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KFP COPY Flashcards

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1
Q

Initial pregnancy consult examination? (9)

A 
- Always
	○ BP
- Initial visit
	○ Height, weight, BMI
	○ Dental check
	○ Thyroid exam
	○ CVD - listen for murmurs
	○ Breast Exam  
	○ Abdomen - uterus size
	○ CST if due
	○ Urine - proteinuria (or ongoing if high BP, renal disease)
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2
Q

Investigations for initial pregnancy consult? (9)

A

(BFG CRUSHH)

○ Blood group
○ FBE

○ Genetic screening

○ CST
○ Rubella
○ Urine MCS
○ Syphilis
○ Hepatitis B/C
- HIV

NOT INCLUDED = Abdo blds + thyroid (UEC, LFT, TSH)

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3
Q

Initial Pregnancy visit - Management advice (6)

A
  • Influenza vaccine at any time (even if patient had for that year)
  • Iodine 150mcg daily
  • Folic acid 0.5mg daily (or 5mg if high risk)
  • 30 mins exercise, mod exercisex5 ○
  • Diet - Avoid Vitamin A, mercury, caffeine (2 cups coffee)
  • CST
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4
Q

Who gets an early OGTT in pregnancy? (7)

And when?

A

14 weeks

DM, PCOS, ATSI, PHx, BMI >30, age 40+, multiple pregnancy, previous impaired fasting BGL,

Ethnicities - SE Asian, Maori, Pacific Islanders

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5
Q

RF for PE? (6)

A 
Pregnancy
BMI >30
Malignancy
Immobilisation/Recent surg
COCP
Thrombophilia
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6
Q

Relevant history prior to breast ca consult? (8)

A
  1. Previous breast problems/Ix/Rx
  2. FHx
  3. Pregnancy history
  4. Recent breast trauma
  5. Nipple changes
  6. Nipple discharge, ducts + bleeding
  7. Breast pain
  8. Breast lump
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7
Q

Mod risk breast ca screening demographics and Mx?

A
  • 1 of below = Normal Risk
  • 2 of below = Moderate risk and increase screening

> 2 relatives (same side)
First degree relative
<50 yo at Dx

  • Annual screening from 40yo
  • Repeat every 1-2 years until 50, then go to normal
  • Refer to family cancer clinic for genetic testing
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8
Q

High risk breast ca screening demographics and Mx?

A

(Two first degree <50yo)

- Family cancer clinic

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9
Q

Nipple trauma/crack Mx (5)

A
  1. Feed from non sore breast first
  2. Pump express on affected side to maintrain supply
  3. Simple analgesia
  4. Break suction with finger when feeding
  5. Referral to lactation consultant for optimal fit
  6. Hydrogel to nipples or breast milk to soften before feed
  7. Ice pack to nipples when not feeding
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10
Q

Engorged breast Mx (4)

A
  1. Avoid giving baby other fluids
  2. Cold packs after feeding
  3. Wake baby for feed if more than 4 hours
  4. Use a good comfortable bra
  5. Simple analgesia
  6. Massage breast towards nipple whilst feeding
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11
Q

Mastitis non pharm Mx (4)

A
  1. Paracetamol
  2. Express after feeds if still in pain
  3. Drain affected side first
  4. Cold packs after feeds
  5. Lactation consultant to optimise fit
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12
Q

Nipple Pain DDx (6)

A
  1. Poor positioning/latching (most common cause)
  2. Breast pump (shield wrong size/suction too high)
  3. Breast engorgement
  4. Nipple vasospasm (worse with cold)
  5. Eczema/Psoriasis
  6. Mastitis
  7. Candida
  8. HSV
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13
Q

Intermenstrual bleeding causes (6)

A
  1. Recently starting contraception, missed pills, continuous use of active pills without having regular withdraw bleeds
  2. Medicines impacting on OCP metabolism (st john’s wort, grapefruit juice)
  3. Cervical/Endometrial cancer
  4. Cervical ectropion
  5. Uterine polyp
  6. PID/STI’s
  7. Pregnancy implantation
  8. PCOS
  9. Vaginal trauma
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14
Q

Post-coital bleeding causes (5)

A
  1. Cervical cancer
  2. STI (chlamydia commonly)
  3. cervical polyps
  4. cervical ectropion
  5. atrophic vaginitis
  6. Vaginal or vulval cancer
  7. Vaginal trauma
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15
Q

Causes of splenomegaly (5)

A 
CHF
Cirrhosis
Amyloidosis
Thalassaemia
Leukemia
Portal vein aneurysm
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16
Q

Causes of primary amenorrhoea (6)

A
  • Constitutional delay in puberty
  • Prolactinoma
  • Mullerian Agenesis - imperforate hymen
  • Turner Syndrome - gonadal dysgenesis
  • Pregnancy
  • PCOS
  • Eating disorders (anorexia nervosa)
  • Adrenals - Hypothyroidism, Hyperthyroidism, CAH
  • Ovarian tumour
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17
Q

Investigations of primary amenorrhoea (6)

A
  1. FSH, LH, testosterone (PCOS), prolactin, TFT, b-hcg

2. Pelvic US

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18
Q

Causes of secondary amenorrhoea (6)

A
  1. Pregnancy
  2. Lactation
  3. Menopause/Premature ovarian failure
  4. Contraception SE
  5. PCOS
  6. Hyperthyroidism
  7. Prolactinoma
  8. Excessive exercise
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19
Q

Investigations of secondary amenorrhoea (6)

A
  1. FSH, LH, estradiol, prolactin (only if nipple discharge), TFT, b-hcg
  2. Pelvic US
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20
Q

Contraindications for COCP (9)

A
  1. Pregnancy
  2. Migraines with aura
  3. PHx VTE or FHx <45 yo with VTE
  4. PHx Oestrogen dependent tumours (breast, ovarian)
  5. CVD
  6. DM > 20years duration
  7. Severe liver cirrhosis
  8. Smokers >35 yo (>15 cigarettes/day) or quit in last year
  9. Breastfeeding <6 weeks postpartum
  10. Uncontrolled HTN
  11. Multiple CVD RF’s
  12. Postpartum up to 6 weeks
  13. Thrombogenic mutations (factor V Leiden, Protein C and S deficiencies)
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21
Q

Side effects of COCP (5)

A
  1. Breakthrough bleeding
  2. Nausea, headache,
  3. breast tenderness
  4. Abdominal bloating, fluid retention
  5. Acne, excess body hair
  6. Mood swings, depression,
  7. decreased libido
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22
Q

CI to implanon? (4)

A
  • Breast cancer in last 5 years
  • Developing stroke/IHD during use
  • Severe Liver disease
  • Unexplained suspicious vaginal bleeding
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23
Q

SE of Depot Provera (4)

A
  • Delayed return of fertility (up to 1 year following cessation)
  • Persistent menstrual irregularity
  • Slight increase in osteoporosis (long term use)
  • Weight gain (3kg in first year)
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24
Q

CI to IUD (5)

