Handbook Section 3b Flashcards
1
Q
Polycystic ovary syndrome, Rotterdam criteria
A
> 2 must be present
- oligo/anovulation
- hyperandrogenism
clinical - hirsutism, balding
biochemical - FAI, testosterone - polycystic ovaries on ultrasound
- other etiologies must be excluded
2
Q
Polycystic ovarian syndrome, treatment
A
OLIGOMENORRHOEA/AMENORRHOEA
- lifestyle
- COCP
- Cyclic progestins
- Metformin
HIRSUTISM
- cosmetics (eg laser therapy)
- eflornithine cream
INFERTILITY
- lifestyle
- medical therapy (clomiphene, metformin, gonadotropins, surgery, in vitro fertilization)
CARDIOMETABOLIC RISK
- lifestyle
- metformin
3
Q
Endometrial cancer, presentation
A
RISK FACTORS
- >50 years old
- Conditions that increase estrogen or tumors
- Estrogen increasing medications
- High fat diet
- Family history (lynch syndrome, HNPCC)
- long menstruation span
- radiation therapy
SYMPTOMS
- vaginal bleeding
- lower abdominal pain
- postmenopausal vaginal discharge
- menorrhagia after 40 years old
4
Q
Endometrial cancer, management
A
INVESTIGATION
- CA-125 assay
- CT scan/ MRI/ Transvaginal Ultrasound/ Hysteroscopy
- Endometrial biopsy/ Dilation and curettage
TREATMENT
- Chemotherapy
- Radiation
- Hormones
- Immunotherapy
- Targeted medications
- Surgery
5
Q
Urinary incontinence, types
A
- Stress - leak small amount of urine everytime abdominal pressure increases
- Urge - sudden urgent need to void
- Associated with chronic retention - blockage prevents full void thus leaks minimally instead
- Functional - unable to physically go to the toilet
6
Q
Top 10 cancers in australia
A
- Prostate
- Breast
- Melanoma
- Colorectal
- Lung
- Non-hodgkin lymphoma
- Kidney
- Pancreatic
- Thyroid
- Uterine
7
Q
6 Common adverse effect of COCP and their management
A
- Nausea - reduce oestrogen, take pills at night
- Breast tenderness - reduce oestrogen/progesterone, change to drospirenone
- Headache - reduce oestrogen/progesterone, extend if it happens on pill free days
- Dysmenorrhoea - extend pill regimen
- Decreased libido
- Breakthrough bleeding - increase oestrogen/progesterone
8
Q
COCP non-contraceptive benefits
A
- Decreased Acne - all oestrogen
- Decreased Hirsutism - all progestogens
- Menorrhagia - oestradiol valerate + dienogest
- Premenstrual syndrome/dysphoric disorder - drospirenone + ethinyloestradiol
9
Q
Henoch-Schonlein purpura, key features
A
- most common vasculitis in children, 2-8 years of age
KEY FEATURES
Rash + arthralgia/arthritis/abdominal pain/nephritis
10
Q
Henoch-Schonlein Purpura, possible physical examination results
A
PHYSICAL EXAMINATION
- hypertension
- pressure dependent rash
- painful non pitting edema
- large joint arthritis/arthralgia (usually lower limb)
- diffuse abdominal pain
- testicular pain
- respiratory distress (alveolar haemorrhage)
- mental status changes
- focal neurologic changes
- haematuria/proteinuria
11
Q
Henoch-Schonlein Purpura, Management
A
KEY POINTS
- Most cases are self-limiting and only require symptomatic management
- Close follow-up is critical to identify significant renal involvement requiring intervention. Renal involvement is usually asymptomatic
POSSIBLE INVESTIGATIONS
- urinalysis (usually the only investigation needed)
- any other tests to rule out possible diagnosis
RED FLAGS FOR ADMISSION/REFERAL
- Serious abdominal complications
- Severe debilitating pain
- Severe renal involvement
- Neurological or pulmonary involvement
- If treatment with prednisolone is considered
