AKT/KFP weak spots Flashcards
1
Q
Acute management of migraine.
List 6 non-pharmacological and pharmacological options.
A
- Advise rest in a dark, quiet place
- Heat pack over neck or cold pack over forehead
- ibuprofen 600mg STAT
- Metoclopramide 10mg oral STAT
- Paracetamol 1g STAT (2nd line)
- rizatriptan 10mg oral or sublingual wafer STAT (2nd line)
2
Q
Name 2 specific treatments for new diagnosis of pernicious anaemia
A
- Hydroxocobalamin 1mg IM second daily for 2 weeks, then every 2-3 months for maintenance
- Oral iron supplementation equivalent of 100-200mg elemental iron daily
3
Q
Name 6 risk factors for urinary tract malignancy in the setting of haematuria
A
Age >50
Smoking history - current or past
Irritative LUTS
History of gross haematuria
History of chronic UTI
History of pelvic irradiation
4
Q
What 3 investigations are required in persistent macroscopic haematuria if UTI is excluded?
A
CT IVP - urinary tract malignant mass
3x urine cytology - malignant cells
Referral to urologist for cystoscopy
5
Q
You have a suspected measles case in your room. List 6 immediate next steps in management.
A
- Isolate patient in single room with airborne precautions
- Arrange urgent measles investigations: nasopharyngeal PCR and measles IgG/IgM
- Notify local public health department
- Perform contact tracing on any exposures in the clinic
- Inform any close contacts to be alert to symptoms for 18 days post exposure
- Leave any exposed room vacant for 2 hours post exposure
6
Q
Which drugs improve outcomes in HFrEF? Name 4
A
ACEI/ARB
beta blockers (carvedilol, bisoprolol, metoprolol succinate)
spironolactone
ARNI eg. sacubitril/valsartan
- substitute for ACE/ARB if persistent symptoms with LVEF <40 despite maximal doses ACE/ARB and beta blockers
7
Q
What are some non pharmacological management options for heart failure? List 7
A
Salt restriction <2g sodium daily
Tailored exercise program with physio
Refer to multidisciplinary heart failure disease management program
Immunisation - flu, pneumococcal
Fluid restriction to 1.5L daily
Daily weights monitoring
VicRoads notification for conditional license
8
Q
What questions on history would you ask to elicit symptoms of OSA? List 7
A
Loud snoring
Witnessed apnoea
Unrefreshing sleep
Excessive daytime sleepiness
Poor concentration
Low mood
Weight gain
9
Q
What does STOPBANG stand for?
A
S - snoring loudly
T - tried, fatigued
O - observed apnoeas
P - pressure (hypertension)
B - BMI >35
A - age >50
N - neck circumference >40cm
G - male gender
10
Q
What are some general measures for OSA? List 7
A
Weight reduction 5-10% if overweight
Refer to dentist for mandibular advancement splint
Smoking cessation
Good sleep hygiene
Avoidance of alcohol/illicit drugs
Intranasal corticosteroids
Positioning - side sleeping
11
Q
What are the main differentials for thyrotoxicosos? List 8 (4 common, 4 uncommon)
A
Most common:
Graves’ disease
Toxic multinodular goitre/Toxic adenoma
Postpartum thyroditis
Exogenous thyroid hormone
Less common:
Painless sporadic thyroiditis
Painful subacute thyroiditis (De Quervain’s)
Thyrotoxic phase of Hashimoto’s
Amiodarone-induced thyroiditis
12
Q
What are 4 situations in which a GP may share medical information about an adolescent to a 3rd party?
A
Patient consents to release of information
Disclosure to another health professional for the purpose of ongoing medical care
Mandatory disclosure required under law eg. Subpoena
High risk of threat to self or others
13
Q
Your patient is diagnosed with bipolar 1 disorder. What are 6 features of long term management?
