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AMC notes > Qbank1 > Flashcards

Qbank1 Flashcards

1
Q

Osteoporosis, investigation

A

Diagnosis -
postmenopausal/men >50yrs
+ fracture

Scoring-
DXA
Garvan fracture risk indicator

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2
Q

Osteoporosis, treatment

A

Low risk without fracture -
falls reduction
exercise
diet, no smoking, no alcohol
education and support

The rest:
Bisphosphonates
Denosumab (rank ligand inhibitors)
Oestrogen replacement
Strontium ranelate (antiosteoporotic agent)

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3
Q

Triad for primary adrenal crisis

A

Low serum sodium
Low serum glucose
High serum potaaaium

  • consider diagnosis in unexplained severe dehydration or shock
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4
Q

Adrenal crisis, management

A

Investigation
Cortisol
ACTH
17 hydroxyprogesterone
Plasma renin activity
Urinary steroid and sodium
serum pH, electrolytes and glucose

Treatment
1. steroid replacement - hydrocortisone, fludrocortisone
(glucocorticoid if mild or moderate)
2. IV fluids
3. Dextrose
4. Electrolyte adjustments
5. Treat trigger

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5
Q

SINBAD clasification system

A
  • All other characteristics are scored 0
  • > 3 severe ulceration

Score of 1 each
SITE - Midfoot and hindfoot
ISCHAEMIA - Clinically reduced pedal blood flow
NEUROPATHY - Sensation lost
BACTERIAL INFECTION - Present
AREA - > 1cm
DEPTH - Reaching muscle / tendon or deeper

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6
Q

Diabetic foot ulcer antibiotics

A

NONE
- just debridement and dressing

MILD
- Flucloxacillin,
- Mod Pen allergy(Cefalexin)
- Severe Pen allergy (Clindamycin)

MODERATE
- Flucloxacillin + Metronidazole
- Mod pen allergy (Cefazolin/Cefalexin + Metronidazole)
- Severe pen allergy (Clindamycin)

SEVERE
- Amoxicillin Clavulanic Acid / Piptaz
- Mod pen allergy (Cefepime + Metronidazole)
- Severe pen allergy (Clindamycin + Ciprofloxacin)

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7
Q

Pheochromocytoma triad

A

Episodic headache, sweating, and tachycardia.

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8
Q

Thyroxine dose adjustments

A

Halflife of 7-10 days
Initial doses increased every 3-4 weeks
Full benefit 3-4 months

Monitoring every 4-6 weeks until near euthyroid

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9
Q

Nipple discharge differentials

A

MILKY - medications, hyperprolactinemia (adenoma, etc)

MULTICOLORED - duct ectasia, comedomastitis

PURULENT - mastitis, abscess

WATERY SEROUS/BLOODY - intraductal papilloma, malignancy, premalignant lesion

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10
Q

Nipple discharge differentials

A

MILKY - medications, hyperprolactinemia (adenoma, etc)

MULTICOLORED - duct ectasia, comedomastitis

PURULENT - mastitis, abscess

WATERY SEROUS/BLOODY - intraductal papilloma, malignancy, premalignant lesion

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11
Q

Renal artery stenosis, referral criteria

A

Category 1 (<30 days)
Confirmed RAS + worsening renal function/hypertension

Category 2 (<90 days)
Incidental RAS of >60%

Category 3 (<365 days)
None

Requirements
History
UE
Renal USS

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12
Q

Acute coronary syndrome, initial management

A

IF OUTPATIENT:
1. Refer via ambulance for assessment
2. Aspirin
3. Sublingual GTN

IF A AND E:
1. ECG (q15 mins)
2. Biomarkers (cardiac troponin)
3. obtain Chest x-ray (old/new record)
4. Morphine if with ongoing chest pain
5. Oxygen if <93% or <88%
6. GTN if with ongoing chest pain
7. Aspirin

  • If ECG is negative then repeat assessment for other life threatening causes
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13
Q

Acute coronary syndrome, high risk features of chest pain

A

Refer if with any of the following:
1. ongoing/repetitive chest pain after treatment
2. elevated troponin
3. persistent ST depression/T wave inversion
4. ST elevation (>2 leads)
5. Haemodynamic compromise
6. sustained ventricular tachycardia
7. syncope
8. known LV Ejection fraction (<40%)
9. prior ACS

