28/11/21 Flashcards
When PEP is indicated, how long after exposure can PEP be prescribed and started?
When PEP is recommended → should be prescribed and started as soon as possible after exposure and within 72 hours. After 72 hours, it should generally NOT be prescribed.
Management points for Gonorrhoea (7 points)
- ABx Therapy - as below
- No sexual contact for 7 days after treatment is administered
- No sex with partners for the last 2 months until partners have been tested and treated as necessary
- Contact Tracing - 2 months
- IUD can stay in place
- Review in 1 week - assess symptoms,
- Test of Cure → at 2 weeks with PCR swab (pharyngeal, anal or cervical NOT urethral)
- Retest in 3 months after exposure
Specific ABX therapy for Gonorrhoea. Genital or Anorectal vs Pharyngeal.
- Anorectal and Genital
- Ceftriaxone 500mg in 2ml of 1% lidocaine IM or 500mg IV Stat
- PLUS Azithromycin 1g PO Stat
- Pharyngeal
- Ceftriaxone 500mg in 2ml of 1% lidocaine IM or 500mg IV Stat
- PLUS Azithromycin 2g PO with food Stat
Symptoms in a male with gonorrhoea
- Urethral Discharge
- Dysuria
- Ano-Rectal Symptoms: Pain on defecation, irritation, Discharge, Disturbed bowel function
- Conjunctivitis: purulent, sight threatening
Symptoms in a female with gonorrhoea
- Vaginal Discharge
- Dypareunia with cervicitis
- Ano-Rectal Symptoms: Pain on defecation, irritation, Discharge, Disturbed bowel function
- Conjunctivitis: purulent, sight threatening
Testing for males with gonorrhoea. MSM for males.
- FPU for NAAT → collect even if asymptomatic (no discharge)
- in MSM → collect pharyngeal and anorectal swabs as well
- Urethral Swab for Culture → if discharge or other local symptoms present
Discharge medications following AMI? principles.
Anti-platelet Therapy
Statin
Beta-Blocker
ACEi
Discharge medications following AMI specific dosing + duration: Anti-platelet therapy.
- Aspirin 100-150mg/day - continue indefinitely
2. Clopidogrel - for 12 months
Discharge medications following AMI specific dosing + duration: Statin
- Statin, highest tolerated dose - continue indefinitely
- atorvastatin 40-80mg PO daily
Discharge medications following AMI specific dosing + duration: beta-blocker. options aplenty.
Beta-Blocker (vasodilatory) in patients with reduced LV systolic function (LV ≤ 40%)
- for stable patients → atenolol 25-100mg PO daily or metoprolol tartate 25-100mg PO BD
- if stable with preserved LV function → consider ceasing beta-blocker at 12 months
Heart Failure
- bisoprolol 1.25mg PO daily → increasing to max 10mg daily
- nebivolol 1.25mg PO daily → increasing to max 10mg daily
- carvedilol <85kg: 3.125mg PO BD → max of 25mg BD, >85kg: 3.125mg PO BD → max of 50mg PO BD
- metoprolol succinate MR 23.75mg PO daily → increasing to 190mg PO Daily
Discharge medications following AMI specific dosing + duration: ACEi
perindopril arginine 2.5mg PO daily → increasing to 10mg daily
Continue ACEi long-term
Management of SCC. (3 points)
- Treatment is Surgical Excision with 3-5mm margin
- Radiotherapy can be used when surgery is likely to produce severe scarring or unsuitable (for an elderly or infirm patient)
- Review patients with a primary SCC every 6 months for at least 2 years after excision → look for signs of secondary tumours at each visit
Management of Keratoacanthoma 2 points
- Surgical Excision → 3-5mm margin
- difficult to distinguish between a keratoacanthoma and an SCC on clinical diagnosis or partial biopsies
For Low Severity CAP, if no improvement after 48/24 -> what is the next step for ABx?
- amoxicillin 1g PO TDS
- AND doxycycline 100mg PO BD
Red Flags for admission for hosptial for CAP (7 points)
- Tachypnoea → RR >22 resp/minute
- Heart Rate → HR >100bpm
- Hypotension → systolic BP <90mmHg
- Acute Onset Confusion
- O2<92% on RA
- Multilobar Involvement on CXR
- Blood Lactate Concentration >2mmol/L
Definition of small parapneumonic effusion and management.