A
Psychoeducation around mania, signs of deterioration and relapse prevention
Discuss importance of medication adherence
Advise to avoid recreational drug use
Refer to psychologist
Educate on community support services such as lifeline
Recommend 30 minutes exercise daily 5 days per week
14
Q
List 8 contraindications (UKMEC 4) to COCP
A
Current breast cancer
First 6/52 postpartum if BF
migraine with aura
PMHx IHD/TIA/stroke
PMHx VTE
35+ smoking >15 cigarettes daily
Htn SBP > 160
Major surgery with prolonged immobilisation
15
Q
List 6 circumstances requiring expert clinical judgement for prescription of COCP (UKMEC 3)
A
BMI >35
T2DM with micro/macrovasc complications
Multiple RF for CVD
gallbladder disease
First degree relative VTE <45y
<6/52 postpartum and not BF
16
Q
List 5 storage symptoms for LUTS
A
Urgency
Daytime frequency
Nocturia
Incontinence
Abnormal bladder sensation
17
Q
List 6 voiding symptoms of LUTS
A
Slow stream
Intermittent stream
Hesitancy - difficulty initiating stream
Straining to void
Terminal dribble
Dysuria
18
Q
List 4 indicators of good asthma control
A
Daytime symptoms <2 days per week
Need for SABA reliever <2 days per week
No limitation of activities
No nocturnal/early waking symptoms
19
Q
List 6 causes of jaundice in babies 24 hours - 14 days old (nil Ix required unless red flags)
A
Physiological jaundice
Dehydration/insufficient feeding
Sepsis
Haemolysis
Breastmilk jaundice
Bruising / birth trauma
20
Q
List 5 causes of jaundice in babies >2 weeks
A
Sepsis
Haemolysis
Dehydration/insufficient feeding
Breastmilk jaundice
Hypothyroidism
21
Q
List 5 investigations for jaundice in a neonate > 2 weeks
A
SBR (conjugated/unconjugated)
FBE, blood film and reticulocytes
TFTs
Group and DAT
LFTs
22
Q
List 6 causes of conjugated hyperbilirubinaemia in a neonate
A
Neonatal hepatitis
Biliary atresia
Choledochal cyst
Bile plug
Metabolic eg alpha 1 anti trypsin
Drugs
23
Q
What 3 serological test constitute diagnostic panel for HBV?
A
HBsAg - active infection acute or chronic
Anti-HBs - immunity, vaccination or past infection
Anti-HBc - infection, past or current
24
Q
Name 5 features of an innocent murmur in a baby
A
Grade <2 intensity (soft)
Softer when sitting vs supine
Short systolic
No radiations
Musical/vibratory quality
25
List 4 aspects of management for scabies
ivermectin 200mcg/kg po with fatty food. Repeat in 7 days
OR
Permethrin 5% cream top, leave on for 8 hours. Repeat in 7 days.
Empirically treat all family members
Hot wash all clothes, towels, bedding >60C or store in sealed bag for 7 days
Notify school
Return to school when 2 treatments complete
26
List 6 contraindications to systemic MHT (oestrogen)
Age 60+
Previous VTE
Previous TIA, stroke or AMI
Uncontrolled htn
Oestrogen-dependent cancer
Undiagnosed vaginal bleeding
27
List 7 risk factors for endometrial cancer
Oligomenorrhoea
PCOS
FHx endometrial or colon cancer
Use of unopposed oestrogen/tamoxifen
Age >45
ET >12mm pre-menopause, or >5mm in perimenopausal
Obesity
28
List 6 clinically-determined high risk CVD factors
Diabetes and >60 years
Diabetes with microalbuminuria
CKD stage 3a (eGFR <45) or worse
Systolic BP >180 or DBP > 110
Total cholesterol > 7.5
ATSI >74
29
List 4 aspects lifestyle management advice for cardiovascular risk modification
Smoking cessation
Nutrition - avoid saturated and trans fats, increase omega 3 consumption, salt <4g daily
Limit EtOH to no more than 10 STD/weeks and no more than 4 in any one day
30min moderate intensity exercise on at least 5 days of the week
30
What does CHA2DS2VA stand for?
