FMP_2 - VOL. 4

Case 1 - Sarah Locks Tuesday, March 25, 2008 9:01 AM

1. Potentially serious consequences need to be ruled out? a. OT:How she's sleeping? Doing self-care activities? Dressing? Leesure activities? b. Physio: VBI: vertebral basilar insufficiency: rotation and extension of the c -spine passively then you look for some cardinal i. Fatal consequence c. Meds: i. Serious c-spine injury? Could you be walking around with a hemorrhage or something crazy like that? ii. More minor c-spine injury d. Dentist: i. Jaw: the firsrt thing would be looking for: all other issues have ben taken care of; vital signs stable; no head injuries; looking for the condyle; in the case hitting jaw, usually condyle that fracture; maybe take a radiograph and then look for fractures; look extraorally for lacerations bruises, andy other swellings; if can't handle it, would refer to oral surgeon (who would deal with those kinds of fractures) e. Nursing: i. Health history, vitals, pain assessment f. Spinal injury g. Piercing headaches/persistent headaches h. Focal neurological signs i. Traumatic brain injury j. Concussion k. Subdural hemorrhage l. Skull fractures or other fractures m. PTSD - post traumatic stress disorder n. Meds masking inflammation 2. Aspects of Med Hx that are important? a. Past meds history b. OPQRSTUVW - write in full c. All past otc's, herbal, prescription, and current d. What dose, how often take ibuprofen e. Any relief with that f. Has she continued taking it just as often? g. Any associated symptoms? h. If been using it for more than 3-4 days, how much been using it, any side effect from that? i. FHx, risk factors for fractures j. Allergies - nature of allergy, what happens when she takes it k. Check for peptic ulcer disease l. If has high BP m. Pain hx: what in past has been prevented from doing due to pain

3. What possible settings do you think as a profession you'd encounter this patient? a. Outpatient pharm b. Walk-in clinic c. Emergency room d. Family doctor 4. What have we learned from the continued dialogue from Sarah and the HCPs? a. So she's taking ibuprofen, hepls at first gets prog. Worse b. She described the pain, worse than morning c. Dull, throbbing d. Back of neck, low down, left side e. Concerned about left cheeck and jaw Week13 Page 543

d. Back of neck, low down, left side e. Concerned about left cheeck and jaw f. Fact at end: taking more ibuprofen and not helping: maybe moving out of inflammatory phase and into mechanical phase g. Head is sore 5. Is there something different that we'd like to assess for? a. Migraines b. Cognitive functioning - executive processes; is she still able to plan her day?

Getting her day together with respect to ADLs (eg. Banking) c. Neuro sympx d. Rate the quality of pain i. 0 - 10 6. Want to know more about the effect of the pain on a. Self i. Self-care: showeing, putting clothes on ii. Distracting iii. Avoidance of activities iv. Ptsd v. sleeping b. Activity c. Medications i. Allergies ii. Hx of ulcers, GI bleding iii. Want make sure not OD'ing, 1) frequency, 2) Dose 3) Drug interactions 4) Side effects d. Description of actual pain i. Pain scale e. Internal and external infeluences i. Ibuprofen f. Personal and envrionemtnal factors i. Support at home g. Relationships and lifestyle i. Partner ii. Intimacy iii. Children iv. Taking time off work 7. What do sara's responses tell you about her pain and her situation? a. Pain is 8 b. Bedridden, since Fri c. Hasn't been able to do "much of anything" 8. The hcp has used a numerical pain rating scale; a. why imp use this scale? i. Benchmark/comparison b. What else need know? i. (see above) c. What else out there help you? i. MPQ - McGill Pain Questionnaire ii. BPI - Brief Pain Inventory iii. OT's: looking at how she's managing: is there someone helping her?

9. Based on dialogue and sarah's dsecriptions, what kind o pain do you think she's having? a. Sounds more nocicpetive then neuropathic (just from info have so far) 10. What are the diff's between nocicpetion, pain, and suffering? a. Nociception - pain perception b. Pain - body - perceived threat to biological integrity c. Suffering - emotional aspect; sth. That happens to a person - a state of severe distress associatied with events that threaten the intactness of person; perceived Week13 Page 544

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distress associatied with events that threaten the intactness of person; perceived damage What additional questions if any would you ask to rule out the need for urgent attention? a. The fact that it's worsening b. Hx of Cancer c. Sig trauma d. Unexplained weight loss e. High fever > 37.8 f. Risk factors for infection g. Neuro deficit h. Known osteoporosis i. Steroids? j. No improvement after 1 month k. Morning headache l. Focal neurological symptoms m. Recent change in pattern, freq, severity n. Progressive worsening headache desprite meds o. Onset of headache with cough, exertion or sex p. Onset after age 40 q. What impact has this incident had on i. your ability to ambulate ii. Your daily function 1) eating What are your initial thoughts on next steps? a. Med hx i. Past and current b. Imaging c. Triggers d. Supports i. Family ii. Friends who can help e. Refer to physio f. Address the pain - ie. Change in meds g. Work factors i. Does she have insurance? Financial situation? Can she take it off? ii. Disability form iii. WSIB What does the evidence say about tylenol 3? a. It works! i. She can take a mx of 6-8 tabs per day and need to watch out for medication overuse headache; may get rebound headaches; especially with those formulations with caffeine in them ii. No evidence for T3 and acetaminophen in this type of acute pain (3-6 months) b. Is this is the most appropriate drug? i. Give T3 if not work, give something else What is the evidence on using the use of soft collar or neck pillows? a. PT doesn’t advocate for the use of soft collar - unless if need to stabilize the cspine; get learned helplessness; PT doesn’t think she warrants a soft collar b. Does WSIB cover cost of soft collar? c. Ice packs around jaw for pain and muscle management d. Posture could be influencing jaw What critque do you have of the management plan thus far? a. Because she's delivering as part of her job, not safe to drive i. Also because her blind spot can't see b. Add stool softener c. What's she eating? d. Physician has to inform MOT e. Plan doesn't say to NOT continue using ibuprofen; may want to dc/ it Week13 Page 545

e. Plan doesn't say to NOT continue using ibuprofen; may want to dc/ it f. She has a son and daughter so if she can't drive, can they help with her transportation and ADLs g. Refer to physio 16. What are your suggestions to improve it? a. See above

• Also draw attention to Red and Yellow flags ○ Latter are the psychosocial factors, ie. Interaction between person social env.

What's happening with work, supports, coping strategies, ○ Red flags prominent med conditions

Implications for ○ Job requriements  Driving  Talking on the phone  Sitting for long period of time may exacerbate condition  Educate her about "energy conservation strategy" □ Eg. Taking breaks inbetween tasks □ Eg. Breaking jobs down into smaller components ○ Family  Driving - if need drive kids somewhere  Loss of independence  Taking care of kids and fam ○ Leisure situations  She can't probably play sports  Intimacy ○ Personal  Fact that can't lay down Emails: 1. Ketan a. Ketan.vegda@utoronto.ca 2. Karen a. Karen.montgomery@utoronto.ca 3. Adele a. Adele.swinnard@utoronto.ca 4. Ali a. Ali.okhowat@gmail.com 5. Patty a. Patty_makram@hotmail.com 6. Milka a. m.ignjatovic@utoronto.ca 7. Neal a. Neal.irfan@utoronto.ca 8. Matt a. Matt.schlenker@utoronto.ca 9. Marie a. Marie.irvine@utoronto.ca 10. Ellison a. Ellison.bautista.chan@utoronto.ca

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THE CASE OF FRANK AWEIDA

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Dr. Schreiber Review 3/28/2008 Friday, March 28, 2008 2:14 PM

1. Jaundice a. 3x Normal (normal < 17 micomol/L) i. Prehepatic 1) HA 2) G ii. Hepatic 1) Hepatitis 2) Cirrhosis 3) Intrahepatic a) Cholestatsis b) Sepsis c) Drugs d) PBS - primary biliary sclerosis iii. Posthepatic 1) Stones 2) Cancer 3) Stricture

List 3 hepatic causes of jaundice?

The 1 blood test that defines hepatitis is (increased or decreased ___?

2. Hepatitis a. Systemic complains b. Feel lousy, tired, nauseated c. 1 blood test that defines hepatitis i. ALT - L is for liver d. Clinical syndrome of increased ALT i. Other enzymes AST, GGT, ALP - are non-specific; they can originate elsewhere e. So what causes it? i. Viral 1) A, B, C, D, a) D coinfects with B b) E is a lot like A 2) Other viruses that hit the liver: a) CMV b) HSV ii. Meds or Toxins 1) Alcohol a) What's special about it? i) AST bigger than ALT ii) Moderate elevations! Never actually that high! iii) Really bad hepatitis ALT in the thousands; here you get it in the hundreds 2) Acetaminophen a) Shouldn't take more than 4 grams of acetaminophen per day; if elderly or liver disease, no more than 2.6 grams 3) Virtually any drug can cause liver injuiries; some more than others a) Eg. See patient with RA who has hepatitis, one of first questions want to ask them is are you taking methotrexate b) Recurrent gout: want to ask them are you taking: allopurinol 4) Ischemic hepatitis - people who've had cardiac arrest or are in shock, etc 3. Cirrhosis a. Bridging fibrosis and inside bridegs have nodular regeneration b. Ddx - by far most common in NA are 1 and 2: i. Alcohol ii. Viral (B, C) iii. NASH - gaining as a cause of fatty liver iv. A few metabolic factors 1) Wilson's disease - accumulation of copper 2) Hemochromatosis - accumulation of iron a) Nb. Menstruating women very rare to get this 3) Alpha-1 antitrypsin deficiency 4) (peripherally related) CF v. Autoimmune hepatitis vi. PBC - Primary Biliary Cirrhosis - autoimmune disorder that attacks the small and large bile ducts vii. PSC - Primary Sclerosing Cholangitis - can complicate IBD viii. NB. Hep A DOES NOT cause cirrhosis BUT IT CAN CAUSE FULMINANT HEPATIC FAILURE c. Complications i. 2 families of mechanisms of complications of cirrhosis

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For a healthy person, what's the limit on the amount in grams of acetominophen that they not exceed per day?

Which is higher in hepatitis secondary to chronic alcohol use: AST or ALT? Apart from the hepatitis viruses, list 2 other viruses that can cause hepatitis?

List 5 possible causes of cirrhosis?

The two most common causes of liver cirrhosis in North America are ___ and ___?

List 3 metabolic conditions that can lead to liver cirrhosis?

i. 2 families of mechanisms of complications of cirrhosis 1) Complications due to PORTAL HYPERTENSION a) Ascites i) SBP - Spontaneous Bacterial Peritonitis b) Varices 2) Complications due to LIVER CELL FAILURE a) Decreased clotting b) Decreased albumin c) Jaundice d) Hepatic encephalopathy 3) One that fits under both: HepatoRenal Syndrome - essentially renal failure that happens because of very deranged hemodynamics that get: intense vasodilation all over body but vasoconstriction in kidneys 4) Get big spleen --> blood cell counts decrease (pancytopenia (anemic, leukopenic, thrymobocytopenic, etc.))

5) One other thing that the liver makes that a sick liver fails to make: hypoglycemic ii. Treatment of Ascites 1) Salt restriction 2) Diuretics 3) Large volume paracentesis 4) TIPS - via jugular vein pass a catheter into the liver - break through liver into portal vein  TIPS = transjugular intrahepatic portosystemic stent-shunts

Within the context of ascites, what does SBP stand for?

Broadly, complications of cirrhosis can fall into which two categories?

Complications due to liver cell failure (leading to cirrhosis) include (list 3)?(4) Within the context of treatment for ascites, what does TIPS stand for?

List 3 treatments for ascites?(5) In a patient with encephalopathy as a complication of liver cirrhosis, the KEY factor in helping them to get better is …?

List 4 ways in which GI bleeding can present?

5) Txp - transplant d. Encephalopathy i. Worst thing in patient with chronic liver disease is to have no bowel movement! ii. Key factor in getting patients better is to get bowels to move (ie. Enema) using laxative called lactulose 4. GI Bleeding a. 5 ways in which GI bleed can present i. Melena ii. Hematemesis iii. Hematochezia iv. Syncope v. Iron deficiency anemia

b. Upper GI Bleeding - causes 1) Esophageal varices 2) PUD - Peptic Ulcer Disease a) Gastric b) Duodenal 3) Mallory Weiss tear  Mallory-Weiss syndrome refers to bleeding from tears (a Mallory-Weiss tear) in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting.

4) 5) 6) 7)

Cancer Zollinger-Ellinson Syndrome - Tumor that's producing gastrin Trauma Drugs a) NSAIDs i) PUD ii) Gastritis - can be important cause of GI bleedingdue to NSAIDs or alcohol b) Anticoagulants 8) Esophagitis - reflux! c. Treatments i. First thing you do is NOT SCOPE THEM! 1) Stabilize patient 2) Fluid: normal saline or ringer's lactate ii. Blood work: 1) Hb 2) INR, PTT, platelets 3) C + T: cross and type - might need to transfuse 4) Electrolytes, creatinine - not as pressing but good for supportive care iii. If suscept upper GI bleed of any cause, most patients treated with which meds?

1) PPI - proton pump inhibitors 2) + transfusion 3) If varices, use octreotide (a somatostatin analogue)  Octreotide (brand name Sandostatin, Novartis Pharmaceuticals) is an octapeptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone.

a) OGD - EsophagoGastricDuodenoscopy (really "O"esophagus) b) If varices can either inject them (sclerotherapy) or banding them with a material

5. Acute pancreatitis

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What is a Mallory-Weiss tear?

Patients suspected to have GI bleeding of ANY cause are most often treated with ___?

If varices are the cause of GI bleeding, then use ___?

Within the context of esophageal varices, OGD stands for?

5. Acute pancreatitis a. Typical presentation: epigastric pain that radiates classically to the back, made worse by being in the supine position i. Usually also have vomiting ii. 3 things that make pain worse in same part of body when SUPINE: 1) AP 2) Reflux 3) Pericarditis b. Key lab tests: i. Amylase ii. Lipase - more specific than amylase c. KEY treatment: i. Fluids: Normal Saline d. 2 major causes: i. Alcohol - acute and chronic ii. Gallstones 1) If suspecting this, in addition to supportive care that may include antibiotics (since often devleop septic complications) and Drainage a) ERCP (usually) or (through skin and liver) 6. PUD a. Prominent causes i. H. pylori 1) Biopsy 2) Serology 3) Urea breath test ii. NSAIDs iii. Zollinger Ellinson Syndrome b. Treat i. Triple therapy - can hand patients week's worth pack all taken twice a day 1) One week of PPI's (prazole) 2) Antibiotics (classically metronidazole and clarithromycin)

Key lab tests for acute pancreatitis include ___ and ___?

