Gen Med

Question 1

What are the features on assessment suggestive of delerium as a cause of behavioural disturbance?

Answer 1

Delirium Signs
- Fluctuating sensorium
- Altered conscious state
- Disorientation
- Hallucinations (visual)
- Poor attention
- Acute onset
- Disrupted sleep/wake cycle

Causes
- Fevers/abnormal vitals
- Drug withdrawal
- Drug changes
- Recent surgery/illness
- Abnormal electrolytes
- Focal neuro signs
- Hypoglycaemia/Hypoelectrolyte
- Active infection
- Signs of head trauma
- Chest pain (AMI)

Question 2

What should be discussed with the next of kin when completing a resuscitation plan for a patient?

Answer 2

• Identity of EPOA/MPOA or closest next of kin to make decisions
• Pre-existing advanced health care directive
• Previous expressed wishes
• Level of premorbid function
• Co-morbidities
• Quality of life
• Cognitive status
• Prognosis of current illness
• Limits of treatment

Question 3

What can be done in the emergency department to prevent delerium?

Answer 3

• Frequent repeat orientation
• Give usual medications
• Avoid sedatives/hallucinogens
• Meals at regular times, prevent dehydration and hunger
• Adequate analgesia
• AWS if history of ETOH excess
• Engage family, talk/accompany
• Window access with natural light
• Accurate clocks and dates
• Maintain normal sleep wake cycle for the patient
• Glasses and hearing aids
• Low background noise
• Catheter to prevent retention
• Familiar objects

Question 4

What are the benefits of advanced care directives?

Answer 4

• Reduce rates of non-beneficial care and hospitalisation
• Allows patients wishes to be respected re treatment and location ie dying on country in NT
• Reduced stress on families/staff

Question 5

What non-pharmacological things can be done to assist with end of life care?

Answer 5

Environment
- comfort, food, drink, warmth, family, music

Social
- Appropriate cultures/religous care

Patient
- Avoid unneccesary procedures or disturbance
- Access to items of comfort

Medical
- Mutlidisciplinary approach
- Early and thorough end of life discussions
- Identify suitability for organ donation

Question 6

What are the clinical discharge criteria for patients with back pain?

Answer 6

• Pain reasonably controlled
• Able to mobilize near or at baseline
• Afebrile and stable
• Safe discharge destination
• Appropriate follow up arranged
• Nil serious alternate diagnosis and red flags screened for and cleared

Question 7

What is the CriSTAL tool for risk of death within 3 months?

Answer 7

Age >65 + score >4 = high prediction for short or medium term death
- Cognitive impairment
- Repeat ICU admissions
- RACF resident
- Fra(I)lty score moderate to high
-Hospitalisation within the last year
- Proteinuria
- Abnormal ECG
- Advanced organ disease or malignant cancer

Question 8

What are some safe doses of parenteral medications that can be used to treat delirium?

Answer 8

IM Olanzapine 2.5mg

IM Haloperidol 0.5mg

Question 9

What are the typical medications prescribed for end of life care and their indications?

Answer 9

Question 10

What are the differentials for unilateral leg redness/swelling?

Answer 10

Infection
- Cellulitis
- Nec fasc etc

Thrombosis
- DVT, superficial thrombophlebitis

Vasculitis
- SLE, kawasakis, HSP etc

Inflammatory conditions
- Ie gout

Dermatitis
- Stasis, contact

Iatrogenic
- Drug reaction ie DRESS, SJS

Bites
- Snake, spider etc

Question 11

What are the different screening tools that can be helpful in initiating palliative care?

Answer 11

• Clinical frailty score
• CriSTAL tool (most validated)
• SPICT (support and pall care indicative tool)
• SURPRISE question

Question 12

What are the pros and cons of using Na+ HC03 for treatment of hyperkalaemia with acidosis?

Answer 12