A
  • Previous PID, ectopic
  • Breast Ca Hx
  • Current chlamydia infection
  • Malformation of the uterus
  • Unexplained vaginal bleeding - suspicious
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25
SE/Risks of Mirena? (4)
- Breakthrough bleeding - Expulsion - Uterine wall performation on insertion (0.1%) Increased risk of ectopic pregnancy and PID
26
Colposcopy referral indications (4)
- HPV 16/18 detected - HSIL detected - HPV any type in immune-deficient - Recurrent HPV present - 3rd time (3 strikes) ○ Only 2 strikes if: □ 50+yo □ ATSI - Overdue for screening by 2+ years
27
Who is not eligible for self collection CST? (4)
Pregnancy Discharge/Bleeding/symptoms Previous high risk <30yo
28
Dysmenorrhoea Ix (4)
- bhCG - Transvaginal U/S - FBE: infection, - STI screen - CST
29
Dysmenorrhoea causes (6)
1. Endometriosis/Adenomyosis 2. PID 3. Fibroids/Uterine leimyoma 4. Ovarian cyst 5. Cervical stenosis 6. Retained tampon 7. Endometrial ca
30
Dyspareunia causes (6)
``` Vaginismus Vulvodynia Endometriosis PID/STI Vaginal atrophy Dermatological - lichen planus/sclerosus, psoriasis Cervical ectropion ```
31
What groups of people need early OGTT? (6)
``` DM PCOS ATSI PHx GDM Age 40+ BMI >30 ```
32
Causes of infertility (8) - Female
- Endometriosis - PCOS - Fibroids/Polyps - PID/STI's - Premature menopause - Hypothyroidism - Prolactinoma - Illicit drugs - Recent Depot Provera
33
Subfertility Ix to consider - female (7)
1. Day 1-3 FSH and estradiol – Checks for ovarian reserve 2. Day 21 progesterone - anovulation 3. Prolactin - if discharge 4. Free androgen index + free testosterone 5. TFT's 6. HIV/Rubella 7. Anti Mullerian Hormone - contraversial 8. Pelvic US - 5-10 of cycle 9. STI screen
34
Causes of infertility (6) - Male
``` - STI ○ Mumps - Varicocele - Testicular ca - Klinefelter syndrome - Recent radio/Chemotherapy ○ Testicular injury - Low sperm count - Poor sperm motility - Hyperprolactinemia - Hypogonadotrophic hypogonadism (Kallman) ```
35
Premature menopause secondary risks? (4)
``` Osteoporosis CVD Infertility Depression Autoimmune disease ```
36
Lifestyle advice for menopause? (6)
1. Loose fitted clothing, avoid waxing/shaving 2. Weight loss + exercise 3. Avoid smoking, ETOH, spicy foods 4. 1300mg calcium diet/day 5. 400IU Vit D daily 6. Yoga 7. CBT
37
Cyclical combined HRT options (2)
Mirena IUD + daily 0.75mg oestradiol gel | 12 days 200mg micronised progesterone + daily 0.75mg oestradiol gel
38
Continuous combined HRT options (2)
Mirena IUD + daily 0.75mg oestradiol gel | 25 days 100mg micronised progesterone + daily 0.75mg oestradiol gel
39
CI to HRT? (6)
``` ○ 60+ yo ○ Previous breast cancer ○ Previous endometrial cancer ○ Uncontrolled HTN ○ High risk VTE/Stroke ○ Undiagnosed vaginal bleeding - Significant liver disease (relative) ```
40
Increased risks with HRT (5)
1. Breast cancer increase - tiny (not oestrogen only) 2. Ovarian/Endometrial cancer increase 3. VTE 4. CVD 5. Stroke
41
SE of HRT (3)
○ Breast tenderness ○ Change in menstrual bleeding ○ Nausea + bloating - Irritation of skin if using patches
42
Types of Rx for menopause? (5)
- HRT - tibolone - clonidine - gabapentin/pregabalin - SSRI/SNRI
43
Causes of menorrhagia? (8)
``` PCOS Pregnancy/Miscarriage Hyperprolactinaemia Thyroid dysfunction (hypo) Uterine fibroids (leiomyomas) Polyps Endometriosis/Adenomyosis Cancers: uterine and cervical PID Endometritis Coagulation disorders ```
44
Investigations for menorrhagia? (8)
``` Pregnancy test TFT FBE iron studies bhCG coag studies (APTT, INR, fibrinogen) STI screen CST US Pelvis - day 5-10 ```
45
Treatment options for menorrhagia? (6)
1. TXA oral 1g 6-8hrly for first 3-5 days 2. NSAID 3. COCP 4. Mirena 5. Medroxyprogesterone 150mg IM every 12 weeks 6. Norethisterone 5-10mg QID until bleeding settles 7. Endometrial ablation 8. Hysteroscopy D+C
46
When to refer menorrhagia? (6)
- Fibroids >3cm - Persistent bleeding >6 months despite treatment - Tamoxifen use - >12mm thickness in pre-menstrual - PCOS - Suspected endometriosis/adenomyosis - Concurrent dysmenorrhoea - Polyps
47
Miscarriage Ix? (5)
``` Group and hold Transvaginal pelvic US Serial hcg - 48hrs FBE Kleihauer (if more than 10 weeks) ```
48
Risk Factors for miscarriage (6)
``` Advanced maternal age Smoking Illicit drugs Overweight/Underweight T2DM Previous miscarriages Septate uterus Hyperthyroidism ```
49
Risk Factors for Ovarian Ca (5)
- Nulliparity - FHx - Mirena use - Smoking - HRT use - NIL breastfeeding
50
Secondary risks with PCOS? (4)
1. T2DM 2. Infertility 3. CVD 4. Endometrial cancer 5. Hirsutism/Acne
51
PCOS Mx (7)
- If BMI >25, aim for 5-10% weight reduction - Exercise 30 mins x5 - COCP - Metformin 500mg daily - Quit smoking - OGTT every 2 years - BP checked annually - Lipids every 2 years (or yearly if abnormal)
52
What infectious diseases in children need to stay away from pregnant women? (6)
TORCH PVZ ``` Toxoplasmosis Other - Hep B Rubella CMV Herpes Simplex ``` Parvovirus Varicella Zika
53
Postpartum visit things to ask (10)
1. Labour, birth, complications, bleeding, progress since discharge 2. Pain: perineum/ CS 3. Breast issues: feeding/ pain 4. Bowels/Bladder Urinary and faecal incontinence - pelvic floor exercises 5. Intercourse and dyspareunia 6. Bleeding 7. Fevers 8. Tiredness and fatigue - anaemia, postpartum depression, thyroid disease 9. Safety and intimate partner violence 10. Mental health/ sleep/ mood 11. Social: substances (avoid ETOH with BF) 12. Contraception
54
Pre-Eclampsia symptoms? (4)
1. Headache 2. Visual disturbance 3. Epigastric pain 4. Confusion 5. Nausea/vomiting 6. Retrosternal chest pain
55
Pre-Eclampsia examination (5)
``` 1. Abdominal palpation ○ Foetal lie, fundal height, presentation ○ RUQ/epigastric tenderness 2. Foetal HR 3. Tendon reflexes - hyperreflexia 4. Clonus 5. Urinalysis - proteinuria 6. Mental State Examination ```
56
Increased risks of pregnancy if diabetic? (5)
1. Miscarriage/Stillbirth 2. Macrosomia 3. Shoulder dystocia 4. Pre-eclampsia 5. Preterm
57
Investigations to ALWAYS order preconception? (5)
1. FBE 2. Ferritin 3. Genetic carrier screening 4. Rubella 5. Varicella
