21/10/21 - 22/10/21 Flashcards
Typical demographic for pyloric stenosis. in whom do we need to consider pyloric stenosis as a DDx?
- need to consider pyloric stenosis as a differential diagnosis for all infants presenting with vomiting → particularly those under 3 months of age
- Should be suspected in infants 3-6 weeks with non-bilious vomiting after meals
History of pyloric stenosis (3 points)
- gradual onset of non-bilious vomiting after feeds → becoming more forceful and projectile in nature
- child is typically hungry and irritable and easily re-fed after a vomit
- failure to gain weight or even weight loss
Examination of pyloric stenosis (3 points)
- Dehydration
- Visible gastric peristalsis → may be seen after a feed, just before the baby vomits
- Pyloric Mass → felt below the liver edge just lateral to the edge of the right rectus abdomens muscle
5 investigations of pyloric stenosis. 4 bloods and 1 imaging
- Bloods → VBG, UEC, FBE, BGL
- VBG → hypokalaemic alkalosis, hypochloraemia
- Abdominal Ultrasound** → confirms diagnosis
Presentation of Acute Bacterial Prostatitis (2 main + 2 bonus)
- UTI Symptoms → dysuria, frequency and urgency
- Systemic Features → fever (>38), chills and sweats
- Obstructive Symptoms → urinary retention, dribbling, weak stream
- Prostate Symptoms → pelvic or perineal pressure, prostate tenderness on DRE
Investigations for Acute Bacterial Prostatitis (2 main + 1 bonus)
- Urine MCS
- If in hospital - consider blood cultures
- Imaging to determine if prostatic abscess has formed → U/S, CT or MRI
Treatment for Acute Bacterial Prostatitis (1 point)
- Trimethoprim 300mg PO for 2 weeks
Definition of Chronic Bacterial Prostatitis (1 point)
Defined as recurrent UTI with culture of a recognised uropathogen from urine or prostatic fluid
Treatment of Chronic Bacterial Prostatitis (1 point)
- ciprofloxacin 500mg PO, BD for 4 weeks
Clinical Features: History for OSA (4 points + 4 bonus)
- Habitual snoring during sleep
- Witnessed apnoeic episodes
- Falling asleep inappropriately during non-stimulating activities such as watching television, sitting reading, travelling in a car, when talking with someone
-
Feeling tired despite adequate time in bed
- Poor memory + concentration
- Morning Headaches
- Insomnia
- History of T2DM and difficult to control HTN → should increase suspicion of OSA
Clinical Features: Physical Examination for OSA (3 points)
- BMI >35
- Thick Neck
- Narrow Oedematous or Crowded Oropahrynx
Subjective Assessment of OSA - 2 quizzes
- STOP BANG
2. ESS
Drivers who are NOT fit to hold an unconditional license secondary to OSA. (4 points)
NOT fit to hold an unconditional license if:
- established OSA
- frequent self-reported episodes of sleepiness or drowsiness while driving
- has had crashes caused by inattention or sleepiness
- if treating doctor believes that driver is at significant risk to driving as a result of a sleep disorder
How often to patients with OSA need review? Who with?
Yearly
For private - with GP
For commercial - with sleep specialist
If there is a delay in seeing the sleep specialist, can a patient who may qualify for a conditional commercial license drive?
- If delay prior to seeing sleep specialist in assessment for a conditional commercial license (and do not meet criteria for an unconditional license), then the driver is permitted to drive pending assessment if:
- the person has an appointment to see the specialist at the earlier practicable opportunity
- in the opinion of the GP, the conditions which the driver has are not likely to lead to acute incapacity or loss of concentration. These conditions include ischaemic heart disease, OSA or blackouts other than vasovagal syncope.
Order of Stepping Up Therapy in managing asthma in child 1-5yo.
- SABA as required
- Preventer + SABA as required
- Preventer → Low Dose ICS OR Montelukast
- Stepped Up Preventer + SABA as required
- Preventer → High Dose ICS or Low Dose ICS + Montelukast
- Referral to Specialist for additional therapy
Indications for preventer treatment in children aged 1-5yo.
In children that have mild symptoms greater than every 3 months → preventer is not indicated.
In children that have mild symptoms every 4-6 weeks → preventer to be considered
In children with moderate or severe flare-ups + mild flare-ups weekly → preventer is indicated.
Points to consider when assessing asthma symptom control. (4 points)
- Frequency in Daytime Symptoms: ≤ 2 days per week → >2 days per week (lasting only a few minutes) → >2 days per week (lasting minutes to hours)
- Limitation of Activities: No limitation → Any Limitation
- Nocturnal Symptoms: No symptoms → Any Symptoms
- Need for SABA reliever: ≤2 days per week → >2 days per week
POints to consider when choosing between low dose ICS and montelukast as preventer. (2 points ICS, 3 points Montelukast)
- ICS → atopy or raised blood eosinophil count
- Montelukast → refuses pMDI + spacer/mask or comorbid allergic rhinitis or parental refusal of ICS
Dosing of Low and High Dose ICS (Name 1)
Beclometasone Dipropionate: 100-200 microg → >200microg (maximum 400microg)
Budesonide: 200-400microg → >400microg (maximum 800microg)
Ciclesonide: 80-160microg → >160microg (maximum 320microg)
Fluticasone: 50microg
Fluticasone Propionate: 100-200microg → >200microg (maximum 500microg)
Dosing of montelukast based on _____? (2 points)
Children 1-5yo → 4mg PO Daily
Children >6yo → 5mg PO Daily
Clinical Presentation of Bronchiectasis (3 points + 5 bonus)
- Chronic Productive Cough
- Recurrent Bronchial Illness
- Sputum is usually purulent and intermittently bloodstained
- fatigue, breathlessness, pleuritic chest pain, clubbing of the fingers, coarse crackles on examination
Investigations for Bronchiectasis (1 point)
- HRCT is gold standard
Imaging for all breast symptoms that are not consistent with hormonal change. (1 point)
U/S +/- Mammography
In women <35yo - discuss imaging for breast symptoms (4 points)
- U/S is first line
Use Mammography if:
- U/S does not match clinical findings
- U/S shows inconclusive, suspicious or malignant findings
- clinical findings are suspicious or malignant
In women >35yo - discuss imaging for breast symptoms (1 point)
U/S + Mammogram
In pregnant women - discuss imaging for breast symptoms (2 points)
- U/S is the most useful modality
- Mammography should be used if the clinical or U/S findings are indeterminate, suspicious or malignant or there is inconsistency between test results
Risk Factors for Oral Candidiasis (5 local, 2 systemic)
Local
- Dentures
- Poor Oral Hygeine
- Inhaled Corticosteroids
- Salivary Gland Dysfunction
- Smoking
Systemic
- Medication
- Immunocompromise
Treatment of Oral Candidiasis (1 point)
Miconazole 2% 2.5ml QID for 7-14 days, continue treatment for 7 days after symptoms resolve
Common presentation of Nasal Foreign Body (1 point)
Most common presenting complaint → unilateral malodourous rhinorrhoea
Non-invasive methods of removing foreign body?
- Non-Invasive Technique → “mother’s kiss” which is a positive pressure procedure
- puff of forced exhalation into child’s mouth while covering the non-affected nostril with a finger such that the glottis closes over and the air is forced through the nasal cavity along with the foreign body.
