AKT COPY Flashcards
Pharm for reducing ETOH effects
Naltrexone or Disulfiram (makes you feel worse/crap with ETOH)
Pharm to reduce ETOH cravings
Acamprosate
Post viral URTI with vertigo, hearing loss and tinnitus
Labyrinthitis
Post viral URTI with vertigo, NO hearing loss and tinnitus
vestibular neuronitis
Investigation for accoustic neuroma
MRI with gadolinium contrast
“What bld test to test annually in Down’s?”
TSH
How long to avoid sexual intercourse post AMI?
8 weeks
COCP medication components
ethinyloestradiol 30mcg levonorgesterol 150mcg
Mirena IUD medication component
Levonorgesterol 52mg
“3 Cx’s of haemachromatosis (systems)”
- CLD
- Heart failure (restrictive)
- Arthritis (hands)
Gonorrhoea pharm Mx
500mg ceftriaxone IM + 1g azithromycin PO stat
Gonorrhoea contact tracing
2 months
Chlamydia test of re-infection
3 months
Chlamydia test of cure
4 weeks - pregnant or rectal chlamydia
Chlamydia pharm Rx
100mg doxycycline bd 7 days OR
1g azithromycin stat (pregnant)
Chlamydia contact tracing
6 months
Which anti-HTN can inc risk of T2DM
Thiazides
Which anti HTN causes HIGH calcium
Thiazides
Which anti HTN causes LOW calcium
Loop diuretics (Frusemide)
ICS example name and dose
Fluticasone proprionate 50mcg - child
125mcg - adult
SABA name and dose
salbutamol 100mcg
ICS/LABA name + dose
fluticasone proprionate 50 - 250mcg
salmeterol 25mcg
LAMA name + dose
tiotropium 5mcg (respimat) daily
Metformin eGFR contraindication
<30
SGLT2 eGFR contraindication
<45
DPP4 eGFR contraindication
NONE, just dose adjustment (except linagliptin - no change)
Sulphonylureas eGFR contraindication
<30
Metformin eGFR reduce dose to 1g?
30-60
GLP1 agonist dose
dulaglutide 1.5mg weekly
Sulphonylurea + dose
Gliclazide 40mg daily
DPP4-i dose
Linagliptin 5mg
SGLT2 and dose
Empagliflozin 10mg daily
Shockable rhythms
V Fib, V tach
Shockable rhythms pharmacology
Adrenaline 1mg after 2nd shock
Amiodarone 300mg after 3rd shock
Non-Shockable rhythms pharmacology
Adrenaline 1mg now, and then every 2nd cycle
“4 H’s of collapse”
Hypoxia
Hypovolaemia
Hyper/hypokalaemia/metabolic disorders
Hypothermia
“4 T’s of collapse”
Toxins
Tension pneumothorax
Thrombosis
Tamponade
AMI - GTN dose
300-600mcg sublingual every 5mins
Always check BP and avoid in inferior AMI
Indications for warfarin for AF Mx
eGFR <30
Valvular AF
(moderate-severe mitral stenosis or mechanical valve)
NOAC dose for AF
Apixaban 5mg bd
2.5mg if
At least 2 of:
- 80+ years old
- Weight under 60kg
- Creatine over 133
Contraindications to NOAC and warfarin (3)
- Previous intracranial bleed
- Recent GI bleed
- Pregnancy
Heart rate aim in AF
<80
Beta blocker dose in AF
Atenolol 25mg daily
Post AMI driving abstinence duration
2 weeks (private licence)
Post TIA driving abstinence duration
2 weeks (private licence)
Post CABG driving abstinence duration
4 weeks (private)
Post stroke driving abstinence duration
4 weeks (private)
2nd degree Type I ECG
Gradually elongating PR until drop (Wenkebach)
not serious
2nd degree Type II ECG
PR interval is normal Sudden drop in QRS
Urgent cardio referral
CCF - Moderate on exertion (Class)?
Clas III
CCF - Mild on exertion (Class)?
Class II
CCF - Symptoms at rest (Class)?
Class IV
CCF - No symptoms (Class)?
Class I
BNP level for CCF
BNP >1800
LVEF <35% medication
Ivabradine
LVEF <40% medication
ANRI - Entresto
Heart Failure Medications + Dose (3)
- Perindopril 2.5mg daily
- Spironolactone 25mg daily
- Bisoprolol 1.25mg daily (2nd line if euvolaemic)
HOCM ECG criteria
Deep R waves anterior leads
Tall Q waves lateral leads
Diabetic retinopathy medication and dose
Fenofibrate 145mg daily
Tamponade triad
“Beck’s”
- Low BP
- Muffled heart sounds, Jugular venous distension
Pericarditis meds + dose
Colchicine 500mcg
(bd if >70kg, daily if <70kg) for 3 months
Acute Rheumatic Fever Rx immediate (2)
Benzathine benzylpenicillin IM as a single dose 1.2 million units (adults)
NSAIDs/aspirin
Groin Rash DDx (4)
Candida Intertrigo
Tinea Cruris
Flexural Psoriasis
Erythrasma
PMHX Melanoma skin checks frequency
- 3 monthly for 2 years
- 6 monthly for 2 years
- 12 monthly for lifetime
Cat Scratch Disease Rx
Azithromycin 500mg 1st day, 250mg daily for next 4 days
Chickenpox Rx - adults
Adults - Valaciclovir 1g tds 7 days
Chilblains Rx
Keep warm
DO NOT RUB/MASSAGE
If extensive or painful:
- Strong topical steroid +/- occlusive dressing (betamethasone dipropionate 0.05% ointment bd)
OR
Severe/recurrent:
- GTN spray
- Nifedipine MR 20mg daily
Which infection is linked with Erythema Multiforme?
Herpes Simplex Virus
Commonest KNOWN cause of Erythema Nodusum
Sarcoidosis
4 causes of LVH
- HOCM
- HTN
- Atrial regurg
- Mitral regurg
- Coarctation aorta
Actinic/Solar Keratosis Mx
Spot area = Cryotherapy or Shave + curettage
Large area = Imiquimod 5% 3xweekly for 4 weeks or Fluorouracil 5% daily for 4 weeks
Keratocanthoma Rx
3-5 excisional biopsy
SCC Ix
Punch biopsy
BCC Ix
Punch biopsy
SCC Rx
Superficial = Cryotherapy, shave+curettage, Imiquimod 5% 5xweekly for 6 weeks
Fluorouracil 5% daily for 4 weeks
3D = surgical excision 3-5mm
Melanoma Ix
Excisional biopsy 2mm
Melanoma Rx
WLE + melanoma unit referral
BCC Rx
Superficial = Cryotherapy - double freeze thaw, shave+curettage, Imiquimod 5% 5xweekly for 6 weeks
Fluorouracil 5% daily for 4 weeks
3D = surgical excision 3-5mm
BCC typical spread
Locally
SCC typical spread
Lymphatics
Causes of acne flares (4)
- PCOS
- Humidity
- Occlusive cosmetics
- Drugs - steroids
What features to examine when assessing for a burn? (4)
Colour
Blisters
Sensation
Cap Refill
Deep dermal burn signs?
Painless
Non-blanching
White/mottled skin
Prolonged cap refill
Satellite lesions in skin folds
Candida Intertrigo
Candida intertrigo Rx
Clotrimazole 1% cream daily
Erysipelas pathogen
strep pyogenes
Chondrodermatitis nodularis Rx
Nitroglycerin ointment bd (1–2% glyceryl trinitrate)
1st line pharm to increase breastmilk supply
Domperidone
Compression mmHg to bandage ulcers
40mmHg
Secondary causes of hyperlipidemia (4)
CKD
Hypothyroidism
T2DM
CLD
4 contraindications to stress echo
Unstable angina
Severe aortic stenosis
New LBBB
Uncontrolled arrhythmia
Lateral STEMI leads + supply
I, AVL, V5, V6
Left Circumflex artery
Inferior STEMI leads + supply
II, III, AVF
Right Coronary Artery
Anterior STEMI leads + supply
V3-V4
Left Anterior Descending
Septal STEMI leads + supply
V1-V2
Left Anterior Descending
Posterior STEMI leads + supply
V7-V9
Right Coronary Artery
Contraindications to performing Valsalva’s for SVT (4)
AMI
Haemodynamic instability
Aortic stenosis
Glaucoma
Takotsubo Cardiomyopathy Rx
ACEi or beta blockers until resolved systolic dysfunction ~ 1 month
Dandruff 1st line Rx
Selenium sulphide shampoo
Discoid Eczema Rx
Strong steroid (betamethasone diproprionate 0.05% daily for 2 weeks)
What disease is dermatitis herpetiformis linked with?
Coeliac disease
Dermatofibroma distinctive features (2)
Pale centre Pinch sign (central dimple)
Rash with target lesions
Erythema Multiforme
Treatment of Erythema Multiforme
Treat Cause, but otherwise self resolves
- Aciclovir for HSV
- ABx for mycoplasma pneumoniae
ASTI smoking screening age
10
ATSI fasting T2DM check age
18
ATSI BP, UEC check age
18
Coral pink fluorescence under wood lamp
Erythrasma
Erythrasma Rx
Fusidate sodium 2% ointment bd for 14 days
Red swollen fingers+toes, linked with T2DM
Erythromelalgia
Itch/pain/burning rash in sun-exposed skin
Exercise-induced vasculitis or Golfer’s vasculitis
Exercise-induced vasculitis or Golfer’s vasculitis Rx
Self-resolving in 3-4 weeks
Folliculitis causative pathogens
Bacterial - Staph aureus, Pseudomonas aeruginosa
Fungi
Folliculitis Rx
Treat according to swab MCS
- commonly - flucloxacillin or cephalexin 500mg QID
Rash with firm papules “string of pearls” ring
Granuloma Annulare
Granuloma Annulare associated conditions (3)
T2DM
Hyperlipidemia
Autoimmune Thyroiditis (children)
Granuloma Annulare Rx
Strong steroid (betamethasone diproprionate 0.05% daily for 2 weeks)
Grover’s Disease Rx
Strong steroid (betamethasone diproprionate 0.05% daily for 2 weeks)
Spotty itchy rash in children (trunk) sparing hands/feet?
Guttate psoriasis
- linked with strep infection
Telogen Effluvium triad
- Stressful event
- 2-3 months to diffuse hair loss
- white bulbs
(Pull test = hair coming out)
Hair loss with chemo/radiotherapy
Anagen Effluvium
Exclamation mark hairs
Alopecia Areata
Androgenetic Alopecia Rx
- Minoxidil to dry scalp - for 12+ months (not for females)
- Finasteride for 2+ years - halts balding process (SE gynaecomastia)
What virus is associated with Hand, Foot & Mouth Disease?
Coxsackie virus
Management of Hand Foot & Mouth (2)
- Supportive, fluids (can become dehydrated)
- Keep home until blistered have dried/crusted
Herpes Simplex Virus Type I management?
First sensation - Aciclovir 5% cream 5 times daily for 5 days
Severe - Aciclovir 400mg tds for 5 days
Post-herpetic Neuralgia Rx (3)
- Simple analgesia/Ice massage
- Lidocaine 5% patch,
- Amitriptyline 10–25 mg nocte
Gabapentin 300 mg nocte
Shingles Rx
Valaciclovir 1g tds for 7 days
Impetigo NON-PHARM Rx
- Keep away until 24hrs after starting Abx
- Cover wounds
Impetigo Rx (non-endemic) + multiple sores
- Flucloxacillin 12.5 mg/kg up to 500mg QID 7 days.
- Keep away until 24hrs after starting Abx
Impetigo Rx (Endemic)
- Benzathine benzylpenicillin IM 1.2 million units
- Keep away until 24hrs after starting Abx
Impetigo Rx (non-endemic) + localised sores
- Mupirocin 2% ointment tds for 5 days
Impetigo Rx (penicillin allergy)
- Trimethoprim + sulfamethoxazole, bd for 3 days
- child 4/20mg/kg up to 160/800mg
Bullous Impetigo pathogen
Staph aureus (infectious!)
Bullous Impetigo Rx
- Flucloxacillin 500mg QID for 7 days
- Do not share towels with other family members
Keratosis Pilaris Rx
- Topical retinoids, salicyclic acid
Lichen Planus Rx
- Symptomatic - potent steroid (beta. dip 0.05%)
- Otherwise resolves in a few months
Molluscum Contagiosum causative pathogen
Pox virus
Nappy rash Rx
Dependent on cause
hydrocortisone 1% + nystatin 100 000 units BD or clotrimazole
Molluscum Contagiosum Rx
Self Resolves
Nappy rash causes (3)
Irritant dermatitis
Candida
Seborrheic dermatitis
Psoriasis
Nappy rash Rx
Dependent on cause
hydrocortisone 1% + nystatin 100 000 units BD
Lump with buttonhold invagination when pressed?
Neurofibroma
Perioral dermatitis Rx
Doxycycline 100mg daily for 8 weeks
Tiny black pits in soles of feet (Pitted Keratolysis) Rx?
Clindamycin 1% bd for 10 days
Pityriasis Rosacea Rx?
- Self-limiting - 6-8 weeks
- Use corticosteroid cream for itch
Pityriasis Versicolor Rx (2)
selenium sulfide shampoo 2.5% for 10 days
OR antifungal creams
Apply to wet skin and leave on for 10 mins
If ineffective, flucanozole 400mg oral stat
Pyogenic Granuloma Rx (1)
Imiquimod 5% 5xweekly for 6 weeks vs excision
Rosacea Non-pharm Rx (4)
Cleanser + moisturising routine
SPF 30+
Trigger avoidance
Avoid perfumes/colognes
Rosacea Pharm Rx (3)
- Topical metronidazole
- Azelaic acid
- Doxy 100mg daily 8 weeks
Scabies Rx
Permethrin 5% cream from jawline downwards overnight
Repeat in 1 week
Scarlet fever causative pathogen
Strep Pyogenes
Lace-like/sandpaper rash
Scarlet Fever
Scarlet Fever Rx
Phenoxymethylpenicillin 500mg bd for 10 days
Seborrhoeic Dermatitis (infants) Rx
Salicylic acid 2% + LPC (liquor picis carbonis = coal tar solution) 2% + sulfur 2%
Which tinea locations need oral terbinafine?
What dose?
Scalp, nails or widespread
250mg oral terbinafine daily
Toenails = 12 weeks
Fingernails = 6 weeks
Which tinea locations need topical terbinafine?
Everywhere except scalp/nails
1% terbinafine cream bd 2 weeks
Venous Ulcer appearance
Ragged edge, slight pain, slough
Arterial Ulcer Appearance
Punched out, Pain +++, Cold. Relieved by hanging out of bed
Lump with buttonhold invagination when pressed?
