Aboriginal Health Flashcards
ATSI - key socioeconomic issues
Domestic violence/safety at home/sex without consent
Child abuse and neglect
Food security
Smoking/alcohol/drugs - foetal alcohol syndrome
Mental health issues
Communication issues with medical team/trust factor
Transport issues to hospital/living in remote areas
Poor access to local healthcare
Poor compliance
Low immunisation rate
Overcrowded households (respiratory/skin infections)
Family involvement in decision making/support
Cultural differences (death/after death/men’s business
and women’s business)
ATSI - role of aboriginal health worker
● Help people understand their conditions, medications and treatments
● Assist people and their carers to manage one or more of their severe chronic diseases
● Arrange and remind people and their carers of appointments
● Assist with access to specialist and allied health services
● Direct people to community programs
● Organise and assist with travel to and from medical appointments
ATSI - closing the gap methods
Aboriginal health assessment (item 715) Close the gap prescriptions Extra vaccines ● Bexsero and Vaqta (children) ● Pneumococcal (13 = children, after 50; 23 = 12 months after 12 then at least 5 years later)
50F, aboriginal, known active hepatitis C (5 yrs ago). Never received any treatment. Drinks 10 standard drinks/week.
LFTs are mildly deranged. Hepatitis A,B and HIV negative. Liver ultrasound shows superficial coarseness with normal
size. (Barriers preventing treatment, signs on examination, investigations to plan treatment)
Barriers preventing treatment 1. Financial limitations 2. Lack of understanding of seriousness of diagnosis 3. Lack of access to medical care 4. Lack of trust in the medical system 5. Alcoholism 6. Concerns about side effects of treatment 7. Lack of access to Aboridinal health worker Specific signs on examination ● Spider naevi ● Palmar erythema ● Finger clubbing ● Peripheral oedema ● Ascites ● Asterixis ● Jaundice ● Caput medusa Investigations to plan treatment ● Hep C viral load ● INR ● Fibroscan (liver transient elastography)
18F, Aboriginal, from a remote community. ? Pregnant, BMI 31. Lives with aunty, mother in rehab for ETOH issues.
Mum and aunties have T2DM, uncle has CKD. Brother committed suicide. No PHx or medications. IUTD.
Extra info - Dating scan 7+2/40. Excited about pregnancy. Good family support. Smoking 10/day. Occasionally gets
drunk.
Extra info - 18/40, black eye with bruising on arms, on edge.
Extra info - patient leaves partner (jailed for violent crime). Gave birth at 40 weeks, healthy boy, 3kg, 3 day stay in
hospital for BF establishment. IUTD. Hx 2x otitis media and recent pneumonia. Still BF, skinny side, weight chart
shows drop in percentile.
(relevant history, additional antenatal care, key features of consultation domestic violence, diagnosis for Jimmy, strategies for vaccine hesitancy)
Relevant history points to ask
● Sex without consent
● Risk profile for STIs
● Explore safety at home
● Substance use
● Last menstrual period
● Her feelings around pregnancy
● Financial security
● Mental health
In addition to routine antenatal care, what measures will you take to mitigate specific risks
Extra info - Dating scan 7+2/40. Excited about pregnancy. Good family support. Smoking 10/day. Occasionally gets
drunk.
● Early OGTT
● 5mg folate daily
● Involve Aboriginal health worker
● Smoking cessation advice
● Advise against alcohol in pregnancy
● Recommend limited weight gain in pregnancy given BMI
● Mental health assessment at each antenatal visit
● Advise 150 minutes of exercise per week
What are key features of consultation when discussing domestic violence in this context?
Extra info - 18/40, black eye with bruising on arms, on edge.
● Ask in a non-judgemental manner
● Validate decision to disclose
● Explain that violence is unacceptable regardless of cultural differences
● Enquire about immediate safety
● Offer involvement of police
● Explore financial impacts
● Respond with empathic approach
● Offer involvement of Aboriginal health worker
What is your diagnosis for Jimmy?
Extra info - patient leaves partner (jailed for violent crime). Gave birth at 40 weeks, healthy boy, 3kg, 3 day stay in
hospital for BF establishment. IUTD. Hx 2x otitis media and recent pneumonia. Still BF, skinny side, weight chart
shows drop in percentile.
● Failure to thrive (poor growth)
Patient is hesitant to consent to the vaccinations. What are strategies you would employ?
