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Exams :) > General/Misc > Flashcards

General/Misc Flashcards

1
Q

Side effects of corticosteroids (broad categories) - 9

A 
• HTN
	• Obesity
	• T2DM
	• Cataracts
	• Fractures
	• Osteoporosis
	• CVS disease
	• GIT symptoms
          Poor wound healing
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2
Q

Treatment of renal colic (oral opioids of choice, expulsion therapy)

A

1) Tapentadol 50mg IR or Tramadol 50-100mg PO

Expulsion therapy = tamsulosin if >5mm stone/distal segment

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3
Q

ADHD history questions (different aspects of history) (4)

A
  • Impact on function
  • Difficulty concentrating
  • Mood, anger/irritability (often associated w/ ODD)
  • Adulthood - dropping out of courses/work difficulties/relationship dysfunction
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4
Q

Hep C treatment goal

A

Cure OR sustained virologic response (SVR) [undetectable plasma HCV RNA >12 weeks post-end of treatment]

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5
Q

Hep C investigations:

  • For diagnosis
  • Work-up for +ve pts

-When to refer

A

Diagnosis:

  • HCV serology
  • If +ve, confirm current infection with PCR for HCV RNA

Work-up for +ve pts

  • FBE, UEC, LFT
  • INR
  • Pregnancy test
  • Hep A, Hep B, HIV serology
  • Fibroscan
  • ?HCV genotyping - can differentiate relapse vs. re-infection

Refer if CIRRHOSIS

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6
Q

MAFLD monitoring frequencies

  • Without cirrhosis
  • With cirrhosis
A

W/o cirrhosis - 2-3 yearly

With cirrhosis - 6 monthly surveillance for HCC w/ USS + AFP

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7
Q

Anaphylaxis management steps (6)

A

1) Call for assistance
2) Lie patient flat
3) IM adrenaline 0.01mg/kg 1:1000, repeat doses every 5 mins PRN
4) Remove allergen
5) Ambulance transport to hospital
6) Monitor obs, IV accessfluid bolus, O2 therapy

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8
Q

When to commence allergenic foods (egg/dairy/peanut) in kids

A

At ~6 months, not before 4 months

This reduces risk of development of later allergy

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9
Q

HIV PrEP High risk criteria (4)

A

1) Receptive CLI with any casual male/MSM partner
2) Rectal gonorrhoea, rectal chalmydia or infectious sy[hili
3) Methamphetamine use
4) CLI with a regular HIV+ve partner (not on treatment or detectable viral load)

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10
Q

Tests before starting PrEP

A

Current HIV test

-eGFR
-Hep A/B/C serology
Full STI screen - rectal/pharyngeal swab, FPU for chlamydia/gonorrhoea, serology for syphilis, HIV, Hep B
-Pregnancy test if female

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11
Q

HIV PrEP practice points

  • ?Duration for effectiveness
  • Common side effects
  • ?Ongoing monitoring required
A
  • 7 days to become effective
  • A/e’s - nausea, headache –> renal toxicity, reduced BMD
  • Ongoing HIV tests & side effect assessment 3 monthly, STI screen 3 monthly, eGFR 6 monthly
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12
Q

Genital herpes acute treatment

  • Episodic dose
  • Recurrent dose
A

Valaciclovir 500mg BD 5-10 days
Valaciclovir 500mg BD 3 days
Valaciclovir 500mg daily for 6 months

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13
Q

Pelvic inflammatory disease empirical Rx (3)

A

1) Ceftriaxone 500mg in 2ml 1% lignocaine IM stat
2) Metronidazole 400mg BD for 14 days
3) Doxycycline 100mg BD for 14 days

Also, test of cure in 3 months
Contact tracing
No sex for 1/52 till after treatment finishes

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14
Q

Gender affirming hormone therapy - initial baseline Ix

A
  • FBE
  • UEC
  • LFT
  • Fasting lipids
  • Fasting glucose
  • Baseline oestradiol
  • Baseline testosterone levels
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15
Q