Neurofibroma
Diabetic/Pressure Ulcer Mx (3)
Clean base with saline
Relief of friction
Iodosorb ointment/Foam dressing
Pityriasis Rosacea Rx?
- Self-limiting - 6-8 weeks
- Use corticosteroid cream for itch
Pityriasis Versicolor Rx
selenium sulfide 2.5% for 10 days
Apply to wet skin and leave on for 10 mins
Rosacea Non-pharm Rx (4)
Cleanser + moisturising routine
SPF 30+
Trigger avoidance
Avoid perfumes/colognes
Rosacea Pharm Rx
- Topical metronidazole
2. Doxy 100mg daily 8 weeks
T2DM assessment for low risk asymptomatic patients.
- AUSDRISK >40yo
Scarlet fever causative pathogen
Strep Pyogenes
Lace-like scarlet rash
Scarlet Fever
Scarlet Fever Rx
Phenoxymethylpenicillin 500mg bd for 10 days
Seborrhoeic Dermatitis (infants) Rx
Salicylic acid 2% + LPC (liquor picis carbonis = coal tar solution) 2% + sulfur 2%
Which tinea locations need oral terbinafine?
What dose?
Scalp, nails or widespread
250mg oral terbinafine daily
Toenails = 12 weeks
Fingernails = 6 weeks
Requirements for HbA1c to diagnose T2DM
> 6.5% on TWO occasions
Causes of low HbA1c
Anaemia
Haemoglobinopathies
CKD
Requirements for OGTT to diagnose T2DM
(EITHER)
Fasting >7
2 hours >11
Neuropathic Ulcer Location
Plantar surface (pressure areas), well demarcated
What to examine for with foot ulcers (3)
- Sensation with 10gm monofilament
- Ankle Brachial Index Measurement
- Dorsalis Pedis/Posterior Tibialis pulse
T2DM Driving license with insulin
2 yearly license review +/- conditional
Arterial Ulcer Mx
Urgent vascular surgeon review for reperfusion
Diabetic/Pressure Ulcer Mx (3)
Clean base with saline
Relief of friction
Iodosorb ointment/Foam dressing
Urticaria Rx
Loratadine 10mg daily
Who needs annual screening for T2DM? (FBGL) (2)
Prediabetes
ATSI
T2DM assessment for low risk asymptomatic patients.
- AUSDRISK >40yo
FBGL intermediate range
5.5-6.9
Mx = perform HbA1c or OGTT
HbA1c intermediate range
6.0-6.4%
Mx = retest in one year
OGTT results for Impaired glucose tolerance
Fasting: <7 mmol/L
2 hour : 7.8 - 11 mmol/L
OGTT results for Impaired fasting glycaemia
Fasting glucose: 6.1-6.9
2 hour glucose < 7.8
Addison’s Ix
Short Synacthen test
○ Gives synthetic ACTH, should normally increase cortisol
○ In Addison’s (underfunctioning adrenal), there is no increased cortisol - positive test
Requirements for HbA1c to diagnose T2DM
> 6.5% on TWO occasions
Causes of low HbA1c
Anaemia
Haemoglobinopathies
CKD
Requirements for OGTT to diagnose T2DM
(EITHER)
Fasting >7
2 hours >11
OGTT results to Dx GDM
Fasting glucose >5.5 (reduce by 1.5)
Two hour glucose >8.0 (reduce by 3.0)
T2DM Driving license with OHA’s
5 yearly license review +/- conditional
T2DM Driving license with insulin
2 yearly license review +/- conditional
Which diabetic patients need conditional licenses (4)
- Severe hypoglycaemia
- Acute hyperglycaemia
- End-organ damage
- Commercial drivers on OHA’s/insulin - specialist review
Pre-exercise BGL range for T2DM
5 - 13.9
How often to check BGL during exercise if on insulin or sulfonylureas
30-45 minutes
How long after exercise can you get hypoglycaemia with SU’s/insulin?
48 hours
Fasting BGL aim in T2DM
4-7
2 hour post-prandial BGL aim in T2DM
5-10
Severe hypoglycaemia event, driving restriction
6 weeks until stabilised by specialist
Late Onset Autoimmune Diabetes Ix (4)
- glutamic acid decarboxylase (GAD) antibodies
- insulinoma antigen-2 (IA2) antibodies
- islet cell antibodies
- Insulin antibodies
How often to get eye Ax with T2DM?
24 monthly
12 monthly if - ATSI, systemic disease, >15 years Dx, poor control
What T2DM meds to cease on sick days or if BGL >15 on two occasions
Metformin, SLGT2 (dehydration risk)
Acromegaly Ix
IGF-1 - insulin-like growth factor
Carcinoid Syndrome Ix
24 hr urine 5-hydroxyindoleacetic acid
Conn’s syndrome Ix
Plasma aldosterone-renin ratio
Cushing’s Syndrome Ix (3)
- Overnight 1mg dexamethasone suppression test
- 2 measurements of late night salivary cortisol
- 2 measurements of 24 hour urinary - free cortisol excretion
Diabetes Insipidus triad
Weakness + Massive Polyuria + Polydipsia
Diabetes Insipidus Rx
desmopressin intranasally bd
DKA BGL and ketones diagnosis
BGL>11mmol/L and ketones > 0.6mmol/L
Hyperosmolar Hyperglycaemic State BGL and ketones diagnosis
BGL >30mmol/L and ketones anything
Mild hypoglycaemia Mx (BGL <4.0)
15 rule
- 15g of sugar (half fruit juice glass)
- Recheck in 15 mins
- Test every hour for next 4 hours
Severe hypoglycaemia Mx (reduced GCS)
Glucagon 1g IM stat
OR
Dextrose 50% 20mL
Severe hypoglycaemia event, driving restriction
6 weeks until stabilised by specialist
When to assess risk for OP
- Annually in post-menopausal women or men >50yo
T1DM Ix (2)
- Glutamic acid decarboxylase (GAD)
- Insulinoma antigen-2 (IA-2) antibodies
Osteopenia Dx
-1 to -2.5 T score
Osteoporosis Dx
Less than -2.5 T score
What Z score to be concerned for secondary causes
Less than -2.0 score
After starting carbimazole, when to recheck TFT’s and adjust dose?
4-6 weeks
Bisphosphonate dose
Alendronate 70mg oral weekly
Denosumab dose
60mg subcut 6 monthly
When to stop osteoporosis Rx?
5-10 years of Rx without any fractures and BMD >-2.5
Osteoporosis new medication. When to review?
6 months
Osteoporosis pt monitoring. When to review?
12 months
Osteoporosis pt monitoring. When to DEXA?
2 yearly
Non-osteoporotic, high-risk pt. When to review?
2-5 years (including DEXA)
Which medication to use in CKD + osteoporosis
Denosumab
Phaeochromocytoma Ix
24 hour urine metanephrines/catecholamines test
SIADH Ix (3)
- Urine osmolality >100
- High urinary sodium
- Low blood sodium (dilution)
SIADH Mx (1)
Fluid restriction <800mL/day
T1DM Ix (2)
- Glutamic acid decarboxylase (GAD)
- Insulinoma antigen-2 (IA-2) antibodies
Imaging of choice for goitre with Hyperthyroidism (uptake)
Thyroid Scintigraphy scan
Imaging for goitre with Hypothyroidism
Trial levothyroxine and check if nodule regresses first
If not, consider ultrasound
Drugs that can cause hypothyroidism (2)
Lithium, amiodarone (also hyper)
Graves Ix
Anti TSH Receptor Antibodies
Hashimoto’s thyroiditis Ix
anti-TPO (anti-thyroid peroxidase antibodies)
also elevated in thyroiditis
Hyperthyroidism Rx
Carbimazole 10-15mg bd
After starting carbimazole, when to recheck TFT’s and adjust dose?
4-6 weeks
When to use PTU instead of carbimazole?
Pregnancy, Thyroid storm, Preconception
Multiply CBZ dose by 10 to get PTU dose
Most important SE of carbimazole/PTU?
Agranulocytosis
Cease if febrile or pharyngitis
Subclinical asymptomatic hypothyroidism Mx
Repeat TFT’s in 6 weeks. Commence thyroxine if:
- TSH >10
OR
- Thyroid peroxidase antibody
When to consider partial hypothyroid replacement?
25-50mcg daily
- Elderly
- High CVD risk
- Subclinical (where TSH >10 on retesting)
Hypothyroidism Rx dose
levothyroxine 1.6mcg/kg daily (to nearest 25mcg, (50-100mcg
Thyroiditis Rx
- propranolol 10mg bd if symptomatic
- Repeat TFT’s in 6 weeks
- If painful - NSAID’s too
Allergic Rhinitis Examination signs (3)
- turbinate hypertrophy
- pale blue nasal mucousa
- Suborbital oedema
Oral thrush Rx
Under 2yo = 100 000 units nystatin 1mL QID for 1 week
Over 2yo = Micanozole 2% gel, 2.5mL QID 1 week
Imaging of choice for cholesteatoma
CT temporal bone
Examination findings of Infectious Mononucleosis (3)
- Splenomegaly
- Hepatomegaly
- Jaundice
- Rash
Meniere’s Disease Triad
Vertigo, tinnitus, hearing loss - Unilateral
Meniere’s Disease Mx (3)
- Limit salt <2g/day, ETOH, caffeine,
- Vestibular rehab
- Prochlorperazine 10mg daily
- Hydrochlorothiazide 25mg daily
What age to refer Nasolacrimal duct obstruction to opththal
> 12 months of age
Otitis Media risk factors (3)
- Smoking exposure
- Childcare
- Down’s syndrome
- Adenoid disease
Otitis Media ABx
Amoxicillin 15mg/kg tds for 5 days
Review in 48 hours
Otitis Media ABx if not improving with amoxi
If not improving in 48 hours,
Augmentin DF 875/125 bd for 5 days
Otitis Media ABx if allergic to penicillin
Cefuroxime 500mg bd for 5 days
Recurrent AOM criteria and Rx
3+ episodes in 6 months and need to be <2yo
amoxicillin 25mg/kg bd for 6 months
Glue ear (AOM with effusion) Mx?
- Tend to self drain in 4 weeks
- Refer if >3 months, or if causing hearing issues
Chronic Suppurative Otitis Media Dx criteria
> 6 weeks of perforated TM with discharge
Chronic Suppurative Otitis Media Mx (3)
- Ear toileting (rolled tissue spear QID until ear dry)
- Ciprofloxacin 0.3% ear drops (x5) bd until discharge free for 3 days
- Refer to audiology for hearing assessment
- ENT referral
Grommets +/- adenoidectomy indications (2)
- Chronic otitis media (>3 months) with effusion and hearing loss
- Recurrent otitis media with effusion
Otitis Externa Mx (3)
- Sofradex ear drops - 3 drops tds for 7 days
- Paracetamol 15mg/kg QID PRN
- Dry aural toileting QID PRN until canal is dry
Otitis Externa prevention (2)
- Aqua-Ear after water exposure
- Keep ear-dry, use earplugs or bathing cap during showering/swimming
Otosclerosis - what bone does it affect?
Stapes
Otosclerosis Mx (1)
- Referral to ENT for stapedectomy
Perforated TM broad causes (3)
Infection, trauma, growths
Safe perforated TM Mx (3)
- Dry toileting with tissue spear
- Self-resolving in 4 weeks
- Amoxicillin 500mg tds for 5 days if infected
Antibiotic indications for rhinosinusitis (3)
- Discoloured purulent discharge
- 38oC
- Severe localised pain
Sialoliths Mx (2)
- Conservative with massage and analgesia, warm liquids
- Infected = 7 days Flucloxacillin 500mg QID
Tonsillectomy Indications
Tonsillectomy Indications (6-4-2, 1-2-3 rule)
- 6+ episodes/year for more than 1 year
- 4+ episodes/year for more than 2 years
- 2+ episodes/year for more than 3 years
When to treat tonsillitis with ABx?
- Bacterial likely
- Immunosuppressed
- Previous complications
- ATSI
Bacterial tonsillitis Rx
Phenoxymethylpenicillin 500mg bd for 10 days
Penicillin allergy - azithromycin 500mg daily for 5 days
Vestibular Neuronitis Rx (1)
- Prednisolone 1mg/kg (up to 75mg) for 5 days
Anal fissure Mx? (4)
- Topical lignocaine
- Treat constipation - stool softeners, high fibre diet
- Sitz bath
- Topical GTN/diltiazem
- Local injection of botox
Bowel cancer 4 flag criteria for moderate risk
First degree relative <55yo (4)
First degree relative >55yo (2)
Second degree relative any age (1)
If moderate risk bowel cancer, screening?
FOBT every 2 years from 40-49
Colonoscopy every 5 years from 50-74
Aspirin 2.5 years from 50-74yo
If high risk bowel cancer, screening?
(Reduce age points by 5 years compared to mod risk)
Refer to family cancer clinic
FOBT every 2 years from 35yo
Colonoscopy every 5 years from 45-74yo
Medication for liver cirrhosis from portal HTN
carvedilol
Risk factors for coeliac disease (3)
Hypothyroidism
T1DM Diabetes
Autoimmune thyroid disease
Down’s syndrome
Diverticulitis non-severe attack Mx (3)
- Clear liquids for 2-3 days
- Amoxicillin + clavulanic acid 875/125mg bd for 5 days
- Penicillin allergy = Trimethoprim + sulfamethoxazole 960mg bd AND metronidazole 600mg bd 5 days
Gastro in nursing home. When to notify public health unit
- 2+ more residents
ABx indications for gastro (3)
- Septic
- Immunocompromised
- Salmonella or severe C.Diff (all other bacterial causes don’t require Abx)
When do you avoid loperamide for gastro? (3)
○ Children
○ Bloody diarrhoea
○ High fever
- Systemic symptoms
Lifestyle Mx for GORD (4)
- Avoid spicy food
- Remain upright after eating
- Weight loss
- Stop smoking
Urea Breath Test preparation advice (3)
- No Abx for 4/52
- No PPI for 2/52 before test
- Nil water in morning
- Nil brushing teeth
H. Pylori Rx (3)
HP7 treatment. ACE - all given BD
- Amoxicillin 1g (metronidazole 400mg bd if hypersensitive)
- Clarithromycin 500mg
- Esomeprazole 20mg
When to repeat UBT post H.Pylori Rx
4 weeks
Haemochromatosis Ix
Elevated transferrin + ferritin
Typical arthritis region for haemochromatosis
MCPJ 2nd/3rd joint
Hep A Mx
- Self limiting - 6 weeks
- Avoid fats, ETOH, panadol and smoking
- Wash hands, do not share cutlery
surface antigen
surface antibody
core antibody
Acute Hep B
POSITIVE surface antigen
NEGATIVE surface antibody
POSITIVE core antibody
surface antigen
surface antibody
core antibody
Chronic Hep B
POSITIVE surface antigen
NEGATIVE surface antibody
POSITIVE core antibody
surface antigen
surface antibody
core antibody
Vaccinated Hep B
NEGATIVE surface antigen
POSITIVE surface antibody
NEGATIVE core antibody
surface antigen
surface antibody
core antibody
Resolved Hep B
NEGATIVE surface antigen
POSITIVE surface antibody
POSITIVE core antibody
When does Hep C Mx need referring to specialist? (2)
- If HIV/HBV co-infection
- Cirrhosis present
When does Hep C Mx need referring to specialist? (2)
- If HIV/HBV co-infection
- Cirrhosis present
Assessment of cure for Hep C
- Hepatitis C RNA PCR and LFT’s at 12 weeks post treatment
IBD - pain before defecation?
