Term
|
Definition
Board like rigidity
Involuntary guarding
Rebound tenderness
Free air under diaphragm |
|
|
Term
| Mesenteric ischemia presents with |
|
Definition
Pain out of proportion to tenderness
+ lactic acidosis |
|
|
Term
|
Definition
| Hypotension + abdo/back pain + pulsatile abdo mass |
|
|
Term
Most common ado pain causes for:
<15
15-24
25-44
45-64
65+ |
|
Definition
<15 - GE > viral
15-24 - GE > IBS
25-44 - GE > IBS
45-64 - GE > diverticulitis
65+ - diverticulitis > IBS |
|
|
Term
| Dx of infantile colic, symptoms? |
|
Definition
Otherwise healthy infant crying 3+ hrs per day, 3+ days per week for 3+ weeks
Symptoms - crying, flushed face, high pitched screams, passing flatus |
|
|
Term
| Complications of diverticulitis... |
|
Definition
| Abscess 4+ cm, generalized peritonitis, fistula formation |
|
|
Term
| Inpatient vs. Outpatient Rx of Complicated Diverticulitis |
|
Definition
Inpatient - Ceftriaxone + Metronidazole
Outpatient - Ciprofloxacin + Metronidazole |
|
|
Term
| Prevalence of fatigue in general population and in family practice |
|
Definition
6-8% of general population
20-30% of primary care |
|
|
Term
| Most common aetiologies of fatigue in <45 and 45+ |
|
Definition
<45 - NYD > viral > anxiety
45+ - NYD > viral > depression |
|
|
Term
|
Definition
Fatigue - worsened by activity, lack of energy; non-restorative sleep
Somnolence - alleviated by activity, restorative sleep |
|
|
Term
| Reasonable lab investigations for fatigue... |
|
Definition
| CBC, Lytes, Ferritin, Cr, Glucose, LFTs, ESR, , TSH, U/S |
|
|
Term
| Idiopathic Chronic Fatigue |
|
Definition
| Persists for 6+ months, debilitating; NOT chronic fatigue syndrome |
|
|
Term
| Chronic Fatigue Syndrome; 6+ months of fatigue with 4 or more of the following, .... |
|
Definition
Short term memory loss
Headaches
Tender cervical or axillary LN
Post exertional malaise
Unrefreshing sleep
Sore throat
Muscle pain; multi joint pain |
|
|
Term
| Baby should regain birth weight by... |
|
Definition
2 weeks of age
Lose 7% of birth weight in first week, back to birth weight by 2 weeks |
|
|
Term
|
Definition
| Baby startles with noise, can be calmed by mom, focus on objects |
|
|
Term
|
Definition
| Cooing, tracks with eyes, smiles |
|
|
Term
| When does baby start to laugh? |
|
Definition
|
|
Term
| When does the baby begin to vocalize? |
|
Definition
|
|
Term
| When can milk products be introduced to baby? |
|
Definition
| 9-12 months; need FULL FAT (HOMO) products until 2 years of age |
|
|
Term
| When does object permanence develop in the baby? |
|
Definition
|
|
Term
| When does object permanence develop in the baby? |
|
Definition
|
|
Term
| Baby should have 3+ words in vocab by... |
|
Definition
|
|
Term
| When are live vaccines given to the baby? |
|
Definition
At 1 year (e.g. MMR)
Give varicella at 15 month appointment; give MMR + varicella together if MMR was missed at 12 month; otherwise make sure varicella is given at least 4 weeks later |
|
|
Term
| 1st, 2nd and 3rd line treatments for Strep. pneumo? |
|
Definition
1st = penicillins
2nd = cephalosporins
3rd = macrolides
Septra and Quinolones are last line treatments |
|
|
Term
| Macrolide half life from longest to shortest |
|
Definition
Azithro > clarithro > erythro
1/2 life correlates with resistance - longer 1/2 life = more resistance with Strep. pneumo |
|
|
Term
| Rx for AECB in Low vs. High Risk patients? |
|
Definition
Low Risk - Amoxil or Septra or Doxycycline
High Risk - Amoxil + Clavulinic Acid |
|
|
Term
| 3 risk factors that increase risk of AECB? |
|
Definition
FEV1 < 50%
3+ episodes in past year
Antibiotic use in the past 3 months |
|
|
Term
| Clinical Prediction Rule for Strep Throat? |
|
Definition
1 point for - age < 15, exudate/palatal petechiae, no cough, anterior cervical lymphadenopathy, fever
- 1 point if age > 45
0-1 = nothing
2-3 = swab, wait
4+ = start Ab's and swab |
|
|
Term
| Causative organisms of Otitis Media and Sinusitis |
|
Definition
| Strep. pneumo > H. influenzae > M. catarrhalis |
|
|
Term
| 1st line treatment for sinusitis? |
|
Definition
NOT ANTIBIOTICS
Saline irrigation +/- steroid nasal spray |
|
|
Term