C - CCF
H - hypertension
A2 - >75
D - diabetes
S2 - previous stroke, TIA, VTE
V - vascular disease: MI, PAD
A - >65
>2 = start anticoagulation
31
List 5 aspects of management for peripheral arterial disease
Graduated walking program
Attention to foot care
Smoking cessation
Statin therapy
ACE inhibitor
32
List 5 differentials for restrictive impairment on spirometry
Pulmonary fibrosis
Neuromuscular disorders
Congestive cardiac failure
Sarcoidosis
Obesity
33
List 5 causes of obstructive defect on spirometry
COPD
asthma
Bronchiectasis
Cystic fibrosis
a1-antitrypsin deficiency
34
List 6 co-morbidities that affect asthma control or increase the risk of exacerbations
Allergic/non allergic rhinitis
GORD
obesity
COPD
Smoking
Mental health issues
35
List 5 elements of an individualised written asthma action plan
Usual preventer and reliever regimen
How to recognise symptoms of deterioration
When to start or change reliever/preventer therapy
When to start oral steroids
When to seek medical attention
36
List 4 indicators for hospitalisation in pneumonia
Confusion
RR >20
SBP <90 or DBP <60
Age >65
1/4 = 3% mortality
2/4 = 8% mortality
3/4 = 20% mortality
37
List 6 features of venous disease on examination
Varicose veins
Peripheral oedema
Venous ulcer
Haemosiderin pigmentation
Atrophie Blanche
Lipodermatosclerosis
38
List 7 aspects of management for a venous leg ulcer
Refer to vascular surgeon for consideration of intervention
Compression stockings up to 40mmHg if no concurrent peripheral arterial disease
Adequate nutrition for wound healing
Pain management with analgesia
Leg elevation
Regular ankle exercises / structured exercise program
Skin care for venous dermatitis with daily paraffin emollient
39
List 3 aspects of non-pharmacological management for restless legs syndrome
Rule out secondary causes: anaemia, iron deficiency, uraemia, hypothyroidism
Maintain ferritin >50 with oral supp
Pre-bedtime walking or calf stretches
Sleep hygiene
40
List 6 warning signs for inflammatory bowel disease
Rectal bleeding
Unexplained weight loss
Abdominal mass
Nocturnal symptoms
Severe perianal pain or discharge
Arthritis
41
List 4 aspects of scabies management
1. Ivermectin 200mcg/kg po. Rpt 7 days
2. Empirical treatment of family members
3. Wash family’s clothes and bedding in hot cycle >60C or store in sealed bag
4. Notify school
42
List 5 differentials for hair loss in women?
Female pattern hair loss
Telogen effluvium
Alopecia areata
Tinea capitis
Hypothyroidism
43
List 5 aspects of management for nappy rash
Hydrocortisone 1% BD 7-14 days
clotrimazole 1% top BD
Use highly absorbent nappies
Apply a thick layer of barrier cream at every nappy change
Allow as much nappy-free time as possible
44
List 4 aspects of management of asymptomatic carotid artery stenosis
Commence aspirin
Commence statin
CVD risk modification
Refer to vascular surgeon if stenosis >70%
45
List 4 aspects of management for mallet finger (rupture of extensor tendon +\- avulsion fracture of distal phalanx)
Analgesia
Immobilisation of DIP in full extension with a splint, leaving PIP free
Refer to hand surgeon within 7 days
Conservative management: splint for 6-12 weeks
46
List 6 features on history of lichen sclerosus in men
Burning sensation
Bleeding
Fissuring
Painful urination
Painful erections
Painful sex
47
List 5 features of borderline personality disorder
Self harm
Chronic suicidal ideation
Poor self image
Turbulent interpersonal relationships
Fear of abandonment
48
Describe 5 aspects of appropriate initial management of burns
Cool running water for 20 minutes
Analgesia
Clean wound with normal saline
Remove all loose and non viable skin/tissue
Debride blister if >2.5cm or over joint
49
Describe the clinical features of each type of burn
Epidermal:
- painful, red, intact epidermis
Superficial dermal:
- blistered, painful, pale pink/red, brisk cap refill
Mid dermal:
- sluggish cap refil, dark pink/red
Deep dermal:
- deep red or white, dull sensation, severely delayed or absent cap refill
Full thickness:
- no sensation, no cap return, leathery, white/black/yellow
50
List 4 pathology findings that suggest alcohol use disorder
Macrocytosis MCV > 96
Elevated GGT
AST/ALT ratio >1.5
BAC >0.05%
51
List 7 common presenting symptoms of breast cancer
New breast lump
Breast thickening or ridge
Breast or nipple asymmetry
Skin changes eg. Dimpling, redness
Nipple changes
Nipple discharge
Unilateral breast pain
52
List 5 indications for referral to a breast surgeon for a new breast symptom
Any component of triple test is positive
Incomplete cyst aspiration
Spontaneous unilateral nipple discharge >60
Eczematous changes of nipple/areola persisting >2/52 despite treatment
Inflammatory breast conditions not resolving after 2/52 of abx
53
What is test of cure surveillance after a high-grade cervical abnormality is treated?
