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Practice Exams > 5/12/21 > Flashcards

5/12/21 Flashcards

1
Q

Discuss commencement of insulin. Dosing and titration numbers.

A
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2
Q

Counselling when starting insulin?

A

NDSS medication change registration → to allow patients access to strips and pen needles

timing and frequency of SMBG, timing of meals, dose adjustment

impact of diet → carb counting, impact of irregular eating patterns - religious fasting, intermittent fasting etc.

impact of physical activity

hypoglycaemia management

insulin delivery techniques → rotation of sites, injection technique, storage of insulin

weight management and mitigation of weight gain

Sick day management

Notification re: driving

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3
Q

Prevent progression or worsening of diabetic retinopathy?

A

To reduce risk and slow progression of Diabetic Retinopathy → optimise glycaemic control, blood lipid levels and bloods pressure + smoking cessation

monitor progression of diabetic retinopathy with ophthalmologist

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4
Q

Risk factors of progression of Diabetic Retinopathy?

A

Poor Glycaemic Control

Poor Lipds

Poorly controlled HTN

Anaemia

Pregnancy

Microalbuminuria

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5
Q

Examination for Peripheral Neuropathy

A
  1. 10g monofilament - pressure sesnation
  2. Ankle Reflexes
  3. Vibration Sensation on dorsum of great toe
  4. Protective sensation - 10g monofilament
  5. Pinprick sensation
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6
Q

Investigations in Peripheral Neuropathy?

A

Diabetes

B12 Deficiency

Hypothyroidism

Renal Disease

Excessive Alcohol Consumption

Bloods: B12, TFT, UEC, HbA1c

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7
Q

Medical Management of Peripheral Neuropathy?

A

Review Glycemic Control

Symptomatic Management

Anticonvulsants → pregabalin (75mg po daily, review in 7 days), gabapentin, valproate

Antidepressants → amitryptiline (10mg nocte review in 7/7), duloxetine, venlafaxine

Topical Nitrate Spray

Opioid Analgesics

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8
Q

Examples of SGLT2 inhibitors and dosing please.

A

Dapagliflozin 10mg PO Daily

Empagliflozin 10mg PO Daily

Ertugliflozin 5mg PO Daily

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9
Q

OPtions and dosing of Dpp4 inhibitors?

A

Aloglitptin 25mg once daily

Linagliptin 5mg once daily (safe in all stages of renal impairment)

Saxagliptin 5mg once daily

Sitagliptin 100mg once daily

Vildagliptin 50mg BD

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10
Q

Which med in patients with t2dm, poor glycaemic control on metformin + CVD?

A

SGLT2 inhibitors - flozins

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11
Q

Counselling for SGLT2 Inhibitors

A

increased risk of UTI, urinary frequency or incontinence

increased risk of euglycaemic ketoacidosis

cease medication at least 3 days prior to surgery or procedures that require hospital stay. if day procedures, cease day of the procedure.

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12
Q

CV screening in PCOS? What about in the context of pregnancy?

A

Smoking

BP - annual check

Lipid profile - annually if BMI >25

Screen with OGTT, fasting glucose or HbA1c

if high-risk use OGTT (e.g history of GDM, Impaired Fasting Glucose, Impaired Glucose Tolerance, FHx of diabetes, hypertension or high risk ethnicity) → every 1-3 years (annually if IFG/IGT)

If PCOS and planning pregnancy → complete OGTT (esp if over 30yo)

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13
Q

Pre-Conception Consult

A

CST

No safe alcohol

Smoking Cessation

Safe Exercise - moderate intensity 150mins/week

Folic Acid supplementation - 5mg 1 months prior to planned conception

Social Supports + Domestic Partner Violence

Mental Health

Preconception Genetic Screening

Diet - healthy well balanced diet

if overweight/obese - drop 5-10% weight prior to conception

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14
Q

Folic Acid Supplementation in pregs? Same for all?

A

400-500 microgs for at least 4 weeks prior to pregnancy and for the first 12 weeks of gestation

if high risk → 5mg daily same time frame

  • high risk -> malabsorption, BMI >30, GDM, anticonvulsant medication, previous neural tube defect
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15
Q

Examinations in First Antenatal Consult

A

BP

BMI

HR

Thyroid

Teeth and Gums

Breast + Nipples

Heart

CST if needed

Abdomen - uterine size and fetal heart if indicated

Urinalysis - protein and glucose

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16
Q

Diagnosis of GDM?

