CCFP flash cards.txt

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CCFP flash cards.txt
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2012-04-30 00:07:59
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CCFP family medicine exam 2012
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CCFP 2012 Exam Prep
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  1. What are 8 physical symptoms at the end of life?
    • PND FADDDS
    • Pain, nausea, dyspnea, fatigue, anorexia/cachexia, delirium, depression, dehydration
  2. How do we manage fatigue?
    • SAMP
    • SLEEP hygiene, decrease/increase ACTIVITY, D/C MEDS, improve PAIN control
  3. What are Sx of opioid toxicity?
    • MAD
    • Myoclonus,
    • Allodynia/HyperAlgesia, Delirium/hallucinations
  4. What are common side effects of opioids?
    • DNSP - DO NOT START PANICKING:
    • Dry mouth,
    • N/V/C,
    • Somnolence (transient), Pruritis
  5. What are signs of substance abuse in adolescents?
    • SIB (Substance IBuse)
    • School failure, Isolation, Behavioral change
  6. 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)
  7. 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.
  8. 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.
  9. 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)
  10. What are the pituitary hormones?
    • GFTAPAO
    • Go Find The Adenoma Please And Oxygenate
    • (GH, FSH/LH, TSH, ACTH, Prolactin, ADH, Oxytoxin)

    POSTERIOR pit = OA (oxytocin, ADH)
  11. Who is immune compromised?
    • SADMIST
    • (Suppressants, AIDS, Diabetes, Malnutrition, Ig deficiency, Solid organ dysfunction, Tumor)
  12. What are the causes of bloody diarrhea?
    • YES just a SEC, gotta bloody poo!
    • Yersinia, ETEC/EHIC, Salmonella, Shigella, Enteroamoeba, Campylobacter
  13. What are the 3 symptoms of Reiters Syndrome?
    • PST:
    • Can't pee, can't see, can't climb a tree
    • urethritis, then Conjunctivitis, then arthritis
  14. 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

    • LABS:
    • - glucose <2.7, >22
    • - coags: INR>1.7, Plt <100, elev aPTT
  15. What does HAS BLED stand for?
    Hypertension, Abnormal Liver/Renal, Stroke, Bleeding hx, Labile INRs, elderly (>65), Drugs/Etoh
  16. What is wernickes syndrome
    • WACO
    • Ataxia, confusion, opthalmoplegia
  17. What's the CAM?
    • Has to have:
    • 1. Acute, fluctuating course
    • 2. In attention

    • ONE of the following:
    • 3. Disorganized thinking
    • 4. Altered LOC
  18. What is seen in Korsakoff's syndrome
    • Air Canada PAID
    • Amnesia
    • Confabulation
    • Preservation of LT memory & cog skills
    • Apathy
    • Intact sensorium
    • Denial of Illness
  19. How do to diagnose Alzheimer's Dementia?
    • 4 A's and 1 D
    • MUST HAVE:
    • Anterograde/retrograde amnesia
    • ONE of:
    • Aphasia
    • Apraxia (losing learned skill with normal muscle function
    • Agnosia (sensory function normal but doesn't recognize things)
    • Disturbance of exec. F'n
  20. 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
  21. How do you manage domestic violence?
    • RESCCue
    • Risk assessment, educate about course, Safety plan, counseling (sw)/community resources, CAS,
  22. What are common causes of chronic cough?
    • GAP
    • gerd,
    • asthma,
    • PND:post nasal drip
  23. 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
  24. 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
    • Circulation
    • - skin color
  25. 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
  26. 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
  27. What is a complicated UTI?
    • COMSS
    • -Catheter (chronic)
    • -Obstruction
    • -Men
    • -Structural abN
    • -SC injury
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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
  33. 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
  34. What risk factors should lead you to screen for osteoporosis in <50yoa
    • HIP MD
    • Hypogonadosm
    • Inflammatory disorders
    • PTH elevated
    • Malabsorption
    • Drugs - high risk ones
  35. What are the features of PTSD?
    • TRAUMA
    • Traumatic experience
    • Re-experienced
    • Avoidance of stimuli
    • Unable to fx
    • Month >1
    • Arousal increased
  36. 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
  37. 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)
  38. What are common smoking triggers?
    • SMAC
    • - after Sex
    • - after Meal
    • - with Alcohol
    • - morning Coffee
  39. How do you design a quitting plan (for smoking)?
    • STAR
    • 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
  40. What are the symptoms of nicotine withdrawal?
    • MSI(no GE)CAP
    • Mood disturbance
    • Sleep disturbance
    • Irritability
    • Concentration imp
    • Appetite increased/wt gain
    • Psychomotor - restless
  41. 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!
  42. How should NRT be prescribed?
    • Patch
    • - 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

