Random things Flashcards
(152 cards)
1
Q
Recommended daily calcium intake
A
at least 1300mg/day
2
Q
antivirals for genital herpes
A
valaciclovir 500mg Q12H for 10 days; if rapid improvement can stopa t 5 days
3
Q
treatment for genital warts
A
- imiquimod 5% cream, 3x per week until warts resolve (usuually 8-16 weeks)
- podophyllotoxin 0.5% paint, BD for 3 days, repeated weekly, until warts resolve (usually 4-6 weeks)
- leave them be
- cryotherapy
4
Q
Supporting smoking cessation
A
ask assess advise assist arrange follow up
5
Q
Rotterdam criteria
A
if 2 present, PCOS diagnoses
- history of oligo/anovulation
- hyperandrogrenism
- polycystic ovaries on USS (12 or more follicles 2-99mm, and/or increased ovarian volume)
6
Q
live vaccines
A
japanese encephalitis Imojev MMR varicella MMRV oral rotavirus zoster lBCG typhoid (oral)
7
Q
Testing for typhoid
A
Blood and stoop culture; serology not helpful
8
Q
Medications that cause hyponatremia
A
CARDISH Chemotherapy Antidepressants, antipsychotics, anticonvulsants, anti inflammatory drugs (cox2 inhibitors) Recreational drugs - ecstasy Diuretics Inhibitors - ACEi, ssris Sulfonylureas Hormones desmopressin, oxytocin, hypnotics (temazepam)
9
Q
Automatic high cv risk
A
Diabetics >60 Atsi >74 Moderate or above Ckd (45) Fh Cholesterol >7.5 Bp >180/>110 Diabetes with microalbuminuria
10
Q
TSH ranges for replacement
A
<60 aim 0.5-2.5 > 60 aim 1-5 >80 aim 4-6 pregnancy 1st trimester 0.1-2.5 2nd trimester 0.2-3 third trimester 0.3-3
11
Q
timing for pertussis PCR
A
up to 4 weeks of cough
serology can become positive after 2 weeks
12
Q
LFT analyss cholestasis versus hepatocellular damage
A
cholestasis ALP >200 and ALP >3x ALT
hepatocellular damage ALT >200 and ALT >3x ALP
13
Q
enzym inducing anti-epileptics
A
carbamazepine, phenobarbitone, phenytoin, primidone and topiramate (when 200mg or more a day)
14
Q
gout MCS from joint aspirate
A
negative birefringence, needle shaped crystals, blue crystals
15
Q
Who is at high risk of diabetes?
A
AUSDRISK >12 >40yo and overweight IFG 1st degree relative with diabetes personal hx CV event high risk ethnicity history GDM women with PCOS antiphyscotics ATSI
16
Q
What testing do you have to do for patients who are at high risk of diabetes?
A
every 3 years FBG or HbA1c
17
Q
Diabetes HbA1c
A
> 6.5
18
Q
OGTT results
A
IFG 6.1-6.9 pre glucose
IGT >7.8-11 2hr after glucose
fasting >7 or 2hr >11.1 = diabetes
19
Q
T score level for osteoporosis
A
<-2.5
20
Q
Z score level
A
z score <-2 warrants invesitgation for secondary causes of bone loss; recommended in <50yo, premenopausal
21
Q
testing for Addison’s disease
A
short synacthen test (aka ACTH stimulation test)
low morning serum cortisol
22
Q
Hypoglycemia management
A
Rule of 15
BSL <4mmol/L
give 15g quick acting CHO (1/2 can non diet soda)
wait 15mins, then repeat
if not rising - repeat
provide long acting CHO if next meal >15mins away (i.e. tub of yoghurt)
test BSL every 1-2 hours for next 4 hours
23
Q
severe hypoglycemia management