58
Preconception things to ask (8)
FLIP Fertility issues Lifestyle - exercise + diet, folic + iodine Immunisations/Infections - STI's, MMR, VZV PMHx/psychosocial - domestic violence etc
59
Causes of early pregnancy bleeding? (5)
1. Implantation bleeding (First 2 weeks only) 2. Ectopic pregnancy 3. Molar pregnancy 4. Miscarriage 5. Cervical ectropion/polyps/cancer 6. PID/STI
60
Causes of late pregnancy bleeding? (6)
1. Placenta praevia 2. Placental abruption 3. Vasa praevia 4. Bloody show from ROM 5. Cervical trauma/polyps/cancer/ectropion 6. Uterine rupture
61
Causes of vulvovaginitis (7)
1. Candidiasis 2. Bacterial vaginosis 3. HSV 4. Irritant dermatitis 5. Atrophic vaginitis 6. Lichen planus 7. Lichen sclerosus 8. Psoriasis 9. Trichomoniasis (if discharge too)
62
Non-pharm Mx of vulvovaginitis? (3)
1. Loose Cotton underwear 2. Non-soap cleanser 3. Barrier cream/emolient 4. Avoid vulval irritants (steroids, unless dermatitis, lichen planus/sclerosus)
63
CHADSVA
``` Congestive HF HTN Age >75 (2) Diabetes Stroke/TIA (2) Vascular disease Age 65-74 ```
64
Post AMI medications + dose (5)
``` Aspirin 100mg daily Clopidogrel 75mg daily Atorvastatin 80mg daily Perindopril 2.5mg daily Atenolol 25mg daily ```
65
Automatically high risk and cannot use calculator (7)
``` Diabetic >60yo ATSI >74yo Diabetic + microalbuminuria Moderate/severe CKD Familial hypercholesterolemia Total cholesterol >7.5 SBP >180 ```
66
Acne options + dose (5)
- Benzoyl Peroxide 5% daily - Adapalene 0.1% daily - Doxycycline 100mg daily - Spironolactone 25mg - COCP - Minocycline 50mg bd
67
Secondary causes of HTN (6)
``` OSA Conn's, Cushing's Phaeochromocytoma CKD, Fibromuscular Dysplasia Coarctation of Aorta (kids) Acromegaly Thyrotoxicosis ```
68
When to treat Erythema Nodusum and Mx? (4)
Only if symptomatic as most resolve in 3-8 weeks - NSAID's - Rest - Leg elevation - Cease COCP - Prednisolone 25mg daily for 2 weeks and taper
69
Psoriasis Rx options (4)
1. Coal tar lotion 3% + salicylic acid 3% bd for 1 month 2. Calcipotriol topical cream daily 3. Betamethasone diproprionate 0.05% daily for 2 weeks 4. UV phototherapy
70
Melasma Mx (4)
- SPF 50+ sunscreen daily - Change to progesterone only contraception - Camouflage make up - Hydroquinone 2% cream bd for 2-4 months +/- tretinoin 0.025% cream topically daily (CI pregnancy) - Laser
71
Venous Ulcer Mx (5)
- Compression bandage 40mmHg - Foam dressings twice/weekly - Stop smoking - Keep elevated - Weight reduction
72
Vitiligo Mx (4)
Pimecrolimus 1% cream (if on face) Betamethasone diproprionate 0.05% daily for 3 months Cosmetic camoflauge Phototherapy
73
Wart Rx (4)
- Salicylic acid 40% daily - Podophyllotoxin 0.5% paint (Anogenital warts) - Cryotherapy - Curettage
74
Who to screen 3 yearly for T2DM? (FBGL) (7)
- High risk AUSDRISK >12 - PCOS - FHx (1st degree) - Gestational diabetes - Antipsychotics use - 40yo + overweight - Indian/Pacific Islanders
75
Metabolic Syndrome Dx
Elevated waist circumference >102cm men >88cm women and 3 of: - Triglycerides >1.7 - HDL <1.0 - SBP >130/85 - FBGL >5.5
76
12 monthly T2DM investigations (6)
``` HbA1c UEC's Hb fasting lipids B12 if on long-term metformin uACR ```
77
Addison's Mx/prevention of crisis (4)
Wear an alert bracelet/necklace Increase glucocorticoids during illness Carry injectable hydrocortisone when away from medical care Recognise early features of adrenal crisis (severe cortisol deficiency - vomiting, dec LOC, dehydration)
78
Long-term Steroid SE's (7)
``` C – Cataracts U – Ulcers S – Striae, Skin thinning H – Hypertension, Hirsutism I – Immunosuppression, Infections N – Necrosis of femoral heads G – Glucose elevation O – Osteoporosis, Obesity I – Impaired wound healing D – Depression/mood changes ```
79
Hyperglycaemia causes (non-diabetics) (4)
- Trauma/Surgery - AMI/CVA - Endocrine • Cushing's - Medications • Thiazide • Diuretics • Beta-blockers • Clozapine/Olanzapine Acute/chronic pancreatitis
80
Secondary causes of Osteoporosis (9)
- Malabsorption e.g., coeliac disease - Eating disorders - Male hypogonadism - CLD - CKD - Hyperparathyroidism/Hyperthyroidism - Medications e.g., steroids >3 months, anticonvulsants, prolonged Depo Provera, prolonged proton-pump inhibitors (PPIs). - Cushing's syndrome - Metabolic bone disease s (e.g., Paget’s disease, fibrous dysplasia, osteogenesis imperfecta, osteomalacia)
81
Lifestyle Mx of Osteoporosis (5)
- Stop/reduce smoking and alcohol - Weight-bearing exercise ○ Reduces falls from balance and strength - Stop steroids - Vitamin D above 75 or 30 mins sunlight/day - Calcium rich diet - 1300mg daily - Prevention of falls ○ Improve vision ○ Household risks ○ Review medications ○ Walking aids - Suggest hip protectors
82
Indications for Osteoporosis Rx (4)
- Minimal trauma # at hip/vertebrae - Minimal trauma with T < -1.5 - T score < -2.5 - Fracture Risk Calculator ○ >5% hip fracture >20% fracture anywhere else
83
Contraindications to ear syringe (5)
- <10yo - perforated TM - Active AOM - Hx of ear surgery - Hearing loss
84
Complications of Infectious Mononucleosis (5)
- Splenic rupture - Liver failure - Pneumonia - Haemolytic anaemia - Glomerulonephritis - Airway compromise - Pancreatitis - Myocarditis
85
When to give ABx for acute otitis media (6)
HIGH RISK - <2yo with bilateral AOM - Immunocompromised - <6 months old - Perforated/CSOM - Systemically unwell - Remote/ATSI
86
What makes tonsillitis likely to be bacterial? (5) (2 of 5)
2 of: ``` Temp >38 Tender cervical lymph nodes Tonsillar exudate No cough 3-14yo ```
87
Complications of tonsillitis (4)
- Quinsy (peritonsillar abscess) - Acute rheumatic fever - Post strep GN - Reactive arthritis - Otitis media
88
Causes of CLD (6)
``` NAFLD Alcohol Haemochromatosis Chronic Hepatitis B/C Hypothyroidism Coeliac ```
89
Gastroscopy indications for GORD (5)
- Anaemia, weight loss, - haematemesis, vomiting, dysphagia, - Changing severity of symptoms - Inadequate response to treatment - Diagnostic clarification
90
Complications of haemochromatosis (5)
- Cardiomyopathy - Infertility - Hypothyroidism - Diabetes - Chronic Liver Disease
91
Chronic Hep B Mx (4)
