CCE Flashcards
1
Q
Domestic Violence approach
A
LIVES Listen non judgementally Inquire as to needs and concerns Validate - explain not her fault Enhance safety - risk assessment and safety planning Support - organise appropriate referrals
2
Q
When would you be cautious about doing the Epley manouvre
A
• neck injury
• severe cervical spondylosis
• severe positional dizziness or vertigo.
carotid stenosis
3
Q
Eligibility criteria for NDIS
A
Age 7-65 years
Australian citizen/permanent resident
Live in Australia
Permanent disability
Need disability specific supports to complete ADLs
4
Q
When would you be cautious about doing the Epley manouvre
A
- neck injury
- severe cervical spondylosis
- severe positional dizziness or vertigo.
5
Q
when does drivers licence need to be restricted for OSA
A
ESS >=16
or self reported sleepingess or drowsiness while driving
history of crash caused by inattention or sleepiness
6
Q
In COPD when do you consider adding an ICS
A
when FEV1 <=50% AND
2 exacerbations in past 12 months AND
sig symptoms despite LABA/LAMA combo
7
Q
HASBLED
A
Hypertension Abnormal liver or renal function Stroke Bleeding history Labile INRs Elderly >65 years Drugs - antiplatelets
8
Q
Pericarditis causes
A
TB SLE post myocardial infarction uraemia post coronary intervention HIV
9
Q
H Pylori treatment
A
Esomeprazole 20mg orally BD for 7 days
• Amoxicillin 1g orally BD for 7 days
• Clarithromycin 500mg orally BD for 7 days
10
Q
what sleep apnoea scores are needed for sleep study
A
STOP Bang >=4
ESS >=8
11
Q
General medical rules for DSP
A
your condition will last more than 2 years
your condition is fully diagnosed, treated and stabilised
you have an impairment rating of 20 points or more
your condition will stop you working at least 15 hours a week in the next 2 years.
12
Q
patient characteristics which may impact medication compliance
A
• Low literacy • Old age • Ethnic background eg ATSI • Mental health issues - depression, memory loss • Physical disabilities • Low socioeconomic status • Language barrier • Not believing in medication • Busy lifestyle Drug/alcohol issues
13
Q
When does a patient qualify for home medicines review
A
• 5 or more medications
• More than 12 doses of medication per day
• Recent significant cahnges made to medications
• Medications requiring therapeutic monitoring
• Symptoms suggestive of adverse drug reaction
• Suspected non compliance
• Sub optimal response to treatment
• Difficulty managing own medications
• Dementia
• Pt has lots of different doctors
Recent discharge from hospital
14
Q
age eligibility for my aged care
A
- that you are 65 years or older (50 years or older for Aboriginal or Torres Strait Islander people).
- 50 years or older (45 years or older for Aboriginal and Torres Strait Islander people) and on a low income, homeless, or at risk of being homeless.
15
Q
signs and symptoms of lithium toxicity
A
Gastrointestinal Effects :Nausea, vomiting, diarrhoea
CNS effects: tremor, hyper reflexia, ataxia, dysarthria
16
Q
what are the indications for antipsychotic treatment
A
Schizophrenia, schizoaffective disorder, depression with psychosis, mania
17
Q
typical antipsychotics
A
haloperidol, chlorpromazine
higher risk fo EPSE
18
Q
atypical antipsychotics
A
olanzapine, clozapine, risperidone
lower risk EPSE
more metabolic SEs
19
Q
side effects of clozapine
A
agranulocytosis
cardiomyopathy
neutropenia
metabolic
20
Q
Maximum safe dose for lignocaine with adrenaline
A
7mg/kg
Without adrenaline 3mg/kg
21
Q
sex post CABG
A
wait 6-8 weeks
if you can climb 2 flights of stairs without SOB or pain all is good
22
Q
4Ds smoking cessation
A
Delay
Deep breathe
Drink
Distract
23
Q
Examination features IBD
A
- Arthritis/enthesitis
- Episcleritis/iritis
- Mouth ulcers
- Erythema nodosum
- Pyoderma gangrenosum
- Anaemia: pallor of conjunctivae
- Abdominal mass
- Evidence of weight loss
Perianal fistula, skin tags
24
Q
How to calculate APRI score
A
AST to platelet ratio
25
Anaphylaxis adrenaline dose
0. 5mls of 1:1000
| 0. 01 mL/kg of 1:1000 (maximum 0.5 mL)
26
Management of severe croup
0.5ml/kg of 1:1000 adrenaline to a maximum of 5ml (5mg) undiluted AND 0.6mg/kg (max 12mg) dexamethasone IM/IV/PO.