A
glucagon 1mg IM or subcut
IV fglucose 50% 20mL (10% in child)
24
Q
Diabetes screening recommendation
A
screen everyone >40 with AUSDRISK every 3 years
ATSI >18yo annual blood test
high risk otherwise test every 3 years
25
Graves disease antibodies
TSH receptor Ab positibe, TPO Ab often positive
26
Hashimoto's thyroiditis abs
TPO antibodies +
27
Prep effectivness time frames
7 days to for receptive anal
| 21 days for receptive vaginal and IVDU
28
points about Prep
safe in pregnancy and breastfeeding
test within 7 days of starting for HIV
very effective as long as no missed pills
regular reviews - 30 days, then every 90 days
can impair renal function, BMD, liver function
SE - HA, nausea
29
complications of CF
```
pancreatic exocrine insufficiency/steatorrhea
FTT
sinusitis
nasal polyposis
meconium ileus
diabetes mellitus
infertility
hyponatremic dehydration
```
30
COPDX
```
case finding and confirm diagnoses/severity
optimise function
prevent deterioration
develop plan of care
manage eXacerbations
```
31
aspect of management
```
pharmacotherapy
rehabilitiation programs
action plan
self management
co-morditities
exercise
vaccination
nutrition
smoking
prascevns
```
32
severity in COPD
mild 60-80% FEV
moderate 40-59% FEV predicted
severe <40% predicted
33
pneumococcal vaccinations in at risk patients
1 dose 13 at diagnoses (at least 2 months after any previous dose 13)
1 dose 23 12 months after 12, or at 4yo (whichever is later)
2nd dose 23 at least 5 years later
or ATSI 13 at 50, then 23 1 yr later and 23 again 5 years later
non ATSI >70 = single 13
34
age zostavax
70-79
35
asthma stepwise management
1. as needed SABA
2. ICS + PRN SABA
3. ICS + LABA
4. consider referal; ICS + LABA (medium high dose)
5. refer
BAse decisions on last 4 weeks
36
good control of asthma
daytime symptoms <2 days per week
SABA needed <2 days per week
no night symptoms
37
ICS doses in adults
low budesonide 100-200
medium 500-800
high >800
38
aged 1-5 stepwise asthma
1. SABA PRN
2. ICS low dose or montelukast
3. ICS low dose + montelukast or high dose ICS - consider referral
4. referral for add ons
39
astham stepwish management in 6-11yo
1. SABA PRN
2. ICS low dose or montelukast
3. ICS high paediatric dose,
ICS/LABA low dose, ICS + montelukast - consider referral
4. referral
40
SMART therapy
low dose budesonide-formoterol
rapihaler 100/3 2 puffs or turbuhaler 200/6 1 inhalation
when needed
41
acute asthma attack
adults 12 puffs slabutamol
8 puffs ipratropium
if severe do both, start oxygen to target sats 93-95%
if life threatening
2xsalbutamol nebs + 1x ipratropium neb
start oxygen
reassess within minutes; repeat doses in 20-30mins
add ons:
- IV magnesium sulfate 10mmol IV over 20 minutes
- steroids
42
acute asthma doses in kids
```
1-5yo: 2-6 puffs slabutamol
6-11yo: 4-12 puffs
piratroprium 4 puffs in 1-5yo, 8 puffs >6yo
1/2 neb doses in >5yo
add ons:
- IV Mg So4 0.1mmol/kg
pred 1mg/kg
aim sats 95% in kids
```
43
consider adrenaline in asthma when...
