17/11/21 Flashcards
Oral anitbiotic choices for treatment of acne.
- Doxycycline 50-100mg orally, once daily for 6 weeks, then review
ECG Changes in pericarditis (1 main point + 2 bonus)
- 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
Clinical Features associated with cardiac tamponade (3 main)
- Beck’s Triad → muffled heart sounds, elevated JVP, hypotension
Non-Pharmacological Options for management of insomnia.
- CBT including sleep hygeine/education
- Brief behavioural therapy
- Exercises
Specific Sleep Hygeine advice (5 points)
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
Difference between gestational hypertension and pre-eclampsia?
Both are diagnosed after 20/40.
Gestational hypertension does not ahve all the liver, renal, thrombocytopenia, urine acr, neuro and pulmonary changes or preeclampsia.
What is chronic (preexisting) hypertension in pregnancy?
- Hypertension diagnosed or present before pregnancy or before 20/40 gestation
1st line and 2nd line medications for treatment hypertension in pregnancy? (be specific)
- First Line → Methyldopa or Labetalol
- Methydopa 250-750mg TDS
- Labetalol 100-400mg TDS
- Second Line → Nifedipine, Hydralazine or Prasozin
- Nifedipine Sustained Release 20-40mg daily
- Hydralazine 25-50mg TDS
- Prazosin 0.5-5mg TDS
Which anti-hypertensive can you not use in pregnancy?
- ACE inhibitors are contraindicated in pregnancy → use as been associated with fetal death and neonatal renal failure
Diagnosis of chronic bacterial prostatitis
Diagnosis → comparing leucocyte count and the results of the pre- with post-prostatic massage urine samples - 2 glass test
Treatment of Chronic Bacterial Prostatitis?
- ciprofloxacin 500mg PO, BD for 4 weeks
2. OR Norfloxacin 400mg PO for 4 weeks
If no evidence of bacterial prostiatitis and still having prostatic symptoms, what is our diagnosis?
If no evidence of bacterial prostatitis → chronic (nonbacterial) prostatitis or chronic pelvic pain syndrome → no need for ABx and treatment is symptomatic
Diagnostic Criteria of Kawasaki Disease (5 points)
- Bilateral non-exudative conjunctivitis
- Polymorphous rash
- Cervical lymphadenopathy (at least 1 lymph node >1.5cm in diameter)
- Mucositis → cracked lips, injected pharynx, strawberry tongue
- Extremity Changes - erythema of palm/soles, oedema of hands/feet (acute phase), and periungal desquamation (convalescent phase)
Causes of Nappy Rash (5)
**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
Treatment of Kawasaki Disease
- 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
Vaccinations due at 12 months.
MNP
- MMR2
- Nimenrix
- Prevenar13
Causes of Nipple Pain in Breastfeeding (5)
- Poor Fit and Hold
- Breast Pump Trauma and Misuse
- Nipple Candidiasis
- Mastitis
- Tongue-Tie
- Nipple Vasospasm
- Nipple Eczema
- Nipple Bacterial Infection
General Management Advice for Sore Nipples
- Try to use “chest to chest, chin on breast” feeing position
- Vary feeding positions
- Start feeding from less painful side first if one nipple is sore
- Express some milk first to soften and “lubricate” the nipple
- Gently break the suction with your finger before removing the baby from the breast
- Ice to sore nipple
- Keep nipples dry by exposing breasts to air
- Soothing hydrogel pads inside the bra
Other points of advice to mother with cracking nipples
- 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
Causes of Thrombocytopenia
- Pregnancy → Gestational Thrombocytopenia (10% of pregnancy) is mild and becomes less common as the pregnancy progresses
- Medications (antibiotics)
- Chronic Liver Disease
- Autoimmune Disease → Systemic Lupus Erythematosus
- Haematological Malignancy
- Infection → Viral, Bacterial or Intracellular Parasites (Malaria)
- Alcohol
- Nutrient Deficiencies → Folate, B12 or Copper
- Artefactual Thrombocytopenia → in the absence of clinical features including petechiae and ecchymoses
Examination Findings in Thrombocytopenia
- *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
Management of ITP: Advice.
- 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
History Findings for Acute Angle Glaucoma
- Halo around lights
- Red Eye
- Nausea and Vomiting
- Painful Eye
- Decreased Vision
Examination Findings for Acute Angle Glaucoma
- 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
GP Management of Acute Angle Glaucoma (5 points)
- Emergency Ophthalmology Consult - transfer to hospital via ambulance
- Place the patient supine
- Analgesia PRN - morphine
- Antiemetic PRN - ondansetron/metoclopramide
- Nil by Mouth
- NO eye patches → do not want to maintain the conditions that cause pupillary dilation as this will perpetuate the attack
Causes of Burning Feet (5)
- Vascular - Ischaemic Rest Pain, Chillblains, Raynauds
- Diabetic Neuropathy
- Complex Regional Pain Syndrome
- Tarsal Tunnel Syndrome
- Psychogenic
- Morton’s Neuroma
Clinical Features of Tarsal Tunnel Syndrome
- Anterior burning pain in the forefoot with associated aching in the calf
Non Pharmacological Management of Chillblains (4 points)
- 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
Pharmacological Management of Chillblains
- Betamethasone Dipropionate 0.05% BD with or without occlusive dressing
- for prophylaxis in before or during winter months - nifedipine controlled release 20mg daily
Non-Pharmacological Management of Osteoporosis? (6 points)
- Calcium 1300mg/day
- Vit D - if <50mmol/L for supplementation. Ensure 15mins of sunlight/day
- Exercise -> Resistance or Balance Exercises
- Smoking Cessation
- Reduce Alcohol below 1 std drink/day
- Falls Prevention Strategies -> removal of home hazards and appropriate well-fitting footwear
Dosing of Aledronate and Pros and Cons.
-
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.
Dosing of Risedronate and Pros and Cons
-
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.
Dosing of Denosumab and Pros and Cons
-
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:
- adherence to 6 montly dosing regimen is essential to prevent loss of bone mineral density between doses,
- therapy must be indefinite, or replaced by bisphosphonate
- if stopped, withdrawal or interruption of treatment (dose delayed by >4 weeks) is associated with increased risk of multiple, spontaneous vertebral fractures**
- can also cause hypocalcaemia - needs to be replete of Ca2+ -> Ca2+ → 2.10-2.60
- Before administering Vit D >50
- Needs renal function tested prior to commencement -> Creatinine Clearance >30
Dosing of Zoledronic Acid and Pros and Cons
-
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
