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UCPEX > Other Medicine > Flashcards

Other Medicine Flashcards

1
Q

Most common cause of fever after travel to Sub-Saharan Africa and tropical areas

A

Malaria

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2
Q

Most common cause of fever after travel to Latin America or Asia

A

Dengue

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3
Q

Definition of severe malaria

A

Fever in last 48 hours

P falciparum infection, >100 parasites/200 leukocytes, no other causative organism

At least one of:
- Impaired consciousness, GCS <10
- Multiple grand mal seizures
- Jaundice
- Hypoglycaemia (<2.5)
- Hyperparasitaemia (parasite density >100000)
- Renal impairment
- Cardioresp distress

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4
Q

Causes of fever + haemorrhage

A

Viral haemorrhagic disease
- Dengue
Leptospirosis
Meningicoccaemia
Rickettsial infection

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5
Q

Investigation for malaria

A

Malaria antigen rapid diagnostic test (RDT)
Thick and thin blood films taken on 2 occasions
- >3 negative blood films on 3 consecutive days to rule out

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6
Q

Investigation for travellers diarrhoea

A

Only test stools if prolonged diarrhoea (10-14 days) or severe symptoms (fever, tenesmus, bloody stools)
- Stool culture
- Shiga toxin assay
- Ova and parasites
- Giardia and cryptosporidium antigen

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7
Q

Treatment of uncomplicated malaria

A

P. falciparum or unidentified species: artemether+lumefantrine (Riamet, Coartem) or atovaquone+proguanil (Malarone)

P. vivax, P. ovale, P. malariae, P. knowlesi: Chloroquine, hydroxychloroquine, artemethar+lumefantrine (Riamet, Coartem)
If P. vivax, P. ovale liver hypnozoites: Primaquine (do not give in G6PD deficiency-haemolysis)

Chloroquine resistant P. vivax: artemethar+lumefantrine + Primaquine

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8
Q

Management of traveller’s diarrhoea

A

Antiemetic
Oral fluid + electrolyte replacement
Loperamide for profuse diarrhoea

Empiric abx:
Ciprofloxacin 750-1000mg stat, or 500mg BD 3 days
Or azithromycin 1g stat or 500mg BD 3 days if South/SE Asia (high fluoroquinolone resistance)

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9
Q

Symptoms and incubation for traveller’s diarrhoea

A

Bacterial + viral - 6-48 hours incubation
- vomiting more prominent in Norovirus
- Rice water diarrhoea in cholera

Parasitic infection 1-2 week incubation
Slower onset, low grade symptoms

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10
Q

Malaria presentation

A

Plasmodium parasite
<1 month incubation
P. vivax hypnozoites can stay dormant for months-years
Fever, chills, sweats
Headache
Nausea, vomiting, anorexia
Body aches, general malaise

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11
Q

Fever, arthralgia/myalgia, rash

3 possible traveller’s infections:

A

Dengue
Zika
Chikungunya

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12
Q

Dengue presentation

A

Aedes aegypti mosquito
Incubation 4-10 days
Most asymptomatic or subclinical
Sudden onset fever
Arthralgia
Maculopapular or macular confluent rash 2-5 days after fever
Minor haemorrhage - epistaxis, heavy menstrual bleed, petechiae, gum bleeding
Extreme malaise
Headache behind eyes
Sore throat, conjunctival injection, abdo pain

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13
Q

Chikungungya presentation

A

Fever >39 several days-1 week
Bilateral, symmetrical arthralgia - small joints of hands and feet
Tenosynovitis
2-5 days after fever onset - maculopapular rash of trunk and extremities. Petechial or vesiculobullous in infants

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14
Q

Causes of travellers diarrhoea

A

Enterotoxic E coli (most common)
Enteroinvasive E coli
Enteroaggregative E coli
Shigella
Campylobacter
Salmonella
Norovirus (10-20%)
Protozoal parasites

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15
Q

Transmission of Hepatitis strains
Acute vs chronic

A

A, E - orofaecal, gastro symptoms, usually self-limiting

B, C, D - bloodbourne: intercourse, transfusion, vertical transmission, blood to blood
D always co-infected with B, indicator of worse prognosis. Cirrhosis, failure, ca.
C - 80% chronically infected
B - 50% chronically infected

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16
Q

Risk factors for
Hep A
Hep B, C, D

A

A - travel to high risk areas, sewage workers, MSM, IVDU

B, C, D - IVDU, tattoos, MSM.