?anaphylaxis as ddx
| if unresponsive, cannot inhale bronchodilators, peri-arrest
44
kids >6yo steroid doses
fluticasoen (flixotiode) 100-200 is low dose, >200 high
| budesonide (pulmicort) 200-400 low dose, >400 high dose
45
ddx splenomegaly
```
Massive - CML
myelofibrosis
moderate - "PLTS"
portal HTN
lymphoma
leukemia
thalassemia
Mild
hemolytic anemia
EBH, IE
SLE
sarcoidosis infiltration
```
46
symptoms of nasopharyngeal carcinoma
neck mass
nasal obstruction with epistaxis
serous otitis media
47
red flags sinusitis
```
unilateral
bleeding
cacosmia
menignism
altered neurology
frontal swelling
orbital involvement - diploplia, decreased VA etc
```
48
teen assessment
```
Home
Education & employmen
Eating and exercise
Activities
Drugs and alcohol
Sexuality and gender
Suicide, depression & self harm
Safety
```
49
Risk factors for open angle glaucoma
```
increased age
black
family history
diabetes
HTN
myopia (near sightedness)
steroid use
prior vitreous surgery
```
50
medication classes and examples for open angle glaucoma
topical beta blockers - timolol
topical prostaglandins - latanoprost
alphra adrengeric agonists - brimonidine
topical carbonic anhydrase inhibitors - dorzolamide
51
tests before starting immunosuppression
Hep B/C, MMRV serology, quantiferon tuberculosis
52
red flag system breast cancer
1. two relatives on same side
2. first degree relative
3. relative <50
1 flag = moderate risk, no action
2. flags = consider referral; annual mammograms from 40yo maybe if 1st degree relative with breast can <50
53
managament missed OCP
<24hrs take as usual
>24hours or missed more than one pills - take as usual and add extra protection for 7 days
if <7 pills left in packet - skip sugar pills and add 7 days condoms
if missed >1 pill missed in first seven days or new pack, or start the pack >7 days late - consider emergency contraception, + condoms 7 days
54
uliprsital acetate cautions
reduced effect on BMI >30 (but better than LNG EC)
use up to 120hours
delay hormonal contraception for 5 days (or reduced UPA effectiveness)
55
acronym for enquiring about abuse
WHO LIVES
listen closely with empathy and without judgement
Inquire about needs and concerns
Validate and show you understand and believe them
Enhance safety, discuss a plan to protect themselves
Support with referrals and follow up
56
antibodies in Post partum thyroiditis
TPO Ab high titre, normal ESR
57
Graves disease Abs
TSH R Ab +. TPO Ab often+ also
58
different causes of vertigo based on duration
seconds - BPPV
mins -hrs Menieres, vestibular migraine
days - vestibular neuritis
days - weeks : CVA, vertebrobasilar insufficiency
59
HINTS exam - peripheral if
+ (abnormal) head impulse test
no nystagmus, or nystagmus that is unidirectional and horizontal
NO vertical skew
60
Menieres treatment
low sodium diet 2-3g/day
avoid caffeine
hydrochlorothiazide
referral to auidologist for hearing aid
referral to exercise pysiology for vestibular rehab program
referral to ENT for iutnratympanic injection, + pressure therapy, surgery
61
vitiligo treatment
avoid sunburn
cosmetic camouflage
does not need treatment
mometasone 0.1% furoate 0.1% cream TOP
if face/body folds: pimecrolimus 1% cream TOP BD for 3 months
OR for not on face
calcipotriol+betamethasone dipropionate 5+500microg/g ointment TOP daily for 3 months
62
vitiligo treatment
63
red flags bowel cancer risk screening levels
4 flags = moderate risk
2nd degree relative any age = 1 flag
1st degree relative >55 = 2 flags
first degree relative <55 = 4 flags
64
moderate risk bowel cnacer screening
iFOBT every 2 yrs from 40-49
colonoscopy every 5 years from 50-74yo
aspirin 2.5 years from 50-70
65
bipolar 2
Depression + hypomania, no need for manic episode
66
contact tracing time frame gonorrhea
2 months
67
contact tracing chlamydia
