NP Practice - the whole thing

1. DERM

1.1. Tinea

1.2. Dermatitis

1.3. Parasites

1.4. HSV

1.5. Acne

1.6. Miscellaneous Skin Drugs

1.6.1. Keratolytic Drugs

1.6.1.1. Retinoic Acid - Vit A acid - Derivatives

1.6.1.1.1. Tretinoin

1.6.1.1.2. Antineoplastic Agents

1.6.1.2. Trichloroacetic Acid

1.6.2. Benzoyl Peroxide

1.6.3. Topical Steroids

1.6.3.1. Hydrocortisone 0.5 - 1% - low potency

1.6.3.2. Hydrocortisone valerate 0.2% - intermediate potency

1.6.3.3. Betamethasone Diproprionate 0.5% - high potency

1.6.4. Hydroxyzine

2. Cardiovascular

2.1. HTN

2.1.1. HTN Guidlines

2.1.1.1. Primary HTN

2.1.1.1.1. treat to <140/90

2.1.1.1.2. diabetic treat to <130/80

2.1.1.1.3. 80yr+ treat carefully SBP 150 is ok

2.1.2. hepatojugular reflux sign

2.2. Dyslipidemia

2.3. CV Disease

2.4. PVD

2.4.1. Peripheral Vascular Tests

2.4.1.1. Allens Test

2.4.1.1.1. occlude both ulnar and radial arteries till hand goes white

2.4.1.2. Pallor Leg Raise Test

2.4.1.2.1. raise both legs to 60deg x 1 minute

2.4.1.3. Trendelenberg Test

2.4.1.3.1. lay supine, raise legs to 90 deg for to empty venous system

2.5. Cardiovascular drug classes

2.5.1. Diuretics

2.5.1.1. Thiazide Diuretics

2.5.1.2. Loop Diuretics

2.5.1.3. Potassium Sparing Diuretics

2.5.2. Vasodilators

2.5.2.1. Renin Angiotensin System Blockers

2.5.2.1.1. ACE inhibitors

2.5.2.1.2. Angiotensin Receptor Blockers

2.5.3. Antiplatelet Drugs

2.5.3.1. ASA

2.5.3.2. Clopidogrel

2.5.4. antithrombotic

2.5.4.1. Warfarin - Coumadin

2.5.4.2. Dabigatran

2.5.5. Cardioinhibitory Drugs

2.5.5.1. Alpha bockers

2.5.5.1.1. Clonidine

2.5.5.1.2. Methydopa

2.5.5.2. Calcium Channel Blockers

2.5.5.2.1. Dihydropyridine CCB - for HTN not ischemic disease

2.5.5.2.2. Non-Dihydropyridine CCB

2.5.5.3. Beta Blockers

2.5.5.3.1. Cardioselective Beta Blockers

2.5.5.3.2. non-cardioselective Beta Blocker

3. Mental Health

3.1. Anxiety

3.1.1. anxiety Pharm

3.1.1.1. First line

3.1.1.1.1. SNRI

3.1.1.1.2. SSRI

3.1.1.2. second line/ adjunct

3.1.1.2.1. TCA

3.1.1.2.2. Benzodiazepines

3.1.1.2.3. MOAI

3.2. Depression

3.2.1. Depression Pharm

3.2.1.1. SSRIs

3.2.1.1.1. Citalopram

3.2.1.2. SNRIs

3.2.1.2.1. venlafaxine

3.2.1.3. single vs Dual action

3.2.1.4. TCAs 2nd line

3.2.1.4.1. amatriptyline

3.2.1.5. MAOIs - 3rd line

3.2.1.5.1. phenelzine

3.2.1.5.2. meclobemide

3.2.1.6. atypical antidepressants

3.2.1.6.1. bupropion

3.2.1.6.2. Trazodone

3.2.1.7. which are safer

3.2.1.7.1. citalopram for SSRIs

3.2.1.7.2. Bupropion for atypicals and TCAs

3.2.1.7.3. venlafaxine for SNRIs because it has been around longer

3.2.1.7.4. NO MAOs, too many DDI and small therapeutic window.

3.2.1.8. which are less sedating

3.2.1.8.1. most of the SSRIs, SNRIs and bupropion

3.2.1.9. SIGECAPS - for depression

3.2.1.9.1. Sleep

3.2.1.9.2. Interest

3.2.1.9.3. Guilt

3.2.1.9.4. Energy

3.2.1.9.5. Concentration

3.2.1.9.6. Appetite

3.2.1.9.7. Psychomotor

3.2.1.9.8. Suicide

3.2.1.10. DIG FAST - for mania

3.2.1.10.1. Distractable

3.3. Suicide

3.3.1. SADPERSONS

3.3.1.1. sex (male)