● Involve the Aboriginal health worker
● Non-judgemental approach
● Find out perceived barriers
● Explain how vaccination prevents the risk of serious infection
● Explain the specific preventive impact of immunisation on his respiratory infections
● Inform about financial impact with “no jab no pay”
● Explain limitations on child care and school attendance
Acute rheumatic fever (cause, clinical features, investigations, diagnostic criteria, management)
Cause: Group A Streptococcus pyogenes
Clinical features:
● Young
● Acute onset fever, joint pains, malaise
● Arthralgia
Investigations: FBE, throat swab, ESR, streptococcal ASOT, ECG, CXR, consider ECHO (.if ECG changes)
Diagnosis:
● Initial - two major, or one major + two minor manifestations plus evidence of preceding S.pyogenes infection
● Recurrent - two major, or one major + one minor, or three minor manifestations plus evidence of preceding
S.pyogenes infection.
Management:
● IM benzathine penicillin/azithromycin
● NSAID
○ Cease once symptom free for 1-2 weeks
○ Typical duration is 6 weeks
9M, febrile, developed a jerky dance-like movement of hands. Local hospital on bypass.
(important diagnosis, features on examination to confirm, immediate management apart from Ix, long-term management, primary prevention)
What important diagnosis should not be missed?
● Acute rheumatic fever
What features in history or physical examination would help to confirm your diagnosis?
● Evidence of preceding Streptococcus pyogenes infection
● Evidence of carditis (new murmur)
● Arthritis/arthralgia
● Subcutaneous nodules
● Erythema marginatum (rare)
Apart from investigations, what are two features of your immediate management?
1. IM benzathine penicillin
2. Ibuprofen 10mg/kg TDS
What is the most important consideration in ongoing management following the resolution of his acute rheumatic
fever?
● Secondary prophylaxis with monthly IM benzathine penicillin until 21 years or at least 10 years (whichever is
greater)
How could this have been prevented?
● Primary prevention with IM benzathine penicillin or phenoxymethylpenicillin with each episode of pharyngitis
or tonsillitis
Post-streptococcal glomerulonephritis (diagnostic features, Ix, Tx, follow up)
Diagnostic features: discoloured urine + periorbital oedema + oliguria.
Investigations: group A haemolytic-B streptococcal antigens, blood urea/creatinine, complement studies,
antistreptolysin O titre, DNase B
Treatment:
● Hospital admission
● Bed rest
● Strict fluid balance chart
● Daily weight
● Penicillin (if GABHS positive)
● Low protein and salt, high carbohydrate diet
Follow up: BP and kidney monitoring. Regular urinalysis.
4F, puffy face, presentation for impetigo 2/12 ago and scabies 4/12 ago.
(important diagnosis to consider)
What is the most important diagnosis that you need to consider?
● Post-streptococcal glomerulonephritis
Embedded tick
common location, treatment
Common location: scalp behind the ears.
Treatment: early removal. Need to remove the mouth parts too.
● First aid outdoor removal method
○ Loop strong thin thread around tick’s head as close to skin as possible
○ Pull sharply with twisting motion
● Office procedure
○ Administer small amounts of anaesthetic
○ Make a small incision to remove
Ocular trachoma
diagnosis, criteria, cause, mode of transmission, risk factors, complications
Diagnosis: clinical, no swab necessary
Criteria: more than 5 follicles over tarsal plate
Cause: Chlamydia trachomatis
Mode of transmission: close contact
Risk: overcrowded household, poor hygiene
Complication: scarring and contraction causing inturned eyelashes which may cause blinding
Treatment: oral azithromycin 1g STAT (adults), azithromycin 20mg/kg STAT (children), azithromycin 20mg/kg for 3 days (neonates)
8M, Aboriginal, sticky eyes for the past 2 weeks. Both are itchy, mainly in the morning but not sore. Denies blurry
vision.
(history questions, likely diagnosis, management)
History questions ● Preceding trauma ● Hay fever symptoms ● Gritty sensation in the eyes ● Ocular redness ● Recent URTI ● Fever ● Exposure to soaps/chemicals Likely diagnosis ● Ocular trachoma Management ● Oral azithromycin (20mg/kg) STAT ● Discuss treatment of the whole family if they have symptoms ● Encourage daily hand and face washing
3M, Aboriginal, 12 hour fever (39) with mild stridor. Not eating or drinking.
(most important diagnosis, other diagnoses, history to support most important diagnosis, immediate management (remote/rural GP in ED, GP practice)
Most important diagnosis and other to consider
● Most important: acute epiglottitis
● Others: croup, peritonsillar abscess, bacterial tracheitis
History to support most important diagnosis
● Lack of immunisation to Haemophilus influenza
● Recent drooling
● Muffled or hoarse voice
● Absence of cough
● Contact with similar case
Immediate management (remote or rural hospital run by GP)
● Keep child calm and comfortable
● Minimal handling
● Nil by mouth
● Transfer to ED via ambulance
● Oxygen to maintain saturations above 92-94%
Key features of immediate management (GP practice)
● Urgent transfer to hospital by ambulance
● Supplementary oxygen
● Keep child calm in sitting position
● Explain life-threatening situations to parents
● Defer invasive examination/procedure