Co-test (HPV + LBC) 12 months post treatment, and annually thereafter until 2 consecutive negative co-tests. Then return to 5 yearly screening
54
What are the Ottawa ankle rules for ankle XR in ankle injury?
Pain in malleolar zone PLUS any of:
- tender posterior aspect of distal 6cm lateral malleolus
- tender posterior aspect of distal 6cm medial malleolus
- inability to weight beat 4 steps immediately after injury and in the room
55
What are the Ottawa ankle rules for foot XR post ankle injury?
Pain in mid foot PLUS any one of:
- tenderness at navicular bone
- tender base of 5th metatarsal
- inability to weight bear at least 4 steps immediately after injury and in the room
56
How do you assess osteoporosis risk in patients >70 with no history of minimal trauma fracture?
DEXA spine and proximal femur
If T score < -2.5, TREAT
If T score >-2.5, estimate absolute fracture risk
If 10 year fracture risk >3% hip or >20% any site: TREAT
57
List 6 major risk factors for osteoporosis
Premature menopause
Hypogonadism
Rheumatoid arthritis
CKD
chronic liver disease
Steroids >7.5mg/day >3mo
58
How do you assess osteoporosis management after minimal trauma fracture?
If hip/vertebral # - TREAT + baseline DEXA
Any other site:
- T score < -1.5 - TREAT
- T score > -1.5 - refer metabolic bone clinic
59
List the diagnostic criteria for complex regional pain syndrome
1. Continuing pain disproportionate to inciting event
2. At least 3/4 symptoms of: sensory, vasomotor, oedema, motor dysfunction
3. At least 2/4 signs of: sensory (hyperalgesia), vasomotor (temp or skin colour asymmetry), oedema, motor (decreased ROM, weakness, tremor)
60
List 3 options for emergency contraception and their timeframes
Levonorgestrel 1.5mg within 4 days
Ulipristal 30mg within 5 days
Copper IUD within 5 days
61
List 6 non pharmacological measures for BPSD
Identify and reduce triggers for aggression
Anxiety management eg. Reassurance
Provide calm, low stimulus environment
Simplify instructions in clear, concise manner
Offer positive reinforcement
Provide familiar environment
Time orientation aids eg. Whiteboard routine
62
List 5 non-pharmacological management steps for severe croup
Allow child to sit in position of comfort
Minimise handling
Allow carer to remain with child
Keep child calm with TV or reading
Reassure parents on cause and usual course of croup to relieve anxiety
63
Your patient’s follow up CST after 12 months returns a second positive HPV non 16/18 result. List 3 indications for direct referral to colposcopy
>50y
Aboriginal / Torres Strait Islander
Overdue for screening by at least 2y at initial screen
64
Your patient undergoes treatment of her CIN2 lesion with a LEEP procedure. What follow up does she need for test of cure?
Co-test 12 months post treatment
Annually thereafter until 2 consecutive negative co-tests
Can then return to 5 yearly screening
65
What are 3 screening questions for falls risk?
Have you had 2 or more falls in the past 12mo?
Are you presenting following a fall?
Are you having difficulty with walking or balance?
If any one is positive, complete multi factorial falls risk assessment
66
Describe 2 screening tests for balance deficits on examination
Single leg stance test: stand on one leg for 10 seconds. Repeat 3 times. Any less than 3/3 indicates significant sensory and strength impairment
Timed up and go test: stand from seated position, walk for 3m in a line, turn, return to chair and sit down. 15 or more seconds indicates high risk of falls
67
List 6 non pharmacological falls prevention strategies
Manage incontinence
Manage visual/hearing impairment
Refer to physio for strength and balance programs
Recommend Tai Chi
Refer to podiatrist for foot care
Refer to OT for home assessment and environmental modification
68
List 5 pharmacological measures for falls prevention
Medication rationalisation/home medication review
Reduce or cease psychotropic medications
Review medications that may contribute to postural hypotension
Supplement vit D if low
Supplement b12 if low
69
How is severity of obstruction graded on spirometry?