12
Q
Cyanotic heart defects (5 T)
A
- Truncus arteriosus
- Transposition of great arteries
- Tricuspid atresia
- Tetralogy of fallot
- Total anomalous pulmonary venous return
13
Q
Acyanotic Heart Defects
A
- Ventricular septal defects
- Atrial septal defects
- Patent ductus arteriosus
- Coarctation of the aorta
- Aortic valve stenosis
14
Q
Acute otitis media, management
A
- most cases of AOM resolve spontaneously and does not require antibiotics
- May treat pain with simple anaesthesia
- studies only required to rule out suspected differentials or complications
- Antibiotics if indicated: amoxycillin, amoxicillin-clavulanic, ciprofloxacin (chronic otorrhoea), cefuroxime (delayed pen allergy), trimethoprim-sulfamethoxazole (immediate pen allergy)
15
Q
Acute otitis media, antibiotic indications
A
- no improvement after first 48 hrs of symptoms (amoxicillin)
- no improvement after amoxicillin (amoxicillin-clavulanate)
- received amoxicillin in the last 30 days (amoxi-clav)
- with purulent conjunctivitis (amoxi-clav)
- recurrent amox resistant AOM (amoxi-clav)
- with chronic otorrhoea (cipro drops)
- delayed pen allergy (cefuroxime)
- immediate pen allergy (trimethoprime-sulfamethoxazole)
- with red flags (ENT guidance)
16
Q
Acute otitis media, red flags for immediate treatment
A
- <6 months old
- immunocompromised
- indigenous children
- only hearing ear
- with cochlear implant
- possible suppurative complication
17
Q
Constitutional growth delay vs Familial short stature
A
BONE AGE
Constitutional delay - delayed
Familial short stature - not delayed
GROWTH RATE
Constitutional delay - slow
Familial short stature - normal
HEIGHT PROGNOSIS
Constitutional delay - good
Familial short stature - poor
18
Q
Features suggesting pathologic short stature
A
- crossing centiles have a higher chance of being pathologic
- <1st centile
- Abnormally short even for family
female = min is mom, max is dad-13 cm
male = min is mom+13 cm, max is dad - exam shows sign of chronic illness
- abnormal proportions
- dysmorphic or midline defects
19
Q
Causes of pathologic growth (Endocrine PICNICS)
A
Endocrine (Thyroid, GH)
Psychosocial (Deprivation)
Iatrogenic (Glucocorticoid, Spinal irradiation)
Chronic illness
Nutritional
Intrauterine growth retardation
Chromosomal (Turner, Down, Prader-willi)
Skeletal dysplasia
20
Q
Indications for growth hormone therapy in short statures
A
- patient <1st centile, 1 year growth velocity <25th centile
- tested growth hormone deficiency
- turner syndrome
21
Q
Active seizure, management
A
Treat if:
- with suspected pathology
- cardio-respiratory compromise
- > 5mins/ unknown seizure duration
- Oxygen
- Venous access
- Check BGL (Blood glucose)
- Give Benzodiazepine if with IV
- If no IV, give IM/Buccal Midazolam
After 5 mins, still seizing
6. Repeat Benzodiazepine
After 5 mins, still seizing
7. Give Leviteracetam or Phenytoin
After 5 mins, still seizing
8. Give Leviteracetam or Phenytoin
- agent not already administered
After 5 mins, still seizing
9. Refer to senior staff
10. airway management
22
Q
Epilepsy, criteria for diagnosis
A
- The diagnosis is often made after two unprovoked seizures (>24 hours apart) or after one seizure if EEG or neuroimaging findings indicate a genetic or structural basis for a seizure tendency.
- Epilepsy remains a clinical diagnosis.
- Normal EEG and neuroimaging do not exclude the diagnosis; rather, abnormal findings assist in classifying the epilepsy syndrome.