Crohn’s
IBD commonly blood and mucous stools
Crohn’s
IBS Mx (4)
- Regular meal times
- Avoid triggers
- Low FODMAP diet
- Referral to dietitian
- Referral to psych for CBT
NAFLD Ix diagnosis
- AST and ALT >2x ULN
- AST/ALT < 1
- Needs USS/MRI/Imaging
NASH monitoring
6 monthly liver US +/- AFP
NAFLD Mx
Cirrhosis/NAFLD fibrosis score high = gastro referral, fibroscan +/- biopsy
NAFLD fibrosis score Low = manage risk factors
NAFLD Monitoring
6 monthly LFT’s
NASH monitoring
6 monthly liver US +/- AFP
Acute Pancreatitis Ix (Dx)
Lipase >3 UNL
Acute Pancreatitis Mx
- ED Mx for IV hydration due to high mortality
PBC or PSC
Males commonly
PSC
PBC or PSC
Linked with Ulcerative colitis
PSC
PBC or PSC
Female
PBC
PBC and PSC symptoms (4)
- Abdo pain
- Fever
- Fatigue
- Pruritis
- Jaundice
PBC or PSC
Colorectal cancer risk
PSC
PBC or PSC
Intrahepatic ducts only
PBC
Dx, pain in throat with cold/hot food
Oesophageal spasm
Gastric peptic ulcer. Pain after eating time frame?
Pain 30 mins after eating
Dudodenal peptic ulcer. Pain after eating time frame?
Relieved when eating, Pain starts 2-3 hours later
External haemorrhoids difference
Painful
Visible/palpable lump on outside
What type of haemorrhoids is treated with banding?
Internal
External haemorrhoids difference
Painful
Visible/palpable lump on outside
When can you break consent? (4)
- Patient permission
- Mandatory by law
- Necessary discussion with other health professional
- Duty to public health
What age to screen smoking in ATSI?
12yo
What age screen CVD (risk calculator)
45+ yo (ATSI >30yo)
Adrenaline dose for anaphylaxis in children
0.01mL/kg every 5 mins
My Aged Care referral criteria
> 65yo or >50 with homelessness/complex needs
Disabled Parking criteria
- Sig mobility deficit
- Sig neuro/cognitive deficit
- Standard parking bay is not big enough for equipment
Varenicline CI’s
Psychosis, suicidal thoughts, CVD, pregnancy/BF
Smoking cessation - Champix dose
Varenicline - 0.5mg for 3/7 -> 0.5mg BD for 4/7, then 1mg BD for 12/52
Smoking cessation 3 options (Rx)
Nortriptyline
Varenicline
Bupropion
NRT dosing
> 12yo - 10+ cigs or smoking within 30 mins wake up
▪ 21mg/24hr patch >45kg
▪ 14mg/24hr patch <45kg
Quick acting = 2mg chewable every 2 hours
NO false negatives = what statistical term
100% sensitivity
NO false positives = what statistical term
100% specifiicity
What helps to rule out disease (sensitivity or specificity)
SNOUT - Sensitive tests, where negative helps rule OUT
What helps to rule out disease (sensitivity or specificity)
SNOUT - Sensitive tests, where negative helps rule OUT
How to calculate number needed to treat?
1/Absolute risk increase
Incidence definition
number of new cases
Prevalence definition
number of exisiting cases
1st line investigations for easy bruising (4)
○ FBE + blood film
○ APTT
○ PT/INR
- Fibrinogen
Pernicious anaemia Rx (1)
IM 1mg hydroxocobalamin every second day for 2 weeks
and lifelong:
1 mg hydroxocobalamin IM every 3 months
Pernicious anaemia Rx (1)
IM 1mg hydroxocobalamin every second day for 2 weeks
and lifelong:
1 mg hydroxocobalamin IM every 3 months
Iron deficiency Rx (1)
100mg elemental iron daily for 3 months
Assessment for DVT?
Well’s score
Low = D dimer
High = Venous doppler of affected
DVT Mx
Apixaban 10mg bd for 7 days, then 5mg bd for 3 months
Except if pregnant or eGFR <30
Lymphoma’s how to diagnose
Excisional biopsy only
CRAB criteria multiple myeloma
Calcium - elevated
Renal - uremia
Anaemia
Bones - pain and fractures
Risk Factors for temporal arteritis (3)
Female
Age >50yo
PMR
Rotavirus vaccine age cutoff
1st dose by 14 weeks, 2nd dose by 24 weeks
Live vaccines CI (2)
○ Cancer patients on immunosuppressive therapy (e.g RTx/CTx)
High dose immunosuppressive therapy (>90mg pred/day or >2mg/kg children)
Pregnancy
Meningococcal B dosage for age groups
6 weeks – 12 months, 3 doses
12+ months, 2 doses
Pneumococcal ages for people who are well
70+yo
ATSI 50+yo
Shingles vaccine age
Recommended 60+, but anyone 50+ can request
Influenza dosing
- 6 months – 9yo need two doses 4 weeks apart only if first ever influenza vaccine
What vaccines can you not give for egg allergy (2)
Yellow Fever
Q fever
Causes of vaccines not working in patient (3)
- Expired vaccine given
- Cold chain breach of vaccine
- Manufacturing defect of vaccine
- Individual’s immune response was ineffective
Malaria Prophylaxis (1)
PROMOZIO start 2 days before continue 7 days after
OR
Doxycycline 100mg daily 2 days before, 4 weeks after
Fever + rash, travelled to NSW
Barmah Forest Virus
Fever, been with sheep and pigs
Brucellosis
Bruce Willis looks like sheep/pig
Fever, SE asia, retroorbital pain
Dengue Fever
Dengue Fever Mx
Conservative Mx, advise about possible risk of haemorrhage and shock
Giardia symptoms (2)
- Steatorrhoea
- Anorexia/LOW
- Fatigue
Giardia Rx (1)
- Metronidazole 400mg tds for 5 days
Fever, stupor, vomiting, returned from overseas
Japanese B Encephalitis
Fever, conjuncitivitis, headache, farmer
Leptospirosis
EPT = PET = Farmer pets
Or meat industry
Gastro symptoms after someone had poorly stored milk
Listeriosis
Li for milk
Listeriosis Rx (1)
Amoxicillin 1g tds for 2 weeks (pneumonia)
Leptospirosis Rx (1)
Doxycycline 100mg 7 days
Malaria Ix (1)
Thick and thin blood films for 3 days (initial may be too early to detect)
Malaria Examination findings (3)
Splenomegaly
Conjunctival changes
Cervical lymphadenopathy
Resp infection caught by birds
Psittacosis
Weakness, fever, abbatoir worker
Q fever
Q fever Rx (1)
- Usually spontaneously resolves in 2-6 weeks
- Doxycycline 100mg bd for 14 days
Can do Q fever vaccines for those at high risk
Insect bite, Queenslander
Queensland Tick Typhus
Queensland Tick Typhus Rx (1)
Doxycycline 100mg bd for 7 days
Painful animal bite + pain with drinking
Rabies
Rabies Rx
Vaccinate, even if after bite
Farmer, sparse spotty rash, fever
Ross River Virus
Parasitic worms in - Sub-Saharan Africa, the Middle East, Southeast Asia and the Caribbean
Schistosomiasis from contaminated faeces
Cat litter and contaminated/uncooked food
Fever, muscle aches
Toxoplasmosis
Traveller’s diarrhoea Rx
azithromycin 1g oral stat
Gradually worsening fever and abdo fever in returned traveller
Typhoid
Typhoid Rx (1)
Azithromycin 1g oral daily for 7 days
Eschar rash - Transmitted through bites, Asia
Typhus
Typhus Rx (1)
- Doxycycline 100mg bd
Anal warts Rx (1)
Podophyllotoxin 0.15% cream bd for 3 days, then nothing for 4 days. Repeat x4
Hairy leukoplakia is a sign of?
HIV
Time frame for post-exposure HIV prophylaxis
Within 72 hours of exposure
How long to take PrEP for HIV until covered
Males - 7 days
Females - 20 days
Exposure to influenza, but negative result Mx (1)?
Vaccinate
Influenza Rx (1)
Oseltamivir up to 75mg bd for 5 days
What Ix to do for needlestick injury (3)
- Hep B (anti-HBs, HBsAg)
- Hep C (anti-HBc IgG, Hepatitis C serology HCV RNA PCR)
- HIV serology
When to repeat testing for needlestick injury?
3 and 6 months
Indications for tetanus booster after injury
> 5 years since last dose + DIRTY or MAJOR wound
Indications for tetanus immunoglobulin after injury
Not completed 3 course of tetanus + DIRTY or MAJOR wound
Primary syphillis symptom (1)
Painless ulcer (Chancre)
Secondary syphillis symptom (1)
Rash
Tertiary syphillis symptom (1)
Systemic paralysis
Acute syphillis infection Ix (1)
- Syphillis Rapid Plasma Reagin (RPR) testing AND enzyme Immunoassay
This is also used for test of cure in 3, 6, 12 months
Chronic syphillis infection Ix (1)
Enzyme Immunoassay (EIA), positive for lifetime
Syphillis chancre investigation (1)
NAAT swab of ulcer
Rash, fever and myalgia after syphilis treatment?
Jarisch-Herxheimer reaction
Syphilis Rx (1)
Benzathine benzylpenicillin 2.4 million units IM injection stat
Pen allergy - Doxycycline 100mg bd for 14 days
Duration of therapy for provoked, distal DVT
6 weeks +
Duration of therapy for unprovoked DVT
3 months +
Duration of therapy for proximal DVT
3 months +
What is Pott’s disease?
MSK TB (TB in spine)
Tuberculosis Ix for acute disease (1)
- Sputum acid-fast bacilli smear x3
Tuberculosis Ix for chronic disease (1)
- Quantiferon Gold (does not check for active disease)
Prostate cancer screening age
- Offer 50-69yo every 2 years
- Offer 45-69yo every 2 years if risk factors
Even if high risk, controversial with screening
Prostatitis empirical Rx
Trimethoprim 300mg daily for 14 days
Epididymo-orchitis causes (4)
Mumps
Urinary source
STI source
Amiodarone
Epididymo-orchitis examination specific finding (1)
Prehn’s sign - relief of pain upon lifting of scrotum
Ehn happening to me - BXO
Blue dot sign
Torsion of testicular appendage
Indirect hernia vs Direct hernia
Common in young
Indirect
Indirect hernia vs Direct hernia
Can descend into scrotum
Indirect
Indirect hernia vs Direct hernia
Medial to inguinal vessels
Direct
Balanitis Rx
Canesten (1% clotrimazole) bd for 7 days after symptoms resolve
Peyronie’s disease associated conditions (3)
HTN
T2DM
Obesity
When to Rx Peyronie’s disease
- Only if causing pain or sexual interference
- Surgical
- Injections - collagenase
Erectile Dysfunction Rx (1)
Sildenafil 50mg PRN (max 1/day)
- Have on empty stomach
Erectile Dysfunction non-pharm Mx (3)
- Quit smoking
- Exercise
- Avoid ETOH/caffeine
- Weight loss
- Psychology
Premature Ejaculation Rx (2)
- Topical anaesthetic to penile shaft (lignocaine)
2. Dapoxetine 30mg 1-3 hours before intercourse
SPC monitoring Ix (2)
Yearly:
- bladder USS
- UEC’s
When to use triangular sling?
supports elbow - for fractures where traction would make it worse
E.g AC joint or clavicle # SNOH
When to use collar + cuff sling?
- when you need traction for fracture to heal
Humerus shaft, shoulder dislocation (internal rotation)
Shoulder dislocation Mx (1)
Collar and cuff
AC joint dislocation Mx (1)
Triangular sling (clavicle traction isn’t good)
Humerus fractures Mx (1)
Unless in corners, or displaced since it’s non WB bone, mostly conservative
What structure can get injured with humerus shaft fractures?
Radial nerve
Ulnar nerve palsy findings?
- Claw hand
- Unable to abduct fingers
Radial nerve palsy findings?
Unable to extend wrist
Median nerve palsy findings?
Unable to make OK sign (finger opposition)
Simple forearm fracture Mx (1)
Above elbow cast (to avoid supination/pronation)
Always do 1 joint below and above
Simple Wrist fracture Mx (1)
Below elbow cast
Olecranon fracture Mx (1)
ORIF (intrarticular normally)
Pulled elbow Ix (1)
None
Pulled elbow Mx (1)
Passive pronation and flex elbow
Maxillary # Mx (1)
Send to maxfax as can affect teeth modelling
Nasal # Mx?
Non-displaced = conservative Displaced = Max-fax referral
Orbital # Mx?
Send to ED urgently
Facial fracture ED referral indications? (3)
Pain with eye movements
Diplopia
Depressed malar eminence
Hyphaema
Pelvic # Mx
Usually conservative if non-displaced
Patellar # signs
Unable to straighten (extend) knee or SLR
as pulls on quads tendon
Patellar # Mx
No displacement = Immobilise walking plaster cylinder 4 weeks
Displacement or unable to extend knee = K wires
Distal fibular # Mx
POP back slab/moon boot
Repetitive back rotational movements leading to pain. Dx?
Spondylosis
Spondylosis Mx (1)
Rest from aggravating activity for 6 weeks
Radius/Ulnar # Mx
- If both fractured and aligned = heals well with cast
- Rotational deformities = reduction
- Displaced = operation
Colles # Mx
- Non-displaced = below elbow cast 4 weeks
- Displaced = reduction
Scaphoid # Mx
- Displaced = ortho referral
- Non-displaced = thumb spica cast
Mallet finger Mx
- Simple = Full extension splint
- Fracture/complex = surgery
Subscapularis action
Internal rotation
Teres minor action
External rotation
Infraspinatus action
External rotation
SLE Ix (3)
ANA +ve
anti-dsDNA
anti smith antibodies
RA Ix (3)
RF +ve
anti CCP
ANA +ve
Scleroderma Ix (1)
Limited anti centromere
Systemic anti SCL 70
“anti topoisomerase 1
Cut off for normal endometrial thickness post-menopause
<4mm
During what time of menstrual cycle is it best to get a TV US done to Ix?