Incidental Small Effusion - <10mm depth on CXR
NIl change to management
Definition of large parapneumonic effusion and management.
Clinically significant effusion
- > 10mm depth on lateral decubitus X-ray
- > 30mm on CT
- dyspnoea attributable to effusion
Pleural Fluid Sampling and Drainage
IV ABx in Hospital
Definition of empyema and management
Collection of Pus in the pleural space associated with active infection
Pleural Fluid Sampling and Drainage
Admit to Hospital for IV ABx
Diagnosis of Post-streptococcal Glomerulonephritis
Discoloured Urine (Haematuria) + Peri-orbital Oedema + Oliguria ⇒ Post-Streptococcal Glomerulonephritis
Clinical Features of Post-Streptococcal Glomerulonephritis (4 points)
Can vary from asymptomatic microscopic haematuria to full-blown acute nephritic syndrome (gross haematuria, proteinuria, oedema, HTN, AKI)
- Rapid weight gain secondary to oedema
- Peri-orbital oedema - legs and scrotum as well
Management of post-streptococcal glomerulonephritis (4 points)
- Hospital Admission
- Bed Rest
- Strict Fluid Balance + Fluid Restriction
- Daily Weighing
- ABx for those with Streptcoccal infection at time of diagnosis
Diagnostic criteria of acute mesenteric ischaemia
Diagnostic Triad → anxiety and prostration + intense central pain + profuse vomiting +/- bloody diarrhoea → mesenteric arterial occlusion
Clinical Features of Chronic Mesenteric Ischaemia (2 points)
- Dull, Cramp, Post-Prandial Epigastric Pain (usually within 1 hour of eating)
- Pain worse after larger meals with high fat content
- Pain settles after the course of the next 2 hours
- Symptoms can worsen and can lead to acute mesenteric ischaemia from thrombus formation
Management of Symptomatic Chronic Mesenteric Ischaemia (1 point)
- Indication for revascularisation is the presence of symptoms including abdominal pain and weight loss
Risk Factors for Actinic Keratoses (4 points)
- Signs of photoageing skin
- Fair skin with history of sunburn
- History of long hours spent outdoors for work or recreation
- Defective immune system
First Line Management of Actinic Keratoses
First Line - Cryotherapy
- avoid prolonged cryotherapy on the lower legs due to poor healing at this site
- apply for approx 5 seconds
- warn patients of the risk of hyper/hypopigmentation (especially those with dark skin)
If no benefit from cryotherapy and no indication for excisional biopsy, what is the next step of treatment?
- *Topical Field Treatments**
- Consider in patients with multiple solar keratoses or those who cannot tolerate repeated cryotherapy
- These treatments cause severe inflammation that can last up to several weeks
1. Fluorouracil 5% cream topically, once or twice daily for 2-4 weeks on the face or 3-6 weeks on the arms and legs
- Imiquimod 5% cream topically, at night 3 times weekly for 3-4 weeks. In the morning, wash the treated area with mild soap and water. Review patient at 4 weeks - if lesions persist, repeat treatment once.
Symptoms of Cystitis. Symptoms of pyelonephritis. Difference?
- UTI/Cystitis → dysuria, frequency, urgency and lower abdominal discomfort
- Infants and Pre-Verbal Children often present with non-specific sypmtoms → fever, vomiting, poor feeding, lethargy and irritability.
- Pyelonephritis → systemic features such as fever, malaise, vomiting and loin tenderness
- Non-Severe Pyelonephritis → no systemic features → tachycardia, nausea or vomiting or sepsis/septic shock
Treatment for Acute Cystitis (be specific)
- trimethoprim + sulfamethoxaole 4+20mg/kg up to 160+800mg orally BD for 3/7.
- trimethoprim 4mg/kg up to 150mg orally, 12 hourly for 3/7.
- Cefalexin 12.5mg/kg up to 500mg PO Q6H for 3/7.
Difference between a pterygium and a pinguecula
pterygium can involved the cornea.
Pnguecula - yellowish, slightly raised conjunctival lesion arising at the limbal conjunctiva. Confined to the conjunctiva without corneal involvement, there is usually a space between the pinguecula and the edge of the cornea