27
Pericarditis treatment
Restriction of exercise
Colchicine 500mcg BD for 3 months
AND
Aspirin 1000mg, TDS for one to weeks with tapering course
28
when do you do cascade screening for haemochromatosis
Cascade screening is warranted for all first-degree relatives of patients with HHC who are C282Y homozygous or C282Y/H63D compound heterozygous.
29
Haemochromatosis Mx
Refer for therapeutic venesection, every 1- 2 weeks
Refer to gastroenterologist
Screen for liver complications
Avoid iron tablet and vitamin C
30
What are the phases of hepatitis B infection
Phase 1: immune tolerance
• High HBV DNA (often >170,000,000)
* Normal LFTs
* HbeAg positive
Phase2: Immune clearance
• High HBV DNA
• Abnormal LFTs
• HbeAg positive
Phase 3: Immune Control
- Low HBV DNA
- Normal LFTs
- HbeAg negative
- Anti Hbe positive
```
Phase 4: Immune escape
- High HBV DNA
- Abnormal LFTs
- HbeAg neg
Anti Hbe pos
```
31
Hepatitis B management
Refer to Gastroenterologist for antivirals
Contact trace partners of past 6 months
Advise partners are tested
Advise pt to wear condoms in new sexual relationships
Regular testing of viral load up to 4 times per yr
Annual HbsAg and anti Hbs testing
6 months HCC surveillance with liver ultrasound/afp
Reduce alcohol
Cease smoking
Ensure vaccinations up to date
32
apixaban dose in DVT
10mg BD for 7 days then 5mg BD
33
DDx for splenomegaly
```
CML
Myleofibrosis
Portal HTN
Lymphoma
Leukaemia
Thalassemia
```
34
Causes of thrombocytopenia
```
medication induced
chronic liver disease
vitamin B12 deficiency
SLE
lymphoma
HIV
Pregnancy
ITP
artefact
```
35
causes of thrombocytosis
```
• Essential thrombocytosis
• Polycythaemia vera
• Primary myelofibrosis
• Chronic myeloid leukaemia
• Myelodysplastic syndromes
• Acute myeloid leukaemia
Familial thrombocytosis
```
36
what are cycloplegic eye drops used for
paralysis of muscles for accommodation
37
treatment for posterior epistaxis
foley catheter along floor of nasal cavity
38
Ottawa ankle rules
* The ankle X-ray is required only if there is any pain in the malleolar zone and any one of the following
* bone tenderness along the distal 6cm of the posterior edge of the tibia or the tip of the medial malleolus OR
* bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus OR
* an inability to weight bear both immediately and in the ED for 4 steps
39
Ottawa foot xr rules
pain in the mid foot zone and any one of the following
- bone tenderness at the base of the 5th metatarsal OR
- bone tenderness at the navicular bone OR
- an inability to bear weight
40
mx of weber A ankle fracture
WBAT in boot
| fracture below
41
imaging required for suspected syndesmotic injury
XR mortise view - widening of space between tibia and fibula
42
what kind of ankle sprain causes Pain reproduced with external stress and dorsiflexion
syndesmosis sprain
43
mx of calf muscle tear
- RICE 48 hours
- Ice packs for 20 mins then every 2 hours when awake
- A firm elastic bandage from toes to below the knee
- Raised heel in shoe aids mobility
- Commence mobilisation after 48 hours with active exercises
Physio
44
carpal tunnel examination
examine neck and upper limbs
```
• Sensory loss of median nerve distribution of hand (palmar aspect of thumb and first 2.5 fingers)
• Positive Tinel test
• Positive Phalen's test
• Weakness of thumb abduction
Wasting of abductor pollicis brevis
```
45
underlying causes of carpal tunnel
```
• Idiopathic
• Pregnancy
• Diabetes
• Hypothyroidism
• Rheumatoid arthritis
• Gout
• Acromegaly
Repetitive activity
```
46
mx of fractured surgical neck of humerus