23
Q
Antiepilepsy drugs, common adverse effects
A
- Phenytoin - hirsutism, acne, coarse face, gum hypertrophy, rash, SJS
- Clonazepam - sedation, ataxia, tolerance
- Carbamazepine - hyponatremia, rash, SJS
- Valproate - wt gain, tremor, alopecia, teratogenic
- Lamotrigine - rash, SJS
- Gabapentine - wt gain, affected by renal problems
- Topimarate - anorexia, wt loss, nephrolithiasis, oligohidrosis, metabolic acidosis, depression
- Levetiracetam - agitation, depression
- Pregabalin - wt gain
24
Q
Age of consent
A
Any sexual activity - > 16 years old
Contraceptives - >16 years old (Gillick)
Medical treatment - >18 years old, unless if child understands the information with the sign off of another practitioner
Gillick competence requirements
1. able to understand all relevant matters regarding the advice
2. medical professional is unable to persuade the child to inform the parents
3. the child will still continue with the act with/without the advice
4. advice/treatment is needed to avoid the physical or mental suffering of the child
5. receiving the advice is in the child’s best interest
25
Suspected early pregnancy loss, investigation
Investigation
1. Serum B-hCG
2. USS (TVS preferred)
If pregnancy of unknown location
1. refer to specialist
2. Serum B-hCG x 2 (48-72 hours apart)
if >50% fall (Serial B-hCG, TVS)
If fetal heart beat not visible
1. TVS
Nonviable - CRL >7mm, MSD >25mm
If not - repeat TVS (7-10 days),
Optional B-hCG
26
Preterm pre-labour rupture of membranes, management
Initial
- History and PE
- Ultrasound
- Test vaginal discharge (if none then swab)
- CTG for >28 wks/ Doppler for < 28 wks
- Antibiotic prophylaxis
>34 wks AOG - induction can be advised
<34 wks AOG - only induce if with other obstetric indications
- placenta histopathologic examination
IF NOT IN LABOR - with low risk of amnionitis and hypoplasia
- antibiotic prophylaxis as needed
- UTZ monitoring
- Weekly HVS
- Bi-weekly FBE and CRP
- Daily FHR
- Immediate review if decreased fetal movements
IF IN LABOR
- transfer to equiped hospital
- consider tocolysis, corticosteroids, MgSO4
- refer for holistic support system
27
Delay in second stage of labour, criteria
Nulliparous - >2 hrs
Multiparous - >1 hr
28
Delay in second stage of labour, differentials
- Malposition or presentation of fetus
- Inadequate uterine activity
- Inadequate maternal effort
- Inadequate pelvis
- Obstruction (full bladder)
29
Delay in second stage of labour, Management
PREVENTION:
- regular voiding
- maintain hydration
- encourage upright and active maternal positions
PASSIVE:
- refer to Obstetrician
- CTG monitoring
- Amniotomy
- Oxytocin augmentation
ACTIVE:
- refer to Obstetrician
- trial of vaginal birth in operating room
- CS
30
Group B Streptococcus infection in pregnancy, risk factors and treatment
RISK FACTORS
- prior baby with GBS
- urine infection/vaginal swab with GBS
- >38C temp while in labour
- PROM (>18hrs)
- chorioamnionitis
TREATMENT
- penicillin ( at least 2-4hrs prior to birth)
31
Rubella (German measles), epidemiology
Fetal damage - if infected 8-10 wks AOG
Maternal viraemia - 5-7 days after exposure
Incubation period - 14-23 days after exposure
Infectivity - 7 days prior to 4 days after the rash onset
32
Congenital rubella syndrome, presentation
- CNS dysfunction
- Eye abnormalities
- Sensorineural deafness
- Cardiac abnormalities
- Intrauterine growth restriction (short stature)
- Inflammatory lesion (brain, liver, lungs, bone marrow)
33
Rubella infection in pregnancy, management
INVESTIGATION
Rubella IgG - Routine antenatal screening
Rubella IgM - Test for suspected exposure or presentation
MANAGEMENT
Current infection - (+) IgM and Increasing IgG
- counselling (1st tri: offer abortion, 2nd tri: test)
No immunity - (-) IgM, (-) IgG
- repeat test
exposure: after 3 weeks
symptom: within 7 days of onset
- counselling
Recent/False infection - (+) IgM, (-) IgG
- repeat serology, immunize after delivery if still no IgG
Immunization/Past infection - (-) IgM, (+) IgG
- counselling
34
Causes of thrombocytopenia in pregnancy
