Randoms Flashcards
(32 cards)
Risk factors for endometrial ca
History of chronic anovulation
Exposure to unopposed oestrogen
Polycystic ovary syndrome (PCOS) associated with chronic anovulation
Exposure to tamoxifen
Strong family history of endometrial or colon cancer (Lynch syndrome)
Nulliparity
Obesity (often with diabetes and hypertension)
Endometrial thickness > 8mm
Which tests should a sexually active MSM have 3 monthly
Hep A, B, HIV, Syphilis serology, First pass urine and ano-rectal swab for Chlamydia and Gonorrhea NAAT
If monogamous - yearly
Hep C test yearly only - if IVDU, HIV, or on Prep
Post menopausal bleeding - endometrial thickness 4mm or more on T/V ultrasound
Any post menopausal bleed - Refer in 6 weeks to Gynae
If Endometrial thickness greater than 4 mm - endometrial biopsy
Perineal tears - long term issues and when to refer?
Long term - dyspareunia, perianal pain, flatal and feacal incontinence
Refer - dyspareunia, severe constipation, faecal incontinence, wound dehiscence
Acute management of poisoning in toddler
Call Poisons hotline 1131126, ABC D1- disability - (treat seizures), D2 - Decontaminate - skin, eyes and GIT (with toxicologist cos emesis, activated charcoal and lavage have limited evidence and carry risks) D3 - drug antidotes, E1- ECG E2 - exposure (think about hypo and hyperthermia) E3 - enhanced elimination (urinary alkilisation, multi dose activated charcoal, dialysis)
Lethal in 1-3 tabs
Beta blockers, calcium channel antagonists, Sulphonylureas (hypoglycaemia may be delayed up to 8 hours), chloroquine and hydroxychloroquine, ecstasy and amphetamines, tricyclic antidepressants, theophylline
Candidal vulvovaginitis - candida albicans vs glabrata
If can tolerate topicals: Topical 1% cotrimazole intravaginal cream one applicator full nocte for 6 nights.
If cant tolerate topicals and not prego - oral fluconazole 150mg stat
For candida glabrata- Boric acid 600mg intravag nocte for two weeks
Red flags for hospital admission in Community acquired pneumo?
patients with any of the following parameters need close clinical observation, and are therefore likely to need inpatient management [NB2]:
tachypnoea (respiratory rate 22 breaths/minute or more)
heart rate higher than 100 beats/minute
hypotension (systolic blood pressure lower than 90 mmHg)
acute-onset confusion
oxygen saturation lower than 92% on room air (or lower than baseline in patients with comorbid lung disease)
multilobar involvement on chest X-ray
blood lactate concentration more than 2 mmol/L [NB3].
Definition of infertility?
Infertility is defined as the inability to conceive after 12 months of regular, unprotected sexual intercourse and this typically affects 15 - 20% of couples.
Causes of male infertility?
Pre-testicular
• Hypogonadotrophic hypogonadism – Kallmann syndrome
• Hyperprolactinaemia
• Pharmacological
Testicular • Varicocele • Cryptorchidism • Testicular cancer • Radiation • Chemotherapy or pharmacological • Genetic azoospermia or oligospermia • Y-chromosome microdeletions • Klinefelter syndrome • Environmental • Infection • Injury or trauma • Primary ciliary dyskinesia • Sertoli cell-only syndrome • Anti-sperm antibodies
Post-testicular • Coital • Pharmacological • Retrograde ejaculation • Congenital bilateral absence of the vas deferens • Ejaculatory duct obstruction or seminal vesicle dysfunction • Vasectomy or Iatrogenic injury to the vas deferens • Young’s syndrome • Nerve injury • Spinal cord injury • Retroperitoneal lymph node dissection • Systemic disease
Elevated lft
Elevated lifts - exclude etoh, viral hep b and c, autoimmune hep, thyroid prob, coeliac, haemochrom
And u/s
Nafld criteria
Evidence of fatty infiltration- on u/s MRI or liver biopsy
Exclusion of significant etoh consumption
Exclusion of other causes of steatosis (meds, surgery, metabolic disorders
Emergency contraception for a woman?
Levonorgestrel tablets:
1.5mg tablet stat dose taken as soon as possible (within 72 hours of unprotected intercourse)
if this is unavailable, a woman can take 25 tablets of the levongesterel progestin-only mini-pill with another 25 tablets to be taken 12 hours later (50 tablets total)
may have reduced efficacy in women with a BMI > 30
2. Ulipristal acetate tablets (“EllaOne”):
30mg tablet taken orally as soon as possible, up to 5 days following unprotected intercourse
most effective of the oral methods
may have reduced efficacy in women with a BMI > 30 (but less so compared with levonorgestrel)
3. Copper intrauterine device:
the most effective overall method
not affected by body weight
insert within 120 hours of unprotected intercourse without loss of efficacy for 5 days
the only method that will be effective if ovulation has already occurred
Recommencing the oral contraceptive pill or inserting an etonogestrel implant (Implanon) after counselling may be appropriate long-term options to prevent pregnancy but are not appropriate in the short term as emergency contraception.
How would you manage a simple ovarian cyst?
Simple cysts will usually resolve within three menstrual cycles and require no investigation.”
