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GP Academy > 01. KFP Insights: Formats and Cases > Flashcards

01. KFP Insights: Formats and Cases Flashcards

1
Q

Characteristics of migraine?

A
  • Recurrent attacks that last 4-72 hours
  • Typically on sided, pulsating, moderate to severe intensity, aggravated by routine physical activity
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2
Q

Characteristics of migraine with aura?

A

Migraine
- Recurrent attacks that last 4-72 hours
- Typically on sided, pulsating, moderate to severe intensity, aggravated by routine physical activity

Aura:
- Reversible focal neurological symptoms that usually develop over 5-20 minutes and last for less than 60 minutes
- Symptoms can affect vision, sensors, speech and/or , motor function, brainstem and retina

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3
Q

Characteristics of tension type headache?

A
  • Last from 30 minutes to seven days
  • Usually bilateral, feels like pressure or tightness in their head
  • Not associated with nausea
  • May be associated with photophobia
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4
Q

Management of medication over-use headache?

A
  • Commence NSAID e.g. naproxen
  • Cease/gradually reduce offending medication
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5
Q

Options for prophylaxis in migraine?

A
  • Candesartan
  • Amitriptyline
  • Verapamil SR
  • Propranolol
  • Pizotifen
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6
Q

Characteristics of pityriasis rosea?

A
  • Self limiting inflamamtory skin condition
  • Cause: viral infection (reactivation of human herpesvirus 6 or 7)
  • Starts with a herald patch and then 2 weeks later, multiple scaly, oval, salmon-coloured macules appear
  • Macules confined to the trunk and proximal limbs, Christmas tree appearance as it follows the skin tension lines
  • Rx: no specific treatment is required as it is benign and not contagious
  • DDx: guttate psoriasis, secondary syphilis
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7
Q

What exam findings would you search for when assessing for an alternative cause of frequent urination other than urge urinary incontinence?

A
  • Appearance of frailty
  • Problems with mobility, problems with transfers
  • Cognitive impairment, cognitive function
  • Presence of enlarged bladder
  • Presence of pelvic mass
  • Presence of Atrophic vulval or vaginal changes
  • Presence of pelvic organ prolapse
  • Loss of urine observed at the urethral meatus on coughing
  • Presence of constipation, faecal impaction on digital rectal examination
  • Presence of altered perineal sensation on digital rectal examination
  • Presidents of altered anal tone
  • Presence of perineal skin disease (e.g. Dermatitis, thrush)
  • Presence of lower limb weakness
  • Presence of upper motor neuron signs On lower limb neurological examination
  • Signs of other conditions associated with incontinence(eg diabetes, neuropathy, cerebro vascular disease, parkinson’s disease)
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8
Q

Risk factors for overactive bladder syndrome?

A

Non-modifiable risk factors:
* Age
* Female
* Metabolic syndrome
* Post menopausal
* Benign prostatic hyperplasia
* Pelvic organ prolapse in women

Modifiable risk factors
* Alcohol
* Smoking
* Obesity
* Caffeine intake
* Carbonated beverages
* Spicy foods
* Bladder stones

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9
Q

Differentials for overactive bladder?

A

Neurological (neurogenic detrusor overactivity):
* Stroke
* Multiple sclerosis
* Dementia
* Diabetic neuropathy
* Spina bifida
* Spinal trauma
* Reversed diurnal rhythm

Malignancy
* Urothelial carcinoma

Lower urinary tract
* Recurrent urinary tract infection
* Bladder outlet obstruction (Including benign prostatic hyperplasia, urethral stricture)
* Foreign body in lower urinary tract’s (eg eroded synthetic mesh)
* Overflow incontinence

Systemic pathologies
* Obstructive sleep apnea
* Congestive heart failure
* Diabetes resulting in polyuria

Medications
* Diuretics
* Anticholinergics
* Narcotics

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10
Q

Management for overactive bladder?