Day 5-10 of menstrual cycle
Normal endometrial thickness PRE-menopausal
<12mm
Normal endometrial thickness PERI-menopausal
<5mm
What medication to give to stop breastmilk production
Cabergoline 1mg stat dose
COCP given and patient develops migraine with aura
Stop COCP
COCP Smoker >35 but quit last year
Stop COCP
COCP FHx of breast cancer <30yo
Okay to take COCP. Only PHx of breast ca
Major surgery with immobilisation, okay for COCP
No. high risk VTE
Sudden onset neck pain with RA/Down’s syndrome
Atlanto-axial disruption
Examination findings for cervical radiculopathy
Spurling test, slightly lateral flexion neck and push down head causes pain
Middle finger nerve root distribution
C7
Shoulder pain + stifness in all directions, active and passive movement pain
Frozen shoulder
Shoulder pain, active movements only, external rotation, abduction
Rotator cuff injury
Shoulder pain with Passive overhead movements
Bursitis/Impingement
Repetitive throwing -> shoulder pain
Glenoid Labrum Tear
How to assess for AC joint disruption
Paxinos sign - pinching AC joint together
Passive adduction of shoulder
When to consider radicular back pain imaging?
> 6 weeks, trial physical therapy
Ankylosing spondylitis triad
<40yo
Lasting >3 months
Morning stifness improving with exercise
Repetitive rotation causing back pain
SpondyloLYsis
Teenager with kyphosis, can’t touch toes
Scheuermann’s disease
Risk Factors for Carpal Tunnel Syndrome (4)
- Diabetes
- Hypothyroidism
- Pregnancy
- Trauma
When to give ABX for rhinosinusitis? 3 criteria
Fever > 38
Discoloured purulent discharge
Severe localised pain
Pain on lateral thigh, worse on pressure and climbing stairs
Greater Trochanteric Pain Syndrome (including bursitis)
Young athlete, tenderness in pubic symphysis
Osteitis Pubis
Young person who jumps a lot, pain inferior knee cap
Patellar Tendinopathy
Female and obesity, anterior knee pain ,worse with sitting prolonged period of time (movie theatre sign)
Patellofemoral Pain Sydrome
Teenager with pain on tibial tuberosity
Osgood Schlatter Disease
Painful knee clicking
Meniscal tear
Suprapatellar pain after overuse, worse at night
Quadriceps Tendonitis
Marathon runner with lateral pain on thigh
Iliotibial Pain syndrome
Pain in knees after kneeling prolonged period
Prepatellar bursitis
MRI knee rebatable conditions (2)
16-49 yo with either
- Acute ACL concern (following trauma)
- Acute unable to straighten knee (meniscal tear)
Unfit tennis player with calf pain during lunge
Gastrocnemius tear
Spa folliculitis. Causative organism + ABx choice?
Pseudomonas Aeruginosa
Ciprofloxacin
Shaving folliculitis causative organism + Rx
Staph aureus
Mupirocin 2% ointment bd
RF for scabies (3)
Nursing homes
ATSI
HIV
Onycholysis Rx (2)
Keep nails short
Avoid exposure to contact irritants
Wait for nail to regrow (separated nail won’t reattach)
Dermatoscopy - thrombosed capillaries
Warts
Plane (flat) warts on face treatment
tretinoin 0.05% cream daily for 3 months
RF for DDH (3)
Female
Breech
FHx
When to do US for DDH
6 weeks - 6 months, after this XR is better
Organic causes of constipation in children (3)
Allergy
Coeliac Disease
Hypothyroidism
Hypercalcaemia
Examination components for child constipation (2)
Abdominal palpation for faecal matter
Inspect anus for fissures/patency
Hyperpigmentation, weight loss
Addison’s
How is sarcoidosis diagnosed?
Bronchoscopy with endobrachial biopsy
Post exposure - when can people get chickenpox vaccine
Within 3-5 days of exposure
Cardiac complication of Marfan’s syndrome?
Aortic dissection
Marfan’s syndrome inheritance pattern?
Autosomal dominant
What valvular problem is in Marfan’s?
Mitral valve prolapse (MVP = tall guy)
Wernicke’s Encephalopathy triad
- Confusion/Encephalopathy
- Ataxia
- Occulomotor dysfunction
Wernicke’s treatment
IV thiamine 300mg tds -> 100mg IV daily -> oral 100mg thiamine (severe thiamine deficiency)
Korsakoff syndrome features?
Memory loss from chronic B1(thiamine) deficiency
Poor prognosis indicators in RA (3)
> 20 joints affected
High sustained ESR
Smoking
Impaired function early in disease
How long is erythema infectiousum contagious for
Until 24 hours after fever settles
Neonatal cephalic pustulosis Rx
Ketaconazole 2% topical bd
Fibromyalgia 1st line Rx
Amyitryptyline 10mg oral
What medications interact with COCP (2)
- Anti-epileptics
- Rifampicin
What contraception to use with anti-epileptics (2)
Mirena IUD
Medroxyprogesterone 150mg every 12 weeks
3 reasons for referral for acne
- Severe
- Considerable scarring
- Emotional/Social impact
Pre-eclampsia + Gestational Hypertension gestation diagnosis
> 20 weeks
Cardioselective beta-blockers (4)
Atenolol
Bisoprolol
Nebivolol
Metoprolol succinate
Causes of mouth breathing in children (3)
Allergic rhinitis
Deviated nasal septum
Adenoid hypertrophy
Smooth philtrum in child
Foetal Alcohol Syndrome
What blds to order when suspecting ADHD to exclude organic cause? (3)
- FBE
- iron studies
- TFT’s
Boxer # findings and Rx
Angulation of 5th metatarsal, K-Wire insertion
Morton’s neuroma location
Typically 3rd and 4th MTP joint space
Morton’s neuroma Rx (3)
Loose shoes with sponge metatarsal pad/Conservative (30% involute)
CSC injection
Surgical
Tibialis Anterior tendinopathy findings
Pain on plantar flexion (stretch) or resisted dorsiflexion (contraction)
5th metatarsal fracture Mx
If undisplaced, NWB for 4 weeks
If displaced or Jones (avulsion) #, ortho referral
Calcaneal # Mx
Caused by severe axial loading force Ortho referral (urgent)
Ankle Ottawa rules
Malleolar or Midfoot pain with either
Tenderness on these sites or inability to WB
Ankle tendinopathy history
Pain on rising after sitting
Plantar fasciitis history
Pain early morning during first steps
Tarsal Tunnel Tinnel test location
Inferior to medial malleolus
Tarsal tunnel syndrome Mx (2)
Orthotics
ICS injection
Surgical release
Elderly patient with medial foot/ankle pain and flat feet
Posterior tibialis tendinopathy
Posterior tibialis tendinopathy sign
Pain on resisted ankle inversion during plantar flexion
Ballet dancer, big toe pain on flexion
flexor hallucis longus tendinopathy
Name of test to check fo achilles tendon rupture?
Simmonds test (kneel on chair and calf squeeze)
Painful tiny fat lobules on heel. Dx?
Piezogenic Papules
Piezogenic Papules Mx?
Weight loss or cushioning
Active child with night time ankle pain
Tarsal coalition (accessory tarsal bone)
Severs disease age + pain location (Calcaneal apophysitis)
7-15yo - heel pain
Severs disease Mx (2)
Raised heel shoes
Avoid strenuous sport for 12 weeks
Paget’s disease Ix
Bone specific alkaline phosphate antigen
Sunburst appearance on XR
Osteosarcoma
Onion skin on XR
Ewing sarcoma
Pseudogout Ix
- Synovial joint aspiration with calcium pyrophosphate crystals
Dupuytren’s contracture difference with trigger finger
Dupuytren’s cannot be reversed
Dupuytren’s contracture associations
○ Overuse
○ ETOH
○ T2DM
Liver disease
Dupuytren’s Ix (2)
○ FBGL
LFT’s
Dupuytren’s Mx (3)
- Watchful waiting
- Physio/Hand therapy
- Collagenase injections
- Consider plastics/ortho referral
Rheumatoid extra-articular manifestations (3)
Episcleritis, carpal tunnel syndrome, pericarditis
Reactive arthritis extra-articular manifestations (2)
Urethritis, conjuncitivitis
Gout Mx (2)
Maintain healthy weight
Abstain from triggers (ETOH, red meat, soft drink)
Gout flare prophylaxis Rx
- NSAID - naproxen 500mg bd
OR - colchicine 0.5mg daily or bd
Gout prevention Rx
Allopurinol 50mg daily for 4 weeks, titrate with uric acid
Urate targets
<0.36 for gout
<0.3 for gouty tophi
Nailbed injury Ex (2)
- Check neurovascular status
- Check signs of fracture by finger movements (needs XR if suspicious)
Pseudogout Mx
Same as gout except for NSAID use
Osteomyelitis Rx (1)
IV flucloxacillin QID
Paget’s disease XR findings (3)
- Cortical thickening
- Sclerosis
Trabeculations of bone
Examination finding for plantar fasciitis (1)
- Pain on dorsiflexion of big toe (stretches plantar fascia)
PMR referral indications
○ diagnostic uncertainty
patient < 50yo
PMR Mx (2)
- Prednisolone – 15 mg/day for 1 month, then wean.
- Low-impact, light aerobic exercise to mitigate the effects of steroids
Definitive way to diagnose Rickets
XR
Morphea linked with?
Scleroderma
Myasthenia Gravis Ix (1)
Acetylcholine receptor antibodies
Motor Neurone Disease presentation
Hyperreflexia in wasted limb
Receptive aphasia, brain lobe?
Temporal
Expressive apahsia, brain lobe?
Frontal
Spatial disorientation, mathematics, brain lobe?
Parietal
Recognising faces/objects, brain lobe?
Temporal
Sparing of forehead with facial weakness?
Stroke
Bell’s Palsy Rx (3)
Prednisolone 1mg/kg (up to 75mg) daily for 5 days
Lubricating eye drops/Tape eye when not being used
Facial massage
Takes 3 months to recover
Ramsay Hunt Syndrome Rx (1)
- Valaciclovir 1g tds for 7 days
Carpal Tunnel Syndrome associated conditions? (4)
T2DM
Pregnancy
Repeated movements
RA
Carpal Tunnel Syndrome Mx (4)
- Night time splint
- Avoid repeated/overuse
- Referral to physiotherapist
Ultrasound guided corticosteroid injection at wrist
Medication for prevention of cluster headache? (1)
Verapamil
Huntington’s Disease inheritance pattern?
Autosomal dominant
Symptoms of intracranial hypertension (2)
Severe headache
Blurred vision
Migraine Rx (3)
Sumatriptan 50mg oral, then 2 hours later if needed
Ibuprofen 400mg tds
Metoclopramide 10mg tds
Migraine prophylaxis Rx (1)
Amitryptylline 10mg daily
Myasthenia Gravis presentation
NIL SENSORY, muscle weakness, diplopia and ptosis
Parkinson’s triad
Cog-wheeling rigidity
Shuffling gate
Pill rolling tremor
What two anti-emetics to avoid in Parkinson’s?
metoclopramide
prochloperazine (stemetil)
When to avoid levodopa
Addiction/Gambling problems
Perioral dermatitis mild (1)
metronidazole 0.75% cream or gel topically, twice daily for 4 to 6 weeks until skin returns to normal
Perioral dermatitis moderate Rx (1)
Doxy 100mg daily
Diabetic neuropathy Rx (1)
amitriptyline 5mg nocte
Restless legs Syndrome Rx (3)
Gabapentin 100mg/Pregabalin 25mg
Pramiprexole 0.125mg daily
Levodopa benzaride 100/25mg
When are seizures resolved?
- Resolved if seizure free for 10 years (including 5 medication free)
Post-ictal definition
> 10 minutes of
- Disorientation
- Memory loss
- Decreased verbal/interactive skills
Simple seizure meaning
no impaired awareness
Complex seizure meaning
impaired awareness
Occipital partial seizure symptoms
contralateral vision aura
Parietal partial seizure symptoms
contralateral sensory neuropathy
Temporal partial seizure symptoms
psychic changes (jamais vu, déjà vu)
Epilepsy diagnosis?
2 seizures at least 24 hours apart
Shingles Ix (1)
○ Viral swab for PCR
When to give Zoster vaccine after shingles diagnosis?
12 months afterwards
Shingles lifestyle advice (2)
Avoid contact with children, pregnant women and immunosuppressed until crusted lesions
Cover rash with non-stick dressing and Vaseline
Shingles Rx (2)
Valaciclovir 1g tds 7 days
Lidocaine 5% patch
Gabapentin 100mg/Pregabalin 25mg
Post stroke Rx (3)
- ACEi (aim for SBP 120-130)
- Atorvastatin 80mg daily
- Aspirin 300mg first day, then 100mg daily
Essential tremor Rx (1)
Propanolol 10mg bd
Trigeminal Neuralgia Mx (2)
- Avoid touching face
2. Carbamazepine MR 100mg bd
Wernicke’s Encephalopathy triad
- Ophthalmoplegia (Diplopia)
- Ataxia
- Confusion
Wernicke’s Encephalopathy Rx (1)
Thiamine 300mg IV for 3 days, then 100mg daily oral
Private Licence acuity requirements
At least one eye 6/12
Commercial Licence acuity requirements
Better eye at least 6/9 AND
Worse eye at least 6/18
Skin conditions linked with blepharitis (3)
Acne
Rosacea
Seborrhoeic Dermatitis
Blepharitis Non-pharm Mx (3)
- Warm compresses daily for 2 to soften crusts
- Gentle scrubbing of lashes with
- Massage eyelid
Sodium bicarbonate
Anterior blepharitis Pharm Mx (1)
If symptoms not controlled - chloramphenicol 1% eye ointment BD for 2 weeks
Amaurosis Fugax Mx (1)
- Referral to a neurologist within 72hrs of symptoms
Stop driving for 4 weeks
Cataracts RF (4)
- Smoking
- Age
- T2DM
Excessive ETOH consumption
Complete Heart Block Rx (2)
Atropine 0.5mg IV stat
Pacemaker
SVT Rx (1)
Adenosine IV 6mg
after trying Valsalva
SVT prophylaxis
Atenolol 25mg oral
V tach if stable Rx (1)
Amiodarone
If unstable, needs DC shock
Which NSAID’s have lowest GI SE’s
COX-2 inhibitors - Celebrex/Celecoxib
When to do 6 monthly AFP and Liver us for HCC surveillance? (2)
Cirrhosis and Chronic Hep B
Alcohol related liver disease specific findings (3)
Dupuytren’s contracture
Proximal myopathy
Parotidomegaly
Acute MiILD ascites Rx (2)
Spironolactone
Frusemide (second line)
Sodium restriction
Hepatic encephalopathy signs
Asterixis
Confusion
Muscle rigidity
Genital herpes Mx (3)
Valaciclovir 500mg bd for 10 days
Lignocaine gel topically to lesions/paracetamol 1g QID
Urinate in bath/shower if dysuria
Genital warts Mx options (4)
- No need for treatment if not causing discomfort
- Cryotherapy
- Imiquimod 5% cream, alternate days until warts resolve
OR - Podophyllotoxin 0.5% paint, bd for 3 days followed by a 4-day break; repeat weekly until warts resolve.
