GP Flashcards
(769 cards)
1
Q
Most common cause of androgen deficiency
A
Klinefelter Syndrome (47 XXY)
2
Q
What are the physical features of Klinefelter syndrome
A
Tall, reuduced facial and body hair, small testes, breast development, feminine fat distribution
3
Q
What is the hormone profile of Klinefelter syndrome
A
Low testosterone, high FSH and high LH
4
Q
Causes of Gynaecomastia
A
Testicular cancer Klinefelter syndrome Androgen deficiency Cirrhosis breast cancer hyperthyroidism Chronic renal failure Alcohol
5
Q
What is Kallman Syndrome
A
X linked syndrome with anosmia, hypogonadism and colour blindness
Hypothalamic failure: Low FSH
6
Q
What are the findings on ECG for pericarditis
A
widespread concave ST elevation
PR depression
7
Q
What imaging is needed for pulsatile tinnitus?
A
CT Angiography
8
Q
As per the National Standards governing medical fitness to drive how long should a pt be seizure free before they can be judged fit to return to driving a private vehicle?
A
6 months
9
Q
What are the criteria for metabolic syndrome
A
HDL<1 (men) <1.3 (women) triglycerides >/=1.7 BP >/=130/85 elevated waist circumference fasting sugar >5.5
10
Q
what animal is brucellosis associated with
A
Feral pigs
11
Q
What scan do you do for pagets disease
A
bone isotope scan
12
Q
what vaccinations are at 18 months
A
MMRV
Hib
Dip, tetanus, pertussis (infanrix)
13
Q
What vaccinations are at 4 years
A
Infanrix IPV
ATSI pneumovax 23 and Hep A
14
Q
What vaccinations at 12-13 years
A
Gardasil 9
Boostrix
15
Q
What vaccinations at 14-16 years
A
Men ACWY
16
Q
when is zostavax recommended on the schedule
A
70-79 years
17
Q
causes of erythema multiforme
A
HSV Idiopathic food additives medications - penicillins TB Lymphoma SLE
18
Q
causes of erythema nodosum
A
IBD, COCP, Sarcoidosis, Streptococcal infection, HIV
19
Q
Causes for raised CA125
A
Ovarian cancer endometriosis pregnancy cirrhosis SLE breast cancer fibroids
20
Q
RIsk factors for ovarian cancer
A
Family history no pregnancies Obesity older age gene mutations
21
Q
HASBLED
A
Hypertension Abnormal liver or renal function Stroke Bleeding history Labile INRs Elderly >65 years Drugs - antiplatelets
22
Q
Pericarditis causes
A
TB SLE post myocardial infarction uraemia post coronary intervention HIV
23
Q
Coeliac antibodies
A
TTG-IgA, DDP-IgG
24
Q
Treatment for balanitis
A
Soak in warm slt water
barrier cream
antifungal cream - clotrimazole (if candida)
do not retract foreskin
25
CKD risk factors
```
Age >60
Smoker
Diabetes
Hypertension
CVD
History of AKI
ATSI
```
26
Treatment for H pylori
* Esomeprazole 20mg orally BD for 7 days
* Amoxicillin 1g orally BD for 7 days
* Clarithromycin 500mg orally BD for 7 days
27
IBS treatment options
* Hyoscine butylbromide
* Mebeverine
* Amitriptyline
28
treatment for addison crisis
IV hydrocortisone 100mg
29
Superficial BCC treatment options
* Excise 5mm margins
* Double freeze thaw cryotherapy
* Imiquimod (Aldara) 5% topically at night 5 times a week for 6 weeks
* Photodynamic therapy
30
Examination findings for haemochromatosis
Bronze skin
arthritis
testicular atrophy
hepatomegaly
31
Which part of the scaphoid is at risk of AVN
proximal scaphoid
32
Causes of skin hyperpigmentation
```
Addisons
Haemochromatosis
Cushing Syndrome
Hyperthyroidism
Pregnancy
```
33
Managment of venous dermatitis
```
Leg elevation
measure ABI
if ABI ok apply compression stockings up to knee
regular waslk
betamethasone 0.05% daily
regular walks/exercise
daily moisturiser
frusemide 40mg daily
```
34
Management of keratosis pilaris
urea cream 10% topically daily
use pumice stone while bathing
topical retinoid: tretinoin 0.025%
reasurrance no treatment required
35
Drugs that can cause hyponatremia
SSRI
Hydrochlorothiazide
SNRIs
Carbamazepine
36
Treatment for neuroleptic malignant syndrome
Bromocriptine
37
Symptoms of neuroleptic malignant syndrome
```
lead pipe rigidity
bradykinesia
tremor
hyperthermia
tachycardia
hypertension
drowsiness
```
38
what scan do you want for myasthenia gravis
CT chest for thymoma
39
Examination findings for intracranial hypertension
Papilloedema, abducens nerve palsy and reduced visual acuity
40
managment of dystonia
benztropine
41
Treatment of bronchiectasis exacerbatiob
Amoxicillin 1g TDS for 14 days
42
First line treatment for peripheral neuropahty diabetes
amitriptyline 25mg nocte
43
Investigations to consider in allergic rhinitis
RAST
| skin prick testing
44
Physical Examination allergic rhinitis
Darkened circles around eyes
transverse nasal crease
pale swollen inferior turbinates
red oedematous eyelids
45
peripheral vertigo nystagmus direction
horizontal
46
Examination for parotid glad sialolithiasis
Examination for parotid stones include palpation of buccal mucosa and inspection and palpation of Stenson's duct (adjacent to 2nd upper molar)
47
Management of sialolithiasis
- Apply moist heat
- Massage the gland
- Manage pain with NSAIDs
Suck on hard tart candies to encourage saliva flow
48
Management of sialadenitis
- Antibiotics : fluclox 500mg QID for 10 days
- Warm compresses
- Salivary gland massage
Sialogogues to increase saliva flow eg pilocarpine
49
features of barotrauma
• Retraction
• Redness
• Fluid
Pain, tinnitus, vertigo
50
PID Treatment
* Ceftriaxone 500mg in 2mL lidocaine IM
* Metronidazole 400mg BD 14 days
* Doxycycline 100mg 12 hourly for 14 days
51
Actinic Keratosis treatment
* Flurouracil 5% cream topically once or twice daily for 2-4 weeks on the face or 3-6 weeks on arms and legs
* Imiquimod 5% cream topically at night 3 times weekly for 3-4 weeks
* Or Ingenol Mebutate 0.05% gel topically for 2 days
52
Treatment for pitted keratolysis
• Clindamycin 1% topically BD for 10 days
53
Cold sore treatment
* Famciclovir 1500mg stat OR
| * Acyclovir cream 5% 5 times a day 5 days
54
what is needed for CVD assessment
age, sex, smoking status, total cholesterol and HDL–C, systolic blood pressure (SBP)
55
How long after an acute MI can you not drive for
2 weeks
| 4 weeks post cabg
56
Cardiac tamponade
Hypotension, Raised JVP, Muffled heart sounds
57
Digoxin Effect on ECG
- Downsloping ST depression
- Shorted QT interval
Flattened, inverted or biphasic T waves
58
causes of inverted T waves
- Normal in children
- Myocardial ischaemia and infarction
- Bundle branch block
- Ventricular hypertrophy
- Pulmonary embolism
- Hypertrophic cardiomyopathy
Raised ICP
59
causes of left ventricular hypertrophy
- Hypertension
- Aortic Stenosis
- Aortic regurgitation
- Mitral regurgitation
- Hypertrophic cardiomyopathy
Coarctation of the aorta
60
causes of bradyarrhythmias
- Drugs: BB, Ca
- raised ICP
- Ischaemic heart disease
- Hyperkalaemia
Hypothermia
Hypothyroidism
61
causes of RBBB
```
• pulmonary hypertension
• atrial septal defect
• rheumatic heart disease
• myocarditis
• Brugada syndorme
pulmonary embolism
```
62
causes of LBBB
```
• aortic stenosis
• IHD
• hypertension
• dilated cardiomyopathy
• anterior MI
• primary degenerative disease (fibrosis) of the conducting system
• Hyperkalemia
Dignoxin toxicity
```
63
Hypertrophic Cardiomyopathy
Shortness of breath, palpitations, bifid apical beat and increased intensity of systolic murmur on valsalva
64
Management of Familial Hypercholesterolaemia
• Pts must be started on statin straight away - 40mg atorvastatin
• Test close family relatives: cascade testing
• Immediately high risk CVD
• Dietician referral: low fat diet
• Exercise: 30 mins/day
Refer to lipid specialist
65
Erysipelas
• streptococcus pyogenes infection of the deep dermis and subcutis
treatment relies upon IV benzylpenicillin
66
erythrasma treatment
Fusidate sodium 2% BD for 14 days
67
causes of erythromelalgia
diabetes, polycythaemia ruba vera, connective tissue disease
68
Hot tub folliculitis
Caused by pseudomonas
| Ciprofloxacin
69
Management of guttate psoriasis
1. Mometasone 0.1% cream daily for 2-6 weeks
2. Daivobet (calcipotriol + betametasone)
3. Coal tar topical 1% gel/emulsion OR LPC 6% + salycilic acid 3% cream. BD for 1 month
70
causes of hairy tongue
```
• Poor oral hygiene
• Smoking or chewing tobacco
• Drinking alcohol
• Cocaine
• Chlorhexidine or peroxidase-containing mouthwash
• Coloured beverages, including coffee
• Dehydration
• Hyposalivation (dry mouth)
Radiation therapy
```
71
medical mx of hidradenitis suppurativa
doxycycline 50 to 100 mg orally, once daily for 6 weeks, then review
72
palmar hyperhidrosis
Iontophoresis
73
Itch with normal skin
```
• Cholestasis
• Chronic renal insufficiency /uraemia
• Iron deficiency
• Polycythaemia rubra vera
• Hyperthyroidism/ hypothyroidism
• Diabetes
• Hyperparathyroidism
• Malignancy ;lymphoma, multiple myeloma, leukaemia
• Drug induced - statins, ACEI, diuretics, recreational drugs
• Hyperparathyroidism
• Neurological condition: cerebral infarct, brain abscess, MS, Parkinson's
HIV, Hep C
```
74
Causes of balanitis
Chemical irritation: urine trapping, soiled nappies, soap residue
Physical trauma: forcible retraction
Candida nappy rash in infants
75
commonest causes of priapism in children?
sickle cell disease (65%), leukaemia (10%) and trauma (10%)
76
Differentials for jaundice and weight loss
- Head of pancreas cancer
- Cholangiocarcinoma
- Choledocholelithiasis
- Alcoholic hepatitis
- Viral hepatitis
- Primary biliary cirrhosis
- Hepatocellular carcinoma
Hepatic metastatsis
77
Causes of unconjugated bilirubinaemia
- Haemolysis
- Ineffective erythropoiesis
Impaired hepatic uptake or conjugation of bilirubin: Gilbert, Crigler-Najjar syndrome
Physiological: breast milk jaundice, neonatal jaundice
Iatrogenic: drug eg gentamicin
78
causes of conjugated bilirubinaemia in neonate
- Biliary atresia
- Neonatal hepatitis
Metabolic (galactosaemia, fructose intolerance)
79
causes of uncongugated bilirubin in neonate
```
phyioological jaundice
breast milk jaundice
breast feeding jaundice
sepsis
Haemolysis
```
80
Pancreatic cancer risk factors
• Smoking
• obesity (body mass index >30 kg/m2)
• heavy alcohol use (>4 standard drinks/day)
• long-standing diabetes (>5 years)
one first-degree relative (FDR) with pancreatic cancer, BRCA1 gene carrier status, Lynch syndrome and familial adenomatous polyposis
81
Morton neuroma mx
• Use of metatarsal insoles/inserts in shoes
• Wearing broad toed shoes
• Corticosteroid injection in the affected area
Surgical removal
82
referral of paediatric inguinal hernia
○ 2 days <6 weeks
○ within 2 weeks for child <6 months and
2 months for >6 months
83
Indications to use a syringe driver
```
• Persistent nausea and vomiting
• Dysphagia
• Bowel obstruction
• Coma
• Poor absorption of oral drugs
Patient preference
```
84
spinal mets pain mx options
- Radiotherapy
- Paracetamol
- Morphine syrup
- Bisphosphonate therapy
- NSAIDS
Dexamethasone
85
Investigations in Hypertrophic cardiomyopathy
Echo, ECG, 24 hour holter monitor
86
Pancreatitis causes
```
Idiopathic
Gallstones (60%)
Ethanol (20%)
Tumours
Scorpion stings
microbiological: mumps, CMV, mycoplasma
Autoimmune: SLE, PAN, Crohn's
Surgery/ trauma
Hyperlipidemia, Hypercalcemia, Hypothermia
Emboli or Ischaemia
Drugs/ Toxins
```
87
tumour markers for testicular cancer
LDH, AFP and HCG
88
risk factors for gastric cancer
- Smoking
- Intestinal metaplasia of stomach
- Atrophic gastritis
- Increasing age
- H pylori
- Previous partial gastrectomy
89
risk factors for testicular cancer
• cryptorchidism, with cancer developing in both the undescended and the contralateral testicle
• subfertility (small, soft testes)
• Caucasian ethnicity
• family history of testicular cancer
• previous contralateral tumour
• human immunodeficiency virus infection (untreated)
Down syndrome.
90
drugs that can trigger psoriasis flares
lithium, beta blockers, chlorquine, hydroxychloroquine and interferon alfa
91
First line treatment of trunk and limb psoriasis
LPC 6% + salicylic acid 3% cream BD for 1 month
92
Factors that aggravate psoriasis
Streptococcal tonsillitis
Injuries - cuts, abrasions
Sun exposure in 10%
Obesity
Smoking
Excessive alcohol
Stressful event
Medications: lithium, beta blockers, anti malarias, anti inflammatories
Stropping oral steroids
93
Scalp psoriasis
Methylprednisolone aceponate 0.1% lotion topically, once daily until skin is clear
If response is inadequate after 2 weeks change to
Betamethasone dipropionate 0.05% lotion topically BD for 6 weeks
94
Triad of signs in grAVES DISEASE
Pretibial myxoedema
Ophthalmopathy (prominent eyes due to deposition of myxoedema behind the orbit)
Acropachy (swelling of distal digits with overgrown nail plates that may lift off the nail bed; similar to clubbing)
95
pyoderma gangrenosum is associated with
Inflammatory bowel disease
More commonly UC
Rheumatoid arthritis
Leukaemia
Hepatitis
96
digital myxoid cyst treatment
Aspiration of contents
Sclerosant injection
Cryotherapy
Surgical removal
97
most risk gene mutation for haemochromatosis
C282Y
98
what is lichen sclerosis associated with
Vulval cancer
Hashimoto's thyroiditis
Vitiligo
Pernicious anaemia
99
causes of facial flushing
```
menopause
rosacea
phaeochromocytoma
carcinoid syndrome
food additive
alcohol
```
100
tinea corporis
tebinafine 1% daily for 7-14 days
101
Anaphylaxis adrenaline dose
0.5mls of 1:1000
102
treatment for funnel web spider bite
pressure immobilisation bandage
| anti venom if required
103
Initial treatment of symptomatic ascites
spironolactone 50-100mg daily
104
Management of ascites
• sodium restriction
• adequate protein and energy intake
• diuretics
• large-volume paracentesis and intravenous albumin for severe or refractory ascites
• transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites
liver transplantation for refractory ascites.
105
Ichthyosis
fish scale skin
106
Management of Anal Fissure
○ Avoid hard stools
○ Warm salt baths after bowel movements
GTN ointment 0.2% topically 3-4 times a day
107
Non pharmacological mx for Hidradenitis Suppurativa
* wear loose clothing
* stop smoking
* eat healthily and lose weight, if appropriate.
