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GP FELLOWSHIP RNZGP > General Medicine & Medication > Flashcards

General Medicine & Medication Flashcards

1
Q

Five types of medications used in Palliative care (be specific)

A
  1. Morphine
    2.5mg-5mg Q1hourly (max 15mg/24hr)
  2. Haloperidol
    1mg Q4H
  3. Midazolam
    2.5mg Q2hourly
  4. Glycopyrolate
    0.2mg Q4H
    Or Hyoscine butylbromide 20mg Q4H
  5. Metoclopramide
    10mg Q8H
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2
Q

Morphine dose for End of life

A

SUB CUT 2.5mg-5mg Q1hourly (max dose 15mg in 24hours)

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3
Q

Midazolam dose for end of life care

A

2.5mg Q2hourly (max 15mg)

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4
Q

Haloperidol dosing end of life care & use

A

1mg Q4H
Used for agitation and nausea

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5
Q

Secretion management in end of life care:

A

Option 1
Hyoscine butylbromide 20mg Q4H

Glycopyrolate 0.2mg Q4hH

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6
Q

Pain relief in Palliative care

A

Morphine:
Oral “ordine” Immediate release 2-5mg Q1H Max 6 doses in 24hrs

Morphine Slow release “MS contin: 5mg BD

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7
Q

Otitis externa treatment
2 short term
2 long term

A
  • Dry aural toiletting 6 hours until dry
  • Dexamethasone + framycetin + gramicidin 0.05%+0.5%+0.005% ear drops, 3 drops , TDS for 7 days
  • If cant see TM or perforation
    Ciprofloxacin + hydrocortisone 0.2% + 1% ear drops 3 drops instilled into the affected ear, twice daily for 7 days.
  • Isopropyl alcohol drops following water exposure
  • Ear plugs
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8
Q

Fungal otitis externa

A

flumetasone+clioquinol 0.02%+1%, 3 drops, BD for 7 days

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9
Q

Otitis Media (when to use abx)

A
  1. Aboriginal
  2. Bilateral in <2
  3. <6months
  4. Ottorhoea
  5. Immunocompromised
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10
Q

Otitis media antibiotics

A

Amoxicillin 15mg/kg 8hourly 5 days

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11
Q

Causes of hypercholesterolaemia (8)

A
  • Familial hypercholesterolaemia
  • Hypothyroidism
  • Cholestasis
  • Chronic Kidney disease /nephrotic syndrome
  • T2DM
  • Excessive etOH
  • Obesity
  • Drugs (Oral oestrogens, thiazides, beta blockers, atypical antipsychotics)
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12
Q

Diagnostic criteria for familial hypercholesterolaemia (name of it and diagnostic score)

A

Dutch Lipid Clinic Network Diagnostic Criteria
>8 (more than 8)
>6 likely

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13
Q

Dutch Lipid Clinic Network Diagnostic Criteria

A

1) family history
- 1st deg with arcus cornealis or tendon - xanthomata (2)
- child <18 with LDL >95th centile (2)
- 1st deg with LDL >95th centile (1)
-1st deg with premature CVD (1)

2) Exam findings
- Arcus cornealis <45 (4)
- Tendon xanthomata (6)

3) Cholesterol levels LDL - C level
- 8.5 (8)
- 6.5- 8.4 (5)
- high

5) Clinical history
- premature CVD, pVD, cerebral vascular disease

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14
Q

Management of FH

A

1) Commencement of high dose statin (atorvastatin 40mg -80mg)

2) cascade testing (relatives)

3) Referral to Lipid specialist

4) Exercise Physiology

5) Dietician

6) consider ACEi given likely high risk CVD

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15
Q

Chronic diarrhoea DDx

A
  • IBD
  • IBS
  • Chronic gastroinfection: giardiasis, cryptospiridium infection
  • Coeliac disease
  • Lactose intolerance
  • SIBO
  • Laxative abuse
  • Endocrine causes: hyperthyroidism, addisons
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16
Q

Infanrix hexa - what is in it?