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14
Q

Acute coronary syndrome, treatment

A
  1. GOLD STANDARD
    PCI
  2. < 12 hrs from onset, PCI not available
    FIBRINOLYTICS (tenecteplase, alteplase, streptokinase)
    +
    ANTITHROMBIN (enoxaparin, heparin)
    +
    ANTIPLATELET (clopidogrel)
    THEN
    Coronary Angiography
  3. Failed fibrinolysis
    PCI
  4. > 12 hrs from onset but still with chest pain
    PCI
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15
Q

Hypertension, measurement methods

A

INITIAL/CVD RISK CALCULATORS
Clinic blood pressure >140/90

CONFIRMATORY
Ambulatory blood presure
Home monitioring

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16
Q

Hypertension, treatment targets

A

TREATMENT INITIATED AT:
Low absolute CVD risk >160/90mmHg

Moderate absolute CVD risk
>140/90mmHg

TREATMENT GOALS:
Uncomplicated hypertension
<140/90mmHg

CKD
<140/90mmHg

High cardiovascular risk
<120/90mmHg

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17
Q

Hypertension, initial medications

A

Uncomplicated:
1. ACEI - captopril, enalapril, etc
2. ARB - losartan, candesartan, etc
3. Calcium channel blockers - veralpamil, diltiazem, nifedipine, etc
4. Thiazide diuretics - hydrochlorothiazide, indapamide

  • ACEI + ARB = Increased side effects

Specific conditions
1. CKD + Albuminuria - ACEI, ARB
2. MI - ACEI, Beta blocker
3. Symtomatic Angina - BB, CCB
4. CHF - ACEI, BB
5. Intolerant to ACEI - ARB

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18
Q

Rate control drugs

A

Amiodarone
Dronedarone

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19
Q

Rhythm control drugs

A

BB
CCB
Digoxin

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20
Q

Heart failure, basic investigation

A

ECG
Chest x-ray
Transthoracic echocardiogram

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21
Q

Acute heart failure, management

A

Oxygen - <94% O2 sat
Ventilation - persistent shortness of breath
Loop diuretics - acute heart failure
Vasodilators - >90mmHg SBP
Inotropes - Hypoperfusion

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22
Q

Chronic heart failure, management

A

ACEI: LV EF <49%
Beta Blocker: LV EF <49%
- bisoprolol, carvedilol, metoprolol, nebivolol
Mineralocorticoid receptor antagonist: LV EF <49%
Diuretics: congestion
Cardiac resynchronisation therapy
Implantable cardioverter defibrillators
Pressure monitoring
Surgery

2nd option after ACEI: ARB, ARNI, Ivabradine, Hydralazine, Digoxin, Nutraceuticals

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23
Q

Pericarditis, presentation

A

Most common symptom: sharp, piercing chest pain in the centre or left side of the chest.

Others:
low fever
heart palpitations
shortness of breath
weakness or fatigue
nausea
dry cough
swelling of the legs or abdomen

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24
Q

Pericarditis, management

A

INVESTIGATION:
ECG
Chest x-ray
Optional: Echocardiogram, CT scan, MRI

MEDICATION:
NSAID
Colchicine
Pain -relief

Optional: Anitibiotics (causes are usual idiopathic)

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25
Q

Acute limb ischemia, investigation

A

DSA, CTA, DUS, and CE-MRA
- CT angiography is 1st line
- DSA is gold standard

Myoglobin and creatinine kinase to assess prognosis and treatment

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26
Q

Acute limb ischemia, Initial treatment

A

Initial medical treatment
analgesia
unfractionated heparin (UFH)
refer to specialist for further management

27
Q

Superior vena cava syndrome, management

A

*avoid biopsies due to bleeding risk

Required diagnostic tests
Chest x-ray

Management if cancer related SVC

bronchoscopy with washing
sputum cytology
limited biopsy

local radiation
antineoplastic agents
anticoagulant or fibrinolytic therapy
diuretics
steroids

28
Q

Bleeding parameter monitoring

A

aPTT - heparin
BT - platelet function
INR - warfarin

29
Q

Indications for AAA repair

A

Male with AAA >5.5 cm
Female with AAA >5.0 cm
Rapid growth >1.0 cm/year
Symptomatic AAA (abdominal/back pain/tenderness, distal embolisation)