108
antibiotics options for Hidradenitis Suppurativa
Clindamycin 1% lotion topically BD if mild
| doxycyline 100mg daily for 6 weeks
109
what is Wernicke's Encephalopathy associated with
Generally associated with chronic hazardous alcohol use, but also occurs in associated with bariatric surgery, cancer and recurrent vomiting or chronic diarrhoea
110
Box Jellyfish first aid
Vinegar and remove tentacles
ice packs
analgesia
(anti venom available)
111
psychosocial reasons behind opioid dependency
```
depression
unemployment
use of other substances
negative life events
social isolation
low self esteem
```
112
management of paediatric clavicle fracture (middle third)
broad arm sling for 2 weeks
113
weber A ankle fracture
WBAT in boot
| fracture below
114
risk factors for DDH
female, 1st born child, family history, breech presentation, oligohydramnios
115
Treatment for severs disease
* Rest
* Well fitting shoes
* Icepacks
* Gel heel pads
* Calf stretches
* Pain usually settles within 6-12 months
116
what is a toddlers fracture
Toddler fractures occur in young ambulatory children (from 9 months to 3 years).
A toddler's fracture is a spiral or oblique undisplaced fracture of the distal shaft of the tibia with an intact fibula. The periosteum remains intact and the bone is stable. These fractures occur as a result of a twisting injury. Septic arthritis and osteomyelitis should be excluded.
117
How to reduce pulled elbow?
Fully pronate forearm and then flex the elbow
118
skin prick testing
- Avoid antihistamines 4 days prior to test
- Carries a low but serious risk of side effects
- Not useful for food additives
The size of the skin prick reaction odes not correlate with severity of allergic manifestations
119
symptoms of orbital blowout fracture
pain (especially on vertical movement), local tenderness, diplopia (especially on vertical gaze), eyelid swelling and crepitus after nose blowing
120
Examination of orbital blowout fracture
* epistaxis, ptosis, localised tenderness
* restricted eye movements, particular on vertical gaze, resulting in diplopia
* complete eye examination looking for evidence of ocular injury, e.g. hyphema, subconjunctival hemorrhage, retro-orbital hemorrhage, retinal detachment and vitreous hemorrhage.
* check for infraorbital nerve involvement — anesthesia of the affected cheek, and the upper teeth and gums on the affected side. this nerve passes along the floor of the orbit and be stretched or otherwise damaged.
* palpate the eyelid for crepitus
* there may be no other significant facial injury.
121
Monteggia fracture
fracture of the ulna shaft with dislocation of the radial head at the elbow
122
Galleazi fracture
fracture of the distal radial shaft with dislcoation of the ulnar with its articulation at the distal radial head
(widened distal radioulnar joint)
123
Colles fracture
transverse fracture of the distal radius with dorsal displacement
(dinner fork deformity)
124
Smith Fracture
distal radial fracture with volar (palmar displacement)
125
nerve likely to be impacted with humeral shaft fracture
radial nerve (wrist drop, sensory impairment dorsum of hand)
126
type 1 Supracondylar fracture mx
Immobilisation in an above-elbow backslab in 90 degrees elbow flexion with sling for 3 weeks.
127
Bennet Fracture
- fracture of the base of the first metacarpal bone which extends into the carpometacarpal joint
- Intra articular fracture
- most common type of fracture of the thumb
- nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint
128
Fractured surgical neck of humerus mx
Triangular sling
When pain subsides (10–14 days), encourage pendulum exercises in the sling
Aim for full activity within 8–12 weeks post-injury
129
Jones Fracture
Fracture at the base of the 5th metatarsal
130
Mallet finger
Injury to the extensor digitorum at its distal insertion
131
Initial measures to manage priapism
- Cold shower
- Oral pseudoephedrine 120mg
Walk up and down stairs/gentle jog
132
complications of priapism
- May cause permanent damage to erectile tissue
- Erectile dysfunction
Possible disfigurement of penis
133
bacterial sinusitis abx
Amoxicillin 500mg TDS for 5 days
| Allergy (doxycycline 100mg BD 5 days)
134
Signs of Addisons
```
Hyperpigmentation
postural hypotension
tachycardia
dry mucous membranes
vitiligo
decreased body hair
```
135
Diagnosis of Addison's
```
short synacthen
(ACTH stimulation )
```
136
Aspects of self care for pts with addisons
• Medicalert bracelet
• Increase glucocorticoid dose during illness
• Recognise early features of adrenal crisis (nausea, vomiting, dehydration, hypotension)
• Carry injectable hydrocortisone when away from medical care
Carry a wallet card with details about condition
137
What to measure when monitoring a pt with adrenal insufficiency
Measure sodium, potassium and plasma renin
| plasma renin upper normal = good
138
Cushing's Disease
adrenocorticotropic hormone–producing pituitary adenoma
139
Clinical Features of Cushing's Syndrome
```
• Proximal muscle wasting and weakness
• Central obesity, buffalo hump on neck
• Cushing facies: plethora, moon face, acne
• Weakness
• Hirsutism
• Abdominal striae
• Thin skin, easy bruising,
• Hypertension
• Hyperglycaemia
• Menstrual changes
• Osteoporosis
• Psychiatric changes, especially depression
backache
```
140
Testing options for Cushing's Syndrome
- Late night salivary cortisol (2 measurements)
- 24 hour urinary free cortisol (2 measurements)
Overnight 1mg dexamethasone suppression test
141
causes of diabetes insipidus
```
• Post operative (hypothalamic -pituitary ) - transient
• Tumours
• Infections
Infiltrations
• trauma
• Anorexia nervosa
Familial and congenital disorders
```
142
Causes of SIADH
• stress (pain, nausea, post-surgical)
• malignancy (lung (bronchial carcinoma), pancreas, lymphoma)
• CNS disease (inflammatory, haemorrhage, tumour, Guillain-Barré syndrome)
• respiratory disease (TB, pneumonia, empyema)
• drugs (SSRIs, vincristine, chlorpropamide, cyclophosphamide, carbamazepine, nicotine, morphine, DDAVP, oxytocin)
Hypothyroidism
143
carcinoid syndrome
Flushing, diarrhoea, bronchospasm
| Classic Triad: skin flushing, diarrhoea, valvular heart disease
144
antibodies in post partum thyroiditis
antithyroid peroxidase antibodies
145
what change do you make to thyroxine dose in pregnancy
increase by 25% at 6 weeks
| test TSH 4-6 weeks during 1st trimester
146
iodine dose in prengancy
150MCG
147
TSH aim for pts younger than 60
0.5-2.5
148
De Quervain Thyroiditis
inflammation of the thyroid that results in transient thyrotoxicosis followed by hypothyroidism and usually a subsequent return to euthyroidism
pain, fever, malaise
(near absent uptake on thyroid scan), marked increase in ESR
149
Treatment for De Quervain Thyroiditis
Ibuprofen
| Prednisolone 40mg daily, tapering over 2-4 weeks
150
common causes of goitre
```
• Hashimoto thyroiditis
• Graves disease
• Familial or sporadic multinodular goitre
• Iodine deficiency
• Follicular adenoma
• Colloid nodule or cyst
Thyroid cancer
```
151
Suppurative Thyroiditis
caused by an infection of the thyroid gland (usually bacterial) and is rare but potentially life-threatening
152
DDx for painful anterior neck lump
```
• De Quervain's thyroiditis (subacute granulomatous thyroiditis)
• Suppurative or infectious thyroiditis
• Skin infection/cellulitis
• Infected sebaceous cyst/thyroglossal cyst
• Haemorrhage into thyroid nodule
• Graves disease
• Traumatic thyroiditis
Thyroid node harbouring thyroid cancer
```
153
Riedel's Thyroiditis
- A very rare condition where dense fibrotic tissue replaces thyroid parenchyma and extends to involve adjacent tissues (trachea, esophagus, parathyroid glands, RLN)
- Hard, stony, woody, painless goitre
154
what is thyroglobulin useful for
Thyroid cancer
155
anti thyroid drug for primary hyperthyroidism
carbimazole 15mg bd
| second line = propylthiuracil
156
what to warn pts about carbimazole
can cause agranulocytosis: seek medical assistance if acute malaise, fever or infection (usually severe pharyngitis)
157
symptoms of thyrotoxicosis treatment
- propranolol 10mg BD
158
Clinical Features of severe hypomagnesaemia
tetany, muscle weakness, cardiac arrhythmas
159
causes of raised anion gap metabolic acidosis
```
Raised Anion Gap: Failure of H+ excretion (KUSSMAUL)
• Ketosis
• Uremia
• Salicylate poisoning
• Methanol posioning
• Ethylene poisoning
• Uremia
• Lactic Acidosis
```
160
causes of normal anion gap metabolic acidosis
Normal Anion Gap = Loss of bicarbonate
- diarrhoea
- renal tubular acidosis
161
Causes of Hypomagnesaemia
```
poor oral intake
diarrhoea
PPIs
extensive bowel resection
hypercalcaemia
diuretics
```
162
Causes of high Magnesium
```
- Excessive intake
○ Antacids
○ Enemas
○ IV infusion
- Decreased excretion
○ Renal failure
○ Volume depletion
○ Familial hypocalciuric hypocalcaemia
- Rhabdomyolysis
Lithium
```
163
Hypercalcaemia
```
Primary Hyperparathyroidism, Familial Hypercalciuric Hypercalcaemia and neoplasia
vitamin D toxicitity
• Drugs: thiazide diuretics
• Paget disease
• Williams syndrome
• Prolonged immobilisation
• Sarcoidosis
Milk-alkali syndrome
```
164
ECG features of hypokalaemia
* Increased P wave amplitude
* Prolongation of PR interval
* Widespread ST depression and T wave flattening/inversion
* Prominent U waves (best seen in the precordial leads V2-V3)
* Apparent long QT interval due to fusion of T and U waves (= long QU interval)
165
What indicates good asthma control?
Daytime symptoms <=2 days/week
Need for reliever <= 2 days/wee
no limitation of activity
No symptoms during night or on waking
166
Risk factors for asthma exacerbations
```
poor adherence
poor inhaler technique
lack of asthma action plan
any asthma exacerbation within past 12 months
exposure to tobacco smoke
allergic rhinitis
poor symtpom control
```
167
Risk factors for life threatening asthma flare
• Poor asthma control
• Admission to hospital in preceeding 12 months
• History of intubation for acute asthma
• Over-use of short acting beta2 agonist reliever
• Poor adherence to asthma action plan
• Exposure to tobacco smoke
• Frequent failure to attend appointments
Parent/carer unequipped to manage asthma emergency
168
in a child what are the indications to prescribe a preventer?
- Episode of life threatening asthma requiring hospital/ICU
- More than 2 ED presentations
- Requiring oral corticosteroids for more than 2 flares
- Flare up more than once every 6 weeks
- Night time symptoms more than twice per month
- Asthma symptoms restrict activity
- Asthma symptoms restrict sleep
Day time symptoms more than once per week
169
what is symbicort
budenoside/formoterol
| asthma low.mid dose 200/6 BD
170
Maintenance asthma treatment children 1-5 years
Children 1 -5
Step 1: Salbutamol
Step 2: Fluticasone propionate 50mcg BD
Step 3: Refer to respiratory physician
171
Maintenance asthma treatment >6 years
Step 1: Salbutamol
Step 2: Fluticasone propionate 50-100mcg BD
Step 3: Fluticasone propionate 125-250mcg BD OR fluticasone propionate + salmeterol 100+50mcg BD OR ICS + monteleukast
172
causes of hypocalcaemia
- Hypoalbuminaemia
- Renal failure
- Hypoparathyroidism
- Drugs: anticonvulsants, bisphosphonates
- Vitamin D deficiency
- Malignancy
- Acute pancreatitis
Rhabdomyolysis
173
How to assess for diabetic peripheral neuropathy?
• 10g monofilament pressure sensation at metatarsal joints
• Ankle reflexes
• Vibration sensation with 128Hz tuning fork
Pinprick sensation
174
what is the maximum safe dose of lignocaine with adrenaline
The maximum safe dosage for lignocaine 1% (also known as lidocaine) with adrenaline is 7mg/kg.
175
who is eligible for self collected cervical cancer screening
• those who have never participated in the NCSP and are 30 years or over
those who are overdue for cervical screening by 2 years or more and aged 30 years or over
176
what causes slow central vision loss
macular degeneration
177
what diet is good for macular degeneration
diet rich in fish containing omega 3 fatty acids and dark green leafy veg
178
When to refer CKD to nephrologist
stage 4 or 5 CKD of any cause
•persistent significant albuminuria (ACR ≥30 mg/mmol)
•decline in eGFR of >25 mL/min/1.73 m2over a six-month period–Because there can be variation of up to 15–20% between consecutive individual eGFR measurements, the decline should be confirmed on at least three separate readings.
•glomerular haematuria with macroalbuminuria
•CKD with hypertension where target blood pressure is difficult to achieve despite treatment with at least three antihypertensive agents.
179
Non pharmacological management of AF
```
Weight management:aim 10% loss for BMI <27
Screen and manage sleep apnoea
exercise: 210 mins per week
Aim BP <130/80
Aim HBA1c<6.5%
Lipids
Smoking cessation
Alcohol:less than or equal to 3 std/week
```
180
Treatment for phimosis
Topical corticosteroid (hydrocortisone 1%) TDS for 1 month
181
Bloods wanted in Addison's
EUC, Cortisol, BGL, adrenocortiotropic hormone
| diagnose: short synacthen test
182
dihydropyridine calcium channel blocker
Amlodipine
| Nifedipine MR
183
non dihydropyridine calcium channel blocker
diltiazem, verapamil
184
non pharmacological mx of BPSD
-identify and reduce triggers of aggression
- Provide reassurance to patient
- Calm, low stimulating environment
- Positive reinforcement for good behaviour
- Provide familiar environement- photos of family
- Time orientation aids: whit board with time and day
- Massage
Regular leisure activities eg arts
185
medical managment for BPSD
• Risperidone 0.25mg PO, BD (max 2mg day)
| OR olanzapine 2.5mg daily
186
COPDX
```
• Case finding and confirm diagnosis
• Optimise function
• Prevent Deterioration
• Develop a plan of care
Manage eXacerbations
```
187
Normal pressure hydrocephalus
urinary incontinence, gait disturbance, and dementia
188
facial and flexural seborrheic dermatitis treatment
hydrocortisone 1% + clotrimazole 1% cream once or twice daily until skin is clear or for up to 2 weeks
189
most likely organism to cause croup
Parainfluenza virus type 1.
190
Which type of tremor is MOST commonly associated with thyrotoxicosis?
postural tremor
191
most common acute ECG findings of takotsubo cardiomyopathy
ST segment elevation in the praecordial leads and T-wave inversion in most leads
192
Diagnostic criteria for diabetes
single elevated FBG ≥7.0 mmol/L
• single HbA1c ≥6.5%
• a random blood glucose ≥11.1 mmol/L.
(if symptomatic one reading = diabetes,if notsymtpomatic need 2 separate occasions)
193
Impaired fasting glucose numbers
• HBA1c 6-6.4%
| 5.5-6.9
194
what can cause an abnormally low HBA1c
```
anaemia – haemolytic anaemia – congenital (eg spherocytosis, elliptocytosis) – haemoglobinopathies – acquired haemolytic anaemias (eg drug-induced, such as with dapsone, methyldopa)
• recovery from acute blood loss
• blood transfusions, iron infusions
• chronic blood loss
• chronic renal failure (variable).
```
195
Abnormally high HBA1c can be caused by
iron deficiency anaemia
• splenectomy
• alcoholism.