A
  • Hep B
  • Polio
  • HIB
  • Diptheria
  • Tetanus
  • pertussis
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17
Q

Paediatric dose of adrenalin

A

10mcg/kg IM

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18
Q

Anaphylaxis

A
  • SUPINE
  • IV access
  • Bolus
  • Adrenalin 10mcg/kg IM
  • High flow 02
  • 000
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19
Q

Central causes of vertigo

A
  • Cerebellar CVA or haemorrhage
  • Vertobasillar insufficiency (TIA)
  • Migraine (vestibular)
  • MS
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20
Q

Peripheral causes of vertigo

A
  • BPPV
  • Labyrinthitis
  • Accoustic neuroma
  • Vestibular neuritis
  • Menniers
  • Cholesteatoma
  • Ramsay- hunt syndrome
  • Superior semicircular canal dehissence
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21
Q

Features of peripheral vertigo

A
  • Horizontal or torsional (torsional component) nystagmus that is suppressed with eye fixation.
  • Unidirectional nystagmus
  • Hearing loss may be present
  • Walking preserved
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22
Q

Features of central vertigo

A
  • Nystagmus: purely vertical or torsional
  • Nystagmus can be reversible
  • Severely unstable
  • No hearing issues or tinnitus
  • Other neurology (ataxia, diplopia, dysphagia)
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23
Q

Imaging for accoustic neuroma / central cause for vertigo

A

MRI with gadolinium contrast

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24
Q

Red eye questions

A
  • Photophobia
  • FB sensation
  • Pain
  • Vision affected
  • contact lenses
  • irritants
  • truma
  • discharge
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25
Q

RED EYE differentials

A
  • Conjunctivitis
  • Uveitis/iritis
  • Keratitis ( HSV)
  • Acute angle glaucoma
  • FB
  • Corneal abrasion
  • Chemical keratitis
  • Scleritis/episcleritis
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26
Q

Acute glaucoma emergency management

A

-SUPINE
-NBM
-Analgesia- morphine
-Dont patch
-transfer to ophthal

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27
Q

Oral iron supplement dose

A

100-200mg elemental iron daily

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28
Q

How to detect proteinuria (albuminuria)

A
  • Urine ACR (First void ACR !!! is best)
  • Repeat ACR (always do one) first void to confirm

(dipstick not sensitive enough)

Confirmed if 2/3 positive
CKD if present for 3 months

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29
Q

Anti-hyperglycaemic choice (after metformin) in HEART FAILURE

A

SGLT2 (dapaglifozin, empaglifozin)

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30
Q

Anti-hyperglycaemic choice (after metformin) in CARDIOVASCULAR DISEASE

A

**GLP1 **
(Liraglutide, dulaglutide, semaglutide)

OR

**SGLT2 **
(dapaglifozin, empaglifozin)

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31
Q

Celecoxib dose

A

100-200mg BD

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32
Q

Ibuprofen dose

A

200-400mg 8hourly

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33
Q

Naproxen dose

A

250-500mg BD

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34
Q

Sleep history

A
  • Shift worker
  • Jet lag
  • Restless legs
  • Snore
  • Stimulants
  • Mood
  • Thyroid symptoms
  • Quantify sleep
  • Daytime function & symptoms
  • Initiation (delayed sleep- wake phase disorder)
  • waking overnight (Sleep maintenance insomnia)
  • Early waking
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35
Q

THC (CBD oil with THC) Contraindicated in:

A
  • Schizophrenia
  • Past AMI
  • Angina
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36
Q

Risk factors for Acute Rheumatic Fever

A
  • ARF- endemic area
  • ATSI rural/remote
  • ATSI/Maori/islander metropolitan but low SES/overcrowding
  • personal history of ARF or RHD
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37
Q

Management of sore throat:
Note: risk factors present for ARF

A

Benzylpenicillin G (IM)
OR
10 days BD phenoxymethylpenicillin

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38
Q

Major criteria for Acute Rheumatic Fever (ARF)
NOTE: Different for high risk vs normal risk

