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NP Practice - the whole thing
by Aharon Arnstein 07/20/2015
NP Practice - the whole thing
by Aharon Arnstein
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