3.3.1.1.1. age (>60yrs)

3.4. Pharmacologics

3.4.1. Psychiatric disorders

3.4.1.1. Bipolar Depression

3.4.1.1.1. Mood Stabilizers

3.4.1.1.2. Bipolar I - manic

3.4.1.1.3. Bipolar II - depression with no full mania

3.4.1.1.4. Bipolar not otherwise specified

3.4.1.2. Depression

3.4.1.2.1. SSRIs

3.4.1.2.2. SNRIs

3.4.1.2.3. single vs Dual action

3.4.1.2.4. TCAs 2nd line

3.4.1.2.5. MAOIs - 3rd line

3.4.1.2.6. atypical antidepressants

3.4.1.2.7. which are safer

3.4.1.2.8. which are less sedating

3.4.1.3. anxiety

3.4.1.3.1. First line

3.4.1.3.2. second line/ adjunct

3.4.1.4. what drugs are worse to overdose on?

3.4.1.4.1. TCAs because of narrow therapuetic window

3.4.1.5. what drugs are worse to withdraw from?

3.4.1.5.1. Benzodiazepines

3.4.1.5.2. SNRIs

3.4.1.5.3. ETOH

3.4.1.6. antipsychotics

3.4.1.6.1. First Generation

3.4.1.6.2. second generation / atypical

3.4.1.7. ADHD

3.4.1.7.1. methylphenidate

3.5. Sleep Disturbances

3.5.1. BC Guidline on insomnia/hypersomnia/parsomnias

3.5.1.1. Sleep Hygiene/diary handout

3.6. Addictions

3.6.1. Alcohol Abuse

3.6.1.1. BC Guidlines

4. GU

4.1. STI

4.1.1. STIs

4.1.1.1. Common STIs with genital ulcers

4.1.1.1.1. Syphilis

4.1.1.1.2. Lymphogranuloma venereum (LGV)

4.1.1.1.3. Herpes

4.1.1.2. Genital Warts

4.1.1.2.1. Human Papiloma Virus (HPV)

4.1.1.3. Tx Algorithm for Vaginitis/cervicitis

4.1.1.3.1. common STI causing Vaginal Discharge

4.1.1.3.2. for men

4.1.1.3.3. Common STI causing urethritis and cervicitis

4.1.1.4. Pelvic Inflammatory Disease

4.2. Urinary Conditions

4.2.1. UTI

4.2.1.1. complcated

4.2.1.2. uncomplicated

4.2.1.2.1. first line

4.2.1.2.2. second line

4.2.1.3. Pyelonephritits

4.2.2. BPH

4.2.2.1. Alpha1 adrenergic blockers

4.2.2.1.1. "...osins"

4.2.2.2. 5 - alpha reductase inhibitors

4.2.2.2.1. Finasteride

4.2.2.2.2. best for treating large prostates

4.2.2.2.3. targeted effect to prostate so, low side effects and DDI

4.2.2.2.4. blocks testosterone conversion to dihydrotestosterone --> less stimulation, prostate shrinks