A
  • Carditis
  • Polyarthralgia, Polyarthritis, aseptic monoarthritis (polyarthritis in low risk )
  • Sydenham chorea
  • Erythema marginatum
  • Subcutaneous nodules
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39
Q

Diagnostic criteria for acute rheumatic fever - initial episode

A

STREP evidence

PLUS

2 Major
OR
1 Major 2 minor

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40
Q

Minor criteria for Acute Rheumatic Fever (ARF)

A

HIGH RISK
- Fever 38
- Monoarthralgia
- ESR>30 or CRP >30
- Prolonged PR

Normal risk
- 38.5
- Polyarthralgia
- ESR 60
- CRP 30
- Prolonged PR

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41
Q

Treatment of Acute Rheumatic Fever

A

Benzathine benzylpenicillin IM
10kg-20kg: 0.6 million units (1.2ml)
>20kg: 1.2million units (2.3mL)

or oral
PMP 500mg BD 10 days

PLUS
ongoing dose every 21-28 days

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42
Q

Smoking cessation medication options

A

Nicotine Replacement

Varenicline (Champix)

Bupropion (Zyban)

Nortriptyline

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43
Q

Dose of Varenicline (Champix)

A

0.5 mg daily for 3 days,
then 0.5mg BD for 4 days,
then 1 mg BD for remainder of 12-week course.

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44
Q

Dose of Bupropion (Zyban)

A

150 mg daily for 3 days,
Then 150 mg BD for remainder of 9-week course.

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45
Q

Three

Contraindications for Bupropion

A
  • Seizures
  • Eating disorders
  • MAOs
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46
Q

Counselling for Varenicline (Champix)

A
  • Doubles the chance of quitting
  • Nausea 30%
  • Stop smoking in 2nd week of use
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47
Q

Nortriptyline counselling

Side effects

A

Side effects:
- Dry mouth,
- constipation,
- nausea,
- sedation
- headache,
- risk of arrhythmia in CVD

Start 10 to 28 days before quit date & continue for 12 weeks after

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48
Q

Pneumococcal vaccination >70 (non indigenous)

A

Prevenar 13
(13vPCV)

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49
Q

Pneumococcal vaccination ATSI

A

> 50

Prevenar (13vPCV)

23vPPV
12months later
then
23vPPV in 5 yrs

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50
Q

Shingrix vaccine counselling

A
  • Non live
  • Two doses (2-6 months between)
  • > 50yrs immunocompetent
  • > 18 Immunocompromised
  • Higher efficacy
  • Costly
  • Only one available for immunocompromised
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51
Q

Zostavax counselling

A

> 12 months post shingles outbreak

> 50 allowed to use
60 recommended
70 on schedule
50 who are household contacts of immunocompromised

Contraindicated in Immunosuppressed:
- >20mg pred, chemo, radiation
- HIV
- Leukaemia/lymphoma
- DMARDS

52
Q

Symptomatic treatment of acute vertigo

A

Prochlorperazine 5-10mg TDS 2 days

OR if vomiting/not tolerated then
Diazepam 5mg TDS for 2 days
OR Ondans 4-8mg TDS 2 days
OR Prochlorperazine 12.5mg IM then orally

53
Q

SGLT2 example and dose

A

“GLIFOZINS”

Dapaglifozin: 10mg daily
(eGRF>25)

Empaglifozin: 10mg daily
Max dose 25mg
(eGFR>05)

54
Q

DPP4 Inhibitor example and dose

A

“GLIPTINS”

Linagliptin 5 mg daily

55
Q

GLP1 example and dose

A

“GLUTIDES”

Dulaglutide 1.5mg subcut WEEKLY

Liraglutide 0.6mg daily, increasing to max 1.8mg daily

56
Q

Sulfonylurea example and dose

A

Gliclazide MR 30 mg daily
(max 120 mg)

