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Toronto Notes Flashcards

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1
Q

Clinical features of Familial Combined Hypercholesterolemia

A

Premature coronary heart disease, xanthelasma, and obesity

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2
Q

Risk factors for Type 1 diabetes mellitus

A

Personal history of other autoimmune diseases including Graves’ disease, myasthenia gravis, autoimmune thyroid disease, celiac disease, and pernicious anemia<br></br>Family history of autoimmune diseases

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3
Q

Screening for Macrovascular complications of diabetes

A

A1c every 3 mo<br></br>BP monitoring<br></br>Lipid profile every 1-3 yr<br></br>Resting ECG every 3-5 yr for high-risk patients

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4
Q

Etiology of Type 2 Diabetes Mellitus

A

Pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced

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5
Q

Clinical features of autonomic neuropathy

A

Postural hypotension<br></br>Tachycardia<br></br>Decreased cardiovascular response to valsalva maneuver<br></br>Gastroparesis<br></br>Alternating diarrhea and constipation<br></br>Urinary retention and erectile dysfunction

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6
Q

Osteoporosis is an age-related disease characterized by:

A

Decreased bone mass and increased susceptibility to fractures

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7
Q

The 5 Ps of the sexual history:

A

Partners<br></br>Practices<br></br>Protection<br></br>Past history of STIs<br></br>Pregnancy prevention

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8
Q

Sinusitis often presents with PODS symptoms:

A

Facial pain or fullness<br></br>Nasal obstruction<br></br>Postnatal discharge or purulence<br></br>Changes in smell

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9
Q

Sleep apnea is diagnosed using nocturnal polysomnography and first-line treatment is:

A

Continuous positive airway pressure (CPAP)

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10
Q

Group A beta-hemolytic Streptococcus is the most common bacterial cause of:

A

Sore throat (pharyngitis)

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11
Q

List the three categories of benign breast lesions:

A

Non-proliferative<br></br>Proliferative without atypia<br></br>Typical hyperplasia

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12
Q

Which finding on mammogram is pathognomonic for fat necrosis:

A

Oil cysts

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13
Q

Which type of hemorrhoids are associated with painless BRBPR, rectal fullness or discomfort, and mucus discharge:

A

Internal hemorrhoids

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14
Q

Characteristic finding of sigmoid volvulus on AXR:

A

Coffee-bean sign

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15
Q

Surgical emergencies focused history:

A

AMPLE:<br></br>Allergies<br></br>Medications<br></br>Past medical/surgical history (including anesthesia and bleeding disorders)<br></br>Last meal<br></br>Events (history of presenting illness)

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16
Q

Preoperative stress dose coverage:

A

For patients with primary adrenal insufficiency (e.g. Addison’s disease) or secondary adrenal insufficiency (e.g. glucocorticoid use)

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17
Q

Postoperative fever:

A

Inflammatory physiological stress (non infectious, POD#1)<br></br>Atelectasis (POD#1-2)<br></br>Early necrotizing fasciitis (POD#1-2)<br></br>Infectious (POD#3-7)<br></br>Abscess/DVT/drug fever (POD#8+)

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18
Q

Approach to critically ill surgical patient:

A

ABCs<br></br>IV 2 large bore IVs NS wide open<br></br>Monitors (O2 sat, ECG, BP)<br></br>Foley catheter<br></br>Investigations (bloodwork) +/- NG tube Imaging when stable

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19
Q

Patient risk factors surgical site infections:

A

Age<br></br>DM<br></br>Steroids<br></br>Immunosuppression<br></br>Smoking<br></br>Obesity<br></br>Burn<br></br>Malnutrition<br></br>Patient with other infections<br></br>Traumatic wound<br></br>Radiation<br></br>Chemotherapy

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20
Q

Mediastinum is bounded by:

A

Thoracic inlet<br></br>Diaphragm<br></br>Sternum<br></br>Vertebral bodies<br></br>Pleura

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21
Q

6Ss of SSC:

A

Smoking<br></br>Spirits (alcohol)<br></br>Seeds (beetel nut)<br></br>Scalding (hot liquid)<br></br>Strictures<br></br>Sack (diverticula)

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22
Q

Lung cancer prevention:

A

Smoking cessation<br></br>Avoidance of exposures<br></br>Early detection

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23
Q

Most common bariatric surgery for combination malabsorptive and restrictive:

A

Laparoscopic Roux-en-Y gastric bypass

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24
Q

Lung tumours classified as:

