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Practice Exams > 17/11/21 > Flashcards

17/11/21 Flashcards

1
Q

Oral anitbiotic choices for treatment of acne.

A
  1. Doxycycline 50-100mg orally, once daily for 6 weeks, then review
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2
Q

ECG Changes in pericarditis (1 main point + 2 bonus)

A
  • Widespread CONCAVE ST Elevation and PR depression throughout most of the limb-leads (I,II, aVL, aVF) and precordial leads (V2-6)
  • Reciprocal ST depression and PR elevation in lead aVR
  • Sinus tachycardia due to pain and/or pericardial effusion
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3
Q

Clinical Features associated with cardiac tamponade (3 main)

A
  • Beck’s Triad → muffled heart sounds, elevated JVP, hypotension
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4
Q

Non-Pharmacological Options for management of insomnia.

A
  1. CBT including sleep hygeine/education
  2. Brief behavioural therapy
  3. Exercises
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5
Q

Specific Sleep Hygeine advice (5 points)

A

Sleep-Wake Activity Regulation

  • Avoid lying in bed for extended periods of time worrying about sleeping → if cannot sleep for 20mins then get up, do something relaxing and return to bed when sleepy
  • Avoid oversleeping + napping during the day
  • Regularity of schedule → get up at the same time each day

Sleep Setting and Influences

  • Regular Exercise but not vigourous within 3 hours of bedtime
  • Do not have electronic devices in the bedroom + avoid exposure to bright light from late evening onwards
  • Avoid stressful ruminations before or at bedtime → plan for this earlier in the day.
  • Avoid caffeine after midday
  • Reduce/Avoid Alcohol Intake + Tobacco Intake + Illicit Drugs

Sleep-promoting Adjuvants

  • light snack or warm drink before bed
  • warm bath or shower before bed
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6
Q

Difference between gestational hypertension and pre-eclampsia?

A

Both are diagnosed after 20/40.

Gestational hypertension does not ahve all the liver, renal, thrombocytopenia, urine acr, neuro and pulmonary changes or preeclampsia.

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7
Q

What is chronic (preexisting) hypertension in pregnancy?

A
  • Hypertension diagnosed or present before pregnancy or before 20/40 gestation
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8
Q

1st line and 2nd line medications for treatment hypertension in pregnancy? (be specific)

A
  1. First Line → Methyldopa or Labetalol
    1. Methydopa 250-750mg TDS
    2. Labetalol 100-400mg TDS
  2. Second Line → Nifedipine, Hydralazine or Prasozin
    1. Nifedipine Sustained Release 20-40mg daily
    2. Hydralazine 25-50mg TDS
    3. Prazosin 0.5-5mg TDS
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9
Q

Which anti-hypertensive can you not use in pregnancy?

A
  • ACE inhibitors are contraindicated in pregnancy → use as been associated with fetal death and neonatal renal failure
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10
Q

Diagnosis of chronic bacterial prostatitis

A

Diagnosis → comparing leucocyte count and the results of the pre- with post-prostatic massage urine samples - 2 glass test

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11
Q

Treatment of Chronic Bacterial Prostatitis?

A
  1. ciprofloxacin 500mg PO, BD for 4 weeks

2. OR Norfloxacin 400mg PO for 4 weeks

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12
Q

If no evidence of bacterial prostiatitis and still having prostatic symptoms, what is our diagnosis?

A

If no evidence of bacterial prostatitis → chronic (nonbacterial) prostatitis or chronic pelvic pain syndrome → no need for ABx and treatment is symptomatic

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13
Q

Diagnostic Criteria of Kawasaki Disease (5 points)

A
  1. Bilateral non-exudative conjunctivitis
  2. Polymorphous rash
  3. Cervical lymphadenopathy (at least 1 lymph node >1.5cm in diameter)
  4. Mucositis → cracked lips, injected pharynx, strawberry tongue
  5. Extremity Changes - erythema of palm/soles, oedema of hands/feet (acute phase), and periungal desquamation (convalescent phase)
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14
Q

Causes of Nappy Rash (5)

