Fundamentals 1
Name the three classes of anti-coagulant medications we've discussed
1. Heparin
2. Warfarin
3. DOACs
Which anti-hypertensive medication has ototoxicity as a side-effect?
Loop-diuretics
A 34-year-old patient has arrived at the clinic due to diarrhea and reduced urine output. They have a history of sleeping more than usual. Family history is significant for essential hypertension. The patient lives at home with their family. No other family members are sick. Head and neck examination is normal. There is no lymphadenopathy. Cardiac exam is normal. Respiratory examination is normal. Abdominal examination reveals diffuse non-specific tenderness to palpation. MSK examination reveals bruising over the torso and lower extremities. Neurological examination is normal.
Bloodwork reveals:
Hemoglobin 68 g/L (normal range 137-180)
Hematocrit 0.29 L/L (normal range 0.40-0.54)
Erythrocytes 3.6 x 1012/L (normal range 4.5-6.0)MCV 92 fL (normal range 82-100)
Platelets 50 x 109/L (normal range 150-400)
Leukocytes 24.3 x 109/L (normal range 4.0-11.0)
Neutrophils 17.6 x 109/L (normal range 2.0-8.0)
Reticulocytes 5.6% (normal range 0.5-2.5%)
HUS
In other words, describe the location you'd expect to see the JVP
Between the two heads of the sternocleidomastoid
A 64-year-old male patient has arrived at the outpatient clinic for their annual visit. History reveals a history of smoking. On an initial physical examination, the patient's blood pressure is 166/79 mmHg. Other investigations reveal ABPM, mean 24-hour SBP 135 mmHg and DBP 78 mmHg. Additionally, the patient has a history of both peripheral edema and angioedema.
Which class of first-line anti-hypertensive medications is best suited for this patient? Also note which route of administration is best in this case
Oral thiazide diuretic
Which protein is unconjugated bilirubin attached to as it travels from the spleen to the liver?
Albumin
With regards to liver damage, what causes does I4M4 list?
Infection, Inflammation, Immune, Ischemia
Malignancy, Metabolic, medications, mechanical
A 2-year-old patient presents to your clinic with a lump in their cervical area for the past 1 days. They have been limping due to knee and ankle pain. Additional symptoms include fever and rash. On physical exam, they have unilateral enlarged anterior cervical lymph nodes. Other physical exam: a swollen knee and macular rash on their trunk
Is the lymphadenopathy benign (infectious), benign (autoimmune) or malignant?
Benigh Autoimmune
With regards to the Peripheral Vascular Physical Examination, name 2 of the 4 clinical features you are expected to list during inspection
1. Symmetry
* Signs of swelling or edema in the legs
2. Pigmentation
* Is there hyper or hypopigmentation
(1) Darkish brown/red = Venous Insufficiency
(2) Pallor = Arterial insufficiency
** Note: Atrophy blanche is venous congestion which causes swollen capillaries and damage
3. Veins
* Looking for varicose veins (palpable)
* Telangiecasias and/or reticular veins (less dilated, non-palpable)
4. Ulcers
(1) Arterial Ulcers
* Typically on the ankle and plantar surface
* Often painful, looks dry and punched out
(2) Venous Ulcers
* Gaiter area, often painless. Looks wet and superficial
State the cut-offs for pre-diabetes and diabetes diagnosis for all of the following
HbA1C
Fasting Blood Glucose
Glucose Tolerance Test
HbA1C: 1. Pre-diabetes (6.0 - 6.4) 2. Diabetes (6.5+)
FBG: 1. Pre-diabetes (6.1 - 6.9) 2. Diabetes (7.0+)
GTT: 1. Pre-diabetes (7.8 - 11.0) 2. Diabetes (11.0+)
List the three classes of parapneumonic effusions
1. Simple
2. Complex
3. Empyema
What are two AIDS defining conditions
1. Pneumocystis Pneumonia
2. Kaposi Sarcoma
Describe the two special tests used during the liver examination for the OSCE
Shifting Dullness:
1. Patient supine, fluid sinks to periphery with an air-filled bowel forming in the centre
2. Start percussion from umbilicus note tympanic sound. Move inferiorly until dull sound heard, mark location.
3. Ask patient to roll onto their side and repeat the percussion. There will be a shift upwards as fluid readjusts
Fluid Wave:
1. Patient put their hand over umbilicus
2. Hands on both sides of abdomen, give a whack, fluid present is the wave is felt
What are the three physical signs of abnormal lipids that we discussed in class?
Hint: These are specifically referring to symptamology that impacts the cornea, eyelids, and hands
1. Corneal arcus
2. Xanthelesma
3. Xanthoma
Describe the treatment of outpatient pneumonia in the pediatric population for the three following cases
1. Viral cause
2. Typical Bacteria
3. Atypical Bacteria
1. Supportive care
2. Oral amoxicillin
3. Oral azithromycin
2. Viral load testing
1. Total lymphocyte count
Describe how to check for subcutaneous emphysema and the expected findings if present
1. Palpate around the neck and shoulder
2. Crunchy feeling like squishing rice krispies
Regarding the mechanisms of hypoxemia, list all 5. Additionally note the following
1. The expected A-A gradient (normal or elevated)
2. Identifying characteristics
1. Low inspired Oxygen
--> Normal A-A gradient + only seen with pts who recently experienced high altitude
2. Hypoventilation
--> Normal A-A gradient + elevated PaCO2
3. V/Q Mismatch
--> Elevated A-A gradient + oxygen should help
4. Shunt
--> Elevated A-A gradient + oxygen won't help
5. Diffusion Impairment
--> Elevated A-A gradient + exercise induced desaturation
Draw out the "clinical approach to Shock" scheme
I have to pay to put photos in
List 4 myeloid derived white blood cells.
Additionally describe the type of invader they are most active against / the circumstance they are most active. Note, only 2 of the 4 had specific causes of elevation discussed in lecture.
1. Neutrophil (bacteria and fungi)
2. Eosinophil (Allergy, parasite, malignancy)
3. Basophils
4. Monocytes
List the 5 major regional lymph nodes as stated in our clinical skills document
1. Cervical LNs
2. Supraclavicular LNs
3. Epitrochlear LNs:
4. Axillary LNs:
5. Inguinal LNs: