Handbook Section 2a Flashcards

Question

Colorectal cancer, category 2 screening advice

Answer 1

Category 2 - 1 FDR diagnosed at less than 55 yrs, 2 FDR diagnosed at any age, 1 FDR + 2 SDR diagnosed at any age iFOBT - every two years from age 40 to 50 years Colonoscopy - every five years from age 50 to 74 years CT colonography can be offered if colonoscopy is contraindicated Low-dose (100 mg) aspirin daily should be considered

Answer 2

Category 3 - 3 FDR or SDR diagnosed at any age iFOBT - every two years from age 35 to 45 years Colonoscopy - every 5 years from age 45 to 74 years CT colonography can be offered if colonoscopy is contraindicated Low-dose (100 mg) aspirin daily should be considered Possible referral to a genetic centre for hereditary cancer

Answer 3

Category 1 - 1 FDR or SDR, more than 55 yrs of age at diagnosis Category 2 - 1 FDR diagnosed at less than 55 yrs, 2 FDR diagnosed at any age, 1 FDR + 2 SDR diagnosed at any age Category 3 - 3 FDR or SDR diagnosed at any age FDR - first degree relative, SDR - second degree relative

Answer 4

Upper tract urothelial cancer (sometimes called transitional cell carcinoma) is a cancer that occurs in either the inner lining of the tube that connects the kidney to the bladder (the ureter) or within the inner lining of the kidney. The lining of the bladder, kidney and ureter are the same, so there are some similarities between upper tract urothelial cancer and bladder cancer.

Answer 5

blood in the urine (haematuria) pain on one side of the back weight loss urinary tract infections.

Answer 6

- smoking tobacco - long-term inflammation of the ureter or kidney - exposure to certain chemicals over time, such as those used to make plastics, textiles, rubber, paint and dyes - exposure to arsenic - prior chemotherapy or radiation therapy - long-term use of large quantities of painkillers - family history of bladder cancer - having Lynch syndrome (an inherited syndrome) or Balkan nephropathy (due to Balkan region diet).

Answer 7

A relatively common problem in which there is a sense of obstruction or difficulty in swallowing, but food and liquids move normally to the stomach. The globus sensation is most commonly caused by acid refluxing from the stomach causing swelling on the lining of the throat (inflammation)

Answer 8

call for help mcrobert's manoeuvre (knees to nipples position) suprapubic pressure episiotomy manoevre by obstetrician prepare for possible rescucitation

Answer 9

Infant’s arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia.

Answer 10

Erb's palsy results from neuronal damage to the upper C5 and C6 nerves. The clinical presentation includes partial or full paralysis of the arm and often accompanied by loss of sensation. Klumpke's palsy causes paralysis of the forearm and hand muscles as a result of mechanical damage to the lower C8 and T1 nerves.

Answer 11

Conductive Hearing Loss - problems with the outer and/or middle ear - most common causes are fluid in the middle ear (ear infection), a perforated eardrum, wax (cerumen) build up or damage to the tiny bones in the middle ear (ossicles) Sensorineural Hearing Loss - most common cause of hearing loss and is due to damage to the inner ear (hair cells of the cochlea or damage to the auditory nerve) - most common causes are age and noise exposure Mixed hearing loss - has both a conductive and sensorineural hearing loss

Answer 12

- Pain and swelling of the gland, especially at mealtimes followed by swelling of the gland - Dry mouth - Difficulty swallowing or opening mouth

Answer 13

- preferably xray, but may also do sialography - advise drinking plenty of water or sucking on sugar-free lemon drops as methods for increasing flow of saliva - application of heat along with gentle massage to the area can help remove stones - If less invasive treatment do not work then surgical treatment is advised

Answer 14

Early prostate cancer usually does not cause symptoms. Advanced prostate cancer symptoms can include: frequent urination pain while urinating blood in the urine or semen a weak stream pain in the back or pelvis weak legs or feet.

Answer 15

- age, increasing rapidly after 50 years of age - family history of prostate, breast or ovarian cancer, father or brother diagnosed with prostate cancer before the age of 60 - association with high testosterone levels.