196
When to dose reduce metformin
Reduce dose by 50% with eGFR 30-60
| Contraindicated in eGFR <30
197
Management of severe hypoglycaemia
IM glucagon 1mg into thigh, buttock or upper arm
If IV access - 50% glucose 20mls
Recheck BGL in 15 mnutes
198
Management of hypoglycaemia
if BGL <4
give 15g of quick acting carbohydrate -half glass of fruit juice
recheck BGL in 15 minutes
if next meal more than 15 mins away give long acting carb eg sandwich
recheck bgl in 2-4hours
199
BGL targets in diabetes
4-7 fasting
| 5-10 post prandial
200
GDM glucose tolerance test cut offs
fasting >5.5
| 2 hours >8
201
Infant complications GDM
```
• Congenital anomalies of cardiovascular/CNS
• Preterm birth
• Perinatal asphyxia
• Macrosomia
• Respiratory distress
• Hypoglycaemia
• Hypocalcaemia
• Polycythaemia
• Low iron
• Hyperbilrubinaemia
• Transient hypertrophic cardiomyopathy
• Fetal death
Shoulder dystocia
```
202
Pregnancy complications GDM
```
- Increased risk of
○ Pre eclampsia
○ Hypertension
○ Early delivery
○ Induction of labour
C section
```
203
pneumococcal vaccine for at risk condition
give prevenar 13 then 12 months later give pneumovax 23 then 2nd dose at least 5 years later
204
when do ATSI get prevenar
give prevenar 13 at 50 years
205
side effects of metformin
GI adverse effects
lactic acidosis
B12 deficiency
206
which diabetic drug to avoid if previous pancreatitis
DPP4 and GLP-1
207
Medications for osteoporosis
Alendronate 70mg weekly oral on empty stomach
60mg denosumab 6 monthly SC
5mg IV zolendronic acid
208
if someone has a minimal trauma fracture at a site other than hip or spine what does the T score need to be to start treatment
=1.5
209
Risk factors for osteoporosis
```
Rheumatoid arthritis
coeliac disease
premature menopause
kidney disease
prolonged steroid use (>3months of >7.5mg/day)
hyperthyroidism
```
210
post partum endometritis abx
Amoxicillin + clavulanic acid BD 7 days
| if severe to hospitalfor IVAbx
211
cut off endometrial thickness post menopause
4mm
212
cut off endometrial thickness pre menopause
12mm
213
Risk factors for endometrial cancer
```
Obesity
Diabetes
Nulliparous
Hypertension
On exogenous oestrogens
Late menopause
PCOS
Tamoxifen exposure
Endometrial thickness >8mm
Family history of endometrial or colon cancer
```
214
what kind of drug is mirabegron
Beta adrenergic agonist
215
oral progestogen option for HMB
Norethisterone 5mg TDS day 1-21 of cycle (r/v in 6 months)
216
Absolute contraindications for PDE5 inhibitors
- Recent MI, stroke or life threatening arrythmia 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)
217
Example of LABA/LAMA combination
```
Spiolto Respimat (tiotropium/ olodaterol 2.5./2.5)
2 inhalations daily
```
218
Example of LABA/LAMA/ICS
Trelegy Elipta (FUV) : fluticasone furoate/umeclidinium/vilanterol 100/62.5/25mcg)
219
Dementia Screening Tools
• mini mental state examination MMSE
• GP assessment of cognition (GPCOG)
RUDAS: Rowland Universal Dementia Assessment Scale
220
Non pharmacological mx of dementia
• Education regarding diagnosisAnd progressive nature
Review driving ability and report to relevant authorities
Organise aged care assessment services
Discuss advanced care directive
Organise Webster packs
Cease any drugs that could be causing cognitive impairment
○ Anticholinergics, psychotropics (esp benzodiazepines)
Assess safety at home
Refer to Alzheimer's Australia
Consider carer support and respite
Referral to specialist dementia service
221
Investigations required if both testes are impalpable
• Karyotype
• Serum electrolytes (CAH babies can have low sodium)
Ultrasound
222
Why should undescended testes be fixed?
```
• Impaired fertility
○ Temperature is higher in abdomen than scrotum
• Cancer
○ Seminoma increased 5-10 times
• Trauma
○ More likely to tort
Poor self image
```
223
second line agent in cholesterol mx
ezetimibe 10mg
224
prostatitis treatment
Trimethoprim 300mg daily for 2 weeks
225
how to calculate number needed to treate
inverse of absolute risk reduction
| 100/ARR
226
list 2 meds for BPH from different classes
Tamsulosin (alpha blocker)
| Dutasteride (5 alpha reductase inhibitor)
227
fertile window
5 days prior to ovulation + day of ovulation
228
McCune Albright Syndrome
genetic disorder of bones, skin pigmentation and hormonal problems along with premature puberty
229
most common cause of ambiguous genitalia
congenital adrenal hyperplasia
230
Examination features of hypothyroidism
```
non pitting oedema
bradycardia
goitre
hair thinning
ataxia
peripheral neuropathy
slow relaxing reflexes
```
231
stigmata of anaemia
```
pallor
angular stomatitis
tachycardia
flow murmur
koilonychia
glossitis
```
232
first sign of puberty in males?
testicular enlargement
233
HSP Follow up
• If initial urinalysis is normal or only reveals microscopic haematuria, review clinically and check BP/urinalysis:
○ Weekly for the first month after disease onset
○ Fortnightly from weeks 5-12
○ Single reviews at 6 and 12 months
234
Anaphylaxis adrenaline dose
10 microgram/kg or 0.01 mL/kg of 1:1000 (maximum 0.5 mL), i
235
ASD Red Flags
Does not babble or coo by 12 months of age
Does not gesture (point, wave, grasp) by 12 months of age
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
236
Genetic conditions that are linked to ASD
```
• Fragile X syndrome (1)
• Rett syndrome (1)
• Williams syndrome (1)
• Angelman syndrome (1)
• Landau-Kleffner syndrome (1)
• Prader-Willi syndrome (1)
• Tuberous sclerosis (1)
• Chromosomal abnormalities / chromosomal inversions / chromosomal duplications (only 1 of these options will be awarded 1 mark)
Metabolic conditions (1)
```
237
Red flags with sudden onset hearing loss
• Concurrent head trauma
• Neurological signs or symptoms
Unilateral middle ear effusion (post-nasal space must be examined)
238
Clinical Features of redback spider evenomation
```
Radiating pain to draining lymph nodes / chest / abdomen / back (any of = 2 marks)
Unusual distribution of diaphoresis, e.g. isolated to affected limb (2)
Headache (2)
Nausea / Vomiting (2)
Hypertension (2)
Irritability / agitation (2)
Muscle twitches / fasciculation (2)
Fever (2)
Priapism (1)
```
239
what is tinea cruris?
Jock itch
240
Differentials for tinea cruris
• Candidal intertrigo
• Seborrheic dermatitis
• Flexural psoriasis
Erythrasma
241
otodex
dexamethasone, framicidin, gramicidin
| 3 drops TDS for 7 days
242
treatment of perforated tympanic membrane with otorrheoa
amoxicillin 15mg/kg TDS for 5 days
| panadol
243
Investigation for acoustic neuroma
- MRI brain with gadolinium including internal auditory meatus views
244
Secondary causes of restless legs syndrome
* Anaemia (common)
* Iron deficiency (common)
* Uraemia
* Hypothyroidism
* Pregnancy
* Drugs (antihistamines, anti emetics, lithium)
* Multiple sclerosis
* Parkinsons disease
* Peripheral neuropathy (diabetes,amyloid, motor neuron disease)
245
Non pharmacological mx for restless legs
• Mental distraction during symptomatic periods, crosswords when resting
• Exercise/stretching before bed
• Warm baths during symptomatic periods
• Keep legs cooler than body for sleep
• Reduce alcohol
• Replace iron so ferritin is at least 50
Cease medications that could be contributing (eg antihistamines)
246
when should babies be able to sit independently by?
9 months
247
when should kids be toilet trained by
before 3 years old (day time)
248
Components of safety plan
```
warning signs
protective factors/reasons to live
making a safe space
things that can be done to distract self
people and place to connect with
professionals she can connect with
```
249
Poor prognostic factors of rheumatoid arthritis
• young age of onset
• high RF titre,
• elevated ESR
• activity of >20 joints at presentation
• Anti ccp positivity
• smoking
• Extra articular disease manifestation
• Long disease duration at presentation >3-6 months
• Early radiological bone erosions
Early functional impairment
250
what indicates clinical remission of rheumatoid arthritis
• Symptom relief
• Normalisation of inflammatory markers
Absence of joint swelling
251
How to monitor rheumatoid arthritis
```
• ESR/CRP
• Number of tender swollen joints
• Duration of early morning stiffness
• Functional assessment
Visual analogue scale for patinet reported global assessment
```
252
things to discuss regarding methotrexate
• Compliance - weekly dosing
Discuss safe alcohol consumption - no more than 1-2 drinks once or twice weekly
Discuss contraception
Discuss drug interactions with folate antagonists (trimethoprim)
Discuss vaccinations that are recommended - pneumococcal/ influenza
Advise no live vaccines
Discuss ongoing requirement for regular monitoring of liver/kidney/fbe
Ensure taking folic acid supplement weekly
Discuss sun protection strategies due to risk of photosensitivity
253
DDX for fracture of 5th metatarsal
- Midfoot joint sprain
- Peroneal tendon tear
Lateral ankle ligament sprain
254
Lis Franc Injury
```
• Injuries to the tarsometatarsal joint
• Pain and swelling in the midfoot following acute trauma
• Unable to weight bear or stand
• Plantar ecchymosis
Refer all to orthopaedics
```
255
factors other than ckd that increase urine albumin excretion
- UTI
- High dietary protein intake
- CCF
- Acute febrile illness
- Heavy exercise within 24 hours
- Menstruation
- Genital discharge or infection
Drugs: NSAIDs
256
how long does it take for prep to be effective
7 days in males
| 21 days in females
257
waht drug is prep
tenofovir/emtricitabine
258
Adie Syndrome
at least one dilated pupil, which does not constrict in response to light, loss of deep tendon reflexes and abnormalities of sweating
259
possible presentations of cystic fibrosis
- Chronic cough
- Steatorrhoea
- Failure to thrive
- Sinusitis
- Nasal polyposis
- Meconium ileus
- Diabetes mellitus
- Infertility
Hyponatremic dehydration
260
Retinitis Pigmentosa
* Primary degeneration of the retina
* Hereditary condition
* Degeneration of rods and cones
* Displacement of melanin containing cells from the pigment epithelium into the more superficial parts of the retina
Features
- Begins as night blindness in childhood
- Visual fields become concentrically narrowed
- Blind by adolescence
Irreversible course
261
osteoid osteoma
```
• Benign bone forming tumour
• Small radiolucent nidus
• painful area often in the tibia or femur
• often causes night pain
relieved by NSAIDs
```
262
specificity calculation
true negative/ everyone without the condition
Specificity is defined as the ability of a test to correctly detect those people without the disease (a true negative) and this is calculated with: [D / (B + D)] x 100.
263
negative predictive value
probability that people with negative screening test really dont have the disease
264
treatment for neonatal cephalic pustulosis
Ketoconazole 2% cream topically BD until clear
265
most common side effect of TURP
retrograde ejaculation
266
what is the extra vaccine that pre term infants <28 weeks need?
extra pneumococcal at 6 months
| + booster 23vPPV at 4-5 years of age
267
Hep B vaccine changes in preterm <32 weeks and <2kg
give booster dose at 12 months
268
if born to hep B positive mother what should baby get
hep B vaccine at birth and Hep B immunoglobulin
269
How to prevent diverticulitis
- Exercise
- BMI <30
- Avoid smoking
- Limit red meat consumption
High fibre diet
270
Screening Questions to assess risk of falls
- Have you had 2 or more falls in the past 12 months?
- Are you presenting following a fall?
Are you having difficulty with walking or balance?
271
Falls prevention strategies
• Exercise programs/Balance exercises for 2 hours/week (Tai Chi) (1)
• Vitamin D supplementation to achieve a level of >60nmol/L (1)
• Medication review/Psychoactive medication (benzodiazepine) withdrawal/tapering (1)
• Home occupational therapy assessment for home modifications as indicated (1)
Optimise vision/Expedite cataract surgery (1)
272
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
273
Underlying causes carpal tunnel syndrome
```
• Idiopathic
Pregnancy
Diabetes
Hypothyroidism
Rheumatoid arthritis
Gout
Acromegaly
Repetitive activity
```
274
what calcium channel blockers cant go with beta blockers
non dihydropyridine (diltiazem and verapamil)
275
how much gluten is needed to ahve bfore the tests
6 weeks of 3-6 g of gluten daily
276
Kernig's sign
Positive when the thigh is bent at the hip and knee at 90 degrees and extend the knee : get pain
277
Diseases that anterior uveitis is associated with
- Ankylosing spondylitis
- Psoriatic arthritis
- Inflammatory bowel disease
- Sarcoidosis
- Syphilis
Ocular tuberculosis
278
abx treatment for travellers diarrrhoea
azithromycin 1g PO stat
279
Treatment for latent TB
Isoniazid
280
syphilis test of cure
3,6,12 months
281
what antipsychotic to use for BPSD or delirium in parksinsons patients
quetiapine 25mg PO stat
282
when to screen for primary aldosteronism
```
sustained BP >150/100
BP >140/90 on 3 different medications
hypertension and hypokalaemia
hypertension and adrenal incentaloma
hypertesnion and sleep apnoea
all hypertensive first degre relatives of pt with primary aldesteronism
```
283
investigations for high risk bowel cancer
IFOBT every 2 years from 35 to 44
| scope 5 yearly from 45 to 74
284
smoking and inflammatory bowel disease
Smoking is a risk factor for Crohn’s disease and is associated with more severe disease
285
definition of macroalbumninuria
males >25
| females >35
286
microlalbuminuria
males 2.5-25
| females 3.5-35
287
private licence eyesight standards
one or both eyes at least 6/12
288
commercial licence eyesight standards
better eye at least 6/9 AND worse eye at least 6/18
289
causes for bitemporal hemianopia
```
Pituitary adenoma
Craniopharyngioma
Meningioma
Malignant sellar tumour
Sellar benign mass - cyst
```
290
Non pharmacological mx for acne
```
use mild non soap cleanser daily
avoid oil based cosmetic products
use an oil free sunscreen daily
do not pick/squeeze pimples
avoid humid environments where face is exposed to steam eg sauna/spa
```
291
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
292
Contraindications to using PDE5 inhibitors
Recent MI, stroke or life threatening arrythmia 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)
293
Adverse effects of clozapine
- Myocarditis
○ Monitor troponin
- Agranulocytosis
EPSE
294
Causes of thrombocytopenia
```
medication induced
chronic liver disease
vitamin B12 deficiency
SLE
lymphoma
HIV
Pregnancy
ITP
artefact
```
295
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
```
296
risk factors for life threatening asthma flare
• Poor asthma control
• Admission to hospital in preceeding 12 months
• History of intubation for acute asthma
• Over-use of short acting beta2 agonist reliever
• Poor adherence to asthma action plan
• Exposure to tobacco smoke
• Frequent failure to attend appointments
Parent/carer unequipped to manage asthma emergency
297
ICS/LABA for children
fluticasone 50/salmeterol 25mcg 2 puffs BD
298
Imiquimod dose for genital warts
Imiquimod 5% cream 3x weekly at bedtime until warts resolve – 8-16 weeks
299
treatment for initial gential herpes
valaclovir 500mg BD for 5-10 days
300
treatment for episodic genital herpes
valciclovir 500mg BD for 3 days
301
Norethisterone dose in HMB
Norethisterone 5mg 2-3x daily on 1-21 days of a 28 day cycle
302
podophyllotoxin dose for genital warts
0.05% paint BD for 3 days repeated weekly until warts resolve
303
mx for Meniere's disease
```
aim low sodium 2-3g/day
avoid caffeine
commence hydrochlorothiazide
refer to exercise physiologist for vestibular rehab program
refer to ENT for surgery
refer to audiologist for hearing aid
```
304
vitilgo treatment
```
do nothing
cosmetic camoflague
bethamethasone dipropionate 0.05% cream
phototherapy
pimecrolimus 1% cream (body folds and face)
calcipotriol + betamethasone
```
305
Qs to ask about stress/urge incontinence
```
parity
vaginal deliveries
family history of incontinence
smoking history
excessive caffeine intake
vaginal atrophy
recent weight gain
```
306
how long to contact trace gonorrhoea partners?
