General

Question 1

What does one fingertip unit of steroid cream equate to?

Answer 1

Approx 0.5g/ 500mg Enough to cover the space of two adult hands (palm and fingers together)

Question 2

What levels define hyperuricaemia?

Answer 2

Males - >0.42 mmol/L Females - >0.36 mmol/L

Question 3

How can acute gout be treated?

Answer 3

If NSAID okay: high dose for 3-5 days then reduce and cease e.g. indomethacin 50mg 3-4 times daily (comes in 25mg tablets) If NSAID C/I: Colchicine 1mg stat, 500microg an hour later (one day dose, total 1.5g) Prednisolone 15-30mg daily for 3-5 days

Question 4

What is the target urate level for allopurinol therapy?

Answer 4

<0.36 (<0.3 if tophi present)

Question 5

What is the first line treatment for H pylori eradication?

Answer 5

1g amoxycillin BD, PPI (e.g. esomeprazole 20mg BD), clarithromycin 500mg BD - for 7 days

Question 6

What are the ALARM/ red flag symptoms of GORD? (warrant further IX/ endoscopy)

Answer 6

>50 and new onset GORD Anaemia/ iron deficiency unexplained Loss of weight Anorexia/ loss of appetite Recent onset/ progressive symptoms Melena or haematemesis Dysphagia or odynophagia

Question 7

What are the 2 recommended ways of giving 3 injections for a child <12 months?

Answer 7

1. One injection in one anterolateral thigh, two injections in the other (given at least 2.5cm away from each other) 2. One injection in each anterolateral thigh, one injection in ventrogluteal area

Question 8

When two immunisations are given in the same location, how far away must they be from each other?

Answer 8

At least 2.5cm away

Question 9

What treatment can be commenced for Conn syndrome while awaiting treatment?

Answer 9

Spironolactone 50mg PO daily (aldosterone antagonist)

Titrate up according to blood pressure, K+, plasma renin

Question 10

In Addison disease, what needs to be done if ill or undergoing minor surgery?

Answer 10

Glucocorticoid dose needs to be increased - then tapered over 2-3 days after surgery or recovery E.g. increase to 20mg hydrocortisone TDS - then wean to usual maintenance dose once recovered

Question 11

When would a patient with Addison disease require IV hydrocortisone rather than increased oral dose?

Answer 11

If vomiting while unwell - needs IV hydrocortisone If features of Addisonian crisis

Question 12

What can be done for patients with Addison disease that live remotely or are travelling overseas?

Answer 12

Carry injectable hydrocortisone e.g. 100mg IM hydrocortisone Carry medical alert bracelet

Question 13

Name 3 tests that should be performed (in addition to history/ examination) for incidentally identified adrenal mass

Answer 13

Dexamethasone suppression test (for Cushing syndrome/ cortisol-producing) 24hr urinary metanephrine + catecholamines (for phaeochromocytoma/ catecholamine-producing) If hypertensive - plasma aldosterone renin ratio (for Conn syndrome/ aldosterone-producing)

Question 14

For adults (18-64yo), what is the recommended amount of physical activity per week?

Answer 14

• 2.5-5 hours of moderate intensity exercise per week, or
• 1.25 - 2.5 hours of vigorous/ high intensity exercise per week
• Including 2 days of muscle strengthening exercise per week

Question 15

For adults >65yo, what is the recommended amount of physical activity per week?

Answer 15

• Aim for at least 30 minutes of moderate intensity exercise on most days of the week

Question 16

What are the recommendations regarding ‘screen time’ in young children and teenagers?

Answer 16

• 2-5yo - no more than 1 hour screen time daily
• 5-17yo - no more than 2 hours of screen time daily