6 months
68
contact tracing syphilis
primary - 3 months + duration of symptoms
secondary - 6 months + duration of symptoms
early latent syphilis - 12 months
69
contact tracing hep B/C
6 months prior to onset of acute symtpoms
70
management hyphaema
```
manage bleeding tendency
eye shield over eye
elevate pt's head to 30degree
maintain be drest
cyclopegia if not globe ruputre
control N/V agghressively
managfe pain - TOP and orals
opthalmology
```
71
fundoscopy finding in retinal vein occlusion
sunset storm
72
fundoscopy finding in retinal artery occlusion
cherry red spot + pale fundus
73
ddx papilledema
malignant HTN
rasid ICP (eg, tumor, IIHT, CVST)
optic neuritis
optic nerve tumour
74
fundoscopy finding hypertensive retinopathy
```
AV nicking
copper wiring
cotton wool patchy
retinal hemorrhage
optic disc swelling
hard exudate
```
75
diabetic retinopathy fundoscopy findings
```
microaneurysms
dot and blot haemorrhages
cotton wool spots
neovascularisation - at disc esp
* if treatment will have evidece of photocoagulation
hardf exudates
```
76
treatment for bacterial keratitis if delayed referral or vision threatened
ciprofloxacin 0.3% eye drops 1-2 drops into affected eye, every 15mins for 6 hrs; then hourly for 48hours then every 4 hours until healed
77
RFs macular degeneration
```
smoking
increased age
family history
caucasion
obesity
CV disease
```
78
cirrhosis on excam
spider naevi
palmar erythema
gynaecomastia
splenomegaly
79
cirrhosis on pathology tests
thrombocytopenia
low albumin
prolonged PT/INR
AST:PLT ratio >1.0
80
treatment of keratosis pilaris
urea 10% cream TOP 1-2 BD after bathing
| alpha-hydroxy acids (lactic acid 10-20%) TOP nocte
81
causes of skin hyper-pigmentation
```
addisons disease
cushing syndrome
ectopic ACTH syndrome
hyperthyroidism
haemochromatosis
cirrhosis of the liver
porphyria
chronic kidneyt failure
malnutrition/malabsorption
pregnancy
```
82
ABCDE melanoma
```
Asymmetry
Border
Color
Diameter >6mm
Evolving
```
83
non pharm treatment of rosacea
```
minimise factors that cuase flushing
low irritant skin care products and sunscreen
use emollient soap free cleanser
green tinted foundation
avoid topical corticosteroids
```
84
rosacea pharm treatment
1. metronidazole 0.75% gel once or twice daily 6-12 weeks
if severe
2. doxycycline 50-100mg PO for up to 8 weeks, repeat as required; consider minocycline if doxy not tolerated or inadequate response
85
flushing ddx
```
menopause
rosacea
emotional stress
hot/spicy food or beverages
high fever
alcohol
exercise
wind
hot baths
drugs - eg. CCBs, tamoxifen, opioids
food additives
neurologicla disorder - eg PArkinsons
carcinoid syndrome
paeochromocytoma
systemic mastocytosis
```
86
type of tinea
```
cruris - groin
pedis - foot
corporis - body
manuum - hands
capitis - scalp
```
87
causes erythema nodosum
```
sarcoidosis
strep infection
hep B infection
TB
chlamydia
IBD - Crohn's
drugs - OCP
```
88
disease associated with granuloma annulare
diabetes
89
pityriasis rosacea
herald patch
salmon pink scaly eruption
christams tree pattern
if itchy betamethasone valerate 0.02% cream TOP once daily
90
pityriasis types
rosea - christmas tree pattern
vesicolor- patchy yeast
alba - white
91
treatment pityriasis versicolor
miconazole 2%shampoo once daily leave for 10mins then wash off for for 10 days
econazole 1% solution TOP to wet skin, leave povernight for 3 nights
if unresponsive fluconazole 400mg PO STAT
92
non pharm management elevated choldesterol
reduce saturated and trans fat
use monosaturated and polyunsaturated fats to replace saturated fats
improve soluble fiblre intake
plant sterols enriched diary products
93
target HbA1c
7% usually, but can be individualised
94
Psychosis signs and symtpoms
```
alogia/poverty of content
thought blocking
loosening of association
