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General Flashcards

1
Q

Non Modifiable causes of osteoporosis

A

Female

Ageing

Race eg Asian

Family history of maternal hip #

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2
Q

Modifiable risk factors for osteoporosis

A

Smoking

Low Dietary calcium

Lack of vitamin D

Alcohol > 2 std/day

Caffeine intake > 4cups/day

Physical inactivity

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3
Q

Medical causes of osteoporosis

A

Eating disorders Malabsorption eg coeliac disease Cushing’s Diabetes mellitus Hyperthyroidism Hyperparathyroidism Sex hormone deficiency Acromegaly Connective tissue disease eg RA Liver Failure Kidney Failure Heart failure

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4
Q

Drugs causing osteoporosis

A

Corticosteroids Antiepileptics eg phenytoin, carbamazepine Excessive thyroxine Breast Ca hormone therapy Prostate cancer hormone therapy Heparin Thiazolidinediones eg rosiglitazone

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5
Q

What is a T-score

A

Number of standard deviations above or below the mean bone density of a 30 yr old adult >= -1 =. Normal -1 - -2.5. Osteopenia

< -2.5 Osteoporosis

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6
Q

What is a z score

A

Number of standard deviations away from the mean BMD of age, gender and ethnicity matched controls. When z < 2.0 consider coexisting contributing factor

eg. Corticosteroid use, Hyperparathyroidism, Alcoholism.

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7
Q

Contraindications to HRT

A

Absolute:

Pregnancy

Current thromboembolism

Suspected or Active Oestrogen dependent tumour

Acute Ischemic Heart disease

Cerebrovascular disease

Undiagnosed vaginal bleeding

Active Liver disease

Active SLE

Relative (Seek Specialist Advice):

Previous Oestrogen Dependent Tumour (Breast, Ovary, Endometrial)

Increased risk of DVT/VTE

Previous Ischemic Heart Disease

Focal Migraine

Hypertriglyceridemia

Avoid in: Uncontrolled Hypertension and

Acute Intermittent Porphyria (progesterone)

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8
Q

Preconception care

A

Smoking cessation

Alcohol cessation

Weight and diet optimisation

Folate supplementation 0.5 or 5.0 (high risk) start 1/12 before pregnancy to end of first trimester.

Iodine supplementation 150 mcg. 220 mcg when breast feeding.

Physical activity 30 mins daily

Excessive gestational weight gain increases risk of: Gestational diabetes, preeclampsia, c-section, miscarriage, obese child (metabolic syndrome), large for dates. Weight loss is not recommended in pregnancy.

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9
Q

Contraindications Combined oral contraceptives

A

Absolute:

Pregnancy to 6 weeks post partum (if Breast feeding)

Previous DVT,

Previous oestrogen dependent tumour,

Previous stroke,

Uncontrolled Hypertension

Acute liver disease,

Migraine

35 yo w inc CVD risk (eg. smoking >15/day),

Immobilisation,

Chronic Liver disease,

SLE positive

Porphyrias

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10
Q

Contraindications to IUD

A

Absolute: Pregnancy, active PID, undiagnosed DUB, previous ectopic. Relative: Very large uterus, very small uterus, Anemia, immunodeficiency, impaired clotting, valvular heart disease, previous PID.

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11
Q

Hypertension in pregnancy: definitions

A

Hypertension: SBP > 140 or DBP > 90 Severe Hypertension: SBP > 160 or DBP > 110 Increase greater than 30/15 from baseline is concerning SBP > 170 = Urgent Treatment (referral) Timing usually after 20 weeks

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12
Q

Types of hypertension in pregnancy.

A

Preeclampsia = htn + end organ damage (usually proteinuria) Gestational Hypertension = new onset htn at > 20 weeks, resolving

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13
Q

Effects of smoking preconception

A

Male infertility Female infertility Delayed conception Delayed conception during assisted reproduction

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14
Q

Effects of smoking in pregnancy

A

Increased risk of: miscarriage, preterm birth (2x), placental problems (previa, abruption), preeclampsia, ectopic, foetal growth restriction, low birth weight, small for dated, birth defects

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15
Q

Effects of smoking on early childhood

A

Increased risk of: SIDS, T2DM, obesity, HTN, Nicotine dependence, ADHD, conduct disorder, psychiatric problems (eg Depression)

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16
Q

Alcohol in pregnancy

A

No level of alcohol is considered safe in pregnancy. Risks increase with quantity and frequency. Foetal alcohol spectrum: Facial abnormalities eg flat nasal bridge and epicanthal fold Impaired growth Abnormal structure and function of the nervous system and Foetal alcohol disorder Limb defects Intellectual and learning disabilities MSK defects Behavioural difficulties Poor social skills

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17
Q

Motivational Interviewing The 5 As

A

Ask Assess Advise Assist Arrange

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18
Q

Motivational interviewing Stages of change:

A

Precontemplative Contemplative Planning Action Maintenance Relapse

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19
Q

Motivational interviewing and intervention: Approach to education

A
  1. How big is the problem 2. Consequences of not doing/changing 3. Benefits of change 4. Barriers to change
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20
Q

Opportunistic screening

A

SNAP + Weight. All Depression. > 13 yo Chlamydia risk. 15 - 29 yo. Annual testing if sexually active Skin Cancer: opportunistic advice to All. self check > 12 yo, high risk = 3-12 mth screening, others opportunistic. Preconception care 15-49yo Colorectal Ca 50+, 2 yearly fobt CV risk: from 45+, (35yo ATSIC) every 2 years. Cholesterol 45+ (35yo ATSIC) every 1 - 5 years depending on risk. Bp from 18+ every 6 weeks to 2 years (high - low risk) Pap smear 18 - 69 or 2 years after sexually active. Every 2 years if normal. Mammogram 50 - 69 2 yearly. 40+ if 1st deg relative Dx

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21
Q

Stroke Risk ABCD2

A

Age >60 1pt BP > 140/90. 1pt Clinical features: unilateral weakness 2pt Speech impairment w. No weakness. 1pt Duration. > 60 min 2pt, 10 -59min. 1 pt Diabetes. 1pt Other high risk features: AF, 2 or more TIAs in 7 days (crescendo), carotid artery disease. High risk 4-7 immediate CT/MRI +/- Doppler Lower risk 0-3 CT head in 72 hrs