Answer 16

PSA DRE MRI Biopsy

Answer 17

Cannabis intake produces euphoria and relaxation, perceptual alteration, time distortion and the intensification of normal sensory experiences such as eating. withdrawal lasts 1-2 weeks: - craving - anxiety, restlessness, irritability - anorexia (and weight loss) - disturbed sleep and vivid dreams - gastrointestinal tract symptoms - night sweats - tremor

Answer 18

ecstasy increases the activity of neurotransmitters—specifically those that influence feelings of happiness and love—in the brain. This increase in activity also quickly depletes the brain’s supply of the chemicals needed to feel this way. During withdrawal, users typically experience the opposite of what they felt while high, like depression and anxiety. They’ll also intensely crave the drug.

Answer 19

Cocaine is a stimulant that speeds up the workings of the brain. Intense cravings, depression, anxiety and angry outbursts. Physical withdrawal symptoms include nausea, tremors, sleeping problems and muscle pain

Answer 20

Heroin is a depressant drug in the opioid class – it slows down certain functions of a person’s brain and nervous system. withdrawal symptoms: cravings diarrhoea and vomiting stomach cramps sweating bone, joint and muscle pain and twitching mood swings and crying

Answer 21

Injury Infection (Epididymitis is one of the most common) Cyst (Usually harmless) Testicular cancer Testicular torsion (medical emergency) Problems with the nerves, arteries or veins (eg varicocele)

Answer 22

Fibroadenoma - smooth, firm breast lump made up of fibrous and glandular tissue. The term “breast mouse” is also used to refer to a fibroadenoma. Rarely change into breast cancer. Cyst - fluid-filled sac, common in women aged 35-50 and in women who are taking hormone replacement therapy. Simple cysts are not cancer. In rare cases, cysts may have a cancer growing within them or close to them. Breast cancer - Most often a disease of ageing – more than 74% of cases occur in women 50 years and older

Answer 23

Schizophrenia is a mental illness that causes someone to have an altered experience of reality. Someone with schizophrenia will have symptoms for more than 6 months. They may have unusual ideas or beliefs about themselves or the world around them. 3 most common symptoms hallucinations: false sensory experience delusions: false beliefs confused thinking: thoughts are jumbled and the person can’t make sense of what other people are saying

Answer 24

Hyperopia (far sighted): convex lense Myopia (near sighted): concave lense

Answer 25

A decrease in blood flow through one or both of the main renal arteries or their branches Usually due to thromboemboli, atherosclerosis, or fibromuscular dysplasia

Answer 26

steady and aching flank pain abdominal pain fever nausea, and vomiting Gross hematuria, oliguria, or anuria may occur After 24 hours, symptoms and signs of acute kidney injury may develop

Answer 27

Hypertension (may begin at an atypical age and may be refractory) abdominal bruit or signs of atherosclerosis Symptoms and signs of chronic kidney disease

Answer 28

A vascular disease, usually affecting women, that can make the artery walls too weak or too stiff. This can lead to the arteries being either narrowed, known as stenosis, or become enlarged, otherwise known as aortic aneurysm. Most commonly affects arteries that supply the kidneys, and the carotid and vertebral arteries that supply the brain

Answer 29

For those whose kidneys are affected, symptoms can include: High blood pressure Abnormal kidney function, rarely even kidney failure Shrinkage of the kidney known as atrophy FMD in the carotid arteries may cause the following: Pulsatile tinnitus – a ‘wooshing’ sound in the ears Headaches – especially migraines Neck pain Ringing in your ears Dizziness Stroke

Answer 30

Abnormalities of the junction between the ureter and bladder that allow the urine to flow backward which makes urinary tract infections (UTIs) more likely to develop and cause kidney inflammation and scarring. About 30 to 45% of children and about 1% of newborns who have a UTI that causes a fever have VUR. This sometimes tends to run in families. Children usually outgrow VUR by about age 5 years.

Answer 31

Respiratory distress. Agitation with tachypnoea. Hypoxia. Tachycardia. Hypotension. Decreased or absent breath sounds on the affected side. Hyper-expansion. Decreased movement of the affected hemithorax. Subcutaneous emphysema.

