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Practice Exams > 8/10/21 - 9/10/21 > Flashcards

8/10/21 - 9/10/21 Flashcards

1
Q

What are the main 2 characteristics of acanthosis nigracans? Where does it usually occur?

A

Characterised by hyperpigmentation (darkening) and hyperkeratosis (thickening) of the skin

Occurs mainly in the folds of skin → axilla, groin, and back of the neck

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2
Q

Explain the main points of the work-up of acanthosis nigracans? What do you need to differentiate between? Why is this important?

A

important to differentiate acanthosis nigracans related to malignancy from that related to benign conditions. Patients with malignant acanthosis nigracans will spread quickly → so if patient does not have known cancer with malignant acanthosis nigracans need to work-up thoroughly.

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3
Q

How do you treat acanthosis nigracans?

A

Treatment: treat the underlying causes, no specific treatment

- for cosmetic purposes → topical retinoids, dermabrasion and laser therapy
- if caused by obesity → weight loss can reverse the skin changes.
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4
Q

What are the key features of the presentation of acanthosis nigrcans? Appearance, Where, Mucosa or no?

A
  • Thickened brown velvety textured patched of skin
  • Papillomatosis (multiple finger-like growths) + Skin Tags
  • Pruritis (itching) may be present
  • Can appear on mucosal surfaces → oral, nasal and laryngeal mucosa and oesophagus
  • Lesions involving the mucosa, palms and soles tend to be more extensive
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5
Q

What are the 4 points of the DSM5 Criteria of Adjustment Disorder?

A
  • Emotional or Behavioural Symptoms in response to an identifiable stressor within 3 months of the onset of the stressors plus one or both of:
    1. Marked distress out of proportion to the severity
    2. Significant impairment in social, occupational or other areas of functioning
  • Stress-related disturbance does not meet criteria for another mental disorder and is not an exacerbation of a pre-existing mental disorder
  • Symptoms do not represent normal bereavement
  • After termination of the stressor (or its consequences) → the symptoms persist for no longer than an additional 6 months
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6
Q

How long after an event can an acute stress disorder diagnosed? How long after can PTSD be diagnosed? When is it best to diagnose Acute Stress Disorder and why?

A

Can be diagnosed after 3 days after the traumatic event HOWEVER delaying diagnosis a week can better identify patients who can be effectively treated and are higher risk of developing PTSD.

  • PTSD → diagnosis made after persistence of symptoms for at least 4 weeks following trauma
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7
Q

What are the 5 symptoms associated with Acute Stress DIsorder?

A
  • Intrusion
  • Negative Mood
  • Dissociation
  • Avoidance
  • Arousal
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8
Q

Do we screen for or treat asymptomatic bacteriuria on RACF patients?

A

DO NOT screen for or treat asymptomatic bacteriuria in RACF residents → overtreatment leads to antimicrobial resistance

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9
Q

Do we treat RACF patients with cloudy and malodourous urine?

A
  • Cloudy and malodourous urine is NOT reason to treat with ABx in patients who do not have any other symptoms of a UTI
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10
Q

What test (and result) has a high negative predictive value in RACF residents for UTI?

A
  • Negative leuks and nitrites on the urine dipstick have a high negative predictive value for diagnosis of UTI → if negative, do not need to treat.
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11
Q

Criteria for UTI testing in RACF residents without a cathether? (2 and 6, name them all)

A

General Criteria

  • Fever
  • Acute Mental Status Change

Local Criteria

  • Urinary Urgency
  • Urinary Frequency
  • Suprapubic Pain or Tenderness
  • Haematuria
  • Costovertebral Angle Pain or Tenderness
  • Urinary Incontinence
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12
Q

Criteria for UTI testing in RACF residents with a catheter? (4 points)

A
  • Fever
  • Costovertebral angle pain or tenderness
  • Rigors with or without identified cause
  • Acute Mental Status Change
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13
Q

What symptoms do patients with gastric cancer present with? 2 main symptoms.