A

Fasting glucose >= 5.5

OGTT 2 hours > 8

DO NOT USE HBA1C

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17
Q

How to do the OGTT in pregs?

A

75g OGTT

fast 8-12 hours overnight

start before 9:30am

drink glucose drink wihtin 5min, remain seated througout 2 hour period

use metoclopramide if vomit

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18
Q

Follow-up following diagnosis of GDM?

A

conduct OGTT 2 hour test - 6-12 weeks post-partum

if normal - HbA1c every 3 years

if HbA1c >6 → further investigation and advice before next pregnancy

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19
Q

Risks to infant with GDM?

A

congential abnormalities

preterm birth

perinatal asphyxia

macrosomia****

resp distress

hypoglycaemia

hypocalcaemia

polycythaemia**

Low iron stores

hyperbilirubinaemia

transient hypertrophic cardiomyopathy

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20
Q

6 week - Postnatal Consultation

A

Enquire about vaginal discharge (lochia) and whether ceased

Ask about healing of the perineum if vaginal delivery

Review abdomen (uterus should be impalpable) and Caesarean Wound if present

Check for any urinary or bowel problems (incontinence)

Check if breast-feeding and whether there are concerns - Breastfeeding

Check if intercourse has resumed and whether there are problems or concerns

Discuss contraception options - Contraception

Advise on post-natal exercises

Adequate diet, rest and personal care, sleep, exercise

Psychological Health - Edinburgh Post-Natal Depression Scale (Post-Natal Depression (PND)), social supports

Consider Pelvic Examination - checking perineum and pelvic floor strengths

Cervical Screening Test (if due) - Cervical Cancer + Screening

Review antenatal screening tests for follow-up action - rubella booster

Other → smoking and alcohol

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21
Q

ABCDE Rule for Melanoma Diagnosis

A

A → Asymmetry → one half different from the other

B → Border → usually irregular

C → Colour → varies within the lesion. pigment is largely or completely absent in hypomelanotic melanoma

D → Diameter → greater than 6mm, sometimes melanomas are diagnosed when smaller than this - an increasing diameter is more important than size

E → Evolution → changing or evolving

22
Q

Mx of melanoma

A

Excisional Biopsy with 2 mm lateral margin and as deep as the subcutaenous fat

23
Q

Main Parameter for Melanoma Prognosis?

A

BRESLOW THICKNESS

24
Q

If complete excision following initial excisional biopsy of melanoma - what are the next steps? what is incomplete excision?

A

If histology confirms melanoma → will need definitive wide local excision.

if initial excision removed all the lesion - WLE should take place within 4 weeks.

if some lesion was left behind after first excision → WLE should take place ASAP.

Margins of the WLE depend on the tumour thickness

25
Q

Management of Subungal Haematoma

A

Trephination → only perform in <48hours

after 48hours - most haematomas have clotted and trephination is typically not effective

26
Q

Characteristics of Superficial Spreading Melanoma

A

Larger size than most moles: > 6 mm and often 1–2 centimetres in diameter at diagnosis

Irregular shape

Variable pigmentation: colours may include light brown, dark brown, black, blue, grey, pink and red

There may be skip areas, which are skin coloured, or white scars due to regression

Smooth surface at first, later becoming thicker with an irregular surface that may be dry or warty.

27
Q

EFG Rule in context of Melanoma

A

Elevated

Firm

Growing

for NODULAR MELANOMA

28
Q

Clinical Features of SCC

A

Can appear suddenly, grow rapidly OR grow slowly over weeks to months

tender and painful

on sun exposed sites

raised scaly lump

common in those who are immunosuppressed

29
Q

Mnaagement of SCC

A

Need biopsy to establish diagnosis - margin 3-5mm

review every 6 months for skin check for at least 2 years after excision

30
Q

Worrying features of a cutaenous horn?

A

Pain

Large Size

Induration at the Base

Anatomic Site → Nose, Ears, Backs of Hands, Scalp, Forearms, Face and Penis

Wide base or low height to base ratio

Redness at the base of the horn base

Lack of terrace formation - rapid unorganised growth

31
Q

Treatment of Bowen’s DIsease. COnsiderations.

A

Biopsy - but can use topical therapy or photodynamic therapy in regions where the skin heals poorly. Cannot use topical therapies if the disease has extended into the hair follicles

Imiquimod 5% topically, at night 5 times weekly for up to 6 weeks.

Fluorouracil 5% cream topically, once daily for 3-4 weeks

Photodynamic Therapy

32
Q

History of Fitness to Drive in diabetic.