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22
Q

Ideal Weight gain in pregnancy

A

First trimester 0.5 - 2kg total 2nd - 3rd trimester BMI 30.0 0.2 kg/wk

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23
Q

Chronic Abdominal Pain Red flags

A

Older patient, Nocturnal Pain, Nocturnal diarrhoea, Progressive symptoms, Rectal bleeding, Fever, Anaemia, Weight loss, Abdominal mass, Faecal incontinence or urgency (recent onset),

Consider: pancreatic cancer, ovarian cancer, small and large bowel cancers, Mesenteric Ischemic, Crohn disease, metabolic disorder (eg lactase deficiency) If no red flags: Consider chronic appendicitis, adhesions, irritable bowel syndrome, Peptic ulcer,

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24
Q

Spondyloarthropathy types and features

A

Ankylosing spondylitis Reiter’s syndrome Psoriatic arthritis Enteropathic arthritis (Inflammatory Bowel Disease) Features: Chronic Systemic involvement + joint involvement sacroiliac joint involvement Affect areas around the joint including tendon attachments (esp knee, hip, foot)

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25
Q

Ankylosing spondylitis Features and treatment

A

Back +/- gluteal pain and stiffness causing early waking

Pain improves with mobilising

Weight loss, fever, fatigue

Reduced spinal flexion and extension (Schober’s test)

Uveitis (40%) due to HLA-B27 antigen

Age

M > F

Strong familial component

Vertebrae changes (syndesmophytes -> fusion -> bamboo spine)

Ix: Elevated CRP and ESR during acute inflammation Seronegative (RA -ve) ANCAs are oft +ve

HLA-B27 genotype

positive Schober’s test - clinical flexion (mark out 2 points 5cm below and 10 cm above L5. On touching toes should extend to >20 cm)

X-ray SI joints - early erosion and sclerosis. Spine - syndesmophytes -> bamboo spine

Tx: anti-inflammatory drugs eg indomethacin 100mg PR note (first line), cox-2 inhibitors (celecoxib) DMARDs eg sulfasalazine 500mg PO daily TNFa blockers eg. Inflixiamb

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26
Q

Reactive arthritis (Reiter’s syndrome) Common causes

A

Urogenital: Chlamydia trachomatis (male, 20 - 40yo) Enteric: Salmonella typhimurium, Shigella flexneri, Yersinia enteroclitica, Campylobacter jejuni Other: Streptococcal infections. Acute reactive arthritis may require prednisolone 25 mg daily Chronic reactive arthritis is managed as for ankylosing spondylitis

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27
Q

Viral Arthritis Causative organisms

A

Influenza Mumps Rubella Varicella Hepatitis B,C Epstein Barr Virus (esp myalgias) Cytomegalovirus Adenovirus (children) Ross River virus Barmah Forest virus Features: acute onset (within 10 days of viral illness), rash, polyarthritis, symmetrical inflammation, esp hands and feet, lymphopenia or lymphocytosis Terminates rapidly.

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28
Q

Arthritis Red flags

A

Fever Weight loss Profuse rash Lymphadenopathy Cardiac murmur Severe pain and disability Malaise and fatigue Vasculitic signs (palpable purpura, livedo reticularis, glomerulonephritis + Fever, wt loss, etc) Multi system involvement

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29
Q

Management of Spondyloarthropathies

A

eg: Psoriatic arthritis, Reactive arthritis, Enteropathis arthritis, Ankylosing spondylitis (adult and juvenile onset), and Unclassified spondyloarthritis.

Management:

Identify the most active elements of the disease and treat

Educate and reassure

Regular assessment and support

Genetic counselling esp ankylosing spondylitis + HLA-B27

Work and Posture advice

Physiotherapy referral

Occupational therapy referral

NSAIDs: Indomethacin 75 - 200mg PO or 100mg PR daily

DMARDs - Sulfasalazine 500mg daily

TNF-a inhibitors eg inflixamab

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30
Q

Complications of diverticulitis (6)

A

Bleeding Perforation Abscess Peritonitis Fistula (bladder, vagina, small bowel) Bowel obstruction

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31
Q

Red flags chronic Abdo pain

A

Progressively worsening symptoms

Recent Bowel changes eg incontinence

Weight loss

Fevers

Anaemia

PR bleeding

Abdominal mass

Nocturnal pain

Advanced age

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32
Q

Red flags for acute abdo pain

A

History: Progressively worsening vomiting Collapse at toilet (intraabdominal bleeding) Lightheaded Ischemic heart disease Distension Malignancy Signs: Fever Pallor Diaphoresis Hypotension Tachycardia or AF Prostration Rebound tenderness or guarding Decreased Urine output

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33
Q

ray Findings in Osteoarthritis

A

Joint space narrowing

Subchondral cysts

Ostophytes

Altered shape of bone ends.

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34
Q

Osteoarthritis

Principals of Management

A

Explanation

Exercise

Rest

Heat Packs, Heated blankets

Diet/Weight reduction

Mobility aids

Physiotherapy

Occupational therapy

Simple analgesics (Paracetamol)

NSAIDs (esp COX-2 if history or risk of GIT complications)

Glucosamine/Chondroiton

Surgery if severe.

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35
Q

Criteria for the diagnosis of Rheumatoid Arthritis

A

Symptom duration > 6 weeks

Early morning stiffnes > 1 hr

Arthritis in 3 + regions

Bilateral compression tenderness of the MTPs

Symmetrical involvement

RF +ve

Anti-CCP +ve

Bony erosions on xrays of hands or feet (late change)

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36
Q

Rheumatoid Arthritis: Principles of Management.

A

Patient education and support

Early treatment with DMARDs (methotrexate 5-10mg weekly + folate 5-10mg weekly) Can add sulfasalazine and/or hydrochloroquine if required, also infliximab.

Fish Oil 4g

Paracetamol, NSAIDS, Corticosteroids

Early referral to specialist

Regular functional assessment

Regular review

Regular Exercise

Physiotherapy referral

Occupational therapy referral

Daily joint mobilisation

Weight management

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37
Q

Gout Treatment

A

Acute:

NSAIDs eg indomethacin 50mg TDS 3-5 days then taper.

Colchicine 0.5mg q6h until pain relief (~24 hrs).

Corticosteroids: intra articular or oral (40mg daily for 4 days then wean to 10 days.

Chronic:

Allopurinol 100 - 300mg daily PO (lower doses if renal insufficiency)

Weight Reduction

Avoid purine rich food (eg organ meats)

Reduce alcohol intake

Water - 2 litres/day

Reduce sugary soft drinkss

Avoid diuretics and aspirin

Wear comfortable shoes.