| 1st line Rx for Cellulitis? |
|
Definition
Keflex (Cephalexin)
2nd Line = Cloxacillin, Clindamycin |
|
|
Term
| 1st line treatment for UTI |
|
Definition
Septra, Nitrofurantoin
2nd line = Amoxil, Keflex |
|
|
Term
| Lifetime prevalence overall, and gender specific for depression? |
|
Definition
Overall = 1 in 8 (12%)
Women = 10-25%; Men = 5-10% |
|
|
Term
| What % of patients going to their GP go for depressive symptoms? |
|
Definition
|
|
Term
| SADFACIES depression screen |
|
Definition
Need 5+ of these, with either depressed mood or decreased interest for 2+ weeks
Sleep, Appetite, Depressed mood, Fatigue, Agitation, Concentration, Lack of interest, Esteem, Suicide |
|
|
Term
|
Definition
Good screen for depression
+'ve score > 10; 10-15 = moderate; 20+ = severe
When Rx, want less than 5 ideally |
|
|
Term
| Risk factors for suicide: |
|
Definition
Demographics - male, young/old, isolated
History - Fam Hx, past attempts, recent hospital discharge
Symptoms - hopeless, manic in depressive phase, borderline, agitation, substance abuse |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Effexor, Cymbalta (increase NE and 5-HT levels) |
|
|
Term
| How does Wellbutrin (Bupropion) function |
|
Definition
| NDM - increases DA and NE levels (NE and DA reuptake inhibitor) |
|
|
Term
| Anti-depressants can be augmented by which 3 drugs? |
|
Definition
| Li, T3 (Cytomen), Atpical Antipsychotics |
|
|
Term
| Early side effects of anti-depressants |
|
Definition
| Insomnia, agitation, headache, dizzy, nausea |
|
|
Term
| Late side effects of anti-depressants |
|
Definition
| Sex dysfunction, somnolence, weight gain, insomnia |
|
|
Term
| Patients with back pain need what 4 things? |
|
Definition
Pain Relief
Reassurance
Clear prognosis
Education |
|
|
Term
| What 3 things do we need to know about back pain? |
|
Definition
Back vs. Leg Dominant
Constant vs. Intermittent
Any associated GU or GI symptoms? |
|
|
Term
|
Definition
1A - worse on flexion, relieved by extension
B - worse on both
Overall, pattern 1 - back dominant, constant or intermittent, worsened on flexion |
|
|
Term
|
Definition
| Back dominant, intermittent, worsened on extension |
|
|
Term
| Positive Straight Leg Raise indicates |
|
Definition
| Pattern 3 back pain - irritation of sciatic nerve (L4 to S2) |
|
|
Term
| How to test for L5 neuropathy in pattern 3 pain? |
|
Definition
| Heel walking (dorsiflexion), extensor of the big toe |
|
|
Term
| How to test for S1 neuropathy in pattern 3 pain? |
|
Definition
Toe walking (plantar flexion), flexor of the big toe
Achilles/ankle reflex |
|
|
Term
|
Definition
Like straight leg raise, except in prone position
Checks irritation in femoral nerve (L2-4) |
|
|
Term
| What is a "cross-over sign" in regards to testing for lower back pain? |
|
Definition
| When straight leg raise elicits pain in BOTH LEGS - signifies CENTRAL DISC issue |
|
|
Term
|
Definition
| Radiculopathy; leg dominant pain, constant, positive neurologic findings |
|
|
Term
|
Definition
| Neurogenic claudication (spinal stenosis); leg dominant pain, intermittent, usually worse with walking (extension) and relieved by rest (flexion) |
|
|
Term
|
Definition
Morphine = 1
Hydromorphone = 5
Codeine = 0.15
Oxycodone = 1.5 |
|
|
Term
|
Definition
| 30 mg Codeine + 300 mg Acetaminophen |
|
|
Term
|
Definition
| 5 mg Oxycodone + 325 mg Acetaminophen |
|
|
Term
|
Definition
Compulsive
Lack of control
Consequences
Cravings |
|
|
Term
|
Definition
| Aim at or below 200 mg/day of morphine or allotted equivalencies |
|
|
Term
| 5 Risk Factors for Cardiac Chest Pain |
|
Definition
HTN - >140/90 uncontrolled
DM - 2x the risk
Dyslipidemia
Smoking - 40 pack year or quit within last 5 years
Family Hx |
|
|
Term
| Clinical Prediction Rule for Cardiac Chest Pain |
|
Definition
Age < 55 males, < 65 females
Cannot elicit on palpation
Patient thinks it is of cardiac origin
Known Hx of CVD or cerebrovascular disease
Pain worsens with exercise |
|
|
Term
| Signs of respiratory distress in INFANTS |
|
Definition
| Indrawing, nasal flaring, tracheal tug, circumoral cyanosis |
|
|
Term
| Croup = Laryngotracheobronchitis; management... |
