CCFP flash cards.txt

• PND FADDDS
• Pain, nausea, dyspnea, fatigue, anorexia/cachexia, delirium, depression, dehydration

• SAMP
• SLEEP hygiene, decrease/increase ACTIVITY, D/C MEDS, improve PAIN control

• MAD
• Myoclonus,
• Allodynia/HyperAlgesia, Delirium/hallucinations

• DNSP - DO NOT START PANICKING:
• Dry mouth,
• N/V/C,
• Somnolence (transient), Pruritis

• SIB (Substance IBuse)
• School failure, Isolation, Behavioral change

• - 12 month duration
• - Never met criteria for dependence
• - LORD ( legal problems, ongoing use despite substance related problems, responsibilities unmet, dangerous use)

• - 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.

• 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.

• 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)

• GFTAPAO
• Go Find The Adenoma Please And Oxygenate
• (GH, FSH/LH, TSH, ACTH, Prolactin, ADH, Oxytoxin)

POSTERIOR pit = OA (oxytocin, ADH)

• SADMIST
• (Suppressants, AIDS, Diabetes, Malnutrition, Ig deficiency, Solid organ dysfunction, Tumor)

• YES just a SEC, gotta bloody poo!
• Yersinia, ETEC/EHIC, Salmonella, Shigella, Enteroamoeba, Campylobacter

• PST:
• Can't pee, can't see, can't climb a tree
• urethritis, then Conjunctivitis, then arthritis

• 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

Hypertension, Abnormal Liver/Renal, Stroke, Bleeding hx, Labile INRs, elderly (>65), Drugs/Etoh

• WACO
• Ataxia, confusion, opthalmoplegia

• Has to have:
• 1. Acute, fluctuating course
• 2. In attention

• ONE of the following:
• 3. Disorganized thinking
• 4. Altered LOC

• Air Canada PAID
• Amnesia
• Confabulation
• Preservation of LT memory & cog skills
• Apathy
• Intact sensorium
• Denial of Illness

• 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

HOT LATE NIGHT SUV MOOD

Hot flashes, libido decreased night sweats, sleep disturbance, urinary incontinence, vaginal dryness & decreased libido, mood-depression

• RESCCue
• Risk assessment, educate about course, Safety plan, counseling (sw)/community resources, CAS,

• GAP
• gerd,
• asthma,
• PND:post nasal drip

• Cut the GSP high!
• 1. Decrease Catecholamines: clonidine 2. GI (diarrhea): ondanseteon, peptol bismol
• 3. Sleep: trazodone 4. Pain: NSAIDs

• 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

• 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

• 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

• COMSS
• -Catheter (chronic)
• -Obstruction
• -Men
• -Structural abN
• -SC injury

• - 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

• MVP gets PD day
• - Medical condition
• - Variable of normal dev't
• - Psychosocial factors
• - Psych: emotional/behavioral
• - Development/Neuro conditions

• 1. NSAIDs
• 2. Anti-fibrinolytic: tranexamic
• 3. OCP
• 4. IUD
• 5. Danazol
• 6. Lupron

• 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

• 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

• 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

• HIP MD
• Hypogonadosm
• Inflammatory disorders
• PTH elevated
• Malabsorption
• Drugs - high risk ones

• TRAUMA
• Traumatic experience
• Re-experienced
• Avoidance of stimuli
• Unable to fx
• Month >1
• Arousal increased

• Ask about smoking status
• Advise to quit
• Assess readiness
• Assist with quit attempt
• Arrange follow up

• 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)

• SMAC
• - after Sex
• - after Meal
• - with Alcohol
• - morning Coffee

• 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

• MSI(no GE)CAP
• Mood disturbance
• Sleep disturbance
• Irritability
• Concentration imp
• Appetite increased/wt gain
• Psychomotor - restless

• 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!

• 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)

• Chlamydia: azithro 1g x 1
• Gonorrhea: cefixime 400 x 1
• Trich: flagyl 2g x 1
• Herpes: acyclovir 200 5x/d x 5-10d

• 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

• VSA LIST PE contacts
• VS abnormal
• Smoker
• Aspiration
• Lung dz
• Immunosuppressed
• SOB
• travel
• PE risk factors
• Sick Contact

• CF PFT
• Congenital dz
• Family hx serious illness
• Position (sniffing, drool)
• FB
• Failure to Thrive

• HT PANTS
• Hunger
• Trembling
• Palpitations
• Anxiety
• Nausea
• Tingling
• Sweating

• >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

• Onset within 3 months of stressor, subsides within 6 months of stressor going away (unless chronic stressor)
• - impaired functioning
• - treat with psychotherapy

5, 1/5 has to be anhedonia or low mood

• 3 - DIGFAST
• - distractible
• - impulsive
• - grandiosity
• - flight of ideas
• - Activites, pleasurable with neg. consequences
• - pSychomotor agitation (goal directed activities)
• - talkative

• 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?)