A

Primary or secondary, benign or malignant, endobronchial or parenchymal

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25
Contraindications to Liver Transplantation: 
Active alcohol/substance use
Extrahepatic malignancy within 5 yrs
Advanced cardiopulmonary disease
Active uncontrolled infection
26
Define Cholelithiasis: 
The presence of stones in the gall bladder
27
Cholelithiasis Risk Factors for Cholesterol Stones: 
Obesity
Increasing age
Female sex (esp females<50 years)
Estrogens (female, multipariry, OCPs)
Impaired gallbladder emptying (starvation, TPN, DM)
Rapid weight loss
28
Cholelithiasis Risk Factors for Pigment Stones: 
Cirrhosis
Chronic hemolysis
Biliary stasis
Terminal ileal resection/disease (Crohn's disease)
29
Cholelithiasis Protective Factors: 
Statins
Physical Activity
Vitamin C
Poly- and Monounsaturated Fats/Nuts
Coffee
30
Define Acute Cholecystitis:
Inflammation of gallbladder resulting from sustained gallstone impaction in cystic duct or Hartmann’s pouch
31
Define Choledocholithiasis: 
Stones in the common bile duct
32
Define Acute Cholangitis: 
Obstruction of common bile duct leading to biliary stasis, bacterial overgrowth, suppuration, and biliary sepsis
33
Common causes of constipation in older adults: 
Primary impaired colonic and anorectal function
Drugs
Diet
Colo-anorectal disorders (cancer, masses, stenosis, strictures)
Neurologic (stroke, dementia, Parkinson’s disease, autonomic neuropathy)
Psychiatric (depression, anxiety)
34
Transient causes of incontinence: 
(DIAPERS)
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Excessive urine output
Restricted Mobility
Stool impaction
35
Components of delirium prevention: 
Orient patient
Provide eyewear and hearing aids if needed
Mobilization of patient
Improve sleep quality
Medication reconciliation
Adequate nutrition & hydration
36
Risk factors for elder abuse: 
Financial exploitation
Physical signs (e.g. bruising)
Delay in seeking medical attention
Disparities in histories
Lack of close family ties
Dementia
Recent deterioration in health
Family hx of violence
37
Key items to elicit for fall history: 
(SPLATT)
Symptoms
Previous falls
Location of falls
Activity at the time of fall
Time of fall
Trauma
38
Investigations for falls: 
CGA
CBC
Electrolytes
BUN
Creatinine
Glucose
Ca2+
TSH
Vitamin B12
Urinalysis
Cardiac enzymes
ECG
CT head (as directed by history and physical)
Coagulation profile
DEXA if >65y
39
Components of a Comprehensive Geriatric Assessment for management of frailty: 
Past medical/surgical history
Social history
Functional history
Physical assessment
Geriatric review of systems (cognition, mood/mental health, falls, sleep, pain, nutrition, continence)
Polypharmacy
40
Key factors to consider in driving competency in older adults
(SAFEDRIVE):
Safety record
Attention (e.g. concentration lapses, episodes of disorientation)
Family observations
Ethanol abuse
Drugs
Reaction time
Intellectual impairment
Vision/Visuospatial function
Executive functions (e.g. planning, decision-making, self-monitoring behaviours)
41
Pharmacokinetic changes in the elderly (absorption, distribution, metabolism, elimination): 
No significant changes to absorption
Increased distribution of lipophilic drugs
Decreased distribution of hydrophilic drugs
Increased binding of basic drugs
Decreased binding of acidic drugs
Reduced phase I reactions by liver
Reduced renal elimination of drugs
42
Risk factors for polypharmacy: 
Patient level: Age, female sex, cognitive impairment, frailty, mental health conditions, multiple chronic conditions, lack of primary care physician, residing in LTC, use of multiple pharmacies
Systems-level: Multiple prescribers, poor documental systems, automated refill systems/lack of systematic medication review
43
Principles for Prescribing in the Elderly: 
Caution/compliance
Age (adjust dosage for age)
Review regimen regularly
Educate
Discontinue unnecessary medications
44
Etiologies of disseminated intravascular coagulation: 
Obstetric complications
Malignancy
Infection
Trauma
Shock
45
Vitamin K dependent factors: 
X
IX
VII
II
Protein C
Protein S
46
Heparin therapy is monitored with: 
aPTT
47
Clinical features of DVT: 
Unilateral leg swelling
Erythema
Warmth
Tenderness
Palpable cord
48
Most useful test to rule out DVT (in the context of low pre-test probability): 
D-dimer
49
Initial Investigations for Fever in a returned traveller: 
Malaria smears x 3
Blood C&S
Routine (CBC & differential, liver enzymes, electrolytes, Cr)
Urinalysis (+/1 urine C&S)
50
Risk of transmission after needle stick exposure to blood/infectious fluid (HPB, HPC, HIV): 

Risk of HIV transmission after mucus membrane exposure:
Hepatitis B (1/3), Hepatitis C (1/30), HIV (1/300).