A

Most patients are symptomatic → weight loss and abdominal pain

  • abdominal pain is usually epigastric , vague and mild when early in the disease process and gets worse as disease progresses
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14
Q

What are the signs and symptoms of metastatic disease of gastric cancer? 1 main sign and list others.

A
  • liver, peritoneal surfaces, non-regional or distant lymph nodes
  • in regards to lymphatic spread → Virchow’s Node is the mode common physical examination finding of distant metastatic disease. It is left supraclavicular lymph node.
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15
Q

How do you establish diagnosis of gastric cancer?

A

To establish diagnosis → needs endoscopic biopsy and histological examination of tumour tissue

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16
Q

Medical Admission Criteria for Eating Disorder (11 points)

A
  1. Temperature → <35.5
  2. Heart Rate → <50bpm
  3. Cardiac Arrhythmia
  4. Blood Pressure → <90mmHg (psychiatric) or <80/50mmHg (medical)
  5. Postural Hypotension → >10mmHg (psychiatric) or >20mmHg (medical)
  6. Postural Tachycardia → >20bpm
  7. QTc prolongation on ECG → >450milliseconds
  8. Hypokalaemia → <3.0mmol/L
  9. Neutropenia → <1.5x10^9/L
  10. Weight → BMI <14 (psychiatric) or BMI <12(medical)
  11. Rapid Weight Loss → 1kg/week over several weeks
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17
Q

Psychiatric Admission Criteria for Eating Disorder (3 points)

A
  • Suicidal Ideation
  • Active Self-Harm
  • Moderate to High Agitation and Distress
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18
Q

When do you offer chlamydia testing in antenatal care? When do you offer CMV testing? When do you offer TFTs? When do you offer Vit D?

A
  • Chlamydia Testing → age <25yo
  • CMV testing → frequent contact with large numbers of very young children
  • TFTs → symptoms or at high risk of thyroid dysfunction
  • Vit D → if dark skinned or at risk
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19
Q

What are the points of advice for Toxoplasmosis Infection Prevention in pregnancy? (5 points)

A
  • wash hands thoroughly before handling food
  • thoroughly washing all fruit and vegetables
  • thoroughly cooking raw meat
  • wearing gloves and thoroughly washing hands when handling soil or in the garden
  • avoid cat faeces in cat litter or in soil
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20
Q

Describe the presentation of a patient with cognitive impairment secondary to depression. onset, course, orientation, memory, thinking, alertness, attention and sleep.

A

Onset → coincides with life-changes, often abrupt
Course → Diurnal effects and is therefore worse in the morning
Orientation → selective disorientation
Memory → selective or patchy memory impairment
Thinking → intact with themes of hopelessness, helplessness or self-deprecation
Alertness → not impaired
Attention → minimal impairment but is distractible
Sleep → early morning, awakening

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21
Q

How do you classify allergic rhinitis?

A
  1. Duration
    • Intermittent → <4 days/week OR <4 consecutive weeks
    • Persistent → >4 days/week or >4 consecutive weeks
  2. Severity of Symptoms
    • Mild
      • Symptoms present but not troublesome
      • Normal Sleep
      • NO Impairment of ADLs + leisure + sport
      • NO impairment of school or work performance
    • Moderate to Severe (≥1 symptom)
      • Troublesome symptoms
      • Sleep disturbance
      • Impairment of ADLs + Leisure + Sport
      • Impairment of school or work performance
22
Q

How do you treat intermittent + mild allergic rhinitis?

A
  • Oral or Intranasal Anti-Histamine
23
Q

How do you treat intermittent + moderate to severe allergic rhinitis?

A
  • Oral or Intranasal Anti-Histamine
    • Other Options: Intranasal Corticosteroid OR Montelukast
  • Review in 2-4 weeks
    • If improved - treat for 1 more month
    • If no improvement
      • Review Diagnosis + Adherance
      • Increase Intranasal Corticosteroid and/or determine best combination therapy
      • Consider Referral for Immunotherapy
24
Q

How do you treat persistent + mild allergic rhinitis?