30
Q

Supraventricular tachycardia, management

A

Unstable
- DC cardioversion

Stable
- Vagal manoeuveres
- Adenosine (avoid in asthma)
- Verapamil (avoid in <1 yr)

Maintenance (as needed)
- Propanolol
- Diltiazem

31
Q

ECG heart rate estimation

A

300/Big squares between R-R = HR

Estimate by Big square:
1 = 300
2 = 150
3 = 100
4 = 75
5 = 60

If with arrhythmia
Rs in 6 seconds x 10

32
Q

Kussmaul’s sign causes

A
  • dropped JVP during expiration and rise in inspiration (normal is reverse)

restrictive cardiomyopathy
constrictive pericarditis
cardiac tamponade

33
Q

Kussmaul’s sign causes

A
  • dropped JVP during expiration and rise in inspiration (normal is reverse)

restrictive cardiomyopathy
constrictive pericarditis
cardiac tamponade

34
Q

Acute pulmonary oedema, investigation

A

ECG
Chest x-ray
troponin/BNP
Blood test; UE, LFT, Glucose, UA, FBE, ABG
Echocardiogram

35
Q

Acute pulmonary oedema, management

A

Sitting position
Oxygen via Hudson type mask amd reservoir/CPAP/BiPAP
Glyceril trinitrate - reduce preload
Furosemide
Morphine - reduce preload

36
Q

Jelly fish sting management

A

Bluebottle and minor jellyfish
- single sting
Wash sting site with seawater and remove tentacles
Hot water immersion (45°C for 20 mins)

Major box jellyfish
- multiple stings
Apply vinegar and remove tentacles
Commence immediate cardiopulmonary resuscitation on any patient who is unconscious

  • analgesics and referral, consider antivenom
37
Q

Tetanus prophylaxis for wound management

A

TIG - Dirty wound + Uncertain vaccination history

Tetanus vaccine:
Dirty wound + >5 yrs last vaccine
Clean/minor wound + >10 yrs last vaccine
Uncertain vaccination history

DTPa - <10yrs old
dTpa - 10-18 yrs old
dT - >18 yrs old

38
Q

Cushing’s triad

A

Hypertension
Bradycardia
Irregular breathing

  • phenomenon in response to increased ICP
39
Q

Shingles management

A

Investigation
PCR (optional)

Management
Antiviral (famciclovir, aciclovir, valaciclovir)
- CNS, zoster ophthalmicus, disseminated, immunocompromised

Ongoing pain relief
- Paracetamol, Prednisone, Amitriptyline, Oxycodone

additional options for Postherpetic neuralgia
- gabapentin, pregabalin, topical capsaicin, TENS

40
Q

Acne classification

A

Mild - primarily noninflammatory
Moderate - both noninflammatory and inflammatory, a few pustules
Severe - numerous nodules and cysts

41
Q

Acne treatment, mild

A

Mild
1st line comedonal - TR
1st line papule - TR + BPO, BPO, topical AB

2nd line - salicylic acid

TR - topical retinoid
BPO - benzoyl peroxide
AB - antibiotics

42
Q

Acne treatment, Moderate

A

Moderate
1st line - BPO/ topical AB, BPO + TR

2nd line - add Hormones

BPO - benzoyl
AB - antibiotics
TR - topical retinoid

43
Q

Acne treatment, Severe

A

Severe
1st line - Oral isotretinoin
2nd line - Oral AB + TR + BPO, BPO/topical AB
Maintenance - add hormones

AB - antibiotic
TR - tropical retinoin
BPO - benzoyl peroxide

44
Q

Alopecia areata, management

A

1st line
child: topical high potency steroid
adult: intralesional corticosteroid injection

2nd line
topical immunotherapy

Severe cases:
rapid progressive, diffuse, extensive, alopecia totalis, alopecia universalis
1st line : systemic treament, topical corticosteroid, topical minoxidil, topical immunotherapy

2nd line: combine 2 or 3 topicals

45
Q

Melanoma risk factors
greatest to least

A

x10 previous melanoma
x7 multiple melanotic nevi
x6 multiple dysplastic nevi
x4 previous other skin cancer
x2 1st degree family melanoma
x2 fair complexion
x1.5 UV exposure

46
Q

First surveillance interval following removal of low risk conventional adenomas only

A

Low-risk individuals – conventional adenomas

Interval of 10 years

*low-risk conventional adenomas only (1–2 small [<10mm] tubular adenomas without high-grade dysplasia).

