21/11/21 Flashcards
Causes of Genital Ulcer Disease (3)
Herpes Simplex Virus → most common cause
- Syphillis
- Chemical Burns or Contact Dermatitis from topical treatments
- Skin infections by Gram-Postive Bacteria
- Aphthous Ulcers
- Malingancy
- Autoimmune Conditions
- In MSM → consider lymphogranuloma venerum
General management principles of paediatric asthma (6 points)
- Try identify what triggers asthma symptoms → allergens
- Manage comorbid symptoms that affect asthma → allergic rhinitis
- Show parents and children (if old enough) when and how to take reliever medication
- Monitor regularly and adjust treatment accordingly to maintain good control of symptoms and prevent flare-ups, while minimising the dose of inhaled corticosteroids as well
- Written asthma action plan to be provided to parents
- Reduce tobacco smoke in the household
- Healthy eating, physical activity, healthy weight
- Immunisations - influenza
Risk factors for severe-life threatening exacerbation of asthma in children
- *Asthma Related Factors**
- Poor Asthma Control
- Admission to hospital in the last 12 months
- History of intubation for flare-up of asthma
- Overuse of SABA reliever
- Poor Adherence to asthma action plan
- Poor Adherence to preventer or Incorrect inhaler technique for preventer
- Exposure to Tobacco Smoke
- Exposure to clinically relevant allergens
- *Other Clinical Factors**
- Allergies to foods, insects or medicines
- Obesity
- *Family Related Factors**
- Failure to attend consultations or lack of follow-up after an acute flare-up
- Significant parental psychological or socioeconomic issues
- Parent/Carer unequipped to manage asthma emergency
Steps to management of asthma in a child aged >6yo.
Step 1: SABA as required
Step 2:
- ICS (low dose)
- Montelukast 5mg
Step 3:
- ICS (high dose)
- ICS + LABA
- ICS (low-dose) + Montelukast
Step 4: Refer to Specialist
Indications for preventer treatment in a child with asthma >6yo.
Frequency
- Frequent Intermittent → flare-ups once every 6 weeks and no symptoms between flareups
- Persistent → Symptoms between flare-ups
- Daytime symptoms >1 per week
- Nighttime symptoms >2 per month
- Symptoms restrict activity
- Symptoms restrict sleep
Severity
- Moderate to Severe Flare-Ups → >2 ED presentations or >2 episode requiring oral corticosteroids
- Life-threatening Flare-Ups requiring hospitalisation or PICU admission
Discussion points re: adverse effects of inhaled corticosteroid use in children. 4 points
- Local Adverse Effects → hoarseness and pharyngeal candidiasis are NOT commonly reported but can be reduced by the use of spacer devices and by mouth-rinsing and spitting after use
- Systemic Adverse Effects → dose-dependent but uncommon
- Growth → short term suppression of growth, effect is dose dependent, children most likely still achieve normal adult height or 1cm less
- Note that uncontrolled asthma itself reduces growth and final height
- ~~Bone Density~~ → NOT associated with decrease in bone density or fractures
- Adrenal Suppression → can occur even at low doses. Risk is high in children using concomitant intranasal steroids and children with lower BMI.
What is the only ICS + LABA combination that can be used in children >6yo? What age group does the TGA approve this drug for?
Use for children aged 5-12yo (only medicaiton approved by TGA)
Fluticasone propionate + salmetorol 50+25 microg, 2 actuations by inhalation via pMDI with spacer BD
Key Points in approach to youth-friendly preventative care consultation (3 points)
- Validate concerns
- Negotiate time alone with the young person if they attend with the parent/intimate partner/guardian
- Usually avoid asking personal/sensitive questions in front of parent/intimate partners/guardian
- Discuss confidentiality and its exceptions → risk of harm to oneself, harm to others
- Explain purpose of asking lifestyle questions → effect on health and wellbeing
- Ask permission before asking personal/sensitive questions + give permission to decline answering the lifestyle questions
Causes of Genital Ulcer Disease
- Herpes Simplex Virus
- Syphillis
- Aphthous Ulcers
- Contact Dermatitis or Chemical Burn from Topical Treatment
- Malignancy
- Autoimmune Disease
- Gram-Positive Bacterial Skin Infection
Antiviral Therapy for Genital Herpes
valaciclovir 500mg PO BD for 10 days → if clinical response is rapid, can cease treatment after 5 days
Do I wait for microbiological testing prior to commencing treatment? Why or Why Not?
- Take swab of lesion and immediately start treatment, DO NOT wait for microbiological test results to commence treatment
Other than anti-virals, what are other management points for management of genital herpes (6 points)
- Simple Analgesia and Anti-Pyretics
- Topical Lignocaine reduces pain from erosions
- Urinating in bath or shower → relieves superficial dysuria
- Encourage condom use with ongoing partners
- NOT notifiable condition
- NO NEED for contact tracing
- After 1 week - complete sexual health screening
Investigations for Post-Coital Bleeding (2)
- Endocervical Swab for STI including Chlamydia
- Co-Test (HPV + LBC)
Treatment points including pharmacological management of Genital Warts (3 points)
- Human Papillomavirus Infection is transmitted by genital-to-genital contact BUT the HPV types that cause genital warts, are not directly associated with cancer.
- Should screen those with genital warts for STI
- Latency of HPV is not known so it may not be possible to determine who the sexual contact was → contact tracing is not required
- Topical Preparations
- Imiquimod 5% cream topically, 3 times/week on alternate days at bedtime until warts resolve (usually for 8-16 weeks)
- Podophyllotoxin 0.5% pain topically, twice daily for 3 days followed by a 4 day break, repeat weekly for 4-6 cycles until warts resolve
- Cryotherapy → repeated at intervals of 1-2 weeks
BLS Steps
DRSABCD D - Dangers + Move bystanders away R - Responsive S - Send for Help A - Assess Airway (open airway) B - Assess Breathing C - Assess circulation (pulse) -> Start CPR 30:2 D - Attach defibrillator (AED)