tangentiality
clanging
word salad
perseveration
```
95
psychosis signs
delusions
hallucinations
thought disorgnaisation
agitation/aggression
96
types of delusions
```
persecutory
grandiose
erotomanic
somatic
delusions of reference
delusions of control
```
97
PTSD versus ASD
1 month is cut off
98
screened for in heelprick test
```
phenylketonuria
congenital hypothyroidism
cystic fibrosis (only detects 95%)
galactosemia
other rare disorders of metabolism
```
99
causes jaundice in neonates
early - sepsis, hemolysis (blood extravasation, isoimmunisation)
within 2 weeks - BM jaundice, brusing, spesis, dehydration, physiological
>2 weeks - sepsis, hemolysis (G6PD), dehydration, hypothyroidism
hepatitis
biliary atresia
100
anti-HBc
total hep B core Ab: indicates exposure to Hep B ()previous or ngoing)
101
anti-HBs
Hepatitis B surface antibody: immunity; either immunised or previous infection with recovery
102
igM antiHBc
IgM antibody to hep B core antigen = acute infection
103
Hep B sAg
Hep B surface antigen = high levels during acute or chronic Hep B, indicates person is infectious
104
examination questions
ensure general comfort/explain steps
inspection
palpation
adequate exposure
105
reasons for DMMR
```
5 or more regular medications
>12 doses of medication per day
recent significant changes to medications
narrow theraputic range of meds
symptoms suggestive of SEs
sub-optimal response to treatment
suspected non-compliance
difficulty managing meds becuase of language/literacy
cnogitive difficulties
attends a number of doctors
recent DC from hospital
```
106
sodium intake in heart failure
<2g/day
107
CAUSES OF thyrotoxicosis
toxic multi-nodular goitre
toxic adenoma
exogenous thyroid hormone
subacute thyroiditis/de Quervain thyroiditis
108
treatment of mania first line meds
1. olanzapine 10-15mg PO daily
| 1. risperidone 2mg PO daily
109
IgM
acute, then usually reduces
110
IgG
takes time to develop and then persists
111
diagnostic criteria in PTSD
need all of A
A. exposure to event
B. intrusion symptoms - at least once i./e. flashbacks
C. avoidance
D. negative alterations in cognition - at least 2; persistent guilt, disassociative amnesia
E. alteration in arousal/reactivity - at least 2 of - hypervigilance, irritable
F. duration of distrubance > 1/12
G. causing impairment/significant distress
H. Not attributable to substances
112
Lithium monitoring
serum lithium every 3-6 months
electrolytes and eGFR 3-6 months
TSH 6-12 months
Ca every 12 months - screen for hyperparathyroidism
113
causes hyponatremia - hypervolemia
heart failure, renal failure, liver cirrhosis, nephritic syndrome
114
evolemia causes hyponatremia
```
SIADH - drugs, malignancy
hypothyroidism
psychogenic polydipsia
pain
nausea
```
115
hypovolemic causes hyponatremia
```
vomiting/diarhea
burns
thiazides
hypopituitarism
adrenal insufficivnency
```
116
ddx schizophrenia
schizophreniform - >1/12, but <6/12
Schizoaffective disorder - major mood episodes also
delusional disorder - not criterai for schizophrenia disease
brief psychtic episode < 1 month
schizotypal personatlity disrder - "persavive pattern"
major depressive disorder with psuychotic features
bipolar depression with psychotic features
117
medical ddx psychosis
```
delirium - electrolytes
endo - thyroid
hepatic/uremic encephaloptahty
SLE, MS
acute intermittent porphyria
dementia with Lewy bodies
space occupying lesions
vit B12 def
```
118
first generation antipsychotics
chlorpomazine
| haloperidol
119
2nd generation antipsychotics
```
ariprazole/abilify
cloazpine
olanzapine
quetiapine
risperidone
paliperidone
```
120
side effects of antipsychotics
pseudoparkinsonism
acute dystonia
akathisia
tardive dyskinesia
121
delirium pharmacological management
1. hapoeridol 0,5mg PO STAT
1. olanzapine 2.5mg PO STAT
