General/Misc Flashcards

(59 cards)

1
Q

Side effects of corticosteroids (broad categories) - 9

A
• HTN
	• Obesity
	• T2DM
	• Cataracts
	• Fractures
	• Osteoporosis
	• CVS disease
	• GIT symptoms
          Poor wound healing
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2
Q

Treatment of renal colic (oral opioids of choice, expulsion therapy)

A

1) Tapentadol 50mg IR or Tramadol 50-100mg PO

Expulsion therapy = tamsulosin if >5mm stone/distal segment

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3
Q

ADHD history questions (different aspects of history) (4)

A
  • Impact on function
  • Difficulty concentrating
  • Mood, anger/irritability (often associated w/ ODD)
  • Adulthood - dropping out of courses/work difficulties/relationship dysfunction
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4
Q

Hep C treatment goal

A

Cure OR sustained virologic response (SVR) [undetectable plasma HCV RNA >12 weeks post-end of treatment]

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5
Q

Hep C investigations:

  • For diagnosis
  • Work-up for +ve pts

-When to refer

A

Diagnosis:

  • HCV serology
  • If +ve, confirm current infection with PCR for HCV RNA

Work-up for +ve pts

  • FBE, UEC, LFT
  • INR
  • Pregnancy test
  • Hep A, Hep B, HIV serology
  • Fibroscan
  • ?HCV genotyping - can differentiate relapse vs. re-infection

Refer if CIRRHOSIS

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6
Q

MAFLD monitoring frequencies

  • Without cirrhosis
  • With cirrhosis
A

W/o cirrhosis - 2-3 yearly

With cirrhosis - 6 monthly surveillance for HCC w/ USS + AFP

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7
Q

Anaphylaxis management steps (6)

A

1) Call for assistance
2) Lie patient flat
3) IM adrenaline 0.01mg/kg 1:1000, repeat doses every 5 mins PRN
4) Remove allergen
5) Ambulance transport to hospital
6) Monitor obs, IV accessfluid bolus, O2 therapy

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8
Q

When to commence allergenic foods (egg/dairy/peanut) in kids

A

At ~6 months, not before 4 months

This reduces risk of development of later allergy

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9
Q

HIV PrEP High risk criteria (4)

A

1) Receptive CLI with any casual male/MSM partner
2) Rectal gonorrhoea, rectal chalmydia or infectious sy[hili
3) Methamphetamine use
4) CLI with a regular HIV+ve partner (not on treatment or detectable viral load)

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10
Q

Tests before starting PrEP

A

Current HIV test

-eGFR
-Hep A/B/C serology
Full STI screen - rectal/pharyngeal swab, FPU for chlamydia/gonorrhoea, serology for syphilis, HIV, Hep B
-Pregnancy test if female

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11
Q

HIV PrEP practice points

  • ?Duration for effectiveness
  • Common side effects
  • ?Ongoing monitoring required
A
  • 7 days to become effective
  • A/e’s - nausea, headache –> renal toxicity, reduced BMD
  • Ongoing HIV tests & side effect assessment 3 monthly, STI screen 3 monthly, eGFR 6 monthly
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12
Q

Genital herpes acute treatment

  • Episodic dose
  • Recurrent dose
A

Valaciclovir 500mg BD 5-10 days
Valaciclovir 500mg BD 3 days
Valaciclovir 500mg daily for 6 months

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13
Q

Pelvic inflammatory disease empirical Rx (3)

A

1) Ceftriaxone 500mg in 2ml 1% lignocaine IM stat
2) Metronidazole 400mg BD for 14 days
3) Doxycycline 100mg BD for 14 days

Also, test of cure in 3 months
Contact tracing
No sex for 1/52 till after treatment finishes

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14
Q

Gender affirming hormone therapy - initial baseline Ix

A
  • FBE
  • UEC
  • LFT
  • Fasting lipids
  • Fasting glucose
  • Baseline oestradiol
  • Baseline testosterone levels
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15
Q

Gender affirming hormone therapy (feminising) - treatment options (3)

A
  • Oestradiol (patch or oral)
  • Progesterone (?breast development, risk of CVD/clots/weight gain)
  • Anti-androgen therapy (spironolactone or cyproterone - affects fertility)
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16
Q

Gender affirming hormone therapy - timelines for changes to take effect (feminising and masculinising)

A

Feminising:
-3-6 months for breast growth/body fat redistribution/reduced muscle mass
-6-12 months - thinning of body/facial hair
-Voice not altered

Masculinising:
-First few weeks: increased libido/clitoral size
-Throughout first year: amenorrhoea, body fat redistribution, muscle growth, hair growth (irreversible!), deepening of voice (irreversible!)