B - endemic countries

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17
Q

HIV risk factors

A

Travellers and immigrants from Sub-Saharan Africa, SE Asia
MSM
IVDU
Related infections - Hep B, C, STI, TB

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18
Q

Symptoms of HIV

A

60% asymptomatic of acute infection
Fever
Malaise
Sore throat
Rash
Arthralgia/myalgia
Anorexia, weight loss, oral ulcers

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19
Q

Causes of meningitis

A

Viral - most common
Neisseria meningitidis
Strep pneumoniae
Haemophilus influenzae

Children:
Listeria monocytogenes
E coli
Enterococci
Herpes simplex

Consider partially treated meningitis, parameningeal focus (ears, sinus, cerebral abscess)

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20
Q

Management of suspected meningitis

A

Treat as bacterial until proven otherwise
Urgent medicine referral
IVabs if >20min delay to hospital

Neonates <3 months: Benzylpenicillin 50mg/kg, max 2g
Children 3 months to 10 years: Ceftriaxone 100mg/kg, max 2g
Adults: Ceftriaxone 2g + dexamethasone 10mg

IV access x2
IV bolus - 1L adult, 20mL/kg child
Bloods + blood cultures x2

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21
Q

Risk factors for meningitis

A

Infants, children, adolescents
Maori, Pacific
Exposure to smoke
Binge drinking
Other respiratory infection
Crowded house, institutionalism
Close contact with positive meningitis case
Immunocompromised

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22
Q

Cellulitis vs erysipelas

A

Cellulitis - Infection of dermis and subcutaneous tissue

Erysipelas - Infection of superficial dermis

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23
Q

Symptoms less likely to be cellulitis

A

Itch
Bilateral
Symptoms of nec fasc

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24
Q

Necrotising fasciitis
Symptoms
Management

A

Severe pain, systemic symptoms, purple discolouration, necrotic tissue, crepitus

IV ceftriaxone
Immediate referral

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25
Q

Risk factors for cellulitis

A

Elderly with poor circulation
Smoking
Immunocompromised
Diabetes
Overweight

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26
Q

Differential diagnoses for cellulitis

A

Thrombophlebitis
Lipodermatosclerosis
Radiation damage
Dermatitis
Fungal infection
Insect bite
Inflammatory breast ca

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27
Q

Antibiotics for cellulitis

A

Flucloxacillin
Children: 12.5-25mg QID 5 days
Adults: 500mg-1g tds/qid 5 days

Cefalexin
12.5-25mg/kg, 2-4 times/day, 5 days
500mg QID 5 days

Erythromycin
10-12.5mg/kg, QID 5 days
400mg QID 5 days

Co-trimoxazole
24mg/kg BD 5 days
960mg BD 5 days

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28
Q

Causes of UTI

A

E coli
Staph saporphyticus
Proteus
Klebsiella
Enterococcus

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29
Q

Diagnosis of catheter associated UTI

A

Fever >38
Suprapubic tenderness
Costovertebral angle tenderness
Urine dipstick or culture positive