Gender affirming hormone therapy (feminising) - treatment options (3)

A
  • Oestradiol (patch or oral)
  • Progesterone (?breast development, risk of CVD/clots/weight gain)
  • Anti-androgen therapy (spironolactone or cyproterone - affects fertility)
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16
Q

Gender affirming hormone therapy - timelines for changes to take effect (feminising and masculinising)

A

Feminising:
-3-6 months for breast growth/body fat redistribution/reduced muscle mass
-6-12 months - thinning of body/facial hair
-Voice not altered

Masculinising:
-First few weeks: increased libido/clitoral size
-Throughout first year: amenorrhoea, body fat redistribution, muscle growth, hair growth (irreversible!), deepening of voice (irreversible!)

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17
Q

PDE-5 inhibitors patient advice/counselling on how to use (6 points)

A

-Allow 2 hours before last meal
-Avoid fatty foods/alcohol
-Avoid stress or anxiety prior to use
-Engage in adequate sexual stimulation
-Allow 6-7 attempts to appreciate full effect
-Don’t expect it to work very first time

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17
Q

PDE-5 inhibitors patient advice/counselling on how to use (6 points)

A

-Allow 2 hours before last meal
-Avoid fatty foods/alcohol
-Avoid stress or anxiety prior to use
-Engage in adequate sexual stimulation
-Allow 6-7 attempts to appreciate full effect
-Don’t expect it to work very first time

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18
Q

Gonorrhoea management steps (6 points)

A

-Ceftriaxone 500mg in 2ml 1% lignocaine IM stat
-Azithromycin 1g PO stat (uncomplicated infections)
-No sex for 1/52 after treatment
-Contact trace last 2 months
-Notify state health department
-Test of cure in 2 weeks AND 3 months

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19
Q

ATSI factors for non-compliance/non-attendence to hospital (7)

A

-Financial limitations
-Transport limitations
-Lack of understanding/knowledge re: dx
-Language barrier
-Previous negative experience at hopital
-Lack of trust/familiarity in medical system
-Lack of access to social network/being away from family

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20
Q

Pred dose for:
1. Gout
2. PMR
3. GCA
4. Bell’s Palsy

A
  1. 15-30mg for 3-5 days
  2. 15mg daily for 4 weeks –> taper
  3. 40-60mg daily (+aspirin)
  4. 1mg/kg (max 75mg) daily for 5 days
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21
Q

Meningitis pre-hospital Abx (adult & kids doses)

A
  1. Ceftriaxone 2g IV/IM (50mg/kg)
  2. Benzylpenicillin 2.4g IV/IM (60mg/kg)

Withhold if urgent transfer available

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22
Q

Autism - who can diagnose?

A

Psychiatrist/Clin Psych
?Paeds

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23
Q

Bloods & other AH assessments for autism prior to referral

A

Vit D, iron studies, B12 (nutritional status)
**-Audiology assessment

-Speech path r/v**

Can self-refer to NDIS via Early Childhood intervention program - access SW/OT/SP

24
Q

Tourette’s syndrome hx. questions (8)

A

○ PHx of any prev. tics?
○ Onset of 1st tic?
○ Do movements come and go? Change from one site to another? Vocal tics?
○ Mental urge to do tic?
○ Does tic make sensation better/’feel right’?
○ Voluntary control? Agg factors?
○ Associated features
§ Coprolalia (involuntary swearing), copropraxia (involuntary rude gesturing), echolalia, echopraxia
○ FHx of tics, ADHD, OCD, autism

25
Q

DSM criteria for Tourette’s syndrome

A

○ ≥2 motor tics + ≥1 vocal tic for >1 year
§ Less than 1 year = provisional tic disorder
§ No vocal tics = chronic tic disorder

26
Q

Tourette’s management features (4)