4.2.2.3. Phosphodiesterase Inhibitors

4.2.2.3.1. Tadalafil

4.2.3. urinary incontinence

4.2.3.1. Incontinence in Children

4.2.4. erectile dysfunction

4.2.4.1. Phosphdiesterase inhibitors

4.2.4.1.1. Sildenafil

5. Renal

5.1. Chronic Kidney Disease

5.1.1. CKD BC Guidlines

6. OB/Gyn/sexuality

6.1. OB / GYN

6.1.1. Contraceptives

6.1.1.1. Combined hormonal contraceptives (COCs)

6.1.1.1.1. ring

6.1.1.1.2. Evra patch

6.1.2. Menopause

6.1.2.1. HRT

6.1.2.1.1. Estrogen

6.1.2.1.2. Progesterone

6.1.3. Primary amenorrhea

6.1.4. Polycystic ovarian syndrome

6.1.5. endometriosis

6.2. Menstruation and Related Problems

6.2.1. Dysmenorrhea

6.2.1.1. NSAIDs

6.2.2. Amenorrhea

6.2.3. oligomenorrhoea

6.2.4. polymenorrhea

6.2.5. hypomenorrhea

6.2.6. Menorrhagia

6.2.7. metrorrhagia

6.2.8. menometrorrhagia

6.2.9. intermenstrual bleeding

6.3. Sexuality

6.3.1. Sexual History 5 P's

7. GI

7.1. GI

7.1.1. Acute Abdomen

7.1.2. Diarrhea

7.1.2.1. Osmotic

7.1.2.2. Secretion

7.1.2.3. Inflammation

7.1.2.4. Motility

7.1.2.5. Anal Sphincter Control

7.1.3. Dyspepsia and peptic ulcers

7.1.4. Appendicitis

7.1.4.1. Mcburney's point tenderness

7.1.4.1.1. RLQ (over appendix)

7.1.4.2. Rovsig's sign

7.1.4.2.1. Press deeply in LLQ and quickly release

7.1.4.3. psoas sign

7.1.4.3.1. Flexion of Psoas muscle

7.1.4.4. obturator sign

7.1.4.4.1. stretch the obturator muscle

7.1.5. Cholecystitis

7.1.5.1. Murphy's Sign

7.1.5.1.1. hook left thumb under right costal margin (where gall bladder is

7.1.5.2. Risk for Cholecystitis

7.1.5.2.1. ABCDEF

7.1.6. Ascites

7.1.6.1. Fluid wave test

7.1.6.2. assess shifting dullness to percussion

7.2. GERD

7.2.1. GERD

7.2.1.1. Treatment

7.2.1.2. lifestyle mods

7.2.1.3. PPI x 4-8 weeks

7.2.1.3.1. Chronic if still symptomatic

7.2.1.3.2. R/O H. Pylori infection

7.3. esophagitis

7.4. Abd Pain

7.4.1. IBS

7.4.1.1. IBS

7.4.1.1.1. ALARM FEATURES

7.5. Dyspepsia

7.5.1. Peptic Ulcer Disease

7.5.1.1. H. Pylori testing/treatment

7.5.1.1.1. Chronic Dyspepsia

7.5.1.1.2. triple therapy

7.5.1.1.3. qudruple therapy

7.5.1.2. must stop ABX 4 weeks, bismuth 2 weeks, PPI and H2 blockers 1 week before Urea Breath Test

7.6. IBD

7.6.1. Crohns Disease

7.6.2. Ulcerative Colitis

7.7. N&V

7.7.1. N&V in Pregnancy

7.8. constipation

7.8.1. non pharm measures

7.8.1.1. increase dietary fibre

7.8.1.1.1. bulk forming agents

7.8.1.1.2. Psylium

7.8.2. reduce and treat causal factors

7.8.3. watch for constipating med

7.9. Diarrhea

7.9.1. acute Diarrhea - ? why

7.9.1.1. Infectious Diarrhea?

7.9.1.1.1. antibiotic associated diarrhea?

7.9.1.1.2. Metronizadole

7.9.1.1.3. Vancomycin

7.9.1.2. Viral?

7.9.1.3. Bacterial?

7.9.1.4. O&P?

7.10. antacids

7.10.1. magnesium and aluminum hydroxide

7.11. H2 antagonists

7.11.1. Ranitidine

7.12. PPIs

7.12.1. omeprazole

8. HEENT

8.1. Allergies

8.2. Pharyngitis

8.3. Otitis

8.3.1. Otitis Externa OE

8.3.1.1. Staph Aureus & Psuedomonas most common

8.3.1.2. tender tragus and auricle

8.3.1.2.1. erythema & edema in external canal

8.3.1.3. Malignant Otitis Externa

8.3.1.3.1. Most common in older pts

8.3.1.4. management

8.3.1.4.1. gently remove debri from canal

8.3.2. Otitis Media OM

8.4. Rhinitis

8.4.1. Rhinitis

8.4.1.1. Allergic Rhinitis

8.4.1.2. Infectious Rhinitis

8.4.1.3. Nonallergic/noninfectious Rhinitis

8.4.1.3.1. Occupational Rhinitis

8.4.1.3.2. Drug induced Rhinitis

8.4.1.3.3. Hormonal Rhinitis

8.4.1.3.4. Rhinitis if the elderly (senile)

8.4.1.3.5. NARES (nonallergic rhinitis with nasal eosinophilia syndrome

8.4.1.3.6. smoking rhinitis

8.4.1.3.7. Idiopathic rhinitis (IR)

9. Respiratory

9.1. Asthma

9.1.1. Asthma BC guidlines Summary

9.2. Pneumonia

9.2.1. 60-80% caused by Strep pneumoniae

9.2.1.1. atypical pneumonia caused by other organisms like influenza, mycoplasma, chlamydia