0.09%
51
Diagnosis of active TB (4 main components): 
1) CXR
2) Sputum for direct acid-fast smear
3) Mycobacterial culture & DST
4) NAAT
52
Causes of Nosocomial FUO (BCDE): 
Bacterial and fungal infections of Resp tract & surgical sites
Catheters
Drugs
Emboli
53
Drugs that may cause fever: 
Antimicrobials
Antihypertensives
Anti-epileptics
Anti-arrhythmics
Anti-inflammatories
Anti-thrombotics
Anti-histamines
Anti-thyroid
54
Causes of anion gap metabolic acidosis: 
"MUDPILES CAT"
Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde
Isopropyl alcohol/iron/ibuprofen/Indomethacin
Lactic Acidosis
Ethylene Glycol
Salicylates
Cyanide/Carbon monoxide
Alcoholic ketoacidosis
Toluene
55
What is Kussmaul breathing a feature of? 
Metabolic acidosis
56
What are the general steps in managing hyperkalemia?
a) Stabilize the myocardium (Calcium salts)
b) Shift potassium into cells (insulin and IV dextrose)
c) Enhance potassium excretion (loop diuretics vs. sodium polystyrene sulfonate)
57
What is a potential complication of rapid correction of hyponatremia? 
Osmotic demyelination (of pontine and extrapontine neurons, which may be irreversible)
58
What is a good framework for thinking about the differential diagnoses of acute kidney injury?
- Prerenal (e.g. hypovolemia, cardiac performance, NSAIDs/ACEi/ARBs)
- Renal (e.g. vasculitis, glomerulonephritis, acute interstitial nephritis, acute tubular necrosis)
- Postrenal (e.g. obstructing calculi, ureteric stricture, neuropathy)
59
What are the indications for dialysis? 
Think: “AEIOU”
Acidosis
Electrolyte imbalance (K+)
Intoxication (AKI)
Overload (fluid)
Uremia (encephalopathy, pericarditis, urea >35-50 mM)
60
What are the features of Nephritic Syndrome? 
Think: “PHAROH”
Proteinuria
Hematuria
Azotemia
RBC casts
Oliguria
HTN
61
Describe the presentation of Nephrotic Syndrome? 
Think: “HELP”
Hypoalbuminemia
Edema
Lipid abnormalities
Proteinuria
62
What are the major complications and management principles of CKD? Think of the NEPHRON acronym. 
N - Low-nitrogen diet
E - Electrolytes: monitor K+
P - pH: metabolic acidosis
H - HTN
R - RBCs: manage anemia with erythropoietin
O - Osteodystrophy: give calcium between meals (to increase Ca2+) and calcium with meals (to bind and decrease PO43-)
N - Nephrotoxins: avoid nephrotoxic drugs (ASA, gentamicin) and adjust doses of renally excreted medications
63
What are the extrarenal manifestations of PKD? 
Hepatic cysts
Mitral valve prolapse
Cerebral aneurysms
Diverticulosis
64
Functions of the facial nerve “Ears, Tears, Face, Taste”: 
Ears: stapedius muscle, sensory around concha of auricle, EAC, and TM.
Tears: lacrimation and salivation.
Face: muscles of facial expression.
Taste: anterior 2/3 of tongue
65
Findings suggesting of central vertigo: 
Acute onset
Continuous
Normal head impulse test
Multidirectional nystagmus
Skew deviation present
66
5 “D” of Vertebrobasilar insufficiency: 
Drop attacks
Diplopia
Dysarthria
Dizziness
Dysphagia
67
Order of the Neural Pathway of hearing 
“E COLI”:
Eighth cranial nerve
Cochlear nucleus
superior Olivary nucleus
Lateral lemniscus
Inferior colliculus
68
Signs of BPPV seen with Dix-Hallpike Maneuver: 
Latency ~20 seconds
Crescendo/decrescendo vertigo lasting ~20 seconds
Geotropic rotary nystagmus (required)
Reversal upon sitting up
Fatigability
69
Diagnostic criteria for Meniere’s disease: 
All three of
1) Two spontaneous episodes of rotational vertigo > 20 min.
2) Audiometric confirmation SNHL (often low frequency).
3) Tinnitus/aural fullness
70
Syringing for cerumen impaction, indications: 
Totally occlusive cerumen with pain
Decreased hearing
Tinnitus
71
Syringing for cerumen impaction, contraindications: 
Active infection
Previous ear surgery
OOnly hearing ear
TM perforation
72
Syringing for cerumen impaction, complications: 
OE, OM, TM perforation
Trauma
Pain
Vertigo
Tinnitus
73
Classic triad of mastoiditis: 
Otorrhea
Tenderness to pressure over the mastoid
Retroarticular swelling with protruding ear
74
Common signs of Basilar Skull Fractures: 
Battle’s sign (bruising over mastoid)
Racoon eyes
CSF rhinorrhea/otorrhea
CN involvement (CNV – facial numbness, CNVI – nystagmus, CNVII – facial palsy)
75
Major symptoms of acute bacterial rhinosinusitis 
(PODS, at least 2 with 1 being O or D):
facial Pain/Pressure/fullness
nasal Obstruction
nasal Discharge
hyposmia/anosmia (Smell)
76
What is the most common congenital neck mass found in children?: 
Thyroglossal duct cysts
77
Risk factors for head and neck malignancy include: 
Smoking
Alcohol use
Radiation to the head and neck
Oral HPV exposure
Personal history of malignancy
Family history of malignancy
78
5 Ps of papillary thyroid carcinoma: 
Popular (most common)
Palpable lymph nodes
Positive I131 uptake
Positive prognosis (98% 10 yr survival)
Postoperative I131 scan guides further treatment
79
4 Fs of Follicular thyroid carcinoma: 
Far away metastases
Females (3:1 ratio)
not FNA (cannot be diagnosed with FNA)
Favourable prognosis (92% 10 year survival)
80
Common clinical features of a peritonsillar abscess, the Quinsy Triad: 
Trismus
Uvular deviation
Dysphonia (“hot potato voice”)
81
