artha deck1 Flashcards
1
Q
Pharm for reducing ETOH effects
A
Naltrexone or Disulfiram (makes you feel worse/crap with ETOH)
2
Q
Pharm to reduce ETOH cravings
A
Acamprosate
3
Q
Post viral URTI with vertigo, hearing loss and tinnitus
A
Labyrinthitis
4
Q
Post viral URTI with vertigo, NO hearing loss and tinnitus
A
vestibular neuronitis
5
Q
Investigation for accoustic neuroma
A
MRI with gadolinium contrast
6
Q
“What bld test to test annually in Down’s?”
A
TSH
7
Q
How long to avoid sexual intercourse post AMI?
A
8 weeks
8
Q
COCP medication components
A
ethinyloestradiol 30mcg levonorgesterol 150mcg
9
Q
Mirena IUD medication component
A
Levonorgesterol 52mg
10
Q
“3 Cx’s of haemachromatosis (systems)”
A
- CLD - Heart failure (restrictive) - Arthritis (hands)
11
Q
Gonorrhoea pharm Mx
A
500mg ceftriaxone IM + 1g azithromycin PO stat
12
Q
Gonorrhoea contact tracing
A
2 months
13
Q
Chlamydia test of re-infection
A
3 months
14
Q
Chlamydia test of cure
A
4 weeks - pregnant or rectal chlamydia
15
Q
Chlamydia pharm Rx
A
100mg doxycycline bd 7 days 1g azithromycin stat (pregnant)
16
Q
Chlamydia contact tracing
A
6 months
17
Q
Which anti-HTN can inc risk of T2DM
A
Thiazides
18
Q
Which anti HTN causes HIGH calcium
A
Thiazides
19
Q
Which anti HTN causes LOW calcium
A
Loop diuretics (Frusemide)
20
Q
ICS example name and dose
A
Fluticasone proprionate 50mcg - child 125mcg - adult
21
Q
SABA name and dose
A
salbutamol 100mcg
22
Q
ICS/LABA name + dose
A
fluticasone proprionate 50 - 250mcg salmeterol 25mcg
23
Q
LAMA name + dose
A
tiotropium 5mcg (respimat) daily
24
Q
Metformin eGFR contraindication
A
<30
25
SGLT2 eGFR contraindication
<45
26
DPP4 eGFR contraindication
NONE, just dose adjustment (except linagliptin - no change)
27
Sulphonylureas eGFR contraindication
<30
28
Metformin eGFR reduce dose to 1g?
30-60
29
GLP1 agonist dose
dulaglutide 1.5mg weekly
30
Sulphonylurea + dose
Gliclazide 40mg daily
31
DPP4-i dose
Linagliptin 5mg
32
SGLT2 and dose
Empagliflozin 10mg daily
33
Shockable rhythms
V Fib, V tach
34
Shockable rhythms pharmacology
Adrenaline 1mg after 2nd shock Amiodarone 300mg after 3rd shock
35
Non-Shockable rhythms pharmacology
Adrenaline 1mg now, and then every 2nd cycle
36
"4 H's of collapse"
Hypoxia Hypovolaemia Hyper/hypokalaemia/metabolic disorders Hypothermia
37
"4 T's of collapse"
Toxins Tension pneumothorax Thrombosis Tamponade
38
AMI - GTN dose
300-600mcg sublingual every 5minsAlways check BP and avoid in inferior AMI
39
Indications for warfarin for AF Mx
eGFR <30 Valvular AF (mitral stenosis or mechanical valve)
40
NOAC dose for AF
Apixaban 5mg bd 2.5mg if At least 2 of: - 80+ years old - Weight under 60kg - Creatine over 133
41
Contraindications to NOAC and warfarin (3)
- Previous intracranial bleed - Recent GI bleed - Pregnancy
42
Heart rate aim in AF
<80
43
Beta blocker dose in AF
Atenolol 25mg daily
44
Post AMI driving abstinence duration
2 weeks (private licence)
45
Post TIA driving abstinence duration
2 weeks (private licence)
46
Post CABG driving abstinence duration
4 weeks (private)
47
Post stroke driving abstinence duration
4 weeks (private)
48
2nd degree Type I ECG
Gradually elongating PR until drop (Wenkebach)
49
2nd degree Type II ECG
PR interval is normal Sudden drop in QRSUrgent cardio referral
50
CCF - Moderate on exertion (Class)?
Clas III
51
CCF - Mild on exertion (Class)?
Class II
52
CCF - Symptoms at rest (Class)?
Class IV
53
CCF - No symptoms (Class)?
Class I
54
BNP level for CCF
BNP >1800
55
LVEF <35% medication
Ivabradine
56
LVEF <40% medication
ANRI - Entresto
57
Heart Failure Medications + Dose (3)
1. Perindopril 2.5mg daily 2. Spironolactone 25mg daily 3. Bisoprolol 1.25mg daily (2nd line if euvolaemic)
58
HOCM ECG criteria
Deep R waves anterior leads Tall Q waves lateral leads
59
Diabetic retinopathy medication and dose
Fenofibrate 145mg daily
60
Tamponade triad
"Beck's"- Low BP- Muffled heart sounds, Jugular venous distension
61
Pericarditis meds + dose
Colchicine 500mcg (bd if >70kg, daily if <70kg) for 3 months
62
Acute Rheumatic Fever meds + dose
Benzathine benzylpenicillin IM as a single dose 1.2 million units (adults)
63
Groin Rash DDx (4)
Candida Intertrigo Tinea Cruris Flexural Psoriasis Erythrasma
64
PMHX Melanoma skin checks frequency
- 3 monthly for 2 years - 6 monthly for 2 years- 12 monthly for lifetime
65
Cat Scratch Disease Rx
Azithromycin 500mg 1st day, 250mg daily for next 4 days
66
Chickenpox Rx - adults
Adults - Valaciclovir 1g tds 7 days
67
Chilblains Rx
Keep warm DO NOT RUB/MASSAGE If extensive or painful:- Strong topical steroid +/- occlusive dressing (betamethasone dipropionate 0.05% ointment bd)OR Severe/recurrent:- GTN spray- Nifedipine MR 20mg daily
68
Which infection is linked with Erythema Multiforme?
