- IMAGING: stroke>1/3 MCA territory, any hemorrhage
- - glucose <2.7, >22
- - coags: 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
- Intact sensorium
- Denial of Illness
How do to diagnose Alzheimer's Dementia?
- 4 A's and 1 D
- MUST HAVE:
- Anterograde/retrograde amnesia
- ONE of:
- 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
- 3. Sleep: trazodone 4. Pain: NSAIDs
How do you assess ABCs in Peds?
- Appearance (TICLS)
- - temperament
- - Interaction
- - Consolability
- - Look/gaze
- - Sound/cry
- Breathing (BAR RV)
- - body position (sniff, tripod)
- - airway sounds
- - RR
- - Resp effort
- - Visible movement
- - skin color
What are common extraintestinal manifestations of IBD?
- My GOSH
- -MSK: osteoporosis, PMR, arthritis (sacorilitis,AnkSpond)
- -Growth dist. In children/adol.
- -Ocular: 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)
- -HepatoBiliary: primary sclerosing cholangitis, cholelothiasis, autoimmune hepatitis, fatty liver
What are the high risk criteria for copd/chronic bronchitis?
- 1. Fev<50%
- 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?
- -Catheter (chronic)
- -Structural abN
- -SC injury
Who should you order a RBUS in? VCUG
- - Recurrent febrile UTI
- - FGH: 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:
- FGH: 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
- - Psych: emotional/behavioral
- - Development/Neuro conditions
What are the 6 tiers of therapy for stable vag bleed?
- 1. NSAIDs
- 2. Anti-fibrinolytic: tranexamic
- 3. OCP
- 4. IUD
- 5. Danazol
- 6. Lupron
What are red flags in dyspepsia?
- Jaundice is A Very BAD PFffft
- - Jaundice
- - Age >55
- - vomiting
- - Bleeding: 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
- - Refer
What are 3 broad ways of managing osteoporosis?
- 1. Primary prevention (CASED)
- 2. Falls prevention: address mobility, sensory imp, dizziness, home safety
- 3. Meds: d/c or, don't prescribe meds that incr risk of falls
What risk factors should lead you to screen for osteoporosis in <50yoa
- HIP MD
- Inflammatory disorders
- PTH elevated
- Drugs - high risk ones
What are the features of PTSD?
- Traumatic experience
- Avoidance of stimuli
- Unable to fx
- Month >1
- Arousal increased
What are the 5A's of smoking cessation in or WILLING to quit?
- Ask about smoking status
- Advise to quit
- Assess readiness
- 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?
- MSI(no GE)CAP
- Mood disturbance
- Sleep disturbance
- Concentration imp
- Appetite increased/wt gain
- Psychomotor - restless
What are the stages of change and what should you do at each?
- PCP AMR
- -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?
- Chlamydia: azithro 1g x 1
- Gonorrhea: cefixime 400 x 1
- Trich: flagyl 2g x 1
- Herpes: 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)
- Functional impairment
- Mood (include SI)
- Substance use
- Social factors (LOANS, F&E)
- Sexual Dysfunction
What are red flags for adult cough
- VSA LIST PE contacts
- VS abnormal
- Lung dz
- PE risk factors
- Sick Contact
What are red flags for PEDS cough?
- CF PFT
- Congenital dz
- Family hx serious illness
- Position (sniffing, drool)
- Failure to Thrive
What are autonomic symptoms?
- HT PANTS
What is the criteria for
- >2y of symptoms and never >2 months without symptoms
- (in adolescents >1y)
- - DYSTHYMIA: depressed mood more days than not (adol: irritability)
- - CYCLOTHYMIA: numerous periods of hypo mania and depressive Sx (not MDE)
- - impairs functioning
- 2 of FLASHC
- - fatigue
- - low esteem
- - appetite changes
- - sleep changes
- - hopelessness
- - 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
- - distractible
- - impulsive
- - grandiosity
- - flight of ideas
- - Activites, pleasurable with neg. consequences
- - pSychomotor agitation (goal directed activities)
- - talkative
What should you address in elderly patients?
