ATSI / Rheumatology

Question 1

Why is bronchiectasis more prevalent in ATSI community?

Answer 1

1. Overcrowded housing causing multiple LRTI in childhood
2. Lack of access to timely antibiotics for infections
3. Poor compliance with abx tx
4. Low immunisation rate
5. Higher rate of exposure to smoke / second hand smoker

Question 2

Reasons why ATSI reluctant to accept advice / referral for tertiary care?

Answer 2

1. Financial limitation for travelling
2. Lack of understanding of seriousness of dx
3. Transport limitation
4. Cultural barrier with lack of access to social network whilst away
5. Lack of trust in the medical system
6. Language barrier
7. Family committments
8. Fear of losing job
9. Fear of dx / tx
10. Previous negative experience from hospital

Question 3

DDx chronic dyspnoea

Answer 3

1. COPD
2. Lung ca
3. Interstitial lung disease
4. Pneumonia
5. CCF
6. PE
7. Cardiomyopathy

Question 4

Apart from smoking cessation what are 4 important features of mx for a newly diagnosed pt with COPD

Answer 4

1. Salbutamol inhaler 2 puffs PRN via spacer
2. Commence LABA (Salmeterol) or LAMA (Tiotriopium)
3. Review symptoms in 4-6/52 to assess response
4. Pulmonary rehabilitation
5. Physical activity with at least 150 minutes / week
6. Immunisation for influenza and pneumonia
7. Provide COPD action plan

Question 5

Tx for atypical pneumonia

• Mycoplasma (fever, headache, malaise)
• Chlamydia

Answer 5

Doxycycline PO 100mg BD 7/7

Question 6

DDx for myalgia, arthralgia, fevers in a farmer from NT

Answer 6

1. Q fever (cattle, sheep, goats)
2. Brucellosis (sheep, pigs)
3. Leptospirosis (domestic & wild animal urine)
4. Ross River Fever
5. Barmah Forest Virus
6. Cytomegalovirus infection

Question 7

Examination findings (6) in the following pt
- myalgia, arthralgia, fevers in a farmer from NT

Answer 7

1. Lymphadenopathy
2. Fever
3. Hepatomegaly
4. Rash
5. Swollen joints
6. Jaundice
7. Splenomegaly

Question 8

Clinical manifestations of SLE

Answer 8

1. Constitutional - malaise, fatigue, fever, weight loss
2. MSK - symmetrical polyarthritis in hands, wrists, knees
3. Cutaneous - malar rash
4. Renal - lupus nephritis
5. Haematological - anaemia
6. Serosal - pleural & pericardial inflammation

Question 9

Physical examination findings for a patient with suspected rheumatic fever

Answer 9

• tonsillar exudate
• erythema marginatum
• polyarthritis
• sydenham chorea
• systolic cardiac murmur
• palpable subcutaneous nodules

Question 10

Barriers to accessing healthcare for ASTI community

Answer 10

• shortage of GP services
• lack of affordable health care
• lack of awareness of existing services
• lack of culturally appropriate services
• lack of services available in other languages
• shortage of AHW
• perceived lack of confidentiality in rural areas
• mistrust in Western medicine
• distance to available health services