1. Gestational thrombocytopenia - Asymptomatic normal 10% decrease in platelet
2. Pre-eclampsia
3. HELLP syndrome (Haemolysis, Elevated liver enzymes/Acute fatty liver, Low platelets)
35
Term premature rupture of membranes, management
> 18 hrs PROM - IV antibiotics at onset of labor
> 24 hrs PROM - Induce / Caesarean section
OTHER INDICATIONS FOR ACTIVE MANAGEMENT
- maternal choice
- fetal head not fixed at pelvic brim
- risk for GBS
- maternal infection
- concern for fetal or maternal safety
- cervical suture (remove and culture)
- breech presentation
- contraindications for vaginal birth
36
Nausea and vomiting in pregnancy, investigations
- Blood tests (urea, electrolytes, creatinine, complete blood picture, blood glucose test, liver function tests, thyroid function test, serum amylase)
- urinalysis and urine culture
- obstetric ultrasound
- abdominal x-ray
37
Nausea and vomiting in pregnancy, PUQE 4-6 management
- dietary changes
- hypnosis/acupressure/support
- IV Fluids
- PUQE 4-6 Anti NV medications
(ginger, pyridoxine, doxylamine)
- acid suppression
38
Nausea and vomiting in pregnancy, PUQE 7-12 management
* include with management for milder cases
- consider admission
- cease multivitamins except folate and iodine
- Medications (cyclizine, promethazine, prochlorperazine, metoclopramide, ondansetron)
39
Nausea and vomiting in pregnancy, PUQE >13 management
* include with management for milder cases
- medications (hydrocortisone, prednisolone)
- assess for enteral/parenteral nutrition
40
PUQE score for nausea and vomiting in pregnancy
1-5, least to worst
mild - 3-6
moderate - 7-12
severe - >13
1. duration of nausea
none, < 1hr, 1-3 hrs, 3-6 hrs, >6 hrs
2. number of episodes of vomiting
0, 1-2, 3-4, 5-6, >7
3. number of retching or dry heave
0, 1-2, 3-4, 5-6, >7
41
Estimate age of gestation by uterine fundus
12 wks - just above the pubic bone
20 wks - umbilicus
36- 38 wks - under the sternum
42
Threatened preterm labour management
INVESTIGATION
1. Physical exam
2. High vaginal swab for BV (MC and S)
3. Genital swab for GBS
4. Urinalysis (MC and S)
5. Transvaginal ultrasound of cervical length
- short length associated with PTB
6. Fetal fibronectin testing - rises near term, >50ng/ml at 22 wks - risk for PTB
<10ng/ml - low risk for birth within 1-2 wks
* ideal test is FFN + TVCL
TREATMENT
1. Progesterone therapy - reduce PTB by 9% before 34 wks
2. Cervical cerclage - for cervical length <10mm, or recurrent PTB
43
Preterm labour management
- transfer to a higher hospital
- corticosteroids for 22 - 34 wks AOG
- tocolysis (nifedipine, indomethacin, salbutamol)
- antibiotics (for GBS/chorioamnionitis)
- MgSO4 (Labor in 24 hrs, 30-33wks AOG)
- vaginal birth (preferrred)
44
Prenatal screening for fetal abnormalities
COMBINED FIRST TRIMESTER SCREENING
Down syndrome (trimester 21), Edwards syndrome (trisomy 18), Patau syndrome (trisomy 13)
- Maternal blood test
(inc B-hCG + dec PAPP-A = Down)
(dec B-hCG + dec PAPP-A= Edwards)
- nuchal translucency screening ultrasound
SECOND TRIMESTER MATERNAL SERUM SCREENING (best at 15 and 17 wks, max 20 wks AOG)
- non-invasive prenatal testing or screening
(cell-free DNA testing - trisomies 21,18,13, aneuploidies, microdeletion)
- tests for possible genetic abnormalities (Estriol, beta-HCG, alphafetoprotein, inhibin A)
- chorionic villus sampling (diagnostic)
- amniocentesis (diagnostic)
- fetal ultrasound (best for spinal bifida)
45
STI effects in pregnancy
CHLAMYDIA - via birth (pneumonia, conjunctivitis)
GONORRHOEA - via birth (conjunctivitis)
SYPHILIS - via placenta (congenital syphilis)
GENITAL HERPES - via birth
HPV/WARTS - via birth (URTI warts)
HEPATITIS B - via birth
HIV - via placenta
TRICHOMONIASIS - via birth, will cause preterm delivery and low birth weight
46
Osteochondritis dissecans, management
- reduced bone blood flow causing a segment to separate, possibly genetic or repeated trauma
INVESTIGATION
- plain x-ray
- MRI
RED FLAGS FOR URGENT REFERRAL
- locked knee
- clicking, locking or mechanical symptoms
- pain on knee movement
SEMI-URGENT
- stable osteochondritis
while waiting