The 2 major causes of acute pancreatitis are ___ and ___?

Typical presentation of acute pancreatitis isâ&#x20AC;Ś?

Which is more specific to a diagnosis of acute pancreatitis: amylase or lipase?

List 3 major causes of peptic ulcer disease?

List 3 diagnostic tests that may be done to screen for colon cancer?

Infectious agents that can lead to monoarthritis include ___ and ___?

7. 5 things that might be done for colon cancer screening a. FOBT annually b. ACBE - Air Contrast Barium Enema - q 5 years c. ACBE - Air Contrast Barium Enema / Sigmoidoscopy - q 5 years d. Colonoscopy - q 10 years e. CT colonoscopy 8. Monoarthritis a. Crystal gout (pseudogout) b. Infectious i. Gonococcus ii. S. aureus c. Dx'ic test: aspirate - remember whole focus is to rule out sepsis! i. Micro --> gram stain --> C + S (culture and sensitivity) ii. Hematology --> WBC / Differential iii. Looking under microscope for crystals d. 4 treatments for ACUTE gout i. NSAIDs 1) Remember toxic to the kidneys and promote HTN ii. Cochicine - tons of GI side effects iii. (more and more using) short course of prednisone 30mg/day x 3-9days iv. Intra-articular steroids v. DEFNITELY DO NOT GIVE THEM 1) NOT!!!! Allopurinol -because in the acute phase by destablizing body's uric acid pool can actually make things worse!

9. Polyarthritis a. causes i. Autoimmune inflammatory ii. Degenerative iii. Crystal iv. Metabolic conditions 1) Eg. hemochromatosis b. What are the 4 seropositive chronic polyarthritic conditions i. RA (+ Sjogrens) ii. SLE iii. Scleroderma iv. Poly/dermato myositis (PM/DM)

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If you suspect that someone has ACUTE gout, then you should definitely NOT give them ___(a common medication for chronic gout)?

The 4 seropositive chronic polyarthritic conditions are â&#x20AC;Ś?

Colchicine has lots of (GI/GU/CNS) side effects?

With respect to signs and symptoms of scleroderma, what does CREST stand for?

what does CREST stand for?

iv. Poly/dermato myositis (PM/DM) c. If you're wondering could it be scleroderma: i. CREST 1) Calcinosis 2) Raynaud's 3) Esophageal dysfunction 4) Sclerodactyly 5) Telangiectasias

â&#x2013;Ą

ii. More serious involvement, can hit lungs and kidneys d. PM/DM i. Muscle weakness ii. NEED TO RULE OUT: internal malignancy (CA) e. SLE i. Mildest lupus affects which two systems?

1) Skin 2) Joints ii. More intermediate forms involve: 1) Plerual 2) Blood a) ITP - Immune Thrombocytopenic Purpura b) AIHA - Autoimmune Hemolytic Anemia iii. More serious involve: 1) Kidney 2) Lung 3) CNS 10. Rheumatoid Arthritis a. Classic features: i. Hands ii. Symmetrical iii. Poly iv. Rheumatoid factor (IgM directed against IgG) v. When at worst? --> in morning --> morning stiffness vi. Nodules vii. Hallmark radiographically - Erosions (remember pannus) b. OA - xray i. Joint space decrease ii. Subchondral sclerosis iii. Cysts iv. Osteophytes c. Treatment of rheumatoid arthritis i. Principle NOW (as opposed to when Dr. S. in school and used opposite strategy of today) is to hit hard early to prevent complications - most common DMARD used now is methotrexate, most common side effect is liver fibrosis ii. Remember use a lot of antimalarials, sometimes cyclosporing - principle is again that of immunosuppresion 11. Osteoporosis a. BMD - look at T score (number of SD units away from mean value cf. age-matched controls - comparing to young healthy person's density!) i. Osteopenia (-1 to -2.5) ii. Osteoporosis (<-2.5) b. Risk factors

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b. Risk factors i. Steroids ii. Smoking iii. Heparin iv. Increased T4 v. Depoprovera vi. Family history vii. GI disease viii. Primary PTH ix. Early menopause c. Treatments i. Calcium ii. Vit D iii. Bisphosphonates iv. HRT v. Raloxifene vi. PTH

In determining whether someone has osteopenia or osteoporosis, do you look at the results of the T or Z score?

Osteoporosis is defined as having a ___ score between ___ and ___?

Risk factors for osteoporosis include (list 5) â&#x20AC;Ś?(9) Treatments for osteoporosis include (list 4)?(6)

12. 4 red flags in somebody with low back pain a. Bladder(going a lot or a little)/bowel b. Constitutional (fever, weight loss, sweats) (suggesting infection) c. Other neurologic findings d. Pain at night

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List 3 red flags in somebody with lower back pain?(4)

Week 13 Review Questions

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00 FMP 2008 Week 14 Intro Pages Sunday, March 30, 2008 8:11 PM

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01a BRANIGAN 2008 Beyond the Patient Perspective Sunday, March 30, 2008 8:11 PM

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01b BRANIGAN 2008 Beyond the Patient Perspective Sunday, March 30, 2008 8:12 PM

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02 MYERS 2008 Pain Management Sunday, March 30, 2008 8:12 PM

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03 GOLDMAN 2008 Symptom Management Sunday, March 30, 2008 8:13 PM

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04 BUCKMAN 2008 Breaking Bad News Sunday, March 30, 2008 8:14 PM

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05 BRANIGAN 2008 Decision-making at the End of Life Sunday, March 30, 2008 8:15 PM

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06 LIU 2008 Geriatric Pharmacology Sunday, March 30, 2008 8:17 PM

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â&#x20AC;˘ Even though there are these differences, important to note that actually, there are no diff's in absorption

Heating pad will INCREASE absorption; fentanyl applied once every 3 days; tis is a complete sidebar, one of those interesting factoids lecturers like to throw in to make our day hat much better and have something to smile about when we can't remember the right answer on the exam, save our own smugness in remembering fentanyl and heat pad facts :)

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ALBUMIN: Dilantin: older person: checking levels: looks like it's within the normal range but the person has low albumin; the normal range will therefore represent MORE FREE DRUG so the person may be experiencing some toxicity level even though the drug is in the normal rangeâ&#x20AC;ŚTHERE WILL NOT BE A QUESTION ON THIS ON EXAM but again, something to be smiling about when the important information escapes you but this comes to mindâ&#x20AC;Śsmile hcild, dilantin and the rest of its drug class care about you :)

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AS PEOPLE get older, serum creatinine should be going down because less muscle mass, also, serum creatinine is NOT A sensitive marker of kideny function; but since kideny function going down also, then may actually level out

AS GET OLDER, creatinine clearance declines, MEANING KIDENY FUNCTION DECLINES

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Remember that fecal impaction can actually KILL PEOPLE!

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List 5 high risk medications in the elderly, that are associated with a high rate of adverse drug reactions?

â&#x20AC;˘ If look at studies of ppl. Having ADR's at hospital, VAST MAJORITY RELATED TO THESE DRUGS â&#x20AC;˘ Problem is that ppl. Have to keep taking these drugs; not something you can easily take them off of without compromising their treatment

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• Long acting benzo's metabolized through phase 1 reactions and phaseII is short-half- life • Don't have to memorize drugs on next few pages; just understand principles

• These BZDPs will hang around in older patient's body for days to weeks! NONE OF THESE DRUGS SHOULD BE USED IN THE ELDERLY! DRUGS ON THE NEXT PGE, THAT HAVE A SHORT HALF-LIFE (LESS THAN 24 HOURS) SHOULD BE USED

The LOT drugs: SAFE to use for older patients; a better choice:

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The dose required to achieve same level of effect: TAKES LESS OF A DOSE TO SEDATE ELDERLY PATIENT

Older person is more senstiive to the effect of BZDPs

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07 MADAN 2008 Geriatric Delirium_Dementia_Depression Sunday, March 30, 2008 8:18 PM

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Don't waste your time memorizing names of meds

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Common story

ALZHEIMER'S DISEASE!

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IF YOU EVER think you know what it is, TRY TO DISPROVE IT! That's what a ddx is!

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DIFFERENT FROM DEMENTIA! CARRIES with it a morbidity and mortality rate

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One of main ways to distinguish between dementia and delirium: ALL IN THE HISTORY! â&#x2014;&#x2039; When you go in to see these patients, you may still now know what the dx is, but collateral hx imp here

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Transurethral resection of the prostate

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08 BRANIGAN 2008 Limits of End of Life Care Sunday, March 30, 2008 8:19 PM

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09 BRANIGAN 2008 Handout on Wit Sunday, March 30, 2008 8:20 PM

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10 Breaking Bad News Seminar - Student Guide Sunday, March 30, 2008 8:20 PM

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Notes taken on another page, copied here; relating to case 2

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11 End of Life Care Seminar - Student Guide Sunday, March 30, 2008 8:21 PM

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Palliative Care Electives 2008 Sunday, March 30, 2008 8:21 PM

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Week 13 Summary Questions Wednesday, April 02, 2008 9:06 PM

Case 1 - Sarah Locks

Does WSIB cover cost of soft collar?

Implications for Job requriements Driving Talking on the phone Sitting for long period of time may exacerbate condition Educate her about "energy conservation strategy" Eg. Taking breaks inbetween tasks Eg. Breaking jobs down into smaller components Family Driving - if need drive kids somewhere Loss of independence Taking care of kids and fam Leisure situations She can't probably play sports Intimacy Personal Fact that can't lay down What does the evidence say about tylenol 3?

It works!

She can take a mx of 6-8 tabs per day and need to watch out for medication overuse headache; may get rebound headaches; especially with those formulations with caffeine in them No evidence for T3 and acetaminophen in this type of acute pain (3-6 months) Is this is the most appropriate drug?

Give T3 if not work, give something else Dr. Schreiber Review 3/28/2008 Apart from the hepatitis viruses, list 2 other viruses that can cause hepatitis?

Broadly, complications of cirrhosis can fall into which two categories?

Colchicine has lots of (GI/GU/CNS) side effects?

Complications due to liver cell failure (leading to cirrhosis) include (list 3)?(4) For a healthy person, what's the limit on the amount in grams of acetominophen that they not exceed per day?

If varices are the cause of GI bleeding, then use ___?

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If varices are the cause of GI bleeding, then use ___?

If you suspect that someone has ACUTE gout, then you should definitely NOT give them ___(a common medication for chronic gout)?

In a patient with encephalopathy as a complication of liver cirrhosis, the KEY factor in helping them to get better is …?

In determining whether someone has osteopenia or osteoporosis, do you look at the results of the T or Z score?

Infectious agents that can lead to monoarthritis include ___ and ___?

Key lab tests for acute pancreatitis include ___ and ___?

List 3 diagnostic tests that may be done to screen for colon cancer?

List 3 hepatic causes of jaundice?

List 3 major causes of peptic ulcer disease?

List 3 metabolic conditions that can lead to liver cirrhosis?

List 3 red flags in somebody with lower back pain?(4) List 3 treatments for ascites?(5) List 4 ways in which GI bleeding can present?

List 5 possible causes of cirrhosis?

Osteoporosis is defined as having a ___ score between ___ and ___?

Patients suspected to have GI bleeding of ANY cause are most often treated with ___?

Risk factors for osteoporosis include (list 5) …?(9) The 1 blood test that defines hepatitis is (increased or decreased ___?

The 2 major causes of acute pancreatitis are ___ and ___?

The 4 seropositive chronic polyarthritic conditions are …?

The two most common causes of liver cirrhosis in North America are ___ and ___?

Treatments for osteoporosis include (list 4)?(6) Typical presentation of acute pancreatitis is…?

What is a Mallory-Weiss tear?

Which is higher in hepatitis secondary to chronic alcohol use: AST or ALT? Which is more specific to a diagnosis of acute pancreatitis: amylase or lipase?

With respect to signs and symptoms of scleroderma, what does CREST stand for?

Within the context of ascites, what does SBP stand for?

Within the context of esophageal varices, OGD stands for?

Within the context of treatment for ascites, what does TIPS stand for?

Jovey Introduction March 24 Slide Handout.pdf What is the difference between the temporal profile of acute vs. chronic pain?

As opposed to unidimensional scales which address the INTENSITY of pain, multidimensional scales assess the ___ component of pain and assess its ___ impact?

Does neuropathic pain affect the peripheral or central nervous system?

Give an example of a multidimensional pain scale?(2) Give examples of conditions that can lead to neuropathic pain?

In a mechanistic pain classificaiton of nociceptive vs. neuropathic pain, what are the subcategories of these?

List 4 different pain scales?(5) What is the major cause of neuropathic pain?

Within the context of pain assessment, unidimensional scales address the ___ of pain?

Pain Week Student Manual 2008 T/F: a patient's self-report of pain should be used whenever possible?

T/F: almost all acute and cancer pain can be relieved?

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T/F: almost all acute and cancer pain can be relieved?

T/F: while there many different types of pain, such as acute, recurrent, chronic non-cancer and cancer related pains, most people usually have more than one type.

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Week 11 Summary Questions Wednesday, April 02, 2008 9:04 PM

2_Pre-Op Eval and Prep Apart from history and physical, how would you assess cardiovascular system dysfunction?

Apart from history and physical, how would you assess coagulation status?

Apart from history and physical, how would you assess endocrine organ dysfunction?

Apart from history and physical, how would you assess hepatobiliary dysfunction?

Apart from history and physical, how would you assess renal dysfunction?

Apart from history and physical, how would you assess respiratory system dysfunction?

In deciding whether or not you should operate on a patient, what should you consider? (hint: _____ vs. _____?)

List 2 cardiovascular system conditions and their associated treatments that you can prevent post-surgical cardiovascular complications for?

List 2 preventative actions that could be undertaken to prevent post-operative endocrine system complications?

List 4 preventative actions that could be undertaken to prevent post-operative infections?(4) List 4 preventative actions that could be undertaken to prevent post-surgical cardiovascular system complications?(6) T/F: Patients who are hypothyroid react poorly to general anesthesia and surgery but not patients who are hyperthyroid?

What does APACHE II stand for? What is its utility?

Which 3 factors does the APACHE II scoring system take into consideration?

Which drug class is used for ulcer prophylaxis prior to surgery?

3_Pain Mgm Acetaminophen blocks the transmission of pain at which site of the pain pathway?

By approximately how much do NSAID/COXIBs improve pain scores?

Celecoxib blocks the transmission of pain along which arm of the pathway of the pain pathway?

Does acetaminophen have any adverse effects?

Does oxycontin have a biphasic or monophasic release?

Gabapentin and Ketamine block the transmission of pain along which arm of the pathway of the pain pathway?