    • GUM/LOZENGE/INHALER
    • - 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)
  43. 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
  44. 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
    • Pain
    • Mood (include SI)
    • Substance use
    • Social factors (LOANS, F&E)
    • Sexual Dysfunction
  45. What are red flags for adult cough
    • VSA LIST PE contacts
    • VS abnormal
    • Smoker
    • Aspiration
    • Lung dz
    • Immunosuppressed
    • SOB
    • travel
    • PE risk factors
    • Sick Contact
  46. What are red flags for PEDS cough?
    • CF PFT
    • Congenital dz
    • Family hx serious illness
    • Position (sniffing, drool)
    • FB
    • Failure to Thrive
  47. What are autonomic symptoms?
    • HT PANTS
    • Hunger
    • Trembling
    • Palpitations
    • Anxiety
    • Nausea
    • Tingling
    • Sweating
  48. What is the criteria for
    Dysthymia? Cyclothymia
    • >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
  49. 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
  50. How many criteria do you need for MDE??
    5, 1/5 has to be anhedonia or low mood
  51. 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
  52. 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?)
  53. 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)
  54. What's the dDx or normocytic anemia?
    • A HEAD
    • - anemia of chronic dz
    • - Hbgopathy: hemolysis, SC, others
    • - endocrine dz
    • - aplastic anemia
    • - deficiencies, mixed
  55. What's the dDx for macrocytic anemia?
    • HAD Large Mcv
    • - hemolytic anemia
    • - alcohol use
    • - deficiencies (b12, folate)
    • - liver dz
    • - myelodysplasia
    • Also high PTH
  56. What questions can you ask about domestic abuse?
    • SAFE
    • - 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?
  57. What are 6 common food/drink triggers for
    Migraines?
    • CANCAM
    • - chocolate
    • - alcohol
    • - nuts
    • - caffeine
    • - aged cheese
    • - MSG
  58. What are non food/drink triggers for migraines?
    • SHE gets migraines
    • - sensory (lights, sounds, smells)
    • - hormonal (ocp, cycles)
    • - environmental (sleep, irreg meals, stress, weather)
  59. 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
  60. 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
  61. What are the 6 vital signs of the eye?
    • VP FARM:
    • Visual acuity
    • Pupils
    • Fields
    • Applanation
    • Retina
    • Movemengs
  62. What are dangerous causes for a red eye?
    • FATKIK
    • Fb
    • Acute angle glaucoma
    • Trauma
    • Keratitis
    • Iritis
    • Kawasaki
  63. What are the Canadian c spine rules? Exclusion?
    • MAP, DAAS koo, rotate
    • MAP:
    • 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

    • EXCLUSION:
    • Bounce back
    • Pregnant
    • Age<16
    • Not stable VS
    • GCS<15
  64. What should you educated CAD patients & families about
    • New ACS:
    • Nitro use, not with PDE-5
    • AED training
    • CPR training
    • Symptom recognition & mgmt
  65. How should you manage pts in crisis?
    • CRISIS:
    • Coping skills ?unhealthy
    • Resources ie. counseling
    • ID pts supports
    • SI?
    • Intervention: meds
    • Support family/friends
  66. What things do you want to address in a pt with Anxiety?
    • PAST SI:
    • Psych comorbidity
    • Abuse
    • Substance use
    • Type of anxiety
    • SI?
  67. How many criteria need to be present for GAD dx?
    3/6
  68. How many criteria need to be present for panic disorder?
    • 4
    • (syncope, excess Hr, chills
  69. 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
  70. What age group and rx for epiglottitis?
    • 1-8 yoa
    • Cefuroxime/intubation
  71. Tell me about diphtheria
    • Forms a pseudo membrane
    • Any age
    • Caused by corynebacterium dipteriae
    • Rx with intubation, pen g, flagyl, or erythro
  72. 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
  73. Ottawa knee rule
    • MAP Flex:
    • Mobility-unable at time and ER 4+ steps
    • Age >55
    • Pain (patellar, fibular head)
    • Unable to FLEX knee >90deg
  74. 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
  75. What do you need to address in all sexual abuse victims?
    • PAIRE:
    • 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
  76. Complications of mono
    • PS HUN these are the complications:
    • Pharyngeal obstruction
    • Splenic rupture
    • Heme: thrombocytopenia, hemolytic anemia, agranulocytosis
    • Uveitis
    • Neuro: GBS, bells palsy, encephalitis, aseptic meningitis, myelitis, cerebellar ataxia
  77. Who should you do a stool culture in? Treat with abx?
    • HEFTI BM:
    • Hypovolemic/Hospitalization
    • >EIGHT stools/24h
    • Food handlers
    • Travel Hx
    • Immunocompromised
    • BOWEL dx(IBD)
    • Mucus/Blood
  78. What is the SIRS criteria
    • HR>90
    • RR>20
    • Temp <36, >38
    • WBC <4, >12, or >10% bands
  79. What lab finding in positive >90% of the time in Wegener's?
    C- ANCA
  80. What are PE findings in gout?
    • Tophi
    • Limited joint mobility
    • Swollen, red joint
  81. What are the investigations & findings for gout?
    • Joint aspirate - crystals
    • X-ray - punched out holes
  82. Why are the risk factors for gout?
    • Illness
    • Male >45 yoa
    • EtOh
    • Trauma/surgery