``` Stop smoking + ETOH Condoms during sex Ensure vaccinations UTD 6 monthly hepatocellular surveillance (USS + AFP) Annual Hep B serology ```
92
IBD Rx (5)
- 5 ASA (Sulfasalazine, Balsalazide, Mesalamine, Olsalazine) - Abx - Steroids course - Azathioprine/MTX/6MP (Mercaptopurine) - all immunosuppressive - AntiTNFa (anti-cytokines to reduce inflammation) - TPN - Surgery
93
Causes of pruritis without rash (5)
- CKD - Cholestasis - Psychogenic - parkinson's - Thyroid - Leukemia
94
Causes of Acute Pancreatitis (7)
I GET SMASHED ``` Idiopathic Gall stones ETOH Trauma Steroids Mumps Autoimmune Scorpion/Spider bites Hyperlipidemia/Hypercalcaemia ERCP Drugs ```
95
When can you break consent? (4)
- Patient permission - Mandatory by law - Necessary discussion with other health professional - Duty to public health
96
Causes of poor health outcomes in ATSI? (5)
``` Lower health literacy Mistrust in western medicine Lower financial situation Overcrowding High incidence of ETOH, smoking ```
97
Disability Pension Criteria (3)
- intellectual, cognitive, neurological, sensory or physical impairments - Permanent - Sig functional impairment
98
Taxi discount criteria (4)
- Risk of falls and cannot take public transport - Continence concerns - Recent strokes - Dementia/Cognitive - Blindness
99
Health Assessment Criteria (6)
- 45-49 yo at risk of developing chronic disease - 40-49 yo T2DM Ax if high risk on AUSDRISK - 75+ yo - Permanent residents of residential aged care facilities - Intellectual disability - ATSI (annual) - Refugees and other humanitarian entrants
100
What components make a screening program worthwhile (4)
- Important health problem - Understand disease progression - Simple, safe and economic - Needs to have effective treatment available - Benefits outweigh harm
101
TATT investigations (7)
``` FBE UEC LFT's TSH ESR/CRP BGL Ferritin ```
102
Risk Factors for DVT (5)
- Pregnancy - Post major surgery - Immobility - Obesity - COCP use - Smoking - Previous VTE - Varicose veins
103
Multiple myeloma Ix (4)
- Serum protein electrophoresis/ Serum free light chain analysis - 24 hour urine collection for protein electrophoresis - Bone marrow aspirate - Urine Bence Jones Protein - PET scan - Skeletal survey
104
Causes of splenomegaly (4)
``` CHF Cirrhosis Amyloidosis Thalassaemia Leukemia Portal vein aneurysm ```
105
Medical high risk conditions for pneumococcal (11)
- PHx pneumococcal disease - <28 weeks gestation - Immunocompromised - Cochlear implants - Intracranial shunts - Chronic Lung Disease and severe asthma - Chronic Renal Disease/ Liver Disease - Cardiac disease - Trisomy 21 - Diabetes - Smoking (current or in the immediate past) - ETOH (>6 standard drinks/day for males and >4 standard drinks/day females)
106
What steps to take when there is cold chain breach (4)
- Make list of patients who have received dose from batch - Contact Public Health Unit - Do not use further vaccines until advised, move and label them - Make incident report
107
Fever and rash in returned traveller DDx (5)
``` Dengue fever Chikungunya (West Africa) Measles HIV Zika Scrub Typhus QLD tick typhus Ross River Virus Barmah Forest Virus Meningococcal ```
108
Malaria symptoms (4)
``` Dark Urine Diarrhoea Fever Myalgia Nausea ```
109
Indications for HIV PrEP (3)
HIV negative patients with mod risk (exposure in last 6 months of) - Shared injection with HIV+ or MSM - Condomless receptive anal or vaginal sex with HIV+ or MSM - MSM with rectal STD/syphillis
110
Ix to do before HIV PrEP (4)
- Negative HIV antibodies and p24 antigen - UEC's - Pregnancy test - Hep A/B/C and other STI's Will need ongoing CD4 count and viral load
111
Government funding for influenza vaccine (5)
``` ○ 6months – 5yo ○ Pregnant women ○ 65yo+ ○ 6 months + with medical condition - ATSI ```
112
BPH symptoms Mx (5)
- Reduce caffeine/ETOH - Tamsulosin - Reduced evening fluid intake - Pelvic floor exercises - Treat constipation/fibre intake - Finasteride
113
Erectile Dysfunction causes (5)
- Neurogenic (MS, Parkinson's) - Vasculogenic (CVD, DM, smoking) - Psychogenic - Anatomical (Peyronie's, Phimosis, Micropenis) - Hormonal abnormalities/Hypogonadism - Substances - Smoking/ETOH/Drugs/Medications
114
Erectile Dysfunction Ix (4)
Need to assess for CVD 1. FBGL 2. F cholesterol 3. FBE 4. UEC Consider: LFT's LH (high = gonadal failure, low =hypothalamic failure) Testosterone
115
Gynaecomastia Ix (4)
- serum testosterone - LH (hypogonadism) - FSH - TFT's (hyperthyroidism) - oestradiol (Leydig cell) - serum hcg (testicular germ cell tumour)
116
SPC insertion CI's (4)
- Bleeding disorders - Pregnancy - Severe obesity - Lower abdo scar tissue - Pelvic cancer
117
4 common symptoms of ovarian ca
- bloating - pelvic/abdo pain - early satiety - urinary frequency - constipation
118
NEXUS criteria for XR ?c-spine fracture (4)
``` Midline cervical tenderness Altered mental status Focal neurological deficit Evidence of drug/ETOH intoxication Presence of other injury severe enough to mask neck pain ```
119
Ottawa knee XR rules (4)
Any of ``` Age >55 Unable to WB Fibular head tenderness Patellar tenderness Can't flex knee to 90 degrees ```
120
Chickenpox complications (5)
``` Bacterial skin infection Dehydration from vomiting/diarrhoea Pneuomina Exac of asthma Disseminated varicella infection Thrombocytopenia ```
121
When to give zoster immunoglobulin (3)
High risk patient within exposure of 96 hours - Pregnant woman - Neonates - Immunocompromise Check immunity first
122
Major Criteria for Acute Rheumatic Fever
CASES - Carditis - Arthritis - Subcutaneous nodules - Erythema marginatum rash - Sydneham chorea
123
Minor Criteria for Acute Rheumatic Fever
FACT - First degree heart block - Arthralgia - CRP/ESR - elevated - T >38
124
Bechet's disease signs (4)
Mouth ulcers Uveitis/Conjunctivitis Arthritis Genital sores Treated with steroids
125
Triggers for Gout (4)
``` ETOH Soft drink Red meat Medications - diuretics Trauma ```
126
RF for gout (4)
Male Pacific Islander ATSI FHx
127
Acute gout options (4)