Signs of croup, the 3 Ss: 
Stridor
Subglottic swelling
Seal bark cough
82
Lab results for ITP: 
Thrombocytopenia with normal RBC, WBC
83
Three types of leukemia in children, and the most common: 
ALL
AML
CML
ALL is the most common
84
Associated congenital abnormalities with Wilms Tumour: 
WAGR syndrome:
Wilms tumour
Aniridia
Genitourinary anomalies
mental Retardation
85
Treatment for bacterial meningitis
Emergent empiric antibiotic therapy based on age (age ≤28 d: ampicillin + cefotaxime, age 29 d-3 mo: ceftriaxone/cefotaxime + vancomycin ± ampicillin, age >3 mo: ceftriaxone + vancomycin). Add ampicillin IV to the above treatments if risk factors for infection with L. monocytogenes present: age >50, alcoholism, immunocompromised
86
Five stages of rabies
1) incubation period
2) prodrome
3) acute neurologic syndrome
4) coma
5) death
87
Treatment for pulmonary tuberculosis
RIPE - rifampin + INH + pyrazinamide + ethambutol x 2 mo (initiation phase), then INH + rifampin x 4 mo in fully susceptible TB (continuation phase), total 6 mo.
88
Typical causes of community acquired pneumonia
Steptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae
Staphylococcus aureus
89
Two most common causative organisms of cellulitis
Beta-hemolytic streptococci most commonly group A Streptococcus. Staphylococcus aureus is a notable but less common cause.
90
Early clinical features of necrotizing fasciitis
Pain out of proportion to clinical findings, edema ± crepitus, rapid spread of infection, systemic symptoms
91
Common infectious causes of oral lesions
Candidiasis, gonococcal infection, HSV
92
What is the acronym to remember the clinical features of infective endocarditis
FROM JANE (Fever Roth’s spots Osler’s nodes Murmur Janeway lesions Anemia Nail-bed hemorrhages Emboli)
93
Causes of gynecomastia
(DOC TECH): Drugs (esp. anti-androgens, i.e., spironolactone), Other, Congenital (Klinefelter syndrome), Tumour (esp. germ cell tumours), Endocrine (hyperthyroidism), CHronic disease (cirrhosis, CKD)
94
Drugs that cause gynecomastia
(DISCKO): Digoxin, Isoniazid, Spironolactone, Cimetidine, Ketoconazole, Oestrogen/anti-testosterone
95
Definition of lead-time bias
overestimation of survival time ‘from diagnosis’ when the estimate is made from the time of screening, instead of the later time when the disease would have been diagnosed without screening
96
Definition of length-time bias
overestimation of the survival time due to screening at one time point including more stable cases than aggressive cases of disease, which may have shorter survival times
97
Definition of Berkson’s bias
occurs in a case-control study using hospitalized controls, as they may not be a representative sample of the population due to the complexity that led to their hospital admission
98
Diagnostic criteria for behavioural variant FTD
at least 3/5 of the following symptoms must be present and persistent/recurrent: behavioural disinhibition; apathy or inertia; loss of sympathy or empathy; preservative, stereotyped, or compulsive/ritualistic behaviour; hyperorality and dietary changes
99
Key Parkinsonian features
(TRAP): Tremor (resting); Rigidity; Akinesia/bradykinesia; Postural instability
100
Most common location of saccular aneurysms
anterior communicating artery (Acom) (30%)
101
Etiology of most epidural hematomas
rupture of middle meningeal artery (85%)
102
Disc herniations impinge the nerve root at the level above/below the interspace?
below
103
Cystic cavitation of the spinal cord
Syrinx
104
Risk factors for Saccular Aneurysms
(SHAE): Smoking, HTN, Adult Polycystic Kidney Disease, Ehlers-Danlos Syndrome
105
The ABCDEs of Melanoma
Asymmetry, Border (irregular and/or indistinct), Colour (varied), Diameter (increasing or >6 mm), Enlargement, elevation, evolution (i.e. change in colour, size, or shape)
106
Differential diagnosis of hidradenitis suppurativa
folliculitis, furuncles, carbuncles, acne vulgaris, Crohn’s disease, granuloma inguinale, pyoderma gangrenosum
107
Requirements for a diagnosis of drug reaction
1. Temporal relation
2. Recognized response
3. Improvement after drug withdrawal
4. Recurrence on re-challenge with the drug
108
Drug Hypersensitivity Syndrome Triad
Fever
Exanthematous eruption
Internal organ involvement
109
Differential diagnosis for Urticaria
(DAM HIVES): drugs/foods, allergic, malignancy, hereditary, infection, vasculitis, emotions, stings
110
Differences between rosacea and acne
Rosacea can be differentiated from acne by the absence of comedones, a predilection for the central face, and symptoms of flushing
111
The 5 P’s of lichen planus
Purple, Pruritic, Polygonal, Peripheral, Papules, Penis (i.e. mucosa)
112
Differences between pemphigus vulgaris vs. bullous pemphigoid
vulgariS = Superficial, intraepidermal, flaccid lesions
PemphigoiD = Deeper, tense lesions at the dermal-epidermal junction
113
Management of orbital cellulitis
Admit to hospital, draw blood cultures x 2, perform orbital CT, provide IV antibiotics (ceftriaxone + vancomycin) for 1 wk
114
Clinical features of viral versus bacterial conjunctivitis
Bacterial – Mucopurulent discharge, bilateral, no adenopathy