    • Dietary excess (MLS PMS):
    • Meat
    • Lentils
    • Spinach
    • Peas
    • Mushroom
    • Seafood
  83. What is the treatment for gout?
    • Early abortive therapy with COLCHICINE (1.2 mg), then 0.6 mg q1-2h until diarrhea (max 6g)
    • NSAIDs
    • Prednisone 30-50 x5-7 days
  84. What are X-ray findings for OA
    • Chronic OA Signs:
    • Intraosseous CYSTS
    • Osteophytes
    • Assymetric joint space narrowing
    • Subchondral sclerosis
  85. What are X-ray findings in RA
    • SED rates up:
    • Symmetric joint space narrowing
    • Erosions of subchondral bone
    • Demineralization
  86. What are the symptoms of RA
    Constitutional symptoms!

    • 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
  87. What are the signs of lupus?
    • MD SOAP BRAIN:
    • Malar rash
    • Discoid rash
    • Serositis (GI, pleurisy, pericarditis, nephrosis, hepatosplenomegaly)
    • Oral/nasal ulcers
    • Arthritis
    • Photo sensitivity
    • Blood (leukopenia, thrombocytopenia, anemia of CD)
    • RF
    • ANA
    • Immune abn (autoAb prod'n)
    • Neuro (psychosis, seizures)
  88. What specific tests can u order to dx SLE?
    • ANA - 98% of SLE have it
    • Anti-dsDNA - 50-70%
    • Anti- SM - 30%
    • Decreased c3c4
  89. What two lab findings can be Abnormal in a septic joint?
    • Esr >40
    • WBC > 12
  90. What is the dDx for monoarticular pain?
    • HID MIC:
    • Hemarthrosis
    • Inflammatory
    • Degenerative
    • Malignancy (nearby)
    • Infectious
    • Crystals
  91. What is the dDx in polyarthritis?
    • INFECTIOUS:
    • Bacterial - Lyme disease, Gonococcus, Endocarditis
    • Viral - parvo, rubella, hep b/c
    • POST INFECTIOUS:
    • Rheumatic fever, reactive arthritis, enteric infections
    • INFLAMMATORY:
    • IBD, psoriatic, ank spond, SLE
    • Other: hypothyroid, metabolic bone dz, depression
  92. What are features of sjogren's?
    • Females
    • 50-80yoa
    • Autoimmune
    • Lymphocytic infiltration
    • Positive RF & ANA
    • Assoc with: non Hodgkin, nephritis, rashes, pulm lesions, SLE, RA, scleroderma
  93. What should you routinely ask about in it with rheumatoid dz before managing them?
    • Pregnancy
    • Renal dz
    • liver dz (incl etoh use, OAC)
    • PUD
    • Allergies
  94. 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
  95. 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
  96. What has good evidence for routine screening
    • FELT to be good to screen:
    • Falls
    • Ears - hearing protection
    • Lungs - smoking cess
    • Teeth
  97. What is considered significant weight loss? What's is acceptable?
    >5-10% in 6-12 months

    Acceptable = 1 pound/year!
  98. 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!
  99. What are medical causes of weight loss
    • VASCULAR:
    • intestinal angina, stroke
    • INFECTIOUS
    • hiv/tb infections,
    • METABOLIC:
    • GI - dysphagia, dysmotility, PUD, celiac/malabsorption, IBD, hep
    • other end stage dz,
    • Endo-thyroid, diabetes, adrenal
    • Neuro-dysphagia, dementia
    • INFLAMMATORY: RA, sarcoidosis
    • NEOPLASTIC
    • DRUGS:
    • Alcohol
    • Opioids
    • Withdrawals (antipsychotics, marijuana)
  100. Which bite wounds should you NOT close
    • Primary Closure BITE:
    • Puncture
    • Crush injuries
    • Bites (human/cat)
    • Immunocompromised
    • Time (>12h, or >24h if on face)
    • Extremity (ie. hand / foot)
  101. 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
  102. What are common pathogens in bites? Human? Cat? Dog?
    • Pasteurella
    • Human - eickenella corodens
    • Cat - bartonella henselae
    • Dog - capnocytophagia canimorus
  103. What do u treat bites with?
    Amox-clav x 5d