- stop sport activities
- only closed kinetic activities
- protected weight bear
47
Nephrotic syndrome, presentation
Possible history of
- minimal change disease
- focal segmental glomerulosclerosis
- membranous glomerulopathy
- nephritis
- diabetes mellitus
- cancer
- infection
Signs and Symptoms
- Oedema
- Proteinuria
- Hypoalbuminemia
Complications
- Recurrent infections
- Thrombosis
- Dehydration
- Fluid congestion
48
Nephrotic syndrome management
INVESTIGATIONS
- Urinalysis
- Blood (FBE, UEC, LFT)
- Renal biopsy (optional)
TREATMENT
- Admit at 1st presentation
- Diet (low salt, low fat, controlled protein)
- Fluid retention (diuretics)
- Antihypertensives (decrease kidney filtration pressure)
- statins
- vaccines (pneumococcal, etc)
- blood thinners
- steroid tablet (minimal change disease)
49
Neonatal jaundice differentials
< 24 hrs
- Sepsis
- Haemolysis (blood group, bleeding, bruising, RBC defects)
1-14 days
- Physiologic
- Dehydration/Insufficient feeding
- Sepsis
- Breastmilk jaundice
- Bruising
Prolonged/Conjugated
- Sepsis
- Haemolysis
- Dehydration/Insufficient feeding
- Breast milk jaundice
- Hypothyroidism
>10% Conjugated
- Neonatal hepatitis
- Obstruction (Biliary atresia, cyst, bile plug)
- Metabolic
- Drugs/Parenteral nutrition
50
Premature ejaculation diagnostic tool components
1. How difficult is it to delay ejaculation
2. Ejaculate before you want to
3. Ejaculate with very little stimulation
4. Feel frustrated at ejaculating before you want to
5. How concerned are you that your ejaculation time leaves your partner unfulfilled
SCORE
>11 with PE
9-10 probable PE
<8 no PE
51
Premature ejaculation management
Assessment: unlikely
- reassurance
- education
- psychotherapy
- behavioural therapy
- follow up
52
Premature ejaculation
Assessment: likely, not caused by other medical condition
- behavioural/psychotherapy
- SSRI
- attempt medication withdrawal at 6-8 wks (lifelong PE will most likely require lifelong therapy
53
Hallucination vs Delusion vs Illusion
Illusion is false interpretation of correct sensory perception
Hallucination is false sensory perception
Delusion is false belief
54
Personality disorders: Cluster A
'odd' or 'eccentric' thoughts or behaviours
Paranoid personality disorder:
suspicious and mistrustful of others, and may be hostile or emotionally detached.
Schizoid personality disorder:
lack interest in social relationships and have an unemotional response to social interactions.
Schizotypal personality disorder:
behave eccentrically, have peculiar dress, have unusual or bizarre thoughts and beliefs, feel discomfort in social settings, and have trouble forming close relationships.
55
Personality disorders: Cluster B
unstable emotions and dramatic or impulsive behaviours
Antisocial personality disorder:
disregard for the law or for the rights of others, with a lack of remorse
Histrionic personality disorder:
highly emotional and dramatic, have an excessive need for attention and approval, and may be obsessed with their appearance.
Borderline personality disorder:
fear of abandonment, intense and unstable relationships, extreme emotional outbursts, deliberate self-harm or self-destructive behaviour and a fragile sense of self or identity.
Narcissistic personality disorder:
a pattern of inflated self-esteem, need for admiration, lack of empathy or concern for others, and fantasies of success, power or beauty.
56
Personality disorders: Cluster C
anxious and fearful thoughts and behaviour
Avoidant personality disorder:
avoid social interaction and are extremely sensitive to negative judgements by others; they may be timid and socially isolated with feelings of inadequacy.
Obsessive-compulsive personality disorder:
preoccupied by rules, orderliness and value work above other aspects of life. They are perfectionistic and have a need to be in control.
Dependent personality disorder:
fear of being alone and a need to be taken care of, difficulty separating from loved ones or making independent decisions. People may be submissive and even tolerate domineering or abusive relationships.