Gabepentin has additive effects with which class of analgesics?

Give an example of dosages and medications for 3 drugs one would use for post-operative (2hr) total hip arthroplasty?(5) Give an example of dosages and medications for 4 drugs one would use for preoperative (2hr) total hip arthroplasty?(5) If you could use Ketamine OR Gabapentin, which would you use for intraoperative analgesia, if both were equally indicated? Why? In addition to being an analgesic, Gabapentin is also a(n) _______?

In thinking conceptually about the prevention of acute pain, which 3 points in the patin pathway can be targeted with drugs? (hint: Initiation, â&#x20AC;Ś) In using dexamethasone as an analgesic, which other analgesic does it reduce the consumption of?

Intra-operatively, list 3 medications/techniques and one optional medication that you would give for intraoperative analgesia?

Intra-operatively, which mediation would a surgeon administer via local infiltration?

Is it Dexamethasone, Gabapentin, or Ketamine, which has anxiolytic effects?

Ketamine or Clonidine consumption will decrease the consumption of which other class of analgesics?

List 2 drugs that reduce PCEA use?

List 5 multimodal analgesia agents that improve outcomes?

List 5 multimodal analgesics that have additive effects?

Local anesthetic blocks the transmission of pain along which arm of the pathway of the pain pathway?

Name 6 drugs and/or drug classes involved in multimodal analgesia?

Opioids block the transmission of pain along which arm of the pathway of the pain pathway?

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Name 6 drugs and/or drug classes involved in multimodal analgesia?

Opioids block the transmission of pain along which arm of the pathway of the pain pathway?

Out of the following 4 drugs, which one would be administered with the highest dosage pre-operatively (ie. 1000 mg) and which one with the lowest dosage pre-operatively (ie. 5-10mg): celecoxib, acetaminophen, gabapentin, oxycontin, oxycodone?

Out of the following 4 drugs, which one would be administered with the highest dosage pre-operatively (ie. 1000 mg) and which one with the lowest dosage pre-operatively (ie. 8mg): celecoxib, acetaminophen, gabapentin, dexamethasone?

Post-operatively, 1000mg acetaminophen would be approximately every ___ hours?

Post-operatively, 100-200mg gabapentin would be approximately every ___ hours?

Post-operatively, list 5 medications/techniques that you would consider for post-operative analgesia?(7) Pre-operatively, list 4 medications and one optional medication that you would give for pre-operative analgesia?

T/F: Coxib's DO NOT affect platelet function?

T/F: Dexamethasone and pregabalin are in the same drug class?

T/F: Preventing acute pain is a minor risk factor in the prevention of post-operative chronic pain?

T/F: Using Gabapentin results in NO increase in adverse effects?

The duration of oxycontin release is ___ hours?

What does PCEA stand for?

What effect does acetaminophen administration have on opioid consumption?

What effect does acetaminophen admnistration have on the effectiveness of NSAIDs? What effect does acetaminophen have on opioid related side-effects?

What effect does CELECOXIB have on bone fusion?

What effect does CELECOXIB have on platelets?

What effect does CELECOXIB have on thrombosis rates?

What effect does Gabapentin have on opioid consumption?

What effect does Gabapentin have on opioid-related side-effects?

What effect does NSAID administration have on opioid consumption?

What is a downside to the use of ketamines?

What is CELECOXIB? What is multimodal analgesia?

Which analgesic method gives the best movement associated pain relief?

Which is the primary nociceptive factor that is blocked through the use of celecoxib?

Which nociceptive factors does dexamethasone prevent the release of?

Why is it advantageous to give analgesics prophylactically rather than after surgery has started?

5_Gallbladder & Biliary Tree acute acaclculous cholecystitis is commonly seen after which conditions/situations?

Acute cholecystitis is associate with the signs and symptoms of _____?

After which surgical procedure is there an increased risk for cholangitis to develop?

After which type of meal does the pain from biliary colic usually start?

Approximately which percentage of patients with acute cholecystitis improve without surgery?

Are abnormal Liver Function Tests (LFTs) pathognomonic of gallstones?

Are cholecystectomies in Canada now done more often as open surgical procedures, as laparascopic procedures, or approximately the same?

Diabetics with acute cholecystitis have a higher incidence of which 2 complications?

Fever, Jaundice, and RUQ pain together are known as ___?

Generally speaking, how do the complications of gallstones present (ie. Complications related to …, complications related to …, etc.)?

How can cholecystitis be picked up on ultrasound (ie. What do you look for)?

How common is Charcot's triad in patients with cholangitis?

How is alcohol consumption related to gallstone formation?

If in the presence of gallstones, LFTs are abnormal, then one must determine whether they are …(3)?

In which percent of patients suffering from Acute cholecystitis is there a palpable mass and in which percent is jaundice present?

List 2 populations in which there is a clear correlation between increased gallstone risk and family history?

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List 2 populations in which there is a clear correlation between increased gallstone risk and family history?

List 2 treatments that are indicated for biliary colic?

List 3 complications of CBD stones?

List 3 different methods of biliary decompression?

List 3 steps in the management of cholangitis?

List 4 diagnoses that are implicated in acute cholecystitis?(6) List 4 factors that predispose to gallstone formation?

List 4 symptom complexes that patients with gallstones commonly present with?

List 5 diseases which are risk factors for gallstone formation?

T/F: LFT's DO NOT increase in acute cholecystitis but do in chronic cholecystitis?

T/F: Prophylactic cholecystectomy is indicated in 1% of asymptomatic patients over 20 years?

T/F: While in non-diabetic patients, prophylactic cholecystectomy IS NOT recommended in asymptomaic patients, the reverse is true in diabetic patients (ie. Patients who are diabetic AND asymptomic for gallstone disease should still have prophylactic cholecystectomies)?

The pain from Acute cholecystitis usually last more than ___ hours?

Transient gallstone blockage of the Ampulla of Vater leads to ___?

Treatment of acute cholecystitis involves the administration of ___, ___, and ___?

Ultimately, the 3 factors that result in gallstone incidence increasing with age are due to the fact that they all lead to ________ and thus lead to stone formation?

What are the 3 critical phases in the formation of gallstones?

What are the advantages of laparoscopic cholecystectomy (list 3)?(4) What are the disadvantages of laparoscopic cholecystectomy (list 2)?(3) What is another name for biliary sepsis?

What is another name for cholangitis?

What is bilary colic?

What is Reynaud's Pentad?

What is the etiology of cholangitis?

What is the incidence of acute acaclculous cholecystitis as a complication of gallbladder disease?

What is the presentation of acute acaclculous cholecystitis on ultrasound?

What is the treatment of acute acalculous cholecystitis?

What is the treatment of cholelithiasis?

When is early laparoscopic cholecystectomy indicated for patients with acute cholecystitis?

When is surgery recommended for patients suffering from gallstones?

Where does the pain from biliary colic radiate to?

Where is the pain from biliary colic usually felt?

Which well known clinical sign is positive in acute cholecystitis?

Why does gallstone incidence increase with age?

Why is there an increased risk of gallstones in patients who are morbidly obese?

Why should cholecystectomies be very carefully considered AGAINST in patients with cirrhosis?

Within the context of biliary decompression, what does ERCP stand for?

Within the context of biliary decompression, what does PTC stand for?

Within the context of cholangitis, what is charcot's triad?

6_Abdominal Infection What is a PEG tube?

7_Bowel Obstruction Give 2 examples of intraluminal causes of small bowel obstruction?

Give 2 examples of intramural causes of large bowel obstruction?(3) Give 3 examples of extramural causes of small bowel obstruction?

Give 3 examples of intramural causes of small bowel obstruction?

Give an example of an extraluminal cause of large bowel obstruction?

Give an example of an extramural cause of stomach and duodenal obstruction?

Give an example of an intraluminal cause of large bowel obstruction?

Give an example of an intraluminal cause of stomach and duodenal obstruction?

How does small bowel obstruction typically present?

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How does small bowel obstruction typically present?

List 2 common signs/symptoms of gastric outlet obstruction?

List 3 common signs/symptoms of small bowel obstruction?

The laboratory finding of hypochloremic, hypokalemic metabolic alkalosis is pathognomic of ___?

What is an incarcerated hernia?

What is anotehr name for colonic ileus?

What is the definition of obstipation?

What is the treatment for a malignant obstruction?

With respect to laboratory findings, prolonged gastric outlet obstruction leads to ___?

8a_Abdominal Infections Antibiotic prophylaxis for abdominal surgery on the surgical sites of the biliary tract, stomach/duodenum, and small bowel include which two antibiotics?

Antibiotic prophylaxis for abdominal surgery on the surgical sites of the colon and appendectomy include which two antibiotics?

Approximately how long before surgery should prophylactic antibiotics be started (pre-operatively)? Why may you need a second dose to be administered?

How can the incidence of surgical site infection following abdominal surgery be lowered?

Is abdominal infection usually the result of perforation of the GI tract or does it more commonly sponatenously present?

Localized intra-abdominal abscess (localized) can be categorized into which two categories?

Secondary peritonitis can be categorized into ___ and ___?

What do CAPER and HOPER stand for?

Where in the GI tract are the number of anaerobes approximately equal to the number of aerobes?

Which are the antimicrobials of choice for single agent therapy for abdominal infections?

9_Intro to Anesthesiology How are malignant hyperthermia and neuroleptic hyperthermia syndrome different?

In the process of preparing someone for surgery and during the surgery is itself, when is sympathetic tone the highest?

Is malignant hyperthermia autosomal dominant or recessive?

Malignant hyperthermia typically occurs in response to administration of which anesthetics?

Prior to the use of Dantrolene as a treatment for malignant hyperthermia, what was the mortality rate from malignant hyperthermia?

T/F: Malignant Hyperthermia is the modern name of Neuroleptic Malignant Syndrome?

T/F: The penetrance of malignant hyperthermia IS NOT variable?

What are the 5 A's of anesthesiology?

What effect does ketamine have on sleep?

What is malignant hyperthermia?

What is NMS (neuroleptic malignant syndrome)?

What is the approximate incidence of malignant hyperthermia?

What is the difference between an epidural and a spinal?

What is the distinction between a regional and local never block?

What is the incidence of malignant hyperthermia caused secondary to nitrous oxide administration?

What is the treatment for malignant hyperthermia?

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Week 10 Summary Questions Wednesday, April 02, 2008 9:03 PM

01 ALBERT 2008 Intro to Rheumatology Anakinra is a popular ___ used in the management of Arthritis?

Apart from using a soluble TNF receptor or an anti -TNF antibody, which other drug mechanism is used for cytokine neutralization in the treatment of RA? IL-1 receptor blocker Autoimmune diseases may be either ___ or ___?

Autoimmunity is usually benign because of ___ mechanisms?

Autoimmunity results from failure or breakdown of tolerance in ___, ___ or both?

Etanercept is a solube ___ used in Arthritis management?

Fibromyalgia and osteoarthritis are both categorized as: 1. Inflammatory, Non -immune; 2. Inflammatory, Non-immune; or 3. Inflammatory, Immune?

Give 3 examples of inflammatory, autoimmune rheumatoid disorders?(4) Give 4 examples of inflammatory, immune diseases?

Give 4 examples of non-inflammatory, non-immune diseases?

Give an example of a non-inflammatory, non-immune rheumatoid disorder?

Give an example of an inflammatory, non-immune rheumatoid disorder?

Give examples of autoimmune disease that are organ specific?

Give examples of autoimmune diseases that are non -organ specific?

If self-reactive clones of pro-T cells escape the thymus because self-antigen is NOT expressed, then what are the 3 mechanisms in the periphery that may lead to peripheral tolerance?

Iin the absence of chronic infection, chronic inflammatory disease is the result of ___?

In RA there is a (HYPO or HYPER) plastic synovial lining layer?

In RA, there is edema of the ___ membrane with redundant folds and villi?

In the management of Arthritis, cytokine neturalization drugs counteract the actions of which cytokines in the pathogenetic progression of Arthritis?

In the management of Arthritis, drugs such as methotrexate and lefluonmide counteract the actions of which cell in the pathogenetic progression of Arthritis?

In the management of Arthritis, Rutizimab counteracts the actions of which cells in the pathogenetic progression of Arthritis?

Is a hyperplastic synovial membrane present in early or established RA? Is Adulimumab a soluble TNF receptor or an anti -TNF antibody?

List 2 Anti-TNF antibodies that are used in Arthritis management?

List 3 different types of autoimmune reactions?

List 3 environmental and/or lifestyle factors that have been implicated in the development of RA? List 3 inflammatory mediators involved in RA? List 4 serological indicators that may be positive in Reumatoid Arthritis?(5) List the 3 main categories of autoimmune reactions?

Some "non-articular" disorders and crystal arthritis (such as gout and CPPD) are (inflammatory or non-inflammatory) and (immune or non-immune)?

T/F: Flares and remissions DO NOT occur in RA since it is a chronic, progressive disease?

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T/F: The inflammation in all rheumatic diseases represents an abnormal activation of the ADAPTIVE immune system?

T/F: there are extra-articular features in RA? The strongest evidence for a genetic link in RA comes from evidence that the ___ genes are associated with RA? The unifying characteristic for most of the rheumatic diseases is ___?

What do DMARDS stand for?

What does "epitope spreading" refer to?

Which of the following is an acute disease and which is a chronic disease?

While both Etanercept and Infliximab are both exert their effect through cytokine neutralization, one is a soluble TNF receptor while the other one is an Anti -TNF alpha antibody; which is which?

With respect to the development of autoimmunity, Pro -T cells in the thymus may be categoriezed into which 3 groups?

02 BOOKMAN 2008 Clinical Evaluation of Arthritis Eburnation is a feature of inflammatory or non -inflammatory arthritis?

For the clinical evaluation of arthritis, draw a tree showing the classifications in the approach to making a diagnosis?

For the clinical evaluation of arthritis, Lab tests done for ___ blood include ___?(1) For the clinical evaluation of arthritis, Lab tests done for ___ blood include CBC, Urinalysis, ___, and ___?(2) For the clinical evaluation of arthritis, lab tests done to explore degenerative and non articular rheumatism include ___?(1) For the clinical evaluation of arthritis, lab tests performed include ___ and ___?(2) For the clinical evaluation of arthritis, lab tests performed to investigate an infectious cause include ___ and ___?

How are the xray changes different in the clinical evaluation of inflammatory vs. non inflammatory arthritis?

How does the pattern of arthritis different in symmetrical small joint polyarthritis vs. asymmetrical oligoarthritis?

How is class I functional status different from class III functional status in the clinical evaluation of Arthritis?

How is seronegative Arthritis classified?

How is the pattern of arthritis in monoarthritis different from that presented in degenerative joint disease?