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17
Q

PDE-5 inhibitors patient advice/counselling on how to use (6 points)

A

-Allow 2 hours before last meal
-Avoid fatty foods/alcohol
-Avoid stress or anxiety prior to use
-Engage in adequate sexual stimulation
-Allow 6-7 attempts to appreciate full effect
-Don’t expect it to work very first time

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17
Q

PDE-5 inhibitors patient advice/counselling on how to use (6 points)

A

-Allow 2 hours before last meal
-Avoid fatty foods/alcohol
-Avoid stress or anxiety prior to use
-Engage in adequate sexual stimulation
-Allow 6-7 attempts to appreciate full effect
-Don’t expect it to work very first time

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18
Q

Gonorrhoea management steps (6 points)

A

-Ceftriaxone 500mg in 2ml 1% lignocaine IM stat
-Azithromycin 1g PO stat (uncomplicated infections)
-No sex for 1/52 after treatment
-Contact trace last 2 months
-Notify state health department
-Test of cure in 2 weeks AND 3 months

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19
Q

ATSI factors for non-compliance/non-attendence to hospital (7)

A

-Financial limitations
-Transport limitations
-Lack of understanding/knowledge re: dx
-Language barrier
-Previous negative experience at hopital
-Lack of trust/familiarity in medical system
-Lack of access to social network/being away from family

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20
Q

Pred dose for:
1. Gout
2. PMR
3. GCA
4. Bell’s Palsy

A
  1. 15-30mg for 3-5 days
  2. 15mg daily for 4 weeks –> taper
  3. 40-60mg daily (+aspirin)
  4. 1mg/kg (max 75mg) daily for 5 days
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21
Q

Meningitis pre-hospital Abx (adult & kids doses)

A
  1. Ceftriaxone 2g IV/IM (50mg/kg)
  2. Benzylpenicillin 2.4g IV/IM (60mg/kg)

Withhold if urgent transfer available

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22
Q

Autism - who can diagnose?

A

Psychiatrist/Clin Psych
?Paeds

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23
Q

Bloods & other AH assessments for autism prior to referral

A

Vit D, iron studies, B12 (nutritional status)
**-Audiology assessment

-Speech path r/v**

Can self-refer to NDIS via Early Childhood intervention program - access SW/OT/SP