    OR

    • cefuroxime/TMP-SMX/cipro/moxi/doxy
    • PLUS
    • Flagyl/clinda
  104. Which abx have POOR coverage for pasteurella / eickenella
    • Cephalexin
    • Dicloxacillin
    • Erythromycin
  105. What are the three most common causes of meningitis in adults?
    • Hot Nervous System, HNS:
    • H. Influenza
    • N. gonorrhea
    • S. pneumonia
  106. What are the clinical findings in meningitis?
    • Fever
    • Headaches
    • Neck stiffness
    • Altered mental status
    • Photophobia
    • Papilledema
    • Petechial rash
    • Focal Neuro signs
    • Seizures (add acyclovir)
  107. 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
  108. Who should receive prophylaxis for meningitis?
    • Inform PH
    • Anyone in contact with oral secretions
    • Household contact not fully immunized
    • Close contact in past 8h
  109. 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
  110. 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
  111. Who is a candidate for barbaric surgery?
    • If other weight loss attempts have failed
    • BMI>35 with risk factors
    • BMI>40
  112. What non-cardiac conditions are associated with obesity, that u should screen for?
    • POMME - shape of obesity
    • PCOS
    • OSA
    • Mood disorder
    • MSK - OA
    • Eating disorder
  113. What are some Components of total pain?
    • total pain can be a MESs:
    • Material - financial, functional impairment/dependence
    • Emotional - mood, family dysfunction
    • Spiritual
  114. What symptoms can steroids be used for at the end of life?
    • PNFA:
    • Pain
    • Nausea/vomiting
    • Fatigue
    • Anorexia/cachexia
  115. 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
  116. 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
  117. 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
  118. How do u manage opioid toxicity?
    • Hydration
    • Tx symptoms: haloperidol +/- benzo for seizures
    • Rotate opioids/reduce dose
  119. 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
  120. 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
  121. What age can u give the zoster vaccine? Contraindications?
    >60 yoa, CI if immunocompromised (live vaccine), or anaphylaxis to gelatin / neomycin
  122. What are the cardinal symptoms of Parkinson's disease? How many for dx?
    • 2/4, 1 must be bradykinesia
    • TRAP:
    • Tremor
    • Rigidity
    • Akinesia/Brady
    • Postural instability
  123. What features suggest another cause for parkinson's?
    • Poor response to L-dopa
    • Abrupt onset, rapid progression
    • Early: Falls, Cognitive dysfunction, Autonomic dysfunction
  124. What are 4 dopamine agonists?
    • Bromocriptine
    • Pramiprexole
    • Pergolide
    • Ropinirole
  125. What agents are used to treat Parkinson's?
    • Dopamine precursors
    • Dopamine agonist
    • Amantadine
    • Anticholinergic (cogentin)
    • MAOI (selegeline)
    • COMT inhibitors (entacapone)
  126. What are side effects of dopamine agonists?
    • Negatives Of Dopamine agonists:
    • Nausea
    • Orthostatic hypotension
    • Drowsiness
  127. What are signs and symptoms of Parkinson's?
    • RIM HAD A BBM:
    • Rigidity
    • Involuntary tremor
    • Masked facies
    • Hypophonia (soft speech)
    • Aprosody (monotone speech)
    • Dysarthria (articulation)
    • Autonomic (late - urinary retention, constipation, sexual dysfunction)
    • Bradyphrenia
    • Behavioral changes (personality, sleep dist, depression/anxiety, dec spont speech)
    • Micrographia
  128. What OD causes physiological excitation?
    • WAS Hyper:
    • Withdrawal
    • Anticholinergic
    • Sympathomimetic
    • Hallucinogen
  129. What drug interaction do fluoroquinolones and macolides cause?
    Qt prolongation
  130. What drugs does amoxicillin interfere with?
    • Ocp
    • Warfarin
    • Mtx
  131. What is the criteria for HAP
    • Family member with drug resistance
    • Any high level treatment in last month (wound care, dialysis, chemo, iv abx)
    • LTC
    • 2+ days hospitalization in past 3 months
  132. After diagnosing pneumonia, what atypical causes should you consider?
    TB HAT: TB, bird exposure, HIV, aspiration, travel
  133. What can cause a false negative CXR?
    • Early <24 h
    • Dehydration
    • Severe neutropenia
    • HIV/pcp
  134. When treating pneumonia with abx, they should be better by how many days?
    3 d
  135. Who is the flu vaccine indicated for
    • 6 months-24 months
    • 65+ yoa
    • Contacts of <6mo
    • Chronic medical issues/LTC/Healthcare workers
  136. 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
  137. List 3 types of drugs that can cause ED
    • Anti hypertensives
    • Alcohol
    • Psych meds

    Think hypothyroid & depression as well
  138. What features are in keeping with non organic cause of ED
    TAME: no Trauma, Abrupt onset, no Med changes, nocturnal Erections

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