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38
Q

Management of large congenital melanocytic naevi more than 20cm in diameter

A

Lifetime surveillance be undertaken whether or not any surgery has been performed. This could include baseline photography and three-monthly evaluation for the first year of life, followed by six-monthly evaluation for the next three years, and then yearly evaluation

Parents or patients report immediately any concerning changes that occur between follow-up visits

Biopsies be undertaken immediately of any areas which show suspicious features

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39
Q

Management of Cafe au Lait Macules

A

Solitary cALMs are common in up to 3% of healthy infants and 25% of children.

Multiple cALMs are rare in healthy children.

Children with three or more cALMs should be monitored for other features of NF-1

Most Children with six or more cALMs will eventually be diagnosed with neurofibromatosis-1 (NF-1), potentially affecting multiple organ systems.

Café au lait macules may also be seen in multiple other rare syndromes.

Treatment: Isolated cALMs may be treated with pigment laser therapy.

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40
Q

6 week baby check

A

How are family coping.

ANy Concerns

Jaundice, Colour, Birthmarks

Consider trisomy 21

Head Circumfrence, Lentgth, Weight and growth velocity

Engaging with examinars face

Eyes tracking, symetrical light reflections in eyes

Red eye reflex

cleft palate and uvula if able

Heart (ventriculo-septal defect, PDA) and lungs (central cyanosis, chest resesion, CCF, infection)

All limbs moving normally

Ventral suspension - head should be held inline with torso (serebral palsy)

Femoral Pulses (absent in coarctation of aorta)

decended testes, genital normality

Hip Dysplasia (Ortalani = downwards presure , Barlow = liftting, ie relocating)

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41
Q

Abdominal Pain and bowel changes in children

DDx

A

Most likely: Functional Gastrointestinal Disorder (50%) (eg IBS, Abdominal migraine, functional dyspepsia, childhood functional abdominal pain))

Must Exclude:

Coeliac Disease, IBD, Food Allergy, Eosinophilic Oesophagitis, Colorectal Cancer, Gastroenteritis.

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42
Q

Causes of Secondary Amenorrhoea

A

Pregnancy or contraception

PCOS

Hypothalamic-Pituitary axis disorder

Prolactinoma

Malabsorption

Thyroid disorder (Hyperthyroid, Hypothyroid)

Eating Disorder eg Anorexia nervosa

Strenuous exercise

Emotional Stress

Premature ovarian failure

Kidney Disease, Liver Disease

RACGP Exam lists as: Hypothalamic-pituitary axis disorder (stress, exercise, anorexia), Pituitary tumour (prolactinoma), Medication (OCP), Autoimmune (coeliac, pernicious anemia, thyroid), PCOS

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43
Q

Causes of Primary Amenorrhoea

A

Hypothyroidism

Turner’s Syndrome (45 XO)

Kallmann’s syndrome (normal stature + loss of smell)

True gonadal dysgenesis

Hepaphroditism

Androgen secreting tumour

Congenital Adrenal Hyperplasia

Androgen Insensitivity syndrome

Mullerian developmental abnormalities.

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44
Q
A
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45
Q

How do you manage a Pt with BP >160/100

> 45 YO Non idigenous

> 35 YO Indigenous

A
  1. Assess for known CV disease or CVD Risk if no known disease
  2. Frequent and sustained lifestyle advice and support (eg smoking cessation)
  3. If known CVD or Moderate (10-15%) to High Risk (+ 15%) consider commencing BP Lowering (eg. perindopril 5mg) and Lipid lowering (Atorvastatin 40mg) medication.
  4. Monitor individual risk factor response to interventions
  5. Regular review of absolute risk

Low risk = 2 yearly

Moderate RIsk = 6 - 12 monthly

High Risk = as clinically needed

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46
Q

4 Blood Pressure Lowering Combinations to Avoid:

A
  1. ACEI or ARB + K sparing diuretic (eg spironolactone) - May cause hyperkalemia
  2. Beta blocker + Verapamil or Diltiazem (CCB) - May cause heart block
  3. ACEI + ARB - May cause hypotension and kidney injury
  4. Betablocker + Thiazide diuretic - May potentiate worsening glycaemic control
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47
Q

Ideal BP medication combinations for the following:

  1. Diabetes
  2. Post MI
  3. CCF
  4. CAD
A
  1. Diabetes: ACEI (eg perindopril) + CCB (eg Amlodipine)
  2. Post MI: ACEI or ARB + Beta blocker (Atenolol 50mg BD)
  3. CCF: Thiazide Diuretic + ACEI or ARB
  4. CAD: Beta blocker + Dihydropyridine CCB (eg Amlodipine)
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48
Q

Absolute contraindications to Beta Blockers

A

Asthma

Moderate to Severe COPD

Decompensated Heart Failure

Cardiogenic Shock

2nd or 3rd degree Heart Block

Symptomatic Bradycardia

Severe Peripheral Vascular Disease

Sick Sinus Syndrome

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49
Q

Factors affecting adherance to medication

A

Education

Treatment Complexity

Doctor - Patient Relationship

Beliefs

Health literacy

Side effects.

Ecconomic factors (eg cost)

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50
Q

Dx and Treatment

Female

Lower abdominal pain and tenderness

Cervical motion tenderness

Adnexal tenderness

Temp + 38oC

A

Pevic Inflammatory Disease

14 Days Metronidazole 400mg TDS PO

14 Days Doxycycline (not preg) 100mg BD TDS

500mg Ceftriaxone IM stat

1 gm Azithromycin PO stat

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51
Q

Red Flags for Breast Lumps

A

Hard and Irregular

Skin dimpling or puckering

Skin oedema (peau d’orange)

Nipple discharge

Nipple distortion

Nipple eczema (Paget disease)

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52
Q

Probable Diagnosis of different types of nipple discharge:

  1. Bloodstained
  2. Green -Grey
  3. Yellow serous
  4. Yellow pus
  5. Milky white
A
  1. Bloodstained: Intraduct papilloma
  2. Green - Grey: Fibrocystic disease or duct ectasia
  3. Yellow serous: Intraducta carcinoma
  4. Yellow pus: Breast abscess
  5. Milky white: Galactorrhoea eg. hyperprolactinemia.
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53
Q

Differential Diagnosis for post coital bleeding

A

Cervical Ca

Intra-Uterine Ca

Chlamydia (< 30 YO)

Cervical ectropion

Cervical polyps

IUD

OCP (can change to higher oestrogen dose)

Ix:

Pap smear (all ages) if not last taken within 3/12

Referral for endometrial sampling (>35 yo)

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54
Q

Management of cycle irregularity

A

Under 35:

Reassurance, OCP

Over 35: Referred to Gynaecologist for consideration of hysteroscopy and endometrial sampling.