A

Non-pharmacological:
* Treatment of modifiable risk factors eg weight reduction
* Reduction of exposure to bladder stimulants (eg alcohol, caffeine, smoking, carbonated beverages)
* Constipation avoidance - aiming for soft stools passing every one to two days, increasing daily fibre intake, using stool softeners and laxatives
* Fluid optimization - Restricting fluid intake to 6-8 glasses of water per day, avoiding prepared hydration by two hours
* Pelvic floor exercises bladder training with physiotherapy
* Containment devices eg incontinence pads
* Bladder training - Scheduling voiding times, using urge control techniques

Pharmacological:
* Topical estrogen - post menopausal female
* Anticholinergic, nonselective - oxybutynin
* Anticholinergic, M3 selective - solifenacin
* Beta 3 agonist - mirabegron

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11
Q

Non-pharmacological management of urge urinary incontinence?

A
  • Advise appropriate fluid intake of 15 to two litres per day
  • Advise limit caffeine intake
  • Advise to avoid constipation
  • Advise regular toileting
  • Advise good posture when toileting
  • Advise to allow adequate time for emptying when toileting
  • Advise bladder retraining programme
  • Advise pelvic floor exercises
  • Advice the use of incontinence products
  • Advice use of mobility aids
  • Advise the use of toileting aids (bedside commode)
  • Advise to plan her outings by identifying local toilets
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12
Q

Differentials for pelvic discomfort, mildly tender uterus anne milky vagina discharge?

A
  • STI infection: Pelvic inflammatory disease / Chlamydia / Gonorrhoea
  • Non-STI infection: Bacterial vaginosis / vagina thrush / simplex virus
  • Ectopic pregnancy
  • Ovarian Torsion
  • Endometriosis
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13
Q

Pharmacological management for pelvic inflammatory disease?

A
  • Ceftriaxone 500mg in 2mL of 1% lidocaine IM
  • Metronidazole 400mg BD PO for 14 days
  • Doxycycline 100mg BD PO for 14 days
  • Paracetamol or NSAID (ibuprofen)
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14
Q

Non-pharmacological management of pelvic inflammatory disease?

A
  • Contact tracing for any partner in the last six months
  • Avoid alcohol was metronidazole
  • Avoid sexual intercourse for one week following completion of treatments Or until symptomatically better
  • Review after three to seven days to ensure response to treatment
  • Arranged test of cure after three to four weeks
  • Advice regarding barrier contraception such as condoms
  • Provide fact sheet regarding pelvic inflammatory disease
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15
Q

Typical presentation of pelvic inflammatory disease?

A
  • Bilateral pelvic pain but may localise to right or left iliac fossa
  • Deep dyspareunia
  • Abnormal bleeding or discharge
  • Cervical motion tenderness
  • Fever, nausea, vomiting
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16
Q

Possible causes of pelvic inflammatory disease?

A
  • Polymicrobial
  • Sexually transmitted infections eg neisseria gonorrhoea, chlamydia trachomatis, mycoplasma genitalium
  • Vaginal facultative bacteria and other vaginal bacteria associated with bacterial vaginosis
  • Disruption of the cervical epithelium eg intrauterine device insertion
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17
Q

Pharmacological treatment of uncomplicated genital or pharyngeal chlamydia?

A
  • First line: Doxycycline 100mg BD PO for 7 days
  • Second line: Azithyromycin 1g PO STAT
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18
Q

Pharmacological treatment of asymptomatic anorectal chlamydia?

A
  • First line: Doxycycline 100mg BD PO for 7 days
  • Second line: Azithyromycin 1g PO STAT, then repeat in 12-24 hours
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19
Q

Pharmacological treatment of symptomatic anorectal chlamydia?

A
  • First line: Doxycycline 100mg BD PO for 21 days
  • Second line: Azithyromycin 1g PO STAT, then repeat in 12-24 hours
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20
Q

Which chlamydia patients should get a test of cure atleast 3 weeks after starting treatment?

A
  • Pregnant
  • Anorectal infection
  • PID
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21
Q

What examination features do you search for when assessing erectile dysfunction?