2 MONTHS
307
Surgical bariatric interventions
sleeve gastrectomy
Roux en y gastric bypass
biliopancreatic diversion
308
smoking cessation management
Agree on quit plan/quit day
Discuss strategies for managing triggers and removing barriers to success
Refer to Quitline
Motivational interviewing if not ready/unsure
Arrange follow up
Pharmacotherapy
309
painless vision loss differentials
```
retinal detachment
vitreous haemorrhage
optic neuritis
central retinal artery occlusion
central retinal vein thrombosis
```
310
causes of transient monocular vision loss
```
Giant cell arteritis
Carotid artery disease: thromboembolism, stenosis
Retinal vein occlusion
Retinal vasospasm
Optic nerve compression by tumour
Idiopathic amaurosis fugax
Acute angle closure glaucoma
```
311
transient binocular vision loss
Migraine (positive visual phenomenon - scintillations, visual lines)
Occipital tumour
Papilloedema
Vertebrobasilar insufficiency
312
risk factors for progression of diabetic retinopathy
```
Existing DR
Poor glycaemic control
Raised BP
Duration of diabetes >10 years
Microalbuminuria
Dyslipidaemia
Anaemia
pregnancy
```
313
Strategies to delay onset and progression of Diabetic retinopathy
Optimise BGL
Control BP
Add fenofibrate
Treat hypercholesterolaemia
314
Patient education for insulin commencement
```
Self management: timing and frequency of SMBG, timing of meals, dose adjustment
Impact of diet, particularly carbohydrate content
Impact of physical activity
Hypoglycemia management
Insulin delivery techniques
Weight management
Sick day management
Drivers license notification
Apply to NDSS for syringes/lancets etc
```
315
options for peripheral neuropathy
amitriptyline
pregabalin
topical nitrate spray
316
Examination required once pregnant
BP, dental exam, thyroid exam, breast exam, cardiovascular exam, CST
317
infant complications of diabetes
```
congenital heart disease
preterm birth
macrosomia
respiratory distress
hypoglycaemia
polycythaemia
hyperbilirubinaemia
```
318
risks associated with long term use of PPIs
```
Interstitial nephritis
Hypomagnesaemia
Increased risk of pneumonia
Increased risk of C Dif, campylobacter and other GI infections
Impaired nutrient absorption
Risk of fracture
Possible interactions with clopidogrel,
Increased risk of cardiac events
```
319
Non pharmacological mx of reflux
eating smaller meals
drinking fluids mostly between meals rather than with meals
avoiding lying down after eating
avoiding eating or drinking for 2 to 3 hours before bedtime or vigorous exercise
elevating the head of the bed (if symptoms occur at night)
stopping smoking.
320
uric acid target level
<0.36 (<0.3 if gouty tophi)
321
Non pharmacological mx of gout
```
• Keep well hydrated
• Proper footwear to avoid trauma
• Advise against driving while in pain
• Monitor urate level
• Cardiovascular risk modification
• Maintain healthy body weight
Low purine diet - give pt list of high purine foods to avoid (shellfish, alcohol, meat)
weight loss
```
322
prevention of renal stones
```
· good hydration: drink to a level where the urine produced is clear,
· Low salt and low oxalate diet
· Low protein diet
· Normal calcium intake
Foods high in oxalate
• chocolate
• tea
• strawberries
• cola
• rhubarb
• spinach
• beetroot
• peanuts
```
323
EBV complications
```
Jaundice/liver failure
Splenic rupture
Airway obstruction
Encephalitis
Pneumonia
Pancreatitis
Myocarditis
Chronic active EBV infection
```
324
what tests are required to monitor methotrexate?
Full blood count, renal function and liver function tests.
325
How to deal with purple crying?
Explain purple crying
Use a sleep/cry diary to explain the infant's cry/sleep/feeding patterns
Encourage parents to recognize signs of tiredness (frowning, clenched hands, jerking arms or legs, crying, grizzling) Establish pattern to feeding/settling/sleep
Aim to settle the baby for daytime naps and night-time sleep in a predictable way (eg, quiet play, move to the bedroom, wrap the baby, give the baby a brief cuddle, then settle in the cot while still awake)
Avoid excessive stimulation - noise, light, handling. Excessive quiet should also be avoided. Most babies find a low level of background noise soothing.
• Darken the bedroom for daytime sleeps
• Carry baby in a papoose in front of the chest
• Baby massage/rocking/patting
• Gentle music
• Respond before baby is too worked up
Give the primary carer permission to rest once a day without the need to carry out household chores. Have somebody else care for the baby for brief periods to give the parent/s a break
326
macular papular rash in traveller
```
secondary syphilis
acute HIV seroconversion
measles
rubella
dengue
Zika
Chikungunya
Typhoid
```
327
Jarish Herxheimer reaction
• a common reaction to treatment in patients with primary and secondary syphilis.
• It is a mild reaction with fever, headache, malaise, rigors and joint pains that starts a few hours after treatment and lasts for several hours.
• It is not an allergic reaction.
Occurs 6-12 hours post injection
328
timing for TOC syphilis
Repeat syphilis serology at three, six and 12 months to confirm cure
329
Syphilis in pregnancy
- Higher rates of prematurity
- Low birthweight
- Stillbirth
- Perinatal mortality
- Congenital syphilis
○ Deafness
○ Bone deformity
Neurological sequelae
330
Treatment options for post herpetic neuralgia
- Paracetamol 1g PO QID
- Ice massage
- Amitriptyline 10mg nocte
- Gabapentin 100mg nocte
- Topical lignocaine 5% patch
- Tramadol 100mg daily
TENS for at least 2 weeks
331
Behcet disease
- Rare disease
- Painful mouth ulcers, genital ulcers, eye problems and skin lesions
Autoimmune disorder
332
Herpetic whitlow treatment
valaclivoir 1g BD 7 days
333
treatment for dermatitis herpetiforms
dapsone
334
treatment for pyogenic granuloma
Curettage and cauterisation
Laser surgery
Cryotherapy
Imiquimod
335
mx of lichen planus
• Explanation and reassurance
• Usually resolves over 6-9 months, leaving discoloured marks without scarring
Topical moderate to very potent corticosteroids
336
Sentinel facial features of fetal alcohol syndrome
short palpebral fissure length (distance between the inner and outer corners of one eye)
Smooth philtrum
Thin upper lip
337
cradle cap treatment
No treatment required, is self-limiting and will resolve
Apply regular baby oil to scalp
Wash with baby shampoo
Egozite – salicylic acid based lotion
338
Non pharmacological mx of rosacea
```
Minimise sun exposure
Use soap free cleanser
Apply green tinted foundation
Avoid topical corticosteroids
Minimise factors that cause flushing
```
339
Guttate psoriasis mx
1. Mometasone 0.1% cream daily for 2-6 weeks
2. Daivobet (calcipotriol + betametasone)
3. Coal tar topical 1% gel/emulsion OR LPC 6% + salycilic acid 3% cream. BD for 1 month
340
complications of erysipelas
sepsis, cerebral abscess and venous sinus thrombosis
341
granuloma annulare is associated with
autoimmune thyroiditis , diabetes, lymphoma
342
Incubation period of dengue fever
4-7 days
343
Managment of AC joint injury
Rest shoulder for 48-72 hours following injury
Broad arm sling
Analgesia: panadol, neurofen
Ice shoulder
344
Complications of AC joint injury
- Post trauma osteoarthritis
- Chronic pain syndrome
- Cosmetic deformity
- Shoulder impingement
Clavicular instability
345
Symptoms of leptospirosis
Fever, headaches, chills, severe muscle pain, reddened eyes
346
Treatment for Ramsay Hunt Syndrome
```
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
```
347
Contraindication for home oxygen
Smoking: no smoking for 6 weeks
| Hypercapnia
348
traveller's diarrhoea treatment
Azithromycin 1g PO stat
If fever/bloody stools then
Azithromycin 500mg orally once daily for a further 2 days
349
acute heart failure tx
```
• Increase frusemide dose
• Commence ACEI perindopril 2.5mg
• Commence 25mg spironolactone
• Salt restrict 5g/day
• Fluid restrict 1.5 Lday
• Daily weights
• Review in 72 hours
Refer to cardiac rehab program
```
350
treatment required for giant cell arteritis if hisotry of visual loss
IV methylprednisolone
351
giant cell arteritis managment
Commence prednisolone 50mg daily, long term
Aspirin 100mg daily
Urgent referral to ED for ophthalmologist review
352
vaginal prolapse mx pre referral
avoid triggers of prolapse - hevy lifting
avoid constipation
pelvic floor physio
weight loss if overweight
explain mechanical nature of condition, not harmful
(pessary)
353
medications to regulate cycle in PCOS
Ethinylestradiol/levongestrel 30/150mcg daily
Metformin 250mg BD daily
Norethisterone 5mg for the same 12 days per month
354
long term mx of PCOS
diabetes screening with HBA1c every 1-3 years
Monitor for depression/anxiety/disordered eating
Discuss possible sub fertility/potential family planning issues
Cycle regulation - COCP/cyclical progestins/iUD/metformin
Assessment of cardiovascular disease/annual BP/fasting lipids
Hirsutism management - physical hair removal
Aim for 5-10% loss of weight
Regular exercise 30 mins per day
Monitor for sleep apnoea
355
symptoms of lithium toxicity
Tremor, hyper reflexia, ataxia, rigidity, drowsiness, confusion, coma, seizures, myoclonus, nausea, vomiting , diarrhoea
356
risk factors for chronic lithium accumulation
```
Impaired kidney function
Dehydration
>50 years
Previous lithium toxicity
Drug interactions (ACEI, ARBs, NSAIDs, loop and thiazide diuretics)
Lithium induced nephrogenic diabetes insipidus
Intercurrent illness
Thyroid dysfunction
```
357
extrapyramidal side effects
dystonia
parkinsonism
tardive dykinesia
akathesia
358
antipyschotic side effects
```
weight gain
sedation
sexual dysfunction
anticholinergic effects: blurred vision, dry mouth, constipation, urinary retention
postural hypotension,
ECG changes Q – T interval
cataracts: quetiapine and chlorpromazine
EPSE
```
359
side effects of anticholinergic medication
falls, confusion, cognitive decline, dry mouth, constipation and urinary retention
360
treatment of paraphimosis
Urgent transfer to ED
Anaesthetise penile head with ring block
Apply circumferential pressure to glans of penis
Apply intermittent ice to head of penis to reduce swelling
Aspirate blood from head of penis with needle
361
another name for penile lichen sclerosis
Balanitis Xerotica Obliterans
362
what class of medication is dutasteride
5 alpha reductase inhibitor
363
most common side effect from TURP
retrograde ejaculation
364
ddx for breast lump in male pt
```
Cancer
Lipoma
Epidermoid cyst
Gynaecomastia - unusual to be unilateral
Fibroadenoma
Trauma related - haematoma, fat necrosis
```
365
treatment options for male baldness
No treatment
Topical minoxidil 2-5%
Finasteride 1mg PO daily
Oral dutasteride
366
Indications for intermittent 'in and out' urethral catheterisation
Relieving urinary retention
Drainage of post void residual urine
Urethral stricture dilation
Obtaining sterile urine specimens
367
Secondary causes of hyperuricaemia
```
Renal failure
Lead poisoning
Solid organ transplant
Tumour lysis syndrome
Hypothyroidism
Lesch-Nyhan syndrome
```
368
causes of raised ferritin
```
Iron Overload
• haemochromatosis
• Transfusional iron overload
• Alpha thalassaemia
• Chronic liver disease: NAFLD, ALD, Hep B, Hep C
• Excess parenteral iron
Other cause
• Chronic alcohol consumption
• Metabolic syndrome
• Obesity
• Diabetes
• Malignancy
• Infection
Inflammatory conditions
```
369
SLE examination features
- Arthritis
- Malar rash
- Discoid lupus erythematous rash
- Oral ulcers
- Alopecia
- Pericardial rub
- Raynaud phenomenon
Pleural effusion/rub
370
Indications for AAA Repair
Symptomatic
Male >5.5
Female >5
371
mx for osgood schlatter disease
• Ice packs
• Ibuprofen
• Modification of activity
○ Stop high impact exercise: jumping and running
○ Avoid painful activities for 2 weeks
• Advise quadriceps stretching program
Self limiting average 12 months (symptoms resolve with skeletal maturity)
372
treatment for schistosomiasis
praziquantel
373
Grover's Disease
```
Transient Acantholytic Dermatosis
Rash on Chest and back
- Middle aged
- Caucasian man
- Pruritic papulovesicular rash
- Hot humid weather
Betamethasone valerate 0.02%
```
374
Bisphosphonate admin info
- Do not take with calcium and vitamin D supplement
- Take first thing in the morning on empty stomach
- Remain upright for at least 30 minutes
Avoid food or drink 30 minutes post dose
375
Adverse effects of isotretinoin
- Potent teratogen: must use contraception
- Dry lips
- Early flare of acne before it starts to improve
- Cheilitis
- Sun sensitivity, wear daily sunscreen
- Dry skin
- Facial erythema
- Lethargy
- Myalgia and joint stiffness
- Cant take with tetracyclines due to risk of intracranial hypertension
(pancreatitis, rectal bleeding, paronchyia, tinnitus) are all possible adverse effects of isotretinoin but are not as common as chelitis.
376
macular cherry red spot
central retinal artery occlusion
377
pilar cyst
scalp cyst
378
dose for IM ceftriaxone for meningitis in child
50mg/kg
379
malignancies associated with dermatomyositis
breast
lung
colon
Ovarian
380
what is palmoplantar pustulosis associated with?
psoriasis, autoimmune diseases: coeliac, thyroid, t1dm, streptococcal tonsillitis
381
dairy farmer hand lesion
milkers nodule - parapox virus
382
sheep farmers hand nodules
orf
383
rash after sun exposure
polymorphic light eruption
384
mx of onycholysis
Keep nails short
Keep hands out of water
Mild soap free wash
Avoid inserting objects beneath nail
385
malignancy that acanthosis nigricans is related to
stomach cancer
386
Head lice treatment
Permethrin 1% topically, leave on for a minimum of 10 minutes, wash and repeat treatment in 7 days
Wet combing post treatment to check for live lice
Wet combing should be repeated weekly for several weeks after treatment to look for recurrence / monitor for recurrence / monitor for treatment failure
Wash all bedding in hot water
Exclude from school until treatment commenced
• Notify the school of the condition (1)
• School exclusion is not needed once treatment has commenced (1)
A child with head lice does not need to be sent home from school immediately as long as treatment is commenced on the same day (1)
387
painful penile ulcer
chancroid
388
what ages constitute premature heart disease
Premature = men <55, women <60
389
what statin to start (and dose) in FHH
40mg atorvastatin
390
information about screening for FHH
1) Relatives should all have their fasting cholesterol checked
2) Early detection and intervention can prevent premature CVD
3) Children as young as 8-10 years old need to be tested
391
PID tx (meds and non pharmacological)
• ceftriaxone 500 mg in 2 mL of 1% lignocaine intramuscular injection, or 500 mg intravenous, immediately
plus
• metronidazole 400 mg orally, twice daily for 14 days
plus
• doxycycline 100 mg orally, twice daily for 14 days
- Contact trace partners for past 6 months
- No sex for 7 days
- Avoid alcohol with metronidazole
- Review in 3 days to ensure response to treatment
Arrange test of cure after 3 months
392
medication for vestibular neuritis
• IV rehydration
• prochlorperazine (Stemetil) 12.5mg IM (if severe) but may slow recovery
• Metoclopramide or ondansetron
• A short course of corticosteroids often promotes recovery
Pred 1mg/kg up to 75mgPO for 5 days then taper over 15 days and stop
393
pleural effusion causes
* Heart failure (90%)
* Hypoproteinaemia eg nephrotic syndrome
* Liver failure with ascites
* Constrictive pericarditis
* Hypothyroidism
* Ovarian tumour - right sided effusion (Meigs syndrome)
```
Exudate
Causes
• Infection - bacterial pneumonia, pleurisy, empyema, TB, viral
• Malignancy - bronchial carcinoma, mesothelioma, metastatic
• Pulmonary infarction
• Connective tissue diseases (SLE, RA)
• Pancreatitis
• Lymphoma
• Sarcoidosis
HIV with parasitic pneumonia
```
394
peripheral causes of vertigo
```
BBPV
Neuronitis/labrynthitis
menierre' disease
Choleasteatoma
Acoustic Neuroma
Ramsay hunt syndrome
```
395
central causes of vertigo
```
cerebellar infarction
cerebellar haemorrhage
Vertebrobasilar insufficiency
Vestibular migraine
MS
```
396
mx for TMJ dysfunction
```
• Education and reassurance
• Rest the joint
• Soft diet
• Avoid clenching
• Physio
• Massage affected muscles
Aspirin and paracetamol
```
397
Erectile dysfunction examination
- Penile plaques
- Small testicular size
- Lack of body hair
- Gynaecomastia
- Enlarged prostate
- Lower limb neurological. Deficits
Weak peripheral pulses
398
Medications to commence in euvolemic heart failure
ACEI - perindopril 2.5-5mg
Bisoprolol
add later: Spironolactone
399
Medications to commence in congested heart failure
Frusemide
ACE: 2.5mg perindopril
25mg spironolactone
later: bisoprolol
400
Physical Exam Findings in Systemic Sclerosis (scleroderma)
CREST syndrome
Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly and Telangiectasia
```
telangiectasia
calcinosis
Sclerodactyly
Thinning of lips
abnormal nail fold capillaries
Raynaud phenomenon
Digital ulcers
```
401
Hypertension physical examination
Tachycardia/irregular pulse
Displaced apex beat/added heart sounds - a sign of cardiac enlargement
Basal crepitations/raised JVP - cardiac failure
Carotid/renal/abdomen/femoral bruits - arterial disease
Palpation of renal angle for enlarged kidneys
Abnormalities of the optic fundi: retinal haemorrhages, papilloedema
Goitre/hyper reflexia/exopthalmos - hyperthyroidism
Elevated waist circumference/BMI
Neck circumference >40cm: OSA
Skin hyperpigmentation/moon facies/buffalo hump
Urinalyis/dipstick for proteinuria
402
if eGFR come back <60 what do you do
repeat in 7 days
| if stable repeat twice within 3 months
403
If elevation on urine ACR what is next step
repeat twice within next 3 months
404
Factors other than CKD that increase urine albumin excretion
- UTI
- High dietary protein intake
- CCF
- Acute febrile illness
- Heavy exercise within 24 hours
- Menstruation
- Genital or infection
Drugs: NSAIDs
405
Managing end stage CKD (not on dialysis)
- Aim BP <130/80
- Review renal function every 1-3 months
- Advise low salt diet <6g/day
- Protein 0.75g-1/kg/day
- Referral to dietician for individualised diet
- Advise moderate exercise 30 mins/5 days a week
- Ensure immunisations are up to date
- Discuss advanced care directive/end of life care
Monitor calcium and phosphate
406
Causes of confusion in end stage renal failure
```
Uraemic encephalopathy
Urinary tract infection
Subdural haematoma
Cerebrovascular accident
Hypo/hypercalcaemia
```
407
what level of potassium should be referred to ED
>6.5
408
DDx for morning tiredness
```
• Anxiety/depression
• Poor sleep hygiene
• Chronic sleep restriction
• Narcolepsy
• Insomnia
• sleep apnoea
Delayed sleep phase disorder
```
409
what is delayed sleep phase disorder?