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55
Q

3 Most common bacterial causes of Otitis Media

A

Strep pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

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56
Q

Considerations for commencing HRT

A
  1. Previous Breast Ca
  2. Presence of Distressing vasomotor symptoms
  3. Assess Cardiovascular Disease Risk (Known Cardiovascular Disease, Smoking, Lipids, BP)
  4. Oestrogen + Progesterone if Uterus still intact
  5. Lowest dose for shortest duration possible.
  6. OCP or IUD + Oestrogen if requiring contraception
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57
Q

Considerations in Therapeutic Choice of HRT

A
  1. Discuss a woman’s goals and concerns about menopause and her treatment preferences
  2. Oestrogen with or without progestogen is the most effective treatment for women with menopausal symptoms
  3. Consider potential benefits and harms and assess cardiovascular risk
  4. Tailor the dose and duration of therapy according to individual symptoms and existing risks
  5. Inform women about the limited efficacy and safety data on complementary and alternative medicines
58
Q

Features of Autism

A
  1. Impairment in Social interaction
  2. Impairment in Communication
  3. Repetitive Activities (eg. echolalia)
  4. Behavioural Problems
  5. Fixated Intrests (eg sensory sensitivities)
59
Q

Management Options For Cystic Fibrosis

A

Referral to Specialist

Physiotherapy for airway management

Hypertonic saline nebulisers

Bronchodilators

Antibiotics for Respiratory infections

Pancreatic enzyme replacement

Dietician referral for dietary manipulation

Lung and Liver transplant.

60
Q

Contraindications to a medical termination

A

Beyond 9 weeks gestation

Adrenal failure

Severe Asthma

Porphyria

Hypocoagulation Disorders (Including anticoagulant therapy)

Previous allergic reactions to these medications.

61
Q

Leading causes of accidental death in children

A

Drowning

Crush Injuries from large objects

Motor vehicle accidents

Strangulation and suffocation

Unsafe Sleeping environments

62
Q

Risk Factors for Gestational Diabetes

A

Previous GDM

Previously elevated BSL

Ethnicity eg. ATSI, Middle eastern, Pacific Islander, South east asian

Age > 40

First degree relative with DM, Sister with GDM

Obesity esp BMI >35

Previous baby with macrosomia (>4.5Kg birth weight)

PCOS

Medications (corticosteroids, antipsychotics)

63
Q

Conditions associated with vitamin D deficiency

A

Coeliac Disease

Obesity

Use of anticonvulsants

Hyperparathyroidism

64
Q

Complications of Untreated Sleep Apnoea

A

Ischemic Stroke

Heart Failure

Impaired Cognitive Function

Increased risk of MVA

HTN

Depression

Diabetes

65
Q

Features of Cassical Migraine

A

Unilateral Headache

Throbbing

Nausea

Vomiting

Photophobia

Elation

Flushing

Cravings

Optical changes - zigzag lines and tunnel vision

66
Q

Causes of multiple spider naevi

A

Oestrogen therapy

Liver disease (eg alcoholic cirrhosis)

Thyrotoxicosis

Pregnancy

Trauma

67
Q

Features of Labyrinthitis

A

Severe Vertigo - may be positional

Nausea and Vomiting

Hearing Loss (Sensorineural ie Webbers lateralises to unaffected side)

Tinnitus

Nystagmus away from lesion

68
Q

Features of Vestibular Neuritis

A

Vertigo

Nausea and Vomiting

No affect on hearing

69
Q

Asthma diagnosis in Adults:

History (4)

Supporting Evidence (8)

A

2 or more of the following:

Cough

Wheeze

Chest tightness

Breathlessness

Supported by:

Recurrent of seasonal

Identifiable triggers (eg. cold air, URTI, etc)

Response to SABA

Wheeze on auscultation

Family history of atopy

Commenced in childhood

FEV1 or PEF < predicted

Unexplained Eosinophillia

70
Q

Asthma in Adults Diagnosis:

A

Spirometry pre and 10 mins post bronchodilator:

Reversible airway limitation:

FEV1 increased >/= 200mls and 12%

or,

Expiratory airway limitation:

FEV1/FVC < the lower limit of normal for age.

71
Q

Management of Asthma Adults.

Commencing therapy.

A

Start SABA if:

Symptoms less than twice per month with no requirement for oral corticosteroids in last 12 months.

Start SABA + ICS (or LRA) if:

Any episode of artificial ventilation, or

Requiring oral corticosteroids in last 12 months, or

Uncontrolled Severe or bothersome symptoms, or

Waking due to asthma at least once in last month, or

If asthma symptoms twice or more per month.

Usually trial low dose ICS

Review everyone in 4-6 weeks - consider repeat spirometry and technique/compliance

Consider Leukotriene receptor antagonist (Monteleukast, SIngulair) if not responding to ICS + SABA and compliance and puffer technique are satisfactory. Not on PBS >15YO

72
Q

DDx of Asthma in Adults:

A

Coronary Artery Disease

GORD

Obstructive Sleep Apnoea

Aspirin exacerbated respiratory disease

Congestive Cardiac Failure.

73
Q

DDx for Asthma in Children

A

Croup

Bronchiolitis

Inhaled Foreign Body

Sleep DIsordered Breathing

Structural Airway Disease (eg Tracheomalacia, vascular ring)

Reccurent Respiratory tract infections

Suppurative Lung Disease (eg CF)

Other upper airway disorders eg. Post nasal drip, OSA

Tumours

Congenital Heart Disease

Pulmonary oedema

74
Q

Probability Diagnoses of wheeze in young children:

A

Bronchiolitis: < 2 YO, Sudden onset, Coryzal symptoms, Fine global crackles.

Viral Pneumonitis: > 2 YO, Sudden onset, Coryal symptoms, fine global crackles.

Viral Induced wheeze: Gradual onset late infancy/early chilhood, Intermittent episodes, Interval symptoms (exercise, cold air), No improvement with SABA.