A
  • Penile plaques
  • Small testicular size; low testicular volume - signs of androgen deficiency
  • Lack of secondary sexual characteristics (eg lack of hair)
  • Weak peripheral pulses
  • Enlarged prostate
  • Lower limb neurological deficits (eg anal tone, reflexes)
  • Penile sensation
  • Breast enlargement, gynecomastia
  • Obesity
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22
Q

Initial investigations for erectile dysfunction?

A
  • Fasting blood glucose
  • Follicle stimulating hormone
  • Lipid profile
  • Liver function tests - NASH/MAFLD
  • Luteinising hormone
  • Morning testosterone
  • Prolactin
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23
Q

Non-pharmacological management for erectile dysfunction?

A
  • Increase exercise
  • Refer to a psychologist; psychotherapist; sex therapist
  • Appropriate dietary advice - Mediterranean diet
  • Referral to physiotherapist for pelvic floor exercises
  • Consideration of penile pump use
  • Shared decision making/couple therapy
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24
Q

Management of acute paraphimosis?

A
  • Arrange for transfer to emergency department of a hospital with urology specialist cover by ambulance
  • Anaesthetise the penile head eg local anaesthetic topical, penile nerve block, ring block
  • Apply circumferential pressure to the glans of the penis to disperse oedema (eg gloved hand or cling film or compression bandage)
  • Apply ice intermittently to the head of the penis to reduce the swelling
  • Aspiration of blood from the head of the penis with a needle
  • Apply granulated sugar to the head of the penis
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25
Q

Risk factors for erectile dysfunction?

A
  • Increased age
  • Cardiovascular disease and its risk factors: sedentary lifestyle, obesity, diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, smoking
  • Endocrine: diabetes, androgen deficiency, thyroid disorders, hyperprolactinaemia
  • Neurological: brain, spinal cord, or autonomic nervous system
  • Medication: beta blockers, thiazides, antidepressants, antipsychotics, antiandrogens
  • Prostate cancer therapy
  • Penile disorders: Peyronie disease
  • Recreational drug or alcohol use
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26
Q

Management options for erectile dysfunction?

A

Optimise modifiable risk factors and related comorbidities
* Lifestyle - smoking cessation, healthy diet, exercise, reduce alcohol intake, avoid recreational drugs
* Reinforce blood pressure, dyslipidemia, diabetes control
* Assessable cardiovascular disease

Treat reversible causes
* Low testosterone
* Medication induced erectile dysfunction - Consider alternatives
* Psychogenic erectile dysfunction - consider referral to a therapist

First line therapy: phosphodiesterase type 5 inhibitor

Referral to Urologist
* Second line: penile injections, vacuum erection devices, external shock wave lithotripsy
* Third line: penile prosthesis

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27
Q

Pharmacological management options for bone pain from bony metastases?

A
  • Paracetamol
  • Non steroidal anti inflammatory
  • Opioid
  • Bisphosphonate therapy: pamidronate, zoledronic acid
  • Glucocorticoid therapy: dexamethasone
  • Stool softening agents
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28
Q

What advice would you provide if a patient was concerned about Future loss of capacity to make decisions relating to their health care?

A
  • Prepare an advance health directive; advance care plan; living well
  • Appoint a Medical Enjuring Power of Attorney
  • Appoint an Enduring Guardian
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29
Q

What are some signs and symptoms of hypercalcemia?

A
  • Confusion/delirium
  • Nausea and vomiting
  • Pain
  • Constipation
  • Thirst
  • Polyurea
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30
Q

Management actions for a young female sexual assault victim from two days ago who was released from prison weeks ago. No contraception. Intermittently used Intravenous heroin. She does not consent for further physical examination

A
  • Offer referral to sexual assault referral centre
  • Offer emergency contraception: levonorgestrel, ulipristal
  • Refer to sexual assault community support group or counsellor
  • Offer empirical sexually transmitted infection treatment
  • Undertake sexually transmitted infection investigation screen
  • Offer human immunodeficiency virus post exposure prophylaxis
  • Provide education regarding safe needle use
  • Offer referral to drug and alcohol service
  • Undertake mental health assessment and suicide risk assessment
  • Offer referral to homeless support service
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31
Q

Non pharmacological management for aggressive behaviour in an elderly patient In a nursing home?

