BPAC QUIZ Flashcards
PMR
W:
- Most common AI rheum condition >50 & 2nd to RA
- 3F:M, peak 70s
- 20% have GCA, 50% alt.
S:
- Night pain, sleep issues
- Myalgia, NOT weakness
- Am stiffness >30mins
- Symptoms RAPID onset
Ix:
- NO gold-standard test
- CRP/ESR help, can be n
Mx:
- Very very mild -> ?NSAID
- Pred 15mg then taper, 2y
- MTX relapse/persisting/CI
- Asp + PPI if CVD risks
Px
- Relapse 50%, within 2yr
- >Risk arthritis, >CRP/ESR, Female, >Plt
Steroids
- SE: glaucoma, osteoporosis, cushing, infection, GI, bone
Gynae Cancers
Cervical
- <30% LSIL -> HSIL
- Gardasil: 50% H-risk type
- Risks: >full term pregs, smoking, long-term COCP, <immune
Ovarian
- Sx: 90% symptoms
- Ix: avoid Ca125 if period
- BRCA1 > BRCA2. Lynch
- OCP protective
- If genetic, surg 35-40 +/- uterus if oes only MCP or tamoxifen use OR lynch as also risk of endometrial
Endometrial: Also w Sx, associated with lynch, obesity, oestrogen, pacific
Vulval
- Most = majora, Dx after S
- VIN pre-cursor 4 non HPV
- 50% VIN -> SCC in 10yr
- 10% HSIL HPV -> Ca 10yr
Vaginal
- Most = upper
- Most HPV related
- Swab/cyto any lesions -> colposcopy
- Refer if visually abnormal, x wait results
FU
- FU for 2-5 years
- Present if Sx, X wait 4 FU
- ovarian recurrence high
- most are within 2-3years
- most symptomatic
- 10-20% of C-Ca1 recurr
Concussion
+3 rule for activities
Hypertension
W:
- Most >65 (DM, CKD, stiff)
- MAPAS have >untreated
- No specific cut-off for N
- INCREASING BP in NZ
- Diff in arms >10 signif.
IX
- Do CVD in ALL if BP >130/80 consistently
MX
- Salt <1.5g/day or <by 1g
- Exercise 30m/day 5days
Medications generally reduce by 10mmHg. 80% effect on lower dose + fewer SEs. SO >20mm above then START TWO
3x on good dose then ?lifetyle ?adherence ?2ndry and 24hr ambulatory
Melanoma
Diagnosis
- W: M>F, M trunk, F legs
- FH is 2x risk
- Better if clinician finds
- SK can meet A->G bits
- Ugly duckling helpful
Ix
- Dermatoscopy has reduced excisions for benign
Screening:
- People at v high risk: FH, BG of, multiple atypical naevi = total body / dermat 12 months
- Regular self-checks also
Recurrence:
- Risk = staging at Dx, M>F
- Resection margins <1cm
- 75% detected by patient
- 5-10% have 2nd 1ry later
- Stage 1 has higher no of deaths AFTER 10 YEARS
FU: some need USS/CT
For benign, FU or IQ are better than cryo at clearance. BUT cryo better if isolated
Lung Cancer
W: most cancer deaths NZ
- <20% 1yr survival if S4
- 60% advanced at Dx
- Risks: age, smoking, copd, ILD, TB w/o smoke
Dx: CXR may miss 25%
- sputum cytology
- FBC, U&E, LFT, Ca, Coag
FU
- Typically 5 years
- 50% curative Rx -> recurr
- Peak within 2 yrs
- 1-2% new primary risk/yr
LTFU
- CXR at 3 months
- More only if Sx / concerns
- Cough common 2y -> ICS
Vax
- Give 2x flu vaccine year 1
- Live >6m after Rx finish
- Give: Boostrix, hep B, Poli, pneumococcal
- MMR if born 1969 or later and no documented 2x dose
Studies
Cohort
- Exposure to risk factor
- Compare with and without -> outcome
- P: long-term
- N: time, $, confound
Case-control
- Case to control, look for risk factor.
- P: good for rare
- N: recall bias, no direct
Also case studies/series
Cross section: prevalence
Ecological: associations
Relative risk reduction
= % of the original number
Absolute is % - % (easier)
The odds ratio tells you how much more likely the event is in one group compared to the other.
Asthma
W:
- 50% pre-school wheeze will not go on to asthma
- bronchiolitis = most wheeze <1yo
- older viral urti = most
- Nocturnal cough alone unlikely to be asthma
- no ICS if only infrequent
LKRA only if x use ICS or add-on for rec. wheeze
LABA only 5+ WITH ICS
-
5-11yo still have just SABA as first step. AIR can be used but unapproved
SABA alone:
- > exac, tachyphylaxis, sens to allergies, inflamm
LABA only monotherapy not recommended as treats obstruction but NOT inflammation. Okay in COPD.
In COPD, eos >0.3 most likely to benefit from ICS
Prostate
Most common cancer + 3rd highest cause of death for M in NZ
- MAPAS 1/2 test, 2x death
Screen 50-70, or 40 w FH
FU PSA 6mnths 2yr -> yrly
Dementia
Long-term cog abilities grow til 60s, start to decline from 80s
Fluid abilities decline age 20 (new skills, problems)
Working memory (short term processing/storage) declines with normal aging
- long-term memory relatively stable
MHT NOT protective
50% MCI -> dementia
ACE-I slow functional decline but x progression
BPSD Rx doesn’t help wandering, calling out, or sexualised behaviours
Acne
Isotretinoin - option for high risk of 10mg 3x/wk or 5mg unfunded