Delayed sleep phase disorder (DSPD), which is characterised by late wake times and a significant delay in sleep onset times when compared with conventional sleep times, is commonly seen in adolescents and young adults.
410
OSA mx
* Continuous positive airway pressure
* Weight loss 5-10%
* Positional therapy - sleep on side/raise head of bed/positional devices
* Mandibular advancement splint
* Notify road licencing authority
* Smoking cessation
* Avoid alcohol
411
types of glomerulonephritis
Post streptococcal GN
IgA nephropathy
Rapidly progressive GN
Henoch-Schonlein purpura
412
diseases associated with nephrotic syndrome
• Minimal change glomerulonephritis
Focal segmental glomerulonephritis
Membranous glomerulonephritis
SLE
413
Analgesic Nephropathy
• Papillary necrosis and chronic interstitial nephritis caused by the long term consumption of analgesic agents
• Most pts are >45 years
• Usually no symptoms
• But can have flank pain or haematuria
• Daily consumption of analgesic medicines for 2 consecutive years
Paracetamol most implicated
414
Presentation of polycystic kidney disease
Pain in abdomen / flank / back due to enlargement of cysts, bleeding, UTI or nephrolithiasis
Haematuria (self-limiting, lasting up to one week)
Polycystic kidneys are susceptible to injury
Hypertension (diastolic)
Palpable flank mass, hepatosplenomegaly
Renal failure
415
extra renal complications from polycystic kidney diseaae
```
• Berry aneurysms (10%)
• Hepatic + pancreatic cysts (33%)
• Cardiac valve disease (MV prolapse)
• Diverticulosis
• Abdominal wall and inguinal hernias
Seminal vesicle cysts
```
416
DDx for proteinuria
```
Diabetic nephropathy
Hypertensive nephropathy
Multiple myeloma
Structural kidney disease- polycystic kidneys
Nephrotic syndrome
Amyloidosis
```
417
History qs for sore nipples
• Onset of nipple pain within first few days of birth or new onset
○ First few days = most often poor latch
○ Infectious causes occur later
• Breast feeding: when milk came in ?adequate supple
• Frequency/duration of feeding
• Use of breast pump/nipple shields/pads
• Current medications
• History of yeast infections
• History of dermatitis/psoriasis
• History of breast surgery
• Raynauds - can predispose to nipple vasospasm
Low mood
418
miconazole gel frequency for baby
QID
419
fluconazole dose for nipple candidiasis
fluconazole 150mg every 2nd day for 3 doses
420
what comes after the fluconazole in nipple candidiasis
nystatin 1,000,000 units TDS and miconazole gel to nipples QID
421
Non pharmacological mx for nipple candida
• Sterilise dummy every day
• Keep nipples dry
Sanitise hands regularly
422
mx of patella fracture
For nondisplaced or minimally displaced and an intact extensor mechanism (can straight leg raise) non operative treatment may be suitable
Zimmer knee splint for 5-6 weeks - can weight bear in splint
423
what is mononeuritis multiplex associated with?
```
• Diabetes mellitus
• Vasculitis
• Amyloidosis
• Direct tumour involvement- lymphoma, leukaemia
• Polyarteritis nodosa
• Rheumatoid arthritis
• SLE
Paraneoplastic syndromes
```
424
sinusitis red flag history
```
Change in vision/diplopia
Severe headache
Focal neurological signs - third nerve palsy, 6th nerve palsy, facial numbness
Significant/recurrent epistaxis
Neck mass/ cervical lymphadenopathy
Weight loss
Meningism
Change or hearing/ear pain
```
425
Most common causes of excessive crying and vomiting in well infant
Lactose overload
Cows milk protein intolerance
purple crying
426
Clinical features of cows milk protein allergy
```
Significant vomiting
Feeding difficulties
Diarrhoea with mucus or blood
Poor weight gain
Extensive eczema
First-degree family history of atopy
```
427
mx of cows milk protein allergy
2 week trial of extensively hydrolysed formula or dairy +/- soy elimination diet
Refer to paediatrician
428
what diseases can silica dust cause?
```
Silicosis
Chronic Bronchitis
Lung Cancr
Emphysemia
Scleroderma
```
429
differential diagnosis for reticulonodularity
sarcoidosis, silicosis, tuberculosis and lymphangitis carcinomatosis.
430
Sarcoid physical exam finding
lung crackles, lymphadenopathy, hepatosplenomegaly, polyarthritis, rash, uveitis, erythema nodosum
431
Spirometry findings ILD
○ Reduced FVC
○ Normal or decreased FEV1
○ Normal or increased FEv1/FVC (>70-80%)
Decreased diffusion capacity
432
DDx for cavitating lung lesion
• Pulmonary Tuberculosis
• Lung Abscess
• Lung cancer
• Non tuberculosis mycobacterial infection
• Fungal infection
• Sarcoidosis (but mediastinal lymphadenopathy too)
Lymphoma
433
predictors of progression from chronic hep B to cirrhosis
• High HBV viral load.
• Recurrent exacerbations.
• Older age (longer duration of infection).
• Habitual alcohol consumption.
• Concurrent infection with HCV.
• Infection with hepatitis delta virus (HDV) or HIV.
HBV genotype C.
434
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
```
435
what stages of hep B do not require tx
Immune tolerance and immune control
436
Bleeding disorder differentials
```
• Von Willebrand disease
• Haemophilia
• Idiopathic thrombocytopenia
• Hereditary haemorrhagic telangiectasia
• Bone marrow failure/leukaemia
• Underlying liver disease
Trauma/intimate family violence
```
437
5 Hs of Haemophilia
* Haemathroses
* Haematomas
* Haematochezia
* Haematuria
* Head haemorrhage
438
Hereditary haemorrhagic Telangiectasia
s an inherited disorder that causes abnormal connections, called arteriovenous malformations (AVMs), to develop between arteries and veins. The most common locations affected are the nose, lungs, brain and liver.
• These AVMs may enlarge over time and can bleed or rupture, sometimes causing catastrophic complications.
• Spontaneous and unprovoked nosebleeds, sometimes on a daily basis, are the most common feature. Persistent bleeding from the nose and the intestinal tract can result in severe iron deficiency anemia and poor quality of life.
Also known as Osler-Weber-Rendu disease, hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder that you inherit from your parents. Its severity can vary greatly from person to person, even within the same family.
439
RFs for B12 deficiency
```
Autoimminue gastritis - pernicious anaemia
Gastrectomy
Terminal ileal resection
Vegan diet
Bariatric surgery
atrophic gastritis
metformin
Coeliac
Chronic alcoholism
```
440
Examination for LUTS male
Vital signs
Cardiovascular examination – inc signs of cardiac failure
Abdominal examination – palpable bladder
Genital Examination: phimosis or meatal stenosis
DRE – prostate size, tenderness, nodularity: should be rubbery and smooth
Anal tone and sensation
Lower limb neurological examination- to exclude neurological causes of bladder dysfunction
441
Complications of BPH
```
Acute Urinary retention
Recurrent UTIs
Obstructive uropathy
Incontinence
Bladder stones
```
442
Risk factors for thunderstorm asthma
```
hypersensitivity to rye grass pollens
seasonal allergic rhinitis
asthma
not taking ICS preventer
being outdoors during thunderstorm in pollen season
```
443
what is screened for in heel prick test?
Phenylketonuria
Congenital hypothyroidism
Cystic Fibrosis
Galactossemia
444
most common cause of neonatal conjugated jaundicae
biliary atresia
445
Spodylolisthesis
definition: defect in pars interarticularis causing a forward slip of one vertebra on another
usually at L5-S1, less commonly at L4-5
446
presentation of spondylolisthesis
```
Stiff waddling gait
Increased lumbar lordosis
Tender prominent spinous process of slipped vertebrae
Limited flexion
Hamstring tightness or spasm
```
447
mx of spondylolisthesis
• Strict flexion exercise program
| Avoid extension of spine
448
Reasons to do HMMR
• 5 or more medications
More than 12 doses of medication per day
Recent significant changes 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
449
Causes of unstable INR
```
nutritional status
medication adherence
genetic variation
drug interactions
smoking and alcohol use
renal, hepatic and cardiac function
hypermetabolic states
```
450
what foods to avoid with warfarin
kale, spinach, brussel sprouts, collards, asparagus, green tea
451
OSA history/clinical features
- Recent weight gain
- Nasal patency/obstruction/trauma/rhinitis
- Alcohol intake pre bed
- Family history of sleep apnoea
- History of gasping/choking
- Daytime sleepiness
- Impact on driving
- Morning headaches
- Decreased concentration
- Irritability/low mood
Sexual dysfunction
452
OSA examination
- BMI
- Neck circumference
- BP
- Assess mandible for retrognathia
- Check nasal patency
- Tonisllar hypertrophy
Cardiovascular exam
453
causes of thyrotoxicosis
Toxic multinodular goitre
toxic adenoma
exogenous thyroid hormone
De Quervains thyroiditis
454
causes of hypothyroidism
```
Hashimotos
thyroiditis
iodine deficiency
amiodarone
Reidels thyroiditis
post ablative therapy/surgery
```
455
symptoms of agraunulocytosis from carbimazole
Patients should be educated to suspend antithyroid therapy and obtain a neutrophil count if they develop mouth ulcers, fever, sore throat or other symptoms suggestive of infection
456
treatment for acute mania
olanzapine 10mg
457
Rheumatic fever exam findings
```
• Tonsillar exudate
• Erythema marginatum
• Polyarthritis
• Sydenham chorea
• Systolic cardiac murmur
Palpable subcutaneous nodules
```
458
blood clot screening tests
Antiphospholipid syndrome
factor 5 leiden mutations
protein C and S mutations
Prothrombin mutation
459
clinical features of Marfan
• tall stature, long limbs with significantly increased arm span and reduced upper to lower body segment ratio
• long fingers (arachnodactyly)
• joint laxity and flat feet
• Pectus chest deformity and kyphoscoliosis
• long narrow face with deep set eyes, a high narrow palate and dental crowding
• mitral valve prolapse
• dilation of the ascending aorta in 50% of children, which requires drug therapy to prevent or delay development of aortic dissectionand rupture, aortic regurg
• aortic coarctation
• ectopia lentis (dislocation of the lens, often upward); lens subluxation
• myopia
retinal detachment
460
cerebellar ataxia
Gait ataxia, Dysdiadochokinesis, dysmetria, limb ataxia, intention tremor, scanning speech
461
causes of cerebellar ataxia
Acute ataxia
• Minutes to hours
• Medical emergency
• Toxins, medications, infections, ischaemic or haemorrhagic stroke
Subacute
• Days to weeks
• Atypical infections, chronic exposure to toxins or medications, alcohol abuse, vitamin deficiencies, autoimmune disorders, systemic metabolic disorders, paraneoplastic cerebellar degeneration
462
infectious period for measles
Cases are infectious from slightly before the beginning of the prodromal period, usually 1 days prior to symptoms
They continue to be infectious until 4 days after the onset of the rash.
463
urgent lab tests for measles
Nose or throat swab for measles PCR
AND urine for measles PCR
+ if possible measles serology
464
4 year old vaccinations
Diptheria, tetanus, pertussis, polio
465
18 month vaccinations
Hib
MMRV
Diptheria, tetanus, pertussis
466
gradual loss of vision with haloes around lights at nights
cataract
467
painles slow loss of central vision
macular degeneration
468
mx 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.
469
when to refer COPD to specialist
```
age <40
O2 <92% when well
more than one chest infection per year
diagnostic uncertainity
haemoptysis
rapid detrioration
ankl;e oedema
bullous lung disease on CXR
```
470
common adverse effect of azathioprine
mouth ulcers
471
Pericarditis treatment
Restriction of exercise
Colchicine 500mcg BD for 3 months
AND
Aspirin 1000mg, TDS for one to weeks with tapering course
472
who should be screened via blood test for diabetes
```
AUSDRISK >12
GDM
PCOS
Antipsychotics
previous cardiovascular event
```
473
treatmetn of hot tub folliculitis
ciprofloxacin
474
when is depo provera considered late
14 weeks or more (need alternative contraception if been sexually active)
475
what kind of nipple discharge is worrying for cancer
unilateral, spontaneous, bloody or serous from a single duct should raise concern for breast cancer.
476
When to start ICS in COPD
recommended in patients with 2 or more exacerbations per year which require treatment with antibiotics or oral corticosteroids AND those with a FEV1 of 50% or less.
477
what risk of breast cancer does BRCA gene carry
70% risk
478
which BRCA gene is higher risk for ovarian cancer
BRCA1: 45% risk
| BRCA 2= 15% risk
479
options to use in renal impairment for palliative care
Buprenorphine, fentanyl and methadone are the opioids of choice in patients with severe kidney impairment
480
most common side effect of varenicline
nausea
481
Tall +Facies ( large ears, long narrow face) + intellectual disability + large testes
Fragile X syndrome
482
risk factors for biliary colic
```
Older age >50 years
Female
Pregnancy
Obesity
Rapid weight changes
Ethnicity
```
483
Risk factors for groin hernias
• family history
• chronic obstructive pulmonary disease
• Smoking
• low body mass index,
• chronically raised intra-abdominal pressure
and collagen vascular disease
484
what makes a bite wound high risk
"presentation to medical care is delayed by 8 hours or more
the wound is a puncture wound that cannot be debrided adequately
the wound is on the hands, feet or face
the wound involves deeper tissues (eg bones, joints, tendons)
the wound involves an open fracture
the patient is immunocompromised (eg due to asplenia or immunosuppressive medications), or has alcoholic liver disease or diabetes
the wound is a cat bite."