24
Tourette's syndrome hx. questions (8)
○ PHx of any prev. tics? ○ Onset of 1st tic? ○ Do movements come and go? Change from one site to another? Vocal tics? ○ Mental urge to do tic? ○ Does tic make sensation better/'feel right'? ○ Voluntary control? Agg factors? ○ Associated features § Coprolalia (involuntary swearing), copropraxia (involuntary rude gesturing), echolalia, echopraxia ○ FHx of tics, ADHD, OCD, autism
25
DSM criteria for Tourette's syndrome
○ ≥2 motor tics + ≥1 vocal tic for >1 year § Less than 1 year = provisional tic disorder § No vocal tics = chronic tic disorder
26
Tourette's management features (4)
-Advise tics are involuntary/out of control, best to ignore -Psychotherapy (CBIT/habit reversal therapy) -A-adrenergics (guanfacine, clonidine), 2nd gen antipsychotics (risperidone, aripiprazole) -Refer Paeds/Psych
27
ADHD DSM Criteria
○ Symptoms **≥6 months** ○ Several inattentive and/or hyperactive symptoms **before age 12** in **2 or more settings** § Fidgeting, running/climbing, excessive talking, interrupting others, impatience ○ Clear interference w/ academic/social activities ○ Symptoms not explained by other mental disorder
28
ADHD management features (2)
-Non-pharm 1st line - behavioural intervention, social skills training, calming strategies -Meds - stimulants - a/w initial weight loss (regained slowly), 1cm less height growth in first 3 years
29
Complex regional pain syndrome Rx - medication classes (5)
-Oral opioids (eTG?) -SNRIs -TCAs -Gabapentinoids -?Ketamine (specialist), ?corticosteroids ## Footnote Ascorbic Acid (Vit C) - used for prevention, 500-1000mg daily for 50 days
30
Common sources of pain in cerebral palsy (5)
○ Dental pain ○ GORD ○ Constipation ○ Muscle spasms/MSK injuries Pressure injuries
31
Cystic Fibrosis - ?inheritance pattern
Autosomal recessive (if both parents carriers - 1 in 4 chance of child having CF) -Prenatal & pre-implantation genetic Dx available to known carriers -Genetic CF carrier testing available (but $$$) -*Newborn screening = universal in Aus via heelprick + DNA testing*
32
Familial hypercholesterolaemia - inheritance pattern? Rx for children?
Autosomal dominant Refer to specialist for consideration of cascade testing (of 1st deg relatives) Start low dose statin before age 10
33
Triggers/sources for behaviour change in ID/Dementia (9)
○ Sleep disturbance ○ Environmental change ○ Medication changes ○ Physical/sexual abuse ○ Anaemia/thyroid disorders ○ Dental pain ○ Mental health issues ○ Hearing/visual deterioration -?Infection
34
Genetic carrier screening - conditions tested (3)
-Fragile X syndrome -Spinal muscular atrophy -Cystic Fibrosis (CF)
35
Fragile X syndrome ?inheritance pattern
X-linked pattern (on X chromosome) Males affected - almost always have ID Women - may have ↑risk premature ovarian insufficiency ## Footnote * If ↑genetic risk identified prior to pregnancy, couples have option of IVF + preimplantation genetic testing - alternative to prenatal diagnosis
36
Huntington's Disease - ?inheritance pattern
Autosomal dominant -Genetic testing if asymptomatic -> clinical geneticist -Confirmatory genetic testing if symptomatic - neurologist/psychiatrist
37
Hepatitis A -population groups recommended for vaccination
-Travellers to endemic areas -ATSi children -Chronic liver disease -MSM -Injectable drug users -Incarcerated populations - ↑Occupational risk
38
Hep A - infectious period? Management principles?
2 weeks prior to prodrome (fever/malaise/anorexia) --> 1 week post-onset of jaundice Anti-HAV IgM detectable 3-6 months, IgG persists for life Rx - supportive, avoid eTOH/paracetamol -Avoid sharing personal items/sexual activity whilst infectious -Exclude from childcare/work until 1 week after jaundice
39
Measles -management steps -?Who needs immunoglobulin
Isolate patient away from others Apply mask to pt, apply N95 to yourself Immediately notify state department of health ***via phone*** of suspected case -Discuss need for PCR testing w/ health department Take **serology** for *all* suspected cases Vacate consult room for *at least 2 hours* Pregnant women, immunocompromised, kids <6mths age. (=PEP - withiin 72 hrs exposure) ## Footnote Close contact = same room for 30 mins
40
Mycoplasma genitalium -Ix -Rx
NAAT PCR - FPU, **vaginal**/endocervical/rectal swab (pharyngeal infection uncommon, mostly from genital contact) Rx - doxycyline 100mg BD 7/7 + azithromycin 1g stat then 500mg for 3/7 (Moxifloxacin 400mg daily for 7/7) Test of cure 2-3 weeks (no sex 'til then) ## Footnote Mostly asymptomatic - no routine screening recommended
41
Pertussis - definition of close contact -When to start Rx -Rx options
-Family & household members -F2F exposure (within *1 metre*) for at least *1 hour* Start Rx within 3 weeks of symptom onset 1. Azithromycin 500mg d1, 250mg daily for another 4/7 2. Clarithromycin 500mg BD 7/7