Asthma: Gradual onset late infancy/early chilhood, Intermittent episodes, Interval symptoms (exercise, cold air), Improvement with SABA.

Protracted Bacterial Bronchitis, Chronic or intermittent symptoms, progressively worsening, wet cough > 4 weeks, responding to antibiotics.

Tracheomalacia/Broncomalacia: Chronic or intermittent symptoms since birth, well, thriving.

Inhaled Foreign Body: Sudden onset of symptoms, no coryzal symptoms

75
Q

Red Flags for Cough in a child

A

Increased sputum production

Difficulty breathing

Systemic symptems (eg. failure to thrive, fatigue, etc)

Feeding difficulties

Recurrent Pneumonia

Inspiratory Stridor

Abnormal Respiratory exam findings

Clubbing

CXR abnormalities

76
Q

Examination of children with asthma

A

Height & weight,

Skin inspection (eczema etc.)

Upper airways inspection (eg. inflammed turbinates, polyps)

Chest deformities (eg pectus excavatum)

Chest auscultation (wheeze, crackles, etc)

Heart auscultation for murmurs

Fingers for clubbing

77
Q

Diagnosing Asthma in Children

Symptoms

Spirometry

A

Symptoms as for adults, must have > 1 of:

Wheeze, Cough, Chest tightness, Breathing Difficulty

Spirometry >/= 5 yO can be attempted.

>/= 12% improvement, 10 mins post bronchodilator.

When not able to perform spirometry:

< 6 MO refer to specialist

> 6MO Trial of Bronchodilator.

If clear improvement then Asthma

If no improvement at 4-6 weeks refer.

78
Q
A
79
Q

Drugs causing Hyponatremia

A

Hypovolemic: Diuretics: eg. Hydrochlorothiazide

Euvolemic: Amphetamines

Hypervolemic: TCAs, SSRIs, NSAIDS, Chlorpromazine, Chemo

80
Q

Vaccination Schedule

0 - 6 Months

A

Birth: Hep B

2 mths:

Tetanus, Diptheria, Pertusis, Hep B, H. influenzae B, Polio (hepB-DTPa-Hib-IPV)

13v Pneumococcal (13v PCV)

Rotavirus

4 mths:

hepB-DTPa-Hib-IPV, 13vPCV, Rotavirus

6mths:

hepB-DTPa-Hib-IPV, 13vPCV, Rotavirus

Flu vac should be given to Indigenous children annually, from 6months of age.

81
Q

Vaccinations

12 months to 4 years old

A

12mths:

Measles, Mumps, Rubella (MMR)

Haemophillus influenzae b (HiB)

Menigococcal C (MenC)

18mths:

Measles, Mumps, Rubella, Varicella (MMRV)

4 years:

MMR if MMRV not given at 18mths

DTPa-IPV

Note: indigenous should recieve:

Influenza annually from @ 6mths

Pneumococcal @ 12 - 18 mths

Hep A @ 12-24 mths (2 doses, 4 weeks apart) in high risk areas.

82
Q

Vaccinations

12 years old

A

Human Papiloma Virus (HPV)

Varicella

Tetanus, Diptheria, Pertusis

83
Q

Catch up Vaccination

10 - 19 years old

A

DTPA initial, then 2 doses DT (tetanus and DIptheria) (4 wk intervals)

Polio (IPV) 3 doses, 4 week intervals

Hep B (1ml): 2 doses, 4 month interval, (11 - 15 yrs only),

or

Hep B (0.5ml): 3 doses, 0, 1 and 3months, (10 - 19YO)

MMR: 2 doses, 4 week interval

Varicella: 2 doses, 4 week interval

Menigococcal C, 1 dose

Note: Pneumococcal 23vPPV available for Indigenous 15 yrs or older if medically at risk.

Influeza available to anyone over 6mths who is medically at risk (Diabetes, Renal Failure, Lung Disease, Heart Disease…)

84
Q

Indigenous Health Check

Child:

A

All Children

  1. Vaccinations up to date - organise catch up if required. Icluding Influenza >6mth
  2. Growth Monitoring - height, weight, < 5YO
  3. Ear examination annually < 15YO
  4. Visual acuity at 4 YO
  5. Oral health - every visit - 0 - 5YO, and annually 6 - 18YO
  6. Nutritional History - if high risk area
  7. Skin Check - Scabies and impetigo - if high risk area
85
Q

Refugee Health

Aspects of Screening

A
  1. Communication: Cultural and Linguistic Barriers. Telephone interpreter service available. Do not use friends or family.
  2. Communicable Diseases (eg TB, malaria, HIV, STIs, Ebola)
  3. Dietary Aspects eg Malnutrition (check Vit D, Iron, BMI)
  4. Mental Health eg. PTSD, Depression. Perform K10, refer to trauma counselling if indicated.
  5. Immunisation Status: Immunisation Cards? Testing for Abs, and organising catchup schedule.
  6. Thourough Clinical Examination: CV, Respiratory and Skin
  7. Organise Oral and Eye and hearing checkups as required.
  8. Arrange Investigations as indicated.
  9. Organise follow-up for results, etc.
86
Q

Refugee Health:

First Visit…

History and Eamination

A

History:

Country of Origin

Other countries and camps stayed at

Immediate health problems

Any health undertakings on Visa

Medications and Drug allergies

Previous Medical History, including injuries, infections and transfusions

Previous Surgical History

Level of schooling and work history/exposures

Developmental progress (children)

Dietary adequacy

Examination:

Height, Weight, BMI

Blood Pressure

Urinalysis

87
Q

Refugee Health

Investigations - first visit.

A

FBE, ESR

UEC, LFT

Urinalysis

Thick and Thin blood films + Malaria antigen

Tuberculin Skin Test +/- CXR if symptoms

Hep B Ag, Ab, Hep C Ab

Syphyllus serology

Urine PCR Chlamydia and Gonorrhoea > 13YO

HIV

Faecal H.pylori antigen

Parasites/Worms Shistasomiasis & Strongyloides serology

Faecal OCP

Vit D, B12, RC Folate, Iron Studies

Lead levels <13YO

88
Q

Refugee Health

Second Visit….

A

Arrange Womens Health checks - Pap smear, mamogram

Management Plan for Chronic health problems

Cardiovascular an Diabetes risk assessment

Assess for Mental Health issues

Assess for Developmental issues (children)

Assess for Social issues, inc social isolation

Check Oral health

Check Vision and Hearing.