Viral – serous discharge, unilateral (initially, often progresses contralaterally within days), adenopathy (preauricular often palpable and tender)
115
Substance used to differentiate episcleritis versus scleritis
Phenylephrine 2.5% (Mydfrin®; AK-Dilate®) (will blanch episcleral vessels in episcleritis 10-15 min after application)
116
Normal infant and child visual acuity development
6-12 mo: 20/120
1-2 yr: 20/80
2-4 yr: 20/20
117
Treatments for central retinal artery occlusion
Globe massage; decrease IOP; YAG laser embolectomy; thrombolysis; hyperbaric oxygen therapy
118
Clinical features of retinal detachment
sudden-onset; flashes; floaters; curtain of blackness
119
Appearance of basal cell carcinoma
rodent ulcer; indurated base with pearly rolled edges; telangiectasia
120
Risk factors for age-related macular degeneration
female; increasing age; family history; smoking; White individuals; blue irides
121
Risk factors for primary open-angle glaucoma
(A FIAT): age; family history; IOP; African descent; thin cornea
122
Clinical features of cataracts
gradual visual acuity decrease; haloes around lights at night; monocular diplopia; “second sight” phenomenon
123
Causes of vision loss from proliferative diabetic retinopathy
vitreous hemorrhage; tractional retinal detachment; neovascular glaucoma
124
Retinal findings in hypertensive retinopathy
arterial narrowing; arteriovenous nicking; flame-shaped, dot, and blot hemorrhages; cotton wool spots; hard exudates; optic disc edema
125
Clinical features of giant cell arteritis
sudden monocular vision loss; pain over the temporal artery; jaw claudication; scalp tenderness; constitutional symptoms; history of polymyalgia rheumatica
126
The diagnostic criteria for antiphospholipid syndrome are threefold
1) Recurrent Thrombosis
2) Spontaneous Pregnancy Loss
3) Antiphospholipid Antibodies
127
Raynaud’s phenomenon is characterized by triphasic skin colour changes from
1) white (ischemia)
2) blue (hypoxia)
3) red (reperfusion)
128
The four hallmark radiographic findings of osteoarthritis include:
1) joint space narrowing
2) subchondral sclerosis
3) subchondral cysts
4) osteophytes
129
Gonococcal septic arthritis may present with the classic triad of
1) migrating arthralgia
2) tenosynovitis
3) skin lesions
130
Features of small vessel vasculitis
1) palpable purpura
2) vesicles
3) chronic urticaria
4) superficial ulcers (erosions)
131
Features of medium vessel vasculitis
1) livedo reticularis
2) erythema nodosum
3) raynaud’s phenomenon
4) nodules
5) digital infarcts
6) ulcers
132
Six extra-manifestations of ankylosing spondylitis
1) atlanto-axial subluxation
2) anterior uveitis
3) apical lung fibrosis
4) aortic incompetence
5) amyloidosis (kidneys)
6) autoimmune bowel disease
133
Clinical triad of reactive arthritis
1) arthritis
2) conjunctivitis/uveitis
3) urethritis/cervicitis
134
Name the carpal bones
scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, trapezium
135
Name the types of sutures used in plastic surgery
absorbable, non-absorbable, monofilament, multifilament
136
Stages of wound healing
inflammatory phase (Days 1-6)
proliferative phase (Day 4 - Week 3)
Remodeling phase (Week 3 - Year 1)
137
Pathogens responsible for dog and cat bites
pasteurella multocida, staphylococcus aureus, streptococcus viridans
138
Most common causes of chronic cough in non-smokers
GERD, Asthma, Postnasal drip, ACEi
139
Name the 4 factors that shift the Oxygen-Hb Dissociation curve to the right
(CADET, face right): CO2, Acid, 2,3-DPG, Exercise, Temperature (increased)
140
Compare TLC for obstructive vs. restrictive lung diseases
Elevated/normal in obstructive, Reduced in restrictive
141
What disease pattern do increased linear markings and fine/ground glass opacities on CXR indicate
Reticular (interstitial disease)
142
What is the Light's criteria for determining transudative vs. exudative pleural effusion
Exudative pleural effusion when any one of the following criteria is met:
1. Pleural protein/serum protein >0.5
2. Pleural LDH/serum LDH >0.6
3. Pleural LDH >2/3 upper limit of normal serum LDH
143
Berlin criteria for acute respiratory syndrome
1. Acute onset - Within 7d of a defined event, such as sepsis, pneumonia, or patient noticing worsening of respiratory symptoms (usually occurs within 72h of presumed trigger)
2. Bilateral opacities consistent with pulmonary edema on either CT or CXR
3. Not fully explained by cardiac failure/fluid overload but patient may have concurrent heart failure
4. Objective assessment of cardiac function (eg. echocardiogram) should be performed even if no clear risk factors
144
Four categories of shock
hypovolemic, cardiogenic, obstructive, and distributive
145
Differential diagnoses for Upper Lung Disease in ILD
(FASSTEN): Farmer's lung (hypersensitivity pneumonitis); Ankylosing spondylitis; Sarcoidosis; Silicosis; TB; Eosinophilic granuloma; Neurofibromatosis
146
Virchow's Triad consists of
Venous stasis; Endothelial cell damage; Hypercoagulable states
147
A diagnosis of COPD is confirmed on spirometry if the post-bronchodilator FEV1/FVC is
<0.70 or lower limit of normal
148
Differential diagnosis for abdominal distension
6F's - Fat, Feces, Fetus, Flatus, Fluid, Fatal growth
149
Common location for bowel ischemia
The splenic flexure and rectosigmoid junction are watershed areas and are susceptible to ischemia
150
Causes of Acute Bloody Diarrhea
CHESS – Campylobacter, Hemorrhagic E. coli (e.g. O157:H7), Entamoeba histolytica, Salmonella, Shigella
151
Mimickers of IBS
Enteric infections (e.g. Giardia), Lactose intolerance/other disaccharidase deficiency, CD, Celiac sprue, Drug-induced diarrhea, Diet-induced (excess tea, coffee, colas)
152
Four types of IBS
IBS-D: predominant diarrhea
IBS-C: predominant constipation
IBS-M: mixed, diarrhea AND constipation (each >25%)
IBS untyped: insufficient abnormality in stool to meet other types
153
Causes of constipation
(DOPED): Drugs, Obstruction, Pain, Endocrine dysfunction, Depression
154
Etiology of lower GI bleed
(CHAND): Colitis (radiation, infectious, ischemic, IBD [UC > CD]), Hemorrhoids/fissure, Angiodysplasia, Neoplasm, Diverticular disease
155
Differential diagnosis for hepatitis
viral infection, alcohol, drugs, immune-mediated, toxins
156
Cirrhosis complications
(VARICES) - Varices, Ascites/Anemia, Renal failure (hepatorenal syndrome), Infection, Coagulopathy, Encephalopathy, Sepsis
157
Portal Hypertension 1) Signs and 2) Management
1) Esophageal varices, melena, splenomegaly, ascites, hemorrhoids
2) β-blockers, Nitrates, Shunts (e.g., TIPS)
158
Precipitating factors for Hepatic Encephalopathy
(HEPATICS) - Hemorrhage in GI tract/Hypokalemia, Excess dietary protein, Paracentesis, Alkalosis/Anemia, Trauma, Infection, Colon surgery, Sedatives
159
Causes of ascites associated with a low Serum-Ascites Albumin Gradient (<11 g/L)
Peritoneal carcinomatosis, peritoneal TB, pancreatic disease, serositis, nephrotic syndrome
160
Reynolds' Pentad
Charcot’s triad (RUQ pain, fever, jaundice), hypotension, altered mental status
161
Name 5 clinical features that are indicative of a difficult airway
1. Beard
2. Obesity
3. No teeth
4. Elderly
5. Sleep apnea
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162
ASA class 3 is defined as...
a patient with severe systemic disease that limits their activity
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163
Medications that can be given through the endotracheal tube are:
1. Naloxone
2. Atropine
3. Ventolin
4. Epinephrine
5. Lidocaine
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164
In a Mallampati Class I, what structures are visible?
1. Pillars
2. Uvula
3. Soft palate
4. Hard palate
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165
Phenylephrine administration causes a reflexive ____
Bradycardia
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166
What class of local anesthetics does procaine belong to?
Esters
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167
A 30 year old female is induced with succinylcholine and propofol and maintained with sevoflurane for a laparoscopic cholecystectomy. 10 minutes into the procedure, there is a steady rise in EtCO2. You note that the HR is 160, BP is 120/80, and SpO2 is 92%. On assessment, you notice generalized muscle rigidity. What is this patient experiencing?
Malignant hyperthermia
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168
Genetic anticipation is most characteristic of which class of genetic diseases: Imprinting disorders, triplet repeat expansions, mitochondrial DNA disorders, or X-linked disorders
Triplet repeat expansions
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169
You suspect cri-du-chat syndrome in a patient, a genetic condition characterized by very small deletions in chromosome 5. What is the most appropriate diagnostic cytogenetic test?
FISH (fluorescence in situ hybridization)
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170
Define "autonomy"
The right that patients have to make decisions according to their values, beliefs, and preferences
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171
Define "competence"
The ability to make a specific decision for one's self as determined legally by the courts
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172
Define "capacity"
The ability to make a specific decision for oneself as determined by the clinicians proposing the specific treatment
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173
Define "beneficence"
An obligation to provide benefit to the patient, based on what is considered to be their best interests.

