Qbank1 Flashcards

Question

Acute limb ischemia, investigation

Answer 1

DSA, CTA, DUS, and CE-MRA - CT angiography is 1st line - DSA is gold standard Myoglobin and creatinine kinase to assess prognosis and treatment

Answer 2

Initial medical treatment analgesia unfractionated heparin (UFH) refer to specialist for further management

Answer 3

*avoid biopsies due to bleeding risk Required diagnostic tests Chest x-ray Management if cancer related SVC bronchoscopy with washing sputum cytology limited biopsy local radiation antineoplastic agents anticoagulant or fibrinolytic therapy diuretics steroids

Answer 4

aPTT - heparin BT - platelet function INR - warfarin

Answer 5

Male with AAA >5.5 cm Female with AAA >5.0 cm Rapid growth >1.0 cm/year Symptomatic AAA (abdominal/back pain/tenderness, distal embolisation)

Answer 6

Unstable - DC cardioversion Stable - Vagal manoeuveres - Adenosine (avoid in asthma) - Verapamil (avoid in <1 yr) Maintenance (as needed) - Propanolol - Diltiazem

Answer 7

300/Big squares between R-R = HR Estimate by Big square: 1 = 300 2 = 150 3 = 100 4 = 75 5 = 60 If with arrhythmia Rs in 6 seconds x 10

Answer 8

* dropped JVP during expiration and rise in inspiration (normal is reverse) restrictive cardiomyopathy constrictive pericarditis cardiac tamponade

Answer 9

* dropped JVP during expiration and rise in inspiration (normal is reverse) restrictive cardiomyopathy constrictive pericarditis cardiac tamponade

Answer 10

ECG Chest x-ray troponin/BNP Blood test; UE, LFT, Glucose, UA, FBE, ABG Echocardiogram

Answer 11

Sitting position Oxygen via Hudson type mask amd reservoir/CPAP/BiPAP Glyceril trinitrate - reduce preload Furosemide Morphine - reduce preload

Answer 12

Bluebottle and minor jellyfish - single sting Wash sting site with seawater and remove tentacles Hot water immersion (45°C for 20 mins) Major box jellyfish - multiple stings Apply vinegar and remove tentacles Commence immediate cardiopulmonary resuscitation on any patient who is unconscious - analgesics and referral, consider antivenom

Answer 13

TIG - Dirty wound + Uncertain vaccination history Tetanus vaccine: Dirty wound + >5 yrs last vaccine Clean/minor wound + >10 yrs last vaccine Uncertain vaccination history DTPa - <10yrs old dTpa - 10-18 yrs old dT - >18 yrs old

Answer 14

Hypertension Bradycardia Irregular breathing - phenomenon in response to increased ICP

Answer 15

Investigation PCR (optional) Management Antiviral (famciclovir, aciclovir, valaciclovir) - CNS, zoster ophthalmicus, disseminated, immunocompromised Ongoing pain relief - Paracetamol, Prednisone, Amitriptyline, Oxycodone additional options for Postherpetic neuralgia - gabapentin, pregabalin, topical capsaicin, TENS

Answer 16

Mild - primarily noninflammatory Moderate - both noninflammatory and inflammatory, a few pustules Severe - numerous nodules and cysts

Answer 17

Mild 1st line comedonal - TR 1st line papule - TR + BPO, BPO, topical AB 2nd line - salicylic acid TR - topical retinoid BPO - benzoyl peroxide AB - antibiotics

Answer 18

Moderate 1st line - BPO/ topical AB, BPO + TR 2nd line - add Hormones BPO - benzoyl AB - antibiotics TR - topical retinoid

Answer 19

Severe 1st line - Oral isotretinoin 2nd line - Oral AB + TR + BPO, BPO/topical AB Maintenance - add hormones AB - antibiotic TR - tropical retinoin BPO - benzoyl peroxide

Answer 20

1st line child: topical high potency steroid adult: intralesional corticosteroid injection 2nd line topical immunotherapy Severe cases: rapid progressive, diffuse, extensive, alopecia totalis, alopecia universalis 1st line : systemic treament, topical corticosteroid, topical minoxidil, topical immunotherapy 2nd line: combine 2 or 3 topicals

Answer 21

x10 previous melanoma x7 multiple melanotic nevi x6 multiple dysplastic nevi x4 previous other skin cancer x2 1st degree family melanoma x2 fair complexion x1.5 UV exposure

Answer 22

Low-risk individuals – conventional adenomas Interval of 10 years *low-risk conventional adenomas only (1–2 small [<10mm] tubular adenomas without high-grade dysplasia).

Answer 23

Interval of 5 years: • 1–2 tubular adenomas with HGD or tubulovillous or villous adenomas, all of which are <10mm • 3–4 tubular adenomas without HGD, all of which are <10mm. Interval of 3 years: • 1–2 tubular adenomas with HGD or tubulovillous or villous adenomas (with or without HGD), some are ≥10mm • 3–4 tubular adenomas, some are ≥10mm • 3–4 tubulovillous and/or villous adenomas and/or HGD, all <10mm.

Answer 24

5–9 adenomas, intervals are • 3 years if all tubular adenomas <10mm without high grade dysplasia (HGD) • 1 year if any adenoma ≥10mm or with HGD and/or villosity. ≥10 adenomas, interval is 1 year

Answer 25

Clinically significant serrated polyps only 5 years: 1–2 sessile serrated adenomas all <10mm without dysplasia. 3 years: • 3–4 sessile serrated adenomas, all <10mm without dysplasia • 1–2 sessile serrated adenomas ≥10mm or with dysplasia, or hyperplastic polyp ≥10mm • 1–2 traditional serrated adenomas, any size. 1 year: • ≥5 sessile serrated adenomas <10mm without dysplasia • 3–4 sessile serrated adenomas, one or more ≥10mm or with dysplasia • 3–4 traditional serrated adenomas, any size With synchronous conventional adenomas 5 years for: • 2 in total, sessile serrated adenoma <10mm without dysplasia. 3 years for: • 3–9 in total, all sessile serrated adenomas <10mm without dysplasia • 2–4 in total, any serrated polyp ≥10mm and/or dysplasia • 2–4 in total, any traditional serrated adenoma. 1 year for: • ≥10 in total, all sessile serrated adenomas <10mm without dysplasia • ≥5 in total, any serrated polyp ≥10mm and/or dysplasia • ≥5 in total, any traditional serrated adenoma. Synchronous high-risk conventional adenoma (tubulovillous or villous adenoma, with or without HGD and with or without size ≥10mm) 3 years for: • 2 in total, sessile serrated adenoma <10mm, without dysplasia • 2 in total, serrated polyp ≥10mm and/or dysplasia • 2 in total, any traditional serrated adenoma. 1 year for: • ≥3 total adenomas, sessile serrated adenoma any size with or without dysplasia • ≥3 total adenomas, one or more traditional serrated adenoma.

Answer 26

interval should be 12 months after en-bloc excision of large sessile and laterally spreading lesions. interval should be 6 months after piecemeal excision of large sessile and laterally spreading lesions.

Answer 27

> 75 years with charleson score of >4 > 80 years

Answer 28

Blood tests: FBC, EUC, LFTs, lipase, BSL, an ECG and a CXR. Beta-HCG in women of childbearing age, VBG for lactate. Plain films: Initial imaging should include upright CXR and erect/supine AXR films (or lateral decubitus) CT abdomen: provides more information than plain films. May be useful to identify the specific site (i.e. transition point) and severity of the obstruction (partial vs complete). It will also give information about the aetiology, by identifying hernias, masses or inflammatory changes, and potential complications, such as ischaemia or perforation.