Opioid toxicity withdrawal Rx (1)
IV naloxone
Baby well in between episodes of vomiting with distress and pallor?
Intussusception
Intussusception age
2 months to 2 years
ETOH abstinence Rx (3)
Acamprosate - 666mg TDS
Disulfiram (Antabuse) 100mg daily
Naltrexone - 50mg daily
Bartholin’s abscess Mx (1)
Semi urgent gynae referral for marsupialisation IF recurrent
Patient complaint Mx (3)
Apologise to patient that “this has happened” (even if not your fault)
Offer to show clinic’s policy for lodging a complaint
Discuss with medical defence organisation
Document your actions and discussion points
Negative birefrigerence crystals joint aspirate
Gout
Rhomboid shaped crystals, joint aspirate
Pseudogout
Positive birefrigerence crystals joint aspirate
Pseudogout
Needle shaped crystals, joint aspirate
Gout
Medication overuse headache Rx (2)
- Change to ibuprofen 400mg tds for 5 days, then 3 days/week, then stop
OR - Prednisolone 50mg daily for 3 days, then taper over 10 days
Tension headache prophylaxis Rx (1)
Amitriptyline 10mg daily
Bacterial conjunctivitis Rx (1)
Chloramphenicol 0.5% drops 1 drop QID for 7 days
Viral conjunctivitis Mx (3)
Cold compresses
Lubricating eye drops
Hand hygiene
Allergic conjuncitivitis Rx (1)
olopatadine 0.1% 1 drop bd
Follicular conjunctivitis causes
Viral and chlamydia
Papillary conjunctivitis causes
pABillae (allergic and bacterial)
Chlamydial conjuncitivitis /Trachoma Rx (1)
Azithromycin 1g as single dose for all household contacts
Gonorrhoea conjuncitivitis Mx (2)
Urgent referral to ophthal
Ceftriaxone 1g stat IM and 1g Azithromycin oral stat
Coagulopathy after bite - animal/insect?
Brown snake
Most deadly spider
Funnel-web
Acute cholangitis triad
Jaundice, Fever, RUQ Abdo pain
Acute cholangitis Mx (1)
Refer to ED
High risk patient (pregnancy) exposed to shingles Rx?
Zoster immunoglobulin
Anal fissure Rx (1)
Glyceryl Trinitrate 0.2% ointment tds
Exercise induced asthma Rx (1)
If on most exercise days - first line = ICS
If very occasional - first line = SABA 15 mins before
Causes of leukocoria in children (3)
- Retinoblastoma
- Coat’s disease (retinal vessel growth)
- Congenital cataract
Dacrocystitis Rx (1)
Cefalexin
How to calculate ovulation date?
Length of period -14 days
Weakness + joint/muscle pain + violaceous facial rash
Dermatomyositis
Allopurinol hypersensitivity syndrome features (3)
High fever
Rash
Kidney Failure
(Life threatening)
What PHx to avoid probenacid in? (uric acid lowering med)
Kidney stones
Inflammatory picture hand joint pain DDx (5)
- RA
- SLE
- Reactive arthritis
- Psoriatic arthritis
- Scleroderma
Rheumatoid Arthritis Mx (3)
- NSAID’s
- Fish oil daily
- Physiotherapy
- Rest from exacerbating activities
- Quit smoking
Referral to rheum/pred
People on MTX can develop what deficiency?
Folic acid (1mg daily)
Complications of PMR (3)
- Giant cell arteritis
- Stroke
- Depression
- Chronic pain
Paget’s disease Rx
Zoledronic acid (or bisphosphonates)
Cryotherapy areas to avoid (3)
Head, neck, sides of fingers (nerves)
Which preterm/low birth weight infants need extra Hep B at 12 months?
<2000g or <32 weeks
TOC gonorrhoea
2 weeks for all infections other than uretheral infection
Gonorrhoea retest
3 months
Rabies exposure, vaccinated. Rx?
2 doses vaccine
Rabies exposure, never vaccinated. Rx?
4 doses vaccine and give HRIG
Small corneal abrasion Rx (1)
Chloramphenicol 0.5% eye drops, 1 drop QID daily
AND double eye pad
3 broad causes of dry eyes?
- Functional (aging)
- Systemic diseases (SLE, RA, Sjogren’s syndrome)
- Drugs (TCA, beta blockers)
Episcleritis Mx?
Self-resolving 2-4 weeks
NSAID’s for discomfort
Scleritis Mx?
Urgent ophthal review
Acute angle glaucoma Rx (1)
Pilocarpine 2% 1 drop
Fundoscopy findings for glaucoma (3)
Drusen (yellow deposits in retina)
Subretinal Haemorrhage (red patches)
Cupping
3 classes of medications for open angle glaucoma
- Prostaglandins- Latanoprost (Xalatan)
- Beta blockers -Timolol (Tenopt)
- Alpha adrenergic agonist (AAA) - Pilocarpine
Gestation you can fly at?
Under 35 weeks
Parvovirus exposure in pregnancy management
Serology now
If non-immune, repeat in 3 weeks to check for conversion.
Will need serial US to check for foetal hydrops
Keratitis (NON HSV) Rx whilst waiting for ophthal review
Ciprofloxacin 0.3% eye drops every hour
HSV Keratitis Rx whilst waiting for ophthal review
Aciclovir 3% eye ointment 5 times daily for 14 days
Loss of central vision - slow
WET macular degeneration
Pterygium Mx (3)
- Topical lubricants
- Wear sunglasses
- If sight is affected -> surgery
Retinal artery occlusion presentation
- Sudden, painless loss of vision - can be central or paracentral
Retinal vein occlusion presentation
- Subacute distorted vision; can be transient
Pain
Diabetic ophthal screening
1-2 yearly depending on glycaemic control
Established DM retinopathy ophthal review frequency
Reviewed by ophthal 3-6 monthly
Two examination tests for strabismus
Cover test
Light reflex test
When is strabismus not concerning?
Intermittent and <3 months old
Medication treatment for temporal arteritis (3). (Must refer urgently for biopsy +/- rheum)
- aspirin 100mg daily
- IV methylpred (if evolving vision loss)
- prednisolone 50mg daily 4 weeks (no vision loss)
Trachoma Rx (1)
Azithromycin 1g oral stat
Vitreous detachment presentation
40-70yo with floaters/flashes
Painless, blurred vision -> vision loss
When to refer infantile haemangiomas (3)
Ulcerated
Big
Not resolved by school age
Interference of confidence/function
Salmon patch/Naevus simplex Mx?
Nothing, facial ones fade within 1-2 years
Port Wine Stain Management?
Can refer to derm for laser if cosmetic concern.
Persist over lifetime
Sturge Weber Syndrome triad?
- PWS on face
- Vascular malformation of eye (glaucoma, enlarged pupil)
- Vascular ipsilateral malformation
Neonatal Cephalic Pustulosis Rx(1)
Ketoconazole 2% cream, bd until clear (usually 2 or 3 days)
Roseola Infantum Mx?
- Once rash is present, no longer contagious
- Spares face
- Conservative management - self resolving
Paracetamol dose kids
15mg/kg
Ibuprofen dose kids
10mg/kg
CMPA Mx? (3)
- Mum avoid CM if breastfeeding
- Baby avoid CM
- Hydrolysed baby formula (Aptamil gold or Pepti-Junior)
- Reintroduced CM with “Milk Ladder” at 12 months age
If re-bleeds, avoid for 6 months
Gold standard Ix for Meckel’s diverticulum?
Technetium-99 scan
Croup age
6 months - 6 years
When can you consider stopping anti-epileptics?
Seizure free for >2 years
Epilepsy resolved if seizure free for 10 years (including 5 medication free)
When to expect double birthweight?
6 months
When to expect triple birthweight?
12 months
Normal weight gain in 0-3 months?
150g every week or 30g per day
Febrile convulsions age?
6 months - 6 years old
Convulsions >5 mins? Rx?
Midaz (up to 10mg) buccal/intranasal
repeat in 10 mins
Given baby anti-emetic and they look like they’re having a seizure. Dx?
Dystonic reaction
ondansetron is best anti-emetic
When to start cow’s milk?
12 months (yoghurts/custards before are fine)
Growing pains presentation
3-5 yo and 8-11 yo
evening after intensive exercise
Thighs and calves
Kawasaki Disease criteria
Fever > 38.5 5 days AND “COLOR”
Conjunctivitis Oral mucous changes Lymphadenopathy Oedema Rash
How long to avoid live vaccines post IV methylpred/immunoglobulin
6 months after administration
DDH risk factors?
FHx First born Female Funny delivery - breech Fluid (Olighydramnios)
Imaging for DDH
Ultrasound (for 6 weeks - 6 months)
XR (for over 6 months)
Intoeing age
2-4 years old
Bow legs age
1-3 years old
What age should bow legs correct by?
3
What age should knock knees correct by?
8
Normal age for thelarche in females?
8-13yo
Normal age for menarche in females?
10-15yo
Normal age for puberty in males?
9-14yo
Precocious (early) puberty age?
GIRLS before 8, BOYS before 9
Delayed puberty age?
GIRLS thelarche over 13, no menarche over 16
BOYS over 14
PURPLE crying presentation
2 weeks - 5 months
Crying 3-4 hours/day, 3-4 times/week, resolves 3-4 months
Neonatal undescended testicle Mx?
Watchful waiting until 3 months, after this needs surgery if not down
ADHD triad
> 6 months
- Inattention
- Hyperactivity
- Impulsivity
Adjustment disorder presentation
Symptoms within 3 months of stressor, and not longer than 6 months after stressor has ceased
Out of proportion distress and impairment
Differentiating feature between Bipolar I and II?
No impairment of functioning with mania in II
hypomania
Side effects of clozapine (2)?
- Agranulocytosis
- Myocarditis
How often to review driving in dementia patient?
6 monthly
Dementia Rx (3)
Donepezil 5mg (CI seizures, heart block, asthma/COPD) Memantine 5mg (CI seizures) Rivastigmine
Lewy body dementia features
- Parkinsonism
- Visual Hallucinations
DSM criteria for anorexia nervosa
- Fear of weight gain
- Body dysmorphia
- Calorie restriction
Which anti-epileptics are safe in COCP, implanon and POP?
sodium valproate, levetiracetam
Which contraceptive measures are safe with all anti-epileptics
Depot or IUD
Narcolepsy presentation
Sudden attacks of sleepiness
Hallucinations
Cataplexy (sudden loss of muscle tone)
Idiopathic Hypersomnia presentation
- Confusion, disorientation after waking from sleep
- Difficult to wake from sleep
Lithium toxicity presentation
GI - nausea/vomiting/diarrhoea
Neuro - Tremor/hyperreflexia
CVD - QTc elongation
Lithium toxicity investigations (2)
Lithium levels + ECG (QTc)
What blds do you do for monitoring on lithium? (3)
Lithium level
TFT’s (every 6 months)
eGFR (every 6 months
Calcium
Assessment Order criteria
- Appears mentally unwell
- Sig risk to self/others
- No less treatment that will work
PTSD timeframe criteria
Symptoms >4 weeks since traumatic event
Acute Stress Disorder timeframe criteria
Symptoms >2 days, but less than 1 month of traumatic event
Baby blues presentation
Less than 10 days
- Lasts for 3-5 days
- Moodiness, overwhelming feeling or anxiety
- Affects up to 80% of women
Psychotherapy choice for borderline psd?
DBT
Psychotherapy choice for eating disorders
Family Therapy for children
CBT for adults
Psychotherapy choice for phobias
Desensitisation
Psychotherapy choice for interpersonal conflict
Insight-oriented or
Interpersonal
Psychotherapy for adjustment disorder
Supportive therapy
How to manage hyperprolactinemia from antipsychotic?
Add aripiprazole
OR
Cease antipsychotic
Management of mild hypomagnesemia
500mg bd Mg tabs
Causes of hypermagnesemia (3)
- Excessive intake - antacids, supplements
- Kidney impairment
- Rhabdomyolysis
- Lithium
Medications that can cause hyperkalaemia (3)
NSAID’s
Spironolactone
Trimethoprim
ACEi/ARB’s
Management of mild hyperkalaemia
<6.5
Stop any medications contributing
Resonium A
Management of severe hyperkalaemia
> 6.5
Send to ED for lethal risk of arrhythmia
Causes of hypokalaemia?
Conn’s
Insulin overdose
GI loss
Diuretics
Hypovolaemic Hyponatraemia causes? (3)
Vomiting
Burns
Diuretics
Adrenal insufficiency
Euvolaemic Hyponatraemia causes? (3)
SIADH SSRI's/SNRI Carbamazepine Hypothyroidism Adrenal insufficiency
Hypervolaemic Hyponatraemia causes? (3)
○ Heart failure
○ Liver cirrhosis
○ Kidney failure
- Nephritic syndrome
Hypernatraemia causes? (3)
Low Water
- Dehydration/Burns/Diarrhoea
- Diabetes insipidus (low vasopressin)
Sodium Overload
- Hypertonic NaCl
- Enemas
Hypernatraemia Management?
Slow volume replacement
Rash starting on neck, happens after fever subsides?
Roseola Infantum
Tellogen Effluvium Mx?
Reassurance, self corrects in 1 year
Alopecia areata Mx?
Self-resolving, can trial steroid topical/injections
Tinea Capitis Rx? (1)
Oral terbinafine 250mg daily 6 weeks
Hirsutism Rx? (1)
Cyproterone acetate
Seborrheic dermatitis Mx? NEONATE
Soak in baby oil for 1 hour, then wash and peel
Can trial Salicylic acid 2% + LPC (liquor picis carbonis = coal tar solution) 2% + sulfur 2%
Acute paronychia Mx?
Rx = Incisision for relief (with 21G needle), nil Abx needed
Chronic paronychia Mx?
Rx = avoid trigger, moisturiser + strong steroid cream
Angular cheilitis Mx?
vaseline
Geographical tongue Mx?
Reassurance and antiseptic mouthwash
How to determine milk tongue instead of candida?
Not thick
Present on inside of cheek as well (milk)
2 serology tests for post-strep GN?
Antistreptolysin O Titre (ASOT)
Anti DNase B Ab
Painless small haematuria Mx?