57
Personality disorder management
- physical examination or blood tests to rule out medical issues
- refer to a psychiatrist or psychologist for further assessment or treatment
Psychotherapy
- Most effective long-term treatment option. Helps people to understand their thoughts, motivations and feelings. These insights can help people to manage their symptoms and make positive behaviour changes
Methods include:
cognitive behaviour therapy (CBT)
dialectical behaviour therapy (DBT)
psychodynamic psychotherapy
psychoeducation
Medicine and personality disorders
- Antidepressant, antipsychotic, and mood stabilizer medicines may be used to treat/decrease associated conditions
Crisis management
- may be required in severe cases to prevent the risk of self-harm or suicide, or for the treatment of other mental health conditions
58
Charles bonnet syndrome, presentation and treatment
- visual hallucinations caused by the brain’s adjustment to significant vision loss. It occurs most often among the elderly
1. Significant vision loss
2. Visual hallucinations
3. No control over the hallucinations
4. A realisation that the hallucinations aren’t real
TREATMENT
Medical advice (doctor/counsellor)
Vision therapy
Moving your eyes
Changing visual variables
59
Ekbom syndrome (delusional parasitosis)
psychiatric disorder characterized by the patient’s conviction that he or she is infested with parasites
Treated by psychotherapy, antipsychotic, atypical antipsychotic
60
Cotard delusion definition
A rare condition marked by the false belief that you or your body parts are dead, dying, or don’t exist.
61
Diogenes syndrome, definition
A condition with distinct hoarding behaviors, severe self-neglect, and neglect in taking care of one's physical environment, as well as social isolation.
62
Briquet's syndrome (Somatoform disorder), definition
A clinical complaint of symptoms made by a patient for which there is no physical exidence of disease
63
Main types of somatoform disorder
1. Hypochondriasis - illness anxiety disorder
2. Conversion Disorder - physical or sensory problems without neurologic pathology
3. Body Dysmorphic Disorder - person spends a lot of time worrying about flaws in their appearance
4. Pain Disorder - complain of pain that does not match their symptoms
5. Somatisation disorder - excessive thoughts, feelings, and behaviors relating to physical symptoms
64
Anorexia nervosa, DSM-5 criteria
- Restriction of energy intake resulting in a low body weight
- Intense fear of gaining weight; or persistent behaviour that interferes with weight gain, despite low weight
- Disturbance in body image; or persistent lack of recognition of the seriousness of the current low body weight
65
Bulimia nervosa, DSM V criteria
- Recurrent episodes of binge eating (excessive amount of food in a discrete period of time AND a sense of lack of control)
- Recurrent inappropriate compensatory behaviours to prevent weight gain
- Frequency of at least once per week for three months
- Self-evaluation unduly influenced by body shape and weight
- Absence of anorexia nervosa
66
Binge eating disorder, DSM V criteria
- Recurrent episodes of binge eating
- Associated with symptoms such as eating more rapidly, feeling uncomfortably full, not feeling hungry, eating alone due to embarrassment and/or feelings of self-disgust
- Marked distress regarding binge eating
- Frequency of at least once per week for three months
- Absence of compensatory behaviours, anorexia nervosa and bulimia nervosa
67
SCOFF questionnaire, eating disorder, components
1. Do you make yourself Sick because you feel uncomfortably full?
2. Do you worry you have lost Control over how much you eat?
3. Have you recently lost more than One stone (6.35 kg) in a 3 month period?
4. Do you believe yourself to be Fat when others say you are too thin?
5. Would you say that Food dominates your life?
68
Analgesic ladder
Mild Pain: Paracetamol +/- NSAIDs
Moderate Pain: Paracetamol, NSAIDs and weak opioids
Severe Pain: Paracetamol, NSAIDS and strong opioids
Neuropathic pain: tricyclic antidepressants, serotonin, noradrenaline reuptake inhibitors, pregabalin, gabapentin.
69
Electroconvulsive therapy (ECT), side effects
- delivery of a small electric current to the brain while you are under anaesthetic
SIDE EFFECTS
- You may feel disorientated and confused straight after ECT
- Other common side effects are headaches and nausea (feeling sick).
- Main side effect of ECT is short-term memory loss which usually improves once you finish your ECT treatment
- Ability to drive may also be affected, mainly in the first month after ECT
70
Insomnia management
Treat any source of discomfort
Treat any psychiatric causes
Cognitive behavioural therapy
Medications
- benzodiazepines (diazepam, alprazolam)
- Z drugs (zolpidem, zopiclone)
- dual orexin receptor antagonist (suvorexant , lemborexant, daridorexant)
Other medications
- sedative, antidepressants, melatonin, antihistamines, calcium channel alpha-2 ligands
71
Important sertraline side effects
1. nausea
2. diarrhea
3. dry mouth
4. insomnia
5. tiredness
6. sexual side effects
7. weight gain or weight loss
8. suicidal thoughts and behaviors
9. serotonin syndrome
10. higher risk of bleeding
72
Most common causes of death by suicide
1. hanging, strangulation, and suffocation
2. poisoning
3. jumping from a high place
4. firearm or explosives
5. Others
73
Intermittent explosive disorder, definition
- an impulse-control disorder characterized by a failure to resist one’s aggressive impulses, which can lead to frequent explosions of aggressive behavior that is out of proportion to any provocation or stress
- episode is preceded by a sense of tension or arousal, and followed by an immediate sense of relief and, often, sincere and genuine regret. Later, the individual may feel upset, remorseful, or embarrassed about their behavior.