Consideration of best interests should consider the patient’s values, beliefs, and preferences, so far as these are known. Best interests extend beyond solely medical considerations.
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Define "non-maleficence"
Obligation to avoid causing harm; primum non nocere (“First, do no harm”)
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175
Define "justice"
Fair distribution of benefits and harms within a community, regardless of geography, income, or other social factors
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176
Situations where confidentiality can be breached:
Child abuse, Fitness to drive, Communicable disease, Coroner report.

All Physicians have a duty to inform/warn.
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177
Four basic elements of consent are:
Voluntary, Capable, Specific, Informed
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178
What are the exceptions to consent?
Emergencies, legislation, and special situations
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What is a Power of Attorney for Personal Care?
A legal document in which one person gives another the authority to make personal care decisions on their behalf if they become mentally incapable
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180
Silhouette sign:
When two objects of the same radiolucency abut, they appear indistinguishable on imaging (i.e. the silhouette expected at an anatomical border disappears)
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Spine sign:
On lateral films, vertebral bodies should appear progressively radiolucent (dark) as one moves down the thoracic vertebral column; if they appear more radio-opaque, it is an indication of pathology
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182
Air bronchogram:
Branching pattern of air-filled bronchi on a background of opacification/fluid-filled airspaces 
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183
7 danger signs on a head CT scan:
1. Space-occupying process resulting in mass effect — growing lesion or contusion causes surrounding areas of tissue to be displaced, compressed and injured
2. Midline shift — displacement of midline structures due to mass effect
3. Herniation (tonsilar or uncal) — rising intracranial pressure causes portions of the brain to move from one intracranial compartment to another
4. Hydrocephalus — expansion of the ventricular system
5. Hemorrhage — intra- or extra-axial bleeding; acute blood is bright on CT
6. Edema — hypo-dense areas on CT reflecting blood-brain barrier breakdown
7. Loss of grey-white matter differentiation — in cases of acute infarction differentiation between grey and white matter is lost due to cell death
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184
Radiographic hallmarks of osteoarthritis:
1. non-uniform joint-space narrowing
2. subchondral sclerosis and cyst formation
3. osteophytes
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185
Radiographic hallmarks of rheumatoid arthritis:
1. uniform joint-space narrowing
2. soft tissue swelling
3. erosions
4. periarticular osteopenia
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186
Techniques to induce ‘stress’ during a myocardial perfusion scan/nuclear stress test:
1. Exercise: Bruce protocol
2. Pharmacologic: Persantine challenge (vasodilator) or dobutamine infusion (chronotropic)
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187
What are the 3 clusters of personality disorders and the types within each:
A ("mad"): Paranoid, schizoid, schizotypal
B ("bad"): Antisocial, borderline, histrionic, narcissistic
C ("sad"): Avoidant, dependent, obsessive-compulsive
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188
What are the alcohol consumption guidelines for men and women (Canada)?
Women: No more than 2 standardized drinks/day and 10 drinks/week

Men: No more than 3 standardized drinks/day and 15 drinks/week
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189
What are the duration of symptoms differentiating the following:
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizophrenia
- Brief Psychotic Disorder: <1 month
- Schizophreniform: 1-6 months
- Schizophrenia: >6 months
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190
Criteria for manic episode:
GST PAID (3 or more criteria):
- Grandiosity
- Sleep (decreased need)
- Talkative
- Pleasurable activities or painful consequences
- Activity (increased)
- Ideas (flight of)
- Distractible
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191
What is the difference between Bipolar Disorder I and II?
Bipolar I Disorder: At least one manic episode has occurred
Bipolar II Disorder: At least 1 major depressive episode, 1 hypomanic episode, and no manic episodes
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192
Classic opioid overdose triad:
RAM: Respiratory depression, Altered mental status, Miosis
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193
What are the 3 steps regarding the natural history of disease?
1. Pathological onset
2. Presymptomatic stage: from onset to first appearance of symptoms/signs
3. Clinical manifestation of disease: may regress spontaneously, be subject to remissions and relapses, or progress to death
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194
What are the 3 different types of screening?
1. Universal screening
2. Selective screening
3. Multiphasic screening
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195
What are the 2 different risk reduction strategies? Give an example of each.
1. Risk reduction: lower the risk to health without eliminating it (e.g. avoiding sun to lower risk of skin cancer)

2. Harm reduction: a set of strategies aimed to reduce the negative consequences of drug use and other risky behaviours (e.g. needle exchange programs)
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196
What are prevalence and incidence?
Prevalence: Total number of cases in a period of time

Incidence: The number of new cases
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197
What is the difference between linear and logistic regression?
Linear regression is for a continuous dependent variable, logistic regression is for a binary one.
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198
What is the utility of the sensitivity and specificity of a test?
A highly sensitive test helps to rule out (SnOut).

A highly specific test helps to rule in (SpIn).
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199
Osteoporosis risk stratification, criteria for high-risk category
  • 10 yr fracture risk >20% OR
  • Prior fragility fracture of hip or spine OR
  • More than one fragility fracture
200
Causes of gynecomastia
DOC TECH
  • drugs (especially antiandrogens, i.e. spironolactone)
  • other
  • congenital (Klinefelter syndrome)
  • tumour (especially germ cell tumours)
  • endocrine (hyperthyroidism)
  • chronic disease (cirrhosis, CKD)
201
Approach to hypercalcemia
  1. Is the patient hypercalcemic?
  2. Is the PTH high/normal or low? 
  3. If PTH is low, is phosphate high/normal or low? 
  4. If phosphate is high/normal, is the level of vitamin D metabolites high or low?
202
Two distinct features of primary hypogonadism
  • decrease in sperm count is affected to a greater extent than the decrease in serum testosterone level
  • likely associated with gynecomastia
203
Infectious causes of Inflammatory Diarrhea
(Your Stool Smells Extremely Crappy):
  • Yersinia
  • Shigella
  • Salmonella
  • E. coli (EHEC 0157:H7), E. histolytica
  • Campylobacter, C. difficile
204
Causes of acute diarrhea
CHESS:
  • Campylobacter 
  • Hemorrhagic E. coli (e.g. O157:H7)
  • Entamoeba histolytica 
  • Salmonella 
  • Shigella
205
What is Wilson Disease?
autosomal recessive defect in copper elimination
206
Risk Factors for NAFLD
  • metabolic syndrome w/ obesity (T2DM, HTN, hypertriglyceridemia)
  • less commonly meds (e.g. tamoxifen, corticosteroids, MTX)
  • Wilson’s, TPN, rapid wt loss, etc
207
What is the Serum Ascites Albumin Gradient (SAAG)?
Serum Ascites Albumin Gradient (SAAG) = serum albumin – ascites albumin. >11 g/L suggests the ascites is due to portal hypertension.
208
What is Charcot’s triad?
Charcot’s triad (result of ascending cholangitis) is comprised of: fever, RUQ pain, jaundice
209
Key differences between delirium and dementia
Dementia is insidious in onset with gradual cognitive decline, stable LOC, whereas delirium is acute onset of fluctuating mental status characterized with inattention. 
210
List the IADLS and ADLs
ADLs: “DEATH” → Dressing, Eating, Ambulating, Toilet, Hygiene.