No other cause of fever
Pyuria is common in catheter

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30
Q

Management of asymptomatic bacteriuria in pregnancy

A

Risk of preterm birth and low birth weight
Treat empirically, urine for culture

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31
Q

Treatment of UTI with haeamaturia

A

Macroscopic - treatment for 10 days, repeat urine 2 weeks post treatment

Microscopic - treatment for 7-10 days, repeat urine 1 week post treatment

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32
Q

Empiric antibiotic treatment for UTI
Men
Women
Pregnant
Child

A

Men:
Nitrofurantoin 100mg BD 7 days
Trimethoprim 300mg nocte 7 days
Cefalexin 500mg BD 7 days

Women:
Nitrofurantoin 100mg BD 5 days
Trimethoprim 300mg nocte 3 days
Cefalexin 500mg BD 3 days

Pregnancy:
Treat for 7 days
Not for trimethoprim first trimester
Not for nitrofurantoin after 36 weeks

Child:
Cotrimoxazole 24mg/kg BD 3 days
Cefalexin 12.5-25mg/kg BD 3 days
Augmentin 15m/kg tds 3 days

Nitrofurantoin - do not give in renal failure, CrCl <30

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33
Q

Symptoms of acute pyelonephritis

A

Fever
Flank pain
Nausea and vomiting

Augmentin
Co-trimoxazole
Cefalexin

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34
Q

Treatment of pyelonephritis

A

Cotrimoxazole 960mg BD 10 days
Augmentin 625mg tds 10 days
Cefalexin 1g tds/qid 10 days - only if susceptible and resistant to other choices

Refer pregnant women
Low threshold referral for elderly

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35
Q

Cause of Herpes zoster (shingles)

A

Varicella zoster virus
Recurrence in nerve root - stress, immunocompromisation, old age

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36
Q

Herpes zoster presentation

A

Blistering rash, allodynia, within dermatomal distribution, does not cross midline
Resolves in 10-15 days

Itching, tingling, pain along distribution and viral prodrome prior to appearance of rash

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37
Q

Treatment of Herpes zoster

A

Antiviral most useful within 72 hours of rash
Over 72 hours use if - new lesions, HZO, age >50, immunocompromised, prodrome presence, severe/disseminated rash, severe pain

Valaciclovir 1g tds 7 days
Aciclovir 800mg 5 times/day 7 days
Famiciclovir 500mg tds 7 days

Ice, calamine
Capsaicin cream (post herpetic neuralgia)
Lidocaine
Codeine
Tramadol
Oxycodone

Sometimes: prednisone, TCA, gabapentin

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38
Q

Complications of Herpes zoster

A

Uncommon in immunocompetent patients
Highest risk in lymphoproliferative cancers
Mortality 5-15%

Encephalitis
Meningitis
Pneumonitis
Blindness/permanent visual impairment - HZO
Post herpetic neuralgia

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39
Q

Causes of infectious mononucleosis

A

Epstein-Barr virus
Cytomegalovirus
Toxoplasmosis
HIV

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40
Q

Infectious mononucleosis symptoms and signs

A

Classic triad: Fever, pharyngitis, lymphadenopathy (posterior cervical)

Splenomegaly (50% in first 2 weeks)
Hepatomegaly + jaundice (uncommon)
Generalised maculopapular/urticarial/petechial rash - especially after amoxicillin

Fever + sore throat - 1 month
Fatigue - 2-3 months

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41
Q

Encephalitis diagnosis criteria

A

3 or more of:

Fever
Seizures
Focal neurological signs
CSF pleicytosis (WCC >5x10^6)
EEG slowing
Abnormal MRI

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42
Q

Causes of encephalitis

A

30-50% infective
Herpes simplex - most common
Measles
Varicella zoster
Adenovirus
Mumps
EBV
Enterovirus
Toxoplasmosis gondii
Mosquito, tick-borne virus
Mycoplasma pneumoniae
Influenza

Non-infective
acute demyelinating encephalomyelitis
antibody-mediated autoimmune disease
Paraneoplastic syndromes

Treat all suspected as infective until proven otherwise - antivirals + abx

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43
Q

Complications of encephalitis

A

Seizure
Hydrocephalus
Neurological sequelae - behaviour, motor disturbance
Herpes encephalitis in children 70% mortality untreated