9.2.1.1.1. young adults more succeptible to atypical pneumonia

9.2.2. LRT infection

9.3. Chronic Cough

9.4. COPD

9.4.1. mild/moderate COPD

9.4.2. Bronchitis

9.4.2.1. Viruses most common cause

9.4.2.1.1. influenza A&B, parainfluenza, RSV, carona, adenovirus

9.4.2.2. usually resolves in <6wks in healthy

9.4.2.3. cough with normal VS and absence of other resp findings of consolidation are very suggestive

9.4.2.4. consider CAP and pertussis

9.4.2.5. treatment

9.4.2.5.1. rest

10. Neuro

10.1. parkinsons disease

10.1.1. levodopa/carbodopa

10.1.2. NMDA receptor blocker

10.1.2.1. amantadine

10.1.3. COMT blocker

10.1.3.1. entacapone

10.1.4. MAOIs

10.1.4.1. Selegiline

10.2. Headache

10.2.1. Migraine

10.2.1.1. abortive agents

10.2.1.1.1. sumatriptan

10.2.1.1.2. ergotamines

10.2.1.1.3. what not to use with peds

10.2.1.1.4. Metoclopramide

10.2.1.2. suppressive/prophylactic agents

10.2.1.2.1. CCBs

10.2.1.2.2. TCAs

10.2.1.2.3. BBs

10.2.1.2.4. what to avoid in peds

10.2.1.3. analgesics

10.2.1.3.1. NSAIDs

10.2.1.3.2. acetaminaphen

10.3. Dizziness

10.4. Bells Palsy

10.4.1. cause of 50% of unilateral LMN facial paralysis

10.4.1.1. some correlation with HSV

10.4.1.1.1. often triggered by something - often URTI

10.4.2. Sparing Forehead muscles suggests UMN lesion instead of Bells Palsy (LMN)

10.4.2.1. quick onset 2-5 days compared to other etiologies

10.4.2.1.1. post auricular pain

10.4.3. Treatment

10.4.3.1. protection of the unclosing eye

10.4.3.1.1. patch at night

10.4.3.2. better prognosis if not full paralysis

10.4.3.2.1. 80-85% recover in 6 months

10.4.3.3. High dose steroids for a week then tapper

10.4.3.3.1. antivirals

10.5. Trigeminal Neuralgia

10.5.1. 2 types of TN

10.5.1.1. TN1/ Primary Classic

10.5.1.1.1. most caused by vascular compression

10.5.1.2. TN2/ Secondary - trigeminal neuropathy

10.5.2. Diagnosed mainly on clinical presentation and lack of other cause

10.5.2.1. immediate referral if ophthalmic involvement

10.5.2.1.1. Usually unilateral

10.5.3. Treatment

10.5.3.1. First Line - Anticonvulsants

10.5.3.1.1. Carbamazepine

10.5.4. Often a symptom of MS

10.5.4.1. Treatment with some success using Misoprostol (NSAID)

10.6. Crancial Nerves

10.6.1. Oh Oh Oh, Tiny Tits Are Fun And Give Virgins Awkward Hips

10.6.1.1. Oh-1

10.6.1.1.1. Olfactory

10.6.1.2. Oh-2

10.6.1.2.1. Optic

10.6.1.3. Oh-3

10.6.1.3.1. oculomotor

10.6.1.4. Tiny-4

10.6.1.4.1. Trochlear

10.6.1.5. Tits-5

10.6.1.5.1. Trigeminal

10.6.1.6. Are-6

10.6.1.6.1. Abductens

10.6.1.7. Fun-7

10.6.1.7.1. Facial

10.6.1.8. And-8

10.6.1.8.1. Auditory

10.6.1.9. Give-9

10.6.1.9.1. glossopharyngeal

10.6.1.10. Virgins-10

10.6.1.10.1. Vagus

10.6.1.11. Awkward-11

10.6.1.11.1. Accessory (spinal accessory)

10.6.1.12. Hips-12

10.6.1.12.1. Hypoglosal

10.6.2. Sensory Nerve

10.6.3. Motor Nerve