Repeat in 6 weeks with FWT
Common causes:
- Exercise, menstruation, trauma, STI, UTI
Persistent haematuria Ix? (2)
Urine MCS + casts
RBC morphology
AKI - pre-renal causes (2)
Hypovolaemia
- Sepsis/shock
- Burns/Trauma
- Dehydration
- Renal artery stenosis
test BP and HR
AKI post-renal causes (2)
RCC
BPH
test with US
AKI definition?
Over <48 hours
- Increase creatinine > 1.5 times baseline
OR - Significant reduction or urine output compared to normal (0.5ml/kg/hour)
How much renal function reduction is okay when starting ACEi/ARB?
<25% in 2 months
4 common causes of CKD?
HTN, DM, PCKD and GN
Side effects of ACEi (2)
Cough, hyperkalaemia, angio-oedema
After starting ACEi, when do you repeat UEC?
2 weeks, to check for <25%
CKD diagnosis
> 3 months of either eGFR <60 or 2/3 elevated uACR’s
uACR range for CKD?
Males <2.5
Females <3.5
What Ix to further do once Dx with CKD? (4)
fasting lipids, glucose, ESR/CRP
Renal tract US
When are statins indicated in CKD?
> 50yo with any CKD
<50yo with any CKD + stroke/DM/CVD
BP aim in CKD?
<130/80
Initially reduced eGFR, when to recheck?
7 days. if >20% reduction in eGFR, then AKI
When might uACR be unreliable?
- UTI/STI
- Menstruation
- Acute illness
- NSAID’s
eGFR <60, Stage of CKD?
Stage 3
eGFR <30, Stage of CKD?
Stage 4
Overactive bladder syndrome symptoms (3)
- Urgency - key symptom
- Frequency
- Nocturia
Overactive bladder syndrome initial Ix (2)
- Urinalysis to exclude infection, bld or glucose
- Urinary tract US to check PVR
- Bladder diary for at least 3 days
When to refer renal cysts?
- Multiple cysts
- Bilateral
- Hx of malignancy
UTI female Rx options (3)
- Trimethoprim 300mg for 3 nights (avoid 1st trimester)
- Nitrofurantoin 100mg QID for 5 days (avoid with Ural)
- cephalexin 500mg oral bd for 5 days.
UTI male Rx
Trimethoprim 300mg night for 7 nights
UTI prophylaxis indication?
> 2 UTI’s every 6 months
UTI prophylaxis Mx (3)
1.5-2L water daily
Intravaginal oestrogen cream in postmenopausal women
trimethoprim 150 mg orally, at night
Non-severe pyelonephritis adult Rx
Aug DF 875/125 bd for 14 days
Non-severe pyelonephritis child Rx
Trimethoprim 150mg bd for 10 days
Oral HSV treatment
valaiclovir 1g bd
What blds to do before treating with terbinafine?
LFT’s, risk of liver toxicity
What age to consider fasting lipids
> 45yo
How often to test lipids in healthy person >45yo with previous normal results?
5 yearly
Within how many days worker needs to notify employer for Worksafe injury
<30 days
When to refer umbilical hernias neonatal?
2 years
When to refer neonatal inguinal hernia
<6 weeks, refer within 2 days
<6 months, refer within 2 weeks
>6 months, refer within 2 months
When can you tell the eye colour of baby
6 months
When will fontanelle close in baby
posterior = 1-2 months anterior = 9-18 months
How long between breastfeeds in baby?
3 hours - to prevent lactose overload
When to avoid vagal manouvre
AMI
Glaucoma
Aortic stenosis
Haemodynamic instability
Coeliac disease testing for sensitivity
Transglutaminase-IgA (tTG-IgA),
Deamidated gliadin peptide-IgG (DGP-IgG)
Coeliac disease testing for specificity
HLA DQ8, HLA DQ2 gene test
Chronic prostatitis Rx (1)
Ciprofloxacin 500mg bd 4 weeks
Acute prostatitis Rx (1)
Trimethoprim 300mg daily 14 days
What thyroid increases risk of OP?
Hyperthyroidism
When to avoid live vaccine?
> 20mg CS and >14 days
OR within 6 months of chemo/RTx
Lifestyle advice prior to spirometry test
- No exercise/smoking day of test
What age can spirometry be performed at?
6yo
Reversibility SABA that is significant?
12% or 200mL
Approach to spirometry interpretation and cutoffs?
FEV1/FVC >0.7, FVC >0.8
Asthma triad of physiology
- bronchospasm
- airway obstruction
- mucous production
RF for asthma (3)
Smoking
PMHx of atopy
FHx
?Prematurity
Acute asthma - MILD/MODERATE
- speaking
- HR
- O2
speaks in sentences, normal HR, O2>94%
Acute asthma - SEVERE
- speaking
- HR
- O2
speaks in words, accessory muscle use, tachycardia, O2 - 90-94%, distress
Asthma - MILD/MODERATE. PEFR?
PEFR 50-75%
Asthma - SEVERE. PEFR?
PEFR 33-50%
Asthma classification. Intermittent with frequent flare ups?
no symptoms between attacks
attacks <1.5 months apart
Asthma classification. Intermittent with infrequent flare ups?
no symptoms between attacks
attacks >1.5 months apart
Asthma classification. Persistent - mild?
persistent = weekly symptoms or x2 nights/month
MILD =
FEV1>80%
Daytime symptoms more than once/week
Asthma classification. Persistent - moderate?
persistent = weekly symptoms or x2 nights/month
MODERATE =
FEV1>61-80%
Night symptoms more than once/week
Asthma classification. Persistent - severe?
persistent = weekly symptoms or x2 nights/month
SEVERE =
FEV1>60%
Continuous day/night symptoms
Pulsus paradoxus meaning?
decreased BP and pulse amplitude during inspiration
Sign of asthma
Second line testing for asthma?
Challenge testing (bronchial provocation) (metacholine; muscarinic agonist measuring hyper-responsiveness of asthma)
Phaeochromocytoma triad
Headache, palpitations and sweating with fever
How many days of pred for asthma flare?
3 days (given for moderate episode or worse)
3 history of poor asthma/COPD control
- Night symptoms
- > 2 days/week daytime symptoms or SABA use
- Limitation of activity or sleep
When can you step down asthma inhalers?
Well controlled for 6 months
Review in 1 month
ICS example and dose
fluticasone propionate - 1 puff bd
Kids - 50mcg
Adults - 125mcg
ICS/LABA example and dose
fluticasone propionate 50mcg (children), 125mcg (adults) +
salmeterol 25mcg
1 puff bd
Montelukast dose
2-5 years old: 4mg daily
>6 years old: 5mg daily
Symbicort age?
> 12yo
Asthma step up after low dose ICS
Under 12, increase to high dose ICS
Over 12, add LABA to low dose ICS
Gold standard for Ix bronchiectasis?
HRCT
Bronchiectasis exacerbation Rx?
- Amoxicillin 1g tds for 14 days
2. Doxycycline 100mg bd for 14 days
What demographic should COPD be considered in?
> 35yo + smoker/dust/gas/fumes
COPD CXR signs (2)
(Hyper-inflated lung fields)
- More than 6 anterior or 10 posterior ribs at mid clavicular line
- Flattened diaphragm
COPD exacerbations Mx steps
Worsening COPD (cough/sputum) = More SABA (4-8 puffs every 3-4 hours)
Infection (fever, sputum colour/volume) = Pred 50mg 5 days AND
Amoxicillin 500mg tds or doxy 100mg daily for 5 days
COPD step up approach
- SABA or SAMA
- Add LABA or LAMA
- Add ICS
After initiating new inhaler for COPD, when to reassess?
6 weeks
When to repeat spirometry in COPD patients?
Every 2 years or if symptoms worsen
What type of inheritance pattern is cystic fibrosis?
Autosomal recessive
Investigation for cystic fibrosis?
Sweat test
Complications of cystic fibrosis? (4)
Infertility
Steatorrhoea
DM
Recurrent respiratory infections
Which CCB and ABx is linked with pulmonary fibrosis (2)?
Amiodarone and Nitrofurantoin
Granulomatous lung disease types (2)
Sarcoidosis/Hypersensitive pneumonitis
Which interstitial lung disease is NOT linked with smoking?
Sarcoidosis
Pancoast tumour triad?
Shoulder pain
C8-T2 radicular pain
Horner syndrome (ptosis, miosis, anhidrosis)
Common CI to home O2 supplementation?
Smoker in last 6 weeks
Neck size thresholds for OSA RF
Male - 43cm
Female - 41cm
Two questionnaire’s for OSA?
Epworth Sleepiness Scale
Stop BANG questionnaire
Croup severe Rx (2)
nebulised adrenaline oral dexamethasone (0.6mg/kg) OR 2mg/kg pred and 1mg/kg next day
Croup mild Rx
1mg/kg prednisolone (max 50mg) oral stat, then wait for 30 mins to check improvement
When to give ABx for uncomplicated diverticulitis? (3)
- Failure to improve in 72 hrs
- R) sided
- Immune compromised
CT shows uncomplicated diverticulitis. 4 reasons to send them anyway?
- Unable to tolerate oral intake
- Fever >39
- Sepsis
- Severe pain/peritonitis
What is considered high falls?
2+ falls in last 12 months
Falls screening questions? (3)
- Are you presenting following a fall?
- 2+ falls in last 12 months?
- Are you having difficulty with balance
3 secondary conditions to lichen sclerosus vulvo-vaginal
Vulval cancer
Hashimoto’s thyroiditis
Pernicious anaemia
Vitiligo
Driving reviews for OSA?
COMMERICAL - Annual review with sleep physician
Investigations for pertussis and time frame? (2)
Pertussis serology - 4 weeks +
Nasopharyngeal swab - pertussis PCR - <3 weeks
Pertussis isolation period
5 days
Pertussis household contacts. Who needs acute Rx?
Treat member if in contact with childcare/<6mo/pregnancy/unimmunised
Pertussis household contacts. Who needs vaccination?
All close contacts who have not had booster within 10 years
Pertussis Rx (1)
ONLY if infection less than 3 weeks symptomatic
- Azithromycin 5 days - 500mg 1st day, then 250mg daily for 4 days
- Child = 10mg/kg for 5 days
Pleural Effusion - transudative causes (3)
Heart Failure
Liver Failure
Kidney failure (nephrotic syndrome)
Hypothyroidism
Pleural Effusion - exudative causes (3)
Infection - pneumonia
Malignancy - Lung
Connective tissue disorder - SLE
Sarcoidosis
Atypical pneumonia symptoms
Dry cough, low grade fever, body aches
Patchy bilateral infiltrates
Typical pneumonia Rx?
- Amoxicillin 1g tds for 5-7 days (pneumonia = double dose of amoxi)
Atypical pneumonia Rx?
Doxycycline 100mg bd for 5-7 days
Legionella Pneumonia Rx?
Azithromycin 500mg daily for 3-7 days
Pneumocystis Jirovecii Rx?
- Trimethoprim + Sulfamethoxazole 480/2400mg tds for 21 days
Typical pneumonia pathogens (3)
- Strep pneuominae
- Haemophillus Influenzae
- Legionella
Air-conditioning spreading pneumonia? Pathogen?
Legionella
How to diagnose Legionella pneumonia
Urine Ag or swab/sputum PCR
Atypical pneumonia pathogens (3)
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- TB
- Pneumocystis jirovecii
- Viral
Spontaneous pneumothorax acute Mx (2)
Observe for 4 hours
If hemodynamically stable, can D/C with analgesia
Normally resolves in 24-48 hours
Spontaneous pneumothorax monitoring (2)
2 weekly CXR’s until cleared
If not resolving by 8 weeks, refer to resp
Radiation pneumonitis Rx (1)
Prednisolone 40mg daily for 2 weeks then wean over 6 weeks
How to approach PE suspicion?
Well’s score high -> CPTA
Well’s score low -> PERC rule
ECG findings for PE?
Deep S wave in Lead I, deep Q wave in Lead III and inverted T wave in Lead III
Recommendation of gap between pregnancies?
2 year gap (<12 months = complications)
When to take folic acid in pregnancy
1 month prior to conception, continue until end of 1st trimester
When to take iodine in pregnancy?
As soon as trying + through to breastfeeding
When to do DTP vaccine in pregnancy?
20-32 weeks, at least 3 weeks before birth
When to do OGTT in pregnancy?
24-28 weeks
When to give anti-D in pregnancy and dose?
If bleed 12+ weeks and Rh -ve,
650IU anti-D injection within 72 hours
Under 35yo with breast changes. Ix?
Ultrasound +/- mammography
Over 35yo with breast changes. Ix?
Ultrasound + mammography (unless pregnancy/lactating, only for suss results or high clinical suspicion)
Suspicious breast change. Ix?
Ultrasound + mammography AND refer to breast surgeon regardless of result
When to refer fibroadenoma to surgeon? (2)
> 3 cm or persistent pain
Normal risk breast ca screening
50-74
Repeat every 2 years
If FHx, every 1-2 years
Physiological nipple discharge features (3)
- Bilateral
- Milky/yellow
- On expressing
PERC rule positive
- Oestrogen use
Breast thrush Mx (non Rx) (3)
- Sterilise dummy every day
- Keep nipple dry
- Wash hands frequently
Galactocele Mx
- If asymptomatic + not infected, Reassure.
Aspiration if persisting after breast feeding has ceased
Insufficient breast milk supply signs? (2)
- Baby demanding frequent feeds: continually suck hand
- Less than 3 wet nappies/24 hours
- Weight gain should be ~25g per day or a minimum of 150g per week
Insufficient breast milk Mx (3)
Breastfeed frequently
Offer each breast twice
Express after feeds
Insufficient breast milk 2 Rx options
- Domperidone 10mg tds
2. Metoclopramide 10mg tds
Mastitis Rx
- Flucloxacillin 500mg QID for 5-10 days
Allergy: cephalexin 500mg QID 5-10 days
Suppression of lactation Rx (1)
Cabergoline 1mg stat dose
Post-menopausal bleeding Ix (3)
- TV US including endometrial thickness (<4mm = normal)
- Co-test
- STI screen
Who needs chickenpox Rx?
Adults, children <28 days, eczema, immunocompromised
Primary amenorrhoea definitions (3)
- Not had menarche by 15yo
- Not had menarche and >3yrs post thelarche
- Not had menarche by 13yo with no sexual development
Secondary amenorrhoea definition
no menstruation for 3 months (regular) 6 months (irregular) in a woman previously menstruating
Missed pill and less than 7 active pills taken?
Usual advice and
Consider emergency contraception if it has occurred in last 5 days
Missed pill and less than 7 active pills left?
Skip inactive pills and go straight to active pills in next pack
3 Emergency contraceptions, dose and time frame
- Levonorgestrel 1.5mg <3days
- Ulipristal acetate 30mg <5 days
- Copper IUD <5 days
UPA (emergency contraception) special considerations (breastfeeding and COCP)?