44
Q

Risk factors for encephalitis

A

Immunosuppression
<1 or >65
Unvaccinated
Exposure to infected contacts (cold sores)
Concurrent or recent viral infection
Animal/insect bite
Occupations - farming, abbatoir
Recreations - hiking, swimming, spelunking
Travel history

45
Q

Causes of upper GI bleed

A

Peptic ulcer, oesophageal-gastric varices (most common)
Mallory-Weiss tears
Acute stress erosions (shock, NSAIDs)
Oesophagitis
Gastritis
Duodenitis
Upper GI cancer
Arteriovenous malformation

46
Q

Forms of upper GI bleed

A

Haematemesis
Coffee ground vomit
Malaena
Haematochezia

47
Q

Vital signs of moderate and severe haemorrhage

A

Moderate (25-50%)
- Postural drop 10mmHg
- Severe lightheadedness rising from supine
- Increase in HR by >30bpm rising from supine

Severe (>50%)
- Systolic BP <90mmHg
- Tachycardia >120bpm

48
Q

Rockall score for upper GI bleed

A

Need for emergency endoscopy

Age 60-79 = 1
Age >80 = 2
Tachycardia >100, SBP >100 =1
Hypotension SBP <100 = 2
Renal failure, liver failure, disseminated malignancy = 2
Other significant comorbidity = 1

49
Q

Glasgow Blatchford bleeding score

A

Score higher than 0 = urgent intervention

Hb <100
BUN >18.2
Systolic BP (initial) <100
Sex
HR >100 =1
Melaena =1
Recent syncope =2
Hepatic disease =2
Cardiac failure =2

50
Q

Management of H pylori

A

Omeprazole 20mg BD 7-14 days
Clarithromycin 500mg BD 7-14 days
Amoxicillin 1g BD or metronidazole 400mg BD 7-14 days

51
Q

Causes of lower GI bleed

A

Internal haemorrhoid, diverticular bleed - most common
Ischaemic colitis
Inflammatory bowel
Cancer
Rectal ulcer
Angiodysplasia
Post procedure

52
Q

Discharge criteria for lower GI bleed

A

Age <60
Haemodynamically stable
No ongoing gross rectal bleed
PR or sigmoidoscopy reveals anorectal source

53
Q

Causes of GORD

A

Functional - most common
Oesophagitis
Peptic ulcer disease
H pylori
NSAIDs
coeliac disease
Malignancy

54
Q

GORD vs dyspepsia symptoms

A

GORD - heartburn, acid regurgitation
Dyspepsia - bloating, early satiety, epigastric pain/discomfort after meals, nausea

55
Q

Management of GORD

A

GORD:
Lifestyle modification - spicy food, caffeine, ETOH, smoking, stress, obesity
Stepdown therapy - omeprazole 20mg OD 4-12/52 > 10mg OD > ranitidine > PRN antacids

Dyspepsia:
r/o H pylori
If bloating/early satiety - domperidone > ranitidine
Stepdown therapy

56
Q

Risk factors for H. pylori (>30%)

A

From South Auckland, East Cape, Porirua
From low-middle income countries
Maori, Pacific, Asian

57
Q

Red flag symptoms for upper GI malignancy

A

FHx gastric cancer <50
Unexplained weight loss
Progressive oesophageal dysphagia
Protracted vomiting, persistent regurgitation
Abdominal mass
Iron deficiency anaemia
Age >55 with persistent heartburn

58
Q

Conditions with high risk of constipation

A

IBS
Dehydration
Diabetes
Neuro: Parkinson’s, MS
Electrolytes: hypercalcaemia, hypokalaemia
Psych: depression
Coeliac
Hypothyroidism
GI obstruction
Pelvic floor damage