FEV1 % of predicted
mild 60-80%
moderate 40-59%
severe <40%
70
List the 3 parameters of spirometry and what their uses are in interpretation
FEV1/FVC - determine if obstructive
FEV1 - severity of obstruction
FVC - determine if restrictive
71
List 6 indications for referral to respiratory physician for asthma
Asthma associated with anaphylaxis
Following life threatening exacerbation
Frequent ED or urgent GP visits
Frequent exacerbations despite good lung function
Poor self management skills
Occupational asthma
72
List 5 indications for referral to respiratory physician for COPD
Diagnostic uncertainty/exclusion of asthma
Haemoptysis
Moderate/severe COPD
Assessment for home O2
COPD <40y
73
List 4 structural and 4 non structural causes of intermenstrual bleeding
Polyp (cervical)
Adenomyosis
Leiomyoma (fibroid)
Malignancy (cervical)
Coagulopathy
Ovulatory dysfunction
Endometrial hyperplasia/cancer
Iatrogenic (eg hormonal contraception)
Infection eg. Chlamydia
74
List 4 nocturnal symptoms and 3 daytime symptoms of OSA in children
Nocturnal:
Snoring >3 nights per week
Restless or agitated sleep
Increased work of breathing
Pauses in breathing or gasping
Daytime:
Excessive sleepiness
Morning headaches
Poor school functioning/behavioural
75
List 5 neurological differential diagnoses for muscle weakness
Multiple sclerosis - sensory, eye, cerebellar
Cervical myeloradiculopathy - pain
Chronic inflammatory demyelination polyneuropathy - fluctuating/episodic weakness
Myasthenia gravis - fatiguable weakness
Motor neurone disease - painless progressive weakness
76
List 6 differentials for recurrent pregnancy loss
Antiphospholipid syndrome
Parental balanced chromosomal anomaly
Uterine fibroids (intramural or submucosal)
Mullerian abnormalities eg septate uterus
Hypothyroidism
Poorly controlled diabetes
77
List 5 differential diagnoses for secondary hypertension
Bilateral renal artery stenosis
Primary aldosteronism (Conn syndrome)
Cushing’s syndrome (primary hypercortisolism)
Phaeochromocytoma
OSA
78
List 5 clinical features of primary adrenal insufficiency (Addison disease)
Fatigue
Anorexia
Weight loss
Postural hypotension
Skin/mucosal hyperpigmentation
79
Which viral vaccines are live in Australia (6)?
MMR / MMRV
varicella
Oral rotavirus
Yellow fever
Zostavax
Japanese encephalitis
80
List 4 motor features of Parkinson’s disease
Bradykinesia
Rigidity
Resting tremor
Postural instability and gait disturbance
81
List 5 investigations required for TIA <48 hours ago
CTB
12 lead ECG
carotid Doppler US
TTE
bloods: FBE, UEC, BSL, ESR, CRP
82
List 6 features of rheumatoid arthritis on history
Joint pain
Joint swelling
Morning stiffness >30 minutes
Previous similar episodes
Fever
Fatigue
83
List 3 features of rheumatoid arthritis on examination
Three or more tender and swollen joints
Symmetrical joint involvement in hands or feet
Positive squeeze at MCP or MTP
84
List 6 non pharmacological features of management for rheumatoid arthritis
Weight control
Patient education and self management programs
Occupational therapy
Exercise - strengthening and weight bearing
Psychosocial support
Smoking cessation
85
List 6 features of a nodular BCC on examination
Sun exposed area
Slow growing
Pearly appearance
Rolled edges
Telangiectasia
Central pit or ulceration
86
List 5 features of a high risk BCC
>2cm in low risk area (trunk or proximal limbs)
Any region other than trunk or proximal limbs
Poorly defined borders
Recurrent lesion
Aggressive growth pattern
87
Lost 5 management options for superficial low risk BCC
Imiquimod 5% cream top nocte 5 nights per week for 6/52
Excision with 3-4mm margin
Cryotherapy
Curettage and cautery
Photodynamic therapy
88
List 5 goals of treatment for lichen sclerosus
Relieve symptoms of pruritis, pain and fissuring
Return skin to as normal texture as possible
Improve sexual function
Prevent further anatomical destruction
Monitor for malignant transformation (vulval SCC)
89
List 9 diagnostic criteria for borderline personality disorder
