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Practice Exams > 31/10/21 > Flashcards

31/10/21 Flashcards

1
Q

Common Causes of Secondary Amennorrhoea (2 commonest causes + 4 others)

A
  1. PCOS
  2. Hypothalamic Amenorrhoea excessive exercise, psychological stress- weight loss- severe or prolonged illness
  3. Thyroid Disease - hyper/hypo
  4. Cushings Disease
  5. Primary Ovarian Insufficiency
  6. Hyperprolactinaemia
    (7. Pregnancy)
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2
Q

Management of irregular menstrual cycle (3 points - BE SPECIFIC)

A
  1. COCP -> Ethinylestradiol/Levonorgestrol 30/150microg PO at the same time every day
  2. Cyclical Progestin -> Levonorgesterol IUD 52mg/replace every 5 years
  3. Cyclical Progestin -> medroxyprogesterone 10mg PO daily for the same 12 days every month
  4. Metformin IR 250mg PO BD
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3
Q

PCOS Management Areas (4 main and 4 other points)

A
  1. Irregular Menstrual Cycles
  2. Subfertility
  3. Cardiometabolic Health
  4. Hyperandrogenism -hirsutism and acne
  5. mental and emotional health
  6. lifestyle
  7. sleep apnoea
  8. management
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4
Q

Management options for Hirsutism (1 non-pharm, 2 pharm)

A

Hirsutism → physical hair removal (laser/epilation)

Pharmacological Therapy → will take 6-12 months to see benefit

  • COCP → aim for lowest effective dose
  • Combination Therapy → if ≥ 6 months of COCP is ineffective, add anti-androgen to COCP
    • anti-androgen → spironolactone 100mg-200mg daily
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5
Q

Management of Fertility in the context of PCOS (1 non-pharm, 1 pharm, referral?)

A

Important to discuss subfertility

  • BMI >25 → weight loss is first line
    • 5-10% weight loss may assist in cycle control and fertility
  • Pharmacological Therapies
    • GP: Metformin
    • Specialist: Letrozole and Clomiphene
  • Referral to specialist:
    • 12 months if <35years
    • 6 months if >35 years
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6
Q

Management of Cardiometabolic Health in context of PCOS (5 points)

A
  1. smoking cessation
  2. Annual BP check
  3. Lipid Profile at baseline if BMI >25 and then every 2-4 years based on CV Risk
  4. Screen for Diabetes with OGTT/HbA1c or Fasting Glucose every 1-3 years
  5. Regular exercise 30mins/day
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7
Q

Common causes of Acute Upper GIT Bleed (8 points, give me top 5 in decreasing order of frequency)

A
  1. Gastric and/or duodenal ulcers
  2. Severe or erosive gastritis/duodenitis
  3. Severe or erosive esophagitis
  4. Oesophagogastric Varices
  5. Portal Hypertensive Gastropathy
  6. Angiodysplasia (also known as vascular ectasia)
  7. Mallory Weiss Syndrome
  8. Mass Lesions (polyps/cancers)
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8
Q

History Questions in the context of Acute Upper GI Bleed (6 points)

A
  1. Characterise the vomit
  2. Bowels
  3. Associated Symptoms - heartburn, stomach pain
  4. Alcohol Intake + Smoking
  5. Medication - NSAIDs, Anticoagulants, Antiplatelets, aspirin
  6. PHX - GI Bleeds, Liver Disease, Coagulopathy
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9
Q

Management of Acute Upper GI Bleed (6 points)

A
  • Call an ambulance for transfer to the nearest tertiary hospital
  • Intravenous Access: 2 x 18G or larger IV cannulas
  • Fluid Resuscitation: commence immediately and should not be delayed → 500-1000ml of Normal Saline
  • Transfusion: active bleeding and hypovolaemia may required RBC transfusion (even with a normal Hb)
  • Begin Proton Pump Inhibitor Infusion → esomeprazole/pantoprazole 80mg IV
  • Continuous monitoring of vital signs, cardiac rhythm, urine output, NG output
  • Nil by Mouth
  • Elevate legs to promote venous return
  • Call gastroenterology registrar from nearest tertiary hospital for advice
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10
Q

Barriers to hospital presentation for ATSI population.