In considering therapy for the clnical evaluation of Arthritis, what are the 5 factors that one must take into consideration?

Infectious arthritis may be classified into which two types?

Into which categories may degenerative Arthritis be classified into?

Into which categories may inflammatory Arthritis be classified into?

Into which categories may non-articular Arthritis be classified into?

Is the duration of AM stifness less or more in a patient with inflammatory vs. degenerative arthritis?

List 3 characteristics of seropositive arthritis?

List 4 Activities of Daily Living (ADLs) that are used in the clinical evaluation of arthritis?(6) Week10 Page 2

arthritis?(6) List 4 characteristics of arthritis that are explored further in performing a history and physical?(7) List 4 different classifications for seropositive Arthritis?

List 4 extra-articular features of arthritis What are tophi?

What does eburnation mean?

What is podagra?

What is seropositivity?

What is the distinguishing feature between class I and class II functional capacity, as it relates to the clinical evaluation of arthritis?

What is the distinguishing feature between class Ii and class III functional capacity, as it relates to the clinical evaluation of arthritis?

Which of the following has asymmetric spine involvement: Ankylosing spondylitis, or psoriatic arthritis?

03 UROWITZ 2008 Connective Tissue Disorders Apart from patient education, what are the 5 other components in the approach to SLE therapy?

Dermato/Polymyositis is a disease in which inflammation may be present in which 2 organs?

Dermato/polymyositis is more common in males or females?

Dermato/polymyositis is more common in patients over the age of ___?

In dermato/polymyositis is there proximal or distal muscle weakness?

In dermato/polymyositis is there symmetrical or asymmetrical muscle weakness?

In SLE, leukocytes, lymphocytes, and thrombocytes are all (reduced OR increased)?

Is infection or atherosclerosis more commonly associated with early deaths from SLE? Is it active or inactive SLE that is associated with late deaths in SLE? Is it dermatositis or polymyositis which is immune complex mediated?

Is it inactive or active nephritis that is associated with early deaths in SLE? Late deaths from SLE are associated more commonly with (atherosclerosis OR infection)?

List 3 manifestations of hematologic disorders that may be found in SLE?(4) List 3 manifestations of neurological disorders that may found in SLE?(4) List 3 manifestations of serositis that may found in SLE? (hint: pericarditis, â&#x20AC;Ś) List 9 criteria included in the 1997 Revised Criteria for the Classification of SLE?(11) Purple discoloration, or a purple heliotrope rash, on the upper eyelids of patients is very pathognomonic of which disease?

Red rashes over the knuckles are called ____ papules and are characteristic of ___?

Scleroderma is essentially progressive ___?

T/F: In dermato/polymyositis the two regions of the body in which the muscles are characteristically weak are the hands and feet?

T/F: In scleroderma there's a great deal of skin inflammation?

T/F: Patient with scleroderma DO NOT have inflammation but DO HAVE auto -antibodies present in their blood?

T/F: Patients with dermato/polymyositis have a typical malar rash?

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T/F: patients with scleroderma and those with reynaud's henomenon in general tend to lose peristalsis in the esophagus?

T/F: With respect to the pathogenesis of dermato/polymyositis, polymyositis is cell mediated.

The mnemonic CREST, relating to the symptoms of scleroderma, stands forâ&#x20AC;Ś?

The pathogenesis of SLE can be broadly categorized into which 4 main categories?

What is serositis?

With respect to the pathogenesis of dermato/polymyositis, dermatositis is ___ mediated while polymyositis is ___ mediated?

04 ALBERT 2008 Seronegative Spondyloarthropathies A 35 year old patient comes to your office with a six month history of back pain that improves with exercise and is associated with morning stiffness. What is the MOST LIKELY diagnosis?

According to the New York Criteria, DEFINITE ankylosing spondylitis can be diagnosed if you have ____ + ___?

Another name for reactive arthritis is ___ syndrome?

Approximately what percentage of patients who have ankylosing spondylitis are positive for HLA-B27?

Asymmetric transient polyarthritis is a pattern common to which type of arthritis?

Campylobacter and Yersinia are both possible (GI or GU) causes of reactive arthritis?

Can the acute phase reactants ESR and CRP be used as diagnostic tests for ankylosing spondylitis?

ESR and CRP are both acute phase reactants?

How do sacrolitis/spondylitis vs. peripheral arthritis differ in their course in relation to the course of IBD? How do you treat GI infections that lead to reactive arthritis?

How is reactive arthritis diagnosed (list the 3 criteria, ie. "Following a GI or GU infection the onset of â&#x20AC;Ś(3))?

How many criteria must be positive bilaterally or unilaterally for there to be a positive diagnosis of ankylosing spondylitis?

In the clinical evaluation of arthritis, there are 3 major categories; name them?

Indomethacin and Naproxen are both ___ that can be used in the treatment of ankylosing spondylitis?

Indomethacin and Naproxen are both NSAIDs that can be used in the treatment of ___?

Is it sacrolitis/spondylitis OR peripheral arthritis that is associated with HLA B -27?

Is it seroPOSITIVE or seroNEGATIVE arthritic diseases that have characteristic extra articular manifestations?

List 2 different types of enteropathic arthritis's?

List 2 drugs that can be used for anti-TNF therapy in treating ankylosing spondylitis?

List 2 organisms implicated in the gastrointestinal etiology of reactive arthritis?(4) List 2 therapies used to treat acute, reactive arthritis?

List 3 extra-articular manifestations of reactive arthritis?(5) List 3 possible treatments for enteropathic AXIAL arthritis?(4) List 3 possible treatments for enteropathic PERIPHERAL arthritis?(5) List 3 possible treatments for Psoriatic arthritis?(5) List 4 common patterns of psoriatic arthritis?

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List 4 common patterns of psoriatic arthritis?

List 4 subsets of the spondylarthropathies?

List the 4 New York criteria for the diagnosis of ankylosing spondylitis?

List three drugs that are common between the treatments for enteropathic axial and peripheral disease?

RARE extra-articular manifestations of AS include â&#x20AC;Ś(list 3)?(5) Should you treat an active chlamydia infection leading to reactive arthritis or is it best to first see if it resolves on its own?

T/F: One of the New York criteria for the diagnosis of ankylosing spondylitis is low back pain for more than 3 months that INCREASES with exercise?

The 2 most common extra-articular manifestations of AS are ___?

The association between HLA-B27 and ___ is one of the strongest immunogenetic associations observed with any human disease?

The KEY clinical symptom of ankylosing spondylitis is ___?

There is an overlap between AS and which 3 other spondylarthropaties?

What are the newly proposed criteria for inflammatory back pain in young to patients < 50 years old with chronic back pain (list the 4 criteria)?

What are the subsets of the degenerative arthritis category?

What are the subsets of the inflammatory arthritis category?

What are the subsets of the non-articular arthritis category?

What do the CRA Consensus Guidelines state regarding the use of anti -TNG in ankylosing spondylitis (differentiate between recommendations for primary axial vs. primary peripheral disease)?

What is a syndesmophyte?

What is enthesitis?

What is the risk of ankylosing spondylitis in patients who are positive for HLA -B27?

What should you avoid in using corticosteroids to treat ankylosing spondylitis?

When should you treat GU infections in persons with reactive arthritis?

Where is the entheses located?

With respect to arthritis, a prime example of a seropositive disease is ___?

With respect to therapy for ankylosing spondylitis, is sulfasalazine helpful for axial disease?

With respect to therapy for ankylosing spondylitis, is sulfasalazine helpful for peripheral disease?

05 KEYSTONE 2008 Therapeutics in Rheumatic Diseases ___ is a pivotal cytokine in RA? Approximately how long do DMARDs used for the treatment of RA take to act?

Compared to methotrexate, leflunomide has a more direct effect on ___ cells?

Do most patients taking DMARDs to treat arthritis achieve full remission?

List 3 pharmacologic interventions for RA? List 3 potential safety issues with the use of TNF antagonists in the treatment of RA?(6) List 4 drugs that are in current use for the treatment of RA? List the 5 levels of treatment in the traditional "Pyramid" approach to therapy, as indicated for the treatment of RA? Methotrexate is the GOLD STANDARD for the treatment of moderate/severe ___?

RA affects 3x as many (women or men)?

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RA affects 3x as many (women or men)?

The goal of disease modifying anti-rheumatic drugs is to ____?

The incidence of RA increases in persons between the ages of ___ and ___ years old?

What is the GOLD STANDARD for the treatment of moderate/severe RA? When should you initiate DMARDs following the initial diagnosis of RA? 06 CARETTE 2008 Vasculitis Giant cell arteritis is more common in females or males?

List 2 arteriole/capillary venule related vasculitis's?

List 2 large artery vasculitis's?

List 2 medium artery vasculitis's?

List 2 small artery vasculitis's?(3) List 3 signs of medium vessel vasculitis that can be found on physical exam?(5) List 3 signs of small vessel vasculitis that can be found on physical exam?(6) 07 HAWKER 2008 Osteoarthritis and Low Back Pain T/F: Exercise is an economic and effective though underprescribed therapy in osteoarthritis?

T/F: Osteoarthritis is a natural consequence of aging that occurs secondary to superficial fissuring, erosions and loss of cartilage?

08 MCDONALD-BLUMER 2008 Osteoporosis List 4 common locations for fragility fractures?

09 JUURLINK 2008 Pharmacologic Treatment of Rheumatic Diseases 2 important side effects of colchicine are ___ and ___?

3 potential treatments for the treatment of acute gout are …?(4) A common drug used to treat gout is ___?

A very serious ACUTE adverse effect of corticosteroids is ___?

ASA is NOT used in the treatment of gout because …?

Avascular necrosis is far more common in (men/women)?

Colchicine is ONLY added as a treatment if a(n) ____ is added to the regimen?

Corticosteroids impair (list 2)?(3) Does allopurinol stimulate or block xanthine oxidase?

For the prevention of gout attacks, one should avoid or minimize drugs that can increase uric acid levels, such as … (name 4)?(6) Generally speaking, the two drugs that are used to treat acute gout are ___ and ___?

HPA axis suppression (Addisonian Crisis) commonly occurs during which 2 common conditions?

If patients are taking prednisone >5mg/d for 3 or more months, then 3 other medications should be given to prevent steroid -associated osteoporosis, namely…?

In avascular necrosis, there is death of ___ and progressive ___?

In the treatment of acute gout, NSAIDs are genereally the preferred treatment unless the risk of adverse effects is deemed too high, such as (list 2)?

It appears that all NSAIDs (selective AND non-selective) may sligthtly increase the risk of vascular events, WITH THE POSSIBLE EXCEPTION OF ___?

List 2 adverse effects of allopurinol?(4) Week10 Page 6

vascular events, WITH THE POSSIBLE EXCEPTION OF ___?

List 2 adverse effects of allopurinol?(4) List 2 features of allopurinol hypersensitivity?

List 3 cautions for colchicine prescription?

List 3 chronic adverse effects of corticosteroids?(9) List 3 drugs that should be avoided in persons with gout because they increase uric acid levels?(6) Most patients with avascular necrosis have ___ pain; a minority have ___ pain?

Podagra refers to …?

Prior to an operation, a patient with adrenal insufficiency should receive (more or less) steroids?

Risk factors for avascular necrosis include (name 3)?(7) Steroid-associated osteoporosis may occur because glucocorticoids increase the rate of bone loss by …(list 2 ways)?(4) Symptoms of acute Addisonian Crisis include (list 3)?(6) T/F: Allopurinol hypersensitivity is a common, mild reaction to allopurinol that is mainly manifested as diffuse petichiae over the abdomen and chest areas?

T/F: Corticosteroids suppress inflammatory responses regardless of their etiology?

T/F: dietary modifications are generally effective for the prevention of gout?

T/F: In the prevention of gout attacks, ___ decreases the frequency of gout episodes by about 75%?

T/F: In using corticosteroids, pain, erythema, warmth, and swelling often DO NOT occur?

T/F: it appears that all NSAIDs (selective AND non -selective) may sligthtly increase the risk of vascular events?

The end product of purine breakdown is ___?

The KEY drug interactions with allopurinol are ___ and ___?

Treatment for Addisonian Crisis secondary to abrupt cessation of steroid administration is to …?

What effect do corticosteroids have on scar formation and wound healing?

What effect do corticosteroids have on the synthesis of prostaglandins and leukotrienes?

What effect do corticosteroids have on WBC migration and function?

What is the mechanism of action of colchicine?

Which group of patients have the highest risk for developing steroid avascular necrosis?

10 TUES Acute Monoarthritis Seminar Notes A joint is an articulation between … or …?

Does inflammatory synovial fluid have high or low viscosity?

How long should antibiotic therapy continue for the management of septic arthritis?

In which 2 categories of patients should colchicine be avoided?

In which 3 cateogires of patients should you avoid NSAID treatment of acute gouty arthritis?

Inflammatory vs. Septic arthritis is composed of what percentage of PMNs? List 3 signs of inflammatory arthritis?(4) List 3 systemic therapy options for acute gouty arthritis?

List the 4 categories of differential diagnoses for shoulder pain (hint: articular, …)?

Name 3 synovial lined spaces?

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Name 3 synovial lined spaces?

Noninflammatory and normal synovial fluid is comprised of what percentage of PMNs? Rotator cuff pain is referred to the ___?

Synovial fluid is an ultrafiltrate of plasma to which _____ and other factors are added locally by synoviocytes?

The most frequent crystal induced arthritis is ___?

The three different types of joints are â&#x20AC;Ś?

What are the 2 categories of septic arthritis? Which is more serious?

What are the two steps in treatment of septic arthritis?

What is the best way to treat acute monoarthritis?

What is the cut-off for WBC #'s for non-inflammatory synovial fluid?

What is the difference between Type A vs. Type B Synovytes?

What two things must be of short duration to ensure better outcomes in the case of septic arthritis?

Which of the following crystal depositions are known as "Gout": Momosodium Urate or Calcium Pyrophosphate Dihydrate?

11 THURS Special Tests in Rheumatology Seminar Notes Almost all patients with SLE have a positive ___?

Anti-Jo-1 is specific for myositis associated with _______ and __________?

Anti-Ro (SS-A) and Anti-La (SS-B) is associated with which disease (though it can be seen in SLE)?

Bloodwork of a patient with myositis/myopathies would reveal high levels of which enzyme?

In a usual patient with lower back pain, would you test HLA -B27?

In considering the diagnosis of fibromyalgia, which 5 other diagnoses would you consider in order to arrive at this diagnosis of exclusion?(6) In terms of how they are DIAGNOSED, fibromyalgia syndrome and major depressive disorder are similar in that they are both â&#x20AC;Ś?

Diagnoses of exclusion Is a positive ANCA diagnostic of vasculitis?