At least 5 of:
Paranoid ideation
Abandonment - frantic efforts to avoid
Self image instability
Suicidal behaviour/self mutilation (recurrent)
Turbulent interpersonal relationships
Impulsivity - sex, spending, substance use
Mood cycling/affective instability
Emptiness - chronic
Anger - inappropriate and intense
90
List the diagnostic criteria for PTSD
>1 month after traumatic event of:
Intrusive symptoms eg. Memory, dreams, flashbacks
Avoidance of stimuli eg. Thoughts, reminders
Hyperarousal / reactivity
Causing distress or functional impairment
91
List the DSM criteria for generalised anxiety disorder
>6mo excessive worry and anxiety most of the time, with 3 or more of:
- restlessness
- fatigue
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
Causing distress or functional
Impairment
92
List the criteria and recommended screening for women at moderately increased risk of breast cancer
1x 1st deg <50y
2x 1st deg same side
2x 2nd deg same side, 1 <50y
Annual mammo from 40
Clarify risk stratification with online tool
Consider referral to familial cancer clinic
93
List criteria for moderate risk of colorectal cancer (1-4% 10 year risk) and recommended prevention
1x 1st <55y
2x 1st deg
1x 1st deg and 1x 2nd deg
iFOBT 2 yearly 40-49
Cscope 5 yearly 50-74
LDA at least 2.5 years age 50-70
94
List criteria for high risk (>4% 10 year risk of CRC) and recommended prevention
At least 3x 1st deg
At least 3x 1st/2nd deg, 1<55y
iFOBT 2 yearly age 35-44
Cscope 5 yearly age 45-74
Referral to familial cancer clinic for genetic risk assessment
95
List 5 differentials for painless, monocular vision loss
CRVO
CRAO
Retinal detachment
Vitreous haemorrhage
Optic neuritis
Giant cell arteritis
96
List 4 findings of poorly controlled hypertension on fundoscopy
Papilloedema
Haemorrhage
Silver wiring
AV nipping
Hard exudates (cholesterol/lipid deposits)
97
List 5 findings of diabetic eye disease on fundoscopy
Cotton wool spot
Hard exudates
Proliferative vessels around disc
Microaneurysm
Haemorrhage
98
List 8 differentials for unilateral painful red eye
Corneal foreign body
Corneal abrasion
HSV keratitis
Bacterial keratitis (contact lenses)
Marginal keratitis (ocular rosacea)
Viral conjunctivitis
Episcleritis (assoc inflammatory disorder)
Acute closed angle glaucoma
99
List 5 contraceptive options for women over 50
Mirena IUD
Implanon
POP
Copper IUD
Barrier contraception
100
List 3 pieces of advice for women over 50 on progesterone contraception
Continue contraception until age 55 if still bleeding
If amenorrhoeic for at least 12mo and FSH >30, cease contraception in 12mo
If FSH <30, continue contraceptive and recheck in 12mo
101
List 5 clinical features of a SUFE
Hip pain, groin, thigh or knee pain
gradual onset of symptoms >3 weeks
Limp
Leg length discrepancy
Obligatory external rotation during hip flexion
102
Describe features and management of mallet finger injury
Forced flexion of extended finger
Fixed flexed position
No active DIP extension
Splinting neutral/slight hyperextension 6-8 weeks
Follow up hand surgery clinic
103
Describe 5 features of a pulled elbow
Toddlers or young children
Sudden longitudinal pull or axial traction on arm in extension
Partial subluxation of radial head
Arm held in mid prone position in front of chest
Pain with supination/pronation
104
List the DSM criteria for bipolar I disorder
Manic episode
- persistent elevation, expansive, irritable
- increased goal directed activity
lasting >1 week, present most of the day every day
PLUS 3 of:
Distractibility
Insomnia
Grandiosity
Goal-directed activity
Impulsivity
Talkative ++
Causing marked functional impairment
105
List the DSM criteria for bipolar II disorder
Hypomanic episode (lasting at least 4 days)
Not severe enough to cause functional impairment
No psychosis
106
List 4 positive signs of psychotic disorders
Hallucinations
Delusions - persecutory, paranoid, grandiose
Impaired insight
Disorganised thinking and speech
107
List 5 negative symptoms of psychotic disorders