Wait 5 days before COCP start
Express and discard milk for 1 week
SE of emergency contraception (3)
Nausea
Breast tenderness
Spotting
Increased risks of COCP (4)
VTE
Stroke/MI
Gall bladder disease
Cervical cancer
2 ways of starting COCP
- Active pills on 1st day of period (no contraception needed)
- Quick start, condom 7 days, pregnancy test in 4 weeks
NuvaRing action
- Insert ring and keep in for 3 weeks then remove for withdrawal bleed
Contraindications to POP (1)
Breast cancer in last 5 years
How quick does POP start to work?
2 days, if missed pill, need condoms for 2 days as well
Window for POP?
3 hours
How long does implanon take to work?
7 days
2 ways of starting Implanon
- Inserted 1st day of period (no contraception needed)
2. Quick start, condom 7 days, pregnancy test now and in 4 weeks
Implanon duration of effectiveness?
3 years
Depot Provera generic name
Medroxyprogesterone acetate
Depot Provera window of dosing
12 weeks (>14 weeks is delayed)
How long is delay in fertility of depot provera?
Up to 1 year
Apart from pregnancy, what condition to check before Mirena insertion?
Chlamydia screen
When to insert IUD?
1-5 days of period
When to review IUD after insertion
4 weeks for position and repeat pregnancy
When to use endocervical brush as well as cervical sampler? (2)
Non-visible transformation zone (post-menopause or post LLETZ)
Cervical ca screening routine age and frequency
25-74yo 5 yearly
Immunodeficiency = 3 yearly
Early sex <14yo before HPV vaccination, when to test CST?
Single HPV test between 20-24yo, then routine
If inadequate sample on HPV test?
Recollect in 6-12 weeks
When do you only need 2 abnormal HPV results before referral for colposcopy? (3)
○ Only 2 strikes if:
□ 50+yo
□ ATSI
- Overdue for screening by 2+ years
After colposcopy/high risk patient, when can they return to normal screening?
- TWO normal co-tests before they can go back to normal screening
Who is eligible for self collection CST? (2)
30yo + either
> 2 years since last test or never been tested
Immune deficient + HPV detected, but not 16/18. Mx?
Colposcopy (any HPV in immune-deficient = colp)
Hysterectomy CST screening?
- None if benign condition
- 2x annual co-test until 2 negative results
- Subtotal (cervix still present) - routine
Pain on sexual entry, young female?
Vaginismus (pelvic floor spasm)
Pain on sexual entry, burning on light touch
Vulvodynia
When to do early OGTT for high risk pt?
16 weeks
Postpartum GDM monitoring? (2)
OGTT 12 weeks post delivery
FBGL + HbA1c 3 yearly thereafter
Glycaemic targets for GDM?
Fasting, 1 hour post, 2 hours post
- FBGL <5
- 1 hour after meals <7.4
2 hours after meals <6.7
Subfertility definition?
> 12 months if <35yo
>6 months if >35yo
Sub-fertility lifestyle advice (3)
- Smoking cessation
- Weight loss 5-10% if BMI >30
- Ovulation awareness + intercourse at least 3 times/week
Premature menopause age?
<40yo
What age can you use COCP/vaginal ring until with menopause?
50yo
When has someone hit menopause?
> 12 months from LMP (but 2 years if <50yo)
How long is contraception needed in menopause
12 months after final period for >50yo
24 months after final period for <50yo
How to Dx premature menopause? (2)
- FSH >25IU on two occasions at least 1 month apart
AND - Amenorrhoea 6 months
HRT risk reductions (3)
- Osteoporosis risk reduction
- Colorectal cancer risk reduction
- Diabetes risk reduction
Tibolone indication
Menopause only
Tibolone risk difference to combined HRT?
No VTE risk with tibolone
Atrophic vaginitis Rx (1)
Estriol 1mg/g cream - one applicatorful intravaginally nocte for 2 weeks, then reduce to t
SNRI name and dose for menopause?
Venlafaxine 37.5mg daily
What size fibroids do we refer for?
3+cm
What percentage of pregnancies miscarry?
15%
CAP children If penicillin hypersensitivity or not improving after 48 hrs?
Azithromycin 10mg/kg or clarithro or doxy
cefuroxime for non-severe
If immediate penicillin allergy, what do you want to avoid?
anything ending in cilin, OR anything starting with cef (cephalosporins)
If mild penicillin allergy - e.g rash, what do you give usually?
Cephalosporins (cef—)
Osgood Schlatter Mx (1)
Quadriceps strengthening + modified activities
Timing between COVID vaccine and influenza vaccine?
7 days
What age to consider LABA addition to ICS (instead of high dose)
6yo+
Neonatal hydrocele, when to refer?
12 months if not resolved
What to do if one parent doesn’t want vaccination?
Do not give, need to discuss with both parents
What temp to not give vaccine?
> 38.5
Dose of anti D to give to women >10 weeks
250IU
What size miscarriage POC needs surgical Mx?
> 5cm
Follow up for expectant miscarriage Mx? (2)
TV US after TWO week
HCG every second day -> weekly
Follow up for medical miscarriage Mx? (2)
TV US after ONE week
HCG every second day -> weekly
When is expectant miscarriage Mx considered failed
3 weeks
How long to try again for pregnancy after miscarriage?
2 months/cycles
PCOS Dx?
2 of 3
- Irregular cycles
- Clinical/serological hyperandrogenism
- > 12 cysts
What sign on FWT indicates contamination?
Epithelial cells
UTI Rx children (1)
Trimethoprim-sulfmethoxole 4+20mg/kg (160/800 max) bd for 3 days
What do if pregnancy exposed to VZV?
If had VZV, nil concern.
If unsure, check serology before giving varicella immunoglobulin
What classifies as Sig exposure to VZV? (2)
Face to face for more than 5 mins
Same household
When is chickenpox infectious
2 days before rash comes until crusted
What is the name of dislocated radius and fractured ulnar?
Monteggia fracture-dislocation
Rx = reduction
Nerve injury = radial nerve
What is a buckle fracture?
Incomplete fracture -> bulging or cortex but no radiolucency
Buckle fracture of distal radius Mx?
Below elbow removeable backslab/splint 3 weeks (buckle heals well because incomplete fracture)
Complete fracture of distal radius Mx?
Below elbow cast for 6 weeks + fracture clinic in 7 days
because it is unstable and can move
How long limping child do you get worried and XR?
> 7 days
When can boys retract foreskin?
17yo
How long is pertussis infectious (if not treated?
3 weeks
How long is pertussis infectious (if treated)
5 days (same duration as ABx)
What is classified as sig exposure to pertussis
within 1m for 1 hour
Otherwise intelligent and well child with generalised clumsiness?
Dyspraxia/Apraxia or Developmental coordination delay
Dyslexia meaning?
Poor reading and spelling
Diagnostic criteria for ITP?
Isolated low platelets
HSP triad?
arthralgia, rash and abdo pain
HSP investigations?
Urinalysis - protein, otherwise clinical diagnosis. Normal bleeding time, platelets and coags
Night terror characteriristics
Glassy open eyes, unable to recognise/be comforted
PID Rx
Ceftriaxone 500mg + metronidazole 400mg bd + doxy 100mg bd 14 days (double chlamydia duration)
When to resume intercourse post birth?
1.5 months after NVB, 3 months if tear/c-section
Endometritis Rx?
Localised = Augmentin DF bd for 7 days Systemic = urgent ED for IV ABx
Pre-eclampsia Dx?
> 20 weeks gestation
HTN + proteinuria OR HTN with end-organ dysfunctio
Pre-eclampsia Mx?
Urgent hospital transfer
Gestational HTN Dx?
> 20 weeks, SBP >140/90 without signs of pre-eclampsia
Rx for HTN in pregnancy? (3)
Labetalol (CI asthma), methyldopa (avoid in depression), nifedipine
Which asthma preventer is best in pregnancy
Budesonide
How long to avoid pregnancy after live vaccine?
28 days
Nausea/vomiting in pregnancy? Rx (1)
Pyridoxine (vitamin B6) 25mg PO tds 1st line
GORD Rx options in pregnancy? (2)
- Mylanta PRN
2nd line - H2 receptor antagonist - ranitidine/famotidine
Implantation bleeding timeframe?
First 2 weeks
Medical termination time frame?
9 weeks
Surgical termination time frame?
24 weeks
Two medications for medical termination?
Mifepristone and misoprostol
Vaginal candidiasis Rx?
Clotrimazole 1% PV nocte for 6 nights
Tinea Cruris Rx?
terbinafine 1% top BD for 7-14 days
How to diagnose lichen sclerosus vulvovaginal?
Punch biopsy
Lichen sclerosus Mx? (3)
Refer to gynae
Strong steroid (diprosone OV) for 6 months - derm
Follow up every 6 months for vulval cancer checking
Lichen planus difference to lichen scelrosus - vulvovaginal?
Planus = pain, sclerosus = itch
Bacterial vaginosis Rx?
metronidazole 400mg BD for 7 days
Urethral caruncle Rx?
Topical oestrogen
Head lice Rx?
1% permethrin cream scalp. Leave for 10 mins and then repeat next week
Or maldison topically
WET COMBING
Private license driving requirements?
At least one eye 6/12
Commercial license driving requirements?
Better eye at least 6/9
Worse eye at least 6/18
Chickenpox Rx - children and indication
Children with immunocompromise/eczema or <28 days
- aciclovir 20 mg/kg up to 800 mg orally, 5 times daily for 7 days
Champix - how to start?
Start 1/52 before quit date
OR
Continue smoking, but stop smoking after day 8 of champix
Plantar fasciitis Mx? (3)
Get arch supported shoes
Exercise to stretch calf muscle
Ice
Posterior blepharitis Mx?
Systemic antibiotics used (particularly if associated with rosacea) Doxycycline 100mg daily
When is denosumab dose delayed?
> 4 weeks
Cluster headache Rx (1)
Verapamil
Elevated, firm, growing skin lesion. Dx?
Nodular melanoma
Diameter cut off for melanoma concern?
6mm
Tender and ulcerated new skin lesion
SCC
Painful central vision loss in one eye?
Optic neuritis
lower EYELID non-healing growth?
BCC
lower LIP non-healing growth?
SCC
Yellow spot on sclera?
Pinguecula
Which side does pterygium affect?
Medial canthus only
Difference between scleritis and anterior uveitis?
Scleritis = nil vision change
HSV keratitis Mx (2)
Urgent ophthal review + start aciclovir 3% drops 5 times day for 2 weeks
standard dose PPI
Esomeprazole 20mg or pantoprazole 40mg
Photokeratitis Rx? (2)
AKA flash burn
Oral analgesia
chloramphenicol drops
3 NON-idiopathic causes if subconjunctival haemorrhage?
- HTN
- DM
- Coagulopathy/Trauma
Sudden onset painless loss of vision, flashes and floaters. Curtain closing over
Retinal detachment
Night blindness in child?
Retinitis pigmentosa
Sixth cranial nerve?
Abducens
Anterior uveitis Mx
Urgent referral 24 hours to ophthal
Viral keratitis Mx
Urgent referral 24 hours to ophthal
What condition is linked with marginal keratitis?
Rosacea
Marginal keratitis Mx (3)
Treatment is same as blepharitis (3)
- Lid massage
- Warm compress
- Scrub any crusting off
Bacterial keratitis Rx? (1)
Ciprofloxacin 0.3% eye drops
Herpes Zoster Ophthalmicus Rx?
Valaciclovir 1g tds for 7 days
Infected tear duct Dx?
Dacrocystitis
Dacrocystitis Mx (3)
Treatment is same as blepharitis (3)
- Lid massage
- Warm compress
- Scrub any crusting off
Gonococcal conjunctivitis Rx? (1)
Ceftriaxone 1g IM stat and Azithro 1g oral stat
Periorbital cellulitis Mx? (2)
- Flucloxacillin 500mg QID for 7 days
- Review in 48 hrs, if not improving, IV therapy needed
How to tell if raised ALP is due to bone?
Normal GGT
Investigations to assess overal liver function? (2)
Serum albumin (raised = chronic cause) INR
Alcholic liver disease classic finding`
AST:ALT >2
Multiple melanoma looking spots, all looking similar. dx?
Atypical naevus
Behcet’s disease triad
Mouth ulcer, genital ulcer, eye problems
Angular stomatitis Rx?
vaseline OR (fungal) clotrimazole cream 1% bd for 2 weeks
Joint pain, hearing loss, headache
Paget’s disease
Serology for Paget’s Disease (1)
ALP
Rx for Paget’s Disease (1)
Bisphosphonates
Eczema herpeticum Rx? (1)
Antiviral
Herpetic whitlow Rx (1)
Antivirals
Dermatitis Herpetiformis Rx (1)
Dapsone oral (specialists) and avoid gluten
Dermatitis Herpetiformis Ix (1)
Punch biopsy
Dermatitis Herpetiformis distribution (4)
Back, knees, bum, elbows
What to screen 1st degree relatives of haemochromatosis with?
HFE gene mutation and iron studies
Haemachromatosis genotypes? (2)
C282Y and H63D
Kids need testing =
Homozygous C282Y OR
Heterozygous combined C282Y/H63D
Scalp seborrhoeic dermatitis Rx? (2) ADULT
Selenium sulphide/anti-fungal shampoo + strong steroid
Body seborrhoeic dermatitis Rx? (2) ADULT
Hydrocortisone 1% + clotrimazole 1% daily until skin clear
Flushing Rx (1)
- propanolol 10mg bd
2. clonidine
Erysipelas Rx
phenoxymethylpenicillin 500mg QID for 5 days
What condition is linked with multiple granuloma annulare?
T2DM
PTSD, acute stress disorder classic features
Intrusive/negative thoughts of previous trauma that causes avoidance of stimuli
Adjustment disorder Mx? (2)
- Psychoeducation, relaxation, stress Mx
2. Clonazepam, Diazepam, Lorazepam
What herbal Rx with SSRI -> serotonin syndrome?
St John’s Wort
Chronic Fatigue Syndrome Timeframe?
> 6 months
Performance anxiety Mx (2)
- CBT/Psychotherapy
2. Propanolol 10mg bd
Which SSRI to avoid in pregnancy?
Paroxetine
Which SSRI to avoid in breastfeeding?
Fluoxetine
Excessive worry about a little medical condition?
Somatic symptom disorder
What two antipsychotics can cause inc prolactin and galactorrhoea?
Risperidone and paliperidone
Reversing parkinsonism from antipsychotic? Rx(1)
benzatropine
Neuroleptic Malignant Syndrome Rx? (1)
Bromocriptine
Cannabis overdose Rx?
Relaxation +/- Benzodiazepine
Methamphetamine overdose Rx?