Answer 32

If tension pneumothorax is suspected, or cannot be excluded in the hypotensive multi-trauma patient who is not responding to volume resuscitation, then chest decompression must be performed without delay.

Answer 33

Haemothorax has been consistently defined as an accumulation of blood and fluid in the pleural space that prevents adequate ventilation and compresses the lung; (18) especially when there is >1500mls or 1/3 of the patients’ blood volume in the chest cavity.

Answer 34

CXR and eFAST in the first instance. Ultrasound has consistently demonstrated to be more sensitive

Answer 35

Initial: restoration of circulating blood volume (blood products) Resuscitation finished: Insertion of an intercostal catheter Where >1,500ml is drained, thoracotomy is likely required.

Answer 36

Occurs when blood, fluid or air enters the pericardium, restricting cardiac activity and interfering with filling. It primarily results from penetrating trauma however is also possible in cases of severe blunt chest trauma that results in right heart injury.

Answer 37

The symptoms and signs evolve and may develop within minutes, or less commonly over the better part of an hour. Classic presentation of Becks Triad (hypotension, raised JVP, muffled heart sounds)

Answer 38

Definitive management of pericardial tamponade involves decompression (Pericardiocentesis) of the pericardial sac and repair of the myocardial defect Permissive hypotension and minimal volume resuscitation should be employed until decompression is achieved.

Answer 39

Air will follow the path of least resistance, therefore if an opening in the chest wall is approximately 2/3rd of the diameter of the trachea or greater, air will pass through the chest wall defect with each respiratory effort, rather than down the trachea. Hypoxia and hypercarbia will ensue as ventilation is impaired.

Answer 40

Initial 3-sided occlusive dressing Then insertion of a chest tube at a site away from the wound Convert to a 4-sided, occlusive dressing

Answer 41

Fractures of 2 or more ribs in continuity, in 2 or more places. This injury results in a segment of the chest wall that is no longer in continuity with the rest of the thoracic cage, causing disruption of its integrity.

Answer 42

Considered an immediate life-threat. Adequate oxygenation and analgesia, fluid administration ABG’s should be performed regularly. Non-invasive ventilation (NIV) may assist patients requiring inspiratory support. All patients who develop respiratory failure should receive intubation and mechanical ventilation early.

Answer 43

Short stature: height below the 1st centile for age when plotted growth chart over a minimum of 6 months Refer if: - downward trajectory of height-for-age percentiles on growth chart - more than 2 centile lines below mid-parental height / outside family pattern - with any other symptoms, especially visual or headache

Answer 44

- Urgent ENT referral for button batteries and paired magnets - Refer to ENT for removal if first attempt (via any method) is unsuccessful.

Answer 45

Shoulder flexion, abduction/lateral rotation - C5 extension/adduction/medial rotation - C6,7,8 Elbow Flexion (biceps) - C5,6 Extension (triceps) - C6,7,8 Forearm Pronation - C7, 8 Supination - C6 Wrist - C7,8 Hand - T1 Fingers (long tendons) - C7,8

Answer 46

Hip Adduction/internal rotation - L1,2,3 Flexion - L2,3 Extension - L4,5 Abduction/external rotation - L5,S1 Knee Extension - L3,4 Flexion - L5, S1 Ankle Extension - L4,5 Flexion - S1,2

Answer 47

basal cell carcinoma (BCC); squamous cell carcinoma (SCC); and melanoma. BCC - most common, rarely spreads, typically seen on sun exposed areas SCC - second most common, typically seen on sun-exposed areas Melanoma - rarer than BCC and SCC, but is more deadly, If not detected early, it can spread to other organs

Answer 48

Tamoxifen (Nolvadex® or Soltamox®) is a drug that treats hormone receptor-positive (hormone-positive) breast cancer. (Hormone-positive breast cancer is a type of cancer that needs estrogen and/or progesterone to grow.) Healthcare providers also use tamoxifen to help prevent breast cancer in people over 35 who have a high risk of the disease.

Answer 49

- Menopause-like symptoms - Weight gain (more common) - fluid retention (edema). - Nausea. - Vaginal discharge. - Skin rash. - Erectile dysfunction. - Fatigue. - Headaches.