Is fibromyalgia syndrome more common in males or females?

Myositis/Myopathies are characterized by (proximal/distal) muscle weakness?

T/F: ANA is recommended as a screening test?

T/F: Rheumatoid factor is not diagnostic of Rheumatoid arthritis?

T/F: The ANA test is NOT specific for SLE? T/F: The set ANA titre above which persons DEFINITELY have SLE is 1:40?

T/F: There are conditions, such as in some infections, in which rheumatoid factor levels decrease markedly?

The major target antigen of C-ANCA is __________?

The major target protein of cANCA is ___?

The major target protein of pANCA is ___?

What are ANCAs? What does C-ANCA stand for?

What does GCA stand for?

What does P-ANCA stand for?

What does PMR stand for?

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What does PMR stand for?

What is fibromyalgia syndrome?

What is the approximate sensitivity of HLA-B27 in patients with ankylosing spondylytis?

What is the main way in which RA and SLE are screened for?

What value of ESR must be present (mm/hr) to suggest PMR (Polymyalgia Rheumatica)?

When is HLA-B27 testing useful?

When should you order an ANA? Which disease is C-ANCA associated with?

Which disease is P-ANCA associated with?

Which test VIRTUALLY RULES OUT SLE if negative?

Extracted pages - seminar Allopurinol is a ___ inhibitor which decreases uric acid synthesis?

Allopurinol is a xanthine oxidase inhibitor which decreases ___ synthesis?

Allopurinol is the preferred ___ lowering drug?

Colchicine is rarely used in the treatment of acute gout because of itsâ&#x20AC;Ś?

Gout chiefly affects middle-aged and elderly (men or women)?

Gross urate crystal deposits are also known as ____?

In the treatment of acute gout, ___ such as indomethacin and ___ are the drugs of first choice?

The LEAST common type of microcrystalline arthritis is ___?

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Week 9 Summary Questions Wednesday, April 02, 2008 9:03 PM

01 WONG 2008 Abnormal Liver Biochemistry and Function A cholestatic pattern of liver enzyme abnormality refers mainly to high levels of which two liver enzymes?

A patient's skin turns yellow in times of stress. The likely diagnosis is ___?

A point system known as the Child’s-Pugh-Turcotte score (CPT score) has been devised to determine the severity of ___?

ALP is also, in addition to being found in the liver, is found in ___ and ___?

ALT was formerly known as ___?

Apart from being found in the liver, ALT is also found in ___?

Apart from being found in the liver, AST is also found in …(name 3 )?

Apart from cirrhosis, symptoms of hemochromatosis can include…(list 3)? (hint: heart, skin, joints) AST was formerly known as ___?

Can EITHER primary sclerosing cholangitis OR primary biliary cirrhosis lead to fulminant liver failure?

Cholestasis refers to …?

Cirrhosis secondary to non-alcoholic fatty liver disease develops over: days, weeks, months, years, decades?

Compared to a fibrotic liver, a normal liver will show increased or decreased echogenicity on ultrasound examination?

Do the majority or minority of patients with viral hepatitis experience fulminant liver failure?

Does autoimmune hepatitis have a male or female predominance?

Gilbert's syndrome is a common cause of (choose one): isolated hyperbilirubinemia, autoimmune hepatitis, Kayser-Fleischer rings, liver cirrhosis, OR primary biliary cirrhosis ?

Gilbert's syndrome is due to not being able to get rid of ___ efficiently?

Hereditary causes of hepatitis tend to present earlier or later in life?

How do AST, ALT, and ALP levels manifest in cholestasis?

How do AST, ALT, and ALP levels manifest in hepatitis How do AST, ALT, and ALP levels manifest in hepatitis?

How do AST, ALT, and ALP levels manifest in hepatitis?

How do the following factors rise and fall and in which order in the progression of liver fibrosis: Albumin, INR, Platelets, Bilirubin?

In autoimmune hepatitis, how long does it take for liver cirrhosis to develop?

In both primary sclerosing cholangitis AND primary biliary cirrhosis, how long does it take, approximately, for liver cirrhosis to develop?

In hepatitis ___ and ___ there is no chronic infection?

In mild hepatitis is ALT higher than AST or the other way around?

In the progression of fibrosis, does INR increase first or does Albumin drop first?

Kayser-Flescher rings are pathognomonic of which disease?

Kayser-Flescher rings occur where?

List 2 enzymes related to cholestasis?

List 2 enzymes which are released when the liver is damaged?

List 2 populations in which high levels of ALP are seen?

List 3 biochemical disorders that are uncommon but important to know about in having a differential for liver disease?

List 3 common causes of cholestasis?

List 3 hepatobiliary causes of elevated ALP? List 3 investigations you could use to diagnose fibrosis of the liver?

List 3 medication classes that are associated with cholestasis?(5) List 3 non-hepatic sources of mild hepatitis where ALT < AST? List 3 other places in the body, apart from the liver, in which GGT is found?

List 3 potential complications of cirrhosis?(4)

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List 5 criteria measured to calculate a Child-Pugh-Turcotte score?

List 6 causes of ACUTE, SEVERE hepatitis?

Mild hepatitis refers to ALT and/or AST being less than ___ x the limit of normal whereas severe hepatitits is defined as ALT and AST levels up to ___x the level of normal?

Most blood tests are pretty stable with age except for which prominent enzyme related to cholestasis?

Name 2 enzymes that are released when hepatocytes are damaged, but which DO NOT correlate with liver function?

Name an uncommon cause of liver disease which, if caught, is very important to treat right away as it may be acutely fatal?

Onset of liver disease secondary to medications and toxins usually takes ____ (weeks, months, years) but can take up to ___ (weeks, months, years)?

Out of the following enzyme blood tests, which is the LEAST stable with age: AST, ALP, ALT, GGT? Out of the four enzymes below, which 2 would you test to further investigate hepatitis and which two for cholestasis: ALP, AST, ALT, GGT? People diagnosed with metabolic disorder should also be suspected of having which liver disease?

Primary sclerosing cholangitis has a (male/female)predominance while primary biliary cirrhosis has a (male/female) predominance?

Primary Sclerosing Cholangitis is associated with ___?

Primary sclerosing cholangitisis diagnosed through ___?

Since there is rapid deompensation in young Wilson's disease patients with cirrhosis, they should get an immediate ___?

T/F: Alcoholic liver disease causes cirrhosis over the course of weeks and months instead of years/decades?

T/F: ALP levels are not stable with age, meaning that a growing teenager will have levels which will vary, and be lower than usual, compared to a non-growing adult?

T/F: Cirrhosis begins to occur soon after the start of symptoms secondary to the drop in platelets?

T/F: fulminant liver failure is an unfortunate, common event in viral hepatitis?

T/F: GGT is NOT found in bone?

T/F: In mild hepatitis, ALT may be up to ALMOST 5 TIMES higher than AST? T/F: Non-alcoholic Fatty Liver can NEVER cause fulminant liver failure BUT it CAN LEAD TO cirrhosis?

T/F: the biggest culprit of medications causing liver disease are dermatologic medications?

T/F: Though ALT and AST are markers of liver damage, they HAVE NO correlation with liver function?

T/F: you can donate the right lobe of your liver and within two weeks, it will grow back?

Tetrathiomolibdate, Trientene, zinc, and penicillamine are all potential treatments for which disease?

The diagnosis of viral hepatitis can be made via ___ and ___?

The first step in the treatment of liver disease secondary to medication use is to â&#x20AC;Ś?

The progression of primary biliary cirrhosis is retarded through the use of ___?

The upper limits of the 4 major liver enzymes, GTT, ALP, AST, ALT, are all ___ except for ALP which has an upper limit of 105?

Vaccines are present against which hepatitis viruses?

What do ALT and AST stand for?

What does fulminant mean?

What does SGOT stand for?

What is a potential treatment for autoimmune hepatitis that can prevent increased liver fibrosis?

What is a potential treatment for hepatitis secondary to chronic alcohol consumption?

What is primary sclerosing cholangitis?

What is the Childâ&#x20AC;&#x2122;s-Pugh-Turcotte score used for?

What is the difference between fibrosis and cirrhosis?

What is the difference between type 1 and type 2 autoimmune hepatitis?

What is the gold standard for the diagnosis of fibrosis?

What is the treatment for hereditary hemochromatosis? Why? What may be the cause of itchy skin in cholestasis?

When do you first start to experience symptoms from the progression of fibrosis (name after which of the following factors rises or falls): bilirubin, platelets, INR, albumin?

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the following factors rises or falls): bilirubin, platelets, INR, albumin?

Which has a predominantly FEMALE predominance: Primary Biliary Cirrhosis OR Primary Sclerosing Cholangitis?

Which is less sensitive as a marker of liver damage: AST or ALT? Which of the following types of hepatitis does not have a specific diagnostic test: autoimmune hepatitis, hereditary hemochromatosis, alpha1-antitrypsin deficiency, viral hepatitis?

Why is ultrasound not a good method for diagnosing mild fibrosis of the liver?

With which of the following causes of liver disease is fulminant liver failure possible (may be more than one): viral hepatitis, non-alcoholic fatty liver, medications and toxins, autoimmune hepatitis, alpha-1antitrypsin deficiency?

02 WONG 2008 Viral Hepatitis Approximately how many week after Hep E exposure does the virus show up in stool?

Case fatality of Hep A is highest in which age group?

Hepatitis ___ and ___ are the major causes of end-stage liver disease and liver cancer?

How can Hep D infection be prevented?

How is Hepatitis G acquired?

How long should interferon treatment for Hep B be given?

IF ALT and AST are both < 30 and HCV PCR is negative, then what should be done in follow up to confirm no HCV infection?

If you suspect acute HAV infection, which antibody titre should you check and when?

In evaluating for HCV infection, if the patient has ALT and AST levels < 30, then â&#x20AC;Ś?

In evaluating for HCV infection, if the patient has ALT and AST levels > 30, then â&#x20AC;Ś?

In HBV-HBD Superinfection, there is a high risk of ___?

In Hep E infection, ALT reaches its peak approximately how many weks after exposure?

In Hep E infection, levels of (ALT or AST or ALP) reach their peak at approximately the same time as levels of (IgM anti-HEV or IgG anti-HEV) reach their peak?

In which of the following age categories is jaundice frequently seen during a Hep A infection and in which is it a more rare occurrence: < 6 y.o., 6-14 y.o., > 14 years old?

In which of the following body fluids are Hep B levels the highest (may be more than one): Urine, Vaginal Fluid, Serum, Saliva, Wound exudate, Saliva, Semen, Breast milk, Tears, Blood, Sweat, Feces?

Is Hep A an RNA or DNA virus?

Is Hep E an RNA or DNA virus?

Is it safe to BREASTFEED if a mother has an HCV infection?

Is jaundice secondary to Hep B infection seen more commonly in children < 5 y.o or >5 y.o.?

Is there a higher level of HBV via percutaneous and perinatal transmission or sexual transmission?

List 3 ways in which Hep A can be transmitted?

List 4 drug classes that are available for the treamtent of HBV? List 4 group sof drugs that may be used to treat Hep B? List the 2 main populations in canada who are at risk for Hep B infection?

List the two steps in evaluating for HCV infection?

Name a complication of Hep A infection?

Out of the following, which would be the most contagious (ie. Contain the most virions) in a Hepatitis A infected person: Serum, Stool/Feces, Saliva, Urine?

Recovery from Hep A infection in the majority of cases takes approximately ___ month(s)?

Symptoms of Hep B infection start approximately how many weeks after exposure?

T/F: Hep A infection CAN BE transmitted through blood exposure (ie. Injection drug use or transfusion)?

T/F: Hep G infection is associated with downregulation of which chemokine receptor that plays an important role in determining the progression of HIV infection?

T/F: Hepatitis G infection is actually NOT associated with liver infection?

T/F: If a patient tests positive for HBsAg, they have a Hep B infection?

T/F: If a patient tests positive for HBsAg, they have a Hep B infection?

T/F: If a patient tests positive for HBsAg, they have a Hep B infection?

T/F: If a patient tests positive for levels of Total anti-HBc, then you still CANNOT distinguish between whether the person has an acute or chronic Hep B infection?

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T/F: Immigrants are screened for HIV, syphillis, and HBV BUT NOT TB? T/F: Perinatal transmission of HCV occurs less frequently in infants delivered vaginally (ie. NOT via C section)?

T/F: There is NO CURE for Hep B infection?

Untreated, chronic infection with HBV typically leads to ___ OR ___?

What 5 tests can you do to assess the severity of HCV infection?

What is the difference between the levels of anti-HBs in acute vs. chronic Hep B infection?

What is the difference between the temporal profile of HBsAg levels in acute vs. chronic Hep B infection?

What is the primary immune modulatory treatment for Hep B infection?

What is the treatment for Hep C? What is the treatment for Hep D infection?

What' s the Incubation period (range and average) of Hep A? What' sthe Incubation period (range and average) of Hep B? Which groups/ persons are at increased risk for infection by Hep A (name 3)?(5) Which of the hepatitis viruses IS NOT associated with liver disease?

03 LILLY 2008 Liver Failure A synonym for decompensation, in the context of liver failure, is â&#x20AC;Ś?

Do patients with a Child-Pugh Score of A or C have higher 1-year and 5-year survivals?

Do recurrent bleeds occur in the majority of patients who have had at least one index variceal bleed secondary to cirrhosis?

End Stage Liver Disease is marked by ___ and ___?

How is decompensated cirrhosis managed?

Is cirrhosis or chronic infection more common as a clinical feature in Hep C infection?

List 3 signs of decompensated cirrhosis?(4) List 4 prognostic factors in cirrhosis?

List the 5 steps in the stepwise approach to the management of ascites?

T/F: In fulminant hepatic failure, encephalopathy occurs 2 weeks after the onset of symptoms?

T/F: The lower the Child-Pugh Score, the better?

T/F: THE MAJORITY of deaths in HCV infection are liver-related?

The average western diet has approximately ___ - ___ meq of Na whereas a low salt diet has about ___ meq of Na? The most common adult indication for liver transplant is ___?

The top two adult indications for liver transplantation are ___, ___ and ___?

The typical incubation period for Hep C is ___ to ___ weeks?

What is the definition of fulminant hepatic failure (include whether or not it's reversible and when the onset of encephalopathy should occur after appearance of first symptoms)?

What is the difference between compensated and decompensated cirrhosis?

What is the prevalence of cirrhosis in Hep C infection?

Which is more common: cirrhosis or fulminant liver failure?

05 KANDEL 2008 Dyspepsia and Peptic Ulcer Disease Chief cells are located in the ___?

Chief cells produce ___?

Diagnosis of a peptic ulcer is made by ___?

Diagnosis of peptic ulcer is made by ___?

