AMC GP/Public Health Flashcards
Nicotine replacement therapy
Dependence with 3 criteria
Waking
No of sticks
Agitation
Frequency for screen colon ca
Asymptomatic
Low: FOBT 50-74 2 yr
Mod: FOBT 2 yr 40-49, scope 5 yr
High: FOBT 2yr 35-45, scope 5yr
Apnoea : refuse stop driving
- empathy advise
- Civil right to inform DVLA
- Fail, to do by the Dr
- Weight reduction if the cause
Travel to southeast Asia
Post splenecetomy
Watch out for comm disease
Malaria
Biochemical marker for CV risk
Waist : hip ratio
0.01 unit increase= 5% RR of CV risk
Relative risk or risk ratio
Expose gp RR= % exposed group / % unexposed or placebo X 100
Unexposed gp RR : % unexposed gp/ %exposed group X 100
Post exposure Hepatitis B
Pregnancy Vs non pregnant
Same therapy
Pregnancy nurse exposed to hep B+ needle stick injury.
No ab/<10 : IvIg & hep B vaccine 0.1.6 ( less than 72hrs, 12 hr best)
AB +( >10) : No action
*Ag + in RPT serology 3/12: baby receive IvIg and HepB 12 hrs from birth
Breast cancer BRCA +
Autosomal dominant
State funded
Eligible for genetic testing
Not by Medicare
BRCA candidates
- BRCA gene in family
- Breast ca less than 30yr
- Breasts ca less than 40 yr with triple test negative
Many q 66 on GP section
Post exposure chicken pox in a child
Give Vaccine ( live) within 1st 5 days of exposure ( earlier better)
Exposure to school Chicken pox
After vesicles dries off
Reliability of studies
Highest(1-4) : meta analysis}systematic review } practise guidelines} RCT
Lowest 5-9:cohort }case ctrl }cross sectional} case report) individual opinion
Salmonella outbreak in area. Teenage boy is infected. Important information?
Part time job
Case control Vs Cohort Vs Cross sectional Vs case report
Finding cause of outbreak/ disease
Vs link btw cause& effect Vs study incidence of disease in a target population within a specific period
Vs detail writing of a single case
Prevalence studies
Cross sectional studies (observational type)
Lipid target in IHD
LDL< 1.8
HDL>1.0
TG<2.0
NHDL< 2.5
Vaccination for febrile child
<38.5 : Give Vaccine
>38.5 : w/hold, give later once febrile settles
Anaphylaxis: avoid vaccine
Other conditions: Give !!!!
Measles incubation & symptoms
2 days BEFORE onset of symptoms - 4 days of RASH development
Sym: fever, conjunctivitis, Koplik spots, rash, coryza, cough (3C+R+K)
Measles post exposure for immunocompetent Vs immunocompromised
Competent but unsure of immune status : within 72hrs MMR vaccine
Sure of status: observe
Compromised: give NHIG ( MMR vaccine contraindicated for pregnant& low immunity)
Babies: preterm, upto 8mths: NHIG
9-11 mth: if <72hrs: MMR
> 72Hrs: NHIG
Child missed all immunization
Start catch up vaccination NOW!
Child with pneumococcal meningitis despite vaccination. Why?
Serotype of Invasive Pneumococcal Disease not covered in the vaccine. Current vaccine covers upto 7 serotypes, there are 90 serotypes of Strep pneumoniae
Q fever vaccination
Travel to Africa and central/south American
1-2weeks onset which lasts 10years
Single dose 0.5ml IM/Sc
Q fever
Important prevention
Vaccination!
Netting, repellant
Avoid jungles
Q fever symptoms
Same like dengue fever sx
Reservoir: monkey
Vector: aedes Aegyptus
Endemic : Africa
CAD major risk
🚭 always advised cessation 1st !!!