A
  • Identify and reduce triggers of his aggression
  • Anxiety management techniques (eg reassurance, talking about anxiety provoking thoughts, cognitive interventions)
  • Provide calm, low stimulating environments
  • Simplify instructions (Ie clear, concise, neutral volume/tone) when conversing
  • Offer positive reinforcement for good behaviour
  • Provide familiar environment (eg photos of family, consistent staff/routine)
  • Time orientation aids (eg whiteboards with instructions routine, clocks in vision, offering natural light during daytime)
  • Touch therapies (eg massage, acupuncture)
  • Integrate regular leisure activities (eg arts, craft, gardening)
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32
Q

What are some possible causes of erythema multiforme?

A
  • Food additives/food allergy
  • Idiopathic
  • Infection - Eg herpes/hepatitis and other viruses, tuberculosis, leprosy, fungal infection, mycoplasma
  • Neoplasia - eg hodgkin’s disease, myeloma, carcinoma
  • Medications - Eg sulphonamides, barbiturates, penicillin, anticonvulsants
  • Systemic disease eg systemic lupus erythematosus
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33
Q

Differentials for a three month generalised itch with no obvious rash?

A
  • Renal failure / uremia
  • Jaundice, hyperbilirubinemia, cholestasis, liver disease
  • Diabetes
  • Thyroid disease (hyper or hypo)
  • Hyperparathyroidism
  • Iron deficiency anaemia
  • Psychogenic
  • Malignancy, solid (eg lung, colon, brain)
  • Malignancy, haematological (lymphoma, multiple myeloma, leukaemia)
  • Malignancy with paraneoplastic syndrome
  • Polycythemia
  • Macroglobulinemia
  • Neurological condition (cerebral infarct, brain abscess, multiple sclerosis, parkinson’s disease)
  • Infectious cause (human immunodeficiency virus, hepatitis c)
34
Q

Initial investigations for a three month generalised itch with no obvious rash?

A
  • Fasting blood glucose level
  • Full blood count
  • Electrolytes, urea and creatinine
  • Iron studies
  • Liver function tests
  • Parathyroid hormone level
  • Serum calcium
  • Thyroid function tests
  • Chest xray
35
Q

Risk factors for erectile dysfunction?

A
  • Increased age
  • Cardiovascular disease and its risk factors including sedentary lifestyle, obesity, diabetes, hypertension, dyslipidemia, obstructive sleep apnea, smoking
  • Endocrine disorders such as diabetes, androgen deficiency, thyroid disorders, hyperprolactinemia
  • Neurological conditions affecting the brain, spinal cord, autonomic nervous system
  • Medication eg beta blockers, thiazides, antidepressants, antipsychotics, anti-androgens
  • Prostate cancer therapy
  • Penile disorders eg fibrous penile plaques in Peyronie’s disease
  • Recreational drug or alcohol use
36
Q

What must you assess for in males with erectile dysfunction?

A

Assess exercise tolerance to determine whether they’re at risk of death or significant morbidity from sexual exertion

37
Q

Males are generally considered at low risk of death or significant mobility from sexual exertion if they:

A
  • Do you not have uncontrolled hypertension
  • Have not had a recent myocardial infarction (within the last eight weeks)
  • Can climb two flights of stairs in 10 seconds (13 to 16 steps each)
38
Q

Males are generally considered at high risk of death or significant mobility from sexual exertion if they have any of the following (needs cardiology assessment before engaging in sexual intercourse):

A
  • An acute coronary syndrome in the last two weeks (without revascularization)
  • High risk arrhythmias eg exercise associated ventricular tachycardia, poorly controlled atrial fibrillation, implanted cardioverter defibrillator delivering frequent shocks
  • Severe aortic stenosis
  • Symptomatic hypertrophic obstructive cardiomyopathy
  • New York Heart Association class IV symptoms (symptoms of heart failure rests and increasing discomfort with any physical activity
39
Q

Management of erectile dysfunction?