Herpes Simplex Virus
69
Commonest KNOWN cause of Erythema Nodusum
Sarcoidosis
70
4 causes of LVH
- HOCM - HTN - Atrial regurg - Mitral regurg - Coarctation aorta
71
Actinic/Solar Keratosis Mx
Spot area = Cryotherapy or Shave + curettageLarge area = Imiquimod 5% 3xweekly for 4 weeks or Fluorouracil 5% daily for 3-4 weeks
72
Keratocanthoma Rx
3-5 excisional biopsy
73
SCC Ix
Punch biopsy
74
BCC Ix
Punch biopsy
75
SCC Rx
Superficial = Cryotherapy, shave+curettage, Imiquimod 5% 5xweekly for 6 weeksFluorouracil 5% daily for 3-4 weeks3D = surgical excision 3-5mm
76
Melanoma Ix
Excisional biopsy 2mm
77
Melanoma Rx
WLE + melanoma unit referral
78
BCC Rx
Superficial = Cryotherapy - double freeze thaw, shave+curettage, Imiquimod 5% 5xweekly for 6 weeksFluorouracil 5% daily for 3-4 weeks3D = surgical excision 3-5mm
79
BCC typical spread
Locally
80
SCC typical spread
Lymphatics
81
Causes of acne flares (4)
- PCOS- Humidity- Occlusive cosmetics- Drugs - steroids
82
What features to examine when assessing for a burn? (4)
ColourBlistersSensationCap Refill
83
Deep dermal burn signs?
PainlessNon-blanchingWhite/mottled skinProlonged cap refill
84
Satellite lesions in skin folds
Candida Intertrigo
85
Candida intertrigo Rx
Clotrimazole 1% cream daily
86
Erysipelas pathogen
strep pyogenes
87
Chondrodermatitis nodularis Rx
Nitroglycerin ointment bd (1–2% glyceryl trinitrate)
88
1st line pharm to increase breastmilk supply
Domperidone
89
Compression mmHg to bandage ulcers
40mmHg
90
Secondary causes of hyperlipidemia (4)
CKDHypothyroidismT2DMCLD
91
4 contraindications to stress echo
Unstable anginaSevere aortic stenosisNew LBBBUncontrolled arrhythmia
92
Lateral STEMI leads + supply
I, AVL, V5, V6Left Circumflex artery
93
Inferior STEMI leads + supply
II, III, AVFRight Coronary Artery
94
Anterior STEMI leads + supply
V3-V4Left Anterior Descending
95
Septal STEMI leads + supply
V1-V2Left Anterior Descending
96
Posterior STEMI leads + supply
V7-V9Right Coronary Artery
97
Contraindications to performing Valsalva's for SVT (4)
AMIHaemodynamic instabilityAortic stenosisGlaucoma
98
Takotsubo Cardiomyopathy Rx
ACEi or beta blockers until resolved systolic dysfunction ~ 1 month
99
Dandruff 1st line Rx
Selenium sulphide shampoo
100
Discoid Eczema Rx
Strong steroid (betamethasone diproprionate 0.05% daily for 2 weeks)
101
What disease is dermatitis herpetiformis linked with?
Coeliac disease
102
Dermatofibroma distinctive features (2)
Pale centrePinch sign (central dimple)
103
Rash with target lesions
Erythema Multiforme
104
Treatment of Erythema Multiforme
Treat Cause, but otherwise self resolves- Aciclovir for HSV- ABx for mycoplasma pneumoniae
105
ASTI smoking screening age
12
106
ATSI fasting lipids, CVD check age
35
107
ATSI BP, UEC check age
18
108
Coral pink fluorescence under wood lamp
Erythrasma
109
Erythrasma Rx
Fusidate sodium 2% ointment bd for 14 days
110
Red swollen fingers+toes, linked with T2DM
Erythromelalgia
111
Itch/pain/burning rash in sun-exposed skin
Exercise-induced vasculitis or Golfer's vasculitis
112
Exercise-induced vasculitis or Golfer's vasculitis Rx
Self-resolving in 3-4 weeks
113
Folliculitis causative pathogens
Bacterial - Staph aureus, Pseudomonas aeruginosaFungi
114
Folliculitis Rx
Treat according to swab MCS- commonly - flucloxacillin or cephalexin 500mg QID
115
Rash with firm papules "string of pearls" ring
Granuloma Annulare
116
Granuloma Annulare associated conditions (3)
T2DMHyperlipidemiaAutoimmune Thyroiditis (children)
117
Granuloma Annulare Rx
Strong steroid (betamethasone diproprionate 0.05% daily for 2 weeks)
118
Grover's Disease Rx
Strong steroid (betamethasone diproprionate 0.05% daily for 2 weeks)
119
Spotty itchy rash in children (trunk) sparing hands/feet?
Guttate psoriasis- linked with strep infection
120
Telogen Effluvium triad
- Stressful event- 2-3 months to diffuse hair loss- white bulbs(Pull test = hair coming out)
121
Hair loss with chemo/radiotherapy
Anagen Effluvium
122
Exclamation mark hairs
Alopecia Areata
123
Androgenetic Alopecia Rx
- Minoxidil to dry scalp - for 12+ months (not for females)- Finasteride for 2+ years - halts balding process (SE gynaecomastia)
124
What virus is associated with Hand, Foot & Mouth Disease?
Coxsackie virus
125
Management of Hand Foot & Mouth (2)
- Supportive, fluids (can become dehydrated)- Keep home until blistered have dried/crusted
126
Herpes Simplex Virus Type I management?
First sensation - Aciclovir 5% cream 5 times daily for 5 daysSevere - Aciclovir 400mg tds for 5 days
127
Post-herpetic Neuralgia Rx (3)
1. Simple analgesia/Ice massage2. Lidocaine 5% patch, 3. Amitriptyline 10–25 mg nocteGabapentin 300 mg nocte
128
Shingles Rx
Valaciclovir 1g tds for 7 days
129
Impetigo NON-PHARM Rx
- Keep away until 24hrs after starting Abx- Cover wounds
130
Impetigo Rx (non-endemic) + multiple sores
- Flucloxacillin 12.5 mg/kg up to 500mg QID 7 days. - Keep away until 24hrs after starting Abx
131
Impetigo Rx (Endemic)
- Benzathine benzylpenicillin IM 1.2 million units- Keep away until 24hrs after starting Abx
132
Impetigo Rx (non-endemic) + localised sores (3)
- Mupirocin 2% ointment tds for 5 days
133
Impetigo Rx (penicillin allergy)
- Trimethoprim + sulfamethoxazole, bd for 3 days - child 4/20mg/kg up to 160/800mg
134
Bullous Impetigo pathogen
Staph aureus (infectious!)