10.6.4. Sensory Nerves, Motor Nerves or Both

10.6.4.1. Some Say Marry Money, But My Brother Says Big Brains Matter Most

10.7. Dementia

10.7.1. primary treatment

10.7.2. non pharm treatment

10.7.3. cholinesterase inhibitors

10.7.3.1. Donepezil

10.7.3.2. Galantamine

10.7.4. NMDA receptor blockers

10.7.4.1. mementine

10.8. siezures

10.8.1. non-pharm treatment

10.8.1.1. avoid ETOH, Stimulants, stress

10.8.1.2. get enough sleep

10.8.1.3. yoga

10.8.2. pharm depends on type of seizure

10.8.2.1. phenytoin

10.8.2.2. carbamazepine

10.8.2.3. valproic acid

10.8.2.4. phenobarbitol

10.9. Comparing MS, ALS and Musculo dystrophy

10.10. Temporal/Giant Cell Arteritis

11. Hematologic

11.1. Anemia

11.1.1. Anemias

11.1.1.1. Iron Deficiency Anemia

11.1.1.1.1. patient teaching

11.1.1.2. Megaloblastic Anemias

11.1.1.2.1. Folate deficient

11.1.1.2.2. B12 deficient

11.1.1.3. sickle cell anemia

12. Endocrine

12.1. DM

12.1.1. Diabetes

12.1.1.1. Type I

12.1.1.2. Type II

12.1.1.2.1. what HBA1C do you start treatment?

12.1.1.2.2. Biguanides

12.1.1.2.3. Sulfonylurea

12.1.1.3. Insulins

12.1.1.3.1. bolus/prandial

12.1.1.3.2. basal

12.1.1.3.3. premixed

12.1.1.4. acarbose

12.1.1.5. pioglitazone

12.2. Thyroid Disease

12.2.1. Thyroid

12.2.1.1. Thyroid

12.2.1.1.1. no screening asymptomatic pts

12.2.1.2. Hypothyroid

12.2.1.2.1. levothyroxine

12.2.1.3. hyperthyroid

12.3. Obesity

12.3.1. BC Guidline

13. Infectious Disease

13.1. Pharmacology of ID

13.1.1. Infectious Diseases

13.1.1.1. Antiviral Drugs

13.1.1.1.1. Acyclovir

13.1.1.2. Anti parasitic drugs

13.1.1.2.1. Permethrin

13.1.1.3. Antifungals

13.1.1.3.1. Clotrimazole - Canesten

13.1.1.3.2. Ketoconazole

13.1.1.3.3. fluconazole

13.1.1.4. Mechanisms for antibiotic resistance

13.1.1.5. Antibiotic Toxicities

13.1.1.6. Interactions with warfarin

13.1.1.7. Allergic Reactions

13.1.1.8. Atypical Bacteria and their diseases

13.1.1.9. Antibiotics for Atypical Bacteria

13.1.1.10. Infections

13.1.1.10.1. Respiratory Infections

13.1.1.10.2. Skin Infections

13.1.1.10.3. Eye Infections

13.1.1.10.4. Ear infections

13.1.1.10.5. Nasal Infections

13.1.1.10.6. Throat infections

13.1.1.10.7. Eye infections

13.1.1.11. Anaerobic Bacteria

13.1.1.12. Mechanisms of Antibiotics

13.1.1.13. add these to the map: Gentamicin (opthalmic anti-­infective) Timolol (beta blocker antiglaucoma agent) Ciprofloxacin otic solution (otic anti-­infective) Benzocaine antipyrine-­glycerine (otic analgesic) Acetic acid otic solutions Loratadine (2nd generation antihistamine) Chlorpheneramine Diphenhydramine Pseudoephedrine (decongestant, look also at phenylephrine) Codeine phosphate (antitussive) Guaifenesin (expectorant) Intranasal steroids (Fluticosone and betamethasone) Cromolyn (mast cell stabilizer) Ketotifen (opthalmic antihistamine + mast cell stabilizer) Ketorolac (ophthalmic NSAID)