59
Q

Medications causing constipation

A

Antacids with calcium, aluminium
Antispasmodics
Antidepressants
Antihistamines
Antipsychotics
Anti-Parkinsons
Calcium supplements
CCB
Iron
Ondansetron
Opiates
Oxybutynin
PPI
Vinca alkaloids (chemo)

60
Q

Management of constipation

A

Exercise
Dietary changes (water and fibre)
Response to urge to defecate
Bulk laxatives - psyllium, bran (2-3 days)
Stimulant laxatives - docusate + Senna (Laxsol), bisacodyl (Fleet),
Faecal softeners - docusate, Coloxyl
Osmotic laxatives - lactulose, molaxole, glycerol supps, Fleet

61
Q

Identification of Seniors at Risk (ISAR) score

A

Before illness - needing regular help?
Since illness - needing more help than usual?
Hospitalised >1 night in last 6 months?
Generally see well?
Serious problems with memory?
3+ medications daily?

2 or more is high risk

62
Q

Geriatric presentation that is a marker of frailty and risk factor for adverse outcomes

A

Urinary incontinence

63
Q

Causes of falls in elderly

A

Syncopal - cardiac, polypharmacy

Non-syncopal - strength, balance, vision, proprioception, vestibular, environmental hazards (20%), acute medical illness

64
Q

Delirium presentation

A

Acute onset over hours-days
Fluctuating course, impaired attention, altered awareness, cognitive + neuropsychiatric disturbance
Mood disturbance
Caused by underlying medical disorder
Independent risk factor for 6-month mortality rate

Hyperactive - hallucination, delusion, agitation, disorientation
Hypoactive - confusion, sedation
Mixed

65
Q

Richmond Agitation Sedation Scale

A

Likelihood for delirium 57% if score >1 or <-1

+4 - combative, violent
+3 - agitated, aggressive, pulling tubes
+2 - agitated, non-purposeful movements, fights ventilator
+1 - restless, anxious
0 - alert and calm
-1 - drowsy, >10s sustained awakening to voice
-2 - light sedation, <10s brief awakening to voice
-3 - movement/eye opening to physical stimulation
-4 - unrousable

66
Q

Common meds causing delirium

A

Opioids
Antihistamines
Benzos
CCB

Less clear:
H2 receptor antagonists
TCA
Antiparkinsons
Steroids
NSAIDs
Anticholinergics

67
Q

Types of diabetes and features

A

Type 1
- 6 month - young adult onset
- Often acute onset
- Ketosis present
- Autoimmune condition
- Parental diabetes 2-4%

Type 2
- Onset after puberty
- Obesity related
- Ketosis uncommon
- Acanthosis nigricans, striae
- Parental diabetes in 80%

Maturity onset diabetes of the young (MODY)
- Onset after puberty
- Autosomal dominant
- Parental diabetes in 90%

Maternally inherited diabetes and deafness
- Onset after puberty
- Maternal mitochondrial inheritance
- Maternal diabetes 85%

68
Q

Acute presentations of diabetes - hyperglycaemic crises

A

Diabetic ketoacidosis
- Usually T1DM

Hyperosmolar hyperglycaemic state
- More commonly T2DM

33% have combination of both
Polyuria
Polydipsia
Nausea/vomiting
Abdo pain
Dehydration
Altered mental state - lethargy, drowsy, coma

69
Q

Elderly diabetic patient with chronic ear discharge and sudden onset severe otalgia

A

Malignant otitis externa
Can be life threatening

70
Q

Symptoms specific to Grave’s disease

A

Pretibial myxoedema, exophthalmos, periorbital oedema, conjunctival oedema

Causes 85% hyperthyroidism

71
Q

General symptoms of hyperthyroidism

A

Appetite stimulation
Flush, sweats, heat intolerance
Abdo pain
Restlessness, agitation
Tremor, weakness
Palpitations
Amenorrhoea
Hair thinning
SOBOE
Urinary frequency, hyperdefecation

