01. Course Introduction Flashcards
What issues would you address when there is a suspected case of rape?
- Enquire about any other injuries sustained during the encounter e.g. strangulation
- Discuss the option of attending a sexual assault health service for a forensic examination
- Discuss option of reporting to the police/making a signed statement
- Discuss emergency contraception options
- Discuss possibility of sexually transmitted infection and the need for further investigations
- Assess if she has psychosocial supports - family/friends
- Consider referral to sexual assault support service/1800 RESPECT
- Assess mental health risk - pre-existing mental health issues/suicide risk and discuss the likelihood of an acute stress reaction
- Explain that in certain situations, Post-Exposure Prophylaxis can be considered for some STIs
What timeframes are there to collect trace evidence in suspected sexual assault? (In general, need forensic examination within 7 days)
- Licking: 12 hours
- Indecent touching (including digital vaginal or anal penetration): 12 hours
- Penile penetration of the mouth: 24 hours
- Penile penetration of the anus: 48 hours
- Penile penetration of the vagina: up to 5 days
What are 3 options for emergency contraception and their time-frames to be used?
- Copper IUD, 120 hours/5 days
- Levonorgestrel emergency contraceptive pill, 72-96 hours/3-4 days
- Ulipristal acetate emergency contraceptive pill, 120 hours/5 days
What contraindications are there for use of ulipristal as oral emergency contraception?
- Severe oral steroid-dependent asthma
- Severe liver impairment
True/false: administration of a progesterone-containing method of contraception within 5 days of ulipristal acetate should be avoided
true
How long is post-exposure HIV prophylaxis administered for, if required?
30 days of antiretroviral medication
What is the timeframe for administration of Hepatitis B immunoglobulin if an assailant is known to be HBV Ag positive?
Up to 14 days post assault
When should a patient of suspected sexual assault return for STI screening follow up tests?
Ideally, follow up tests for
- bacterial STIs (chlamydia and gonorrhoea) should be performed at 14 days post-exposure, or whenever the patient presents after 14 days;
- syphilis and blood-borne viruses, testing should be performed at three months post-exposure
What investigations are relevant for a female victim of penetrative (vaginal) rape two weeks later?
- HIV serology (3 months)
- Hepatitis B serology (3 months)
- Syphilis serology (3 months)
- Chlamydia PCR endocervical swab
- Gonorrhoea PCR endocervical swab
- Trichomonas high vaginal swab
- Urine pregnancy test
What medications do you consider starting for a patient with stable angina?
- Long-acting nitrate: patch or oral (allow for nitrate free period as tolerance to all forms of nitrate therapy develops rapidly)
- Beta blocker (prevent angina)
- Nondihydropyridine calcium channel blockers (BUT NOT to be used in combination with beta blockers at the rest of bradycardias)
- Dihydropyridine calcium channel blocker
- Nicorandil (potassium channel activator for arterial dilation) - for refractory angina
When is angina considered stable?
If the pattern of symptoms or triggers has not changed during the past month
What are some non-pharmacological management strategies for a 70 year old with ischaemic heart disease and stable angina with suspected depression?
- Cognitive behavioural therapy (GP, clinical psychologist)
- Referral to aged care services, Aged Care Assessment Team assessment (ACAT), My Aged Care services for home support packages
- Referral to cardiac rehabilitation programs
- Exericse (encourage moderate intensity exercise 30 min daily, referral to exercise physiologist for exercise program)
- Encouraged increased social contact (e.g. Men’s Shed, 3UA’, volunteer work, online resources)
- Meals on wheels
What are some causes of delirium in a 91F in a nursing home post gastroscopy and colonoscopy with a background of hypertension, sciatic pain and cognitive impairment on perindopril and buprenorphine patch?
- Post anaesthetic recovery
- Electrolyte disturbance; e.g. hyponatraemia
- Anaemia from PR bleeding
- Intercurrent infection e.g. UTI
- Medication error; e.g. opioid overdose
- Intracranial pathology; e.g. cerebrovascular accident
- Bowel perforation from her procedure
- Hypoglycaemia
- Acute kidney injury/uraemia
- Hypovolaemic shock/hypotension
What are three management options in a 91F with new confusion and a significant Hb drop after return to nursing home from an endoscopy.
- Return to hospital for blood transfusion
- Manage in nursing home with increasing fluid and monitoring
- Comfort care only
What measures can you take to make a decision in this situation: 91F with new confusion and a significant Hb drop after return to nursing home from an endoscopy?
- Discuss the situation with her family
- Refer to the advanced care directive
- Discuss with the treating team at the hospital