135
Bullous Impetigo Rx
- Flucloxacillin 500mg QID for 7 days- Do not share towels with other family members
136
Keratosis Pilaris Rx
- Topical retinoids, salicyclic acid
137
Lichen Planus Rx
- Symptomatic - potent steroid (beta. dip 0.05%)- Otherwise resolves in a few months
138
Molluscum Contagiosum causative pathogen
Pox virus
139
Nappy rash Rx
Dependent on causehydrocortisone 1% + nystatin 100 000 units BD or clotrimazole
140
Molluscum Contagiosum Rx
Self Resolves
141
Nappy rash causes (3)
Irritant dermatitisCandidaSeborrheic dermatitisPsoriasis
142
Nappy rash Rx
Dependent on causehydrocortisone 1% + nystatin 100 000 units BD
143
Lump with buttonhold invagination when pressed?
Neurofibroma
144
Perioral dermatitis Rx
Doxycycline 100mg daily for 8 weeks
145
Tiny black pits in soles of feet (Pitted Keratolysis) Rx?
Clindamycin 1% bd for 10 days
146
Pityriasis Rosacea Rx?
- Self-limiting - 6-8 weeks- Use corticosteroid cream for itch
147
Pityriasis Versicolor Rx (2)
selenium sulfide shampoo 2.5% for 10 days OR antifungal creamsApply to wet skin and leave on for 10 minsIf ineffective, flucanozole 400mg oral stat
148
Pyogenic Granuloma Rx (1)
Imiquimod 5% 5xweekly for 6 weeks vs excision
149
Rosacea Non-pharm Rx (4)
Cleanser + moisturising routineSPF 30+Trigger avoidanceAvoid perfumes/colognes
150
Rosacea Pharm Rx (3)
1. Topical metronidazole2. Azelaic acid3. Doxy 100mg daily 8 weeks
151
Scabies Rx
Permethrin 5% cream from jawline downwards overnightRepeat in 1 week
152
Scarlet fever causative pathogen
Strep Pyogenes
153
Lace-like/sandpaper rash
Scarlet Fever
154
Scarlet Fever Rx
Phenoxymethylpenicillin 500mg bd for 10 days
155
Seborrhoeic Dermatitis (infants) Rx
Salicylic acid 2% + LPC (liquor picis carbonis = coal tar solution) 2% + sulfur 2%
156
Which tinea locations need oral terbinafine?What dose?
Scalp, nails or widespread250mg oral terbinafine dailyToenails = 12 weeksFingernails = 6 weeks
157
Which tinea locations need topical terbinafine?
Everywhere except scalp/nails1% terbinafine cream bd 2 weeks
158
Venous Ulcer appearance
Ragged edge, slight pain, slough
159
Arterial Ulcer Appearance
Punched out, Pain +++, Cold. Relieved by hanging out of bed
160
Lump with buttonhold invagination when pressed?
Neurofibroma
161
Diabetic/Pressure Ulcer Mx (3)
Clean base with salineRelief of frictionIodosorb ointment/Foam dressing
162
Pityriasis Rosacea Rx?
- Self-limiting - 6-8 weeks- Use corticosteroid cream for itch
163
Pityriasis Versicolor Rx
selenium sulfide 2.5% for 10 days Apply to wet skin and leave on for 10 mins
164
Rosacea Non-pharm Rx (4)
Cleanser + moisturising routineSPF 30+Trigger avoidanceAvoid perfumes/colognes
165
Rosacea Pharm Rx
1. Topical metronidazole2. Doxy 100mg daily 8 weeks
166
T2DM assessment for low risk asymptomatic patients.
- AUSDRISK >40yo
167
Scarlet fever causative pathogen
Strep Pyogenes
168
Lace-like scarlet rash
Scarlet Fever
169
Scarlet Fever Rx
Phenoxymethylpenicillin 500mg bd for 10 days
170
Seborrhoeic Dermatitis (infants) Rx
Salicylic acid 2% + LPC (liquor picis carbonis = coal tar solution) 2% + sulfur 2%
171
Which tinea locations need oral terbinafine?What dose?
Scalp, nails or widespread250mg oral terbinafine dailyToenails = 12 weeksFingernails = 6 weeks
172
Requirements for HbA1c to diagnose T2DM
> 6.5% on TWO occasions
173
Causes of low HbA1c
AnaemiaHaemoglobinopathiesCKD
174
Requirements for OGTT to diagnose T2DM
(EITHER)Fasting >72 hours >11
175
Neuropathic Ulcer Location
Plantar surface (pressure areas), well demarcated
176
What to examine for with foot ulcers (3)
- Sensation with 10gm monofilament - Ankle Brachial Index Measurement- Dorsalis Pedis/Posterior Tibialis pulse
177
T2DM Driving license with insulin
2 yearly license review +/- conditional
178
Arterial Ulcer Mx
Urgent vascular surgeon review for reperfusion
179
Diabetic/Pressure Ulcer Mx (3)
Clean base with salineRelief of frictionIodosorb ointment/Foam dressing
180
Urticaria Rx
Loratadine 10mg daily
181
Who needs annual screening for T2DM? (FBGL) (2)
PrediabetesATSI
182
T2DM assessment for low risk asymptomatic patients.
- AUSDRISK >40yo
183
FBGL intermediate range
5.5-6.9Mx = perform HbA1c or OGTT
184
HbA1c intermediate range
6.0-6.4% Mx = retest in one year
185
OGTT results for Impaired glucose tolerance
Fasting: <7 mmol/L2 hour : 7.8 - 11 mmol/L
186
OGTT results for Impaired fasting glycaemia
Fasting glucose: 6.1-6.92 hour glucose < 7.8
187
Addison's Ix
Short Synacthen test ○ Gives synthetic ACTH, should normally increase cortisol ○ In Addison's (underfunctioning adrenal), there is no increased cortisol - positive test
188
Requirements for HbA1c to diagnose T2DM
> 6.5% on TWO occasions
189
Causes of low HbA1c
AnaemiaHaemoglobinopathiesCKD
190
Requirements for OGTT to diagnose T2DM
(EITHER)Fasting >72 hours >11
191
OGTT results to Dx GDM
Fasting glucose >5.5 (reduce by 1.5)Two hour glucose >8.0 (reduce by 3.0)
192
T2DM Driving license with OHA's
5 yearly license review +/- conditional
193
T2DM Driving license with insulin
2 yearly license review +/- conditional
194
Which diabetic patients need conditional licenses (4)
- Severe hypoglycaemia- Acute hyperglycaemia- End-organ damage- Commercial drivers on OHA's/insulin - specialist review
195
Pre-exercise BGL range for T2DM
5 - 13.9
196
How often to check BGL if on insulin or sulfonylureas
30-45 minutes
197
How long after exercise can you get hypoglycaemia with SU's/insulin?