- SHELFS MAD Meds (SIN)
- - social supports
- - hearing
- - eye sight
- - living situation
- - functional status (death & shaftm)
- - sleep
- - mood
- - appetite
- - driving
- - 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?
- A HEAD
- - anemia of chronic dz
- - Hbgopathy: 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
- - myelodysplasia
- 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
- - chocolate
- - alcohol
- - nuts
- - caffeine
- - aged cheese
- - MSG
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#)
- If <2yo: Most Hematomas Act Loco
- - MOI severe - fall 3 ft
- - Scalp Hematoma (non frontal)
- - not acting normal
- - hx LOC
- >2yo: Most HA lack vomiting
- - MOI Severe - fall 5 ft
- - headache
- - 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)
- - pregnant
- - alcohol
- - young
- - bounce back
- - anticoagulant
- - non trauma
- - seizure
What are the 6 vital signs of the eye?
- VP FARM:
- Visual acuity
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
- Age 65+
- Paresthesias in extremities
- DAAS: (if any, then rotate)
- Delayed onset of pain
- Ambulatory at any time
- Absent midline tenderness
- Sitting in ER
- Bounce back
- Not stable VS
What should you educated CAD patients & families about
- New ACS:
- Nitro use, not with PDE-5
- AED training
- CPR training
- Symptom recognition & mgmt
How should you manage pts in crisis?
- Coping skills ?unhealthy
- Resources ie. counseling
- ID pts supports
- Intervention: meds
- Support family/friends
What things do you want to address in a pt with Anxiety?
- PAST SI:
- Psych comorbidity
- Substance use
- 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.
- Age group: 6 months-8yoa
- Bugs: s. aureus, s. pneumo, H. Flu
- Clinical hx: 2ndary worsening, toxic, no resp to epi
- Tx: ceftriaxone
What age group and rx for epiglottitis?
- 1-8 yoa
Tell me about diphtheria
- Forms a pseudo membrane
- Any age
- Caused by corynebacterium dipteriae
- Rx with intubation, pen g, flagyl, or erythro
Tell me about croup
- Age: 6mos-3years
- Bug: parainfluenza
- Natural hx: resolves <48h
- Mild: occasional bark
- Mod: retractions at rest, frequent bark, stridor with min. exertion
- Severe: strider at rest
Ottawa knee rule
- MAP Flex:
- Mobility-unable at time and ER 4+ steps
- Age >55
- 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
- IMPULSIVE: (5+)
- Impulsivity (sex, food, drugs, driving)
- Mood instability (lasts hours)
- Paranoid in extreme stress/dissociative (lasts days)
- Unstable self image
- Labile/intense relationships
- SI/self harm
- Inappropriate anger (feel loved ones don't care)
- Vulnerable to abandonment
- Emptiness - chronic
What do you need to address in all sexual abuse victims?
- Pregnancy prevention
- 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:
- Pharyngeal obstruction
- Splenic rupture
- Heme: thrombocytopenia, hemolytic anemia, agranulocytosis
- Neuro: GBS, bells palsy, encephalitis, aseptic meningitis, myelitis, cerebellar ataxia
Who should you do a stool culture in? Treat with abx?
- HEFTI BM:
- >EIGHT stools/24h
- Food handlers
- Travel Hx
- BOWEL dx(IBD)
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:
- Intraosseous CYSTS
- Assymetric joint space narrowing
- Subchondral sclerosis
What are X-ray findings in RA
- SED rates up:
- Symmetric joint space narrowing
- Erosions of subchondral bone
What are the symptoms of RA
- 4+ criteria:
- 3+ joints for >6 months
- Morning stiffness >1h
- 1 joint in hand affected - not 1st CMC
- Symmetric arthritis
- Rheumatoid NODULES
- RF in 60-80%
- X-ray changes
What are the signs of lupus?
- MD SOAP BRAIN:
- Malar rash
- Discoid rash
- Serositis (GI, pleurisy, pericarditis, nephrosis, hepatosplenomegaly)
- Oral/nasal ulcers
- Photo sensitivity
- 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%
- Decreased c3c4
What two lab findings can be Abnormal in a septic joint?