74
First choice antidepressant by each symptom
Anxiety - SSRI, Moclobemide
Weight loss/reduced appetite - Mirtazapine, Mianserin
Insomnia - Agomelatine, Mirtazapine, Mianserin, TCA
Sexual dysfunction - Agomelatine
Anhedonia/demotivation - SSRI, Agomelatine, MAOI, Reboxetine
Melancholia/severe depression - SSRI, TCA, Vortioxetine, MAOI
Pain - Duloxetine, TCA
Cognitive difficulties - Vortioxetine
75
Childhood disintegrative disorder (Heller's syndrome), presentation
The cause is unknown and affected children have normal developmental milestones before the rapid regression of skills, typically seen after 3 years old
Losses of at least 2 acquired skills:
- Expressive language skills.
- Receptive language skills.
- Social skills and self-care skills.
- Bowel or bladder control.
- Play skills.
- Motor skills.
- Abnormal function also occurs in at least two of: Social interaction, Communication, Repetitive interests or behaviours
76
Parkinson's disease, cardinal manifestation
bradykinesia, or slowness of movement, combined with rest tremor
rigidity
77
5 Parkinson’s disease mimics and when to consider
1. Essential or dystonic tremor - Symptom is ONLY Tremor that is absent at rest, present with posture or movement. Can also affect the head, neck and voice
2. Medication-induced Parkinsonism - Parkinson symptoms with exposure to dopamine-blocking medications (prochlorperazine, metoclopramide, antipsychotic medications)
3. Normal pressure hydrocephalus - Parkinson's motor symptoms with urinary incontinence and cognitive impairment.
4. Dementia with Lewy bodies - Fluctuating cognition, visual hallucinations, Dementia before or during onset of motor symptom
5. Progressive supranuclear palsy - Early (back) falls, postural instability, cognitive slowing or personality change
78
Alzheimer's, vascular dementia, lewy body dementia comparison
Alzheimers - more on loss of thought control, memory and language
Vascular dementia - more on loss of speed thinking and problem solving
Lewy body dementia - changes in thinking and reasoning, delirium-like cognition, parkinsonism movements
79
Population based screening programs in Australia
National Bowel Cancer Screening Program - 50-74 years old
National BreastScreen Australia Program - 50-74 years old
National Cervical Screening Program - 25-74 years old
Newborn Bloodspot Screening
Newborn Hearing Screening
80
Malaria chemoprophylaxis
Doxycycline
- wide range use, cheap
- 2 days prior to 4 weeks after exposure
Mefloquine
- can be used for children
- 2 weeks prior to 4 weeks after exposure
Malarone
- minimal side effect, can be used short notice, can be used for children
- 1 day prior to 1 week after exposure
81
Tetanus vaccination guidelines
Tetanus vaccines are only available in Australia as combination vaccines (pertussis and diphtheria)
Recommended for
- children at 2, 4, 6 and 18 months, and 4, 11–13, 50, 65 years of age
- more than 5-10 years since the last dose
Wound prophylaxis
- No tetanus vaccine history, receive 3 doses of vaccine with at least 4 weeks between doses
- Immunoglobulin given to people with immune deficiency with any wound/vaccine history
- no documented history of a complete primary vaccination course should receive all missing doses and TIG for tetanus-prone wounds
82
Vesicoureteral reflux grading
Grade 1: Reflux only into the non-dilated ureter
Grade 2: Reflux into the ureter and the renal pelvis without dilatation
Grade 3: Reflux with mildly dilated ureter and pyelocalyceal system
Grade 4: Reflux with the tortuous and moderately dilated ureter with blunting of renal fornices
83
Vesicoureteral reflux grading
Grade 1: Reflux only into the non-dilated ureter
Grade 2: Reflux into the ureter and the renal pelvis without dilatation
Grade 3: Reflux with mildly dilated ureter and pyelocalyceal system
Grade 4: Reflux with the tortuous and moderately dilated ureter with blunting of renal fornices