Do decreasing prostaglandin levels lead to increased or decreased levels of joint inflammatino and gastric cytoprotection?

G cells are located in the ___?

G cells produce ___?

How are arthritis and gastric mucosal stability related?

In ordering a STELLAR workup for dyspepsia, which 5 lab investigations would you order in addition to: liver enzymes, CBC, creatinine, and glucose?

In ordering an ordinary workup for dyspepsia, which 4 lab investigations would you order?

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In ordering an ordinary workup for dyspepsia, which 4 lab investigations would you order?

Intrinsic factor is produced by ___ cells located in the ___ region of the somtach?

Is cancer a common, uncommon, or rare cause of dyspepsia?

Is dyspepsia a reliable indicator of an ulcer?

Is there a higher rate of dyspepsia as a complication of NSAID use or ulcer formation?

Is there a higher rate of dyspepsia or ulcer complications in patients who have adverse reactions to NSAIDs? List 2 common causes of peptic ulcer?

List 2 complications of peptic ulcer disease?(3) List 3 common causes of dyspepsia?

List 3 rare causes of dyspepsia?

List 3 RARE causes of peptic ulcer?

List 3 uncommon causes of dyspepsia?

List the 3 regions of the stomach?

Most patients who have dyspepsia should be investigated via (general tests/investigations) ___, ___, and ____?

Most useful diagnostics for H. pylori infection are ___ and ___, though the most accurate is ___?

Name a proton pump inhibitor?

Out of the 4 questions that one should ask a patient with dyspepsia, which one is the only one which is correlated with a diagnosis?

Oxyntic glands in the body and fundus of the stomach contain which 3 types of cells?

Parietal cells are located in the ___?

Parietal cells produce ___ and ___?

Patients with peptic ulcer disease commonly present with ___ and ___?

Pepsinogen is secreted by ___ cells whereas gastrin is secreted by ___ cells?

Pyloric glands in the antrum contain which 2 types of cells?

Suppressing gastric acid prevents and heals peptic ulcers BUT ONLY WHILE â&#x20AC;Ś?

T/F: ALL persons with H. pylori infection have gastritis, but only a minority will go on to develop a peptic ulcer and even fewer gastric cancer?

T/F: Disease secondary to H. pylori infection occurs years after the initial exposure and infection?

T/F: H. pylori infection can now be effectively eliminated with a single drug?

T/F: In trying to minimize the wastage of resources, only ONE blood test should be done for dyspepsia and that is Helicobacter serology?

T/F: Pathogen isolation NOT NECESSARY to diagnose someone with an H. pylori infection?

T/F: Regarding complications of NSAID use, there is a 10x higher likelihood of dyspepsia complications compared to ulcer complications?

T/F: The commonest cause of functional dyspepsia is peptic ulcer disease?

T/F: The commonest cause of peptic ulcer disease is functional dyspepsia?

The cells which secrete gastrin are located in which region of the stomach?

The cells which secrete HCL are located in which region of the stomach?

The cells which secrete pepsin are located in which region of the stomach?

The ONLY place where H. Pylori is found is in the ___ mucosa?

The three drug regimen for the treatment of H. pylori infections usually includes a proton pump inhibitor plus the following two antibiotics: ___ AND (___ OR ___)?

The workup for dyspepsia includes which 3 tests (hint: one is a blood test)?

What are the 4 key questions to ask someone presenting with dyspepsia?

What is a helpful menomic in eliciting a history of pain?

What is dyspepsia?

What is functional dyspepsia?

What is giardia?

What is the commonest cause of dyspepsia?

What is the effect of inhibition of cyclo-oxygenase by NSAIDS on prostaglandins levels?

What should you do when presented with any gastric ulcer in order to rule out cancer?

Which 3 cancers are most commonly related to complaints of dyspepsia?

Which is a more common cause of dyspepsia: Crohn's disease or pancreatitis?

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Which is a more common cause of dyspepsia: Crohn's disease or pancreatitis?

06 KANDEL 2008 Dysphagia and Gastro-esophageal Reflux Disease ___ and ___ affect parietal cells via ____ cells?

2 accurate indicators of reflux are ___ and ___?

24 hour esophageal pH monitor is the most accurate test for ___?

Apart from prescription of proton pump inhibitors and elevating the head of the bed, what is another common non-pharmacological approach to treating reflux?

Dysphagia can be due to a lower esophageal ____'s ring?

Extra-esophageal symptoms of GERD include … (list 4)?

GERD stands for?

H. pylori infection and NSAIDs are the two most common causes of ___?

How can you distinguish between mechanical and neuromuscular obstruction based on the type of food that causes dysphagia?

If someone is deemed to have progressive mechanical obstruction, the next level in the diagnositic algorithm is to determine …?

If someone is deemed to have progressive neuromuscular obstruction, the next level in the diagnositic algorithm is to determine …?

In barrett's esophagus there is increased risk of ___ of the lower esophagus?

In barrett's esophagus there is metaplasia of the esophageal mucosa from ___ to ___?

In esophageal reflux, If nocturnal symptoms are present, what is a suggested non-pharmacological treatment that can alleviate In Scleroderma, there is abnormal esophageal motility, namely, ABSENCE OF … and DECREASED …?

In the algorithmic approach to dysphagia, food that stops or "sticks" after being swallowed is suggestive of ___ dysphagia whereas a person who has difficulty initiating swallow has a condition suggestive of ___ dysphagia?

Is gastroscopy in a patient with achalasia found to be normal or abnormal?

List 3 esophageal complications of esophageal reflux?(5) List 5 common causes of dyspepsia?

List the 3 most common causes of dyspepsia?

Name 3 receptors on parietal cells which play an important role in gastric acid secretion?

Reflux is due to transient relaxation of the …?

Scleroderma is a disease of abnormal ____ (HINT: a type of protein)?

Somatostatin decreases both ___ cell secretion of acid AND ___ cell secretion of gastrin?

Somatostatin is made by stomach ___ cells?

Stomach D cells make ___?

T/F: a diagnosis of dysphagia can be made by history alone?

The diagnosis of achalasia is confirmed by a ____ test?

The efficacy of using a proton pump inhibitor is close to ___%?

The most accurate test for reflux is …?

There's a high correlation between helicobacter infection and which type of cancer?

What are ECL cells?

What does NERD stand for?

What is achalasia?

What is the suggested investigation in barrett's esophagus?

Which patients benefit most from proton pump inhibitors (list 4 types)?

Why may patients with pneumonia be more likely to be taking a proton pump inhibitor than a control group?

Because pneumonia is one of the extra-esophageal signs of reflux disease (also wheezing, laryngitis, cough). The PPI is therefore perhaps secondary to a diagnosis or less commonly, a prophylactic.

07 STEINHART 2008 Inflammatory Bowel Disease ___ may reduce the immunogenecity of infliximab?

5-ASA and sulphapyridine are both derivatives of ___?

Antibiotics, ___ and methotrexate can be used to induce remission in (CD or UC)?

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Antibiotics, ___ and methotrexate can be used to induce remission in (CD or UC)?

Azathioprine, methotrexate, and infliximab can be used to induce remission in (CD or UC)?

Azathioprine/6-Mercaptopurine is indicated for ___ dependent or resistant disease (especially in (CD or UC)?

Budenoside has a high topical affinity for the ___ receptor?

Corticosteroids and immunosuppressive agents can be used to induce remission in (CD or UC)?

Corticosteroids and immunosuppressive agents can be used to induce remission in (CD or UC)?

Even though there is NO role for cyclosporine in maintenance therapy for UC, there MAY be a role for it in treating (which type of) CD or pyoderma gangrenosum?

For the induction and maintenance of treatment remission in BOTH UC and CD, which 2 drugs can be used?

In prescribing azathioprine/6-mercaptopruine, which 2 blood tests should you order to monitor levels?

In the disease severity assessment of IBD, which 2 neutrophil-derived proteins can be measured in the feces because they are released by cells in inflammatory conditions?

In Ulcerative Colitis, if ONLY the rectum and sigmoid colon are involved, then you should consider which category of diseases?

Is it in CD or UC that an abdominal mass MAY be present?

Is it in Crohn's disease or Ucerative Colitis that non-caseating granulomas are found?

Is it in Crohn's disease or Ucerative Colitis that skip lesions are found?

Is it in Crohn's disease or Ucerative Colitis that the small bowel is involved?

Is it in Crohn's disease or Ucerative Colitis where there is superficial inflammation?

Is the risk of malignancy increased in UC or CD? Is the risk of massive hemorrhage increased in UC or CD? Is Toxic Megacolon more associated with CD or UC? List 3 common intestinal complications of CD? List 3 drugs that can be used to induce remission in UC?(4) List 3 drugs that can be used to maintain remission in UC?(4) List 3 indications for surgery in CD?(8) List 3 indications for surgery in UC?(7) List 3 indications for the use of infliximab in CD?(5) List 3 potentially adverse outcomes relating to the use of biologics in the treatment of IBD?(4) List 4 drugs that can be used to induce remission in CD?(6) List 4 drugs that can be used to maintain remission in CD?(5) List 4 extraintestinal manifestations of IBD? List 4 signs/symptoms you would investigate in order to assess the severity of Crohn's Disease?(6) List 4 signs/symptoms you would investigate in order to assess the severity of Ulcerative Colitis?(6) List two indications for the use of infliximab in UC? Methotrexate may reduce the immunogenecity of ___?

Metronidazole can be used in (UC or CD) as a treatment option?

Strictures, fistulas, and sepsis, are all common in UC or CD? T/F: Crohn's disease can affect ANY part of the GI tract, from the mouth to the anus?

T/F: Cyclosporine is sometimes used in maintenance therapy for UC? T/F: perianal disease may or may not be present in UC but it is very commonly seen in CD? T/F: Since therapy must be individualized in IBD treatment based upon disease and patient factors, in many specific circumstances, there may NOT be an 'evidence base' available for treatments?

T/F: The ONLY histologic feature that's histologic of ulcerative colitis is crypt distortion?

T/F: There is NO role for antibiotics in Crohn's disease?

T/F: Toxic megacolon is a very rare complication of Crohn's Disease?

The maximum incidence of UC and CD occurs between ___ and ___ years of age?

The primary diagnostic sign of ulcerative colitis is ___?

The two most important side-effects of corticosteroids to worry about in patients with IBD are ___ and ___?

Weight loss, signs of malnurtrition, and perianal disease are ALL MORE COMMON in ulcerative colitis or crohn's disease?

What are the top 3 locations for Crohn's disease?

Week9 Page 7

crohn's disease?

What are the top 3 locations for Crohn's disease?

What is budesonide?

What is crohn's disease?

What is the advantage of using budenoside as opposed to conventional steroids?

What is the differential diagnosis of suspected jejunal + ileal inflammation, apart from CD? What is the differential diagnosis of suspected jejunal + ileal inflammation, apart from CD? What is the differential diagnosis of suspected jejunal + ileal inflammation, apart from CD? What is thought to be the pathogenesis of IBD? What is ulcerative colitis?

Which blood tests would you do (name 4) to conduct a disease severity assessment in IBD?(6) Which clinical feature(s) are most diagnostic of CD? Which drug, apart from sulphasalazine and 5-ASA, can be used to maintain remission in BOTH CD and UC? Which two drugs can be used to BOTH induce AND maintain remission in CD? 09 ROSSOS 2008 Pancreatitis Difference between acute and chronic pancreatitis?

Examples of local complications secondary to acute pancreatitis include?

Fat necrosis secondary may occur secondary to the release of which major pancreatic enzyme?

How can you clinically diagnose acute pancreatitisâ&#x20AC;Ślist 5 ways?(5) How is BMI related to prognosis of AP? In actue pancreatitis, over the course of the first week of enzyme release, levels of which pancreatic enzyme are generally higher than amylase?

In renal failure levels of serum amylase and lipase may be as high as ___ X normal?

In which of the following causes of increased levels of BOTH serum lipase AND amylase will levels of amylase and lipase actually be INCREASED: tubo-ovarian disease, renal failure, macoamylasemia, intestinal injury, pancreatitis, parotitis, biliary stone?

In which of the following causes of increased serum lipase will serum lipase actually be NORMAL (ie.

NOT be raised): pancreastitis, parotitis, biliary stone, intestinal injury, tubo-ovarian disease, renal failure, macroamylasemia.

List 2 antimicrobial agents that may cause acute pancreatitis?(5) List 2 drugs which may cause drug-induced pancreatitis via chronic accumulation of toxic metabolites?(3) List 2 indications for early (48-72 hrs) ERCP in acute pancreatitis?

List 3 miscellaneous causes of acute pancreatitis (ie. Not alcohol, gallstones, idiopathic)?(5) List 3 signs/symptoms of chronic pancreatitis?(4) List 3 supportive therapies that can be offered in acute pancreatitis?(5) List 7 groups of drugs that cause acute pancreatitis?

Overall mortality due to acute pancreatitis is about ___ to ___%?

Overall mortality for acute pancreatitis is ___ to ___%?

Pancreatitis is often caused by ___ or by ___?

Prognostic factors in acute pancreatitis include (name 2 general ones)?

Regarding the etiology of acute pancreatitis, the TWO MAJOR causes are ___ and ___?

Release of complement from the pancreas leads to which major systemic effect?

Release of elastase, chymotrypsin, and kallikrein from the pancreas leads to which major systemic effect(s)?

Release of lipase from the pancreas leads to which major systemic effect?

Release of Phospholipase A 2 from the pancreas leads to which major systemic effect?

Release of thrombin from the pancreas leads to which major systemic effect?

Symptoms of acute pancreatitis include â&#x20AC;Ś(list 4)?(5) T/F: It IS NOT recommended that CFTR mutation screening be regularly performed in patients with pancreatitis?

What are the endocrine and exocrine functions of the pancreas?

What is the gold standard for establishing or excluding a CF diagnosis?

When does acute pancreatitis become chronic?

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When does acute pancreatitis become chronic?

11 FMP 2008 THURS GI MALIGNANCY Seminar What is Zenker's diverticulum?

Zenker's diverticulum typically occurs above which muscle?

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Summary Week 8 Questions

01 SCHAFFER 2008 Diagnosis and Etiology of Depression 2x3 50% of those with Major Depressive Disorder have onset before the age of ___?

Biochemically, what is the response to anti-depressants that target norepinephrine?

Briefly describe how sadness is different from depression?

Do antidepressants increase or decrease dopamine levels?

Do antidepressants work by upregulating or downregulating beta-adrenergic receptors (thereby influencing norepineprhine)?

Give examples of 3 substances that can lead to substance-induced MDE?(4) How are serotonin levels linked to precipitating the symptoms of depression?

How is major depressive disorder diagnosed?