- Triangular sling
- When pain subsides: encourage pendulum exercises in slings
- Aim for full activity in 8-12 weeks post injury
47
what nerve injury is most common in supracondylar fracture
anterior interosseus nerve
48
What is a monteggia fracture
dislocation of radial head and fracture of ulnar shaft
49
mx of clavicle fracture
broad arm sling and follow up in fracture clinic in 7 days
50
Causes of acute haemarthroses of the knee
Intra articular fracture
ACL rupture
Patella dislocation
51
XR features of osteoarthritis
Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes
52
when would you use a z score in osteoporosis?
pre menopausal women
men <50
children
53
Signs of Addisons
```
Hyperpigmentation
postural hypotension
tachycardia
dry mucous membranes
vitiligo
decreased body hair
```
54
what T score is diagnostic of osteoporosis
-2.5 or lower
55
side effects of 5 alpha reductase inhibitors
• 5 alpha reductase inhibitors (finasteride or dutasteride) may be added to alpha blockers
Can cause gynaecomatia, loss of libido and erectile dysfunction
56
how do 5 alpha reductase inhibitors work
Reduce prostate volume over 6-12 months
57
side effects of tamsulosin (selective alpha blocker)
dizziness, nasal congestion, anejaculation, hypotension
58
what to tell patient before psa test
avoid ejaculation or vigorous exercise 48 hours prior to test
59
what to do if psa raised between 3 and 5.5
repeat in 1-3 months
60
what are the criteria for a useful screening test
condition should be an important health problem
natural history of the condition should be understood
should be a recognised latent or early symptomatic stage
should be a test that is easy to perform and interpet, acceptable, reliable, sensitive and specific
should be an accepted treatment recognised
policy on who should be treated
diagnosis and treatment should be cost effective
case finding should be a continuous process
61
first line treatment for premature ejaculation
SSRI
| reduce penile sensation, anaesthetic spray
62
treatment for epididymorchitis
○ Ceftriaxone 500mg IM
○ Azithromycin 1g PO (repeated one week later) OR doxy 100mg BD for 7 days
○ No sex for 7 days post treatment
- Non sexually active:
○ Trimethoprim 300mg PO daily for 14 days or cefalexin 500mg BD while awaiting test results
63
side effects of PDE5 inhibitors
headaches, flushing, dyspepsia, nasal congestion, backache and myalgia, may cause transient retinal effects: blurred vision, blue-green colour tinge and light sensitivity
64
contraindications for PDE5 inhibitors
- Recent MI, stroke or life threatening arrhythmia within the last 6 months
- Resting hypotension BP<90/50
- Hypertension >170/100
- Unstable angina or angina with exertion
- Severe congestive heart failure
- Nitrates or nitric oxide donors
Known hereditary retinal disorders (sildenafil and vardenafil only)
65
tumour markers for testicular cancer
LDH, AFP and HCG
66
important issues to discuss regarding vasectomy
- Permanent nature of the procedure
- Need at least 3 months until effective
- Needs a sperm analysis in 3 months
- Risk of haematoma
- Risk of infection
- Risk of formation of sperm antibody
Small failure risk
67
diet recommened to prevent renal stones
```
adequate hydration
low salt
low oxolate: chocolate, tea, strawberries
low protein
normal calcium
```
68
Diseases associated with nephrotic syndrome
Minimal change glomerulonephritis
Focal segmental glomerulonephritis
Membranous glomerulonephritis
SLE
69
Types of glomerulonephritis
Post streptococcal GN
IgA nephropathy