1. NSAID - naproxen 500mg bd 3-5 days 2. Low dose colchicine a. 1mg immediately, then 0.5mg 1 hour later 3. Prednisolone a. 30mg daily 3-5 days 4. ICS injection (if only 1 or 2 joints) Methylprednisolone acetate 40mg
128
Osteomyelitis RF (5)
- recent trauma or surgery - immunocompromised patients - illicit IV drug use - poor vascular supply systemic conditions such as diabetes
129
Raynaud's Phenomenon Mx (4)
- CCB - e.g, amlodipine or felodipine - Stop smoking - Avoid beta blockers Use warm clothes/gloves
130
Causes of Raynaud's Phenomenon (4)
• SLE Scleroderma • RA Thyroid disorders
131
Cutaneous systemic sclerosis features (5)
``` CREST Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telengiectasias ```
132
Idiopathic intracranial hypertension RF (4)
- Females - Pregnancy - OCP Doxycycline
133
Migraine characteristics (4)
- Unilateral - Pulsatile - Mod-severe pain - Impacting routine
134
Migraine triggers (4)
``` Stress Insomnia Fatigue Sunlight Salty food ```
135
Conditions associated with mononeuritis multiplex? (4)
``` T2DM SLE RA Amyloidosis Vasculitis ```
136
Peripheral Neuropathy examination findings (4)
10g monofilament sensation Ankle reflexes Vibration - 128Hz tuning fork Pinprick sensation
137
Restless Legs Syndrome Ix (4)
As associated with iron def, CKD and T2DM - FBE - HbA1c/FBGL - UEC's - Iron studies
138
Cataracts RF (4)
- Smoking - Age - T2DM Excessive ETOH consumption
139
Non LFT Ix findings in CLD (3)
Thrombocytopenia Low albumin INR increased Hyponatraemia
140
Decompensated Liver disease signs (3)
Ascites Easy bruising Peripheral oedema Jaundice
141
Alcohol related liver disease specific findings (3)
Dupuytren's contracture Proximal myopathy Parotidomegaly
142
Secondary conditions/states to cirrhosis (5)
``` Variceal haemorrhage Spontaneous bacterial peritonitis Hepatocellular carcinoma Hepatic encephalopathy Ascites Hepatorenal syndrome ```
143
Genital warts Mx options (4)
- No need for treatment if not causing discomfort - Cryotherapy - Imiquimod 5% cream, alternate days until warts resolve OR - Podophyllotoxin 0.5% paint, bd for 3 days followed by a 4-day break; repeat weekly until warts resolve.
144
Sudden onset crying in infant DDx (5)
``` UTI AOM Volvulus/Intussusception Hair torniquet on fingers/toes Raised intracranial pressure Trauma Corneal Abrasion ```
145
Motor weakness in child DDx (4)
Spinal Muscular Atrophy Duchenne's Muscular Dystrophy Prader Willi Syndrome Cerebral Palsy
146
Investigations to monitor for antipsychotics (5)
``` FBE Prolactin FBGL ECG Lipids ```
147
Urinary incontinence Examination (4)
``` BMI - elevated Abdo - palpable bladder/mass Pelvic organ prolapse Incontinence on coughing Assessment of pelvic floor contraction ```
148
Pharm for Overactive Bladder Syndrome (4)
- Oxybutynin 5mg tds - Darifenacin - Estradiol pessary - 10mcg weekly Mirabegron 25mg daily
149
Rheumatoid Arthritis Mx (3)
- NSAID's - Fish oil daily - Physiotherapy - Rest from exacerbating activities - Quit smoking - Early referral to derm/pred commencement
150
4 factors to ensure before giving zoledronic acid in GP
- Adequate Vit D - Adeqaute calcium - eGFR >35 - Well hydrated patient
151
Erythema Nodusum causes (4)
``` Sarcoidosis Crohn's Idiopathic COCP Pregnancy Strep Infection ```
152
Papilloedema causes (4)
- Intracranial mass - Venous malformation - Idiopathic Intracranial Hypertension - Hypertensive Retinopathy - Diabetic Retinopathy - Optic neuritis - Central Retinal Vein Occlusion
153
Vitreous haemorrhage presentation (4)
- Sudden - Often unilateral - Floaters/Flashes - Blurred vision -> Vision loss - Hx of trauma/DM
154
Benign Rolandic Epilepsy presentation? (4)
- Most common school age epilepsy - 3-13 yo - Simple focal seizure - Speech arrest - Usually night time - Preservation of consciousness
155
SIMPLE Febrile convulsions criteria? (4)
- Associated with fever - 6 months - 6 years old - Generalised with no focal neurology < 10 minutes
156
HEADS DS Ax
``` Home environment Education Activities Drugs Sexuality ``` Dieting/Exercise Suicide/Safety
157
Dementia blds to order? (9)
FBE, UEC, LFT's, CMP, TFT's, FBGL, lipids, B12, folate
158
Anorexia nervosa admission criteria (5)
``` BP <80 HR <50 QTc >0.45 Temp <35.5 Hypokalaemia Postural drop >20 ```
159
Schizophrenia criteria
> 6 months of two or more: - Delusions - Hallucinations - Disorganised speech - Disorganised behaviour - Negative symptoms
160
Schizophreniform disorder criteria
1-6 months of two or more: (1 must be top 3) - Delusions - Hallucinations - Disorganised speech - Disorganised behaviour - Negative symptoms
161
Causes of hypercalcaemia (4)
``` Malignancy Vit D toxicity Hyperthyroid/Hyperparathyroid Thiazides Sarcoidosis Conn's ```
162
Causes of hypomagnesemia (4)
○ GI - diarrhoea, malabsorption ○ ETOH ○ Diabetes - Diuretics, PPI's
163
Causes of hypermagnesemia (3)
- Excessive intake - antacids, supplements - Kidney impairment - Rhabdomyolysis - Lithium
164
Excluding medications, causes of hyperkalaemia? (3)
Haemolysis of sample Kidney failure Addison's Rhabdomyolysis
165
Nephritic Syndrome features (5)
- Oliguria - Oedema - Protein + - HTN - Haematuria Mx = ED
166
Causes of nephrotic syndrome? (4) | DAVID
Minimal change, focal segmental glomeurlosclerosis, membranous DAVID ``` Diabetes Amyloidosis Vasculitis Infection (Hep) Drugs (NSAID's) ```
167
``` Proteinuria causes (7) HMPH DINGO MEDS ```
HTN Multiple myeloma PCKD Hepatitis ``` Diabetes Infection - UTI NSAID's Glomerular - FSGS, minimal change, membranous Orthostatic ``` Menstruation Exercise Diet SLE
168
What drugs to avoid on a sick day? SADMANS
``` Sulfonylureas ACEi Diuretics Metformin ARB's NSAID's SGLT2i ```
169
What RF do we need to do renal check for annually? (5)
``` Age >60 ATSI >30 DM HTN/CVD Smoker Obese BMI >30 FHx CKD PCKD/GN ```
170
Symptoms of CKD (4)
- Pruritis - Restless legs - Dyspnoea - Lethargy - Nocturia/Haematuria
171
CKD referral criteria? (4)
CKD 4 or 5 (<30 eGFR) Persistent sig albumin >30 >25% drop in eGFR sustained in 12 months Uncontrolled HTN with CKD - already on 3 BP meds
172
Long-term CKD, what history and O/E on r/v (5)
- IUTD - Low salt diet <6g/daily - Exercise 30 mins x5 - Stop smoking - BP <130/80 - BMI <25