42
Pertussis - who to give antibiotic prophylaxis? (kids - 4 criteria, adults - 4 criteria)
Children: -Age <6 months OR -<3 doses pertussis vaccine OR -Household member age <6 months OR -Attend childcare in same room as infant <6 months Adults (regardless of immunisation status): -Expectant parents in last month of pregnancy OR -Health care worker in maternity hospital or newborn nursery OR -Childcare worker in close contact with infants <6 months OR -Household member aged <6 months
43
Morphine dose for palliative dyspnoea
1-2.5mg Q4hrly IR OR 5-10mg MR BD
44
Reasons for intentional medication non-adherence (8)
○ Fear ○ Side effects ○ Cost ○ Misunderstanding ○ Too many meds ○ Lack of symptoms ○ Depression ○ Mistrust
45
Signs of sepsis - eTG (5)
-Impaired consciousness -Hypoxaemia -Hypotension -Tachypnoea >22 -Blood lactate >2
46
Reduced cognition/Dementia/memory DDx (9)
-Delirium 2ndary to infection -Depression -CVA -eTOH withdrawal/intoxication -Subdural haematoma -Brain cancer -Vit B12 deficiency -Hypothyroidism -Hyponatraemia
47
Symptoms (7)/signs (5) of strangulation
* Symptoms ○ Neck pain, coughing ○ Difficulty swallowing/breathing ○ Hoarse voice ○ Bladder/bowel incontinence ○ LOC/memory loss ○ Visual changes ○ Seizures * Signs ○ Subconjunctival haemorrhage ○ Petechiae above site of application of force ○ Bruising/abrasions to neck ○ Raspy/hoarse voice ○ Swelling of neck/face/tongue
48
secondary Restless leg syndrome aetiology DDx (5)
Iron deficiency CKD Pregnancy Meds (e.g antidepressants) Thyroid dysfunction
49
Syphilis in pregnancy Rx steps (5)
○ Benzathine benzylpenicillin 1.8g (=2.4 million units) ○ Re-check RPR in 4 weeks time --> need >2 fold drop in RPR titre from 1:128 ○ Also repeat RPR at 28 weeks, 36 weeks and delivery ○ Post-delivery - 3, 6, 12 month repeat testing ○ Contact tracing & notification
50
Syphillis management - ?main reaction ?Clin features ?management
Jarisch-Herxheimer reaction * Reaction 6-12 hours after syphilis Rx - fever, headache, rigors, joint pain * Symptoms controlled w/ analgesics and rest
51
Syphilis stages and clin. features
Primary - chancre (painless genital/anal/oral ulcer), incubation period 10-90 days, spont. heals. Inguinal lymphadenopathy Highly infectious Secondary - systemic symptoms, fever/malaise/headache/lymphadenopathy Rash - trunk, palms/soles Alopecia or mucous patches Incubation period 2-24 weeks Highly infectious Early latent (<2 years)/late latent (>2 years) - late = *no longer infecitous to partners* but can still have vertical transmission Tertiary - Cx incl. destructive skin lesions (gummas), CVS or neurological disease ## Footnote Many asymptomatic (up to 50%)
52
Alcohol withdrawal symptoms/signs (7)
○ Anxiety/panic attachs ○ Tachycardia ○ Diaphoresis ○ Nausea/vomiting ○ Dilated pupils ○ Tremor ○ Delirium tremens - agitation/hallucinations/gross tremors/seizures ## Footnote Give 100mg IV thiamine for 5 days, then oral. Esp. if treating hypogylcaemia, before giving glucose (risk of Wernicke's encephalopathy)
53
People NOT suitable for eToh home detox program (6)
○ History of alcohol-related seizures or delirium tremens ○ Risk of suicide ○ Inadequate availability of social support/requirement for daily care or supervision ○ Polypharmacy misuse ○ Severe liver disease ○ Advanced age
54
Initial evaluation of mild chronic elevated aminotransferases (5)
-Review Medications/recreational drugs -Alcohol abuse? -Serology for Hep B/C -Haemachromatosis screen (iron studies) -Fatty liver w/ USS ## Footnote 2nd line Ix - autoimmune hep screen, TFTs, coeliac serology
55
Fitness to Drive - minimum non-driving periods for: * AMI * TIA * Cardiac arrest * Diabetic severe hypoglycaemic event * Stroke
* AMI - 2 weeks (private), 4 weeks (commercial) * TIA - 2 weeks (private), 4 weeks (commercial) * Cardiac arrest - 6 months (P&C) * Diabetic severe hypoglycaemic event - 6 weeks * Stroke - 4 weeks (private), 3 months (commercial) ## Footnote * Sleep apnoea - any = must have conditional licence
56
Fitness to Drive Guidelines - conditional or unconditional licence?: -Diabetes diet controlled -Diabetes OHGs -Diabetes on insulin
-Diabetes diet controlled - no licence restriction -Diabetes OHGs - Private: not fit for unconditional if end-organ Cx or recent hypo. Commercial: must be conditional w/ endo r/v -Diabetes on insulin: Private: conditional w/ 2yearly review. Commercial: conditional w/ annual endo r/v
57
Fitness to Drive Guidelines - minimum visual acuity: -Private licence -Commercial licence
* Private - minimum 6/12 bilat (for unconditional licence) * Commercial - better eye min 6/9, worse eye min. 6/18
58
# Diagnosis? Cognitive impairment + urinary incontinence + gait disturbance
normal pressure hydrocephalus