47
Q

First surveillance interval following removal of high risk conventional adenomas

A

Interval of 5 years:
• 1–2 tubular adenomas with HGD or tubulovillous or villous adenomas, all of which are <10mm
• 3–4 tubular adenomas without HGD, all of which are <10mm.

Interval of 3 years:
• 1–2 tubular adenomas with HGD or tubulovillous or villous adenomas (with or without HGD), some are ≥10mm
• 3–4 tubular adenomas, some are ≥10mm
• 3–4 tubulovillous and/or villous adenomas and/or HGD, all <10mm.

48
Q

First surveillance interval following removal of ≥5 conventional adenomas only

A

5–9 adenomas, intervals are
• 3 years if all tubular adenomas <10mm without high grade dysplasia (HGD)
• 1 year if any adenoma ≥10mm or with HGD and/or villosity.

≥10 adenomas, interval is 1 year

49
Q

First surveillance intervals following removal of serrated polyps (± conventional adenomas)

A

Clinically significant serrated polyps only
5 years: 1–2 sessile serrated adenomas all <10mm without dysplasia.

3 years:
• 3–4 sessile serrated adenomas, all <10mm without dysplasia • 1–2 sessile serrated adenomas ≥10mm or with dysplasia, or hyperplastic polyp ≥10mm
• 1–2 traditional serrated adenomas, any size.

1 year:
• ≥5 sessile serrated adenomas <10mm without dysplasia
• 3–4 sessile serrated adenomas, one or more ≥10mm or with dysplasia
• 3–4 traditional serrated adenomas, any size

With synchronous conventional adenomas

5 years for:
• 2 in total, sessile serrated adenoma <10mm without dysplasia.

3 years for:
• 3–9 in total, all sessile serrated adenomas <10mm without dysplasia
• 2–4 in total, any serrated polyp ≥10mm and/or dysplasia
• 2–4 in total, any traditional serrated adenoma.

1 year for:
• ≥10 in total, all sessile serrated adenomas <10mm without dysplasia
• ≥5 in total, any serrated polyp ≥10mm and/or dysplasia
• ≥5 in total, any traditional serrated adenoma. Synchronous high-risk conventional adenoma (tubulovillous or villous adenoma, with or without HGD and with or without size ≥10mm)

3 years for:
• 2 in total, sessile serrated adenoma <10mm, without dysplasia
• 2 in total, serrated polyp ≥10mm and/or dysplasia
• 2 in total, any traditional serrated adenoma.

1 year for:
• ≥3 total adenomas, sessile serrated adenoma any size with or without dysplasia
• ≥3 total adenomas, one or more traditional serrated adenoma.

50
Q

First surveillance interval following removal of large sessile or laterally spreading adenomas

A

interval should be 12 months after en-bloc excision of large sessile and laterally spreading lesions.

interval should be 6 months after piecemeal excision of large sessile and laterally spreading lesions.

51
Q

When to stop surveillance colonoscopy

A

> 75 years with charleson score of >4
80 years

52
Q

Small bowel obstruction investigations

A

Blood tests: FBC, EUC, LFTs, lipase, BSL, an ECG and a CXR. Beta-HCG in women of childbearing age, VBG for lactate.

Plain films: Initial imaging should include upright CXR and erect/supine AXR films (or lateral decubitus)

CT abdomen: provides more information than plain films. May be useful to identify the specific site (i.e. transition point) and severity of the obstruction (partial vs complete). It will also give information about the aetiology, by identifying hernias, masses or inflammatory changes, and potential complications, such as ischaemia or perforation.

53
Q

Findings that suggest small bowel obstruction include:

A

-Dilated loops of small bowel proximal to the obstruction > 3 cm
-Predominantly central dilated loops
-Three instances of dilatation > 2.5 - 3 cm
-Valvulae conniventes are visible
-Gas-fluid levels if the study is erect, especially suspicious if >2.5 cm in width and in same loop of bowel but at different heights (> 2 cm difference in height).

