26/11/21

Question 1

Management points in Acute Lower Back Pain with NO RED FLAGS

Answer 1

• Reassure that pain will be self-limiting and settle quickly within 4-6 weeks
• Will improve rapidly with limited intervention → remain as active as possible and avoid bed rest, continue to work with modification as needed
• Simple Analgesia if required
• Can engage with physiotherapy for manual therapy or exercise interventions if needed + Exercise Therapy
• If Severe Pain + Muscle Spasm → heat and massage can provide short term pain relief
• Nil indication for imaging

Question 2

Percentage of couple that conceive within 6 months? Average time to conception?

Answer 2

• 20% chance of conceiving per cycle → 80% of couples will conceive within the first 6 months, 85% will conceive within the first 12 months.
  
  • On average 6-12months to conceive

Question 3

When and at what frequency should the couple have intercourse?

Answer 3

• Fertile Interval is for approximately 6 days and includes the 5 days prior to and including the day of ovulation
  
  • Day of ovulation → is 14 days before the expected day of menses
  • Most fertile time is between days 7-14 of cycle in a 28 day cycle
• Intercourse every 2nd day is adequate → encourage to start after cessation of menses and ensure the intercourse falls in the above period.

Question 4

Patients clinically determined the be at high risk without using the calculator (7 points)

Answer 4

1. Diabetes + Age >60yo
2. Diabetes with microalbuminuria (urinary ACR >2.5mg in male and >3.5mg in female)
3. Moderate or Severe CKD → persistent proteinuria or eGFR <45)
4. Previous diagnosis of Familial Hypercholesterolaemia
5. Systolic Blood Pressure ≥ 180mmHg or Diastolic Blood Pressure ≥ 110 mmHg
6. Serum Total Cholesterol > 7.5mmol/L
7. Aboriginal or Torres Strait Islanders adults ≥ 74yo

Question 5

How long, duration-wise, can a woman use the DMPA injection?

Answer 5

NO Upper Limit of duration of use but women are advised to change at age 50yo

Question 6

Benefit of using DMPA injection? 2 points)

Answer 6

• Manage menstrual issues (e.g heavy menstrual bleeding) and can reduce pain associated with endometriosis
• Suitable for women to medical contraindication to oestrogen

Question 7

Disadvantage of using DMPA injection? 2 points

Answer 7

• Change in bleeding patterns - can lead to amennhorea or reduced bleeding
• Possible delay in fertility and normal cycle (can take up to 18months)

Question 8

How long can you have in between DMPA injections without worrying about increased risk of pregnancy?

Answer 8

• Up to 14 weeks since last DMPA injection → nil repercussions of UPSI + can go ahead with DMPA injection as well

Question 9

Considerations if >14 weeks of DMPA, and no UPSI? ?Give Injection ?other points

Answer 9

Give DMPA injection + 7 days of additional contraception following injection

Question 10

Considerations if >14 weeks DMPA and UPSI in last 5 days. (4 points)

Answer 10

Consider EC (not UPA EC which will theoretically be reduced in efficacy secondary to circulating progestogen) + Give DMPA injection + 7 days of additional contraception + Pregnancy test ≥ 3 weeks since last UPSI

Question 11

Considerations if >14 weeks DMPA and UPSI any time (5 points)

Answer 11

Consider EC (not UPA EC which will theoretically be reduced in efficacy secondary to circulating progestogen) + Give DMPA injection + 7 days of additional contraception Pregnancy test prior to administration of DMPA + Pregnancy test ≥3 weeks since last last UPSI

Question 12

Considerations if >14 weeks DMPA and UPSI >5 days (5 points)

Answer 12

No EC can be offered + Give DMPA injection + 7 days additional contraception + Pregnancy test prior to administration of DMPA + Pregnancy test ≥3 weeks since last last UPSI

Question 13

Considerations if >14 weeks DMPA and UPSI >3 weeks ago 93 points

Answer 13

If negative pregnancy test, can give DMPA injection + 7 days additional contraception + Pregnancy test prior to administration of DMPA

Question 14

Most Common cause of OSA in paediatrics.

Answer 14

most common cause is enlargement of the tonsils and adenoids

Question 15

History features of OSA in paediatrics? (5 points)

Answer 15

• Snoring or Noisy Breathing present ≥ 3 nights
• Difficulty breathing while asleep (including increased effort of breathing, choking, gasping or snorting during sleep)
• Frequent daytime mouth breathing
• Parents who reports being afraid for their child’s health because of the child’s breathing while asleep
• Witness obstructive apnoea during sleep