48 hours
198
Fasting BGL aim in T2DM
4-7
199
2 hour post-prandial BGL aim in T2DM
5-10
200
Severe hypoglycaemia event, driving restriction
6 weeks until stabilised by specialist
201
Late Onset Autoimmune Diabetes Ix (4)
- glutamic acid decarboxylase (GAD) antibodies- insulinoma antigen-2 (IA2) antibodies- islet cell antibodies- Insulin antibodies
202
How often to get eye Ax with T2DM?
24 monthly12 monthly if - ATSI, systemic disease, >15 years Dx, poor control
203
What T2DM meds to cease on sick days or if BGL >15 on two occasions
Metformin, SLGT2 (dehydration risk)
204
Acromegaly Ix
IGF-1 - insulin-like growth factor
205
Carcinoid Syndrome Ix
24 hr urine 5-hydroxyindoleacetic acid
206
Conn's syndrome Ix
Plasma aldosterone-renin ratio
207
Cushing's Syndrome Ix (3)
- Overnight 1mg dexamethasone suppression test- 2 measurements of late night salivary cortisol - 2 measurements of 24 hour urinary - free cortisol excretion
208
Diabetes Insipidus triad
Weakness + Massive Polyuria + Polydipsia
209
Diabetes Insipidus Rx
desmopressin intranasally bd
210
DKA BGL and ketones diagnosis
BGL>11mmol/L and ketones > 0.6mmol/L
211
Hyperosmolar Hyperglycaemic State BGL and ketones diagnosis
BGL >30mmol/L and ketones anything
212
Mild hypoglycaemia Mx (BGL <4.0)
15 rule- 15g of sugar (half fruit juice glass)- Recheck in 15 mins- Test every hour for next 4 hours
213
Severe hypoglycaemia Mx (reduced GCS)
Glucagon 1g IM statORDextrose 50% 20mL
214
Severe hypoglycaemia event, driving restriction
6 weeks until stabilised by specialist
215
When to assess risk for OP
- Annually in post-menopausal women or men >50yo
216
T1DM Ix (2)
- Glutamic acid decarboxylase (GAD)- Insulinoma antigen-2 (IA-2) antibodies
217
Osteopenia Dx
-1 to -2.5 T score
218
Osteoporosis Dx
Less than -2.5 T score
219
What Z score to be concerned for secondary causes
Less than -2.0 score
220
After starting carbimazole, when to recheck TFT's and adjust dose?
4-6 weeks
221
Bisphosphonate dose
Alendronate 70mg oral weekly
222
Denosumab dose
60mg subcut 6 monthly
223
When to stop osteoporosis Rx?
5-10 years of Rx without any fractures and BMD >-2.5
224
Osteoporosis new medication. When to review?
6 months
225
Osteoporosis pt monitoring. When to review?
12 months
226
Osteoporosis pt monitoring. When to DEXA?
2 yearly
227
Non-osteoporotic, high-risk pt. When to review?
2-5 years (including DEXA)
228
Which medication to use in CKD + osteoporosis
Denosumab
229
Phaeochromocytoma Ix
24 hour urine metanephrines/catecholamines test
230
SIADH Ix (3)
- Urine osmolality >100- High urinary sodium- Low blood sodium (dilution)
231
SIADH Mx (1)
Fluid restriction <800mL/day
232
T1DM Ix (2)
- Glutamic acid decarboxylase (GAD)- Insulinoma antigen-2 (IA-2) antibodies
233
Imaging of choice for goitre with Hyperthyroidism (uptake)
Thyroid Scintigraphy scan
234
Imaging for goitre with Hypothyroidism
Trial levothyroxine and check if nodule regresses firstIf not, consider ultrasound
235
Drugs that can cause hypothyroidism (2)
Lithium, amiodarone (also hyper)
236
Graves Ix
Anti TSH Receptor Antibodies
237
Hashimoto's thyroiditis Ix
anti-TPO (anti-thyroid peroxidase antibodies)(also elevated in thyroiditis)
238
Hyperthyroidism Rx
Carbimazole 10-15mg bd
239
After starting carbimazole, when to recheck TFT's and adjust dose?
4-6 weeks
240
When to use PTU instead of carbimazole?
Pregnancy, Thyroid storm, PreconceptionMultiply CBZ dose by 10 to get PTU dose
241
Most important SE of carbimazole/PTU?
AgranulocytosisCease if febrile or pharyngitis
242
Subclinical asymptomatic hypothyroidism Mx
Repeat TFT's in 6 weeks. Commence thyroxine if:1. TSH >10 OR2. Thyroid peroxidase antibody
243
When to consider partial hypothyroid replacement?25-50mcg daily
- Elderly- High CVD risk- Subclinical (where TSH >10 on retesting)
244
Hypothyroidism Rx dose
levothyroxine 1.6mcg/kg daily (to nearest 25mcg, (50-100mcg
245
Thyroiditis Rx
- propranolol 10mg bd if symptomatic- Repeat TFT's in 6 weeks- If painful - NSAID's too
246
Allergic Rhinitis Examination signs (3)
- turbinate hypertrophy- pale blue nasal mucousa- Suborbital oedema
247
Oral thrush Rx
Under 2yo = 100 000 units nystatin 1mL QID for 1 weekOver 2yo = Micanozole 2% gel, 2.5mL QID 1 week
248
Imaging of choice for cholesteatoma
CT temporal bone
249
Examination findings of Infectious Mononucleosis (3)
- Splenomegaly- Hepatomegaly- Jaundice- Rash
250
Meniere's Disease Triad
Vertigo, tinnitus, hearing loss - Unilateral
251
Meniere's Disease Mx (3)
- Limit salt <2g/day, ETOH, caffeine, - Vestibular rehab- Prochlorperazine 10mg daily- Hydrochlorothiazide 25mg daily
252
What age to refer Nasolacrimal duct obstruction to ED?