Answer 50

Rarely, tamoxifen may cause serious issues such as: - Blood clots, deep vein thrombosis (DVT) and strokes. - Cataracts or other eye problems. - Endometrial (uterine) cancer.

Answer 51

High-velocity injury Contact lens use Reduced vision Photophobia Significant pain Loss of red reflex Lid swelling Corneal defect/haze Abnormal pupil reaction Failure to resolve

Answer 52

- Treat with eye toilet - topical chloramphenicol 0.5% eye drops 4–6 times per day for 5–7 days If hypersensitivity to chloramphenicol drops, stop treatment and consult ophthalmology

Answer 53

Pain, especially with overhead movements of the arm. sometimes lying on the affected shoulder at night may cause pain due to cephalad slippage of the humeral head with lateral compression. Hawkin's test - pain noted

Answer 54

shoulder ache and clicking/clunking Pain when lying on affected shoulder Hand/arm tingling/numbness/weakness Anterior release test

Answer 55

similar to anterior shoulder instability, given that a tear of the dynamic stabilisers of the shoulder may result in loss of congruency of the humeral head within the glenoid - pain and/or weakness when elevating arm - there may be night pain when lying on the affected shoulder - numbness/tingling in affected arm or hand. - may have normal or near-normal shoulder function Empty can test - supraspinatus Drop arm test

Answer 56

- Poorly localised/diffuse shoulder pain - sleeping on the affected side often disturbs sleep - across body movements with the arm of the affected shoulder may cause pain. Active compression test (O'brien)

Answer 57

- pain-relievers - laxatives - anaesthetic creams - nitroglycerin creams/botox injections - surgery

Answer 58

• Five yearly cervical screening using a primary HPV test with partial HPV genotyping and reflex liquid based cytology (LBC) triage, 25-69 yrs of age, with exit testing at 74 yrs • Self-collection of an HPV sample, for an under-screened or never-screened woman • A National Cancer Screening Registry was introduced in 2017 and all colposcopy data will be sent to the registry

Answer 59

Major depressive episodes are defined by a history of a >2 weeks of depressed mood or anhedonia with at least 3 of the following: - significant weight/appetite change - psychomotor agitation or retardation - feelings of worthlessness or guilt - diminished ability to concentrate - recurrent thoughts of death/suicide - insomnia or hypersomnia

Answer 60

Bacteria - Typically, severe, bloody 1. Escherichia coli (E. coli) - most common bacteria, Inc (1-9 days), Dur (2-7 days) 2. Campylobacter jejuni - Inc (1-10days), Dur (5-14 days) 3. Salmonella species - Inc (0.25-2 days), Dur (1-7 days) 4. Shigella species - Inc (1-6 days), Dur (2-3 days), dysentery

Answer 61

Parasites- typically mild watery 1. Giardia intestinalis - Inc (5-25 days), Dur (10 days) 2. Entamoeba histolytica - Inc (4-5days), amoebiasis 3. Cryptosporidium parvum - Inc (2-14 days), Dur (3 weeks), immune suppressed

Answer 62

Viruses - most common cause, typically mild and watery 1. norovirus - Inc (0.5-2days), Dur (1-4days) 2. rotavirus - Inc (1-3days), Dur (5-7 days)

Answer 63

Diverticular disease generally causes no symptoms – only 1 in 4 people with it will have symptoms - Alternating bowel habit (constipation and diarrhoea) - Intermittent lower abdominal pain, usually on the left side, brought on by eating and that’s relieved by bowel movement - Bloating

Answer 64

- Haematochezia - Abscess - Perforated bowel - Peritonitis - Fistula - Bowel obstruction

Answer 65

- Colonoscopy - Barium enema - Blood test - CT scan of the abdomen

Answer 66

- Seizures - Headaches - Variable brain impairment ( Depending on location) - May remain asymptomatic for years

Answer 67

- Advanced age - History of radiation therapy - Chromosomal abnormalities - Female hormones

Answer 68

Gliomas, one of the most common subset of primary tumors of the brain and central nervous system, form from the glial cells that surround neurons.