TAILS: thalassemia, anemia of chronic dz, iron def anemia, lead poisoning, sideroblastic anemia + hemoglobinopathy (spherocytosis, SC, thal, g6pd)

• A HEAD
• - anemia of chronic dz
• - Hbgopathy: hemolysis, SC, others
• - endocrine dz
• - aplastic anemia
• - deficiencies, mixed

• HAD Large Mcv
• - hemolytic anemia
• - alcohol use
• - deficiencies (b12, folate)
• - liver dz
• - myelodysplasia
• Also high PTH

• 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?

• CANCAM
• - chocolate
• - alcohol
• - nuts
• - caffeine
• - aged cheese
• - MSG

• SHE gets migraines
• - sensory (lights, sounds, smells)
• - hormonal (ocp, cycles)
• - environmental (sleep, irreg meals, stress, weather)

• 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

• 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

• VP FARM:
• Visual acuity
• Pupils
• Fields
• Applanation
• Retina
• Movemengs

• FATKIK
• Fb
• Acute angle glaucoma
• Trauma
• Keratitis
• Iritis
• Kawasaki

• 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

• New ACS:
• Nitro use, not with PDE-5
• AED training
• CPR training
• Symptom recognition & mgmt

• CRISIS:
• Coping skills ?unhealthy
• Resources ie. counseling
• ID pts supports
• SI?
• Intervention: meds
• Support family/friends

• PAST SI:
• Psych comorbidity
• Abuse
• Substance use
• Type of anxiety
• SI?

3/6

• 4
• (syncope, excess Hr, chills

• Age group: 6 months-8yoa
• Bugs: s. aureus, s. pneumo, H. Flu
• Clinical hx: 2ndary worsening, toxic, no resp to epi
• Tx: ceftriaxone

• 1-8 yoa
• Cefuroxime/intubation

• Forms a pseudo membrane
• Any age
• Caused by corynebacterium dipteriae
• Rx with intubation, pen g, flagyl, or erythro

• 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

• MAP Flex:
• Mobility-unable at time and ER 4+ steps
• Age >55
• Pain (patellar, fibular head)
• Unable to FLEX knee >90deg

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

• 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

• 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

• HEFTI BM:
• Hypovolemic/Hospitalization
• >EIGHT stools/24h
• Food handlers
• Travel Hx
• Immunocompromised
• BOWEL dx(IBD)
• Mucus/Blood

• HR>90
• RR>20
• Temp <36, >38
• WBC <4, >12, or >10% bands

C- ANCA

• Tophi
• Limited joint mobility
• Swollen, red joint

• Joint aspirate - crystals
• X-ray - punched out holes

• Illness
• Male >45 yoa
• EtOh
• Trauma/surgery

• Dietary excess (MLS PMS):
• Meat
• Lentils
• Spinach
• Peas
• Mushroom
• Seafood

• 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

• Chronic OA Signs:
• Intraosseous CYSTS
• Osteophytes
• Assymetric joint space narrowing
• Subchondral sclerosis

• SED rates up:
• Symmetric joint space narrowing
• Erosions of subchondral bone
• Demineralization

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

• 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)

• ANA - 98% of SLE have it
• Anti-dsDNA - 50-70%
• Anti- SM - 30%
• Decreased c3c4

• Esr >40
• WBC > 12

• HID MIC:
• Hemarthrosis
• Inflammatory
• Degenerative
• Malignancy (nearby)
• Infectious
• Crystals

• 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

• Females
• 50-80yoa
• Autoimmune
• Lymphocytic infiltration
• Positive RF & ANA
• Assoc with: non Hodgkin, nephritis, rashes, pulm lesions, SLE, RA, scleroderma

• Pregnancy
• Renal dz
• liver dz (incl etoh use, OAC)
• PUD
• Allergies

• Early (immediately if mod-severe)
• If mild, trial of NSAIDs x 2-3 months, if failed the. DMARD

• 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

• FELT to be good to screen:
• Falls
• Ears - hearing protection
• Lungs - smoking cess
• Teeth

>5-10% in 6-12 months

Acceptable = 1 pound/year!

