01. Course Introduction Flashcards
What issues would you address when there is a suspected case of rape?
- Enquire about any other injuries sustained during the encounter e.g. strangulation
- Discuss the option of attending a sexual assault health service for a forensic examination
- Discuss option of reporting to the police/making a signed statement
- Discuss emergency contraception options
- Discuss possibility of sexually transmitted infection and the need for further investigations
- Assess if she has psychosocial supports - family/friends
- Consider referral to sexual assault support service/1800 RESPECT
- Assess mental health risk - pre-existing mental health issues/suicide risk and discuss the likelihood of an acute stress reaction
- Explain that in certain situations, Post-Exposure Prophylaxis can be considered for some STIs
What timeframes are there to collect trace evidence in suspected sexual assault? (In general, need forensic examination within 7 days)
- Licking: 12 hours
- Indecent touching (including digital vaginal or anal penetration): 12 hours
- Penile penetration of the mouth: 24 hours
- Penile penetration of the anus: 48 hours
- Penile penetration of the vagina: up to 5 days
What are 3 options for emergency contraception and their time-frames to be used?
- Copper IUD, 120 hours/5 days
- Levonorgestrel emergency contraceptive pill, 72-96 hours/3-4 days
- Ulipristal acetate emergency contraceptive pill, 120 hours/5 days
What contraindications are there for use of ulipristal as oral emergency contraception?
- Severe oral steroid-dependent asthma
- Severe liver impairment
True/false: administration of a progesterone-containing method of contraception within 5 days of ulipristal acetate should be avoided
true
How long is post-exposure HIV prophylaxis administered for, if required?
30 days of antiretroviral medication
What is the timeframe for administration of Hepatitis B immunoglobulin if an assailant is known to be HBV Ag positive?
Up to 14 days post assault
When should a patient of suspected sexual assault return for STI screening follow up tests?
Ideally, follow up tests for
- bacterial STIs (chlamydia and gonorrhoea) should be performed at 14 days post-exposure, or whenever the patient presents after 14 days;
- syphilis and blood-borne viruses, testing should be performed at three months post-exposure
What investigations are relevant for a female victim of penetrative (vaginal) rape two weeks later?
- HIV serology (3 months)
- Hepatitis B serology (3 months)
- Syphilis serology (3 months)
- Chlamydia PCR endocervical swab
- Gonorrhoea PCR endocervical swab
- Trichomonas high vaginal swab
- Urine pregnancy test
What medications do you consider starting for a patient with stable angina?
- Long-acting nitrate: patch or oral (allow for nitrate free period as tolerance to all forms of nitrate therapy develops rapidly)
- Beta blocker (prevent angina)
- Nondihydropyridine calcium channel blockers (BUT NOT to be used in combination with beta blockers at the rest of bradycardias)
- Dihydropyridine calcium channel blocker
- Nicorandil (potassium channel activator for arterial dilation) - for refractory angina
When is angina considered stable?
If the pattern of symptoms or triggers has not changed during the past month
What are some non-pharmacological management strategies for a 70 year old with ischaemic heart disease and stable angina with suspected depression?
- Cognitive behavioural therapy (GP, clinical psychologist)
- Referral to aged care services, Aged Care Assessment Team assessment (ACAT), My Aged Care services for home support packages
- Referral to cardiac rehabilitation programs
- Exericse (encourage moderate intensity exercise 30 min daily, referral to exercise physiologist for exercise program)
- Encouraged increased social contact (e.g. Men’s Shed, 3UA’, volunteer work, online resources)
- Meals on wheels
What are some causes of delirium in a 91F in a nursing home post gastroscopy and colonoscopy with a background of hypertension, sciatic pain and cognitive impairment on perindopril and buprenorphine patch?
- Post anaesthetic recovery
- Electrolyte disturbance; e.g. hyponatraemia
- Anaemia from PR bleeding
- Intercurrent infection e.g. UTI
- Medication error; e.g. opioid overdose
- Intracranial pathology; e.g. cerebrovascular accident
- Bowel perforation from her procedure
- Hypoglycaemia
- Acute kidney injury/uraemia
- Hypovolaemic shock/hypotension
What are three management options in a 91F with new confusion and a significant Hb drop after return to nursing home from an endoscopy.
- Return to hospital for blood transfusion
- Manage in nursing home with increasing fluid and monitoring
- Comfort care only
What measures can you take to make a decision in this situation: 91F with new confusion and a significant Hb drop after return to nursing home from an endoscopy?
- Discuss the situation with her family
- Refer to the advanced care directive
- Discuss with the treating team at the hospital
Differentials for a groin rash
- Tinea cruris
- Candida
- Erythrasma
- Flexural psoriasis
- Seborrhoeic dermatitis
- Simple intertrigo
What are some risk factors for the development of tinea cruris?
- Diabetes mellitus
- Immunodeficiency
- Obesity
- Hyperhidrosis
- Poor hygiene
What is first line topical therapy for recent onset of localised tinea affecting the trunk (including groin), limbs, face or between the fingers or toes?
Terbinafine 1% cream or gel topically, once or twice daily for 7 to 14 days
What is the first line oral therapy for tinea not on the scalp or nails?
Terbinafine 250mg daily PO for 2 weeks
What are some aspects of management for localised tinea?
- Terbinafine topical daily/twice daily for 1-2 weeks
- Avoid sharing towels
- Avoid wearing tight-fitting clothing to prevent moisture build-up/keep the area dry
What are two first line options for shingles?
- Valaciclovir 1g TDS PO for 7 days
- Famciclovir 500mg TDS PO for 7 days (10 days for immunocompromised)
When is antiviral therapy indicated for shingles?
- Immunocompetent adults and adolescents: within 72 hours of rash onset
- Immunocompromised (including HIV infection) adults, adolescents and children
- Immunocompetent children with severe or rapidly progressing infection
- Herpes zoster opththalmicus
What is the standard approach to management of herpes zoster ophthalmicus?
- Oral antiviral therapy: limit VZV replication
- Topical steroid drops: reduce the inflammatory response and control immune-associated keratitis and iritis
What situations is Shingrix (shingles vaccination) funded under the National Immunisation Program?
- 18 years and over: immunocompromised at high risk of herpes
- 50 years and over: Aboriginal and Torres Strait Islander people
- 70 years: non-Indigenous people
How long should an immunocompetent person wait to get vaccinated against shingles after an episode of shingles?
12 months
How long should an immunocompromised person wait to get vaccinated against shingles after an episode of shingles?
3 months
How is the shingrix vaccination schedule different between immunocompetent and immunocompromised patients?
- Immunocompetent: 2 doses, 2-6 months apart
- Immunocompromised: 2 doses, 1-2 months apart