<1 month of age
253
Otitis Media risk factors (3)
- Smoking exposure- Childcare- Down's syndrome- Adenoid disease
254
Otitis Media ABx
Amoxicillin 15mg/kg tds for 5 daysReview in 48 hours
255
Otitis Media ABx if not improving with amoxi
If not improving in 48 hours,Augmentin DF 875/125 bd for 5 days
256
Otitis Media ABx if allergic to penicillin
Cefuroxime 500mg bd for 5 days
257
Recurrent AOM criteria and Rx
3+ episodes in 6 monthsamoxicillin 25mg/kg bd for 6 months
258
Glue ear (AOM with effusion) Mx?
- Tend to self drain in 4 weeks- Refer if >3 months, or if causing hearing issues
259
Chronic Suppurative Otitis Media Dx criteria
>6 weeks of perforated TM with discharge
260
Chronic Suppurative Otitis Media Mx (3)
- Ear toileting (rolled tissue spear QID until ear dry)- Ciprofloxacin 0.3% ear drops (x5) bd until discharge free for 3 days- Refer to audiology for hearing assessment- ENT referral
261
Grommets +/- adenoidectomy indications (2)
- Chronic otitis media (>3 months) with effusion and hearing loss- Recurrent otitis media with effusion
262
Otitis Externa Mx (3)
- Sofradex ear drops - 3 drops tds for 7 days- Paracetamol 15mg/kg QID PRN- Dry aural toileting QID PRN until canal is dry
263
Otitis Externa prevention (2)
- Aqua-Ear after water exposure- Keep ear-dry, use earplugs or bathing cap during showering/swimming
264
Otosclerosis - what bone does it affect?
Stapes
265
Otosclerosis Mx (1)
- Referral to ENT for stapedectomy
266
Perforated TM broad causes (3)
Infection, trauma, growths
267
Safe perforated TM Mx (3)
- Dry toileting with tissue spear- Self-resolving in 4 weeks- Amoxicillin 500mg tds for 5 days if infected
268
Antibiotic indications for rhinosinusitis (3)
- Discoloured purulent discharge- 38oC- Severe localised pain
269
Sialoliths Mx (2)
- Conservative with massage and analgesia, warm liquids- Infected = 7 days Flucloxacillin 500mg QID
270
Tonsillectomy Indications
Tonsillectomy Indications (6-4-2, 1-2-3 rule)- 6+ episodes/year for more than 1 year- 4+ episodes/year for more than 2 years- 2+ episodes/year for more than 3 years
271
When to treat tonsillitis with ABx?
- Bacterial likely- Immunosuppressed- Previous complications- ATSI
272
Bacterial tonsillitis Rx
Phenoxymethylpenicillin 500mg bd for 10 daysPenicillin allergy - azithromycin 500mg daily for 5 days
273
Vestibular Neuronitis Rx (1)
- Prednisolone 1mg/kg (up to 75mg) for 5 days
274
Anal fissure Mx? (4)
- Topical lignocaine- Treat constipation - stool softeners, high fibre diet- Sitz bath- Topical GTN/diltiazem- Local injection of botox
275
Bowel cancer 4 flag criteria for moderate risk
First degree relative <55yo (4)First degree relative >55yo (2)Second degree relative any age (1)
276
If moderate risk bowel cancer, screening?
FOBT every 2 years from 40-49Colonoscopy every 5 years from 50-74Aspirin 2.5 years from 50-74yo
277
If high risk bowel cancer, screening?
(Reduce age points by 5 years compared to mod risk)Refer to family cancer clinicFOBT every 2 years from 35yoColonoscopy every 5 years from 45-74yo
278
Medication for liver cirrhosis from portal HTN
carvedilol
279
Risk factors for coeliac disease (3)
HypothyroidismT1DM DiabetesAutoimmune thyroid diseaseDown's syndrome
280
Diverticulitis non-severe attack Mx (3)
- Clear liquids for 2-3 days- Amoxicillin + clavulanic acid 875/125mg bd for 5 days- Penicillin allergy = Trimethoprim + sulfamethoxazole 960mg bd AND metronidazole 600mg bd 5 days
281
Gastro in nursing home. When to notify public health unit
- 2+ more residents
282
ABx indications for gastro (3)
- Septic- Immunocompromised- Salmonella or severe C.Diff (all other bacterial causes don't require Abx)
283
When do you avoid loperamide for gastro? (3)
○ Children○ Bloody diarrhoea○ High fever- Systemic symptoms
284
Lifestyle Mx for GORD (4)
- Avoid spicy food- Remain upright after eating- Weight loss- Stop smoking
285
Urea Breath Test preparation advice (3)
- No Abx for 4/52 - No PPI for 2/52 before test- Nil water in morning- Nil brushing teeth
286
H. Pylori Rx (3)
HP7 treatment. ACE - all given BD- Amoxicillin 1g (metronidazole 400mg bd if hypersensitive)- Clarithromycin 500mg - Esomeprazole 20mg
287
When to repeat UBT post H.Pylori Rx
4 weeks
288
Haemochromatosis Ix
Elevated transferrin + ferritin
289
Typical arthritis region for haemochromatosis
MCPJ 2nd/3rd joint
290
Hep A Mx
- Self limiting - 6 weeks- Avoid fats, ETOH, panadol and smoking- Wash hands, do not share cutlery
291
surface antigensurface antibodycore antibodyAcute Hep B
POSITIVE surface antigenNEGATIVE surface antibodyPOSITIVE core antibody
292
surface antigensurface antibodycore antibodyChronic Hep B
POSITIVE surface antigenNEGATIVE surface antibodyPOSITIVE core antibody
293
surface antigensurface antibodycore antibodyVaccinated Hep B
NEGATIVE surface antigenPOSITIVE surface antibodyNEGATIVE core antibody
294
surface antigensurface antibodycore antibodyResolved Hep B
NEGATIVE surface antigenPOSITIVE surface antibodyPOSITIVE core antibody
295
When does Hep C Mx need referring to specialist? (2)
- If HIV/HBV co-infection- Cirrhosis present
296
When does Hep C Mx need referring to specialist? (2)
- If HIV/HBV co-infection- Cirrhosis present
297
Assessment of cure for Hep C
- Hepatitis C RNA PCR and LFT's at 12 weeks post treatment
298
IBD - pain before defecation?
