20/10/21

Question 1

1 History Questions, 1 Action and 3 Investigations can be used in diagnosis of Work-Related Asthma.

Answer 1

• Screen as to whether asthma symptoms improve when worker is away from work
• Serial Peak Expiratory Flow Measurements
• Skin Prick Tests
• Bronchial Provocation (Challenge) Testing
• Worksite Visits

Question 2

What are petichiae and purpura? What is their significance in assessing a child?

Answer 2

Definition: rash that does not blanch when pressure is applied.

Key Points

• majority of children with petechiae and purpura DO NOT have a severe bacterial illness or meningococcal illness.
• HOWEVER seriously unwell with petechiae/purpura require URGENT MANAGEMENT
  
  • serious bacterial disease such as meningococcal can present with a non-blanching rash, with or without a fever

Question 3

Examination of an unwell child. (5 points)

Answer 3

• Abnormal Vital Signs: Tachycardia, Tachypnoea and/or desaturation
• Cold Shock: narrow pulse pressure, cold extremities, prolonged capillary refill
• Warm Shock: wide pulse pressure, bounding pulses, flushed skin and rapid capillary refill
• Altered Conscious State: irritability, lethargy
• Limb Tenderness or Difficulty mobilising

Question 4

Who is at increased risk of diabetes? What do we need to do for these people as per Red Book?

Answer 4

Increased Risk → AUSDRISK every 3 years

• ≥ 40yo
• ATSI from ≥ 18yo

Question 5

Who is at high risk of diabetes? Who do we need to consider as increased risk at an earlier age or lower BMI? What do we need to do for these people?

Answer 5

High Risk → Fasting Blood Glucose or HbA1c every 3 years

• ≥ 40yo + Overweight or Obese
• AUSDRISK ≥12
• Those with impaired glucose tolerance test or impaired fasting glucose

Consider screening in these groups as they are at increased risk of diabetes at an earlier age or a a lower BMI

- First Degree Relative with Diabetes
- High-Risk Race/Ethnicity → Indian Subcontinent or Pacific Islanders
- History of CV event
- Women with Gestational Diabetes
- Women with PCOS
- Patients on antipsychotic drugs

Question 6

Typical Symptoms of Heart Failure (4 points)

Answer 6

• Dyspnoea
• Orthopnoea
• Paroxysmal Nocturnal Dyspnoea
• Fatigue

Question 7

Specific Signs of Heart Failure (4 points)

Answer 7

• Elevated JVP
• Laterally Displaced Apex Beat
• Hepatojugular Reflex
• Third Heart Sound

Question 8

Other Symptoms of Heart Failure (name 4, there are 10)

Answer 8

• Nocturnal Cough
• Wheeze
• Abdominal Bloating
• Anorexia
• Confusion (elderly)
• Depression
• Palpitations
• Dizziness
• Syncope
• Bendopnoea (SOB on bending forward)

Question 9

Other Signs of Heart Failure (name 4, there are 10)

Answer 9

• Weight Gain (>2kg/week)
• Weight Loss
• Peripheral Oedema (ankle, sacrum)
• Pulmonary Crackles
• Pleural Effusions
• Cardiac Murmur
• Tachycardia
• Tachypnoea
• Cheyne-Stokes Respiration
• Ascites

Question 10

Causes of Chest Wall Pain (10 options, give 4)

Answer 10

Isolated MSK Chest Wall Pain

1. Costochondritis
2. Lower Rib Pain Syndrome
3. Sternalis Syndrome
4. Thoracolumbar Costovertebral Joint Dysfunction

Rheumatic Causes

• Psoriatic Arthritis
• Fibromyalgia
• Rheumatoid Arthritis
• Axial Spondyloarthropathy

Non Rheumatic Causes

• Osteoporotic Fracture
• Neoplasm with Pathological Fracture or Bone Pain

Question 11

Treatment of Isolated MSK Chest Wall Pain

Answer 11

1. Reassurance
2. Stop aggravating activity
3. Stretching
4. Heat for Spasm, Ice for Swelling
5. Simple Analgesia
6. Physiotherapy
7. Corticsteroid Injection