57
Q

Hypercalcaemia in metastatic disease (bone mets) management

A
  • Hydration with IV normal saline
  • Zalendronic acid IV
58
Q

Time frame for ceasing COX2 inhibitors pre-operatively

A

3 days

59
Q

Time frame for ceasing apixaban pre-operatively

A

24-48hrs

60
Q

Preoperative testing for someone with ASA score 2 (eg diabetes well controlled)

A

FBC
EUC
ECG
(not routine for clotting)

61
Q

Anticoagulation in severe renal impairment

A

Warfarin
with bridging enoxaparin 1mg/kg for 5 days until INR 2

62
Q

Malaria prophylaxis (including dose and duration)

A

Doxycycline 100mg daily
1-2 days before leaving, 4 weeks after leaving endemic area

Other:
atovaquone / proguanil 250/100mg
1-2 days before leaving, 7 days after leaving endemic area

*** good for children
Paediatric formulation:
62.5/25mg tablet

** must have with fatty meal or full fat milk

63
Q

Travel advice general

A
  • Travel insurance
  • Supply of prescription medications
  • Bottled/filtered water
  • Avoid street food/uncooked food
  • First aid kit
  • Mosquito advice: DEET containing repellent, long clothes, nets
  • Avoid tattoos, sex, illicit drugs
  • Avoid swimming in contaminated freshwater
64
Q

Sexual assault management

A
  • Referral to sexual assault referral centre
  • Refer to community support group or counsellor
  • Pregnancy risk
  • STI testing 2,6,12 weeks
  • Discuss reporting to police
  • Assess for other injuries
  • Assess for non-fatal strangulation
65
Q

Q fever Treatment

A

Doxycycline 100mg BD 14 days
(even in children 2.2mg/kg)

66
Q

Q fever clinical signs (when to suspect)

A
  • Atypical pneumonia
  • Any febrile disease
  • Abattoir workers
  • Exposure to animals
67
Q

Leptospirosis clinical signs (when to suspect)

A
  • Exposure to animals: rats, dogs, horses, cattle, pigs
  • Freshwater swimming
  • International travel, ecotourism in the tropics
  • Abrupt fever, chills, myalgia, headache, rash, light sensitive conjunctivitis** (3 main signs)
68
Q

Leptospirosis treatment

A

Doxycycline 100mg BD 7 days

69
Q

Q fever causative agent

A

Coxiella burnetii

70
Q

General malaise, fever, joint pain, headache story with travel to QLD, perhaps animal exposure…. DDX

A
  • Brucellosis
  • Leptospirosis
  • Q fever
  • RRV
  • BFV
  • EBV
  • CMV
71
Q

Tests for measels

A
  • Nasopharyngeal PCR
  • Urine measels PCR
  • Measels IgG, IgM serology
72
Q

Dengue symptoms

A

Fever
Headache
Retroorbital pain
Marked myalgia
Bone pain

73
Q

When is tetanus immunoglobulin indicated

A

ONLY if
- Not complete course (3)(or unknown)
- AND Dirty or MAJOR wound

74
Q

When is tetanus booster indicated

A

> 5 years
AND
Dirty/Major wound

75
Q

Two tests for Latent TB

A

TST: tuberculin skin test
IGRA: interferon gamma release assay

*** BCG vaccine will cause positive skin test

76
Q

Carcinoid symptoms

A

Skin flushing, diarrhoea, respiratory symptoms and valvular heart disease

77
Q

Antiviral (tamiflu - oseltamivir) in pregnancy safe or not?

A

SAFE
Oseltamivir

78
Q

Signs of lithium toxicity?

A

Vomiting, diarrhoea, ataxia, sluggishness, confusion, agitation, seizures, NM excitability (clonus, tremor)

79
Q

DDx for lithium toxicity?

A

-Serotonin syndrome,
-neuroleptic malignant syndrome,
-etOH or benzo withdrawal

80
Q

Risk factors for lithium toxicity ?