173
CKD review, Ix (6)
``` UEC's + uACR - frequency depends on CKD level Annual: FBE lipids glucose Calcium Phosphate Parathyroid hormone (eGFR <45) ```
174
When might eGFR be unreliable? (4)
- Pregnancy (use creatinine instead) - AKI - Dialysis - CLD - High muscle index/extreme body size - Children
175
When might uACR be unreliable?
- UTI/STI - Menstruation - Acute illness - NSAID's
176
Kidney stones workup/Ix (6)
1. CTKUB vs renal US (pregnant + children) 2. UEC 3. Serum uric acid 4. Serum calcium +/- parathyroid hormone 5. Stone analysis 6. Urine MCS
177
Kidney stones. When do we need to refer OR ED (4)
``` Stones >6mm Nil stone passed after 4/52 Single kidney Renal impairment Systemic infection signs/UTI ```
178
Kidney stones <6mm conservative Mx (5)
- Fluid intake to maintain 2L urine output daily - Low sodium/protein diet - CT KUB or XR in 4/52 if no stone found by patient - Tamsulosin 400 mcg daily for 4 weeks - Monitor for infective signs/deterioration
179
Overactive bladder syndrome non-pharm Mx (5)
- Bladder training - Avoid caffeine - Quit smoking - Weight loss - Avoid excess fluid intake - Pelvic floor exercises - Maintain soft and regular bowel motions
180
Bladder training advice
○ Find longest day interval that patient can go without voiding ○ Then go when waking and before bed, and try to space out during the day by interval ○ Distraction techniques ○ Increase interval by 15 mins every 1-2 weeks
181
When is vomiting during feeds concerning? (4)
Best question is: what are they like when they vomit? Happy or distressed? ``` Refusing to feed Cough/Wheeze (resp) Faltering growth Haematemesis Projectile Bile Bulging fontanelle ```
182
Causes of lung cavitation? (5)
``` Pulmonary TB Abscess Malignancy Sarcoidosis Fungal pneumonia Lymphoma ```
183
Medications + duration to WH before spirometry
SABA 4 hours SAMA 12 hours BD LABA 24 hours daily LABA/LAMA's 36 hours
184
Medical conditions that are CI spirometry (5)
- Pneumothorax - Haemoptysis of unknown origin (TB) - Recent AMI - Thoracic aneurysms - Recent abdo/thoracic surgery
185
Obstructive causes of spirometry (5)
- COPD - Asthma - Cystic Fibrosis - Bronchiolitis - Bronchiectasis - Alpha 1 antitrypsin deficiency
186
Restrictive causes of spirometry (5)
- Pulmonary Fibrosis - Obesity - Neuromuscular disorders - Sarcoidosis - Diaphragmatic hernia - Ascites
187
Triggers of asthma (6)
- viral infection - cold weather - pollen - dust - animal hair - exercise - smoking - food
188
When to commence ICS in asthma? (5)
- Flare ups within every 6 weeks - >2 past year requiring ED, oral corticosteroids - Persistent symptoms (daytime >2 per week, night time >2 per month) - Hospitalisations - Limitation of activity/sleep
189
Reasons for poor asthma control? (4)
``` Poor inhaler technique Medications not increased enough Incorrect diagnosis Trigger exposure Lack of understanding of asthma action plan ```
190
Bronchiectasis prevention Mx (4)
- Minimise resp infection exposure - Immunisations - Stop smoking - Exercise - Airway clearance with pulmonary rehab
191
Clubbing NOT found in? - Bronchiectasis - Sarcoidosis - Lung Cancer - COPD - Interstitial Lung Disease - Cystic Fibrosis - Empyema - Pertussis - TB
SPC - Sarcoidosis - Pertussis - COPD
192
Resp referral indications for COPD patient (6)
- Rapid decline in function - Frequent chest infections - Haemoptysis - Ankle oedema - SpO2 <92% - for possible home O2 - COPD <40yo Bullous lung disease on CXR or CT
193
Indications for home O2? (4)
Long-term use, exercise, nocturnal or travel O2 use >16 hours/day based on ABG SpO2 <85% whilst flying SpO2 <88% on 6 min walk test SpO2 <89% for 30% of night
194
Croup assessment (4)
CROW Stridor ``` Conscious state RR O2 sats WOB - Accessory muscle use Stridor at rest ``` HOWEVER, O2 sats are too late a sign in mild croup
195
Triggers of urticaria? (5)
- Exercise - new foods - medications - bite/sting - animals/latex/materials - infections (virus/cold)
196
Dementia non-pharm Mx (5)
1. my aged care r/f 2. advanced care planning 3. webster pack/home medicines review 4. carer support/respite (social work) 5. no driving until OT/specialist Ax
197
Colonoscopy referral indications? (5)
1. positive FOBT 2. Unintentional weight loss >10% in 3 months 3. Unexplained iron deficiency 4. Change in bowel habit >50yo 5. nocturnal diarrhoea 6. Unexplained PR bleeding 7. FHx of bowel cancer (immediate member)
198
Bowel cancer non-pharm prevention? (4)
No smoking No ETOH BMI 18-25 Avoid red meat
199
Causes of paeds chronic mouth breathing? (4)
Inferior nasal turbinate hypertrophy Adenoid hypertrophy Deviated nasal septum Allergic rhinitis
200
When to send pneumonia pt to hospital? (7)
Any of ``` HR >100 RR > 22 Sats <92% Confusion SBP <90 Multilobar Involvement on CXR Blood Lactate Concentration >2mmol/L ```
201
Patient groups who need high folic acid? 5mg (5)
DM, BMI >30, poor absorption (IBD) Hx/FHx of NTD Anti-epileptics Thalassaemia
202
When is aspirin indicated in pregnancy? (4)
* PHx of pre-eclampsia * T1DM/T2DM * Multiple pregnancy * Renal disease, chronic hypertension * Autoimmune diseases such as SLE and antiphospholipid syndrome
203
First trimester screening for pregnancy?
Dating scan (>8 weeks) Screening = ○ Maternal serum test - PAPP-A, hcg (9-13 wks) ○ Nuchal thickness ultrasound (11-13 wks) OR Non-Invasive Prenatal Test (10+wks)
204
Which of these are benign? (3) - Atypical lobular hyperplasia and lobular carcinoma in situ (LCIS) - Atypical ductal hyperplasia - Intraductal papilloma - Fat necrosis - Mammary duct ectasia - Radial scar or complex sclerosing lesion
- Fat necrosis - Mammary duct ectasia - Radial scar or complex sclerosing lesion
205
Signs of breast cancer (6)
1. Thickening of ridge 2. Breast or nipple asymmetry 3. Skin changes as dimpling, redness 4. Nipple changes 5. Nipple discharge 6. Unilateral breast pain
206
Breast thrush (Rx only)
1. Mother = flucanozole 150mg every 2nd day for 3 doses, then nilstatin 100, 000 units tds and micanozole QID on nipples 2. Infant with micanozole oral gel QID 7 days, then once daily for 1 week
207
When can't you use PERC rule? (3)