IALDs: “SHAFT” → Shopping, Housework, Accounting, Food, Transport, Telephone, Taking medications.
211
Red flags in constipation, particularly related to the elderly
  • new onset > 50
  • blood in stool
  • unexplained anemia
  • weight loss
  • obstipation
  • severe abdominal pain
  • vomiting
212
5 F’s for a geriatric assessment
Flow, Farmacy, Function/Falls, Feelings, Future and Family
213
Medications associated with increased risk of falls in the geriatric population
  • antidepressants
  • neuroleptics
  • sedatives/hypnotics
  • antihypertensives
  • NSAIDS
  • diuretics
  • B-Blockers
214
DDx for microcytic anemia
TAILS
  • Thalassemia
  • anemia of chronic disease
  • iron deficiency anemia
  • sideroblastic anemia
215
3 features of hemolytic uremic syndrome
  1. thrombocytopenia
  2. microangiopathic hemolytic anemia
  3. acute kidney failure
216
Four clinical findings of hemochromatosis
ABCD
  • Arthralgia
  • Bronze skin
  • Cardiomyopathy/Cirrhosis of liver
  • Diabetes (pancreatic damage)
217
Mechanisms of bacterial disease
  • Adherence (fimbriae)
  • Invasion
  • Evasion
  • Toxin production
  • Intracellular growth
  • Biofilm 
218
Viral disease patterns
  • Acute infections (host cell lysis after virion release)
  • Chronic infections (>6 mo, chronic virion release)
  • Latent infections (viral genome integrated into host cell nucleus, can reactivate) 
219
DNA virus families
HHAPPPPy
  • Hepadnaviridae
  • Herpesviridae
  • Adenoviridae
  • Papillomaviridae
  • Parvoviridae
  • Polyomaviridae
  • Poxviridae 
220
Mechanisms of fungal disease
  • Primary fungal infection (overgrowth, inhalation, traumatic inoculation)
  • Toxins
  • Allergic reactions 
221
Mechanisms of parasitic disease
  • Mechanical obstruction
  • Competition
  • Cytotoxicity
  • Inflammatory (acute, delayed, cytokine-mediated)
  • Immune-mediated injury (autoimmune, immune complex) 
222
Mechanisms of transmission
  • Contact
  • Droplet/contact
  • Airborne
  • Food/waterborne
  • Zoonotic/vector-borne
  • Vertical 
223
Common causes of fever in the returned traveller
  • parasitic (malaria)
  • viral (non-specific mononucleosis-like syndrome, dengue, viral hepatitis)
  • bacterial (typhoid from Salmonella, rickettsioses)
  • diverse (traveller’s diarrhea, RTI, UTI/STI) 
224
Definition of febrile neutropenia
  • fever (≥38.3°C/101°F or ≥38.0°C/100.4°F for ≥1 h) AND 
  • neutropenia: ANC <1.0 (severe neutropenia: ANC <0.5) 
225
Factors that compromise the immune system
  • general (age - very young or elderly, malnutrition)
  • immune disease (HIV, malignancies, asplenia, hypogammaglobulinemia, neutropenia)
  • DM
  • Iatrogenic (Eg. corticosteroids) 
226
Common classes of antibiotics
  • cell wall inhibitors (Eg. penicillins)
  • protein synthesis inhibitors (Eg. macrolides)
  • topoisomerase inhibitors (Eg. FQs)
  • anti-metabolites (Eg. TMP/SMX)
  • anti-mycobacterials (Eg. isoniazid) 
227
 Risk factors for pneumonia
  • Impaired lung defenses (poor cough/gag reflex, impaired mucociliary transport, immunosuppression)
  • Increased risk of aspiration (impaired swallowing mechanism)
  • Mechanical obstruction 
228
Most common causative agents of cellulitis
  • β-hemolytic streptococci (most common cause of non-purulent cellulitis)
  • S. aureus
  • S. lugdunensis (occasionally)
229
Three criteria that comprise the qSOFA score when screening for sepsis
  1. respiratory rate ≥22/min
  2. sBP ≤100 mmHg
  3. altered mentation (GCS <15) 
230
ART Recommendations for Treatment of HIV-naïve Patients
2 NRTIs + 1 INSTI or “boosted” PI (combined with ritonavir or cobicistat for improved pharmacokinetics)
231
Polyuria
output greater than 3 L/d.