Answer 69

Failure to develop of both Mullerian ducts results in absence of both the uterus and oviducts. The patient has amenorrhoea which cannot be corrected. Ovaries are often present so that in theory, the woman may be able to parent a child using in vitro fertilisation and a surrogate mother. NB. that under UK law, a surrogate mother cannot receive any financial reward.

Answer 70

Asymptomatic, low-risk women - mammograms every two years for women aged 50–74 years High risk - with a parent, sibling, or child with breast cancer - consider annual mammograms from 40 years of age if the woman has a first-degree relative <50 years of age diagnosed with breast cancer

Answer 71

TRIPLE THERAPY Esomeprazole 20 mg twice daily, OR omeprazole 20 mg twice daily Amoxicillin 1 g twice daily Clarithromycin 500 mg twice daily POST TREATMENT MONITORING Urea breath test

Answer 72

Triple test 1. History and PE 2. Imaging (mammography/ultrasound) 3. non-excisional biopsy (core / fine needle biopsy) If the symptom is judged as benign, patient is still judged as average risk

Answer 73

The most common form of dementia. Alzheimer’s disease is a physical brain condition resulting in impaired memory, thinking and behaviour.

Answer 74

- persistent and frequent short-term memory loss, frequently recent events - vagueness in everyday conversations changes in ability to plan, problem solve, organise and think logically - taking longer to do routine tasks - language and comprehension difficulties - increasing disorientation in time, place and person - problems in becoming motivated and initiating tasks - changes in behaviour, personality and mood.

Answer 75

- medical history - physical examination - blood and urine tests - psychiatric assessment - neuropsychological tests (memory and thinking) - brain scans After eliminating other causes, a diagnosis of Alzheimer’s disease can be made

Answer 76

1. Uterine abnormalities (endometrium, fibroids) 2. medications (hormones, blood thinners) 3. medical condition

Answer 77

A fatal, progressive, degenerative, neurological condition. The causes of the majority of cases of MND remain unknown. However, about 10% of cases are inherited (familial) and the genetic fault of about 60% of these cases is now known in Australian families. Average survival time after diagnosis is 2.5 years.

Answer 78

Upper motor neurone - muscle spasticity - hyperreflexia - Extensor plantar response (Babinski's sign) - preserved reflex in wasted muscles - ankle clonus - pseudobulbar affect (emotional lability) Lower motor neurone - muscle wasting - muscle weakness - fasciculations - decreased reflexes

Answer 79

Every 4-6 weeks, usually becomes more frequent after 24 weeks (Total 6-10 visits per pregnancy)

Answer 80

Endometrial or cervical polyps Endometrial hyperplasia Endometrial carcinoma Exogenous oestrogens Atrophic endometritis and vaginitis Other (vaginal trauma, urethral caruncle, uterine sarcoma, cervical cancer, anticoagulants)

Answer 81

Nulliparity Late menopause (>age 52 years) Obesity 15–25 kg overweight >25 kg overweight Diabetes mellitus Unopposed estrogen therapy Tamoxifen Atypical endometrial hyperplasia

Answer 82

History and PE Ultrasound Biopsy (Usually done by ObGyne)

Answer 83

History and PE - Characterised by flare ups and periods of improvement (remissions) - Affected organ or system Blood tests - Anti Nuclear Antibody (ANA) test, which measures antibodies to self tissues - Additional blood tests are necessary to confirm the diagnosis as ANA can have a false positive result

Answer 84

- NSAID - Anti malaria drugs - Corticosteroid - Immune suppressing drug - Cytotoxic drugs

Answer 85

1. Lice - human 2. Scabies - human 3. Whipworm - human 4. Threadworm - human (most common) 5. Tapeworm - saginata: beef, solium:pork 6. Hookworm - human, dogs, cat 7. Giardia Lamblia - human, pets, livestock 8. Blastocystis hominis - humans, rats, pigs, chickens 9. Dientamoeba fragilis - humans, pigs, rats 10. Cysticercosis - pigs, humans 11. Toxoplasmosis - farm animals, cats, humans 12. Toxocara - human, dog, cat

Answer 86

CATEGORY 1 - Urgent threat to the life or the health of a woman or fetus. CATEGORY 2 - Maternal or fetal compromise but not immediately life threatening CATEGORY 3 - Needing earlier than planned delivery but without currently evident maternal or fetal compromise. CATEGORY 4 - At a time acceptable to both the woman and the caesarean section team, understanding that this can be affected by a number of factors4.

