19/10/21

Question 1

Risk Factors for Poor Dental Health (8 points, give me at least 3)

Answer 1

• Lower socioeconomic groups with difficulty accessing dental care
• Elderly including RACF residents
• ATSI population
• Rural and remote populations
• Migrant Groups
• Reduced saliva flow → head and neck radiation therapy, Sjögren’s Syndrome, Multiple Drug Therapy
• Smokers >50yo, heavy drinkers, patients chewing tobacco or betel nut
• Excessive sunlight → lip cancer

Question 2

Missed Pill Instructions: If >24hours since last pill and in day 1-7 of cycle.

Answer 2

• Take missed pill now
• Use condoms for 7 days of active pill
• If has sex in last 5 days → for emergency contraception

Question 3

Missed Pill Instructions: If >24hours since last pill and day 8-12 of cycle

Answer 3

• Take missed pill now

- Use condoms until had 7 days of active pills (7 day rule)

Question 4

Miss Pill Instructions: If >24hours since last pill and day 15-21 of cycle (within last 7 days of active pills)

Answer 4

• take missed pill now
• Use condoms until 7 day rule
• Skip sugar tablets and continue through to active pills

Question 5

Indications of Emergency Contraceptive Pill

Answer 5

• Miss more than 1 pill in first 7 days of new pack + have had unprotected sexual intercourse in the previous 5 days
• Start a new pack more than 24 hours late + have had unprotected sexual intercourse in the previous 5 days
• Unprotected sex in the 7 days after missing more than one pill.

Question 6

What are the two characteristics of Klinefelter Syndrome? What is the chromosomal abnormality?

Answer 6

Due to presence of extra X choromosome (47, XXY)
Most common cause of androgen deficiency

Characterised by:

• impaired testosterone production (androgen deficiency)
• impaired spermatogenesis (azoospermia)

Question 7

Clinical Features of Klinefelter Syndrome. (8 points)

Answer 7

1. Taller than average height
2. Reduced facial hair
3. Reduced body hair
4. Breast development - [Gynaecomastia]
5. Feminine Fat Distribution
6. Osteoporosis
7. Small Testes (testicular atrophy) → <4ml is the only consistent feature**
8. Varicose Veins

Question 8

Investigations (hormones) for Klinefelter Syndrome (4 points)

Answer 8

• 2 morning fasting samples of serum total testosterone
  
  • Total serum testosterone → low or low normal from mid-puberty
  • Serum LH → elevated from mid puberty
  • Serum FSH → elevated from mid puberty
• Karyotype → 47XXY, 10% mosaic 46 XY/47 XXY

Question 9

Other Investigations for Klinefelter Syndrome, non-hormonal or genetic testing. (4 points)

Answer 9

• Bone Density Study, DEXA → osteoporosis
• Semen Analysis if fertility is an issue → usually azoospermia
• TFT → hypothyroidism
• Fasting Blood Glucose → diabetes

Question 10

2 classifications of tremor. Categories within each one and basic explanation.

Answer 10

Resting Tremor - relaxed muscles

Action Tremor - with voluntary movement of muscle

Question 11

What is a postural tremor + example?

Answer 11

Postural Tremor → occurs when person maintains a position against gravity (e.g holding arms outstretched)

Question 12

What is a kinetic tremor + example?

Answer 12

Kinetic Tremor → associated with any voluntary movement. opening or closing eyes, moving wrists up and down.

Question 13

What is an intention tremor +example?

Answer 13

Intention Tremor → produced with purposeful movement toward a target (e.g lifting finger to touch the nose and typically the tremor will become worse as an individual gets closer to their target)

Question 14

What is task-specific tremor + example?

Answer 14

Task-Specific Tremor → only appears when performing highly skilled, goal-oriented tasks such as hand-writing or speaking

Question 15

What is a isometric tremor + example?

Answer 15

Isometric Tremor → occurs during voluntary muscle contraction not accompanied by any movement such as holding a heavy book or dumbbell in the same position

Question 16

What are the options for treatment of an essential tremor? (1 points + 1 bonus)

Answer 16

Propanolol and primidone suppress the essential tremor but primidone is less well tolerated (esp in elderly patients)

1. propanolol 10mg orally, twice daily. increase dose slowly over several weeks up to a maximum of 160mg daily in 2or 3 divided doses
2. primidone 62.5mg orally, at night. If needed, increase dose slowly over several weeks up to 250mg at night

In severe cases of essential tremor + if drug therapy is not effective → specialist can consider botulinum toxin injections or deep brain stimulation

Question 17

Characteristics of Essential Tremor? History points and Investigations.

Answer 17

Only sign of essential tremor → postural or kinetic tremor in the frequency of 4-12 Hz

When tremor is severe → some patients also have rest tremor and mild abnormalities of tone and gait

FHx of essential tremor and temporary benefit from drinking alcohol are common.

Need to exclude organic causes of tremor → drug induced or toxin induced tremor or systemic illness before starting treatment for essential tremor

Question 18

2 main body systems affected by Acute Lead Toxicity. Give examples of clinical features within these two body systems.

Answer 18

CNS Toxicity

• fatigue, weakness, headache
• encephalopathy (altered conscious state and seizures)
• cerebral oedema, coma

Gastrointestinal Effects

• abdominal pain, nausea, vomiting, constipation

Other Effects

• haemolytic anaemia, hepatitis

Question 19

3 main body systems affected by Chronic Lead Toxicity. Give examples of clinical features within these body systems.

Answer 19

CNS effects - poor concentration, headaches, impaired co-ordination, aggressive behaviour, irritability, intellectual impairment, muscle weakness especially of the extensor muscle groups of all extremities

Gastrointestinal effects - abdo pain, anorexia, constipation, weight loss

Kidney and Cardiovascular effects - HTN, hyperuricaemia, gout, nephropathy, kidney impairment

Question 20

How do you calculate the Risk of Malignancy Index in the context of ovarian cancer?

Answer 20

U/S Findings: (0 for 0, 1 for 1, 3 for 2-5 features)
- multilocular cyst
- solid area
- metastases
- ascites
- bilateral lesions
Menopausal Status:
1 - premenopausal
3 - postmenopausal
Ca125 - actual number
**U/S x Menopausal Status x Ca125**
- low <25, med 25-200, high >200

Question 21

Management of Sustained VT for an unstable patient? For a stable patient?

Answer 21

• sustained ventricular tachycardia can trigger cardiac arrest → arrange for urgent ambulance transportation to an emergency department
• For unstable patients → DC cardioversion
• For stable patients → amiodarone 300mg IV over 10-20mins followed by 900mg IV infusion over 24hours

Question 22

Criteria for Moderate Increased Risk of CRC (3 point)

Answer 22

Asymptomatic people with:
1. 1 first degree relative with CRC diagnosed <55yo
OR 2. 2 first degree relatives with CRC at any age
3. 1 first degree + 2 second degree relatives with CRC at any age

Question 23

Criteria for High Risk CRC (2 points)

Answer 23

Asymptomatic people with:
1. at least 3 first degree or second degree relatives with CRC with at least one diagnosed <55 years
or 2. at least 3 first degree relatives with CRC diagnosed at any age