Benzodiazepine
Opioid overdose Rx?
Naloxone
What type of leg ulcers are linked with smoking
Arterial
Elevated ABI, leg ulcer?
Venous
Decreased ABI, leg ulcer?
Arterial
Hypergranulation tissue Rx?
Silver nitrate
Age to consider secondary HTN?
<30yo
Box jellyfish Mx? (2)
Remove tentacles using seawater
Apply vinegar to area
How to remove jellyfish tentacles? (1)
Using seawater
Bluebottle jellyfish Mx?
Remove tentacles using seawater
Hot water immersion of limb
Snake Bite Mx? (2)
Immobilise limb Pressure bandage Call ambulance Don't wash Contact poisons hotline if in hospital
2 deadliest snake bites?
tiger snake
brown snake
2 deadliest SPIDER bites?
Funnel web
Red back spider (not so bad)
Red back spider bite Mx? (2)
Analgesia (pain can last for 5 days)
Tetanus
DO not pressure bandage
Funnel web spider bite Mx? (3)
transfer to hospital
Pressure bandage
Contact poisons hotline for antivenom direction
tetanus
1st line Rx for mild dementia (alzheimer’s and lewy body) (2)
- Donepezil OR Galantamine OR rivastigmine
1st line Rx for moderate dementia?
- Memantine
4 types of dementia?
Alzheimer’s
Vascular
Frontotemporal
Lewy Body
If bite infection and allergic to penicillin? Rx?
Metronidazole and Doxycycline
Weber A ankle fracture Mx?
WBAT in walking boot
Sustained erectile dysfunction terminology?
Priapism
Priapism home Mx? (2)
Cold shower on area
Gentle jog around house
Priapism ED dept Mx? (3)
Intracavernous phenylephrine injection
Corporal aspiration of bld
Request urology input
2 complications of priapism?
Disfigurement
Ongoing erectile dysfunction
Mx of viral acute rhinosinusitis (3)
- Nasal cortisone spray
- Nasal saline irrigation
- Paracetamol 1g QID PRN
Acute bacterial rhinosinusitis but penicillin allergy Rx?
Cefuroxime 500mg bd OR Doxy 100mg bd
5 days
Single Ix needed to diagnose HSP?
Urinalysis - for haematuria/proteinuria
Suspected menigococcal immediate Rx? (1)
2.4g benzylpenicillin IM
OR
2g ceftriazone IM
Weakness, joint pain and rash around eyes/swollen? Dx?
Dermatomyositis/Polymyositis
Polymyositis/Dermatomyositis Mx?
Refer to derm urgently as could be malignant cause
Smelly foot in pitted keratolysis cause?
Sulfur compounds
Pitted keratolysis Rx?
Topical clindamycin 1% 10 days
Caused by moisture + bacterial growth
Corn Mx? (2)
Debulk using scalpel
Salicylic acid plaster
Difference between corn and wart in appearance?
Thrombosed capillaries present when shaving down
Milker’s nodule pathogen
Parapox virus (PAR for FARmer)
Orf pathogen
Also parapox virus (PAR for FARmer), but comes from sheep and goats
Milker’s nodule and orf Rx?
Nothing, reassure
Erythema multiforme Rx?
Nothing, unless itchy can use CSC
Lymphogranuloma venereum - STI association?
Chlamydia. Also causes proctitis (anal pain and discharge)
Doxy 100mg bd for 21 days
Mycoplasma genitalium Rx?
Doxycycline 100mg bd 7 days, then Azithromycin 1 g immediately then 500 mg daily for 3 days (total 2.5 g)
Which STI should you high vaginal swab instead of endocervical?
Trichomonas
Chancroid vs chancre difference
Chancroid = painful
Chancroid cause?
haemophilus ducreyi
Syphillis contact tracing
3 months (6 if secondary)
Syphillis Rx?
Benzathine benzylpenicillin 2.4 million units IM stat
Nebulised salbutamol dose
5mg nebules (2x in over 6yo) [10mg in adult]
Nebulised ipatropium dose?
250mcg (2x in over 6yo) [500mcg adult]
IV hydrocort dose for asthma?
100mg
IV mg sulfate dose for asthma?
10mmol
Ix for foreign body
Inspiratory and expiratory CXR
Pernicious anaemia diagnosis with Ix
anti parietal cell antibody
anti intrinsic factor antibody
IBS Rx (2)
Hyoscine butlbromide 20mg QID PRN
Fluoxetine 20mg daily/Amitriptylline 10mg daily
Hyponatraemia + Pneumonia cause?
Legionella
3 non-pharm Mx of SVT?
Valsalva
Cold water to face
Unilateral carotid sinus massage
Patient amenorrhoeic on implanon/IUD. Dx menopause?
x2 FSH 6 weeks apart. >30
What age should bedwetting start treatment for?
6 years +
Conduct order adult version?
Antisocial personality disorder
Metatarsal shaft fracture Mx?
1st = cast/ortho 2nd-5th = CAM boot, partial WB 6 weeks
When to refer paediatric stuttering?
If it has been going on for more than 12 months
When should TB testing be repeated if high suspicion?
8 weeks if initial test was negative
What age do you refer to colp straight away for any abnormal HPV?
70-74
When should UTI kids have follow up renal USS? (3)
Boys <3 months
Seriously unwell
Renal impairment
What ages to give zoster immunoglobulin for kids at home?
<1 month only
Which family contacts also need pertussis Rx?
Jobs/Living with exposure <6 months old
Pregnancy
When to incise thrombosed haemorrhoids?
Within 72 hours of symptoms, otherwise sitz bath
Minimum isolation for chickenpox?
5 days
Difference between NAFLD and NASH monitoring?
NAFLD = 6 monthly LFT's NASH = 6 monthly liver USS and AFP
Antidepressant during breastfeeding?
Sertraline
Pharyngeal gonorrhoea Rx?
ceftriaxone 500mg IM and TWO GRAMS azithromycin stat
What antipsychotics to avoid in Parkinson’s
Risperidone, haloperidol and olanzapine
When do you need to give tetanus toxoid vaccine?
> 5 years since last shot + dirty/major wound
What time frame to treat shingles?
<72 hours onset
MSM how often to check for STI’s
3 monthly unless monomagous relationship (12)
Myasthenia Gravis Ix
Acetylcholine antibody
Headache worse when standing, better on lying?
Post-lumbar headache
Post-lumbar headache Mx? (2)
Analgesia
Resolves in 24 hours
Fluids
What medications increase risk of benign intracranial HTN?
Doxycycline
Benign intracranial hypertension Mx? (2)
Urgent referral to neuro
Stop tetracycline/doxycycline
3 causes of erythema multiforme
HSV
Medications - amoxicillin
Malignancy - Hodgkin’s lymphoma
SLE
Q fever Ix?
Coxiella burnetti PCR
OR
Antibody levels 2-3 weeks later
Q fever BURNS
When to review child with AOM?
48-72 hrs
Either commence Amoxi if not improving, or if already on, step up to Aug DF
Waxing + waning fever , returned traveller
Malaria
Thick and thin, waxing and waning = malaria “up and down”
Step-ladder fever. Dx?
Typhoid
“AVOID walking under ladders, tyPHOID”
How to Dx typhoid
Stool culture
ladder and stool are similar to get up
Salmon coloured macules , returned traveller
Typhoid
Salmon coloured ladder
Eschar in returned traveller
Typhus
Hydrophobia, hyperactivity in returned traveller
Rabies
animals don’t like water
Gastrocnemius tear Rx?
Firm elastic bandage
Post surgical disproportionate pain?
Complex regional pain syndrome
4 underlying causes of bursitis?
infection trauma repeated Overuse Pressure arthritis (OA,gout,RA)
3 management options bursitis
needle aspiration
NSAID’s
compression
Raynaud’s Rx?
amlodipine 5mg
Raynaud’s Rx to avoid?
beta blockers
erythromelalgia Rx?
aspirin
4 precautions to NSAID’s
active peptic ulcer disease/GI bleeding eGFR <30 liver cirrhosis established CVD (stroke/AMI) planning pregnancy/pregnancy
Voltage criteria for LVH?
V3 + V5 = more than 7 squares
Mod risk CVD calc. When to start Rx?
ATSI
Family premature CVD
BP >160
Otherwise review in 3-6 months, if still mod, start Rx
Low risk CVD calc. When to start Rx?
BP >160
Otherwise keep reviewing every 2 months
How much LFT derangement until reducing statin?
> 3x UNL
What two conditions require lower pred dose for flares?
Gout = 15-30mg/day PMR = 15mg/day - 1 month
Symptoms for carcinoid syndrome? (4)
Flushing, diarrhoea, valvular heart disease, wheezing
What situations to treat subclinical hypothyroidism immediately? (2)
TSH >10
Anti-thyroid peroxidase antibody positive
What medication can cause hyper/hypothyroidism
Amiodarone
What medication can cause hypothyroidism only?
lithium
Thyroiditis nuclear uptake results?
absent or low
ASTI FBGL/HbA1c starting age?
18yo, annually
What does DEXA stand for?
Dual energy xray absorption
Post thrombotic syndrome prevention?
Compression Stockings for 18 months
Breastfeeding CI for COCP?
Only if <6 weeks
VTE factors CI for COCP?
first degree <45yo
PHx of VTE
Known thrombogenetic mutation
What to do if someone develops migraine whilst on COCP?
Stop COCP
Breast conditions CI for COCP?
PHx only (FHx doesn’t matter)
New breast lump
BRCA gene positive
When to repeat HPV if inadequate sample?
6-12 weeks
How many negative tests do you need after HSIL treatment?
TWO negative CO-tests
Do we need to do CST for hysterectomy?
Only if hysterectomy was for HSIL, needs 2 negative co-tests
When to consider bariatric surgery for T2DM?
Poor control and BMI >35 or, BMI >40
What HbA1c % do you need to start a second agent immediately with metformin?
8.5%
After commencing ACEI in new CKD, when to review for AKI/K+?
within 2 months, (make sure less than 25%)
What condition do you need to maximise ACE dose before adding 2nd agent?
CKD
Aboriginal health Assessment MBS number?
715
Acute rheumatic fever chronic Mx
Benzathine benzylpenicillin monthly for 10 years or 21yo. Whichever is later
What age is everyone recommended to get extra boostrix?
50
When do ATSI get adult prevenar dose?
50yo
What medication to give when patient is on max dose of allopurinol and not reaching urate level target?
Probenacid (never use in Hx of kidney stones)
How often to do Asthma cycle of care?
Twice per year
How often to do T2DM cycle of care?
Annual at least
Unable to straighten knee, and clicking of knee?
Meniscal bucket-handle tear
According to SCAT5 concussion grading, how long between each step of rehab?
24 hours (1 day)
Post-concussion, when to refer if symptoms still present?
2 weeks after incident
XR doesn’t show suspected fracture. When to choose MRI instead of CT?
CT = acute fracture MRI = stress fracture
What temp to avoid vaccination in?
> 38.5
Balanitis Rx?
Hydrocortisone 1% cream + clotrimazole 1% (if fungal suspected)
Roseola causative organism?
Human herpes virus (no longer infectious after rash appears)
Child can’t perform motor tasks. Dx?
Dyspraxia
Morton’s neuroma Ex finding sign?
Mulder’s sign (clicking when squeezing)
When to repeat needlestick blds?
6 weeks (HIV only) 3 months and 6 months
Trochlear nerve innervation
Superior oblique (medial and downwards eye movement)
Premature CVD age?
<55yo
When to refer for abnormal LFT’s?
Persistent and
2x UNL for liver transaminases
1.5x UNL for liver phosphatases
How long to continue anti-depressant for after commencing?
12 months
How long to delay imaging in new radicular pain after lifting heavy item?
6 weeks.
After trial of conservative Rx, can consider imaging
What age do we not consider HPV vaccination for catch up?
> 19yo (likely already exposed)
Campylobacter diarrhoea Rx?
Azithromycin (only in severe disease, otherwise self limiting)
Or pregnant, immunocompromised, infants
AV nipping and silver wiring are exclusive to what type of retinopathy?
HTN
New bright PR blood, when to organise c-scope regardless of what you examine?
40-50 (plus sigmoidoscopy)
50yo+
Acute mania Rx within bipolar?
Olazapine/Haloperidol/Risperidone
Akathisia Rx?
Propanolol
Chorea + dementia + falls. Dx?
Huntington’s
Urinary incontinence + gait instability + dementia. Dx?
Normal pressure hydrocephalus
Korsakoff triad?
Ataxia, eye movement abnormalities, confusion
AAA surgical referral threshold?
> 5cm (but can refer earlier for vasc to do surveillance themselves)
Post herpetic neuralgia time frame?
3 months after shingles
Standard neck circumference cut off for OSA?
40cm
Weber A Mx?
CAM boot WBAT
Weber B Mx?
Backslab NWB
Weber C Mx?
Backslab NWB
Gestation for chorionic villus sampling?
10-13 weeks
Gestation for amniocentesis?
> 15 weeks
Fluid bolus for paeds?
20mL/kg stat
What size ovarian cyst needs no further Mx?
<5cm (unless post-menopausal, = abnormal)
Bullimia nervosa Rx?
Fluoxetine 20mg daily
SLE Rx?
Hydroxychloroquine
2 organisms that can grow in onychoLYsis?
candida (flucanozole) and pseudomonas (acetic acid)
Urethral caruncle Rx?
Topical oestrogen
Stress fracture suspected but nothing on XR?
Do MRI
Oesophageal spasm Rx?
GTN sublingual
Carotid artery stenosis level post stroke that needs operation?
> 70%
Pseudogout further Ix? (3)
CMP, ferritin, ALP
For haemachromatosis, and thyroid/calcium increasing causes
Amoxicillin child dose?
15mg/kg
30 if pneumonia - double
Pneumothorax chest drain site
2nd space MCL
Heart Failure salt limitation?
<6g
Immunocompromised + pneumonia
Pneumocystitis jirovecci pneumonia
Sulfamethoxazole+Trimethoprim
Second episode of herpes STI?
500mg bd valaciclovir (THREE day course only)
Preferred antiviral in pregnancy?
Aciclovir
How much is high dose glucocorticoid therapy making someone eligible for a DEXA?
7.5mg or more /day for more than 3 months
eGFR for automatically high risk CVD?
<45
GAD timeframe?
> 6 months
BIpolar time frame
1 week
Adjustment triggering event?
3 months
What is the postural HR inrcrease warranting medical admission for eating disorders?
30 or more
How many days before surgery should warfarin be ceased/bridged?
5
How many days before surgery should DOACs be ceased for a HIGH-risk procedure?
2-3
What are the two criteria for a high-risk episode (high chance of treatment failure) of acute otitis media in an ATSI child?
- Children <2yo with fevers >38.5
2. Children <2yo with bilateral AOM