485
mx of fibro
```
Pharmacotherapy
• Low dose TCAs: amitriptyline 10-25mg nocte / dosulepin
• Duloxetine
• Milnacipran
• Pregabalin/gabapentin
```
Nonpharmcological
• Patient education - pain experienced is real but not caused by tissue damage
○ Not progressive or deforming disease
Regular graded aerobic exercise
486
what kind of ankle sprain causes Pain reproduced with external stress and dorsiflexion
syndesmosis sprain
487
what does a mortise XR reveal for syndesmosis injury
widening of space between tibia and fibula
488
DDx for localised heel pain
```
plantar fasciitis
achilles tendinopathy
atrophic heel pad
retrocalcaneal bursitis
tibialis posterior tendinopathy
```
489
what organ does lithium effect in pregnancy (of baby)
heart
490
what medications require higher dose folic acid
valproate and carbamazpeine
491
what genetic tests are done for thrombophilia
Factor V Leiden and prothrombin variant genetic testing.
492
what monitoring is required for dapsone?
Need to monitor for side effects: haemolytic anaemia, methaemoglobinaemia
Need CBE, glucose-6-phosphate dehydrogenase enzyme levels and renal and liver function testing
493
PJP tx
Trimethoprim + sulfamethoxazole
494
Examination features for IBD
- Arthritis/enthesitis
- Episcleritis/iritis
- Erythema nodosum
- Pyoderma gangrenosum
- Anaemia: pallor of conjunctivae
- Abdominal mass
- Evidence of weight loss
Perianal fistula, skin tags
495
Q fever treatment
doxycyline 100mg BD for 14 days
496
Complications of Q fever
- Chronic Q fever
- Chronic fatigue syndrome
- Endocarditis
- Chronic hepatitis
- Osteomyelitis
Alcoholic intolerance
497
Side effects of 5 flurouracil
```
Soreness / pain / discomfort (1)
Itchiness / irritation (1)
Burning sensation (1)
Stinging sensation (1)
Weeping (1)
Crusting of the skin (1)
Sores / ulcers / ulceration (1)
Blistering (1)
Skin peeling (1)
Skin cracking (1)
Allergic contact dermatitis / dermatitis (1)
Photosensitivity / increased sensitivity of the skin to the sun (1)
Hyperpigmentation / skin redness (1)
Hypopigmentation (1)
Rash (1)
Scarring (may be permanent) (1)
```
498
When is DNA testing for Fragile X syndrome available iwht MBS rebate
exhibits intellectual disability, ataxia, neurodegeneration, or premature ovarian failure consistent with an FMR1 mutation
has a relative with an FMR1 mutation.
499
inheritance pattern of fragile X
X linked dominant inheritance pattern
500
some of the tests in newborn screening
CF
PKU
Neonatal hypothryoidism
galactossemia
501
genetic arrhythmia syndromes
Long QT syndrome
Brugada
Catecholaminergic Polymorphic VT
(Autosomal dominant)
502
Inheritance of neurofibromatosis
Autosomal dominant
503
clinical features of Neurofibromatosis
```
6 or more café-au-lait macules
Freckling in skin folds
Lisch nodules in the iris of the eye
Multiple neurofibromas
Learning difficulties
```
504
Genetic conditions that are linked to ASD
* Fragile X syndrome (1)
* Rett syndrome (1)
* Williams syndrome (1)
* Angelman syndrome (1)
* Landau-Kleffner syndrome (1)
* Prader-Willi syndrome (1)
* Tuberous sclerosis (1)
* Chromosomal abnormalities / chromosomal inversions / chromosomal duplications (only 1 of these options will be awarded 1 mark)
* Metabolic conditions (1)
505
List 3 autosomal recessive conditions
cystic fibrosis (CF), spinal muscular atrophy (SMA) and Tay-Sachs disease (TSD)
506
X linked conditions
fragile X syndrome (FXS), haemophilia A and B, and Duchenne muscular dystrophy.
507
what genetic conditions are more common in Ashkenazi Jewish community?
These include Tay Sachs disease, cystic fibrosis, familial dysautonomia, Canavan disease, glycogen
storage disease 1A, mucolipidosis type IV, Niemann-Pick disease, Fanconi anaemia and Bloom
syndrome
508
Inferior myocardial infarction is supplied by what coronary artery?
right coronary artery
509
Side effects of donepezil
urinary incontinence, vivid dreams, dyspepsia
| anticholinesterase inhibitor
510
RFs for Bells palsy
```
• Pregnancy
• Pre eclampsia
• Obesity
• Hypertension
• Diabetes
Upper respiratory illnesses
```
511
Causes of facial weakness
```
stroke
bells palsy
ramsay hunt syndrome
parotid tumour
cholesteatoma
sarcoidosis
```
512
treatment for enuresis
```
Bed alarm
do not punish child
reward/praise child for acheiving dryness
advise against fluid restriction
eliminate caffeinated beverages
desmopression for school camps
```
513
Symptoms of rickettsial infection
```
fever
headache
muscle aches
swollen lymph glands
cough
rash
```
514
treatment for typhoid fever
Azithromycin 1g 5-7 days
515
what corneal finding is blepharitis associated with?
marginal keratitis
516
ddx for facial pain and nasal congestion
```
bacterial rhinosinusitis
nasopharyngeal carcinoma
sinus abscess
cluster headache
rhinitis medicamentosa
```
517
Gout triggers
Alcohol, Diet high in purines, Trauma, dehydration, systemic illness with fever, sugary soft drinks, fasting, aspirin
518
diagnosis options for Cushing's syndrome
24 hour urinary free cortisol, Dexamethasone suppression test
519
Diagnosis of carcinoid syndrome
• 24 hour urine levels of 5-HIAA (hydroxyindoleacetic acid) , the end product of serotonin metabolism
Plasma chromogranin A/hepatic ultrasound
520
alcoholic hepatitis lft ratio
AST:ALT 2:1
521
what is the koebner phenomenon?
Appearance of new skin lesions on areas of cutaneous injury in otherwise healthy skin
Psoriasis is the most researched condition that exhibits the Koebner phenomenon and can be used to aid diagnosis
522
Differentials for chronic productive cough in child
```
• Protracted bacterial bronchitis
• Primary ciliary dyskinesia
• Immunodeficiency
• Chronic/recurrent aspiration
• Interstitial lung disease
• Cardiac disease
• Recurrent bronchiolitis
• Tuberculosis
Alpha-1 anti trypsin deficiency
```
523
tx for protracted bacterial bronchitis
amoxclav BD 2 weeks
524
Clinical features of acromegaly
```
• Acral overgrowth (enlarged extremities nose, ears, jaw, hands, feet)
• Soft tissue changes
• Impaired glucose tolerance
• Increased sweating
• Neuropathy
• Arthritis
• Hypertension
• Cardiomyopathy
• Sleep apnoea
Giganitsm
```
525
Diagnosis of acromegaly
Increased serum growth hormone concentration that does not suppress during an oral glucose tolerance test and
an elevated plasma insulin like growth factor 1 concentration (IGF-1)
526
waht are the enzyme inducing anti epileptic drugs
carbamazepine, phenobarbitone, phenytoin, topiramate
527
what contraception can be used for women taking enzyme inducing anti epileptic drugs
copper IUD
Mirena
depot medroxyprogesterone acetate
528
which seizure drugs need higher folate dose
carbamazepine or lamotrigine
529
organic causes of constipation in child
```
cows milk protein allergy
coeliac disease
hypothyroidism
cystic fibrosis
Hirschprung's disease
spinal cord abnormality - myelomeningocele
```
530
Scheurmann's Disease
```
• Aka scheuermann's kyphosis
• Increased rounding posture of the spine that leads to a hunchback or slouching posture
• Cause is unknown
• Runs in families
• Develops in adolescence 10-15 years
• More common in boys
Thoracic pain
```
531
after xr next imaging for stress fracture
MRI
532
Family screening for coeliac disease
• Risk is 10% if family member affected
• Screen with HLA DQ2/8 and coeliac serology
Screening can be delayed until 4 years old if well and symptom free
533
treatment for oesophageal spasm
May be precipitated or exacerbated by gord
Treat first
Can try ingestion of warm water at onset of attack
GTN 400mcg sublingual
If severe frequent symptoms
Diltazem 180mg SR daily
Isosorbine dinitrate
534
What diseases can psuedogout be associated with
```
• Haemochromatosis
• Hyperparathyroidism
• Hypomagnesemia
• Hypophosphatemia
Familial hypocalciuric hypercalcaemia
```
535
Side effects of dopamine agonists
```
• Nausea
• Hallucinations
• Dizziness (inc postural hypotension)
• Excessive sleepiness
• Headache
• Insomnia
• Peripheral oedema
• Depression
Impulse control disorders behavioural adverse effects—these include pathological shopping, eating, hoarding, gambling, sexual preoccupation, medication abuse and punding (incessantly doing and undoing a project [eg fixing an engine, organising a wardrobe]). Do not use dopamine agonists in patients with a history of impulse control disorders (including problem gambling).
```
536
Charcot-Marie Tooth Syndrome
inherited autosomal dominant polyneuropathy with an insidious onset from puberty. Clinical features include weakness in the legs, variable distal sensory loss and muscle atrophy giving the ‘inverted champagne bottle’ appearance of the legs.
537
Familial Periodic Paralysis
An autosomal dominant skeletal muscle disorder. Clinical features:
young patient (usually adolescent)
day after vigorous exercise awakens with weakness in limbs (for 4–24 hours)
flaccid paralysis/loss of deep tendon reflexes
Related to potassium levels—measure during symptoms. Classify as high, low or normal.
538
Causes of ptosis
1. 3rd cranial nerve palsy—ptosis, eye facing ‘down and out’, dilated pupil, sluggish light reflex
2. Horner syndrome—ptosis, miosis (constricted pupil), ipsilateral loss of sweating
3. Mitochondrial myopathy—progressive external ophthalmoplegia or limb weakness, induced by activity—no pupil involvement
Myasthenia gravis—ptosis and diplopia, no pupil involvement
539
dementia + myoclonus + ataxia
Creutzfeldt–Jakob disease
540
instantaneous: headache ± vomiting ± neck stiffness
subarachnoid haemorrhage
541
typical facies (temporalis atropy and frontal balding) + muscle weakness esp. hands (± myotonia) + cataracts
myotonic dystrophy
542
leg weakness + ataxic gait + clumsiness (appears about 12 years)
Friedrich ataxia
543
Investigations for erectile dysfunction
Bloods: CBE, EUC, Morning testosterone, glycated haemoglobin or fasting blood glucose, lipid panel
If testosterone low: repeat free testosterone, LH and prolactin
544
jone's fracture mx
Definitive treatment involves a short leg non-weight bearing cast for 6-8 weeks and repeat x-ray to confirm evidence of healing.
545
what investigation is best for lung cancer?
CT chest with contrast
546
What are the main effects of snakebite evenomation
• Paralysis
• Myolysis
• Renal failure
Coagulopathy
547
DDx for osgood schlatter disease
- Patellofemoral pain syndrome
- Patella tendonitis
- Sinding-larsen-Johansen syndrome
- Infra patella bursitis
548
patella tendinopathy
“jumpers knee” is a common cause of infrapatellar pain. Pain is usually maximal at the patellar attachment and proximal tendon and is aggravated by jumping or hopping. On examination there is local tenderness over the patellar tendon, and thickening or nodules may be palpable.
549
Complications of sinusitis
```
Pre-septal cellulitis (1)
Orbital cellulitis (1)
Orbital abscess (1)
Sub-periosteal abscess (1)
Cavernous sinus thrombosis (1)
Osteomyelitis (Frontal or Maxillary Bones) (1)
Meningitis (1)
Encephalitis (1)
Cerebrospinal fluid leak (1)
Epidural/subdural/brain abscess (1)
Encephalitis (1)
```
550
after a febrile seizure what are the risk factors for developing epilepsy
• family history of epilepsy
• any neurodevelopmental problem
• prolonged or focal febrile seizures
• febrile status epilepticus
No risk factors: 1% risk of developing epilepsy (similar to population risk)
Risk increases with more risk factors, up to 10%
551
status epilepticus treatment
10mg intranasal midazolam
552
what are the indications for referral to burns unit
Burns with associated inhalation injury
Burns >10% of total body surface area
Burns to special areas – face, hands, major joints, feet and genitals
Full thickness burns >5% total body surface area
Electrical burns
Chemical burns
Circumferential burns of limbs or chest
Burns with associated trauma
Burns in patients with pre-existing illness or disability that could adversely affect patient care and outcomes
Suspected nonaccidental injury in children or vulnerable people
Burns in the elderly and in children <12 months of age
Small area burns in patients with social problems, including children at risk
Burns occurring in pregnant women
553
causes of abducens nerve palsy
```
Idiopathic (2)
Diabetic Mononeuropathy (2)
Microvascular ischaemic nerve palsy (2)
Multiple sclerosis (2)
Intracranial tumour / Intracranial malignancy / Space occupying lesion (2)
Cerebral Aneurysm (2)
Migraine Headache (2)
Post-viral mono-neuropathy (2)
Cerebrovascular Accident (2)
Complicated otitis media/mastoiditis (2)
Cavernous sinus thrombosis (2)
Giant Cell Arteritis / Vasculitis (2)
```
554
what scores are used in palliative care to measure patients performance status
Australian-modified Karnofsky Performance Scale (AKPS)
Eastern Cooperative Oncology Group (ECOG)
An AKPS score of less than 40 or an Eastern Cooperative Oncology Group (ECOG) performance status score of 3 correlates to a median survival of around 3 months for patients with advanced cancer.
555
indications for referral of asymptomatic renal stone
• stone size >5 mm
• single kidney (congenital or postoperative)
• occupational need to be stone-free (eg airline pilot, military)
• chronic obstruction
recurrent urinary infections.
556
what makes someone at high risk of recurrence from renal stones
• early onset of urolithiasis (younger than 20 years of age)
• a family history of stones
• disease-associated stones (eg hyperparathyroidism, genetic conditions)
• anatomical abnormalities (eg single kidney, PUJ obstruction)
previous or concurrent renal calculi.
557
in acute renal colic who needs referral to urologist
· Stones >7 mm
· Patients who have been trialling conservative management for three weeks and have not passed their stone, as renal damage becomes more likely after six weeks of failed passage.
· Patients who have ongoing pain despite adequate oral analgesia
· patients who have passed stones but have ongoing blood in the urine should be referred to a urologist for investigation of haematuria, preferably with three urine cytology tests and a CT IVP.
558
how is absolute fracture risk calculated
FRAX (Australia) or Garvan Fracture Risk Calculator (Garvan)
559
Radiographic hallmarks of osteoarhritis
• Joint space narrowing
• Subchondral sclerosis
• Subchondral cysts
Osteophytes
560
causes of acute haemarthroses of knee
Intra articular fracture
ACL rupture
Patella dislocation
561
Inability to straighten knee
```
Injury to quadricep tendon
Injury to patella tendon
Fracture of patella
Loose body from chondral or subchondral defect
ACL tears (swelling)
Meniscus tear
```
562
How to manage pelvic girdle pain in pregnancy
Management
Activity modification
- Pelvic support garments
Practical advice for minimising pain
- Wear low heeled shoes
- Physiotherapy
- Reduce non essential weight bearing activities: climbing stairs/long periods of standing
- Avoid standing on one leg
Avoid movements involving hip abduction (getting in and out of cars, baths, or squatting
563
what muscle does trendelenburg test test?
```
Gluteus medius (hip adductors)
nwb hemipelvis drops if abnormal
```
564
causes of olecranon bursitis
- Repetitive pressure
- Overuse injury
- Tophaceous gout
Rheumatoid arthritis
565
mx of hyphaema
- Eye patch
- Bed rest
- Elevation
Opthal review
566
red back spider evenomation symptom/signs
malaise, lethargy, nausea, vomiting, hypertension, irritability (especially in children), agitation (especially in children), fever and priapism. Patients can also experience pain and local / regional signs.