A
  • Dehydration
  • Acute illness
  • Renal disease
  • Drug interactions (ACEi, ARBs, NSAIDS)
81
Q

Prophylaxis for bites/clenched fist injuries

A

Augmentin (22.5/3.2mg/kg to up 875/125mg) BD 3 days

82
Q

Barriers to indigenous Australian’s having good health outcomes

A

Shortage of Aboriginal health workers

Poor health literacy

Mistrust in Western medicine

Lack of culturally safe health care services

Cultural or family duties

Distance to health care (remote/rural)

83
Q

Witholding NOAC prior to surgery

A

1-3 days prior to procedure

HIGH risk bleeding: 3 days
Low risk 2 days

84
Q

Witholding metformin before surgery?

A

Only in renal impairment stop before surgery or contrast

85
Q

SGLT2s witholding prior to surgery advice? (hint time frame)

A

3 days prior to surgery

**unless day procedure (eg. scope- can be day of)

86
Q

Nicotine patch dose

A

21mg/24hrs

87
Q

Varenicline dose

A

0.5mg daily for 3 days the 0.5mg for 4 days then 1mg BD for remainder of 12 weeks course

88
Q

Medications associated with Hyponatraemia

A
  • Diuretics: indapamide, hydrochlorothizaide
  • SSRis, SNRIs
  • Carbamazepine
89
Q

Hydrochlorothiazide cautions

A
  • Not in <65yo
  • Not in gout
90
Q

Denosumab counselling

A
  • Strict 6 months
  • Osteonecrosis of the jaw risk- advise major dental work first
  • Risk of atypical femur fracture
  • Need to check Vit D prior to 1st dose
  • 1300mg calcium per day
  • Monitoring BMD 2 yrly
  • Does not completely prevent fractures
91
Q

Opioid poisoning dose of Naloxone

A

0.8mg IM stat

92
Q

Best oxygen provision for opioid induced respiratory depression?

A

15L/min Bag valve mask at 10-20 BPM

(not nonrebreather)

93
Q

Accepting gifts from patients: possible actions

A
  • Discuss with medical indemnity insurer
  • Discuss with colleague “peer test”
  • Discuss with practice manager for advice on how to proceed
  • Sensitively decline the gift
94
Q

Malaria risk reduction non-pharmacological

A

Repellant with 15-30% DEET
Loose clothing
Mosquito nets
reapply repellant post swimming
avoid dusk and dawn
avoid perfume or aftershave

95
Q

Suitability for home detox

A
  • Supportive stable drug free environment
  • No suicidal thoughts
  • No previous withdrawal seizures
  • No previous delirium tremenz
  • no other drug use
96
Q

DOACs preoperatively when to cease

A

2-3 days prior cease.
2 for low risk
3 days for high risk

97
Q

Poor sleep (particularly being tired on waking & late bedtime) differentials

A

Depression/Anxiety
Stimulant use
Poor sleep hygiene
OSA
Narcolepsy
Delayed sleep phase disorder
Insufficient sleep

98
Q

3 Zoononotic Infections to consider with fever chills, myalgias & fatigue

A
  • Q Fever (coxiella burnetii)
  • Brucellosis
  • Leptospirosis
99
Q

Treatment of Clostridium Difficile

A

Metronidazole 400mg 8 hourly for 10 days

Avoid PPis

100
Q

Which two meds can you not use with Beta Blocker

A

Verapamil
Diltiazem

101
Q

The three questions to screen for falls…

A

1) More than 2 falls in last 12 months?
2) Are you presenting following a fall?
3) Difficulty with walking or balance?