A
  • Oral or Intranasal Anti-Histamine AND/OR Intranasal Corticosteroid OR Montelukast
  • Review in 2-4 weeks
    • If improved - treat for 1 more month
    • If no improvement:
      • Review Diagnosis and Adherance
      • Treat as Persistent + Moderate to Severe
25
Q

How do you treat persistent + moderate to severe allergic rhinitis?

A
  • Oral or Intranasal Corticosteroid AND EITHER oral or intranasal anti-histamine AND/OR montelukast
  • Review in 2-4 weeks
    • If improved: treat as persistent + mild and continue treatment for 1 month
    • If no improvement:
      • Review Diagnosis + Adherence
      • Increased Intranasal Corticosteroid and/or use all three therapies above
      • If rhinorrhoea → add intranasal iptratropium
      • consider referral for immunotherapy
26
Q

Role of intranasal corticosteroids in treated allergic rhinitis? Practice Points in regards to use. Any considerations if patient is asthmatic?

A
  • effective in reducing nasal congestion, rhinorrhoea, sneezing and itching and are also beneficial in ocular symptoms
  • must be taken for 2 weeks for maximal efficacy is to be achieved and need to taken continuously
  • can also improve asthma control if used concomitantly → if patients are already on ICS inhaler, consider total daily dosing of corticosteroids
    • consider prescribing Intranasal corticosteroids with lower bioavailability → ciclosonide, budesonide, mometasone, fluticasone
27
Q

Role of intranasal decongestants in treating allergic rhinitis? Role of oral corticosteroids?

A

Intranasal Decongestants

  • LIMITED ROLE → use up to 5 days max
  • repeated or long-term use can cause rebound swelling of nasal mucosa necessitating dose escalation → rhinitis medicamentosa
  • only use in patients with SEVERE nasal congestion to rapid relief of symptoms until intranasal corticosteroids have effect

Oral Corticosteroids

  • avoided → only use with allergy specialist
28
Q

4 ophthalmological complications associated with diabetes.

A
  • *Refractive Errors**
  • lense shape alters with change in blood glucose → result in blurred vision
  • detection is done with pinhole test → if blurred vision is caused by refractive error then vision corrects with pinhole test
  • *Cataracts**
  • *Retinopathy**
  • most common cause of visual loss in people with diabetes
  • *Sudden Blindness**
  • can be caused by central retinal artery occlusion
  • retinal detachment
  • vitreous haemorrhage
29
Q

Risk Factors for developing cataracts? ( 7points)

A
  1. Older Age
  2. Smoking
  3. Alcohol Consumption
  4. Sunlight Exposure
  5. Lower Educational Status
  6. Occur prematurely in people with diabetes
  7. Systemic Corticosteroids
30
Q

How do patients who have cataract present? (4 points)

A
  • blurred vision
  • glare intolerance
  • night vision difficulties
  • over time - interpretation of colours is more difficult
31
Q

Risk Factors of Chronic Lithium Accumulation (8 points)

A
  1. Impaired Kidney Function
  2. Dehydration
  3. Age >50years → lower GFR + decreased volume of distribution
  4. Previous lithium toxicity
  5. Drug interactions → ACE inhibitors, ARBs, NSAIDs, Loop and Thiazide Diuretics
  6. Lithium-induced nephrogenic diabetes insipidus
  7. Intercurrent Illness
  8. Thyroid Dysfunction
32
Q

Symptoms of Acute Lithium Poisoning. Progression of symptoms

A
  • Begins with gastrointestinal symptoms (vomiting and diarrhoea) and progresses late to neurological symptoms (sluggishness → neuromuscular excitability → seizures)
33
Q

Clinical presentation of Chronic Lithium Poisoning? 3 systems involved?