Organise

Arrange appropriate referrals, eg Social worker, Hearing assessment

89
Q

Testing in Hep B Ag positive Pt.

A

LFTs

Coagulation Profile

HBV Viral Load

HBeAg/Anti-HDe serology

HAV, HCV, HDV serology

HIV serology

Alpha Fetoprotein

Abdominal USS

90
Q

Reasons to Involve a professional Interpreter when dealing with NESB Pt.

(The 5 Cs)

A

Consent - Informed consent requires understanding.

Complex Instructions

Competence to make health decisions, including refusal of treatment.

Crisis - If urgent or timely decisions need to be made by the doctor regarding the patients health or well being or that of others.

Chronic Illness management - For effective management patients need a thorough understanding of illness and reasons for treatment

Telephone Interpreter Service is fast, free and professional

91
Q

Catch up Vaccinations for a 4 year old refugee who had DTPa and Polio at 2, 4 and 6 months.

A

MMR - 2 doses 4 weeks apart

DTPa + IPV: 1 dose (as part of usual 4 year old vacination)

HiB: 1 dose (Hiberix)

Meningococcal: 1 dose

Testing for Hep B and Varicella antibodies

If negative can have these organised

Hep B (0.5ml) 3 doses: 0, 1, 4-6 months

Varicella x 1 (Booster at 12 YO)

92
Q

Live vaccines

and considerations

A

MMR

Varicella

Yellow Fever

Must be administered on same day or > 1 month apart

Mantoux test (TST) cannot be performed within 1 month of live vccine

93
Q

Symptoms of Post Traumatic Stress Disorder

A

Re-experiencing phenomena eg flashback, nightmares

Avoidance and Emotional numbing

Hyperarousal eg exaggerated startele response, irritability

Complex PTSD:

Dissociation, Personality Change, Poor Relationships, Aggression, Self harm, Loss of meaning in life.

94
Q

Health Benefits of Identifying ATSI Patients

A

Assess Disease Risk

Appropriate Screening and Treatment

Appropriate Immunisations

Enhance Access to Medications (eg. CTG, ciprofloxacin)

Ensure Access to Medicare Benefits (eg. Aboriginal Health Check)

Facilitate Access to Outreach/Support Workers

To Access Practice Incentive Payments

To be able to Audit the Care and Needs of ATSI patients

95
Q

Practice Measures to Improve Indigenous Participation/Presentation

A

Cultural Safety Training for Staff

Placing Aboriginal Art, Literature and Information in the Waiting Room

Participating in Celebrations of Indigenous Culture (eg NAIDOC week)

Engaging with Indigenous Elders in the Community as project officers

Awareness of Barriers to Care - eg Bulk Billing indigenous patients

Encouraging staff to develop a therapeutic relationship with community members

96
Q

Responding to Disclosures of Abuse (Physical, Emotional, Sexual)

A

Respond with compasion, support and belief

Be Non-judgemental

Address Safety Concerns

Acknowledge the Complexity of the situation

Put patients Identified Needs First

Take Time to Listen, Provide Information and offer referral

Validate Experiences, Challenge Assumptions, Provide Encouragement

Assist to make own decisions.

97
Q

Domestic Abuse

Managing followups

A

Be Patient and supportive

Provide Follow-up and continued support

Respect the patients wishes and decisions. Do not pressure into decisions

Be nonjudgemental if patients do not act on referrals immediately.

98
Q

Strategies for Improving Medication Compliance

A

Simplify Medication Regime.

Utilise “Close The Gap” if elligible

Dosing Aids eg Webster Packs

Patient Education of role and importance of each medication

Home (Domicillaery) Medication Review

Engage with the “Good Medicines Better Health” Program (Indigenous)

Utilise and Indiginous health worker for medication review.

99
Q

What are the immunisation difference for indigenous people

A

Fluvac now reccomended for all Aboriginal people > 6 MO

Pneumococcal vacination at + 50 YO for low risk

Pneumococcal vaccination + 15 YO for high risk.

All others as per schedule

100
Q

What are the Requirements for a GPMP

A

GP in attendance with patient

Patient Consent

Copy offered to Patient

Needs: Identify Healthcare Needs of Patient

Goals: Develop a management plan acceptable to the patient

Actions: Identify what actions are to be taken by the patient

Treatment Services: Identify treatments and services to be initiated

Making referrals to these services

Clear documentation of the patients Needs, Goals, Actions, Treatment Services and Review Date.

101
Q

What are the requirements for a TCA

A

Involves GP and 2 other providers in the patients care

Patient Consent to share information with other providers

Discussing treatments and services which would be of benefit

Consent from chosen providers to participate

2 way collaboration/communication with other providers.

Documentations of Goals, Providers, Treatment Services, Patient Actions and Review Date

Provision of Plan to Providers.

102
Q

Differences between Adjustment Disorder and Depression

A

Adjustment -

Within 3 mo from the stressor

Follows the stressor,

Lasts less than 6 mo,

Symptoms are mild (forget about suicide )

Depression (major)

Does not follow a stressor,

Lasts at least 2 weeks,

Symptoms are much more serious and persistent (including suicide)

103
Q

Mood Disorders without psycotic features

A

Disruptive Mood Dysregulation Disorder: Childhood, Onset before 10 YO

Major Depressive Disorder - SADAFACES, Suicide ideation often a feature

Persistent Depressive Disorder (Dysthymia) - lasting > 2 years, brief episodes, less severity than MDD.

Premenstrual Dysphoric Disorder: Women, Associated with period.

Substance/Medication-Induced Depressive Disorder

Depressive Disorder Due to Another Medical Condition - eg Hypothyroidism

Note: Adjustment Disorder is considered a Trauma and Stress related Disorder.

104
Q

Criteria for an Adjustment Disorder

A

Emotional or behavioral symptoms develop in response to an identifiable stressor or stressors within 3 months of the onset of the stressor(s)

plus either or both of

(1) marked distress that is out of proportion to the severity or intensity of the stressor, even when external context and cultural factors that might influence symptom severity and presentation are taken into account and/or
(2) significant impairment in social, occupational, or other areas of functioningThe stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder

Also:

  • The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
  • The symptoms do not represent normal bereavement
  • After the termination of the stressor (or its consequences), the symptoms persist for no longer than an additional 6 months
105
Q

Define Culturally Safe and Unsafe Practice

A

Culturally Safe = Effective clinical practice for a person from another culture

Culturally Unsafe = any action which diminshes, demeans or disempowers the cultural identity and well being of another.