Crohn's
299
IBD commonly blood and mucous stools
Crohn's
300
IBS Mx (4)
- Regular meal times- Avoid triggers- Low FODMAP diet- Referral to dietitian- Referral to psych for CBT
301
NAFLD Ix diagnosis
- AST and ALT >2x ULN- AST/ALT < 1 - Needs USS/MRI/Imaging
302
NASH monitoring
6 monthly liver US +/- AFP
303
NAFLD Mx
Cirrhosis/NAFLD fibrosis score high = gastro referral, fibroscan +/- biopsyNAFLD fibrosis score Low = manage risk factors
304
NAFLD Monitoring
6 monthly LFT's
305
NASH monitoring
6 monthly liver US +/- AFP
306
Acute Pancreatitis Ix (Dx)
Lipase >3 UNL
307
Acute Pancreatitis Mx
- ED Mx for IV hydration due to high mortality
308
PBC or PSCMales commonly
PSC
309
PBC or PSCLinked with Ulcerative colitis
PSC
310
PBC or PSCFemale
PBC
311
PBC and PSC symptoms (4)
- Abdo pain- Fever- Fatigue- Pruritis- Jaundice
312
PBC or PSCColorectal cancer risk
PSC
313
PBC or PSCIntrahepatic ducts only
PBC
314
Dx, pain in throat with cold/hot food
Oesophageal spasm
315
Gastric peptic ulcer. Pain after eating time frame?
Pain 30 mins after eating
316
Dudodenal peptic ulcer. Pain after eating time frame?
Relieved when eating, Pain starts 2-3 hours later
317
External haemorrhoids difference
PainfulVisible/palpable lump on outside
318
What type of haemorrhoids is treated with banding?
Internal
319
External haemorrhoids difference
PainfulVisible/palpable lump on outside
320
When can you break consent? (4)
- Patient permission- Mandatory by law- Necessary discussion with other health professional- Duty to public health
321
What age to screen smoking in ATSI?
12yo
322
What age screen CVD (risk calculator)
45+ yo (ATSI >30yo)
323
Adrenaline dose for anaphylaxis in children
0.01mL/kg every 5 mins
324
My Aged Care referral criteria
>65yo or >50 with homelessness/complex needs
325
Disabled Parking criteria
- Sig mobility deficit- Sig neuro/cognitive deficit- Standard parking bay is not big enough for equipment
326
Varenicline CI's
Psychosis, suicidal thoughts, CVD, pregnancy/BF
327
Smoking cessation - Champix dose
Varenicline - 0.5mg for 3/7 -> 0.5mg BD for 4/7, then 1mg BD for 12/52
328
Smoking cessation 3 options (Rx)
NortriptylineVareniclineBupropion
329
NRT dosing
>12yo - 10+ cigs or smoking within 30 mins wake up▪ 21mg/24hr patch >45kg ▪ 14mg/24hr patch <45kg Quick acting = 2mg chewable every 2 hours
330
NO false negatives = what statistical term
100% sensitivity
331
NO false positives = what statistical term
100% specifiicity
332
What helps to rule out disease (sensitivity or specificity)
SNOUT - Sensitive tests, where negative helps rule OUT
333
What helps to rule out disease (sensitivity or specificity)
SNOUT - Sensitive tests, where negative helps rule OUT
334
How to calculate number needed to treat?
1/Absolute risk increase
335
Incidence definition
number of new cases
336
Prevalence definition
number of exisiting cases
337
1st line investigations for easy bruising (4)
○ FBE + blood film○ APTT○ PT/INR- Fibrinogen
338
Pernicious anaemia Rx (1)
IM 1mg hydroxocobalamin every second day for 2 weeksand lifelong:1 mg hydroxocobalamin IM every 3 months
339
Pernicious anaemia Rx (1)
IM 1mg hydroxocobalamin every second day for 2 weeksand lifelong:1 mg hydroxocobalamin IM every 3 months
340
Iron deficiency Rx (1)
100mg elemental iron daily for 3 months
341
Assessment for DVT?
Well's scoreLow = D dimerHigh = Venous doppler of affected
342
DVT Mx
Apixaban 10mg bd for 7 days, then 5mg bd for 3 monthsExcept if pregnant or eGFR <30
343
Lymphoma's how to diagnose
Excisional biopsy only
344
CRAB criteria multiple myeloma
Calcium - elevatedRenal - uremiaAnaemiaBones - pain and fractures
345
Risk Factors for temporal arteritis (3)
FemaleAge >50yoPMR
346
Rotavirus vaccine age cutoff
1st dose by 14 weeks, 2nd dose by 24 weeks
347
Live vaccines CI (2)
○ Cancer patients on immunosuppressive therapy (e.g RTx/CTx)High dose immunosuppressive therapy (>90mg pred/day or >2mg/kg children)Pregnancy
348
Meningococcal B dosage for age groups
6 weeks – 12 months, 3 doses12+ months, 2 doses
349
Pneumococcal ages for people who are well
70+yoATSI 50+yo
350
Shingles vaccine age
Recommended 60+, but anyone 50+ can request
351
Influenza dosing
- 6 months – 9yo need two doses 4 weeks apart only if first ever influenza vaccine
352
What vaccines can you not give for egg allergy (2)
Yellow FeverQ fever
353
Causes of vaccines not working in patient (3)
- Expired vaccine given- Cold chain breach of vaccine- Manufacturing defect of vaccine- Individual's immune response was ineffective
354
Malaria Prophylaxis (1)
PROMOZIO start 2 days before continue 7 days afterORDoxycycline 100mg daily 2 days before, 4 weeks after
355
Fever + rash, travelled to NSW
Barmah Forest Virus
356
Fever, been with sheep and pigs
BrucellosisBruce Willis looks like sheep/pig
357
Fever, SE asia, retroorbital pain
Dengue Fever
358
Dengue Fever Mx
Conservative Mx, advise about possible risk of haemorrhage and shock
359
Giardia symptoms (2)
- Steatorrhoea- Anorexia/LOW- Fatigue
360
Giardia Rx (1)
- Metronidazole 400mg tds for 5 days
361
Fever, stupor, vomiting, returned from overseas
Japanese B Encephalitis
362
Fever, conjuncitivitis, headache, farmer
LeptospirosisEPT = PET = Farmer petsOr meat industry