Lack of motivation
Poor self care
Blunted affect
Reduced speech
Social withdrawal
108
List 5 differentials for psychotic symptoms
Brief psychotic disorder (positive signs <1mo)
Schizophreniform disorder (<6mo)
Substance induced psychosis - positive signs <1mo
Schizophrenia (>6mo)
Schizoaffective disorder - prominent mood symptoms
109
List 5 features of SCC in situ / Bowen disease
Slowly expanding
Well demarcated
Erythematous Scaly plaque
Ulceration
Sun exposed areas
110
List 5 topical field treatments for small, well-demarcated SCC in situ
Fluorouracil 5% topical twice daily for 2-4 weeks
Imiquimod 5% topical 5 nights per week for 6 weeks
Photodynamic therapy
Cryotherapy
Curettage and cautery
111
List 6 risk factors for cutaneous SCC
Advancing age
Male
PMHx other skin cancer
Actinic keratoses
Outdoor exposure
Smoking
112
List the diagnostic criteria for CKD
eGFR <60 (x3 occasions) for >3mo
OR
At least 3mo of
- albuminuria (2/3 elevated urine ACR)
- haematuria after exclusion of urological causes
- structural abnormality
- pathological abnormality on biopsy
113
List 7 risk factors for CKD
T2DM
hypertension
Cardiovascular disease
BMI > 30
Smoking
ATSI >30
Age >60
114
List 6 potential cofounders for a raised urine ACR
UTI
high dietary protein intake
Heart failure
Recent heavy exercise
Menstruation/Genital discharge
Recent use of NSAIDs
115
List the stages of CKD
Stage 3a eGFR 45-59
Stage 3b eGFR 30-44
Stage 4 eGFR 15-29
116
List 6 non pharmacological management options for CKD
S - smoking cessation
N - Limit salt <6g daily
A - standard
P - standard
I - flu and pneumococcal
E - kidney health australia number, CKD Go! App
C - no driving limitations
C - advanced care plan
Refer to pharmacist for HMR
117
List 4 specific treatment goals for CKD
Limit salt intake <6g (1 tsp) daily
Aim BP <130/80
Aim BMI <25
50% reduction in urine ACR
118
List 4 common underlying causes of CKD
Diabetes
Glomerulonephritis
Hypertension
Polycystic kidney disease
119
List 6 investigations for determining underlying cause of CKD
FBE
CRP/ESR
fasting lipids
hba1c
Urine microscopy for dysmorphic red cells
Renal tract ultrasound
120
List 7 medications that should be withheld on sick days if inadequate fluid intake in CKD
SUF
ACE
Diuretics
Metformin
ARB
NSAIDs
SGLT2i
121
List indications for referral to nephrologist in CKD
eGFR <30
Persistent albuminuria urine ACR >30
Sustained decrease eGFR >25% in 12mo
Sustained decrease in eGFR 15 per year
CKD with hypertension despite 3 agents
122
List 7 elements of multidisciplinary management for COPD
Physio for exercise training and pulmonary rehab
OT for home modification and adaptive equipment
Speech path for swallowing training to avoid aspiration
Psychologist for depression
Pharmacist for HMR and inhaler technique education
Dietician for nutritional support
ACAS for cleaning assistance, MOW
123
List 7 risk factors for glaucoma
Increasing age
Elevated or fluctuating IOP
Family history
Diabetes
Steroid use
Hypertension
Myopia
124
Describe the difference between wet and dry macular degeneration
Dry
- gradual deterioration in unilateral or bilateral vision
- increasing difficulty with reading or driving
Wet
- acute loss of central vision with metamorphopsia
- urgent referral to ophthal
- potential for rapid progression and irreversible damage
125
List 7 clinical features of acute angle closure glaucoma
Ocular pain
Peri-conjunctival redness
Blurred vision
Mid-dilated, non reactive pupil
Hazy iris
Firm orbit to palpation
Nausea/vomiting
126
List 5 non pharmacological management options for dry eyes
Apply regular ocular lubricants
Treat blepharitis
Optimise mebomian gland function with warm compresses
Modify environment to decrease tear evaporation eg. Increase humidity, reduce screen time, conscious blinking
Review exacerbating medications eg. Antihistamines, beta blockers, TCAs, SSRI
127
List 4 features of cataracts
Loss of visual acuity
Loss of contrast sensitivity
Glare around lights at night
Monocular diplopia