A
  1. Distance to nearest hospital/Distance from family/lack of access to social network
  2. Mistrust of Western Hospital
  3. Perceived Cost
  4. Misunderstanding of prognosis and seriousness of diagnosis
  5. Language Barrier
  6. Previous bad experiences in hospital
  7. Not being able to look after family while away
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11
Q

Common Causes of Posterior Foot Pain (4 points)

A
  • Achilles Tendon Insertion
  • Superficial Calcaneal Bursa
  • Posterior Impingement of Soft Tissues/Os Trigonum in active people
  • Calcaneal Apophysitis - Severs Disease
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12
Q

Common Causes of Inferior Foot Pain (2 points)

A

Plantar Fascia

Calcaneal Fat Pad

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13
Q

Common Causes of Medial Foot Pain (2 points)

A

Tibialis Posterior Tendon and Sheath

Tibilalis Posterior Insertion and Apophysis in Adolescents

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14
Q

Common Causes of Lateral Foot Pain (2 points)

A

Lateral Ligaments of the Ankle

Sinus Tarsi

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15
Q

Common Cause of Deep Vague Foot Pain (1 point)

A

Subtalar Joint

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16
Q

History of Plantar Fasciitis (2 points)

A

severe heel pain in the morning or after rest which subsides with movement but is further aggravated following extended periods of weight-bearing

17
Q

Examination of Plantar Fasciitis (2 points)

A

tenderness over the medial calcaneal tubercle + pain on dorsiflexion of the first toe

18
Q

Management of Plantar Fasciitis (4 points of 7)

A
  1. Rest + Avoid activities that aggravate the condition (e.g running)
  2. Ice Massage
  3. Analgesia → Paracetamol 1g PO QID/Ibuprofen 400mg PO TDS
  4. Stretching of Calf Muscle + Strengthen calf muscle
  5. Stretching of the Fascia → HANDI Plantar Fascia Stretch
  6. Orthotics + Use of Heel Cup or Cushion to take pressure off heel arch
  7. Weight Loss of 5-10% body weight
19
Q

Multi-Organ Consequences of Haemochromatosis (6 points)

A
  • Liver → Liver Fibrosis + Liver Cirrhosis + Hepatocellular Carcinoma
  • Heart → Cardiac Arrhythmias + Restrictive Cardiomyopathy
  • Diabetes
  • Arthropathy → bone swelling of the 2nd and 3rd MCP joints
  • Pituitary → Hypogonadism, Impotence
  • Skin Hyperpigmentation - “Bronze” or Leaden Grey Skin Colour
20
Q

DDx for Plaque Psoriasis (give 4 there are 7)

A
  1. Discoid Eczema/Dermatitis → more itch, vescicles, dry rather than plate-scale
  2. Tinea Corporis → elevated border, slowly extending edge, positive mycology
  3. Pityriasis Rosea → herald patch, fir-tree distribution of oval plaques, trailing scale, duration less than 3 months
  4. Seborrhoeic Dermatitis → thin, paler patches with smaller flakes of scale on the scalp, face and sometimes the upper trunk
  5. Psoriasiform Drug Eruption
  6. Pityriasis Rubra Pillaris
  7. Lichen Simplex Chronicus → skin changes occur secondary to excessive scratching of the skin. Patients develop plaques of thickened skin that have accentuated skin markings; overlying scale or hyperpigmentation may be present.
21
Q

Triggers for Psoriasis (6 points)

A
  • infections (streptococcal) + viral (including HIV)
  • skin trauma (e.g Koebner phenomenon) - cuts, abrasions, sunburn
  • stress
  • smoking, alcohol
  • medications - lithium, beta-blockers, antimalarials, NSAIDs
  • sun exposure in 10% but sun exposure is more often beneficial
22
Q

Options for pharmacological treatment of psoriasis (3 points)

A
  1. Tar
  2. Corticosteroids
  3. Calcipotriol
23
Q

Tar Preparation in the treatment of plaque psoriasis (be specific)

A
  1. coal tar prepared 1% emulsion or gel topically, once daily at night or twice daily for 1 month
24
Q

Corticosteroid progression used in treatment of psoriasis (2 points - be specific)

A

If tar alone is not sufficient or for acute flares - add a topical corticosteroid

  • Methylprednisolone aceponate 0.1% cream, ointment or fatty ointment topically, once daily until skin is clear (usually 2-6 weeks)
  • OR mometasone furoate 0.1% cream, hydrogel, or ointment topically once daily until the skin is clear (usually 2-6 weeks)

If the response to treatment is inadequate after 3 weeks - change the topical corticosteroid component:

  • betamethasone dipropionate 0.05% cream or ointment topically, once daily until the skin is clear (usually 2-6 weeks)

Once symptoms are controlled → reduce corticosteroid component gradually and withdraw completely if possible. Continue to use the tar as maintenance therapy.

25
Q

What is calcipotriol and what is its role in the treatment of psoriasis? Adverse effects of calcipotriol?