13.1.1.14. Highly Resistant Gram Neg Bacteria

13.1.1.14.1. Antibiotics for highly resistant Gram Neg Bacteria

13.1.1.15. Oral Antibiotics against CA - MRSA

13.1.1.16. Preferred Antibiotic for serious Gram + Infections

13.1.1.17. Antibiotic Classes

13.1.1.17.1. Miscellaneous Antibiotics

13.1.1.17.2. macrolides

13.1.1.17.3. penicillins

13.1.1.17.4. cephalosporins

13.1.1.17.5. flouroquinolones

13.1.1.17.6. sulpha

13.1.1.17.7. Tetracyclines

13.1.1.17.8. aminoglycosides

13.1.1.17.9. Metronidazole

13.1.1.18. Infectious Disease Common Etiologies

13.2. Immunization

13.2.1. Which are live attenuated vaccines?

13.2.2. Basic immunization schedule first year of life

13.2.3. Schedule and reccomendations

13.2.3.1. MMR

13.2.3.2. Hep A

13.2.3.3. Hep B

13.2.3.4. Varicella

13.2.3.5. HPV

13.2.3.6. tetanus

13.2.3.7. influenza

13.2.3.7.1. antivirals

13.3. HIV

13.3.1. drugs in pregnancy?

13.3.2. Protease Inhibitors (PI)

13.3.2.1. ritonavir

13.3.3. nucleoside Reverse transcriptase inhibitor (NRTI)

13.3.3.1. 1st Generation

13.3.3.1.1. zodovudine / AZT

13.3.3.1.2. NON-nucleoside REverse Transcriptase Inhibitors (NNRTI)

14. Reumatologic/MSK

14.1. Musculoskeletal Complaints

14.1.1. Shoulder Exam

14.1.1.1. Standing

14.1.1.1.1. Inspect

14.1.1.1.2. Active ROM

14.1.1.1.3. strength

14.1.1.1.4. Reflexes

14.1.1.1.5. palpation

14.1.1.1.6. Sulcus sign

14.1.1.1.7. neer's test - of impingement of supraspinadous tendon

14.1.1.1.8. hawkins test - of impingement of supraspinadous tendon

14.1.1.1.9. acromioclavicular compression test

14.1.1.1.10. test biceps tendon / yurgasons test

14.1.1.1.11. adson's test for thoracic outlet syndrome

14.1.1.1.12. apprehension test

14.1.2. Foot exam

14.1.2.1. Inspect

14.1.2.1.1. inspect from back - look for how many toes you can see. more than 2 is getting too many

14.1.2.2. halux valgus

14.1.2.3. Mortons neuroma

14.1.2.4. achiles tendon rupture

14.1.2.4.1. thompson's test

14.1.2.5. Palpation for tenderness (most important)

14.1.2.5.1. 2nd metatarsal most common for stress #

14.1.2.5.2. Plantar Fasciatis

14.1.2.5.3. chronic heel pain syndrome

14.1.2.5.4. Midfoot - Lisfranc's Joint

14.1.2.5.5. Ottawa Ankle Rules

14.1.2.6. Passive ROM

14.1.3. Joint above/joint below

14.1.3.1. valgus force - applied to lateral side of joint leading to ie: genu Valgum [knock-kneed] distal part angled out)

14.1.3.1.1. Varus force - force applied to medial side of joint (leading to ie: genu VARum[ bow legged] distal part angled in)

14.1.4. Elbow exam

14.1.4.1. inspect

14.1.4.1.1. "carrying angle (greater than women"

14.1.4.1.2. active ROM

14.1.4.1.3. palpation

14.1.4.2. lateral epicondylitis "tennis elbow"