567
what happens to pulse pressure in raised intracranial pressure
widens
568
mx of Duputyren's contracture
```
• Watchful waiting/observe/nil action
• Hand therapy/occupational therapy
• Reduce alcohol
• Collagenase injections
• Needle fasciotomy
Surgical release
```
569
XR findings of pagets disease
- Sclerosis
- Trabeculation
- Cortical thickening
570
Multiple myeloma CRAB
Calcium
Hypercalcaemia, presenting with abdominal pain, constipation, polyuria
Renal failure
Uraemic symptoms, fluid overload
Anaemia and other cytopenias
Leukopenia/neutropenia, with increased risk of infections
Thrombocytopenia with increased risk of bleeding
Bone pain and bone fractures
571
how to reduce breast cancer risk
Current RACGP guidelines advocate for physical activity, adequate folate, a Mediterranean diet, normal body mass index (in post-menopausal women only) and decreased alcohol consumption to reduce breast cancer risk.
572
when do you review fracture risk factors
males >50
| women >45
573
When to prescribe 5mg folate pre conception
```
diabetes
BMI >30
valproate and carbamazepine
history of child with NTD
malabsorption disorder
```
574
what triptan is good for rebound headache
naratriptan
575
Risk factors for glaucoma
- Age
- Race (higher in black)
- Family history
- Diabetes
Hypertension
576
treatment for acute angle closure glaucoma
- Urgent referral to hospital via ambulance for ophthalmology review
- Analgesia - morphine
- Do not patch the eye
- Get patient to lie flat
- Nil by mouth
Give antiemetic if nauseas
577
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
578
Charles Bonnet Syndrome
* experience of complex visual hallucinations in a person with partial or severe blindness
* vivid, complex recurrent visual hallucinations
579
BPSD pharmacological treatment
Risperidone 0.25mg PO, BD (max 2mg day)
580
What are the MOST IMPORTANT high risk features (of recurrence or metastasis) of SCC?
• High risk anatomical sites: head, neck
• Tumour diameter >20mm
• Immunosuppression
• Occurrence in sites of previous trauma or pathology
• Rapid growth
• Ill defined margins
• Symptoms that indicate perineural invasion (tingling, pain, paraesthesia)
• Fixation to underlying structures
• Recurrent or incompletely excised tumours
Regional lymphadenopathy
581
Risk factors for melanoma
```
• >100 common melanocytis naevi
• >5 Dysplastic naevus
• Family history of melanoma
• Blistering sunburns as child or adolescent
• Previous melanoma or non melanoma skin cancer
• Fair complexion and tendency to burn
• Marked solar skin damage
Immunodeficiency
```
582
when do melanomas need to referred for sentinel node biopsy
when >1mm thick
583
most common side effect of acamprosate
transient diarrhoea
584
what is the medication you can use for alcohol dependence in cirrhosis
acamprosate
585
what blood test abnormalities are found in alcoholism
- Elevated INR
- Decreased albumin
- Decreased folate and B12
- Abnormal EUC and creatinine
- Elevated GGT
- AST:ALT 2:1
- Macrocytosis
- Decreased calcium, magnesium and phosphate levels
Elevated ferritin
586
What are the extra articular manifestations of ankylosing spondylitis
```
Atlanto-axial subluxation
Anterior uveitis
Apical lung fibrosis
Aortic incompetence
Amyloidosis (kidneys)
Autoimmune bowel disease (UC)
(psoriasis, cauda equina)
```
587
How to assess severity of bronchiolitis
```
Behaviour
Respiratory rate
Use of accessory muscles
Oxygen saturation
Apnoeic episodes
feeding
```
588
heart failure precipitants
```
H: hypertension
E: Endocarditis
A: Anaemia
R: Rheumatic Heart Disease
T: Thyrotoxicosis
F: Failure to take meds
A: Arrythmias
I: infection/ ischaemia/ infarction
L: lung problems
E: Endocrine (phaechromocytoma/ hyperaldosteronism)
D: dietary indiscretions
```
Pulmonary Embolism
589
Heart Failure Classes
I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
590
heart failure signs
```
• Elevated JVP
• Third heart sound
• Laterally displaced apex beat
• Hepatojugular reflex
• Weight gain
• Peripheral oedema
Pulmonary crackles
Ascites
murmur
tachycardia
```
591
treatment course for PPIs
take 4 week course
| step down to 2nd daily dosing
592
buckle fracture treatment
removable wrist splint for 3 weeks
593
Adolescent HEEADSSS
```
Home
Education/Employment
Eating Exercise
Activities
Drugs and Alcohol
Sexuality and Gender
Suicide Depression Self harm
Safety
```
594
Differentials for infantile haemangioma
- Vascular malformation - present at birth and persist with no proliferative or involutional phase
- Vascular tumours - pyogenic granuloma
- Locally aggressive tumours - Kaposi sarcoma
Malignant tumours - angiosarcoma
595
What makes bruising concerning for NAI?
bruising in children who are not independently mobile
bruising on torseo, 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
596
Risk factors for dementia
```
older age
family history
traumatic brain injury
Down syndrome
Elevated CVD risk: HTN, diabetes, obesity, stroke,
Depression
low level of education
ATSI
Excessive alcohol intake
sedentary lifestyle
poor social supports
```
597
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
598
DDx for bilateral symmetrical sensorineural hearing loss
Gentamicin use in the past / Ototoxic medication use in the past (1)
Noise-induced hearing loss (1)
Presbycusis (1)
599
DDX for sensorineural hearing loss
Presbycusis
Noise induced hearing loss
Ototoxic medication use - eg gentamicin
Hereditary sensorineural hearing loss
Meniere's disease (asymmetrical)
Acoustic neuroma/meningioma (Asymmetrical)
Cerebrovascular ischaemia
600
complications of premature menopause
```
infertility
osteoporosis
depression
atrophic vaginitis
increased risk of CVD
accelerated cognitive impairment
increased risk of autoimmune disease
```
601
hormone profile in Turner syndrome
High FSH and LH
602
causes of hypochromic microcytic anaemia
```
TAILS
Thalassemia
Anaemia of chronic disease
Iron Deficiency Anaemia
Lead Poisoining
Sideroblastic Anaemia
```
603
causes of iron deficiency anaemia
```
inadequate dietary intake
underlying malignancy
anticoagulants
inability to absorb dietary iron
AV malformation of GIT
```
604
Clinical Features Lead Poisoining
```
Acute
• CNS toxicity
○ Fatigue, weakness, headache
○ Encephalopathy
○ Cerebral oedema
• GI effects: abdo pain, nausea, vomiting, constipation
• Haemolytic anaemia, hepatitis
```
Chronic
• CNS Effects: poor concentration, headaches, impaired coordination, aggressive behaviour, irritability, intellectual impairment in children
• Muscle weakness, especially of extensor muscle groups of extremeties
• Gastrointestinal effects: abdominal pain, anorexia, constipation, weight loss
• Kidney and cardiovascular: hypertension, hyperuricaemia, gout, nephropathy, kidney impairment, fancono syndrome
• Chronic anaemia, arthralgia, myalgia, reduced fertiltiy, dental caries
gingival lead lines (Burton’s lines)wrist and foot drop
605
Glandular Fever mx
- Rest
- Paracetamol
- Ibuprofen
- Avoid contact sports for 3-4 weeks
- Avoid kissing others while unwell
- Avoid alcohol
- Drink fluids
Follow up in 7-10 days
606
clinical features of scarlet fever
• sudden high fever (above 38.5°C)
• followed by a distinctive rash (red initially, becoming dry and rough with a sandpaper feel),
○ Rash on trunk and limbs
○ Most prominent in skin folds
• facial flushing with circumoral pallor
• tongue discolouration (white initially, becoming red and bumpy [strawberry tongue]).
Pastia's lines - read streaky lines in axilla and groin
607
first line treatment for cystitis in pregnancy
nitrofurantoin 100mg 6 hourly for 5 days
608
mx of CSOM
Treatment: dry aural toilet 6 hourly until the external canal is dry
Ciprofloxacin 0.3% drops, 5 drops instilled into affected ear 12 hourly until the middle ear has been free of discharge for at least 3 days
advise to keep ear dry as possible
review weekly
609
DDx for haemolysis, renal dysfunction and neurological findings
Thrombotic thrombocytopenic purpura
| Haemolytic uremic syndrome
610
mx of CSOM
Treatment: dry aural toilet 6 hourly until the external canal is dry
Ciprofloxacin 0.3% drops, 5 drops instilled into affected ear 12 hourly until the middle ear has been free of discharge for at least 3 days
611
Mx of dry TM perforation
• <3 months: review regularly
• >3 months
○ Refer to audiology assessment and refer to ENT
○ Hearing loss <20B : review every 3 months
○ Hearing loss 21-30: use hearing support strategies : classroom amplification, speech therapy if required, educational support
Hearing loss >30: refer for hearing aid consult if surgery delayed >6 months
612
otodex ingredients
framycetin sulfate, gramicidin and dexamethasone
613
definition of recurrent acute otitis media
≥ 3 episodes of AOM in the last 6 months or ≥ 4
| episodes in the last year
614
acute otitis media with perforation (ATSI)
amoxicillin 25mg BD for 14 days
615
ATSI AOM
Amoxicillin 25mg/kg BD for 7 days
616
non ATSI AOM
amoxicillin 15mg/kg TDS 5 days
617
5 types of child abuse
```
physical
emotional
sexual
neglect
exposure to domestic and family violence
```
618
risk factors for child abuse
use of hazardous drugs or alcohol during pregnancy
a family violence situation
mental health problems or intellectual disability, which can compromise a parent’s ability to care for their child
poor attachment to the infant
absence of social supports or isolation
unstable housing or financial situation
history of own abuse or neglect or that of another child in the family.
619
Horner's Syndrome
Miosis of the ipsilateral pupil
Ptosis of the ipsilateral upper lid
Anhydrosis of the ipsilateral face
620
causes of acute Horner's syndrome
```
dissection of the internal carotid artery dissection
• brainstem / cerebellar stroke
• cervical spondylosis
• an apical lung tumour
surgery to the chest / neck.
```
621
conditions associated with increased incidence of adhesive capsulitis
```
• Prolonged immobilization (most significant)
• Female gender
• Age >49 yr
• Diabetes mellitus (5x)
• Cervical disc disease
• Hyperthyroidism
• Stroke
• Myocardial infarction
Trauma and surgery
```
622
stages of adhesive capsulitis
Painful: gradual onset of diffuse pain (6 weeks to 9 months)
Stiff: Decreased ROM affecting ADLs (4to 9 months)
Thawing: Gradual return of motion (5-26 months)
623
Extra articular features of rheumatoid
```
• cutaneous ulcers
• rheumatoid nodules
• episcleritis
• scleritis
• pulmonary fibrosis
• pleuritis
• peripheral neuropathy: sensory stocking glove
• splenomegaly
carditis
```
624
complications of rheumatoid arthritis
```
atherosclerosis
osteoporosis
depression
vascultiis
peptic ulcer disease
pulonary fibrosis
neuropathy
atlanto axial involvement
```
625
Complications of Klinefelter Syndrome
- Increased risk of osteoporosis
- Increased risk of thyroid dysfunction
Increased risk of diabetes
Infertility
626
Pharmacological mx of angina
* Metoprolol 25mg BD
* Nifedipine MR 30mg daily
* Isosorbide mononitrate 30mg daily
627
treatment for essential tremor
propanolol 10mg bd
628
rate control medication AF
metoprolol tartrate 25 mg orally, twice daily,
629
when do you start screening for AF
from 65
630
what is valvular AF
moderate or severe mitral stenosis, or a mechanical heart valve.
631
what medications should someone be on post acute coronary syndrome
- DAPT for at least 12 months
- 75mg clopidogrel daily
- 100mg aspirin daily
- Highest dose of statin
- ACEI: perindopril 2.5mg
Beta blocker: atenolol 25mg daily
632
Risk factors for aortic aneursym
```
>65 years
Peripheral vascular disease
Smoking
COPD
Hypertension
Marfan and Ehlers- Danlos
Diabetes
Family history of AAA
Hyperlipidaemia
```
633
causes of malnutrition in the elderly
poverty, isolation inability to shop/prepare food
delirium, dementia, depression, anxiety, alcoholism, bereavement, endocrine disorders, infection, malignancy , poor dentition, medications, cardiac/resp/GI disease
634
peripheral neuropathy causes
```
• Diabetes
• Peripheral vascular disease
• Hypothyroidism
• Vitamin B12 deficiency
• Chronic renal disease
• Amyloidosis
• HIV infection
• Alcoholism
• Idiopathic
Restless legs syndrome (burning feet)
```
635
causes of malnutrition in the elderly
poverty, isolation inability to shop/prepare food
delirium, dementia, depression, anxiety, alcoholism, bereavement, endocrine disorders, infection, malignancy , poor dentitiion, medications, cardiac/resp/GI disease
636
how long before surgery to hold clopidogrel
5-7 days
637
causes of binocular diplopia
Cranial - isolated cranial nerve III, IV or VI palsy, combined cranial neuropathy
Cerebrovascular accident
opthalmoplegic migraine
Neuromuscular - mysasthenia gravis, botulism
Muscular - thyroid eye disease, orbital myositis, tumours, myopathies
638
things to discuss newly diagnosed HIV
Explain that people with HIV have a normal life expectancy
Explain this is a treatable condition with oral medication
Refer to sexual health clinic to commence anti retroviral medication
Explain that pt must not have sexual intercourse without disclosing HIV status
Explain that HIV is notifiable condition
Need further testing to determine CD4 count and viral load
639
causes of binocular diplopia
Cranial - isolated cranial nerve III, IV or VI palsy, combined cranial neuropathy
Neuromuscular - mysasthenia gravis, botulism
Muscular - thyroid eye disease, orbital myositis, tumours, myopathies
640
mx of peripheral arterial disease
graded exercise program
aspirin
statin
low fat, low salt diet
641
differentials for intermittent claudication
• spinal stenosis
• nerve compression
• Venous claudication
Baker’s Cyst
642
medications for incontinence
oxybutynin
solifenacin
oxybutynin
643
strabismus exam
positive cover test
unequal red light reflex
unequal light reflex
abnormal head tilt
644
phenoxymethylpenicillin dose for child
15mg/kg BD
645
proximal Muscle weakness + pain +violaceous facial rash
dermatomyositis
646
Hypotonic infant
```
Prader Willi syndrome
Down Syndrome
Hypoxic Ischaemic Encephalopathy
Spinal muscular atrophy
congenital Muscular dystrophy
Congenital hypothryoidism
```
647
starting allopurinol
start at 50mg for 4 weeks then titrate to urate level
648
what to use if allopurinol is contraindicated
febuxostat or probenicid
649
what to prescirbe for bridigng therapy when ceasing panadeine forte for medication overuse headache
naproxen MR 750mg daily for 5 days then 3-4 days per week for 2 weeks then stop
650
prophylaxis for tension type headache
amitriptyline 10mg daily at night
651
if pityriasis versicolor is unresponsive to topical treatment
fluconazole 400mg oral
652
Nappy rash treatment
use absorbent disposable nappies
use soap substitute
zinc barrier cream
hydrocortisone 1% + nystatin cream BD
653
secondary causes of hyperhidrosis
- Fever
- Thyrotoxicosis
- Acromegaly
- Diabetes
- Phaechromocytoma
- Drugs: alcohol/narcotics/antidepressants
- Parkinsons
Lymphoma
654
what virus causes roseola infantum
human herpes virus 6
655
how long to exclude Scarlet fever from childcare
until 24 hours of antibiotics
656
when to refer knock knees
refer if >8 years old and >8cm Intermalleolar space
657
when to refer bow legs
if >3 years old
if intercondylar space >6cm
asymmetrical
pain
658
when to screen for diabetes (ages)
every 3 years from 40 years
| ATSI: yearly from 18 (with blood test)
659
when to start absolute cardiovascular risk assessment
every 2 years from 45
| ATSI: from 35
660
when to measure lipids
5 years from 45
| ATSI 5 years from 35
661
what number BP do you start medication regardless of risk
160/100
662
for someone with moderate CVD risk post lifestly change what BP number requires treatment
140/90
663
when is air travel safe post spont pneumothorax
6 weeks
664
when is air travel safe post traumatic pneumothorax
14 days
665
driving after a stroke
• After a stroke a private vehicle driver cannot drive for at least 4 weeks and a commercial vehicle driver cannot drive for at least 3 months
• Before starting to drive again the patient must be assessed for residual impairments that could affect the functions needed to drive safely
• Particular concerns are sensory and/or visual inattention
• Refer patients with significant neurological, cognitive or perceptual impairments for a driving assessment supervised by an OT
• Refer patients with hemianopia to ophthalmologist
After a TIA private drivers cant drive for 2 weeks and commercial 4 weeks
666
DDx for bloody diarrhoea in child
```
• Ulcerative colitis
• Crohn’s disease
• Clostridium difficile infection / Pseudomembranous colitis
• Juvenile polyp
• Bacterial gastroenteritis
• Coeliac disease
• Henoch-Schönlein purpura
Amoebic gastroenteritis
```
667
DDx for ankle oedema
```
• Congestive heart failure
• Liver failure
• Venous insufficiency
• OSA
• Renal disease
• Lymphoedema
• Medication induced
○ Amlodipine
Pre tibial myxoedema (Grave's disease)
```
668
DDx child joint pain
```
• Rheumatic fever
• Juvenile idiopathic arthritis
• Ross river virus
• Leukaemia
Parvovirus associated arthritis
```
669
DDx for burning feet
- Diabetic neuropathy
- Arterial claudication secondary to peripheral vascular disease
- Chillblains
- Psychogenic
- B12 deficiency
- Erythromelalgia
- Bilateral tarsal tunnel syndrome
Bilateral mortons neuroma
670
localised folliculitis treatment
mupirocin 2% BD for 5 days
671
most common causes of onycholysis
- Repetitive trauma
- Overzealous manicure
- Prolonged immersion of nails in water
672
mx of chill blains
• Elevate
• Warm gradually to room temperature in warm water
• Thin socks and closed toe shoes
• Betamethasone 0.05% ointment in OV twice daily
• Apply GTN topical spar or ointment
Can use nifedipine SR 20mg
673
Rheumatic Fever prevention
• IM benzathine benzylpenicillin every 28 days for:
o 10 years after most recent episode of ARF, or until 21 years (whichever is longer)
o Until 35 for mod RHD
o Until 40 or lifelong for severe rheumatic heart disease
674
how to diagnose eryhthrasma
clinical diagnosis
pink under wood lamp
send skin scrapings for microscopy: corynebacterium minutissimum
675
non healing ulceration lower eyelid
BCC
676
mx of dacrocystitis
Hot compress
Analgesics
Massage the sac and duct
Abx: cefalexin 500mg QID
677
DDX for cholestatic LFT picture
```
Biliary obstructionL gallstone, cholangiocarcinoma, head of pancrease cancer
Drug related cholestasis
primary biliary cirrhosis
primary sclerosing cholangitis
alcoholic cirrhosis
viral hepatitis
```
678
causes of thrombocytosis
```
• Essential thrombocytosis
• Polycythaemia vera
• Primary myelofibrosis
• Chronic myeloid leukaemia
• Myelodysplastic syndromes
• Acute myeloid leukaemia
Familial thrombocytosis
```
679
2 medical contraindications for vaccination
anaphylaxis
| immunodeficiency for vaccines with live viruses
680
treatment for UTI in infants <3 months
IV antibiotics
681
waht nerve is most injured with Monteggia?