Answer 87

- cord prolapse - failed instrument birth with fetal compromise (bradycardia, high lactate or low pH i.e. < 7.2) - maternal cardiac arrest - abnormal fetal scalp blood sample/pH (high lactate or pH<7.2) - confirmed fetal blood (Apt’s test) indicating ruptured fetal blood vessel, including Vasa Praevia - sustained fetal bradycardia (<70/min for ≥ 3minutes) - Placental abruption - Placenta praevia with major haemorrhage - identified irreversible abnormality on the cardiotocographs that requires imminent delivery

Answer 88

- identified, but irreversible abnormality on the cardiotocographs but safe to deliver within 60 minutes - malpresentation of the fetus

Answer 89

- failure to progress - malpresentation in early labour - planned caesarean section presenting in labour - maternal condition requiring stabilisation, e.g. preeclampsia

Answer 90

In most people, presbycusis is a natural consequence of the body’s aging. Presbycusis can also be exacerbated by consistent exposure to loud noises over a lifetime, which damages the sensory hair cells (stereocilia). Old age health conditions such as diabetes or cardiovascular disease can also be a factor in hearing loss – although this generally suggests a separate and much rarer condition.

Answer 91

Birth - hb vax ii paediatric/engerix b paediatric 2,4 months (BIRP) - Infanrix hexa, rotarix, prevenar 13, bexsero (indigenous people) 6 months (BIP)- Infanrix hexa, prevenar 13, bexsero (indigenous people) Annually (6m-5y) - influenza 12m (NMPB) - nimerix, MMR ii/priorix, prevenar 13, bexsero 18m (PAVI) - Priorix tetra/proquad, ActHib, Vaqta paediatric, Infanrix/tripacel 4y (VIP) - Vaqta pediatric, Infanrix IPV Pneumovax 23 Hepa B - HB vax II paediatrics, Engerix B paediatrics DPT, Hep B, Polio, Hib - Infanrix hexa Rotavirus - Rotarix Pneumococcal - Prevenar 13 Meningococcal B - Bexsero Meningococcal ACWY - Nimenrix MMR - MMR II, Priorix HiB - Act HIB MMR, varicella - Priorix tetra, proquad DPT - Infanrix, Tripacel Hep A - Vaqta Paediatric

Answer 92

All ages - Influenza ( specified medical conditions), (indigenous adolescent) - Prevenar 13/Pneumovax 23 (specified medical conditions) 12-13y - Gardasil 9, Boostrix 14-16y - Nimenrix pneumococcal - prevenar 13, pneumovax 23 HPV - gardasil 9 DPT - boostrix meningococcal ACWY - nimenrix

Answer 93

All ages - Influenza (indigenous, specified conditions), Prevenar 13/Pneumovax 23 (specified conditions) 50 yrs over - Prevenar 13/Pneumovax 23 (indigenous) 65 yrs over - Influenza 70 yrs over - Prevenar 13 70 - 79 yrs - Zostavax Pregnant - Boostrix/Adacel, Influenza Pneumococcal - Prevenar 13, Pneumovax 23 Shingles - Zostavax Pertussis - Boostrix, Adacel

Answer 94

Cystic fibrosis (CF) an autosomal recessive disorder that primarily affects the lungs and digestive system because of a malfunction in the exocrine system that’s responsible for producing saliva, sweat, tears and mucus. There is currently no cure.

Answer 95

heel prick test - newborn sweat test - definitive carrier screening - detects parent's gene

Answer 96

Constipation - most common Other side-effects - CNS depression, nausea, vomiting, urinary retention, respiratory depression

Answer 97

Severe headaches that typically last for between 4 and 72 hours. Migraine sufferers may experience nausea and vomiting as well as sensitivity to light or sound. They also frequently report throbbing pain that worsens with normal activity.