14.1.5. Knee

14.1.5.1. ottawa knee rules

14.2. Sprains

14.3. Strains

14.4. Osteoporosis

14.4.1. full BC Guidline

14.5. Musckuloskeletal Treatment

14.5.1. Back pain

14.5.1.1. acute

14.5.1.2. chronic

14.5.1.3. analgesics

14.5.1.3.1. narcotics

14.5.1.3.2. NSAIDs

14.5.1.3.3. Acetaminophen

14.5.1.4. muscle relaxants

14.5.1.5. non-pharm treatment

14.5.2. Osteoperosis

14.5.2.1. anti catabolic agents - Bisphosphonates 1st line

14.5.2.1.1. alendronate

14.5.3. Rheumatoid Arthritis

14.5.3.1. non biologic DMARDs

14.5.3.1.1. hydroxychloroquine only for mild RA

14.5.4. Gout

14.5.4.1. Acute

14.5.4.1.1. colchicine

14.5.4.1.2. NSAIDs

14.5.4.1.3. glucocorticoids

14.5.4.2. chronic

14.5.4.2.1. allopurinol

14.5.5. fibromyalgia

14.5.5.1. TCAs

14.5.5.1.1. TCA type muscle relaxant

14.5.5.1.2. Cyclobenzaprine

14.5.5.2. Amitriptyline

14.5.6. Polymyalgia Rheumatica

14.5.6.1. 1st line high dose corticosteroid

14.6. SEADS

14.6.1. swelling

14.6.2. erythema/echymosis

14.6.3. atrophy/asymetry

14.6.4. deformity

14.6.5. skin changes

14.7. Arthritis & Joint Pain

14.7.1. Infectious Arthritis

14.7.2. Systemic Rheumatic Disease

14.7.2.1. Rheumatoid Arthritis

14.7.2.2. Myopathy

14.7.2.2.1. Polymyositis

14.7.2.2.2. Dermatomyositis

14.7.2.3. Connective Tissue Diseases

14.7.2.3.1. Systemic Lupus Erythmatosis

14.7.2.3.2. sjogrens disease

14.7.2.3.3. scleroderma

14.7.3. Spondyloarthropathies

14.7.4. Crystal Induced Arthropathy

14.7.5. Degenerative

14.7.6. Vasculitis

14.7.7. Endocrine

14.7.8. Neoplasia

14.8. Vitamin D

14.8.1. Patient Handout

15. PAIN

15.1. Acute Pain

15.2. Chronic Non Cancer Pain

15.3. Cancer Pain

15.4. Pain

15.4.1. narcotics

15.4.1.1. codeine

15.4.1.2. tramadol

15.4.2. NSAIDs

15.4.2.1. ketorolac

15.4.3. Acetaminophen

15.4.4. GABA

15.4.4.1. gabapentin

15.4.5. Chronic pain

15.4.6. acute pain

16. Oncology

16.1. Oncology Pharm

16.1.1. methotrexate

16.1.2. warfarin

16.1.3. tamoxifen

16.2. Breast CA

16.2.1. BC Guidlines

16.3. Colorectal CA

16.3.1. BC Guidlines Colorectal CA

16.4. Palliative Care

16.4.1. BC Guidline Paliative

17. OSCE PROCESS

17.1. 2 min to write reminders in booklet

17.1.1. 2 min to read instructions

17.1.1.1. 10 min for test

17.1.1.2. Evaluation

17.1.1.2.1. To do for all scenarios

18. LEGEND

18.1. NP CAN TREAT INDEPENDANTLY

18.2. NO - NP CAN'T TREAT

18.3. NP CAN CO-MANAGE

18.4. NP CAN PRESCRIBE

18.5. NP CAN CONTINUE PRESCRIPTION ONLY

18.6. NP CAN NOT PRESCRIBE

18.7. Not safe in pregnancy

18.8. probably not safe in pregnancy

18.9. probably safe in pregnancy

19. Diagnostic Testing

19.1. Diagnostic Testing

19.1.1. Laboratory

19.1.1.1. BC Medical Services Plan Payment Schedule

19.1.2. Medical Imaging

19.1.2.1. X- rays

19.1.2.2. ultrasound

19.1.2.3. CT

19.1.2.4. Miscellaneous

19.1.3. Objectives of Diagnostic Tests

19.1.3.1. facilitate diagnosis in a sick pt

19.1.3.2. give prognostic info for pt with a disease

19.1.3.3. screen for sub clinical symptoms in pt with enough risk factors

19.1.3.4. monitor therapy

19.1.4. Questions to ask about each test

19.1.4.1. Why am I considering this test?

19.1.4.2. What question is this test meant to answer?

19.1.4.3. can this test answer my question?

19.1.4.4. do benefits of testing outweigh risks?

19.1.4.5. does the benefit outweigh the cost?

19.1.5. How to decide to use a test?

19.1.5.1. PRE TEST PROBABILITY

19.1.5.1.1. Liklihood Ratios (LR)

19.1.5.2. CLINICAL DECISION RULES (CDR) help set Pre test probabilities for various problems and provide screening tests

19.1.5.2.1. Examples

19.1.5.3. According to Bayesian principles, the pretest odds of disease multiplied by the likelihood ratio gives the post-test odds of disease

19.1.6. Diagnostic and Procedural Codes (ICD9)

20. Pediatrics

20.1. Piaget's stages of Development

20.2. Erickson

21. Geriatrics

21.1. Frailty

21.1.1. Full BC Guidline Frailty