|
Definition
Mild - supportive
Moderate - dexamethasone
Severe - airway management |
|
|
Term
|
Definition
Acute onset with fluctuant course + inattention
Plus at least one of - disorganized thought, decreased LoC |
|
|
Term
| How to treat depression +/- dementia in regards to SSRI and AChEI therapy? |
|
Definition
SSRI given first - need 4 week trial to determine efficacy
Give AChEI 6 weeks to 3 months after SSRI therapy onset |
|
|
Term
| Difference between MCI and dementia |
|
Definition
| MCI has NO effect on ADLs, or IADLs, despite objective evidence of cognitive impairment |
|
|
Term
|
Definition
ADLs - DEATH - Dressing, Eating, Ambulation, Toileting, Hygiene
IADLs - SHAFT - Shopping, Housework, Accounting, Food Prep, Telecommunication, (Meds) |
|
|
Term
| Dx of vascular dementia requires... |
|
Definition
Vascular risk factors present + evidence of ischemic changes on imaging
Can be better mitigated and progress slowed; but more abrupt decline in cognition compared to Alz |
|
|
Term
|
Definition
Alzheimer's dementia + vascular risk factors
Do not necessarily need evidence of ischemic changes on imaging |
|
|
Term
|
Definition
Progressive behavioural change or language decline
Earlier onset than Alz (45-60)
BUT memory and visual perception well preserved |
|
|
Term
| Difference in onset between DLB and PDD |
|
Definition
DLB onset at or before Parkinsonian symptoms appear
PDD onset 1+ year after onset of symptoms |
|
|
Term
|
Definition
| Ointments > creams > lotions |
|
|
Term
| Increasing strength of steroid use for atopic dermatitis |
|
Definition
1% hydrocortisone (low) - body and face
0.05% betamethasone (med) - body only
Clobetasol (high) - last resort; body only |
|
|
Term
| 4 pathogenic factors of ACNE |
|
Definition
Inflammatory mediator release
P. acnes follicular colonization
Alternation in normal keratinization processes
Increased sebum production |
|
|
Term
| Treatment algorithm for management of acne |
|
Definition
1st - Topical Retinoid +/- Antimicrobial (Benzoyl Peroxide)
2nd - Systemic Ab + Retinoid +/- Anti-Androgen (OCP)
3rd - Isoretinoin |
|
|
Term
|
Definition
| Pearly papule with rolled borders and telangiectasia (can look like a pimple that doesn't get better over time) |
|
|
Term
| Risk factors for Actinic Keratoses - |
|
Definition
| Age, Male, Sun Exposure, Fair skin, Smoker |
|
|
Term
| #1 predictor of impending death |
|
Definition
| Decrease in functional status |
|
|
Term
| What do patients want in EoL Care |
|
Definition
SCUBA
Symptom Management
Control
Under no circumstance prolong death
Burden relief for family
Affirmation of self, adequate plan of care |
|
|
Term
|
Definition
| Abnormal pattern; progressively deeper and tachypneic breathing, followed by gradual decrease that results in apnea (temporary stop in breathing) |
|
|
Term
| Medical Management of EoL - Pain |
|
Definition
| 1st Line Opioids (start moderate with Fentanyl, work up to morphine, hydromorphone) |
|
|
Term
| Management of EoL - Dyspnea |
|
Definition
1st = Opioids
2nd = Benzo, Phenothiazines |
|
|
Term
| Management of EoL - Delirium |
|
Definition
1st = Antipsychotics (Haloperidol), Benzo (Lorazepam)
2nd = Chlorpromazine, Phenothiazines |
|
|
Term
| Management of EoL - Terminal Secretions |
|
Definition
|
|
Term
|
Definition
>38 rectal; >37.5 oral; >37 axillary
Rectal is gold standard for kids < 3 months of age |
|
|
Term
|
Definition
Hypothalamic set point altered (#1)
Heat production > loss
Altered heat loss |
|
|
Term
| Types of Fever and Examples |
|
Definition
Intermittent - goes back to normal each day; septic (lymphoma, TB)
Remittent - decreases each day, but not to normal (most common)
Sustained - sustained elevation, no variation (typhoid)
Relapsing - fever returns to normal for days, then comes back (malaria) |
|
|
Term
|
Definition
Wind, Water, Wound, Walking, Womb, Breast
Wind - atelectasis, pneumonia
Water - UTI
Wound - infection
Walking - DVT/PE
Womb - endometritis
Breast - mastitis |
|
|
Term
|
Definition
Wind, Water, Wound, Walking, Wonder Drugs
Wind - PO day 1-2
Water - PO day 3+
Wound - PO day 5
Walking - PE/DVT (PO 7-10)
Drug fever - PO 6-10 |
|
|