72
Q

Management of hyperthyroidism

A

Radioactive iodine 131
Carbimazole
Propylthiouracil
Surgical thyroidectomy

Beta blockers

73
Q

Symptoms of thyroid storm

A

CNS - restlessness, delirium, psychosis, somnolence, seizure
GCS <14
Fever >38
Tachycardia >130, AF
Heart failure, pulmonary oedema
Nausea, vomiting, diarrhoea, jaundice

74
Q

Management of thyroid storm

A

Urgent transfer to hospital
ABCs
IV fluids
Dextrose if hypoglycaemic
ECG
Bloods, infection screen
Passive cooling
Beta blockers for tachycardia
Benzos for agitation
rule out other causes - pregnancy, DKA, infection, embolism

NEVER use aspirin - releases more thyroid hormone

75
Q

Symptoms of hypothyroidism

A

Fatigue, myalgia
Weight gain
Cold intolerance
Depression
Constipation
Dry skin
Menstrual irregularity
Bradycardia
Diastolic hypertension
Decreased reflex
Hyponatraemia
Hypercholesterolaemia
Macrocytic anaemia

76
Q

Risks of hypothyroidism

A

Women
Treatment for hyperthyroidism
Turner, Down syndrome
T1DM, Addison’s disease, coeliac
Hx postpartum thyroiditis
Lithium, amiodarone
Calcium, antacids, phenytoin, carbamazepine, hormone replacement - increased thyroxine requirements

77
Q

Myxoedema symptoms

A

Bradycardia
Cool peripheries, hypothermia
Non-pitting oedema
Hypoglycaemia
Hypotension
Thin hair
Altered consciousness

78
Q

Management of myxoedema

A

Urgent referral to hospital
ABCs
IV fluids
IV dextrose (if hypoglycaemic)
Passive warming
Bloods, septic screen
ECG
Consider other causes - drugs, sepsis, DKA

79
Q

Precipitants of adrenal crisis

A

Sepsis
Trauma
Surgery
Burn
Cardio/metabolic event

Meds:
Heparin
Warfarin
Azole antifungals
Phenytoin
Rifampicin

80
Q

Symptoms of adrenal insufficiency

A

Fatigue
Weight loss, anorexia
Hypotension, syncope
Nausea, vomiting, diarrhoea
Abdo pain
Myalgia, arthralgia
Body hair loss
Irritability
Hyperpigmentation (primary only)

81
Q

Symptoms of adrenal crisis

A

Shock and fever
**Hypotension refractory to fluids

Variable and non-specific: Weakness, fatigue, delirium/altered mental state, vomiting, diarrhoea, abdo pain

Hyponatraemia, hyperkalaemia

82
Q

Causes of primary adrenal insufficiency

A

Addison’s disease - autoimmune
Congenital adrenal hyperplasia - enzyme deficiency
Adrenal haemorrhage (Waterhouse-Friedrichsen) - meningococcaemia
Tumours - breast, melanoma
Infection - TB, HIV

83
Q

Causes of secondary adrenal insufficiency

A

Panhypopituitarism
Pituitary apoplexy - infarction or haemorrhage of tumour
Chronic steroid therapy
Tumours
Granulomas

84
Q

Management of adrenal crisis

A

IV fluids
IV steroids - hydrocortisone 100mg
Urgent referral

85
Q

3 most common cause of acute monoarthritis

A

Infection
Crystals
Trauma

86
Q

Common locations for septic arthritis

A

Knee (50%)
Hip
Shoulder
Elbow

87
Q

Risks for septic arthritis

A

Joint prosthesis
Foreign body
Previous joint damage
Overlying skin infection
Recent joint surgery/injection
RA
Diabetes
Elderly >80
Immunosuppression
IVDU