Distinguish from urinary frequency, where urination occurs multiple times per day but the total volume over 24 h is <3 L
232
Features of Nephritic Syndrome
PHAROH
  • Proteinuria
  • Hematuria
  • Azotemia
  • RBC casts
  • Oliguria
  • HTN
233
Features of Nephrotic Syndrome
HELP
  • Hypoalbuminemia
  • Edema
  • Lipid abnormalities
  • Proteinuria
234
Drugs that can precipitate prerenal AKI 
 Diuretics, ACEi/ARBs, NSAIDs
235
Treatments for hyperkalemia 
C BIG K Drop
  • Calcium gluconate
  • B-agonists
  • Insulin
  • Glucose
  • Kayexalate
  • Diuretics
  • Dialysis
236
Progression of ECG changes in hyperkalemia
  1. Peaking T waves
  2. Loss of P waves
  3. Widening QRS
  4. Sine waves
237
DDx for AG metabolic acidosis
MUDPILES
  • Methanol
  • Uremia
  • Diabetic/alcoholic ketoacidosis
  • Paraldehyde
  • Iron/isoniazid
  • Lactic acidosis
  • Ethylene glycol
  • Salicylates 
238
Most common causes of non-AG metabolic acidosis
  • Diarrhea
  • Renal tubular acidosis
239
Indications for dialysis
AEIOU, if refractory
  • Acidosis
  • Electrolyte imbalance
  • Intoxication/AKI
  • Overload (fluid)
  • Uremia
240
Casts seen in acute tubular necrosis
Pigmented granular casts
241
Maximum correction rate for chronic hyponatremia and associated complication
8 mmol/L/24h to prevent osmotic demyelination
242
Most common cause of secondary HTN
Ischemic renal disease/renal artery stenosis
243
Components of physical exam for CNXI
Assess strength of trapezius (shoulder shrug) and sternocleidomastoid muscles (head turn)
244
Most common lumbar puncture complication
Post-lumbar puncture headache (5-40%)
245
Definition of seizure
transient occurrence of signs and/or symptoms due to abnormal hyper-synchronization of neurons
246
Clinical features of Dementia with Lewy bodies
  • Visual hallucinations
  • Parkinsonism
  • Fluctuating cognition
  • REM sleep behaviour disorder
247
Findings of ballism
Large-amplitude, involuntary, flinging movements that are most commonly unilateral
248
Cause of Wernicke-Korsakoff Syndrome
Vitamin B1 deficiency (thiamine)
249
Signs of Respiratory Distress
  • Tachypnea
  • Cyanosis
  • Tachycardia
  • Inability to speak
  • Nasal flaring
  • Tracheal tug
  • Intercostal indrawing
  • Tripoding
  • Paradoxical breathing  
250
Common Chest X-Ray Patterns
  • Consolidation
  • Reticular
  • Nodular
251
Factors that shift the oxygen-Hb curve to the right
“CADET face right!”
  • CO2
  • Acid
  • 2,3-DPG
  • Exercise
  • Temperature (increased)
252
Causes of anion gap metabolic acidosis
MUDPILESCAT
  • Methanol
  • Uremia
  • Diabetic ketoacidosis/starvation ketoacidosis
  • Phenformin/Paraldehyde
  • Isoniazid, Iron, Ibuprofen
  • Lactic acidosis
  • Ethylene glycol
  • Salicylates
  • Cyanide, Carbon dioxide
  • Alcoholic ketoacidosis
  • Toluene, Theophylline
253
Signs of poor asthma control 
DANGERS
  • Daytime Sx ≥3 d/wk
  • Activities (physical) reduced
  • Night-time Sx ≥1 time/week
  • GP visits
  • ER visits
  • Rescue puffer use ≥3 d/wk
  • School or work absences
254
Treatments for COPD that prolong survival
  • Smoking cessation
  • Vaccination
  • Home oxygen
255
Virchow’s triad
venous stasis, endothelial cell damage, hypercoagulable states
256
Classifications of pulmonary hypertension
  1. Pulmonary Arterial HTN
  2. Pulmonary HTN secondary to left heart disease
  3. Pulmonary HTN due to lung disease and/or hypoxia
  4. Chronic thromboembolic pulmonary HTN
  5. Pulmonary HTN with unclear multifactorial mechanisms
257
Light’s criteria for exudative pleural effusion
  1. Protein - Pleural/Serum >0.5
  2. LDH - Pleural/Serum >0.6
  3. Pleural LDH >⅔ upper limit of N serum LDH
258
Differential for anterior mediastinum compartment mass
4Ts
  • Thymoma
  • Thyroid enlargement (goitre)
  • Teratoma
  • Tumours (lymphoma, parathyroid, esophageal, angiomatous) 
259
Causes of hypercapnia
  • Low total ventilation
  • High dead space ventilation
  • High CO2 production
  • High inspired CO2 
260
Define hypopnea
reduction in airflow ≥30% from baseline, lasting for ≥10 s, associated with oxygen desaturation ≥3% or EEG arousal
261
Quick SOFA (qSOFA) Criteria
  1. Respiratory rate ≥22/min
  2. Altered mentation
  3. Systolic blood pressure ≤100 mmHg
262
Causes of shock
SHOCK
  • Spinal (neurogenic), Septic
  • Hemorrhagic
  • Obstructive (e.g. tension pneumothorax, cardiac tamponade, PE)
  • Cardiogenic (e.g. arrhythmia, MI)
  • AnaphylaKtic 
263
Pathophysiology of ARDS
disruption of alveolar capillary membranes → leaky capillaries → interstitial and alveolar pulmonary edema → reduced compliance, V/Q mismatch, shunt, hypoxemia, pulmonary HTN
264
Risk factors for osteoarthritis
  • genetic predisposition
  • advanced age
  • obesity
  • female
  • trauma
265
Malignancies associated with dermatomyositis
  • Breast
  • Lung
  • Colon
  • Ovarian
266
Classic triad of Sjogren's Syndrome
dry eyes, dry mouth, arthritis
267
Features of Small Vessel Vasculitis
  • Palpable purpura
  • Vesicles
  • Chronic uritcaria
  • Superficial ulcers
268
Clinical Triad of Reactive Arthritis
Arthritis, conjunctivitis/uveitis, urethritis/cervicitis
269
Drugs that precipitate gout
  • Furosemide
  • Aspirin
  • Alcohol
  • Cyclosporine
  • Thiazide diuretics
270
Which 5 components does the Palliative Performance Scale assess?
1. ambulation
2. activity and evidence of disease
3. self-care
4. intake
5. consciousness level
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271
What are the four levels of intervention involved in a code status discussion?
1. Full Code
2. Do Not Resuscitate
3. Comfort Measures
4. Allow Natural Death
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272
What are the 6 components of the SPIKES protocol?
S: Setting up the interview
P: (assessing) Perspective
I: Invitation
K: Knowledge sharing
E:. Emotions/Empathy
S: Strategy and Summary
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273
What are the four categories of pediatric patients who may benefit from palliative care?
1. Life-threatening conditions for which curative treatment may be feasible but can fail
2. Conditions in which premature death is inevitable
3. Progressive conditions without curative treatment options
4. Irreversible but non-progressive conditions causing severe disability
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274
What are the five sources of suffering?
1. physical concerns
2. social-related concerns
3. psychological concerns
4. spiritual concerns
5. existential concern
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