How many months within the onset of a stressful event must depression occur and after how many months must it resolve in order to be diagnosed with Adjustment Disorder with Depresed Mood?

How much of the variance in the incidence of depression is accounted for by life events?

In diagnosing dysthymia, the patient should "never be without symptoms forâ&#x20AC;Ś" what period of time?

In order to diagnose someone with a major depressive episode (MDE), there are 3 major diagnostic criteria according to DSM IV; what are they?

In order to diagnose someone with a major depressive episode (MDE), there they must have 5 or more of which symptoms during a 2 week period? (list 5, there's a total of 9) List 2 ways you can be more assured of a substance-induced MDE diagnosis; ie. There are 3 criteria that must be met to confirm substance-induced MDE, list 2?

List 3 medical conditions that can lead to a mood disorder due to a general medical condition?(5) List 3 neurotransmitters involved in depression?(3) List 4 diagnoses that are associated with MDE's(6)?

List 4 diagnostic criteria for Dysthymia?(5) List 5 signs that indicate the presence of depression?(7) List 6 risk factors for depression?(8) Name 2 vitamin deficiencies that can cause a mood disorder?

T/F: According to the Canadian Community Health Survey, the highest rate of Major Depressive Disorder was amongst the 15-24 year old age group?

T/F: According to the Canadian Community Health Survey, women are overall more likely to suffer from depression compared to men?

T/F: According to the Canadian Community Health Survey, women over 64 are significantly more likely to suffer from depression than men over 64?

T/F: Adjustment Disorder with Depressed Mood is diagnosed in patients with a mental illness/disorder?

T/F: Major depressive disorder occurs more frequently in the elderly (+60 years old) than in those less than 60 years old?

T/F: True depression is NOT a chronic condition but is by definition acute episodes of depressive symptoms?

The mean number of lifetime episodes for someone who suffers from Major Depressive Disorder is __ to __?

What did the Dunedin Multidisciplinary Health and Development Study reveal regarding genetics and depression in S/S genotyped individuals?

What did the Dunedin Multidisciplinary Health and Development Study reveal regarding maltreatment, serotonin transporter gene promoter region genotypes, and propensity to experience depression?

What happens to blood flow to the attention/cognition areas of the brain in depression versus blood flow to the vegetative-autonomic areas of the brain?

What is Adjustment Disorder with depressed mood?

What is substance-induced MDE? What is the effect of untreated depression on hippocampal volume?

Within the course of Major Depressive Disorder, what is the mean duration of an untreated Major Depressive Episode?

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02 SCHAFFER 2008 Biological Treatment of Depression 2x3 A majority of depression patients achieve remission after how many medication trials?

Apart from pharmaceutical therapy, list 2 other biological treatments for depression?(4) Buproprion (Wellbutrin), at high doses, has which common side-effect?

Every patient treated for depression needs to go through at least which 2 phases of treatment?

Give 2 examples of SNRIs? Give 2 examples of SSRIs? Give 3 examples of TCA antidepressants?

Give an example of a reversible MAOI antidepressant and another example of an irreversible MAOI antidepressant?

How are number of episodes of antidepressant treatment correlated with length of antidepressant treatment?

How did trends in the outpatient treamtent of depression change between 1987 and 1997 in the US? How do MAOI antidepressants work?

How do SNRIs work?

How do SSRIs work?

How do TCA antidepressants work?

How does Buproprione (Wellbutrin) work?

How long does the acute phase of antidepressant treatment last?

How long does the continuation phase of antidepressant treatment last?

How long does the maintenance phase of antidepressant treatment last?

In using a 2nd medication for depression treatment, what is the principle that should be followed?

List 2 common side effects of MAOIs?(3) List 2 common side effects of TCAs? List 2 common side-effects of Buproprion (Wellbutrin)?

List 2 common side-effects of Mirtazapine (Remeron)?(3) List 3 categories of patients who would require maintenance treatment?(4) List 4 factors that should influence your choice of which antidepressant to prescribe?

List 4 strategies one should follow if the medications prescribed for anti-depression aren't helping?

MOST remissions from antidepressant use occur between ___ to___ weeks of use?

T/F: A MAJORITY of patients achieve remission from depression after TWO OR MORE medications?

T/F: A MINORITY of patients achieve remission from depression with FIRST line medication?

T/F: Most medication choices have similar efficacy?

The precursor for dopamine, _____, is found in many foods, including cheese and tofu?

Tyramine ingestion while taking MAOIs can cause ___?

Tyramine is the precursor for ___?

What are two specific side effects of most antidepressants that you should warn patients about?

What does it mean to 'augment' anti-depressant medication with other medications?

What is the difference between response and remission?

What is the difference between the goals of acute, continuation, and maintenance treatment with respect to treating depression?

What is the generic name for Remeron?

What is the generic name of Celexa?

What is the generic name of Effexor?

What is the generic name of Paxil?

What is the generic name of Prozac?

What is the generic name of Zoloft?

What is the mechanism of action of Mirtazapine?

What percentage, approximately, of patients will RESPOND to treatment with a first line antidepressant? (nb. Asking for response, NOT remission) Which is the MOST toxic in overdose: SSRIs, TCAs, SNRIs? Which other form of treatment should be added to antidepressant therapy to achieve an even better outcome?

Which type of anti-depressant class has a high rate of drug-drug and drug-food interactions?

Why are SSRI's more sought after than TCAs?

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Why are SSRI's more sought after than TCAs? Why should tripants (used in the treatment of migraines) not be taken with MAOI antidepressants?

03 ZARETSKY 2008 Cognitive Therapy for Depression 2x3 Apart from depression, list 2 other common medical problems which CBT be used for?(5) CBT and SRI treatment responsive OCD patients show similar decreased activitiy in which brain structure?

Cognitive therapy is generally time limited to how many months (for uncomplicated depression or anxiety)?

Give a few examples of comorbidities of depression?

Give an example of how CBT can be used to maintain patients in remission more effectively than clinical case management?

Give examples of how CBT is a structured therapy?

In a typical course of CBT for depression, organize the following session goals from earliest to latest: Goal setting, relapse prevention and termination, assessment and suitability, behavioural activation, use of an automatic thought record?

List 2 different forms of psychotherapy?(3) List 3 non-specific mechanisms of action of psychotherapy?

List 3 specific mechanisms of action of psychotherapy?

List 4 psychiatric conditions in which CBT is the gold standard?

List 5 cognitive distortions?(10) T/F: CBT is as effective as medication for chronic depression?

T/F: CBT is as effective as medication for mild to moderate depression?

T/F: CBT is MORE effective than medication in reducing relapses?

T/F: CBT is NOT as effective as medication for more severe non-psychotic depression?

T/F: Cognitive therapy can be done individually but should not be done in groups?

T/F: For chronic depression, there is no difference between using CBT alone versus using medication alone?

T/F: If you wish to start a patient on CBT, this SHOULD NOT be started mid-way through their medication course because of the inability to discern which is having a positive effect?

The cognitive model states that one's core beliefs in a situation influence which 3 factors?

What are the 6 steps in cognitive restructuring?

What are the stages in the Cognitive Model of Depression?(hint: 5 linear steps before get to symptoms of depression)?

Which of the following is an example of Socratic questioning, in response to a student saying "I'm a complete failure" (there may be more than one right answer): 1. What makes you think you are a complete failure?; 2. Why are you being so hard on yourself?; 3. What would a good student do?; 4.

Would a complete failure be able to get 75% on an exam?; 5. On a scale of 0-100%, where do you fall?

Where do other people fall?

04 SCHAFFER 2008 Introduction to Bipolar Disorder 2x3 A genuine manic episode generally lasts for at least how long?

According to the mood spectrum, what's the difference between bipolar type I and type II? Apart from mood stabilizers and antidepressants what are some other treatments for bipolar disorder?

Approximately ___% of depressed patients have bipolar disorder?

Are depressive episodes necessary for the diagnosis of bipolar disorder?

Atypical antipsychotics are used more for the treatment of mania or bipolar depression?

Atypical antipsychotics were originally introduced for the treatment of ___?

Divalproex and lamotrigine are both ___?

For the pharmacological management of acute bipolar mania, which medications are commonly used for monotherapy?

Give 2 examples of atypical antipsychotics?(4) Hypomania + Depression = ___?

In diagnosing a manic episode, patients must experience 3 or more of which 7 symptoms?(just name 5) In diagnosing a manic episode, what are the 4 general categories?

In diagnosing a mixed episode, criteria for BOTH a manic episode AND major depressive episode should

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be met for what minimum period of time?

Lamotrigine is primarily used for the treatment o f â&#x20AC;Ś?

List 2 different psychosocial interventions for the maintenance phase of bipolar disorder?(4) List 2 popular combination therapies for the treatment of bipolar depression?(3) List 2 psychiatric disorders for which mood stabilizers are indicated for?

List 3 criteria for hypomanic episodes?(6) List 3 populations that are particularly at risk for bipolar disorder?(6) List 3 potential complications of long term mood stabilizer use?(7) List 3 symptoms that overlap between mania and depression?(6) List a popular combination therapy for the treatment of acute bipolar mania?

Long term lithium use has potential complications for which organ?

Monotherapy for treatment of bipolar depression includes which 2 medications?

Olanzapine, risperidone, clozapine, and quetiapine are all examples of which class of medications?

Sexual dysfunction is a prominent side effect of long-term use of which mood stabilizer?

T/F: Bipolar disorder is NOT caused by parents but CAN be reversed by will power?

T/F: Bipolar disorder MAY run in families?

T/F: Lamotrigine and Divalproex are indicated as combination therapy for the treatment of bipolar depression?

T/F: Mood stabilizers DO NOT worsen mania or depression?

T/F: Patients with bipolar disorder do not actually have morphological abnormalities but they do have second messenger and mitochondrial dysfunction?

T/F: Valproic acid is primarily used to treat bipolar depression?

The administration of which anticonvulsant has a 1:1000 risk of ___ Syndrome?

The administration of which bipolar medication has a 1:1000 risk of Stevens-Johnson Syndrome?

The leading cause of mortality in patients with BD is due to ___?

The main side effects of the atypical antipsychotics are ___ risks, such as â&#x20AC;Ś(name 2)?(3) The presence of mania, in Canada, is highest in which age group: 15-24, 25-64, or over 64?

What are the 2 criteria used to define bipolar disorder?

What are the 3 diagnostic criteria for a mixed episode?

What are the two most common conditions that are comorbid with bipolar disorder?

What does CANMAT stand for?

What is Bipolar Disorder Type II? What is Lamotrigine?

What is the generic name for Divalproex?

What is the most common age for the onset of bipolar disorder in males and females?

What percentage of bipolar patients have recurrence?

Which category of long-term mood stabilizers has the highest risk of causing dyslipidemia?

Which category of long-term mood stabilizers has the highest risk of causing glucose dysregulation?

Which category of long-term mood stabilizers has the highest risk of causing liver problems?

Which category of long-term mood stabilizers has the highest risk of causing sexual dysfuntion?

Which category of long-term mood stabilizers has the highest risk of causing teratogenicity?

Which of the following are potential complications of long-term mood stabilizer use: teratogenicity, glucose dysregulation, renal effects, liver problems, sexual dysfunction, dyslipidemia, weight gain?

Which of the following are side effects of anticonvulsants: teratogenicity, glucose dysregulation, renal effects, liver problems, sexual dysfunction, dyslipidemia, weight gain?

Which of the following lead to weight gain (may be more than one right answer): atypical antipsychotics, anticonvulsants, lithium?

With respect to lithium administration, what is the range of dosages used to treat bipolar disorder?

With respect to lithium levels, the treatment of mania or depression has a higher target blood level?

Would a higher target blood level of lithium be sought to treat acute depression or for maintenance treatment of bipolar disorder?

Would a higher target blood level of lithium be sought to treat acute mania or acute depression?

Would lithium, olanzapine, and divalproex be appropriate combination therapy for the treatment of acute bipolar mania?

05 KAHAN 2008 Substance Abuse Key Concepts 2x3 Which of the following is a complication of hallucinogen use (may be more than one): poor social Week8 Page 4

Which of the following is a complication of hallucinogen use (may be more than one): poor social functioning, mania, delerium tremens, drug induced psychosis, cravings, fatigue and irritability, mood disorders?

According to the Low-risk Drinking Guidelines, how many drinks are low risk for men to drink per week?

According to the Low-risk Drinking Guidelines, how many drinks are low risk for the general population to have per day?

According to the Low-risk Drinking Guidelines, how many drinks are low risk for women to drink per week?

Alcohol enhances ___, which is an inhibitory neurotransmitter and suppreses ___ which is a neuroexcitatory neurotransmitter?

Alcohol inhibits which system in the brain?

Alcohol suppresses ___ and enhances ___ (both neurotransmitters)?

Another name for ecstasy is ___?

Another name for endorphin receptors is ___ receptors?

Another name for MDMA is ___?

Another name for Suboxone is ___?

Approximately how long does it take for Buproprion to work?

Are opioids effective for acute pain only, chronic pain only, or both?

Are opioids safe in pregnancy (if not, why; what may they cause)?

As a laboratory marker for alcohol consumption, is MCV found to be depressed or elevated?

Cessation of alcohol use leads to unopposed activity of which neurotransmitter?

Cocaine blocks the presynaptic uptake of which 3 neurotransmitters?

Does methadone administration induce sedation?

Does tolerance to alcohol develop quickly or slowly?

GHB is a metabolite of ___?

GHB stands for ___?

GHB use leads to ___ effects, like ___?

Give 2 examples of hallucinogens?(3) How are the symptoms of uncomplicated alcohol withdrawal different from those of complicated alcohol withdrawal?

In using opioids, what's the difference in the rate of development of tolerance to psychoactive vs. analgesic effects?

List 2 medications that can be used to reduce drinking?

List 2 psychological symptoms of opioid withdrawal?(3) List 3 factors that are correlated with the addictive potential of drugs?(5) List 3 ways in which you could make a drug less addictive?(5) Opioids act on which receptors?

Physical symptoms of opioid withdrawal include â&#x20AC;Ś (name 2)?

Severe withdrawal from nicotine lasts approximately how many days?

Symptoms of alcohol withdrawal typically start how many hours after the last drink?

T/F: BOTH GGT and MCV are poor screening methods for excess alcohol use since both have low sensitivity AND specificity values?

T/F: Buprenorphine is AS EFFECTIVE as methadone at 60-80 mg?

T/F: MDMA use may acutely lead to serotonergic syndrome?

T/F: Nicotine can be both a relaxant AND a stimulant?

T/F: Nicotine replacement therapy is far SAFER than cigarette smoking?