A

CNS: tremor, hyperreflexia, ataxia, rigidity, drowsiness, confusion, coma, seizures, myoclonus
CV: QT prolongation (uncommon), bradycardia, hypotension
GIT: Nausea/Vomiting

34
Q

Steps to diagnosis of PCOS

A
  1. Irregular Cycles and hyperandrogenism
  2. If no clinical hyperandrogenism - bloods (SHBG, in addition to total testosterone, to obtain free androgen index (FAI) or calculated free testosterone
  3. U/S
35
Q

What are examples of hyperandrogenism?

A
  • Adults: Acne, Hirsutism, Alopecia.

- Adolescents: Severe Acne + Hirsutism

36
Q

What constitutes irregular cycles? Adults? Adolescents?

A
  • in women with menstrual cycles >35 days apart or short cycles <21 days
    Adolescents
  • no period by age 15
  • > 1 year post menarche → >90 cycles
  • between 1-3 post menarche → <21 days, >45 day cycles
37
Q

What bloods are to be done in the diagnosis of PCOS?

A

Biochemical Androgens → measure Sex Hormone Binding Globulin (SHBG) in addition to total testosterone, to obtain free androgen index (FAI) or calculated free testosterone

38
Q

When do you do the U/S in the diagnosis of PCOS?

A

If ONLY irregular cycles OR hyperandrogenism

39
Q

In regards to U/S, what is seen as diagnostic of PCOS?

A
  • 10 small antral follicles are see in each ovary. unilateral is rare.
40
Q

What bloods should be done to rule out other causes of irregular cycles?

A
  • TSH, Prolactin Levels, FSH and if clinical status indicates other causes need to be excluded (CAH, Cushings, Adrenal Tumours etc.)
41
Q

In PCOS, in regards to menstrual irregularity, what are the 3 steps to treatment?

A
  1. COCP
  2. Cyclical Progestin
  3. Metformin
42
Q

How do you prescribe the cyclical progestin when managing PCOS?

A
  1. medroxyprogesterone 10mg PO daily for the same 12 days each calendar month
    or
  2. Levonorgesterel-releasing IUD
43
Q

How do you prescribe metformin when managing PCOS?

A
  1. metformin IR 250mg PO BD → increase by 500mg per week, up to maximum of 1g BD
44
Q

In regards to Clinical Hyperandrogenism in PCOS, what are the pharmacological options? 2 steps. Also how long will it take to see effects?

A
  • 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
45
Q

In regards to infertility in PCOS, what are the management options available to a GP?

A
  • 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
46
Q

Lifestyle management of Fibromyalgia?

A
  • graded aerobic exercise → reduce pain and fatigue + improve QoL scores
    • Program determined by time spent exercising rather than pain experienced
47
Q

Pharmacological Management of Fibromyalgia? (3 step options, be specific)

A
  1. Low Dose TCA → amitypitilline 10-25mg PO in early evening → increasing dose up to 25mg every 2-4 weeks as tolerated and according to response, up to a maximum maintenance dose of 50mg each evening
  2. Gabapentinoid → gabapentin 100-300mg PO in the early evening, increasing to TDS as tolerated up to a maximum of 2400mg split in TDS dosing
  3. SNRI → Duloxetine 30mg PO daily, increasing after 1 month to 60mg daily up to max of 60mg BD
48
Q

Do need to investigate trigeminal neuralgia? if so, how?

A

REQUEST IMAGING (MRI Brain) to exclude a structural cause especially in the presence of sensory loss - ?trigeminal neuropathy → request specific views of the trigeminal nerve and ganglion

49
Q

Management of trigeminal neuralgia?

A
  • Drugs are the first-line therapy for trigeminal neuralgia. Carbamazepine > Oxacarbazepine but the latter may be tolerated better.
    1. Carbemazepine MR 100mg PO BD (up to 400mg BD but titrate weekly)
    2. Oxacarbazepine 300mg PO BD (up to 600mg BD but titrate weekly)
50
Q

How do you diagnose Systemic Sclerosis?

A 
C - calcinosis
R - raynauds phenomenon
E - oesophageal dysfunction
S - sclerodactyly
T - telangectasia

Practice Exams (45 decks)

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