Answer 98

- sudden very severe headache - lose of consciousness - have suffered a head injury - have sensory or motor problems - nausea or vomiting (if not clearly related to a flu or hangover) - high fever (above 38° C) - sensitive to light and have a new rash

Answer 99

- history of tubal sterilisation - endometriosis - history PID or salpingitis - use of assisted reproductive technologies - past ectopic pregnancy - other damage to the fallopian tube (surgery/medical conditions)

Answer 100

Usually only diagnosed as emergency cases: - pelvic examination - blood tests - ultrasound - laparoscopy

Answer 101

Excessive or uncontrollable sweating for no apparent reason, even when they aren’t hot and not exercising.

Answer 102

Medicines: strong antiperspirants (containing aluminium), nerve-blocking medicines, antidepressants or botulinum toxin type a Therapy: psychotherapy, behaviour therapy and relaxation techniques Iontophoresis: a mild electrical current is delivered through water to areas of affected skin. Surgery: remove the sweat glands or sever the nerves.

Answer 103

- Aged under 20, 20-24 or 40 and over - Aboriginal and Torres Strait Islander women - Lives in Very remote areas - Lives the most disadvantaged areas of Australia - Smoked throughout pregnancy - Several previous pregnancies (4 or more).

Answer 104

- Born at less than 23 weeks’ gestation - Born with a birthweight less than 2,500 grams - Small for gestational age - Multiple babies in one pregnancy

Answer 105

perinatal deaths: - congenital anomaly (33%) - spontaneous preterm labour or rupture of membranes (<37 weeks' gestation) (13%) - maternal conditions (11%). stillbirths: - congenital anomaly (32%) - maternal conditions (14%) - unexplained antepartum death (13%). neonatal deaths: - congenital anomaly (36%) - spontaneous preterm labour or rupture of membranes (<37 weeks' gestation) (31%) - perinatal infection (6.3%).

Answer 106

Unconscious strategies whereby people protect themselves from anxious thoughts or feelings. Defense mechanisms aren’t inherently bad but they become problematic when applied too frequently or for too long. 1. Projection: Attributing one’s unacceptable feelings or desires to someone else. 2. Denial: Refusing to recognize or acknowledge real facts or experiences that would lead to anxiety. 3. Repression: Blocking difficult thoughts from entering into consciousness. 4. Regression: Reverting to the behavior or emotions of an earlier developmental stage. 5. Rationalization: Justifying a mistake or problematic feeling with seemingly logical reasons or explanations. 6. Displacement: Redirecting an emotional reaction from the rightful recipient to another person altogether. 7. Reaction Formation: Behaving or expressing the opposite of one’s true feelings. 8. Sublimation: Channeling sexual or unacceptable urges into a productive outlet. 9. Intellectualization: Focusing on the intellectual rather than emotional consequences of a situation. 10. Compartmentalization: Separating components of one’s life into different categories to prevent conflicting emotions.

Answer 107

Full blood examination Elevated white cell count may indicate infection or lymphoma Anti-neutrophil antibody (ANA) Elevated ANA may indicate autoimmune diseases Erythrocyte sedimentation rate (ESR) Elevated ESR may indicate autoimmune diseases Thyroid stimulating hormone (TSH) TSH abnormalities may indicate thyroid pathology (eg multinodular goiter, Grave’s disease) Parathyroid hormone (PTH) Elevated PTH may indicate parathyroid adenoma Thyroid ultrasonography May reveal thyroid nodules, parathyroid adenomas Computed tomography of the chest with contrast May reveal lung malignancy, tuberculosis or sarcoidosis

Answer 108

1. Full blood examination - infection or lymphoma 2. Anti-neutrophil antibody (ANA) - autoimmune 3. Erythrocyte sedimentation rate (ESR) - autoimmune 4. Thyroid stimulating hormone (TSH) - thyroid 5. Parathyroid hormone (PTH) - parathyroid adenoma 6. Thyroid ultrasonography - thyroid nodules, parathyroid adenomas 7. Computed tomography of the chest with contrast - lung malignancy, tuberculosis or sarcoidosis 8. Specific infection tests

Answer 109

Identify compatibility in bone and kidney donations