Gen med

Question 1

What exam features are assessed after a wound? When are abx indicated? What abx are used?

Answer 1

Foreign body, N/V damage, joint involvement, tendon damage. Bites to hand/feet/face, deep tissues, open fracture, immunocompromised, cat bite, delay >8hr. Augmentin 1st line, or metro + doxy/bactrim.

Question 2

What are likely and serious diagnoses for fatigue? What tests are indicated?

Answer 2

Stress, depression, poor sleep/OSA, post viral. Cancer, arrhythmia, cardiomyopathy, HIV, hepatitis, anaemia. FBE, ferritin, BSL, TSH, UEC, LFT, ESR/CRP.

Question 3

What is complex regional pain syndrome? When does it occur and how is it managed?

Answer 3

Pain out of proportion to injury (Fracture, sting), with some of sensory, vasomotor, oedema, motor dysfunction. Rehab + multidisciplinary pain service to restore function, gabapentinoids first line or amitriptyline.

Question 4

How should hx be assessed in pt w down’s syndrome? What are some differentials for behaviour change?

Answer 4

Communicate directly, allow time. Collateral from family/support/docs. DDx: pain, depression/anxiety, b12, thyroid, UTI, constipation, dyspepsia, abuse, sleep disturbance.

Question 5

What conditions are more common/need screening in patients with downs syndrome?

Answer 5

Hearing and vision impairment (reg as a child/teen), TFTs childhood, hypogonadism, atlanto-axial instability, immune deficiency and leukaemia, obesity, GORD, epilepsy.

Question 6

Fibromyalgia - features, goals of care and non-pharm management.

Answer 6

Chronic diffuse noninflammatory soft tissue pain, assoc fatigue/cognitive clouding. Real pain but not damage, aim to treat to allow function. Regular graded aerobic exercise improves QoL, stress management/coping strategies, CBT and attention to sleep.

Question 7

What is the pharmacological management of fibromyalgia?

Answer 7

Used in conjunction, panadol/NSAID modest help. Avoid opioids. No TGA approval but low dose tricylic helpful - amitriptyline, dotheipin. If depression, duloxetine 2nd line, gabapentin 2nd line.

Question 8

Approach to intimate partner violence.

Answer 8

Listen with empathy, Inquire re needs/concerns, Validate, Enhance safety - plan for protection, Support - connect to info/services.

Question 9

Causes of hypokalaemia and hypophosphataemia?

Answer 9

K: GI loss, diuretics, malnutrition, hyperaldosteronism, insulin. P: iron infusion, primary hyperparathyroidism, Vit D deficiency, antacid abuse, refeeding syndrome.

Question 10

Causes of hypontraemia by class

Answer 10

CCF, cirrhosis, kidney failure. Euvolaemic: SIADH (carbamazepine, SSRI, cancer), hypothyroid, psychogenic polydipsia. Hypo: vomiting/diarrhoea, burns, thiazides/diuretics, adrenal insufficiency.

Question 11

Hypernatraemia and hypermagnesaemia - causes.

Answer 11

Na from water loss - diabetes insipidus, thiazides, GI loss, burns. Excess hypertonic solution. Replace fluid. Mg: enemas, antacids, AKI.

Question 12

Hypercalcaemia - symptoms and causes.

Answer 12

Polyuria, constipation, N/V, pancreatitis, weakness, confusion, kidney stone. Common: hyperparathyroid (adenoma), malignancy (lung or breast w bone met). Thiazides, Vit D excess.

Question 13

Hyperkalaemia - causes, management.

Answer 13

Pseudohyperkalaemia, renal failure, hypoaldosteronism, K sparing diuretic, ACE/ARB, tissue damage or low insulin - cell release. If >6, stop ACE/ARB, low K diet, thiazide and resonium. >6.5, ED - calcium gluconate, sodibic, insulin.

Question 14

What are the management principles and first line treatments for chronic pain?

Answer 14

Comprehensive assessment, multidimensional approach, supported self management, regular monitoring, long term support. Psychology, lifestyle management, social/environmental interventions.

Question 15

When is vitamin D testing indicated? When is treatment indicated?

Answer 15

Housebound, covered clothing, dark skin, CKD, hyperparathyroid, fat malabsoprtion. Treat < 30 w 3000-5000U daily for 6-12 weeks. Treat < 50 if osteoporosis.

Question 16

What are the features of malingering, somatic symptom disorder and conversion disorder?

Answer 16

M: illness falsification for external benefit. SSD: attributing normal symptoms to illness, seek many opinions, distress from symptoms. C: functional neuro symptoms not consistent w pathology, often w stress, not deliberate (eg. weakness, globus, seizure).