Rapidly progressive GN
Henoch-Schonlein purpura
70
DDx for proteinuria
```
Diabetic nephropathy
Hypertensive nephropathy
Multiple myeloma
Structural kidney disease- polycystic kidneys
Nephrotic syndrome
Amyloidosis
```
71
ddx haematuria
```
• Glomerulonephritis - IgA nephropathy/post strep GN
• Hypertensive nephropathy
• Urinary tract malignancy
• Angiomyolipoma
• Analgesic nephropathy
• Polycystic kidney disease
• Multiple myeloma
• Ureteric calculi
• Pyelonephritis/cystitis
• Menstruation
• Vigorous exercise
• Trauma
• Viral illness
• Renal cell carcinoma
TCC
```
72
definition/diagnosis of AKI
Increase in serum creatinine >26.5 within 48 hours
Increase in serum creatinine to >1.5 times baseline within the prior 7 days
Significant reduction in urine output
73
how does naltrexone work in alcohol dependence
blocks the effects of endogenous opioids released following alcohol intake
74
what questionaires can be used to screen alcohol use
Alcohol Use Disorders Identification Test (AUDIT)
Severity of Alcohol Dependence Questionnaire (SADQ)
Kessler Psychological Distress Scale
75
features of simple febrile seizure
```
Fever and all of the following:
• generalised tonic-clonic seizure
• duration of less than 15 minutes
• complete recovery within 1 hour
do not recur within the same febrile illness
```
76
Information for parents for seizure management
• It is important to stay calm (1)
• Ensure Mackenzie is in a safe position, on a soft surface, lying on his side or back (1)
• Remove any objects from around the child to ensure his safety (1)
• Time how long the convulsion lasts for (1)
• Watch or video carefully the movements that take place during the convulsion so you can inform medical staff later (1)
• Do not try to restrain him (1)
• Do not put anything in his mouth (1)
• Do not put him in a bath to lower his temperature (1)
• Call an ambulance if the seizure last >5 minutes (1)
• Call an ambulance if he does not return to normal once the convulsion stops (1)
Call an ambulance if he looks very sick when the convulsion stops (1)
77
mx of buckle fracture
removable wrist splint for 3 weeks
no contact sport for 6/52
no follow up required
78
what are some red flags for autism spectrum disorder
Does not babble or coo by 12 months of age
Does not gesture (point, wave, grasp) by 12 months of Does not say single words by 16 months of age
Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age
Has any loss of any language or social skill at any age
79
What does autism cause impairment in
* social interaction
* communication, and
* behaviour with restricted and stereotyped interests
80
How to assess severity of bronchiolitis
```
Behaviour
Respiratory rate
Use of accessory muscles
Oxygen saturation
Apnoeic episodes
feeding
```
81
what makes bruising concerning for NAI
bruising in children who are not independently mobile
bruising on torso, genitalia, eyes, neck
bruising that is not over a bony prominence
bruising that is clustered or patterned
bruising with petechiae
bruising that does not fit with the mechanism described
82
5 stages of burns
```
Epidermal
Superficial dermal
Mid dermal
Deep dermal
Full thickness
```
83
when to refer burns
```
• >10% TBSA
• Burns to face, hands, feet, perineum and genitalia, major joints
• Chemical burns
• Electrical burns
• Burns with trauma
• Burns with inhalation injuries
• Circumferential burns of limbs or chest
• Young children <1 year old
Burns in pregnant women
```
84
How to assess severity of croup
```
behaviour
stridor
respiratory rate
accessory muscle use
(o2 sats)