A

If patients patient have few scattered plaques of psoriasis that do not respond to tar, or need longer-term control with topical corticosteroid use:

  • calcipotriol + betamethasone diproprioate 50 + 500microg/g ointment topically, once daily until the skin is clear (usually 6 weeks)
    • Calcipotriol → analogue of 1,25-dihydroxyvitamin D (the active form of Vitamin D) → regulates proliferation and differentiation of keratinocytes
      • Adverse effects → erythema and irritation which is mitigated with concurrent application of a corticosteroid
26
Q

Sexual History (8 basic questions)

A
  1. When was the last time you had sex?
  2. Who have you been having sex with? Other than your regular partner, have you had sex with anyone else?
  3. How did you have sex? Vaginal/Oral/Anal? Did you use a condom?
  4. How your partners been male or female?
  5. In the last three months, how many sexual partners have you had?
  6. Have you been diagnosed with or thought you had an STI?
    - STI Symptom - dysuria, urethral discharge, penile ulcer, rash
    - Vaccination Status → Hep B
27
Q

Risk Assessment (5 points)

A
  • Have you ever been paid to have sex? Have you ever paid to have sex?
  • Have you had any tattoos? Have you ever injected drugs?
  • Have you been in jail?
  • Are you ATSI? Are you a refugee or a migrant?
  • Have you experienced domestic violence?
28
Q

Management Points for Gonorrhoea (6 points)

A

ABx Therapy
- 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

  • 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
  • Test of Cure → at 2 weeks with PCR swab (pharyngeal, anal or cervical NOT urethral)
  • Retest in 3 months after exposure
29
Q

Categories of questions when taking a history following syncope (5 points)

A
  1. Position of the patient
  2. Provocative events
  3. Events preceding syncope
  4. Events following syncope
  5. Witnessed events
30
Q

Examination Findings for Syncope (3 categories)

A

Vital Signs:

  • Pulse
  • BP → measure lying, sitting and standing
  • RR → hyperventilation with elevated RR → PE or anxiety

Cardiovascular Findings:

  • Bilateral BP variation
  • Cardiac Murmurs

Neurologic Findings:

  • Focal Neurologic Signs → hemiparesis, dysarthria, diplopia, vertigo, Parkinson Signs
31
Q

Causes of Left Ventricular Hypertrophy (6 points)

A
  • Hypertension → most common cause
  • Aortic Stenosis
  • Aortic Regurgitation
  • Mitral Regurgitation
  • Coarctation of the Aorta
  • Hypertrophic Cardiomyopathy (HCM)
32
Q

Criteria of Left Ventricular Hypertrophy (1 point)

A
  • Criteria → S wave depth in V1 + tallest R wave height in V5-V6 >35mm
33
Q

LFTs in NAFLD (2 points)

A

ALT + AST elevated, preserved ALT:AST ratio 1.5 + elevated GGT

34
Q

DDx of NAFLD -> essentially causes of hepatocellular pattern of LFT derangement.

A
  • Alcohol Induced Liver Disease → Alcohol History
  • Chronic Hepatitis B → Hep B serology
  • Chronic Heptatis C → Hep C antibody
  • Autoimmune Hepatitis → Anti-Nuclear Antibody, Anti-Smooth Muscle Antibody (ASMA), Anti-Mitochondrial Antibody (AMA)
  • Haemachromatosis → Fe Studies
  • Thyroid Disease → TFTs
  • Coeliac Disease → Coeliac Serology
  • Medications → Amiodarone, Anticonvulsants, Methotrexate, Tamoxifen, Synthetic Oestrogens, Corticosteroids, HIV Therapy
35
Q

Management points for NAFLD (6 points)

A
  1. Vaccination for Hepatitis A and Hepatitis B
  2. Lipid Lowering Therapy for those with hyperlipidaemia
  3. Weight Loss → 5-10% of body weight in overweight and obese patients,
    1. Can refer to dietician
    2. Exercise → 30mins of exercise, most days of the week
  4. Refraining from heavy alcohol consumption and suggest abstinence from alcohol
  5. Discussed increased cardiometabolic risk
    - referral to gastroenterologist for consideration of liver biopsy
36
Q

Criteria for Metabolic Syndrome (5 points)

A
  1. Elevated Waist Circumference
  2. Elevated Triglycerides → ≥1.7mmol/L
  3. Reduced HDL → <1.0mmol/L in men and <1.3mmol/L in women
  4. Elevated BP → ≥130 systolic or ≥85 diastolic
  5. Elevated Fasting Glucose → >5.5mmol/L

Practice Exams (45 decks)

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