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Essential > Choosing Wisely > Flashcards

Choosing Wisely Flashcards

1
Q

With what patients should gonorrhoea PCR be requested?

A

Symptomatic

Asymptomatic - only if high risk (e.g. ATSI, MSM, multiple sexual partners, overseas travel/ partners)

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2
Q

What tool can be used to determine whether C spine imaging is required in trauma patients?

A

Canadian C Spine Rule

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3
Q

Name a tool for children and a tool for adults that can be used to determine whether CT brain is needed after head injury

A

Adults - Canadian CT Head Rule

Children - PECARN (Paediatric emergency care applied research network) or CHALICE

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4
Q

Do anti-histamines have a role in treating anaphylaxis?

A

No
Prompt adrenaline = treatment
Sedating anti-histamines may cause drowsiness/ cause hypotension/ mask symptoms of anaphylaxis

Anti-histamines do have a role in mild-mod allergic conditions e.g. urticaria, hayfever

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5
Q

Evidence shows what association between introduction of solid foods and development of nut allergies?

A

Introducing solid foods containing peanut at an early age (6 months, not before 4 months) is associated with lower risk of developing peanut allergies as a child

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6
Q

Should carotid US be performed following syncopal episode?

A

No, not routinely

Occlusive carotid arterial disease causes focal symptoms e.g. weakness, altered sensation, altered speech - not syncope

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7
Q

Name 4 features of headache that may warrant imaging

A

New onset headache in elderly
Progressively worsening headache
Headache that wakes someone from sleep
Headache worse with Valsalva manouvre

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8
Q

If ANA is negative, should ds-DNA Ab still be performed?

A

No - only if suspicion of SLE remains high

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9
Q

What is the latest evidence regarding US guided subacromial injections?

A

No advantage of US guided versus landmark-guided subacromial injection

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10
Q

Do benzodiazepines have a role in lower back pain?

A

No

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11
Q

In what patient group is FOBT appropriate?

A

In ASYMPTOMATIC patients at or slightly above average risk of colorectal cancer (usually 50yo +)

If GI symptoms or unexplained IDA -> refer for endoscopy

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12
Q

A 38 year old woman on the COCP develops a DVT - should thrombophilia screen be performed?

A

No - only perform in patients <50yo if VTE occurs without exogenous oestrogen, major transient risk factor or if occurs at an unusual site (test is expensive and may inappropriately prolong duration of anti-coagulants)

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13
Q

In a patient with 1st episode VTE in the context of a major transient risk factor (e.g. pregnancy, surgery) - how long should anti-coagulation be continued for?

A

3 months

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14
Q

In patients with ITP without risk factors for bleeding/ upcoming surgery, a platelet count of what or above is acceptable?

A

Platelet count >30 in adult ITP without risk factors - no treatment needed

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15
Q

What 2 office based investigations are important for most patients presenting with syncope?

A

ECG
Lying and standing BP

(NOT carotid US, unless syncope was associated with focal neurological deficit)

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16
Q

Do salbutamol or corticosteriods have a role in the treatment of bronchiolitis?

A

No

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17
Q

Why are PPI not routinely prescribed for infants with reflux?

A

Because it is no better than placebo in infants with reflux - there may be evidence if GORD in older children

PPIs associated with A/E e.g. nausea, diarrhoea, constipation, increased rates of infection, increased rates of food allergy

18
Q

What is the 1st line imaging choice for children/ adolescents with suspected appendicitis?

A

US abdomen

CT only if US result not clear or otherwise indicated (to reduce unnecessary radiation exposure)

19
Q

Why aren’t oral antibiotics routinely given in uncomplicated acute otitis externa or uncomplicated acute discharge from grommets?

A

Because topical agents provide adequate coverage of most causative organisms
Oral Abs have A/E
Reduce antibiotic resistance & risk of opportunistic infections

20
Q

What is the 1st line imaging for investigation of hoarseness?

A

No imaging

Refer to ENT for direct laryngoscopy for IX hoarseness

21
Q

Why is D dimer not useful during pregnancy to evaluate for possible PE?

A

Because D dimer is levels are raised throughout pregnancy (as is ESR)

22
Q

How often should urine ACR be tested in pregnancy in pre-eclampsia?