88
Q

Organisms in septic arthritis

A

Staph aureus
Streptococci
Neisseria gonorrhoea
Pseudomonas aeroginosa
E coli

89
Q

Xray features of osteoarthritis

A

Narrow joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes

90
Q

Insidious onset
Morning stiffness resolving in 30 mins
Stiffness after inactivity, resolving in minutes
Pain worse with use, better with rest
Polyarticular, symmetrical. Usually sparing wrist and elbows
Heberden’s nodes
Bouchard’s nodes

A

Osteoarthritis

91
Q

Over days-weeks
Morning stiffness
Preceding systemic illness - fever, myalgia, fatigue
Often asymmetric presentation

A

Rheumatoid arthritis

92
Q

SI joints, axial spine, ribs
Often associated with iritis, heel pain

A

Ankylosing spondylitis

HLA-B27 in 90-95%

93
Q

Arthritis in greater joints, lower > upper extremities
Erythema nodosum

A

Arthritis associated with inflammatory bowel disease
- Crohn’s
- Ulcerative colitis

94
Q

No joint pain
Tender points in muscles
Headache
Irritable bowel

A

Fibrositis syndrome/Fibromyalgia

95
Q

Asymmetric polyarthritis involving great and small joints, especially IPJ of toes
Associated enthesitis (inflammation of tendon insertion)
Absence of nodules

A

Psoriatic arthritis

96
Q

Asymmetric arthritis of greater joints, lower > upper extremities
Also IP joints of feet

Associated keratodermia, geographic tongue, conjunctivitis, urethritis, Achilles tendonitis

A

Reactive arthritis
Commonly post GI/GU infections

97
Q

Symmetrical polyarthritis involving greater and smaller joints
Skin rash - butterfly rash
Multisystem involvement

A

Systemic Lupus Erythematosus

ANA in 95%

98
Q

Synovial fluid in septic arthritis vs gout vs psuedogout

A

SA:
Cell count >50x10^6/L
>90% neutrophils
Bacteria on gram stain

Gout:
Monosodium urate crystals (birefringent)

Psuedogout:
Calcium pyrophosphate dihydrate crystals

99
Q

Gout diagnosis scoring system

A

Male = 2
Prev patient-reported arthritis attack = 2
Onset within 1 day = 0.5
Joint redness = 1
First MTP involvement = 2.5
Hypertension or CVD = 1.5
Serum uric acid >0.35 = 3.5

4 or less = gout ruled out
8 or more = 80% gout

100
Q

Gout risks

A

Family hx
Purine rich foods - seafood, ETOH, red meat
Dehydration
Diuretics
Maori, Pacific

101
Q

Management of gout

A

Paracetamol
NSAIDs - if no contraindications
Colchicine - if no contraindications
Prednisone - if infection ruled out

GP follow up to start allopurinol
Cont allopurinol if on it already

Use minimal amount of medications to control flare

102
Q

Referral/discussion criteria for DVT

A

Bilateral
Pregnant
Proximal DVT (above popliteal fossa) with comorbidities
Suspicion of PE
Social situation

103
Q

Pulmonary Embolism Rule out Criteria (PERC)

A

Age <50
HR <100
Sats >95% RA
No unilateral leg swelling
No haemoptysis
No recent surgery/trauma
No prior DVT/PE
No hormone use

104
Q

Definition of anaphylaxis

A

Acute onset illness
- Typical skin features PLUS
- Respiratory, cardiovascular, or persistent severe GI symptoms

OR:

  • Hypotension or bronchospasm or upper airways obstruction
  • Even if typical skin features not present
105
Q

Prevalence of biphasic reaction in anaphylaxis

A

3-20%

106
Q

Management of anaphylaxis

A

Adrenaline 0.5mg/0.01mg/kg IM stat
- Repeat as required
Antihistamine
Steroids

Consider nebulised adrenaline for stridor
Nebulised salbutamol for wheeze

Monitor for 4-6 hours

Refer to hospital if requiring more than 1 dose adrenaline
Refer to immunology/paeds/gen med for follow up

UCPEX (13 decks)

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