```
85
croup tx
minimal handling
| pred 1mg/kg oral with repeat dose 2nd evening
86
mx of lactose overload
• Referral to lactation consultant to improve breast feeding technique/observation of a feed to optimise fit and hold technique
• Consider block feeding - offering one breast for all feeds over a 2-3 hour period (receive more cream based breast milk at the end of the feed)
• Refer to Australian breast feeding association
• Acknowledge the impact on mums mental health
• Reassure that green stools are common
Arrange follow up
87
in gastro what should be the aim for oral rehydration
Oral rehydration
| Aim for 10 mL/kg/hr of oral rehydration solution (eg GastrolyteTM, HYDRAlyteTM, PedialyteTM)
88
if both testes are impalpable what investigations are needed
```
Karyotype
Serum electrolytes (CAH babies can have low sodium)
Ultrasound
```
89
Examination features of acute angle closure glaucoma
```
mid dilated pupil
pupil poorly responsive to light
decreased visual acuity
red conjunctivae
cloudy cornea
increased intraocular pressure
```
90
topical medications for glaucoma
Beta blocker – timolol 0.5% 1 eye drop 1-2x daily
• Prostaglandin analogue – Latanoprost 0.005% 1 eye drop daily
• Alpha-2 agonists – Brimonidine 0.15% 1 drop twice a day
• Unsuitable for severe CVD
• Carbonic anyhydrase inhibitors – Brinzolamide 1% 1 eye drop twice a day
91
mx of macular degeneration
- Cease smoking
- Monitor at home with Amsler Grid and present if acute deterioration
- BP control
- Weight loss 5-10%
- Diet rich in fish containing omega 3 fatty acids and dark green leafy vegetables
Annual optometric review is recommended.
wet AMD - intravitreal therapy
92
medications for dementia
Donepezil: cholinesterase inhibitor
Memantine: NMDA receptor antagonist
93
Treatment for Ramsay Hunt Syndrome
• Aciclovir 700mg 5 times a day for 7 days
• Valaclovir 1g TDS for 7 days
• Prednisolone 75mg for 5 days
• Eye patch
• Artificial tears
• Opioid analgesics
• Anticonvulsants such as gabapentin and pregabalin
• Refer to neurologist
Advise patient they are infectious and should avoid contact with any immunocompromised people
94
what is the ABCD2 tool for TIA
```
Age
BP
Clinical Features
Duration
Diabetes
>4 = HIGH RISK
```
95
what are case control studies
retrospective studies
| good for exposure studies
96
Prep
tenofovir/emtricitabine.(Truvada)
97
what to tell pts about prep
Need to be taking for 7 days (20 in females) to achieve protection
Should be taken everyday
If he decides to stop taking needs to take at least 28 days after last HIV exposure
Discuss
• Potential temporary side effects including headache and nausea, which usually subside in one week
• STI prevention: condoms
• Need for ongoing monitoring: 30 days after starting, then 3 monthly
• Prep is safe in pregnancy and breast feeding
• Vey effective at preventing HIV transmission when taken correctly
• Don’t take high dose NSAIDs/nephrotoxic medications with prep
98
if fasting BSL is between 5.5 and 6.9 what is the next step>
OGTT
99
How to assess for diabetic neuropathy
• 10g monofilament pressure sensation at metatarsal joints
• Ankle reflexes
• Vibration sensation with 128Hz tuning fork
Pinprick sensation
100
example of potassium sparing diuretic
spironolactone
101
symptoms of low calcium
- Peri oral numbness
- Paraesthesia's
- Muscle cramps
- Collapse
- Seizures
102
Causes of hypocalcaemia
- Hypoalbuminaemia
- Renal failure
- Hypoparathyroidism
- Drugs: anticonvulsants, bisphosphonates
- Vitamin D deficiency
- Malignancy
- Acute pancreatitis
- Rhabdomyolysis