Question 17

What are the features of heat exhaustion and heat stroke?

Answer 17

E: thirst, weakness, headache, cramps. S = CNS involvement + temp >40, confusion/coma/seizure. Tachycardia, pulmonary oedema, DIC, rhabdo.

Question 18

What are the features of venous stasis eczema/dermatitis? What other condition is associated? What are the differentials?

Answer 18

Erythema, scaling and pigmentation. Can get lipodermatosclerosis - tender red, then thick, pigmented and tethered down from panniculitis. DDx: lymphodema, pretibial myxedema (graves disease), post thrombotic syndrome.

Question 19

What are differentials for insomnia? When is insomnia chronic?

Answer 19

Jet lag, restless legs, OSA, chronic sleep restriction, advance or delayed sleep wake disorder. Chronic 3x per week for >3months.

Question 20

What are the features of sleep hygiene? What therapy can be tried for insomnia?

Answer 20

Restrict bed activities, optimise light exposure (no screen 2hr), exercise during the day, have wind down routine like muscle relaxation, regular sleep wake time, avoid napping/oversleeping, avoid large meal in evening. Bedtime restriction therapy - min amount sleep for 1 week, increase 30min per week.

Question 21

How is oral iron taken? Side effects?

Answer 21

1hr before or 3h after food, with vitamin C. Avoid PPI, calcium, thyroxine, caffeine, dairy. Nausea, constipation, bloating, diarrhoea, black stools.

Question 22

What are the possible side effects of an iron infusion?

Answer 22

Iron staining, anaphylaxis, flu-like symptoms 1-2d post, flushing/dizzy at start (slow rate), transient hypophosphataemia 5-20d post –> pain, weak, tingling, small risk stress fracture. Check PTH, Ph, Ca, Vit D.

Question 23

What are the associations of dupuytren’s contracture? How is it managed?

Answer 23

Repetitive handling/vibration, diabetes, alcohol, smoking, peyronies. White males/FHx. Mx: observe, gloves for pain, intralesion steroid for nodule, collagenases by specialist. Surgery for contraction. Splint/exercise doesn’t affect progress.

Question 24

Causes and effects of B12 deficiency. Treatment.

Answer 24

Gastritis, gastric surgery, Small bowel: coeliac, IBD, SIBO. Pancreatic insufficiency, strict veg/vegan diet, PPIs. Autoimmune (autoantibodies to parietal cells and intrinsic factor). Neuropathy, dementia, anaemia.

IM 1000microg alt daily 2 weeks or every 2-3mo.

Question 25

When are DOACs WH prior to and after surgeries? Aspirin, antiplatlets and NSAIDs. What are 4 low risk bleeding procedures?

Answer 25

DOAC: 1-3d - High risk WH 2 full days, low risk 1 day prior. Minimal- no WH Restart 1-3d after. Aspirin 7 days, clopidogrel 7-10. NSAID 3 days. LR: cataract, scope, angio, dental extraction.

Question 26

What are the symptoms of lead poisoning in adults and children? Where can someone be exposed?

Answer 26

Poor concentration, headaches, N/V, constipation,anaemia, renail impairment. Kids: developmental delay, abdo pain, pica. Exp: mining, batteries, ammunition, old paint.

Question 27

What single dose ingestion of panadol is risky? What 4 other factors also increase risk?

Answer 27

10g. Late presentation (> 8hr), large dose or modified release are high risk. Intentional overdose high risk - stated dose may be inaccurate.

Question 28

What are 6 features to examine when looking at a lower leg wound?

Answer 28

Infection (pain/discharge), hair loss, sensation, pulses, footwear + gait, consider ABPI.

Question 29

Venous ulcers - 5 features, 3 risk factors and 3 features of main treatment.

Answer 29

Lower third of leg, irregular shape, shallow depth, exudate and slough, surrounding oedema/haemosiderin. Obesity, poor mobility (venous stasis), prev DVT. Graduated compression therapy (30-40mmHg at ankle), leg elevated, exercise.

Question 30

Arterial ulcers - 4 features, 2 risk factors, main treatment.

Answer 30

Painful, sharly defined/punched out, deep, thin shiny hairless leg. RF: diabetes, smoking. Tx with surgery (stent, bypass, amputation).

Question 31

When do you use solugel/solosite, opsite, duoderm/comfeel and kaltostat dressings?

Answer 31

Hydrogel - if dry/scabbed. Films - min exudate, keep there post-op. Hydrocolloids - for open wound, forms a gel, good for low/mod exudate. Foams for wet/exudating wounds.