• 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!

• 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)

• Primary Closure BITE:
• Puncture
• Crush injuries
• Bites (human/cat)
• Immunocompromised
• Time (>12h, or >24h if on face)
• Extremity (ie. hand / foot)

• Eyelid: 3 days
• Face: 5 days
• Neck: 3-4 days
• Trunk / UE: 7 days
• LE: 8-10 days
• Scalp: 7-14 days

• Pasteurella
• Human - eickenella corodens
• Cat - bartonella henselae
• Dog - capnocytophagia canimorus

Amox-clav x 5d

OR

• cefuroxime/TMP-SMX/cipro/moxi/doxy
• PLUS
• Flagyl/clinda

• Cephalexin
• Dicloxacillin
• Erythromycin

• Hot Nervous System, HNS:
• H. Influenza
• N. gonorrhea
• S. pneumonia

• Fever
• Headaches
• Neck stiffness
• Altered mental status
• Photophobia
• Papilledema
• Petechial rash
• Focal Neuro signs
• Seizures (add acyclovir)

• Glucose lower in bacterial
• WBC higher in bacterial (Neutrophils)
• Protein higher in bacterial

• Inform PH
• Anyone in contact with oral secretions
• Household contact not fully immunized
• Close contact in past 8h

• Neonates: amp & cefotaxime
• Adults: ceftriaxone and vanco
• IC: amp + ceftriaxone + vanco
• CSF/Neuro Sx: ceftriaxone + CEFEPIME

• 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

• If other weight loss attempts have failed
• BMI>35 with risk factors
• BMI>40

• POMME - shape of obesity
• PCOS
• OSA
• Mood disorder
• MSK - OA
• Eating disorder

• total pain can be a MESs:
• Material - financial, functional impairment/dependence
• Emotional - mood, family dysfunction
• Spiritual

• PNFA:
• Pain
• Nausea/vomiting
• Fatigue
• Anorexia/cachexia

• Pain all over with no systemic disease
• Worse when alone
• Improves with socialization
• No relief with increasing opioids
• Hx of somatization under stress

• Total pain
• Cognitive dysfunction
• Hx of substance abuse
• Incidental pain

Also Inquire about coping strategies, previous rx, metabolic abN

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

• Hydration
• Tx symptoms: haloperidol +/- benzo for seizures
• Rotate opioids/reduce dose

• Determine TDD
• Use equianalgesic table
• Reduce by 25% (50% of toxic)
• Divide by 6 for q4h dosing with 10% TDD BTA

• Same as switching from other opioids but overlap patch in first 12 h with previous meds&doses
• Keep same BTA dose

>60 yoa, CI if immunocompromised (live vaccine), or anaphylaxis to gelatin / neomycin

• 2/4, 1 must be bradykinesia
• TRAP:
• Tremor
• Rigidity
• Akinesia/Brady
• Postural instability

• Poor response to L-dopa
• Abrupt onset, rapid progression
• Early: Falls, Cognitive dysfunction, Autonomic dysfunction

• Bromocriptine
• Pramiprexole
• Pergolide
• Ropinirole

• Dopamine precursors
• Dopamine agonist
• Amantadine
• Anticholinergic (cogentin)
• MAOI (selegeline)
• COMT inhibitors (entacapone)

• Negatives Of Dopamine agonists:
• Nausea
• Orthostatic hypotension
• Drowsiness

• 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

• WAS Hyper:
• Withdrawal
• Anticholinergic
• Sympathomimetic
• Hallucinogen

Qt prolongation

• Ocp
• Warfarin
• Mtx

• 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

TB HAT: TB, bird exposure, HIV, aspiration, travel

• Early <24 h
• Dehydration
• Severe neutropenia
• HIV/pcp

3 d

• 6 months-24 months
• 65+ yoa
• Contacts of <6mo
• Chronic medical issues/LTC/Healthcare workers

1 wk before and 1 day after abx

• Anti hypertensives
• Alcohol
• Psych meds

Think hypothyroid & depression as well

TAME: no Trauma, Abrupt onset, no Med changes, nocturnal Erections