A 
**Common**
Irritant Dermatitis
Candidiasis
Seborrhoiec Dermatitis
Psoriasis
Milaria
Atopic Dermatitis
**Uncommon**
Staphylococcal Infection
Strep Vulvovaginitis
Perineal Dermatitis
Herpes Simplex
Allergic Contact Dermatitis
**Rare**
Kawasaki Disease
Tinea
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15
Q

Treatment of Kawasaki Disease

A
  • Intravenous Immunoglobulin (IVIg) 2g/kg intravenously, as a single slow infusion over 10 to 12 hours
  • methyprednisolone sodium succinate 30mg/kg up to 1000mg intravenously, over 1 hour, daily for up to 3 consecutive days
  • aspirin 3 to 5mg/kg PO daily
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16
Q

Vaccinations due at 12 months.

A

MNP

  • MMR2
  • Nimenrix
  • Prevenar13
17
Q

Causes of Nipple Pain in Breastfeeding (5)

A
  1. Poor Fit and Hold
  2. Breast Pump Trauma and Misuse
  3. Nipple Candidiasis
  4. Mastitis
  5. Tongue-Tie
  6. Nipple Vasospasm
  7. Nipple Eczema
  8. Nipple Bacterial Infection
18
Q

General Management Advice for Sore Nipples

A
  1. Try to use “chest to chest, chin on breast” feeing position
  2. Vary feeding positions
  3. Start feeding from less painful side first if one nipple is sore
  4. Express some milk first to soften and “lubricate” the nipple
  5. Gently break the suction with your finger before removing the baby from the breast
  6. Ice to sore nipple
  7. Keep nipples dry by exposing breasts to air
  8. Soothing hydrogel pads inside the bra
19
Q

Other points of advice to mother with cracking nipples

A
  • Do not feed from the affected breast - rest the nipple for 1-2 feeds
  • Express the milk from that breast by hand → feed that expressed milk to the baby
  • Start feeding gradually with short feeds
  • Refer to Lactation Consultant → consider nipple shield but only after seeking face to face expert advice
  • Paracetamol or Ibuprofen prior to feeding
20
Q

Causes of Thrombocytopenia

A
  1. Pregnancy → Gestational Thrombocytopenia (10% of pregnancy) is mild and becomes less common as the pregnancy progresses
  2. Medications (antibiotics)
  3. Chronic Liver Disease
  4. Autoimmune Disease → Systemic Lupus Erythematosus
  5. Haematological Malignancy
  6. Infection → Viral, Bacterial or Intracellular Parasites (Malaria)
  7. Alcohol
  8. Nutrient Deficiencies → Folate, B12 or Copper
  9. Artefactual Thrombocytopenia → in the absence of clinical features including petechiae and ecchymoses
21
Q

Examination Findings in Thrombocytopenia

A
  • *Examination Findings**
  • Bleeding of the Oropharynx
  • Haematuria
  • Petechiae
  • Menorrhagia
  • Neurological Findings → confusion, gross motor or sensory deficits

Examination Findings to determine cause:

  • Splenomegaly + Lymphadenopathy → Lymphoma with ITP
  • Sepsis or Thombosis → Disseminated Intravascular Coagulopathy
  • Portal Hypertension or other examination findings of Liver Disease
22
Q

Management of ITP: Advice.

A
  • Restrict activities to minimise risk of head injuries
    • Avoid contact sports → footy, rugby, soccer, martial arts
    • Limit activities that have a risk of traumatic injury
  • Avoid aspirin/NSAIDs/IM injections
  • Decrease alcohol intake → >8 std drinks per day can lead to haematological defecits
  • Monitor for significant bleeding symptoms
  • Monitor for signs of intracranial haemorrhage - severe headache
23
Q

History Findings for Acute Angle Glaucoma

A
  1. Halo around lights
  2. Red Eye
  3. Nausea and Vomiting
  4. Painful Eye
  5. Decreased Vision
24
Q

Examination Findings for Acute Angle Glaucoma

A
  • Reduced visual acuity
  • Conjunctival redness
  • Corneal edema or cloudiness
  • A shallow anterior chamber
  • a mid-dilated pupil (4-6mm) that reacts poorly to light or is fixed
25
Q