32% risk reduction by stopping
CAD steps in smoker with high cholesterol
Stop smoking
Exercise and diet
> 6/12 no changes: STatin
Absolute CVD risk assessment calculations:
Age
Sex
Smoking
HDL & Total Chol
Systolic BP
DM present or not
LVF present or not
Absolute CVD risk assessment
Age above 45
2 yearly check-up
Not having hx or current CVD
Does not fall under high risk
CVA/ Stroke important Risk fx
Hypertension
Attributable risk
a/a+b - c/c+d
Urine Albumin creatinine ratio
Normal
<2.5mg)mmol MALE
<3.5mg/mmol FEMALE
Clinical determined high risk for CVD
Age >60 with DM
Urine microalbumin
Urine ACR > 2.5 male, > 3.5 female
SBp > 180 ; > dbp110mmhg
eGFR 45
Familial hypercholesterolemia
Straits and Torrent Islander
Familial hypercholesterolemia
Tendon xanthomas
MI death in family < 50 yrs male
<60yrs female
Very high cholesterol not related with other conditions
Child of father with familial hypercholesterolemia
Pretest genetic counseling
Informed consent
Genetic testing
50% risk of being affected
Smoking in pregnancy
Rx
- Behavioural counseling and support : initial mngt
- Nicotine replacement: short, intermittent therapy upto 8 weeks
Lozenges, spray , gum, patch remove before bedtime
Seizure for driving
1.Chronic seizure:
non commercial: 12mth
Commercial: 10yrs
2. 1st time seizure:
Non commercial: 6mth
Commercial: 5yrs
3. Seizure due to known causes
Eg head injury , metabolic
Non commercial: 6 mth
Commercial: 12mth
4. Epilepsy on treatment 1st time
Non commercial: 6 mth
Commercial: 10yrs
5. Breakthrough seizure:
Non commercial: 3 mth
Commercial: 10yrs
6. Dose tapering:
Non commercial: 3 mth
Commercial: review license
7. Withdrawal one of medicine:
Non commercial: 3 mth but seizure happen, maintain old meds and review 4 weeks then resume driving
Post Stroke : can drive after
4 weeks
Post Stroke assessment on fitness to drive
- Occupational therapist
( simulation, on road off road etc)
1.Intermittent seizure to see well controlled for driving
2. 1 episode of breakthrough seizure , cause unknown Vs cause known
1:12 month free from seizure with therapy
2: cause unknown: 3 mth
Cause known: 4weeks
Aortic aneurysm repair
Fitness to drive
Private: 4 weeks
Commercial: 3mth
MI
Fitness to drive
Mi = P : 2 weeks C : 4 weeks
Post PCI = P : 2 days C: 4 weeks
CABG= P: 4 weeks C: 3mth
*P Private
*C Commercial
Q 18 GP section
Fitness to drive chart hafal
Father has Prostate cancer
Counsel benefits and risk of DRE and PSA
If agree : BOTH
Skin Check
High Med/Low
Fitzpatrick type 1-6
Check q 12 GP section
Skin cancer (doctor assessment)
High risk: 12 mth
Med risk: 2-5 yrs
Low risk: 1 shot skin check
HIV post exposure prophylaxis for HCW
- 4 week therapy
- Baseline,6 weeks, 3 mth , 6 mth serology check
Choice: 2 NRTI
Post exposure Hepatitis B
Now +HbsAg
- Reassurance and Counseling
- 6/12 later still positive, refer to specialist
Aboriginal common cause for blindness
Chlamydia trachoma»» trichiasis
Chlamydia trachoma of eye
SAFE
Surgery: early entropion repair
Azithromycin
Face washing
Environmental ctrl : fly, dust
IPV booster
4yrs old
Primary: 2,4,6 mth
Obesity BMI : 30-40 no co-morbidity
Rx
Stepwise approach
RED
VLED
Pharmacotherapy
VLED
2 meal replacement and 1 lean protein
12 weeks regiment
Aim 1-1.5kg weight loss/week
Pre Exposure Prophylaxis HIV
(Q82 GP)
Receptive MSM with CLI
Receptive MSM with hx rectal Chlamydia, Gonorrhoea, Syphilis
Methamphetamine use
MSM with HIV+ve partner with undetectable viral load/not on treatment
Eye for driving
Fail:
If > 6/12 in corrected eye
If > 6/18 in less eye, and > 6/9 in better eye with correction
Gonorrhoea +
Treat
Notify Health Authorities
Contact tracing : 2 month
Patient referral/provider referral
Chlamydia+ve
1.treat
2.notify
3. Contact tracing 6mth
Smoking and depression treatment
Nicotine replacement therapy
(more nicotine dependent )
+
Varenicycline or Bupropion
Sex worker screening (State Law)
3 monthly
HVS Chlamydia/ Gonorrhoea/trichomonas
Pharyngeal: as above
Vaginalvulva: warts
Blood: HIV Hep B Syphilis
Offer HepB and HepA vaccine
MSM (RACGP) screening
3 To 6mth
Serology: hiv HepB Syphilis
Swab : rectal/ throat for Chlamydia/Gonorrhoea/
Urine: same above
Offer HepB HepA vaccine