102
Q

Signs of venous insufficiency

A
  • Venous eczema
  • Lipodermatosclerosis
  • Varicose veins
  • Haemosiderin deposits
  • Venous flares
  • Peripheral oedema
103
Q

6 P’s of acute ischaemia’

A

Pallor
Pulselessness
Perishingly cold
Paralysis
Pain
Parasthesia

104
Q

Emergency management of acute limb ischaemia

A
  • Consult the vascular surgeon
  • Protect the limbs with cage and heel pad
  • Anticoagulation with heparin IV
  • IV wide bore access
  • IV fluids
  • Analgesia
  • Keep NBM
105
Q

Drug dependent asking for opioid approach…

A
  • Advise cannot be prescribed without a permit if history of opiate dependence
  • Contact Medicare prescribing shopper helpline; Safescript;
  • Contact Medicines Branch of Department of Health to ask whether has a known drug dependence

-Review past prescription history at practice; my health record

Contact usual pharmacy for past dispensing details

Referral to exercise physiologist; physiotherapist

106
Q

Centrelink disability payment qualifiers:

A
  • Must have a disability or medical condition that will last 2 years or more
  • Needs to have a permanent impairment
  • Must have a disability or medical condition that is fully diagnosed, treated and stabilised
  • Must have a disability or medical condition that results in an impairment rating of 20 points or more (on Disability Support Pension Impairment Tables)
  • Must have a disability or medical condition that will stop her working for at least 15 hours a week in the next 2 years
  • Advise that Centrelink decides eligibility for a Centrelink disability support pension not the GP
107
Q

ABI cut off for urgent referral

A

<0.4

108
Q

ABI cut off for caution with
a) applying compression
b) no compression

A

<0.8
<0.7

109
Q

Emergency management of Box Jellyfish sting

A
  • Remove tentacles (use sea water)
  • VINEGAR
  • Then ice
110
Q

Blue bottle management

A
  • Salt water wash
  • Hot water
111
Q

Irukandji (Tiny box jellyfish) first aid

A
  • Wash with sea water
  • Remove tentacles
  • HOT water
112
Q

Young person syncope, some jerking movements, swift recovery differentials

A
  • Seziure
  • Vasovagal syncope
  • Pseudoseizure
  • Conversion disorder
  • Cardiac arrhythmia eg long QT or WPW
  • Basillar migraine
  • Alcohol
113
Q

Young person syncope, some jerking movements, swift recovery differentials

A
  • Seizure
  • Vasovagal syncope
  • Pseudoseizure
  • Conversion disorder
  • Cardiac arrhythmia eg long QT or WPW
  • Basillar migraine
  • Alcohol
114
Q

4 main features of management

A
  • Strong pain relief eg Penthrox
  • Tetanus booster
  • Removal of foreign body under ring block
  • Wound irrigation
  • Cover with abx eg augmentin
115
Q

All Animal bites what not to forget

A

TETANUS

116
Q

Huntington’s percentage of inheritance

A

50% (Autosomal dominant)

117
Q

Animal bite (eg deep cat bite) management

A
  • Tetanus
  • Irrigation
  • Analgesia
  • Antibiotics - augmentin
  • Immobilise and elevate
118
Q

Priapism management initial

A
  • Cold shower
  • Oral pseudoephedrine
  • Gentle jog
119
Q

Asymptomatic Carotid Artery Stenosis Management

A
  • Aspirin
  • Statin
  • CVD risk factor modification
120
Q

Antipsychotic for delirium for parkinsons or lewy body

A

QUETIAPINE 25mg PO

121
Q

18 month vaccinations

A

Infanrix: DTP
MMRV
Act HIB

122
Q

12 month vaccination

A

Meningococcal ACWY (nimenrix)
Pneumococcal (prevenar 13)
MMR

*bexsero for ATSI

123
Q

6 month vaccinations

A

Infanrix hexa: DTP, Hepatits B, polio, HIB

124
Q

6 week and 4 month vaccinations

A

Infanrix hexa
Pneumococcal (prevenar13)
Rotavirus

PLUS bexsero

125
Q

Year 7 vaccinations

A

DTP
HPV

126
Q

Otitis externa treatment

A
  • Dry Aural toiletting eveyr 6 hours until dry
  • Dexamethasone + framycetin + gramicidin 0.05%+0.5%+0.005% ear drops, 3 drops , TDS for 7 days

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