106
Q

Criteria for Close the Gap

A
  1. GP + one staff member must recieve cultural awareness training within 12 months of registering.
  2. GP must perform regular AHC and GPMP
  3. GP must be registered
  4. Patient must register each year
  5. Patient must be at risk of, or have a chronic disease
  6. Accessible by any Aboriginal or TI patient.
  7. Patient must be registered and scripts must be marked with CTG to access PBS.
107
Q

Developmental Red flags

2 mths

8 mths

10 mths

12 mths

18 mths

3 yrs

A

2 mths: Not smiling, Not startling to sound, No visual Tracking, Excess head lag, Asymmetrical Moro reflex

8 mths: Not weight bearing on legs, Not reaching out to grab things, Not fixing on small objects, Not vocalising, Persistent primitive reflexes

10 mths: Unable to sit unsupported

12 mths: Not responding to Name, Showing a hand preference.

18 mths: Not walking, No pincer grip, Persistently casting away objects.

3 yrs: Inaccurate use of spoon, Not speaking in sentences, Not understanding simple commands, Not interacting with other children.

108
Q

Expected Milestones at 6 weeks

A

Moro reflex

Head control when pulled up

Coos

Startles at loud noise

Smiles in response

109
Q

Expected Milestones at 6 months

A

Gross Motor: Sitting, When Prone can support with hands

Fine Motor: Ulnar Grasp

Speech and Language: Babbles, Responds to Name

Social Skills: Stranger Anxiety

110
Q

Expected Milestones at 12 months

A

Gross Motor: Walking with support

Fine Motor: Pincer grip, throws objects.

Speech and Communication: Two words with meaning, Follows one step commands

Social Skills: Drinks with cup, waves bye

111
Q

Expected Milestones at 18mths

A

Gross Motor: Walking independently, Climbs stairs, sits on chair.

Fine Motor: 3 cube tower, takes off shoes, picks up 100s & 1000s

Speech and Communication: 10 words, points to body parts, follows simple commands

Social Skills: Uses spoon, Domestic mimicry, toileting awareness

112
Q

Expected milestones at 3 years old

A

Gross Motor: Tricycle, Stands on one foot, Jumps

Fine Motor: Threads beads, Dresses and undresses, Copies a circle and cross, stacks 8 cubes

Speech and Communication: Counts to 10, Short sentences, Understands prepositions

Social Skills: Dry by day, Plays with children, Knows age and gender.

113
Q

Risks for CKD

A

Impaired Glucose regulation (eg. Diabetes)

Hypertension

Age > 60

Family History - 1st deg relative

Ethnicity - Aboriginal, Afro American, etc.

BMI 25-29 inc 40% > 30 inc 80%

Smoking

Poor Diet

Physical Inactivity

Cardiovascular Disease

114
Q

CKD Stages

A

Stage eGFR

1 >90

2 60 - 89

3a 45 - 59

3b 30 - 44

4 15 - 29

5 <15 or dialysis

115
Q

Define micro and macroalbuminuria

A

UACR mg/mmol

Male Female

Normal <2.5 <3.5

Microalbuminuria 2.5 - 25 3.5 - 35

Macroalbuminuria > 25 > 35

116
Q

Reccomended targets for reducing CVD and CKD in diabetes

A

HBA1C 6.5 - 7.0

BP <130/88

In Patients with High risk for CVD eg. CKD stage 3A or above, Diabetes + microalbuminuria, Diabetes + age > 60 YO, etc. Keeping to BP target reduces progression of CKD by 80%.

Review every 8 - 12 weeks until targets met.

117
Q

When to refer to Specialist in CKD

A

If any one of:

eGFR < 30 (Stage 4 - 5)

Persistent albuminuria UACR > 30 mg/mmol (3 or more successive specimens)

Rapidly declining (> 5ml/min) eGFR from < 60 over 3 or more successive readings in a 6 month period

CKD + hypertension with difficulty getting to target despite 3 antihypertensives

Haematuria + Macroalbuminuria (UACR males >25, Females > 35)

Note: Murtagh also adds: Diabetes + eGFR < 60, or 24hr Protein > 1gm

118
Q

Gout Management in CKD

A

Avoid NSAIDS if CrCl < 30 (Celecoxib) and < 25 (All others)

Paracetamol 1gm QID is acceptable

Colchicine can be used but at half normal dose

Prednisolone is a better alternative

Allopurinol for ongoing maintenance.

If using Opioids in CKD preferences are:

Fentanyl

Oxycontin

Buprenorphine

Always start t lower doses.

119
Q

List the symptoms that may be encountered by a patient with terminal End Stage Kidney Disease:

A

Itchy Skin (manage with Topical moisturisers, Evening Primrose oil and low dose Gabapentin)

Restless Legs (Manage with Low dose Gabapentin)

Nausea (Manage with Metoclopramide, Haloperidol 50% normal dose)

Dyspnoea (Manage with education, fans, supp O2, Opiates, Benzos)

End Stage Symptoms:

Pain (Opiates + Benzos)

Terminal Aggitation (Benzos)

Terminal Secretions (Reassurance, glycopyrolate)

120
Q

What are the 2 reccomended tests to test for Chronic Kidney Disease.

What is the diagnosis criteria

A

First-void spot Urine Albumine Creatinine Ratio

eGFR

CKD = eGFR < 60 and/or UACR > 2.5 (Men), > 3.5 (Women)

on at least 2 occaisions > 3 months apart

121
Q

Management Recommendations in CKD

A

Salt intake < 6gms (Na < 2.3gms)

Maintain adequate protein 1gm/kg/day

Decrease Fats

Weight management BMI 18-25

Regular Exercise

Commence ACEI or ARB - BP < 130/80 -> and repeat EGFR in 7 days

Frusemide 40mg daily

Refer if eGFR < 30, Persistent UACR > 30, 6 month decline in eGFR (3 readings), Haematuria + macroalbuminuria

Uncontrolled hypertension (3 agents)

122
Q

Define Resistant Hypertension

A

blood pressure that remains above 140/90 mmHg in spite of

concurrent use of three antihypertensive drugs from different

classes (including a diuretic) for at least 1 month.