Answer 29

-Dilated loops of small bowel proximal to the obstruction > 3 cm -Predominantly central dilated loops -Three instances of dilatation > 2.5 - 3 cm -Valvulae conniventes are visible -Gas-fluid levels if the study is erect, especially suspicious if >2.5 cm in width and in same loop of bowel but at different heights (> 2 cm difference in height). High-grade mechanical obstruction may also present with the following features: -Gasless abdomen -String-of-beads sign: small pockets of gas within a fluid-filled small bowel

Answer 30

1. men who have sex with men 2. young (heterosexual) Aboriginal and Torres Strait Islander people living in remote and very remote areas 3. travellers returning from high prevalence areas overseas

Answer 31

Uncomplicated genital and anorectal infection - Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine PLUS Azithromycin 1 g PO, stat Uncomplicated pharyngeal infection - Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine PLUS Azithromycin 2 g PO, stat Adult gonococcal conjunctivitis - Ceftriaxone 1 g IMI, stat. in 2 mL 1% lignocaine PLUS Azithromycin 1 g PO, stat Treatment advice 1. Reduced susceptibility to ceftriaxone and azithromycin is emerging in urban Australia 2. Pharyngeal mucosa makes it the most likely site of treatment failure 3. If a patient has an intrauterine device (IUD), leave it in place and treat as recommended 4. Advise no sexual contact for 7 days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later. 5. Advise no sex with partners from the last 2 months until the partners have been tested and/or treated 6. Recommend partner notification 7. Provide patient with factsheet. 8. Notify the state or territory health department. 9. Consider testing for other STI 10. Consider human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP)

Answer 32

Females - hearing, vision and fertility Treatment with hormones can help Cause - all or part of one of X chromosomes is missing

Answer 33

Therapeutic level: INR 2-3 <4.5, bleeding absent (lower or omit next dose, test in 2 days) 4.5-10, bleeding absent (stop doses, test in 1 day, restart at reduced dose), (optional: observation, vit k) >10, bleeding absent (stop doses, give vit K, test at 12 hrs) with minor bleeding (<10 vit k, >10 refer) with major bleeding (stop doses, vit k, prothrombinex, FFP, continuous test until <5)

Answer 34

fluoxetine - SSRI, 1st for PSD, CI bleeder citalopram - SSRI, 2nd for PSD, selective but weaker sertraline - SSRI, 2nd for PSD amitriptyline - TCA, but Disturbing anticholinergic SE

Answer 35

CHOLINESTERASE INHIBITORS - cardiac relaxant (rest and digest functions) Donepezil Rivastigmine Galantamine NMDA RECEPTOR ANTAGONIST - neuroprotective Memantine

Answer 36

CBT > 3 months insomnia BY CHOICE sleep onset difficulties - temazepam, zolpidem, zopiclone waking after a few hours - nitrazepam, oxazepam circadian disruption secondary to shift work or genetic predisposition - melatonin DRUG CLASS Benzodiazepines (long half life)- temazepam, nitrazepam, oxazepam and flunitrazepam - effective in reducing sleep onset latency and increasing sleep duration, exert an anxiolytic effect Non-benzodiazepines (short half life) - zolpidem and zopiclone Dual orexin receptor antagonists - Suvorexant 2ND LINE Antidepressants - insomnia patients with comorbid depression - amitriptyline, doxepin, nortriptyline, mirtazapine and agomelatine

Answer 37

ACUTE 1st trimester: Antipsychotic - risperidone, olanzapine and haloperidol Lithium 2nd and 3rd trimester: Mood stabilizer - lithium, valproate Breast feeding (no psychosis) - valproate MAINTENANCE Lithium Optional antipsychotic - quetiapine and olanzapine

Answer 38

1st line - diazepam Senior, Liver disease - lorazepam, oxazepam 2nd line for psychotic featured - haloperidol,droperidol

Answer 39

Unstable - cardioversion Stable <2 days - treat underlying condition Stable >2 days - anticoag + rate control/cardiovert later anti coag - warfarin, heparin rate control - CCB (vera or diltia), BB (olol), Digoxin, Antiarryth (darone)

Answer 40

Hypnotics - supportive Acetaminophen - NAC Salicylates - CHO, K Opioids - Naloxone Sympathomimetics - Benzo Antimuscarinic - Benzo (physostigmine) Cholinergic - Atropine, Pralidox

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