High-grade mechanical obstruction may also present with the following features:
-Gasless abdomen
-String-of-beads sign: small pockets of gas within a fluid-filled small bowel

54
Q

Gonorrhea high risk population

A
  1. men who have sex with men
  2. young (heterosexual) Aboriginal and Torres Strait Islander people living in remote and very remote areas
  3. travellers returning from high prevalence areas overseas
55
Q

Gonoccocal treatment

A

Uncomplicated genital and anorectal infection
- Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine
PLUS
Azithromycin 1 g PO, stat

Uncomplicated pharyngeal infection
- Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine
PLUS
Azithromycin 2 g PO, stat

Adult gonococcal conjunctivitis
- Ceftriaxone 1 g IMI, stat. in 2 mL 1% lignocaine
PLUS
Azithromycin 1 g PO, stat

Treatment advice
1. Reduced susceptibility to ceftriaxone and azithromycin is emerging in urban Australia
2. Pharyngeal mucosa makes it the most likely site of treatment failure
3. If a patient has an intrauterine device (IUD), leave it in place and treat as recommended
4. Advise no sexual contact for 7 days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later.
5. Advise no sex with partners from the last 2 months until the partners have been tested and/or treated
6. Recommend partner notification
7. Provide patient with factsheet.
8. Notify the state or territory health department.
9. Consider testing for other STI
10. Consider human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP)

56
Q

Turner Syndrome

A

Females - hearing, vision and fertility

Treatment with hormones can help

Cause - all or part of one of X chromosomes is missing

57
Q

Warfarin guidelines

A

Therapeutic level: INR 2-3

<4.5, bleeding absent (lower or omit next dose, test in 2 days)

4.5-10, bleeding absent (stop doses, test in 1 day, restart at reduced dose), (optional: observation, vit k)

> 10, bleeding absent (stop doses, give vit K, test at 12 hrs)

with minor bleeding (<10 vit k, >10 refer)

with major bleeding (stop doses, vit k, prothrombinex, FFP, continuous test until <5)

58
Q

Post stroke depression medication

A

fluoxetine - SSRI, 1st for PSD, CI bleeder
citalopram - SSRI, 2nd for PSD, selective but weaker
sertraline - SSRI, 2nd for PSD
amitriptyline - TCA, but Disturbing anticholinergic SE

59
Q

Alzheimer disease medications

A

CHOLINESTERASE INHIBITORS
- cardiac relaxant (rest and digest functions)
Donepezil
Rivastigmine
Galantamine

NMDA RECEPTOR ANTAGONIST
- neuroprotective
Memantine

60
Q

Insomnia treatment

A

CBT > 3 months insomnia

BY CHOICE
sleep onset difficulties - temazepam, zolpidem, zopiclone

waking after a few hours - nitrazepam, oxazepam

circadian disruption secondary to shift work or genetic predisposition - melatonin

DRUG CLASS
Benzodiazepines (long half life)- temazepam, nitrazepam, oxazepam and flunitrazepam
- effective in reducing sleep onset latency and increasing sleep duration, exert an anxiolytic effect

Non-benzodiazepines (short half life) - zolpidem and zopiclone

Dual orexin receptor antagonists - Suvorexant

2ND LINE
Antidepressants - insomnia patients with comorbid depression
- amitriptyline, doxepin, nortriptyline, mirtazapine and agomelatine

61
Q

Bipolar disorder treatment

A

ACUTE
1st trimester: Antipsychotic - risperidone, olanzapine and haloperidol
Lithium
2nd and 3rd trimester: Mood stabilizer - lithium, valproate
Breast feeding (no psychosis) - valproate

MAINTENANCE
Lithium
Optional antipsychotic - quetiapine and olanzapine

62
Q

Alcohol withdrawal syndrome

A

1st line - diazepam
Senior, Liver disease - lorazepam, oxazepam
2nd line for psychotic featured - haloperidol,droperidol

63
Q

Atrial fibrillation treatment

A

Unstable - cardioversion
Stable <2 days - treat underlying condition
Stable >2 days - anticoag + rate control/cardiovert later

anti coag - warfarin, heparin
rate control - CCB (vera or diltia), BB (olol), Digoxin, Antiarryth (darone)

64
Q

Medication for overdoses

A

Hypnotics - supportive
Acetaminophen - NAC
Salicylates - CHO, K
Opioids - Naloxone
Sympathomimetics - Benzo
Antimuscarinic - Benzo (physostigmine)
Cholinergic - Atropine, Pralidox

AMC notes (6 decks)

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