A
  • Consider referral for socket sexual or relationship therapy, particularly with strong psychogenic component is likely
  • Oral Phosphodiesterase type 5 inhibitors - first line for fit and not taking nitrates
  • Vacuum erection devices
  • Intracavernosal therapy
  • Penile implants
  • If androgen deficiency: testosterone therapy
40
Q

Adverse effects of phosphodiesterase 5 inhibitors such as sildenafil?

A
  • Priapism
  • Vision loss due to NAION
  • Migraine
  • Seizures
  • Sudden hearing loss
  • Transient amnesia
41
Q

What advice do you provide for priapism?

A

If an erection has lasted more than two hours:
* Have a cold shower
* Go for a gentle jog
* Take the pseudoephedrine immediate release 120 mg oral, single dose

If the erection persists 4 hours after it started, advise the person to seek medical attention for aspiration and drainage of the corpora cavernosa

42
Q

What are some contraindications to PDE5 inhibitors?

A
  • On other nitrate medication
  • Severe congestive cardiac failure
  • Unstable angina
  • Resting hypertension
  • Recent stroke and myocardial infarction
  • Recreational nitrate use
43
Q

How long should a male be abstinent to give an accurate sperm sample?

A
  • After two to three days abstinence
  • It needs to be analysed within one hour
44
Q

What instructions would you give for a repeat semen analysis collection?

A
  • After two to three days abstinence - too short affects sperm count; too long affects sperm motility
  • It needs to be analysed within one hour
  • It should be analysed data specialise andrology laboratory
  • If mild to moderate derangement: repeat after 1-3 months
  • If severe oligospermia or azoospermia: repeat within 2-4 weeks
  • If leuks >1 x10^6 —> needs urine culture, urine PCR for chlamydia and gonorrhoea, semen culture
45
Q

What initial investigations are required for male infertility?

A
  • Serum follicle stimulating hormone
  • Morning testosterone levels
46
Q

What investigations are required for patients with initial low serum testosterone?

A
  • Repeat serum morning testosterone
  • Free testosterone
  • Luteinizing hormone
  • Prolactin
47
Q

What are some differentials for low testosterone?

A
  • Hypogonadotropic hypogonadism
  • Testicular failure or hypergonadotropic hypogonadism
  • Prolactinoma
48
Q

What are the initial investigations for haematospermia?

A
  • Urine mcs and cytology
  • Full blood count
  • Coagulations studies
49
Q

What are some red flag risk factors when assessing hematospermia?

A
  • Age > 40
  • Recurrent or persistent hematospermia
  • Prostate cancer risk factors Eg positive family history or African heritage
  • Constitutional symptoms eg weight loss, anorexia, bone pain
50
Q

What are some differentials for haematospermia?

A
  • Urinary tract infection
  • Sexually transmitted infection
  • Prostatitis - Pain on ejaculation
  • Ejaculatory tract obstruction - Pain on ejaculation
  • Recent urological procedure
  • Prolonged sexual intercourse or ejaculation
  • Prolonged abstinence
  • Tuberculosis
  • Schistosomiasis
  • Anticoagulants
  • Bleeding disorder
51
Q

Which antibiotic has reduced efficacy if combined with Ural?

A

Nitrofurantoin

52
Q

Which antibiotic class has increased risk of crystalluria when combined with Ural?

A

Quinolones e.g. ciprofloxacin

53
Q

Define chronic bacterial prostatitis

A
  • Recurrent UTI with culture of a recognised uropathogen or sexually transmitted organism from urine or prostatic fluid
  • History of intermittent symptomatic episodes that resemble acute bacterial prostatitis, except fever is usually absent
  • Diagnosis is confirmed by comparing leukocyte count and the results of culture of pre with post prostatic massage urine samples
54
Q

Management of chronic bacterial prostatitis?

A

First line:
* Ciprofloxacin 500mg 12 hourly PO for 4 weeks

Second line:
* Norfloxacin 400 mg 12 hourly PO for 4 weeks
* Trimethoprim 300 mg daily PO for 4 weeks

55
Q

What conditions are associated with chronic nonbacterial prostatitis/Chronic pelvic pain syndrome?

