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Practice Exams > 28/11/21 > Flashcards

28/11/21 Flashcards

1
Q

When PEP is indicated, how long after exposure can PEP be prescribed and started?

A

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.

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2
Q

Management points for Gonorrhoea (7 points)

A
  1. ABx Therapy - as below
  2. No sexual contact for 7 days after treatment is administered
  3. No sex with partners for the last 2 months until partners have been tested and treated as necessary
  4. Contact Tracing - 2 months
  5. IUD can stay in place
  6. Review in 1 week - assess symptoms,
  7. Test of Cure → at 2 weeks with PCR swab (pharyngeal, anal or cervical NOT urethral)
  8. Retest in 3 months after exposure
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3
Q

Specific ABX therapy for Gonorrhoea. Genital or Anorectal vs Pharyngeal.

A
  • 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
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4
Q

Symptoms in a male with gonorrhoea

A
  1. Urethral Discharge
  2. Dysuria
  3. Ano-Rectal Symptoms: Pain on defecation, irritation, Discharge, Disturbed bowel function
  4. Conjunctivitis: purulent, sight threatening
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5
Q

Symptoms in a female with gonorrhoea

A
  1. Vaginal Discharge
  2. Dypareunia with cervicitis
  3. Ano-Rectal Symptoms: Pain on defecation, irritation, Discharge, Disturbed bowel function
  4. Conjunctivitis: purulent, sight threatening
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6
Q

Testing for males with gonorrhoea. MSM for males.

A
  • 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
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7
Q

Discharge medications following AMI? principles.

A

Anti-platelet Therapy
Statin
Beta-Blocker
ACEi

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8
Q

Discharge medications following AMI specific dosing + duration: Anti-platelet therapy.

A
  1. Aspirin 100-150mg/day - continue indefinitely

2. Clopidogrel - for 12 months

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9
Q

Discharge medications following AMI specific dosing + duration: Statin

A
  1. Statin, highest tolerated dose - continue indefinitely

- atorvastatin 40-80mg PO daily

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10
Q

Discharge medications following AMI specific dosing + duration: beta-blocker. options aplenty.

A

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
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11
Q

Discharge medications following AMI specific dosing + duration: ACEi

A

perindopril arginine 2.5mg PO daily → increasing to 10mg daily
Continue ACEi long-term

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12
Q

Management of SCC. (3 points)

A
  • 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
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13
Q

Management of Keratoacanthoma 2 points

A
  • Surgical Excision → 3-5mm margin

- difficult to distinguish between a keratoacanthoma and an SCC on clinical diagnosis or partial biopsies

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14
Q

For Low Severity CAP, if no improvement after 48/24 -> what is the next step for ABx?

A
  • amoxicillin 1g PO TDS

- AND doxycycline 100mg PO BD

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15
Q

Red Flags for admission for hosptial for CAP (7 points)

A
  1. Tachypnoea → RR >22 resp/minute
  2. Heart Rate → HR >100bpm
  3. Hypotension → systolic BP <90mmHg
  4. Acute Onset Confusion
  5. O2<92% on RA
  6. Multilobar Involvement on CXR
  7. Blood Lactate Concentration >2mmol/L
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16
Q

Definition of small parapneumonic effusion and management.

A

Incidental Small Effusion - <10mm depth on CXR

NIl change to management

17
Q

Definition of large parapneumonic effusion and management.

A

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

18
Q

Definition of empyema and management

A

Collection of Pus in the pleural space associated with active infection

Pleural Fluid Sampling and Drainage
Admit to Hospital for IV ABx

19
Q

Diagnosis of Post-streptococcal Glomerulonephritis

A

Discoloured Urine (Haematuria) + Peri-orbital Oedema + Oliguria ⇒ Post-Streptococcal Glomerulonephritis

20
Q

Clinical Features of Post-Streptococcal Glomerulonephritis (4 points)

A

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
21
Q

Management of post-streptococcal glomerulonephritis (4 points)

A
  • Hospital Admission
  • Bed Rest
  • Strict Fluid Balance + Fluid Restriction
  • Daily Weighing
  • ABx for those with Streptcoccal infection at time of diagnosis
22
Q

Diagnostic criteria of acute mesenteric ischaemia

A

Diagnostic Triad → anxiety and prostration + intense central pain + profuse vomiting +/- bloody diarrhoea → mesenteric arterial occlusion

23
Q

Clinical Features of Chronic Mesenteric Ischaemia (2 points)

A
  • 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
24
Q

Management of Symptomatic Chronic Mesenteric Ischaemia (1 point)

A
  • Indication for revascularisation is the presence of symptoms including abdominal pain and weight loss
25
Q

Risk Factors for Actinic Keratoses (4 points)

A
  • Signs of photoageing skin
  • Fair skin with history of sunburn
  • History of long hours spent outdoors for work or recreation
  • Defective immune system
26
Q

First Line Management of Actinic Keratoses

A

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)
27
Q

If no benefit from cryotherapy and no indication for excisional biopsy, what is the next step of treatment?

A
  • *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
  1. 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.
28
Q

Symptoms of Cystitis. Symptoms of pyelonephritis. Difference?

A
  • 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
29
Q

Treatment for Acute Cystitis (be specific)

A
  1. trimethoprim + sulfamethoxaole 4+20mg/kg up to 160+800mg orally BD for 3/7.
  2. trimethoprim 4mg/kg up to 150mg orally, 12 hourly for 3/7.
  3. Cefalexin 12.5mg/kg up to 500mg PO Q6H for 3/7.
30
Q

Difference between a pterygium and a pinguecula

A

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

Practice Exams (45 decks)

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