A

Driving History → accidents and pattern of driving

How often pt gets lost

Diabetes

Recent Hypoglycaemic Episodes

Compliance with Medications

Hypoglycaemic Aareness

History of Syncopal Episodes

Signs of CVA

Sleep Disorders

Insight into dementia if present

33
Q

Examination findings in Fitness to Drive

A

Visual Examination - visual acuity, visual fields

Co-ordination, Balance, Mobility

Peripheral Neuropathy

Hearing Assessment of Impairment

34
Q

Other means to assess fitness to drive other than history and examination of the patient.

A

Collateral History regarding driving history

Geriatric Assessment for Capacity

Occupational Therapist for Driving Assessment

Anonymous enquiry from Driving Licensing Authority about the requirements

35
Q

Next steps of management if patient is deemed not safe to drive?

A

advice patient that he is not able to drive

advise him to inform the drivers license authority

notify the NOK that pt is not fit to drive

Offer assistance and support to look for alternate transport options

document the discussions in detail in medical records

36
Q

Presentation of Optic Neuritis. Assocaited condition?

A

Associated with Multiple Sclerosis

Monoocular, visual loss + Eye pain

can be with central scotoma commonly

also can have photpsias → flickering or falshes of light

sudden - hours to days - peaking within 1-2 weeks

Fundoscopy - 2/3 is normal. inflammation has retrobulbar neuritis

37
Q

Associated conditions of uveitis?

A

Ankylosing Spondylitis

Inflammatory Bowel Disease (IBD)

Behcet Syndrome

38
Q

Mnaagement points for allergic conjunctivitis - nonpharm and pharm

A

NonPharm - do not rub eyes, no contact lenses, cool compresses,

Management → anti-histamine + mast-cell stabiliser

Azelastine Eye Drops or Ketotifen or Olopatadine - Patanol

2nd line ->. Antihistamine only or Mast-Cell only

39
Q

Clinical Features and Management of Episcleritis?

A

NO BLOOD OUTSIDE THE VESSEL

Localised area of congestion

minimal discomfort, minimal pain, nil impact on vision, unilateral

Associated with autoimmunse

RA - Rheumatoid Arthritis (RA)

IBD

SLE

Management

self-resolving

can trial topical NSAIDS

40
Q

Difference between scleritis and episcleritis?

A

severe pain differentiates between episcleritis and scleritis

also presents with photophobia, deep-red or purplish scleral hue

41
Q

Management of Herpes Keratitis?

A

Immediate referral to ophthalmology***

Topical Antiviral Therapy → aciclovir 3% eye ointment 5 times daily for 10-14 days or at least 3 days after healing whichever is shorter

Oral antiviral therapy → valaciclovir 500mg po BD for 7-10 days

42
Q

Management of Flash Burn?

A

Pain Relief

Topical ABx

NO need for topical anaesthetic

NO need for eye patching

43
Q

Management of Hyphaema?

A

Eye Patch

Bed Rest with 30 degree head elevation

Dilate pupil for examination and pain Relief

Control Nausea and Vomiting

Topical Pain Relief

Referral to Ophthalmologist

44
Q

Clinical Features + Fundoscopy of Retinal Artery Occlusion vs Retinal Vein Occlusion?

A

Artery - Cherry Red Spot + Pale Retina

Vein - Sunset Storm

45
Q

Fundoscopy Findings of Diabetic Retinopathy?

A

Non-Proliferative -> microaneurysms, cotton wool spots, tortuous vessels, exudates

Proliferative -> neovascularisation around the optic disc or retina

46
Q

Clinical Feature of Retinal Detachement?

A

Pain Loss of Vision

Recent history of flashes and floaters

presence of dark shadow or curtain moving over the visual field

47
Q

Clinical Features of Macular Degeneration?

A

Sudden fading central vision

Distortion of Vision

Straight lines may seem wavy and objects distorted - Amsler Chart

Central Vision eventually completely lost

Peripheral Fields normal

48
Q

Risk Factors for Cataracts?

A

Older Age

Smoking

Alcohol Consumption

Sunlight Exposure

Lower Educational Status

Occur prematurely in people with diabetes

Systemic Corticosteroids

49
Q

Clinical Features of Bacterial Keratitis?

A

95% of contact lens infections

Red Eye

Reduced visual acuity

Pain

Eyelid Swelling

Photophobia

Corneal Epithlial Defect

50
Q
A

Practice Exams (45 decks)

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