363
Gastro symptoms after someone had poorly stored milk
ListeriosisLi for milk
364
Listeriosis Rx (1)
Amoxicillin 1g tds for 2 weeks (pneumonia)
365
Leptospirosis Rx (1)
Doxycycline 100mg 7 days
366
Malaria Ix (1)
Thick and thin blood films for 3 days (initial may be too early to detect)
367
Malaria Examination findings (3)
SplenomegalyConjunctival changesCervical lymphadenopathy
368
Resp infection caught by birds
Psittacosis
369
Weakness, fever, abbatoir worker
Q fever
370
Q fever Rx (1)
- Usually spontaneously resolves in 2-6 weeks - Doxycycline 100mg bd for 14 daysCan do Q fever vaccines for those at high risk
371
Insect bite, Queenslander
Queensland Tick Typhus
372
Queensland Tick Typhus Rx (1)
Doxycycline 100mg bd for 7 days
373
Painful animal bite + pain with drinking
Rabies
374
Rabies Rx
Vaccinate, even if after bite
375
Farmer, sparse spotty rash, fever
Ross River Virus
376
Parasitic worms in - Sub-Saharan Africa, the Middle East, Southeast Asia and the Caribbean
Schistosomiasis from contaminated faeces
377
Cat litter and contaminated/uncooked foodFever, muscle aches
Toxoplasmosis
378
Traveller's diarrhoea Rx
azithromycin 1g oral stat
379
Gradually worsening fever and abdo fever in returned traveller
Typhoid
380
Typhoid Rx (1)
Azithromycin 1g oral daily for 7 days
381
Eschar rash - Transmitted through bites, Asia
Typhus
382
Typhus Rx (1)
- Doxycycline 100mg bd
383
Anal warts Rx (1)
Podophyllotoxin 0.15% cream bd for 3 days, then nothing for 4 days. Repeat x4
384
Hairy leukoplakia is a sign of?
HIV
385
Time frame for post-exposure HIV prophylaxis
Within 72 hours of exposure
386
How long to take PrEP for HIV until covered
Males - 7 daysFemales - 20 days
387
Exposure to influenza, but negative result Mx (1)?
Vaccinate
388
Influenza Rx (1)
Oseltamivir up to 75mg bd for 5 days
389
What Ix to do for needlestick injury (3)
- Hep B (anti-HBs, HBsAg)- Hep C (anti-HBc IgG, Hepatitis C serology HCV RNA PCR) - HIV serology
390
When to repeat testing for needlestick injury?
3 and 6 months
391
Indications for tetanus booster after injury
>5 years since last dose + DIRTY or MAJOR wound
392
Indications for tetanus immunoglobulin after injury
Not completed 3 course of tetanus + DIRTY or MAJOR wound
393
Primary syphillis symptom (1)
Painless ulcer (Chancre)
394
Secondary syphillis symptom (1)
Rash
395
Tertiary syphillis symptom (1)
Systemic paralysis
396
Acute syphillis infection Ix (1)
- Syphillis Rapid Plasma Reagin (RPR) testing AND enzyme ImmunoassayThis is also used for test of cure in 3, 6, 12 months
397
Chronic syphillis infection Ix (1)
Enzyme Immunoassay (EIA), positive for lifetime
398
Syphillis chancre investigation (1)
NAAT swab of ulcer
399
Rash, fever and myalgia after syphilis treatment?
Jarisch-Herxheimer reaction
400
Syphilis Rx (1)
Benzathine benzylpenicillin 1.8 g IM injection statPen allergy - Doxycycline 100mg bd for 14 days
401
Duration of therapy for provoked, distal DVT
6 weeks +
402
Duration of therapy for unprovoked DVT
3 months +
403
Duration of therapy for proximal DVT
3 months +
404
What is Pott's disease?
MSK TB (TB in spine)
405
Tuberculosis Ix for acute disease (1)
- Sputum acid-fast bacilli smear
406
Tuberculosis Ix for chronic disease (1)
- Quantiferon Gold (does not check for active disease)
407
Prostate cancer screening age
- Offer 50-69yo every 2 years - Offer 45-69yo every 2 years if risk factorsEven if high risk, controversial with screening
408
Prostatitis empirical Rx
Trimethoprim 300mg daily for 14 days
409
Epididymo-orchitis causes (4)
MumpsUrinary sourceSTI sourceAmiodarone
410
Epididymo-orchitis examination specific finding (1)
Prehn's sign - relief of pain upon lifting of scrotum Ehn happening to me - BXO
411
Blue dot sign
Torsion of testicular appendage
412
Indirect hernia vs Direct herniaCommon in young
Indirect
413
Indirect hernia vs Direct herniaCan descend into scrotum
Indirect
414
Indirect hernia vs Direct herniaMedial to inguinal vessels
Direct
415
Balanitis Rx
Canesten (1% clotrimazole) bd for 7 days after symptoms resolve
416
Peyronie's disease associated conditions (3)
HTNT2DMObesity
417
When to Rx Peyronie's disease
- Only if causing pain or sexual interference 1. Surgical 2. Injections - collagenase
418
Erectile Dysfunction Rx (1)
Sildenafil 50mg PRN (max 1/day)- Have on empty stomach
419
Erectile Dysfunction non-pharm Mx (3)
- Quit smoking- Exercise- Avoid ETOH/caffeine- Weight loss- Psychology
420
Premature Ejaculation Rx (2)
1. Topical anaesthetic to penile shaft (lignocaine)2. Dapoxetine 30mg 1-3 hours before intercourse
421
SPC monitoring Ix (2)
Yearly:1. bladder USS2. UEC's
422
When to use triangular sling?
supports elbow - for fractures where traction would make it worseE.g AC joint or clavicle #
423
When to use collar + cuff sling?
- when you need traction for fracture to healHumerus shaft or SNOH fractures, shoulder dislocation (internal rotation)
424
Shoulder dislocation Mx (1)
Collar and cuff
425
AC joint dislocation Mx (1)
Triangular sling (clavicle traction isn't good)
426
Humerus fractures Mx (1)
Unless in corners, or displaced since it's non WB bone, mostly conservative
427
What structure can get injured with humerus shaft fractures?