T/F: The effects of MDMA may be temporarily decreased by treating with an SSRI? T/F: The withdrawal symptoms experienced in GHB withdrawal are similar to those experienced by withdrawal from hallucinogens?

Tachycardia and vomiting are examples of complicated or uncomplicated signs of alcohol withdrawal?

The ____ and NMDA ____ are inhibited by alcohol?

Treatment for GHB use is ___?

Usually a cocaine high is 20 minutes but with repeated use the euphoria only lasts for ___, followed by ___?

What are the 4 C's of addiction?

What are the cardiovascular chronic effects of alcohol consumption?

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What are the cardiovascular chronic effects of alcohol consumption?

What are the CNS chronic effects of alcohol consumption?

What are the components of serotonergic syndrome?

What are the GI chronic effects of alcohol consumption?

What are the hepatic chronic effects of alcohol consumption?

What are the psychiatric chronic effects of alcohol consumption?

What are the withdrawal symptoms seen in withdrawal from hallucinogens?

What are the withdrawal symtpoms in GHB withdrawal?

What is a standard drink for beer, wine, liquor (give quantities)?

What is the CAGE questionnaire?

What is the difference between the condition that Naltrexone is used to treat vs. Naloxone?

What is the generic name of veranacline?

What is the mechanism of action of Acamprosate?

What is the mechanism of action of buprenophine?

What is the mechanism of action of Champix?

What is the mechanism of action of Naltrexone?

What is the primary difference between the reward pathway of cocaine compared to alcohol, nicotine and opioids?

Which important neurotransmitter does MDMA (ecstasy) stimulate the release of?

Which of the following is a complication of cannabis use (may be more than one): poor social functioning, mania, delerium tremens, drug induced psychosis, cravings, fatigue and irritability, mood disorders?

Why can you not overdose on Buprenophine (Suboxone)?

06 RICHTER 2008 Anxiety Disorders 2x3 A high density of GABA-BZDP receptors are found in the ___, ___ an doccipital /frontal cortex?

Are males or females more prone to panic disorders?

Buspirone is a benzo or non-benzo?

Buspirone is indicated as first line treatment for ___?

BZDP (benzo's), barbiturates, and alcohol all bind to which receptor of a major class of neurotransmitters?

Cell bodies secreting majority of norepinephrine are located in the ___?

EMDR (eye movement desensitization and reprocessing) is indicated for the treatment of which disorder?

First-line treatment for GAD and SAD is ___?

For all anxiety disorders EXCEPT GAD and SAD, ___ are indicated as first-line treatment?

For Generalized Anxiety Disorder to be diagnosed, there must be 3 or more of the following symptoms (list 4)?

For Generalized Anxiety Disorder to be diagnosed, worry must be present most days for greater than or equal to ___ months?

For the diagnosis of panic disorder patients must have symptoms for more than how long (ie. How many weeks or months)?

For the diagnsosis of Social Anxiety Disorder, individuals older than 18 years must have SAD for a duration greater than ___ months?

GABA and glutamate are both examples of neurotransmitters that are biogenic amines, amino acids, or peptides?

GABA is the major (inhibitory/stimulatory) neurotransmitter?

GABAA has allosteric binding sites for which major drugs (name 3)?

Give examples of introceptive expsoures?

How is anxiety differentiated from fear?

HPA axis dysfunction is prominently involved in which disorder?

In agoraphobia, situations are ___, ___, or require the presence of ___?

In diagnosing a panic attack, patients must experience 4 or more of the following (list 5)?(13) In diagnosing social anxiety disorder, it must not be related to any general medical condition, such as ___?

In Mowrer's two stage model of anxiety, which type of conditioning is required for the development of

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fear and which for the maintenance of fear?

In order to be diagnosed with panic disorder, a patient must have both recurrent panics and one or more of which three symptoms?

In the neuroanatomical model of anxiety, avoidance is mediated by which brain region?

In the neuroanatomical model of anxiety, panic is thought to originate in the ___ and conditioned and unconditioned fear in the ___ and the ___?

In the neuroanatomical model of anxiety, the limbic lobe is responsible for which type of anxiety?

In the neuroanatomical model of anxiety, unconditioned fear is thought to originate in the ___ and conditioned fear in the ___?

In the treatment of anxiety, when can you prescribe benzo's PRN? In the treatment of panic disorder, what are the indicated first and second line treatments?

In the treatment of panic disorder, what are the indicated third line and third line/adjunctive treatments?

Is generalized anxiety disorder more prevalent in males or females?

List 2 core features of anxiety disorders?

List 3 examples of agoraphobic situtations?

List 3 physical symptoms of social anxiety?(9) List 3 substances whos use can lead to substance-induced anxiety disorder?(4) List 6 anxiety disorders?(11) List a few compulsions related to OCD? List a few obsessions related to OCD? List the 3 major categories of neurotransmitters related to biogenic amines?

List the 3 phases to a panic attack?

List three subtypes of specific phobias?

List typical situations in patients would experience agoraphobia?

OCD is frequently comorbid with other ___ disorders and ___?

Pharmacologic treatment for generalized anxiety disorder (GAD) may involve the use of which drugs (list 3)?

Pharmacologic treatment of Generalized Anxiety Disorder (GAD) may involve the use of which class of psychiatric medications?

Stimulation of the locus ceruleus leads ...?

Substance-Induced anxiety disorder may be associated with withdrawal from (which drugs) ___ or ___?

T/F: Anxiety is CLEARLY genetic but it's also likely to be multifactorial?

T/F: CBT is the FIRST-LINE treatment for ALL anxiety disorders?

T/F: GABA has been implicated in both panic and ___?

T/F: in addiiton to SSRIs, Venlafaxine is indicated as FIRST LINE treatment for panic disorder BUT NOT for social phobia?

T/F: In chronic anxiety, patients' anxiety levels will dip to normal for a few days at most but will be above normal at a constant level most of the time?

T/F: In the treatment of anxiety disorders, benzo's are never first line treatment but they may be second line treatment?

T/F: Insight is usually absent in patients with OCD? T/F: MAOIs are indicated as second line treatment in the treatment of panic disorder?

The major brain structures involved in OCD are the ___ and the ___?

The neurobiology of anxiety involves which 3 major types of neurotransmitters?

The single most common mental disorder is ___?

The two major classes of pharmacotherapy for the treatment of phobias are ___ and ___?

There's generally a ___ to ___ week lag in benefits from antidepressants and antianxiety medications?

What are the 2 DSM-IV criteria for the diagnosis of OCD? What are the 4 major types of phobias?

What are the three related diagnoses for anxiety disorder?(ie. Panic disorder withâ&#x20AC;Ś, etc.)

What is social anxiety disorder?

What is the approximate lifetime prevalence of anxiety disorders?

What is the difference between acute stress disorder and PTSD? What is the difference between generalized and non-generalized social anxiety disorder?

What is the difference between obsessions and compulsions?

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What is the difference between obsessions and compulsions?

What is the gold standard treatment for phobias?

Which are the two major nuclei on which serotonin has it's effects?

Which two classes of meds are frequently used to treat performance anxiety?

07 FMP 08 Week 8 Substance Abuse SEMINAR NOTES T/F: The CAGE questionnaire is a good diagnostic test for diagnosing someone with alcoholism ONLY if males score 2/4 or higher and females score 1/4 or higher?

Dr. Schreiber Review Lecture Tuesday, February 19, 2008 ___ is probably the most effective smoking cessation therapy available today?

A standar drink is approximately how many grams of alcohol?

Acamprosate reduces cravings OR withdrawal symptoms?

An important side effect of lithium consumption is that it causes …?

Another name for Citalopram is __?

Another name for Citraline is __?

Another name for Fluvoxamine is __?

Another name for Paroxetine is __?

Another name for Varenicline is ___?

Another name for Venlafaxine is ___?

Another name for Zoloft is __?

Chronic complications of alcohol use include …(list 1 per: liver, GI, CVS, CNS, )?(4) Disulfiram inhibits which enzyme?

Does MCV rise or fall with increased alcohol intake?

In choosing a drug to treat alcohol withdrawal, the principle that you use is to select one which has a much (longer/shorter) half-life than alcohol?

Is Venlafaxine an SSRI or an SNRI? List 2 anticonvulsants that are used as mood stabilizers?(3) List 2 CNS consequences of chronic alcohol consumption?(4) List 3 categories of mood stabilizers?

List 3 medical consequences of cocaine use?(7) List 3 SSRIs? (below is just a partial list of 5) List the 3 major neurotransmitters which have been shown to be out of balance in people with depression?

Naltrexone reduces cravings OR withdrawal symptoms?

Patient with moderate alcohol withdrawal often have (auditory OR visual) hallucinations?

Risperidone and olanazapine are both ___?

Signs of overuse of opioids on physical exam include: ↓HR ↓RR ↓pupils ↓BP ↓LoC (level of consciousness) Suggest two lab tests for measuring baseline and follow up alcohol intake?

The half-life of diazepam is much longer than alcohol, at around approximately ___ hours?

The hippocampus of patients TREATED for depression was shown to expand OR contract?

What are the 4 C's of addiction?

What does the CAGE questionnaire stand for?

What is disulfiram used for the treatment of?

What is Mirtazapine used for?

What is the antidote to opioid withdrawal?

What is the difference between tolerance and dependence?

What is the difference in the mechanism of action of Venlafaxine vs. Fluvoxamine?

What is the mechanism of action of Disulfiram?

What is the mechanism of action of Mirtazapine?

What is uncomplicated alcohol withdrawal?

Autonomic "stuff"- Sweating, palpitations, ↑HR, ↑palpitations, ↑sweat, ↑tremor, anxiety Week8 Page 8

Autonomic "stuff"- Sweating, palpitations, ↑HR, ↑palpitations, ↑sweat, ↑tremor, anxiety When used for depression, buproprion is called ___ whereas when it's used for smoking cessation, it's called ___?

Withdrawl from opioids results in "drug opposite effects", which include … (list 3)?(6) You see someone who you suspect has alcohol withdrawal. He reports that he had a seizure that started with the arm then the whole body started to shake. Is this evidence of alcohol withdrawal?

Seminar: Substance Abuse: A Case-Based Approach __ and ___ characterize mild intoxication with GHB? ___ is a clue that a patient on treatment for alcohol dependence may be relapsing?(3) A 750 cc bottle of wine contains approximately how many standard drinks?

An 18 year old patient was brought in by ambulance to the emerg after his friends foundhim unresponsive in an after-hours night club. In the ambulance they gave him O2 and naloxone, to which he didn't respond. In the ER he was unresponsive to deep pain and was noted to have myoclonus and bradycardia and his O2 saturation was 80. After several hours he abruptly woke up, confused but otherwise well. What drug did he overdose on?

An ounce contains approximately ___ cc's and a standard drink of wine contains about ___ oz?

Another name for Naltrexone is ___?

Apart from an inpatient program, list 2 effective treatment plans that you can use for treating problem drinking?

For a patient experiencing alcohol withdrawal, which 3 other important questions would you ask on history?

GHB can cause severe withdrawal syndrome similar to ___ withdrawal?

GHB is a structural analogue and metabolite of ___?

GHB overdose at higher doses is characterized by which symptoms (name 3)?

GHB overdose is treated with Phenobarbital?

Give an example of a long acting benzodiazepines (which, as a group, have been implicated in increasing the risk of falls and hip fractures in seniors)?

How effective is smoking cessation counselling?

How long does buproprion take to work?

If someone has had a coronary event, how long should they wait before using a nicotine patch and gum?

If someone is a problem drinker and you'd like to encourage them to recude their rate of drinking, what strategies can you recommend to help patients avoid intoxication (list 5)?(7) If you suspect that a patient has an alcohol problem, which other questions, besides frequency and quantity of drinks per week and screening using the CAGE questionnaire, would you ask?

In addition to asking how much a patient drinks on average per week and defining the size of the container of the type of alcohol they drink, which other important question should be asked to quantify alcohol consumption per week?

In tracking a problem drinker's progress over time, it may be helpful to order GGT and ___ at baseline and follow-up?

In treating alcohol withdrawal, diazepam is a good choice because it (list 3 reasons)?(5) Insomnia and dysphoria may still be experienced for ___ after opioid withdrawal?

List what a standard drink is in terms of beer, wine, and liquor?

Methadone is an oral opioid ___ with a half-life of __ hours?

Methadone is used in the treatment of patients who are physically and psychologically dependent on ___, such as ___ or high doses of other potent opioids such as ___ (just an example of one)?

Percocet is a combination of ___ and ___?

T/F: even if titrated carefully, methadone still causes drowsiness but this is a tolerated side-effect since it DOES relieve withdrawal and cravings, enabling patients to escape the biological compulsion to continue drug use?

T/F: Low Risk Drinking Guidelines recommend 14 standard drinks per week and three drinks MAXIMUM per day for MEN and 9 standard drinks per week and MAXIMUM 1 drink per day for WOMEN? T/F: Most of the cardiovascular benefits of alcohol can be obtained by drinking less than one drink per day and these benefits of reducing mortality from coronary artery disease are seconary to inhibition of platelet function and improvement in the lipid profile?

T/F: Naltrexone is a competitive beta-2 adrenergic antantagonist, and has been shown in several Week8 Page 9

T/F: Naltrexone is a competitive beta-2 adrenergic antantagonist, and has been shown in several randomized trials to decrease the intensity and severity of binge drinking in alcohol dependent patients engaged in formal treatment programs?

T/F: Naltrexone use reduces alcohol cravings?

T/F: Problem drinkers DO experience alcohol withdrawal?

T/F: There is NO evidence that inpatient programs are more effective than outpatient in treating binge drinking and alcohol dependence?

The 4 main components of methadone treatment are: (4)?

The CAGE questionnaire is scored as "positive" if men score higher than ___ out of 4 and women score higher than ___ out of 4?

The most common symptom of opioid withdrawal is ___?

There is evidence that benzodiazepine use in the elderly increases the risk for â&#x20AC;Ś and the risk of â&#x20AC;Ś?

What are the adverse effects of benzo's in the elderly?

What are the clinical features of alcohol dependence (list 3)?(5) What are the clinical features of opioid withdrawal (list 2 objective signs and 2 subjective symptoms)?

What are the low risk drinking guidelines for men and women (ie. Maximum ___ standard drinks per week, or ___ drinks on any one day for men, â&#x20AC;Ś for women)?

What is the definition of "alcohol dependence" (hint: 4 criteria, one of them being a type of dependence)?

What is the difference in symptoms experienced between mild intoxication with GHB and intoxication at higher doses?

What is the mechanism of action of methadone?

What is the mechanism of action of Naltrexone (ReVia) work?

What is the time course of opioid withdrawal?

Why does Naltrexone use make it easier for patients to practise strategies learned in counselling to control excessive drinking habits?

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