123
Q

Investigations for Resistant Hypertension

A

FBC

UEC (eGFR)

LFT

Fasting Lipids

Plasma aldosterone : renin ratio

Urine MCS (red cells)

Spot UACR

Ambulatory 24Hr BP monitoring

Renal tract Ultrasound

Cardiac echo

ECG

124
Q

Bood Pressure Targets for:

Diabetes

Microabuminuria

Macroalbuminuria

Chronic Kidney Disease

Everyone else

A

Diabetes 130/80

Microabuminuria 130/80

Macroalbuminuria 130/80

Chronic Kidney Disease 140/90

Everyone else 140/90

125
Q

Features of Bipolar

A

Elevated, Expansive or Irritable Mood

Diminished need for sleep

Accelerated Speech

Racing thoughts and flights of ideas

Increased Activity (eg sexual activity

Grandiose Ideas

Reckless or Risk Taking Behaviour

126
Q

Enuresis History

A

Timing: Day or Night only

Previously Dry during Day or Night

Diabetic Hx or Symptoms (polyuria, polydipsia)

UTI symptoms (dysuria)

Symptoms of Sleep Apnoea

Social or Psychological Stressors

Family History of Bed wetting

Constipation or Encoparesis

127
Q

Education and Direction to Resources (eg Black Dog Institute)

Sleep Hygene

Regular Exercise routine

Structured Problem solving

Mental Health Care Plan

Discuss commencing SSRI

Consider Referral for Counselling/CBT

Avoidance of Alcohol and other drugs

Review in 1 week for progress

A
128
Q

Management Options for Nocturnal Enuresis (5)

A

Initial management:

Education about Enuresis

Motivational Therapy

Behavioural Modifications/Conditioning Therapy

Bladder Training Exercises

Use of an Alarm Device

If Initial Management fails then consider..

Fluid restriction before bed

Desmopressin

Alarm Device

Planned Waking time to void.

129
Q

Treatment of H.pylori

Reasons

1st line therapy

Follow-up

A

There are many reasons for treating H.pylori including: Peptic Ulcer Disease, Dyspepsia, NSAID use, Atrophic gastritis, Fam Hx of gastric cancer and patients request.

Tx:

Esomeprazole 20mg BD 7 days

Amoxycillin 1gm BD 7 days

Clarithromycin 500mg BD 7 days

Follow-up

Follow-up is advisable

Urease breath test 4 weeks after cessation of Abs and 2 weeks after cessation of PPI (H2RB is ok)

Ongoing PPI is not required unless regular use of NSAIDS.

130
Q

Indications for BMD scanning

A

Available to all Patients over 70 years old, or

Can be performed at + 50 YO if:

Minimal trauma fracture

Xray spine confirming compression fracture

Corticosteroid treatment >7.5mg daily > 3months

Early menopause

Hypogonadism

≥ 3 months glucocorticoids (at Prednisone ≥ 7.5mg)

Coeliac disease/malabsorption disorders

Rheumatoid arthritis

Primary hyperparathyroidism

Hyperthyroidism

Chronic kidney or liver disease

Androgen deprivation therapy

131
Q
A
132
Q

Side Effects of OCP

A

Headaches

Bloating

Nausea

Acne

Weight gain

Breakthrough Bleeding

Breast Tenderness

Decreased Libido

133
Q
A
134
Q

Indications for Ultrasound in Breast Examination

A

Evaluation of a palpable lesion not seen on mammography

Improved differentiation of a lesion detected on mamography

Detection of an underlying mass or altered architecture associated with mamographic calcifications.

For implant evaluation

As a guidance or localisation technique for biopsy.

135
Q

Causes of Hyperprolactinemia

Prolactin > 500 mLU/L

A

Prolactin < 5000: Exercise, Hypophysitis (pituitary inflammation, rare), Macroprolactin (common), Nipple stimulation, pituitary disease, sarcoidosis, stress, trauma, Medications (Metoclopramide, TCAs, oestrogens, verapamil, opiates, methyldopa), Hypothyroidism, Cirrhosis, Chronic renal failre, pituitary adenoma (non-functioning)

Prolactin > 5000: Prolactinoma, GH secreting tumur

136
Q

Hereditary Thrombophillias

A

Factor V Leiden Mutation

Prothrombin Gene Mutation

Protein C Deficiency

Protein S deficiency

Antithrombin Deficiency

Dysfibrinogrnemia

137
Q

Managing inherited thrombophillias

A
  1. Educate regarding signs and symptoms of VTE
  2. Obtain family history of VTE - Positive family hx increase risk of DVT in individual.
  3. Avoid Oral contraceptives
  4. reduce other risk factors for DVT (especially if positive family Hx)
  5. FVL homozygous should have DVT prophylaxis for any surgery
  6. Limited or unclear evidence on how to manage thrombophillias in pregnancy. Refer to Obstetrician for assessment (significant factors include family history, type of mutation, obesity, etc.)
  7. Advice on reducing clot risk during long travel including compression stockings, alcohol avoidance, hydration, mobilise every 2 hours, loose clothing, dont smoke.
138
Q

Travel History - the returned traveller.

A

Have you travelled in the last 12 months

Travel dates and itinerary for each destination

Date of return

Pre-travel vaccines

Antimalarial medications prescribed and taken as directed

Sexual contacts and contraception

IVDU

any insect or animal bites or scratches

Personal protective measures against insects

Exposure to fresh water

Contact with animals

Consumption of unpurified water and raw foods

Any illness in fellow travellers

139
Q

Symptoms of Schistasomiasis

A

Fever

Abdominal Pain

Dry cough

Headache

Diarrhoea

Myalgias

Neck Pain

Urticarial Rash

140
Q

Investigations for fever in the returned traveller

A

FBC, UEC, LFT, THICK AND THIN FILMS (X3), Blood Cultures (x2), Urine MCS, Chest Xray.

+ any specific tests for specific exposures.

141
Q

Patients Not Suitable for CVD Risk Assessment.

A

Established CVD

Diabetes and aged > 60

Diabetes with microalbuminuria (> 20 micrograms/min or urinary albumin:creatinine ratio > 2.5 mg/mmol for males or > 3.5 mg/mmol for females)

Moderate or severe chronic kidney disease (persistent proteinurea or
eGFR < 45 mL/min/1.73m2)

A previous diagnosis of familial hypercholesterolaemia

Systolic BP ≥ 180 mmHg or diastolic BP ≥ 110 mmHg

Serum total cholesterol > 7.5 mmol/L*

Aboriginal and Torres Strait Islander adults aged over 74

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