This question is assessing knowledge of investigation of a simple ovarian cyst. It is important candidates are aware that simple cysts, in the pre-menopausal period, usually self-resolve within 3 cycles. If the cyst is greater than 5cm, a repeat ultrasound could be performed in 3 months to ensure resolution.
Should you organise a CA125 for a pre-menopausal woman? What can it be elevated in?
In addition to ovarian carcinoma, some pelvic pathologies may contribute to an elevated CA125 including endometriosis, pelvic inflammatory disease and uterine fibroids. In the pre-menopausal female CA125 is not a diagnostic or screening test and as such should not be routinely ordered in the general practice setting.
How does vulval lichen planus present?
Vulval lichen planus often presents with painless white streaks in a fern-like pattern or with painful ulcers / erosions
Eligibility for home Cervical collection?
The new National Cervical Screening Program (NCSP) commenced in Australia in December 2017 and involves screening women aged 25 – 74 years with a 5 yearly HPV test. There are specific eligibility criteria surrounding the use of self-collected vaginal samples which can be seen in the reference below. Eligible people include:
- those who have never participated in the NCSP and are 30 years or over
- those who are overdue for cervical screening by 2 years or more and aged 30 years or over
Amsel criteria for diagnosing bacterial vaginosis?
The Amsel criteria can be used to diagnose bacterial vaginosis; three of the following features must be present:
thin, white, homogeneous discharge vaginal fluid pH more than 4.5 clue cells (epithelial cells covered with small curved coccobacilli and mixed flora) visualised on a wet preparation of a vaginal swab or Gram-stained smear fishy odour when adding alkali (potassium hydroxide 10%) to discharge.
Treatment and important considerations for BV?
Metronidazole orally 2g stat
Clindamycin treatment of choice in pregnant women
Make sure that
Male partners don’t need treatment but female partners should be assessed for BV
Bacterial vaginosis is associated with a 2-3 fold increased risk of acquiring STIs including chlamydia, gonorrhoea, herpes simplex type 2 and HIV infection, and increases the risk of HIV transmission to male partners.
Approach to lactational mastitis?
Acute mastitis is usually associated with breastfeeding and is often caused by Staphylococcus aureus. Poor infant positioning, milk stasis and nipple damage are contributing factors. Breastfeeding or expressing milk (manually or via a pump) from the infected breast is safe and should be continued.
If mastitis is not associated with breastfeeding, seek expert advice for management.
In patients without systemic symptoms, increased breastfeeding and gently expressing milk from the affected breast may prevent progression and resolve infection without antibiotics.
In patients with systemic symptoms, or symptoms or signs that have not resolved after 24 to 48 hours of increased breastfeeding and expressing of milk, early antibiotic therapy is important to prevent abscess formation. Combine antibiotic therapy with increased breastfeeding and expressing of milk.
Use:
1
dicloxacillin 500 mg orally, 6-hourly. If symptoms and signs resolve rapidly, 5 days of therapy may be sufficient; otherwise continue treatment for 10 days
OR
1
flucloxacillin 500 mg orally, 6-hourly. If symptoms and signs resolve rapidly, 5 days of therapy may be sufficient; otherwise continue treatment for 10 days.
Breast cancer risk reduction?
Current RACGP guidelines for preventive activities in general practice (the ‘Red Book’) advocate for physical activity, adequate folate, a Mediterranean diet, normal body mass index (in post-menopausal women only) and decreased alcohol consumption to reduce breast cancer risk.
In this case it is important for candidates to identify that having one first-degree family member with breast cancer, aged over 50, does not change Roberta’s overall risk category. She is still in the ‘average or only slightly higher risk’ of breast cancer category (i.e. >95% of the female population). Therefore, she should be encouraged to have a screening mammogram every 2 years until the age of 74 years and breast awareness should also be discussed.
Smoking does not have the same correlation with breast cancer as alcohol, and there is no strong or proven direct association with smoking and breast cancer in females.
How should a new breast lump be managed?
A triple test with a follow-up appointment is the most appropriate management for a women with a new breast lump. See the Cancer Australia 2017 guidelines referenced below for details. If there are suspicious or malignant breast or nipple changes after having conducted a history and examination, it is recommended to refer to a breast surgeon, preferable with further test results.
The triple test refers to three diagnostic components:
- medical history and clinical breast examination
- imaging – mammography and/or ultrasound
- non-excisional biopsy – core
What do you need to know about self collected tests? What happens with a positive result?
The self-collected test only detects HPV and the sample cannot be tested for cervical cell changes. If a woman completes a self-collected HPV test, and higher risk HPV 16/18 is detected, she should be referred for colposcopy and at that visit, the clinician will collect a cervical sample for liquid-based cytology. If HPV (not 16/18) is detected on the self-collected sample, the woman should be advised to return to see you in 6 – 12 weeks for a clinician-collected cervical sample for liquid-based cytology.
When to refer esotropia?
Inward turning of the eye, known as ‘esotropia’, is considered normal for infants aged under 3 months if it variable and occurs intermittently. After 3 months of age, this condition needs to be referred semi-urgently for evaluation for strabismus. Constant large turning in of the eye also requires semi-urgent referral, regardless of the age of the infant. Acute onset of constant esotropia at any age requires immediate referral.