1. risperidone 0.5mg PO STAT
if IM - haloperidol 0.5mg IM, olanzapine 2.5mg IM
122
drugs to avoid in parkinsons
haloperidol
| metoclopramide
123
drugs that cause delirium
```
anticholinergics
benzos
opioids
steroids
NSAIDs
dopaminerdis - levodopa
soltalol/propanolol
alcohol, drugs
```
124
anticholinergic drugs
```
sedating antihistmaines - doxylamine
oxybutyning
antipsychostics
TCAs - endep
benztropine
prochlorperazine
hyoscine hydrobromide
```
125
delirium prevention
```
hydration, nutrition
pain relief
sleep
visual/heaqring mimpairment
avoid restraints
lighting
quiet
singlew rooms
clock and calendar
family
```
126
improving medication compliance
```
webster pack
eudcation re outcome of poor ocmpliance
HMR
home visit nurse
subsidies for medications
involve appropriate nurses - AHW, diabetic educator
involve family with permission
```
127
TIME acronym for ulcer management
Tissues, Infectionm, Moisture, Edge
128
ABI measurements
<0.5 arterial disease, >0.9 venous diease
129
hydrogels - examples and use
solosite; increase wound moisture, use in dry, scabbed, necrotic wounds
130
film dressings - example and use
opsiyte/tegarderm - don't absorb or create moisture, but can keep moistuyre in; use if nil to low level exudate
131
hydrocolloid dressing - example and use
eg duoderm/comfeel; give soft moisture bed; use in low to moderate exudate
132
abdorbent fibre/hydroactive polymners/polyurethane foams - eg and uses
eg. kaltostat, use in high exudating wounds to manage moisture without maceration
133
medications for dementia
donepezil
galantamine
rivastigmine
memantine
134
causes of abnormal uterine bleeding
```
PALM-COEIN
Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogrenic
Not yet classified
```
135
topical treatment lichen sclerosus
betamethasone diproprionate 0.05% in optimized vehicle BD until itch resolves then wean
136
complications of snake bites
coagulopathy
neurotoxicity - ptosis first sign
myotoxicity - rhabdomyolysis
acute kidney injry
137
treatment of meningitis pehospital transfer
ceftriaxone 50mg.kg p to 2g; IM or IV
138
breast cancer red flags risk categories
```
1 = avg risk
2 = moderate risk = annual mammogram >40yo, if relatives diagnosed <50yo
```
139
breast cancer red flags
2 relatives with breast cancer on same side of family
first degree relative
relative <50yo
140
levonorgestrel emergency contraception
1.5mg PO ASAP
within 96 hours
if BMI >26 or 70kg consider 2x dose
interacts with liver inducers - give 2x dose
141
Ulipristal acetate
```
30mg PO STAT
within 5 days
decreased effect if BMI >30/>85kg
don't 2x dose
interacts with liver enzymes
stop OCP for 5/7
don't give with steroids
```
142
Implanon true name
Etonogestrel implant 68mg subdermally
143
normal PR interval
3-5 small squares
| 120-200msec
144
normal QRS
2.5 small squares
| 70-100msec
145
QTc
M <440msec
| F <460msec (12 small sqauers)
146
pathological Q wave
```
first negative defelction after P wave
needs to be
>1 small square wide
>2mm deep
leads V1-V3 25 % QRS depth
```
147
Rheumatic fever diagnostic criteria - how many required
initial - needs 2 major OR 1 major and 2 minor
AND evidence of step pyogenese infection
recurrent - 2 major, or 1 major + 1 minor, or 3 minor
148
Major manifestations of acute rheumatic fever
```
carditis
polyarthritis or aseptic monoarthritis
chorea
erythema marginatum
subcutaneous nodules
```
149
minor manifestations of acute rheumatic fever
```
high risk pt -
monoarthralgia
fever >38
ESR/CRP >30
prolonged PR
all others
polyarthralgia
fever >38.5
ESR >60, CRP >30
prolonged PR
```
150
sensitivity
= true +/true positive + false negative (i.e. everyone with diease)
151
specificity
true negatives/false positives + true negatives (i.e. all those who do not have disease)
152
haemochromatosis genotypes
C282Y - homo righ risk
| H63D