PERC gross person (obese, amputated, cancer) C for cancer Active cancer Amputated limb Morbid obesity
208
When can't you use Well's score? (3)
Well person (pregnant, arm, 30 days) weLL for lower limb Upper limb suspected Pregnancy >30 day's since presentation
209
Intermenstrual bleeding Ix (4)
bhCG coags Co-test STI screen Consider US Pelvis
210
Post-coital bleeding Ix (4)
bhCG coags Co-test STI screen Consider US Pelvis
211
Post-menopausal bleeding causes (4)
1. Endometrial cancer 2. Cervical/Endometrial polyp 3. Cervical cancer 4. Vaginal atrophy
212
3 Emergency contraceptions, dose and time frame
1. Levonorgestrel 1.5mg <3days 2. Ulipristal acetate 30mg <5 days 3. Copper IUD <5 days
213
Increased risks of COCP (4)
VTE Stroke/MI Gall bladder disease Cervical cancer
214
Pyelonephritis admission criteria (4)
inability to tolerate oral therapy fever (38°C or higher) systemic symptoms (eg tachycardia, nausea, vomiting) sepsis or septic shock
215
Mild-moderate asthma attack features?
Sats >94% | Able to walk and talk in one sentence
216
Severe asthma attack features?
Sats 90-94% | iWOB
217
Critical asthma attack features?
Reduced consciousness Cyanosis Sats <90% Poor respiratory effort
218
Calcium scoring indications (3)
45-75 Intermediate risk Asymptomatic
219
Examination in fitness to drive? (5)
``` Hearing assessment Visual acuity Visual field Insight into cognition Co-ordination MSE BGL Peripheral neuropathy ```
220
Conditions/Events that can impact fitness to drive (6)
``` OSA AMI Stroke Hypoglycaemia Dementia Co-ordination/Parkinson's Vision problems/Cataracts Epilepsy ```
221
Cataracts RF? (5)
``` Smoking ETOH Sunlight exposure Age T2DM High dose corticosteroids ```
222
Causes of flashes/floaters? (6)
Anything that "tugs" on retina ``` Retinal detachment Vitreous haemorrhage Posterior Vitreous detachment Posterior uveitis Retinoblastoma/Tumour Optic neuritis Migraines TIA/Stroke ```
223
Deranged LFT's causes (8)
1) Panadol poisoning 2) non-alcoholic fatty liver disease 3) Hep B/C 4) Autoimmune hepatitis 5) Haemochromatosis 6) Wilson's disease 7) Alpha-1 antitrypsin deficiency 8) Alcoholic liver disease 9) Coeliac disease 10) Hypothyroidism 11) Malignancy 12) PSC 13) PBC
224
First line investigations for abnormal LFT's (4)
Liver US Hep B serology Hep C serology iron studies (haemochromatosis) 2nd line = AMSA, ANA, SPEP, TSH (hypothyroid), coeliac,
225
Causes of oral candida? (3)
``` Smoking Dentures Diabetes ICS use Poor oral hygiene ```
226
MDD DSM criteria
- 2 weeks of depressed mood AND/OR anhedonia with at least 3 of sleep/appetite/energy/suicidal/concentration - causes sig distress/impairment
227
Cannabis overdose symptoms? (4)
Red eyes Increased hunger Sedation Euphoria
228
Methamphetamine overdose symptoms? (3)
Agitation Sweating Hallucinations
229
Stable angina prevention Rx options (4)
1. Atenolol 25mg daily 2. Amlodipine 2.5mg daily 3. glyceryl trinitrate patch 5mg for maximum 14hours/day 3. Nicorandil 5mg bd
230
Stable angina with LVEF <40%? Rx changes? (2)
Use heart specific beta blocker | Avoid heart specific CCB (because decreases output)
231
What CCB's to avoid with beta blockers? (2)
Verapamil and Diltiazem
232
Non-pharm Mx of delirium? (5)
``` Identify and avoid triggers Time orientation aid (clock in room) Regular leisure/exercise Low stimulating environment Speak calmly to reassure patient ```
233
3 investigations for haematospermia
- urine MCS - FBE - coag studies
234
Differentials for sudden collapse in child? (8)
``` Seizure Breath-holding spell Pseudoseizure Conversion disorder Drug withdrawal Drug intoxication Migraine syndrome Vasovagal Cardiogenic - arrhythmia Cataplexy Narcolepsy Anaphylaxis Intracranial bleed Hypoglycaemia Meningitis ```
235
Common causes of confusion - nursing home? (5)
``` Unrecognised Patient Abuse Poor sleep Unrecognised pain UTI Constipation Depression Sensory deficits (hearing/vision) Paranoid delusions ```
236
Non-pharm pain Mx for chronic pain? (4)
``` Physiotherapy Psych - CBT Acupuncture TENS machine Nerve ablation ```
237
Hydradenitis suppurativa Mx? (4)
- Loose clothing - Stop smoking - Lose weight - Topical clinda/Doxycycline oral 100mg daily for 6 weeks
238
Bronchiolitis assessment? (6)
RAW FOB RR Apnoeic episodes WOB Feeding Oxygen sats Behaviour
239
Asthma assessment? (4)
Mild-moderate - can walk and talk in sentences COWS Conscious state Oxygen sats <94% = severe WOB Speaking - sentences
240
CAP assessment in paediatric?
COW TT Conscious state Oxygen sats WOB Tachycardia Tachypnoea
241
Peripheral arterial disease Mx? (5)
- ACEi - Graded exercise regime - Stop smoking - Statin - max tolerated therapy - Aspirin 100mg daily or clopidogrel 75mg daily - Podiatrist for foot care
242
Concussion Mx? (4)
- Most take 1-4 weeks to recover - Gradual return to sport (2 weeks after contact sport) - Gradual return to school (1-2 days of rest) - Follow up in 1 week - Analgesia (Panadol) and ondansetron
243
Concussion referral to ED criteria? (5)
- Signs of skull or basal skull fracture - Focal neurological deficit - Any GCS <8 - Failure to return back to normal >4 hours after incident - Suspected non accidental injury - Seizure
244
Measles investigations?
Throat/Nose PCR Urine PCR Measles serology
245
Gender changing therapy Ix (5)
``` FBE UEC LFT fasting lipids/glucose oestradiol testosterone ```
246
Male to female types of therapy (3)
Feminising hormone therapy | Androgen reducing therapy
247
Home med review indications? (6)
``` 5+ meds/day 12+ doses/day Recent sig change Recent discharge from hospital Concerns for poor compliance Concerns for cognition Sub-optimal response Therapeutic monitoring ```
248
Memory loss DDx (4)
Dementia's MDD Stroke ETOH abuse
249
Delirium Ix (7)
``` FBE UEC LFT TSH BGL ECG O2 Calcium ``` CTB if old
250
Institutions to contact for doctor workplace issues (5)
``` College of specialty AMA AHPRA Human Resources FairWork ```
251
Thrombophlebitis screen? (5)
Protein C and S Antiphospholipid antibodies Prothrombin gene mutation Factor V Leiden
252
Restrictive lung pattern causes (4)