What is the dDx for monoarticular pain?
- HID MIC:
- Malignancy (nearby)
What is the dDx in polyarthritis?
- Bacterial - Lyme disease, Gonococcus, Endocarditis
- Viral - parvo, rubella, hep b/c
- POST INFECTIOUS:
- Rheumatic fever, reactive arthritis, enteric infections
- IBD, psoriatic, ank spond, SLE
- Other: hypothyroid, metabolic bone dz, depression
What are features of sjogren's?
- Lymphocytic infiltration
- Positive RF & ANA
- Assoc with: non Hodgkin, nephritis, rashes, pulm lesions, SLE, RA, scleroderma
What should you routinely ask about in it with rheumatoid dz before managing them?
- Renal dz
- 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?
- MEDICAL: another q'n
- PSYCH: depression, dementia
- MEDS: a/e - nausea, dry mouth, anorexiA
- SOCIAL CONTEXT: poverty, access, excessive excercise
Differentiate between adequate vs inadequate intake!
What are medical causes of weight loss
- intestinal angina, stroke
- hiv/tb infections,
- GI - dysphagia, dysmotility, PUD, celiac/malabsorption, IBD, hep
- other end stage dz,
- Endo-thyroid, diabetes, adrenal
- Neuro-dysphagia, dementia
- INFLAMMATORY: RA, sarcoidosis
- Withdrawals (antipsychotics, marijuana)
Which bite wounds should you NOT close
- Primary Closure BITE:
- Crush injuries
- Bites (human/cat)
- Time (>12h, or >24h if on face)
- Extremity (ie. hand / foot)
How long should sutures remain in eyelids? Face? Neck? Trunk / UE? LE? Scalp?
- Eyelid: 3 days
- Face: 5 days
- Neck: 3-4 days
- Trunk / UE: 7 days
- LE: 8-10 days
- Scalp: 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:
- H. Influenza
- N. gonorrhea
- S. pneumonia
What are the clinical findings in meningitis?
- Neck stiffness
- Altered mental status
- Petechial rash
- 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?
- Inform PH
- 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?
- Neonates: amp & cefotaxime
- Adults: ceftriaxone and vanco
- IC: amp + ceftriaxone + vanco
- CSF/Neuro Sx: 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)
- A/E: steatorrhea, fecal incont, bloating, cramping
- Mechanism: 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
- Mood disorder
- MSK - OA
- Eating disorder
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)
- Total pain
- Cognitive dysfunction
- Hx of substance abuse
- Incidental pain
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?
- Tx symptoms: haloperidol +/- benzo for seizures
- Rotate opioids/reduce dose
How do you rotate opioids
- Determine TDD
- 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
- Postural instability
What features suggest another cause for parkinson's?
- Poor response to L-dopa
- Abrupt onset, rapid progression
- Early: Falls, Cognitive dysfunction, Autonomic dysfunction
What are 4 dopamine agonists?
What agents are used to treat Parkinson's?
- Dopamine precursors
- Dopamine agonist
- Anticholinergic (cogentin)
- MAOI (selegeline)
- COMT inhibitors (entacapone)
What are side effects of dopamine agonists?
- Negatives Of Dopamine agonists:
- Orthostatic hypotension
What are signs and symptoms of Parkinson's?
- RIM HAD A BBM:
- Involuntary tremor
- Masked facies
- Hypophonia (soft speech)
- Aprosody (monotone speech)
- Dysarthria (articulation)
- Autonomic (late - urinary retention, constipation, sexual dysfunction)
- Behavioral changes (personality, sleep dist, depression/anxiety, dec spont speech)
What OD causes physiological excitation?
- WAS Hyper:
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
- Severe neutropenia
When treating pneumonia with abx, they should be better by how many days?
Who is the flu vaccine indicated for
- 6 months-24 months
- 65+ yoa
- 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
- Anti hypertensives
- Psych meds
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