A
  • Irritable bowel syndrome
  • Chronic fatigue syndrome
  • Fibromyalgia
56
Q

What are some symptoms of prostatitis?

A
  • Dysuria
  • Urinary urgency
  • Urinary frequency
  • Painful ejaculation
  • Lower back pain
  • Perineal pain
  • Chills and/or fever
  • Muscular pain
  • Lethargy
57
Q

What is klinefelter syndrome?

A
  • A clinical syndrome in males caused by the presence of two or more X chromosomes
  • It is characterised by impaired testosterone production and spermata genesis
  • The only consistent feature is small testes volume (<4mL)
58
Q

Clinical features of Klinefelter syndrome?

A
  • Taller than average height
  • Reduced facial hair
  • Reduced body hair
  • Breast development (gynecomastia)
  • Feminine fat distribution
  • Osteoporosis
  • Small testes (testicular atrophy)
  • Varicose veins
59
Q

Approach to evaluation of benign prostatic hyperplasia?

A

Symptoms
* Voiding (bladder emptying) symptoms eg weak stream, hesitancy and intermittency of flow
* Storage (bladder filling) symptoms eg urgency, daytime frequency and nocturia

Complicating factors
* Urinary retention
* Microscopic haematuria
* Urinary tract infection
* Personal or family history of prostate cancer

Initial investigations
* Urinalysis - Exclude leukocytosis, haematuria, proteinuria, pyuria and glycosuria
* eGFR - Exclude renal injury from primary renal dysfunction or high-pressure bladder outflow obstruction
* Urinary tract ultrasound - Assessment of prostate volume, bladder wall and residual urine; years to exclude hydronephrosis
* Prostate specific antigen - exclude prostate cancer

60
Q

Management of benign prostatic hyperplasia?

A

Nonpharmacological
* Behaviour modifications eg reducing diuretics (caffeine, alcohol), bladder irritants (acidic, spicy foods), evening fluid intake and constipation
* Bladder training and pelvic floor exercises
* Yearly GP review of symptoms with urinanalysis and eGFR to monitor for progression

Medical therapy
* Alpha-1-adrenoceptor blockade results in smooth muscle relaxation in the prostate and bladder neck
* Uroselective agents eg tamsulosin

61
Q

Risk factors for urinary tract malignancy in patients with haematuria?

A
  • Age
  • History of gross haemateria
  • Irritative lower urinary tract symptoms
  • Smoking (current or past history)
  • Occupational exposure (Dyes, benzenes, aromatic amines)
  • Cyclophosphamide exposure
  • History of chronic urinary tract infection
  • History of pelvic irradiation
62
Q

Clinical presentation of acute bacterial prostatitis?

A
  • Urinary tract infection symptoms eg acute dysuria, urinary frequency, urinary urgency
  • Systemic features eg fever, chills, sweats
  • Obstructive urinary symptoms eg Weak stream, dribbling, hesitancy or urinary retention
  • Symptoms suggestive of prostatic involvement eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination
63
Q

What organisms may cause acute bacterial prostatitis?

A
  • Urinary pathogens eg e coli, proteus species, klebsiella
  • Sexually transmitted pathogens eg chlamydia trachomatis, neisseria gonorrhoea
64
Q

First line management for acute bacterial prostatitis?

A

Trimethoprim 300 mg daily PO for two weeks

65
Q

Management of uncomplicated genital and anorectal gonorrhoea infection?

A

Ceftriaxone 500mg IM stat, in 2mL 1% lignocaine PLUS azithromycin 1g PO stat

66
Q

What instructions would you give to a patient with gonorrhoea?

A
  • Advise no sexual contact for seven days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later
  • Advise no sex with partners from the last two months until the partners have been tested and treated if necessary
  • Recommend partner notification
  • Provide patient with a fact sheet
67
Q

Clinical features and causes of urethritis?

A

Features:
* Urethral irritation
* Dysuria
* Discharge

Causes:
* Most common bacterial causes: Chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium
* Other pathogens: adenoviruses, herpes simplex virus, Trichomonas vaginalis
* In 50% or more of cases, no pathogen is identified

Note: ureaplasma urealyticum, ureaplasma parvum and mycoplasma hominis are part of the normal genital flora

68
Q

What is the treatment for chlamydia trachomatis conjunctivitis?