``` Coal workers pneumoconiosis Asbestosis/Silicosis Idiopathic Pulmonary Fibrosis Hypersensitivity pneumonitis Sarcoidosis ```
253
Underlying conditions that can lead to carpal tunnel? (5)
``` Idiopathic pregnancy DM hypothyroidism gout rheumatoid arthritis repetitive work with flexed wrists ```
254
RF for dupuytren's contracture? (5)
``` Smoking COPD Alcoholism Liver cirrhosis T2DM Heavy manual labour ```
255
Causes of pericarditis (4)
``` SLE viral HIV Trauma AMI Vaccine ```
256
Thyroid disorders referral? (5)
- Pregnancy - Cardiac problems - Goitre/nodule - Unresponsive to therapy - Under 18yo
257
De Quervain's thyroiditis Rx? (3)
NSAID Pred 40mg daily for 2 weeks Propanolol 10mg bd
258
Canadian c-spine criteria? (5)
1. >65 2. paraesthesia 3. Dangerous mechanism - fall >3m, axial load, MVA rollover/ejection 4. c-spine tenderness 5. unable to rotate 45 degrees
259
ATSI Incentives? (4)
ATSI Health assessment Closing the Gap Integrated Team Care Program Indigenous Health - Practice Incentive Program
260
When to report a death to the coroner? (5)
``` Unidentifiable patient Suspicious death Unknown/Unexpected cause of death Following a healthcare procedure Result after injury/violent In police custody Held in care (eg mental health facility) ```
261
When to notify AHPRA of colleague conduct? (3)
REASONABLE BELIEF - observed sexual conduct with patient intoxication/drugs impairment causing harm to patient malpractice
262
Reasons to end the doctor-patient relationship (4)
- Sexual advance - Physical threat - Forged documents (eg certificate) - Theft from practice - Repeated missed appointments - Failure to pay for services
263
When is it inappropriate to end the doctor patient relationship? (2)
``` During acute illness Contractual care (through workplace) ```
264
Causes of acute vision loss? (7)
``` Acute closed angle glaucoma Retinal detachment Vitreous haemorrhage Central retinal artery occlusion Central retinal vein occlusion Orbital cellulitis Temporal arteritis Optic neuritis Idiopathic Amaurosis fugax Tumour (optic on nerve) TIA ```
265
Causes of chronic vision loss? (7)
``` Chronic open angle glaucoma Macular degeneration Diabetic retinopathy Hypertensive retinopathy Cataracts Refractive error Presbyopia Pituitary Adenoma ```
266
Diplopia causes (6)
``` Retinoblastoma Cataracts Graves' disease Optic neuritis Migraine Multiple sclerosis Strabismus Refractive Error ```
267
Eye discharge cause (6)
``` Conjunctivitis Nasolacrimal duct obstruction Blepharitis Keratitis Peri/Orbital cellulitis Foreign body ```
268
XR findings for OA? (4)
1. Subchondral sclerosus 2. Narrow joint space 3. Osteophytes 4. Subchondroal cysts
269
Limping toddler DDx
``` Transient synovitis Acute myositis Toddler's fracture DDH NAI/Trauma Septic/OM Cancer ```
270
3 ways to make sure patient's don't miss bad results
- Computer based recall system - practice to develop automatic system when abnormal results are marked - protocol for doctors to cover for colleague absences
271
DDx for 3 days of delusion symptoms (4)
- Schizophreniform - Substance use - Schizoaffective - Manic episode of bipolar - Delusional disorder - Encephalitis - Brain occupying lesion - Brief psychotic disorder - Schizotypal personality disorder
272
Mx morton neuroma (4)
Wide based shoes Surgical excision Metatarsal insoles ICS injection
273
Determining high risk of blood borne infections? (4)
``` MSM Overseas tattoos Overseas transfusion IV drugs Sexual partner with blood borne infections ```
274
Needlestick injury blds?
HIV, Hep B, Hep C
275
Allergic conjuncitivitis non pharm Mx? (3)
Cool compress Don't rub eyes Avoid triggers
276
RF endometrial cancer (6)
``` Unopposed oestrogen Tamoxifen Early menarche Late menopause Nulliparity PCOS Obesity T2DM FHx breast/ovarian ca ```
277
How to improve compliance Aboriginal patient? (4)
Involve Aboriginal health care worker Arrange Webster pack Arrange home medication review Arrange home visit bu district nurses/DNE Organise access to closing the gap medication subsidy Involve family member Education on poor outcomes
278
Ulcer examination? (5)
``` Infection Hair loss (arterial) Peripheral pulses Sensation/VIbration/Proprioception/Reflexes ABI Assess gait Assess footwear Joint deformity ```
279
Leg Ulcer, What Hx questions? (5)
``` Smoking status Reduced sensation Pain What wound care has he tried Systemic symptoms - fever Claudication - arterial History DVT Discharge Swelling ```
280
Otitis externa Mx? (5)
``` Dry toileting QID Topical sofradex 3 drops tds for 7 days Paracetamol Keep dry using ear plugs Acetic acid + isopropyl alcohol drops after exposure to water (prevention) ```
281
Scleroderma Ex findings?
CREST ``` Calcinosis Raynaud's Esophageal dysfunction Sclerodactyly (thickened skin) Telangiectasia ```
282
Waking up tired DDx (5)
``` Depression OSA Insomnia Narcolepsy Delayed sleep phase disorder Illicit drugs Hyperthyroidism Anaemia ```
283
Reasons for doing a CST early? (4)
Intermenstrual bleeding Post-coital bleeding Unexplained persistent D/C Early sexual debut <14yo
284
T2DM Screening
Annually - Pre-diabetes - ATSI >18yo ``` 3 yearly - >40yo (AUSDRISK only) - High risk AUSDRISK >12 - PCOS - FHx (1st degree) - Gestational diabetes - Antipsychotics - >40yo and overweight Indian/Pacific Islanders ```
285
Haemorrhoids Mx? (3)
Fibre Fluid Avoid straining Go only when urge to defecate
286
Broad causes of mouth ulcers? (6)
``` Infections Trauma GI disease Nutritional deficiencies Cancer Immunodeficiency (HIV) Contact/Irritant causes ```
287
AF causes/RF (6)
- Thyrotoxicosis (Hyperthyroid) - PE - HTN - Heart Failure, AMI, Valvular Heart Disease - ETOH - Surgery - Infection Dehydration
288
History points of adequate breastmilk supply? (4)
5+ wet nappies 150g+/week Waking spontaneously for feeds Settling well after feeds
289
Acute Rheumatic Fever Ix? (6)
``` Anti-streptolysin titre Anti DNase B Throat swab ESR Echo ECG FBE ```
290
GAD symptoms (need 3 of 6)
- Restlessness/on edge feeling - easily fatigued - difficulty concentrating - irritability - muscle tension - sleep disturbance

Artha (4 decks)

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