A

Not repeated - no role for testing for proteinuria once pre-eclampsia is diagnosed (used for diagnostic purposes, not prognostic purposes)

23
Q

Bilateral leg cellulitis is uncommon - what is the likely cause of bilateral redness/ swelling in a patient with chronic venous insufficiency?

A

Lipodermatosclerosis

24
Q

Name 3 features that would indicate bilateral lower leg cellulitis rather than venous changes/ lipodermatosclerosis

A

Fever
Neutrophilia
Expanding area of redness over hours/ days

25
Q

What is the 1st line treatment for inflamed epidermoid (formerly sebaceous) cysts?

A

Incision and drainage

antibiotics not routinely used - inflammation is usually due to leakage of cyst contents into surrounding tissue

26
Q

Why shouldn’t anti-fungals be prescribed for suspected nail infection until confirmed by a lab result?

A

Because 50% of thickened/ discoloured nails are due to age, pressure from footwear, trauma or other skin disorder e.g. psoriasis

27
Q

In light of increasing antibiotic resistance, what is the recommendation regarding antibiotic use for acne?

A

Avoid prolonged duration

Do not use on own - combine with BPO or retinoids

28
Q

What is the most common trigger for acute urticaria in children?

A

URTI and other viral infections

29
Q

Is there a role for phsiotherapy in frozen shoulder?

A

Not beyond devising a simple home exercise program - no evidence for ongoing physiotherapy

30
Q

Under what circumstances should a thyroid US be performed?

A

If there is a palpable thyroid nodule or enlarged thyroid/ goitre

31
Q

Use of what medication increases risk of ‘floppy iris syndrome’ during intra-ocular surgey e.g. cataract surgery?

A

Selective alpha 1 blockers e.g. tamsulosin (in Duodart), prazosin
Avoid use if awaiting cataract surgery - inform surgeon, they may need to change surgical technique

32
Q

In ankle injury after normal x-ray, if there is persistent symptoms e.g. pain and swelling, what imaging modality is 2nd line?

A

MRI

33
Q

Under what circumstances should US leg veins be requested for suspected DVT?

A

If Wells score for DVT is 2 or more, or if D dimer is positive (after Wells score <2)

34
Q

What is the investigation of choice in a pregnant woman with suspected PE?

A

VQ perfusion scan (D dimer elevated in pregnancy, perfusion scan is much lower dose radiation than CTPA)

35
Q

Routine self-monitoring of BSL is not recommended for T2DM patients on oral medication. Name 4 situations where it may be advised.

A 
Symptomatic hypoglycaemia
Heavy machinery operators (on a sulfonylurea e.g. gliclazide)
To demonstrate affect of diet on BSL
Pregnancy
Elderly with renal impairment
36
Q

Acute bronchitis is a common condition seen in patients presenting with cough. It is mostly viral (>90%) and self-limiting. List 2 features of acute bronchitis.

A

Cough +/- sputum lasting <3 weeks

No features of pneumonia (fever, tachypnoea, tachycardia, haemoptysis, signs of consolidation)

37
Q

Should a pelvic examination be routinely performed during pap smears?

A

No

38
Q

What is the recommendation for oral antibiotic use in otitis media in children?

A

Do not routinely give antibiotics if review in 24-48hrs is possible instead, in non-indigenous children aged 2-12 yo with no fever/ vomiting/ lethargy (may reduce risk of perforation but no affect on pain or severe complications - whereas 1 in 14 children will have A/E to antibiotic e.g. rash, diarrhoea)

39
Q

PSA testing in men who are unlikely to live another how many years is not recommended

A

PSA not recommended in men who are unlikely to live another 7 years - as the mortality benefits of early detection of prostate cancer is not seen until at least 6-7 years

40
Q

Should vitamin D be routinely screened for in pregnant women?

A

No - not unless risk factor e.g. overweight, reduced sun exposure

41
Q

Why are medications containing <30mg codeine not recommended for analgesia

A

Studies show that doses of codeine <30mg up to 6 hourly are no more effective than panadol or NSAID alone

Codeine is metabolised to morphine and a person’s ability to metabolise codeine is highly variable

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