Radial nerve
428
Ulnar nerve palsy findings?
- Claw hand- Unable to abduct fingers
429
Radial nerve palsy findings?
Unable to extend wrist
430
Median nerve palsy findings?
Unable to make OK sign (finger opposition)
431
Simple forearm fracture Mx (1)
Above elbow cast (to avoid supination/pronation)Always do 1 joint below and above
432
Simple Wrist fracture Mx (1)
Below elbow cast
433
Olecranon fracture Mx (1)
ORIF (intrarticular normally)
434
Pulled elbow Ix (1)
None
435
Pulled elbow Mx (1)
Passive pronation and flex elbow
436
Maxillary # Mx (1)
Send to maxfax as can affect teeth modelling
437
Nasal # Mx?
Non-displaced = conservativeDisplaced = Max-fax referral
438
Orbital # Mx?
Send to ED urgently
439
Facial fracture ED referral indications? (3)
Pain with eye movementsDiplopiaDepressed malar eminenceHyphaema
440
Pelvic # Mx
Usually conservative if non-displaced
441
Patellar # signs
Unable to straighten (extend) knee or SLR(as pulls on quads tendon)
442
Patellar # Mx
No displacement = Immobilise walking plaster cylinder 4 weeksDisplacement or unable to extend knee = K wires
443
Distal fibular # Mx
POP back slab/moon boot
444
Repetitive back rotational movements leading to pain. Dx?
Spondylosis
445
Spondylosis Mx (1)
Rest from aggravating activity for 6 weeks
446
Radius/Ulnar # Mx
- If both fractured and aligned = heals well with cast- Rotational deformities = reduction- Displaced = operation
447
Colles # Mx
- Non-displaced = below elbow cast 4 weeks- Displaced = reduction
448
Scaphoid # Mx
- Displaced = ortho referral- Non-displaced = thumb spica cast
449
Mallet finger Mx
- Simple = Full extension splint- Fracture/complex = surgery
450
Subscapularis action
Internal rotation
451
Teres minor action
External rotation
452
Infraspinatus action
External rotation
453
SLE Ix (3)
ANA +veanti-dsDNAanti smith antibodies
454
RA Ix (3)
RF +veanti CCPANA +ve
455
Scleroderma Ix (1)
Limited anti centromereSystemic anti SCL 70"anti topoisomerase 1
456
Cut off for normal endometrial thickness post-menopause
<4mm
457
During what time of menstrual cycle is it best to get a TV US done to Ix?
Day 5-10 of menstrual cycle
458
Normal endometrial thickness PRE-menopausal
<12mm
459
Normal endometrial thickness PERI-menopausal
<5mm
460
What medication to give to stop breastmilk production
Cabergoline 1mg stat dose
461
COCP given and patient develops migraine with aura
Stop COCP
462
COCP Smoker >35 but quit last year
Stop COCP
463
COCP FHx of breast cancer <30yo
Okay to take COCP. Only PHx of breast ca
464
Major surgery with immobilisation, okay for COCP
No. high risk VTE
465
Sudden onset neck pain with RA/Down's syndrome
Atlanto-axial disruption
466
Examination findings for cervical radiculopathy
Spurling test, slightly lateral flexion neck and push down head causes pain
467
Middle finger nerve root distribution
C7
468
Shoulder pain + stifness in all directions, active and passive movement pain
Frozen shoulder
469
Shoulder pain, active movements only, external rotation, abduction
Rotator cuff injury
470
Shoulder pain with Passive overhead movements
Bursitis/Impingement
471
Repetitive throwing -> shoulder pain
Glenoid Labrum Tear
472
How to assess for AC joint disruption
Paxinos sign - pinching AC joint togetherPassive adduction of shoulder
473
When to consider radicular back pain imaging?
>6 weeks, trial physical therapy
474
Ankylosing spondylitis triad
<40yoLasting >3 monthsMorning stifness improving with exercise
475
Repetitive rotation causing back pain
SpondyloLYsis
476
Teenager with kyphosis, can't touch toes
Scheuermann's disease
477
Osteomyelitis and arthritis across multiple vertebrae
Pott's disease
478
Risk Factors for Carpal Tunnel Syndrome (4)
- Diabetes- Hypothyroidism- Pregnancy- Trauma
479
When to give ABX for rhinosinusitis? 3 criteria
Fever > 38Discoloured purulent discharge Severe localised pain
480
Pain on lateral thigh, worse on pressure and climbing stairs
Greater Trochanteric Pain Syndrome (including bursitis)
481
Young athlete, tenderness in pubic symphysis
Osteitis Pubis
482
Young person who jumps a lot, pain inferior knee cap
Patellar Tendinopathy
483
Female and obesity, anterior knee pain ,worse with sitting prolonged period of time (movie theatre sign)
Patellofemoral Pain Sydrome
484
Teenager with pain on tibial tuberosity
Osgood Schlatter Disease
485
Painful knee clicking
Meniscal tear
486
Suprapatellar pain after overuse, worse at night
Quadriceps Tendonitis
487
Marathon runner with lateral pain on thigh
Iliotibial Pain syndrome
488
Pain in knees after kneeling prolonged period
Prepatellar bursitis
489
MRI knee rebatable conditions (2)
16-49 yo with either- Acute ACL concern (following trauma)- Acute unable to straighten knee (meniscal tear)
490
Unfit tennis player with calf pain during lunge
Gastrocnemius tear
491
Spa folliculitis. Causative organism + ABx choice?
Pseudomonas AeruginosaCiprofloxacin
492
Shaving folliculitis causative organism + Rx
Staph aureusMupirocin 2% ointment bd
493
RF for scabies (3)
Nursing homesATSIHIV
494
Onycholysis Rx (2)
Keep nails shortAvoid exposure to contact irritantsWait for nail to regrow (separated nail won't reattach)
495
Dermatoscopy - thrombosed capillaries
Warts
496
Plane (flat) warts on face treatment
tretinoin 0.05% cream daily for 3 months
497
RF for DDH (3)
FemaleBreechFHx
498
When to do US for DDH
6 weeks - 6 months, after this XR is better
499
Organic causes of constipation in children (3)
AllergyCoeliac DiseaseHypothyroidismHypercalcaemia
500
Examination components for child constipation (2)
Abdominal palpation for faecal matterInspect anus for fissures/patency