A

Azithromycin 1g PO stat, as a single dose

69
Q

Why is gonococcal conjunctivitis an ophthalmic emergency?

A
  • Usually presents with acute onset of copious,. And discharge
  • Gonococcal conjunctivitis can cause ulceration and perforation of the cornea
70
Q

Treatment of gonococcal conjunctivitis?

A

Ceftriaxone 1g IM or IV, as a single dose

71
Q

Which demographic groups are at a higher risk of having a sexually transmitted infection?

A

People who:
* Had sex overseas
* Had been sleeping rough or homeless
* Worked as a street based sex worker
* Had tattoos, especially overseas
* Injected drugs or use methamphetamine, especially if they shared needles or any other equipment used for injecting
* Had been in prison
* Have been a refugee or recent migrant
* Identify as Aboriginal or Torres Strait Islander
* Experienced violence from a partner
* Had been on PrEP
* Had been sexually assaulted or had sex they didn’t want to have

72
Q

Management of uncomplicated genital or pharyngeal chlamydial infection?

A
  • First line: Doxycycline 100mg BD PO for seven days
  • Second line: azithromycin 1g PO, stat
73
Q

What advice would you give for a patient diagnosed with chlamydia?

A
  • Advise no sexual contact for seven days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later
  • Advised no sex with partners from the last 6 months until the partners have been tested and treated if necessary
  • Contact tracing makes line provide patient with factsheet
  • Consider presumptive treatment if there has been such a contact within the past two weeks or in the person’s individual circumstances mean later treatment may not occur
74
Q

What do you advise a patient if they have missed their combined oral contraceptive pill - Less than 24 hours late (not more than 48 hours since you took your last pill?

A
  • Take it as soon as you remember
  • Then take the next one at the usual time - you may end up taking 2 pills on the same day
  • You will still be protected against pregnancy
75
Q

What do you advise a patient if they have missed their combined oral contraceptive pill - More than 24 hours late (more than 48 hours since you took your last pill)?

A
  • Take it as soon as you remember
  • Then take the next one at the usual time - you may end up taking 2 pills on the same day
  • Keep on taking the pills as usual and use another form of contraception (such as condoms) or don’t have sex for the next seven days
  • If there are less than 7 hormone pills left in your pack and missed one or more pills: Continue to take the remaining home and pills and don’t have the break or take the non hormone pills —-> go straight on the hormone pills in the next pack
76
Q

While having the combined oral contraceptive pill as contraception, when should emergency contraception be considered?

A

Consider using the emergency contraceptive pill if you:
* Miss more than one pill in the first seven days of a new pack of pills and have had unprotected sex in the previous five days
* Start a new pack more than 24 hours late and have had unprotected sex in the previous five days
* Have unprotected sex in the seven days after missing more than one pill

77
Q

Management of mild initial episode of oral mucocutaneous herpes in an immunocompetent patient?

A
  • Benzydamine 1% gel Q2-3hourly TOP on lesions
  • Children should be excluded from daycare
  • Barrier cream (e.g. petroleum jelly) applied to the lips can help prevent adhesions
78
Q

Management of mild recurrences of oral mucocutaneous herpes in an immunocompetent patient?

A

Aciclovir 5% cream 5 times per day, TOP only on lesions on the skin around the mouth for 5 days

79
Q

Management of infrequent but severe occurrences of oral mucocutaneous herpes (e.g. difficulty eating or swallowing) in an immunocompetent patient?

A
  • Famiciclovir 1500mg PO, as a single dose OR
  • Valaciclovir 2g Q12hourly PO for 1 day
80
Q

Management of frequent and severe occurrences of oral mucocutaneous herpes (e.g. difficulty eating or swallowing) in an immunocompetent patient?

A
  • Famiciclovir 250mg BD PO for 6 months then review OR
  • Valaciclovir 500mg daily PO for 6 months then review
81
Q
A

GP Academy (23 decks)

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