GP Management of Acute Angle Glaucoma (5 points)

A
  1. Emergency Ophthalmology Consult - transfer to hospital via ambulance
  2. Place the patient supine
  3. Analgesia PRN - morphine
  4. Antiemetic PRN - ondansetron/metoclopramide
  5. Nil by Mouth
    - NO eye patches → do not want to maintain the conditions that cause pupillary dilation as this will perpetuate the attack
26
Q

Causes of Burning Feet (5)

A
  1. Vascular - Ischaemic Rest Pain, Chillblains, Raynauds
  2. Diabetic Neuropathy
  3. Complex Regional Pain Syndrome
  4. Tarsal Tunnel Syndrome
  5. Psychogenic
  6. Morton’s Neuroma
27
Q

Clinical Features of Tarsal Tunnel Syndrome

A
  • Anterior burning pain in the forefoot with associated aching in the calf
28
Q

Non Pharmacological Management of Chillblains (4 points)

A
  • Avoiding cold, damp and wind
  • Wear loose warm clothes → trousers > short + gloves
  • Thick cotton socks and closed shoes (e.g boots)
  • Stop Smoking → especially if impaired circulation
  • Keep home and workplace well-insulated without draughts and heated in winter
  • Soaking hands in warm water can warm the hands up for several hours
  • Vigourous indoor exercise keeps the body warm
29
Q

Pharmacological Management of Chillblains

A
  1. Betamethasone Dipropionate 0.05% BD with or without occlusive dressing
  2. for prophylaxis in before or during winter months - nifedipine controlled release 20mg daily
30
Q

Non-Pharmacological Management of Osteoporosis? (6 points)

A
  1. Calcium 1300mg/day
  2. Vit D - if <50mmol/L for supplementation. Ensure 15mins of sunlight/day
  3. Exercise -> Resistance or Balance Exercises
  4. Smoking Cessation
  5. Reduce Alcohol below 1 std drink/day
  6. Falls Prevention Strategies -> removal of home hazards and appropriate well-fitting footwear
31
Q

Dosing of Aledronate and Pros and Cons.

A
  • Alendronate (Fosamax): 70mg Oral, Weekly
    • Advantages - oral dosing, low cost
    • Disadvantages - can cause or exacerbate GIT irritation, more frequent dosing, absorption reduced by food, antacids, calcium, magnesium and iron.
32
Q

Dosing of Risedronate and Pros and Cons

A
  • Risedronate (Actonel): 35mg Oral Weekly or Risedronate: 150mg PO Monthly
    • Advantages - oral dosing, low cost, enteric coated formula available for weekly dose (lower incidence of GIT side effects)
    • Disadvantages - can cause or exacerbate GIT irritation, more frequent dosing, absorption reduced by food, antacids, calcium, magnesium and iron.
33
Q

Dosing of Denosumab and Pros and Cons

A
  • Denosumab (Prolia): 60mg SC, 6 monthly
    • Advantages: SC administration avoids GIT side effects, dose adjustment not required in kidney disease, 6 monthly dosing can improve compliance
    • Disadvantages:
      1. adherence to 6 montly dosing regimen is essential to prevent loss of bone mineral density between doses,
      2. therapy must be indefinite, or replaced by bisphosphonate
      3. if stopped, withdrawal or interruption of treatment (dose delayed by >4 weeks) is associated with increased risk of multiple, spontaneous vertebral fractures**
      4. can also cause hypocalcaemia - needs to be replete of Ca2+ -> Ca2+ → 2.10-2.60
      5. Before administering Vit D >50
      6. Needs renal function tested prior to commencement -> Creatinine Clearance >30
34
Q

Dosing of Zoledronic Acid and Pros and Cons

A
  • Zoledronic Acid (Aclasta): 5mg IV, yearly for 3 years
    • Advantages: IV dosing avoids GIT side effects, 3 yearly dosing can improve adherance
    • Disadvantages: can cause transient flu-like symptoms, can cause hypocalcaemia

Practice Exams (45 decks)

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