radial nerve
682
developmental coordination disorder
problems with motor coordination that interfere with function in academics, social integration or recreation
683
Munchausen syndrome by proxy
parent or guardian creates an illness in a child so that the perpetrator gets benefit
684
causes of intoeing
medial femoral torsion
internal tibial torsion
metatarsum varus
685
W sitting position
femoral torsion
686
Signs of adequate milk supply
- Weight gain 150-200g/week
- At least 5 wet nappies per day
- At least one soft stool per day
- Settling well after feeding
Waking spontaneously for feeds
687
How to increase milk supply
- Hold baby skin to skin at breast
- Breast feed frequently -2 to 3 hourly
- Make sure good attachment: refer to lactation consultant
- Switch feed: offer each breast twice
- Express after breast feeds
Domperidone 10mg TDS
688
Causes of reduced milk supply
- Timed breastfeeds and top ups
- Poor fit and hold
Medical causes
- PCOS
- Hypothyroidism
- Retained products of conception
Breast abnormalities
- Insufficient glandular tissue
- Previous breast surgery
Medications
- OCP, cabergoline, aripiprazole
Smoking and alcohol
Mastitis
Pregnancy
Infant factors
- Cleft palate
- Prematurity
Neurological disorders
689
when is rhesus immunoglobulin needed in first trimester?
Chorionic villus sampling
Miscarriage
Abortion (either medical or surgical)
Ectoptic pregnancy
690
Rhesus doses
The dose is 250IU by deep IMI for single gestation pregnancies and 625IU for multiple pregnancies.
691
what percentage of lung cancer is the result of smoking
About 90% of lung cancer in males and 65% in females is estimated to be a result of tobacco smoking.
692
when to give first measles vaccine if baby is travelling to measles endemic area
6 months
693
how to diagnose dermatitis herpetiformis
Skin biopsy for histopathology and direct immunofluorescence
694
what antiemetic to use in Parkinsons
domperidone
695
vague knee pain with locking in child
osteochondritis dissecans
696
risk factors for pitted keratolysis
```
hot humid environment
occlusive footwear
diabetes
hyperhidrosis
immunodeficiency
keratoderma
```
697
treatment for calluses and corns
pare back skin then apply salicyclic acid plasters
698
cervical lymphadenopathy
- TB lymphadenitis
- Lymphoma
- Metastases
- Bartonella infection
- Acute toxoplasmosis
- CMV
- EBV
Non tuberculosos mycobacterium infection
Acute HIV
699
Definition of AIDs
HIV +ve plus one or more of the clinical diseases that are a feature of AIDS, e.g. PJP, KS or CD4 <200.
700
AIDS definining illnesses
```
karposi sarcoma
oesophageal candidiasis
CMV retinitiis
pneumocystis jiiroveci pneumonia
Burkitt Lymphoma
```
701
ddx for someone with cough and fever in HIV
- Pneumocystis jirovecii pneumonia
- Pulmonary TB
- Atypical pneumonia
- Lymphoma
- Lung cancer
Kaposi Sarcoma
702
Clinical Manifestations of B12 deficiency
- Hyper pigmentation
- Jaundice
- Vitiligo
- Glossitis
- Anaemia
- Areflexia
- Cognitive impairment
- Irritability
- Loss of proprioception and vibratory sense
Peripheral neuropathy
703
best test for pernicious anaemia
intrinsic factor antibodies
704
in folate and B12 deficiency why should B12 be replaced first?
to prevent subacute combined degeneration of the spinal cord
705
Who gets erythrasma
- Warm climates
- Skin of colour
- Diabetes
- Obesity
- Poor hygiene
excessive sweating
Advanced age
706
Instructions for corticosteroid use
once daily
apply liberally, not sparingly
apply to all areas of inflammation, then apply emollient elsewhere
use until dermatitis is gone and skin is clear
707
treatment of perianal streptococcal dermatitis
cefalexin 25mg/kg BD 10 days
708
End stage drug for heart failure
Sacubtril/valsartan
709
what cholesterol number makes you automatically high risk
>7.5
710
causes of high prolactin
```
Prolactinoma
Pregnancy
medication: SSRIs
Hypothyroidism
Stress
```
711
preventative treatment for cluster headache
verapamil 80mg TDS for 2 weeks then taper
712
gout flare prophylaxis when commencing allopurinol
500mcg daily
713
contraindications to cardiac stress testing
acute MI, new LBBB, high risk unstable angina, asymptomatic severe AS, uncontrolled arrhythmia, unstable heart failure, acute PE, acute aortic dissection
714
contraindications to perfomring spirometry
```
• Hemoptysis of unknown/ active TB
• Pneumothorax
• Unstable angina pectoris
• Recent myocardial infarction
• Thoracic aneurysm
• Recent eye surgery within 2 weeks
• Active TB
Recent abdominal or surgical procedures
```
715
what drugs increased serum urate levels
aspirin and diuretics
716
treatmetn of non severe pyelonephritis in adults
Amoxicillin + clavulanic acid 875/125mg BD for 14 days
717
12 month ATSI vaccines
Men ACWY
MMR
Pneumococcal
Men B
718
18 month ATSI vaccines
MMRV
Hib
Diptheria, tetanus, pertussis
Hep A
719
ATSI 6 month vaccines
Infanrix Hexa
| Pneumococcal
720
ATSI 4 year old vaccines
Infanrix IPV
| Hep A
721
when is Men B given
2,4,12 months
722
what vaccines would a child with DOwn syndrome get at 6 months
Infanrix hexa
Pneumococcal
meningococcal B
723
methotrexate side effects
```
stomatitis
alopecia
diarrhoea
nausea
flu like symptoms
SOB
hepatotoxicitiy
```
724
long term complications of polymylagia rheumatica
Giant cell arteritis
depression
chronic pain syndrome
Stroke
725
treatment for polymylagia rhuematica
prednisolone 15mg for 4 weeks then taper
726
What is a Z score
The Z-score is the number of standard deviations a person’s BMD varies from the age- and sex-matched mean BMD. A Z-score below –2.0 is below the expected range and warrants investigation for a secondary cause of low bone density. Z-scores are recommended for reporting BMD in premenopausal women, men younger than 50 years, and children.
727
requirements to give zoledronic acid
eGFR>35
vitamin D >50
calcium normal range
well hydrated
728
what are the crystal deposition related disorders associated with hyperuricaemia
gout
urate nephropathy
nephrolithiasis
729
DDx for febrile child with stridor
croup
bacterial tracheitis
quinsy
epiglottitis
730
causes of an obstructive LFT picture
```
Obstructive Cholestasis
- Acute cholecystitis
- Cholelithiasis/biliary colic
- Choledocholithiasis: gallstone in common bile duct
- Ascending cholangitis
- Cholangiocarcinoma
- Carcinoma of head of pancreas
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
Hepatocellular Cholestasis
- Drug related cholestasis
- Alcohol related liver disease
- Viral hepatitis A,B, C: can also cause intra hepatic cholestasis
Cholestasis of pregnancy
```
731
most specific liver enzyme
ALT
732
Risk factors for BCC
```
Fair skin that readily burns
History of high accumulated sun exposure
severe, multiple sunburns
Ionising radiation treatment
immunosupression
family history of skin cancers
solarium use
```
733
Abx choice for mild diabetic foot infection
dicloxacillin 500mg QID
734
features of a diabetic ulcer to suggest infection
```
local swelling
local warmth
local tenderness
erythema extending more than 0.5cm from wound
purulent discharge
```
735
what are the 3 main zoonoses
Brucellosis
Leptospirosis
Q Fever
736
when to do TOC for gonoccal pharyngeal, anal or cervical infection
2 weeks after treatment completed
| retest 3 months after exposure
737
croup assessemnt
```
behaviour
stridor
respiratory rate
accessory muscle use
(o2 sats)
```
738
thrush pharmacological tx
clotrimazole 2% cream intravaginally for 3 nigths
739
causes of urticaria
```
idiopathic
infections
medications
contact allergy
allergic reaction
bites and stings
physical triggers: exercise
```
740
examination of child with chronic mouth breathing
- Dry lips
- Receding chin
- Deviated septum
- Boggy inferior turbinates
- Allergic conjunctivitis
- Crowded lower teeth
- Tonsillar hypertrophy
- High arched palate
- Glue ear
- Wheeze
- Nasal speech
Tooth decay
741
common causes of mouth breathing in children
```
Rhinosinusitis
Inferior turbinate hypertrophy
deviated nasal septum
adenoid/tonsillar hypertrophy
recurrent URTI
nasal polyposis (rare)
```
742
DDx for progressive chronic arm weakness
```
Multiple sclerosis
Motor neurone disease
Cervical myeloradiculopathy
myasthenia gravis
chronic inflammatory demyelinating neuropathy
inclusion body myositis
thyrotoxicosis
vitamin B12 deficiency
lead poisoning
```
743
itchy vulvitis post menopausal
```
lichen sclerosis
lichen planus
atrophica vaginitis
psoriasis
irritant contact dermatitis
atopic dermatitis
```
744
DDx dyspareunia
- Endometriosis
- Vaginismus
- Inadequate lubrication
- Vaginal atrophy
- Vulvodynia
- STI
- Pelvic inflammatory disease
Interstitial cystitis
745
lichen sclerosis mx
• Refer to gynaecologist for confirmation of diagnosis with biopsy
• Treated initially with very potent topical corticosteroids
○ Clobetasol proprionate
○ Diprosone OV 0.05% daily for 4 weeks
• Goal-return skin to normal colour and texture which can take up to 6 months
• Long term maintenance therapy is required in 85% of patients as lichen sclerosis rarely remits
○ Maintenance with betamethasone dipropionate 0.05% once or twice a week
• Avoid vaginal irritants: soap, tight clothing
• Regular application of emollients
Examine patients every 6-12months for carcinoma surveillance
746
when to refer pericarditis to hospital
high fever over 38 degrees
large pericardial effusion
cardiac tamponade
failure to respond to aspirin/NSAIds in 7 days
747
causes of limp in toddler
```
transient synovitis
acute myositis
toddlers fracture
DDH
NAI
```
748
DDX for leukocoria
```
Retinoblastoma
Congenital Cataract
Coats disease
Retinal detachment
Retinopathy of prematurity
```
749
SGLT2 example
Dapagliflozin
750
DPP4 Example
Sitagliptin 100mg
751
mx of blue bottle
Wash with sea water
Remove tentacles by hand or wash them off with sea water
Immerse in hot water for 20 minutes
752
Symptoms of Irukandji Syndrome
- Severe generalised back, abdominal and muscle pain and muscle cramps
- Chest pain
- Anxiety
Headache, nausea, vomiting
753
Priapism treatment
urgent urology input
corporal aspiration
intracavernous injection of Phenylephrine
754
Sinusitis physical exam
unilateral sinus tenderness
inspect nasal cavity for polyposis
decreased visual acuity
neck stiffness
755
DDx for neck lump in neonate
```
brachial cyst
lymphoma
pseudotumour of sternocleidomastoid
rhabdosarcoma
lymphadenopathy
```
756
adverse effects of topical corticosteroids
cutaneous atrophy
telangiectasias
striae
757
what medications lower testosterone
anabolic steroids
opiates
glucocorticoids
758
treatment for legionella pneumonia
azithromycin 500mg for 3-7 days
759
what is the screening for high risk cat 3 bowel cancer
ifobt every 2 years from 35-44
| scope 5 yearly from 45-74
760
Lynch syndrome increases risk fo which cancer
```
Bowel cancer
Endometrial cancer
Ovarian cancer
Stomach cancer
Hepatobiliary cancer (liver/gallbladder)
Urinary tract cancer
Renal and urinary tract cancer
Pancreatic cancer
Brain cancer
Skin (sebaceous adenoma, sebaceous epithelioma, or sebaceous carcinoma and keratoacanthoma)
Small bowel cancer
```
761
causes of angular chelitis
poor fitting dentures
B12 deficiency
Chron disease
atopic dermatitis
762
causes of atrophic glossitis
```
nutritional deficiencies (iron, b12, folic acid)
dry mouth
sjrogen syndrome
oral candida infection
coeliac disease
```
763
treatment for giardia
Metronidazole 2g daily for 3 days
764
PICO
Population, Intervention, Comparator, Outcome
765
what sleep apnoea scores are needed for sleep study
STOP Bang >=4
| ESS >=8
766
what lobe issue would cause a receptive aphasia
temporal lobe
| difficulty with recognising faces, aggressive behaviour, identifying objects
767
treatment for stable VT
amiodarone 300mg IV over 20 minutes
768
unstable bradyarrhythmia treatment
atropine 0.5mg IV
769
Indications for referral of asymptomatic renal stones include:
• stone size >5 mm
• single kidney (congenital or postoperative)
• occupational need to be stone-free (eg airline pilot, military)
• chronic obstruction
recurrent urinary infections.