A

-Advise tics are involuntary/out of control, best to ignore
-Psychotherapy (CBIT/habit reversal therapy)
-A-adrenergics (guanfacine, clonidine), 2nd gen antipsychotics (risperidone, aripiprazole)
-Refer Paeds/Psych

27
Q

ADHD DSM Criteria

A

○ Symptoms ≥6 months
○ Several inattentive and/or hyperactive symptoms before age 12 in 2 or more settings
§ Fidgeting, running/climbing, excessive talking, interrupting others, impatience
○ Clear interference w/ academic/social activities
○ Symptoms not explained by other mental disorder

28
Q

ADHD management features (2)

A

-Non-pharm 1st line - behavioural intervention, social skills training, calming strategies
-Meds - stimulants - a/w initial weight loss (regained slowly), 1cm less height growth in first 3 years

29
Q

Complex regional pain syndrome Rx - medication classes (5)

A

-Oral opioids (eTG?)
-SNRIs
-TCAs
-Gabapentinoids
-?Ketamine (specialist), ?corticosteroids

Ascorbic Acid (Vit C) - used for prevention, 500-1000mg daily for 50 days

30
Q

Common sources of pain in cerebral palsy (5)

A

○ Dental pain
○ GORD
○ Constipation
○ Muscle spasms/MSK injuries
Pressure injuries

31
Q

Cystic Fibrosis - ?inheritance pattern

A

Autosomal recessive (if both parents carriers - 1 in 4 chance of child having CF)

-Prenatal & pre-implantation genetic Dx available to known carriers
-Genetic CF carrier testing available (but $$$)

-Newborn screening = universal in Aus via heelprick + DNA testing

32
Q

Familial hypercholesterolaemia - inheritance pattern?

Rx for children?

A

Autosomal dominant
Refer to specialist for consideration of cascade testing (of 1st deg relatives)

Start low dose statin before age 10

33
Q

Triggers/sources for behaviour change in ID/Dementia (9)

A

○ Sleep disturbance
○ Environmental change
○ Medication changes
○ Physical/sexual abuse
○ Anaemia/thyroid disorders
○ Dental pain
○ Mental health issues
○ Hearing/visual deterioration
-?Infection

34
Q

Genetic carrier screening - conditions tested (3)

A

-Fragile X syndrome
-Spinal muscular atrophy
-Cystic Fibrosis (CF)

35
Q

Fragile X syndrome ?inheritance pattern

A

X-linked pattern (on X chromosome)
Males affected - almost always have ID
Women - may have ↑risk premature ovarian insufficiency

  • If ↑genetic risk identified prior to pregnancy, couples have option of IVF + preimplantation genetic testing - alternative to prenatal diagnosis
36
Q

Huntington’s Disease - ?inheritance pattern

A

Autosomal dominant

-Genetic testing if asymptomatic -> clinical geneticist
-Confirmatory genetic testing if symptomatic - neurologist/psychiatrist

37
Q

Hepatitis A -population groups recommended for vaccination

A

-Travellers to endemic areas
-ATSi children
-Chronic liver disease
-MSM
-Injectable drug users
-Incarcerated populations
- ↑Occupational risk

38
Q

Hep A - infectious period?
Management principles?

A

2 weeks prior to prodrome (fever/malaise/anorexia) –> 1 week post-onset of jaundice

Anti-HAV IgM detectable 3-6 months, IgG persists for life
Rx - supportive, avoid eTOH/paracetamol
-Avoid sharing personal items/sexual activity whilst infectious
-Exclude from childcare/work until 1 week after jaundice

39
Q

Measles
-management steps
-?Who needs immunoglobulin

A

Isolate patient away from others
Apply mask to pt, apply N95 to yourself
Immediately notify state department of health via phone of suspected case
-Discuss need for PCR testing w/ health department
Take serology for all suspected cases
Vacate consult room for at least 2 hours

Pregnant women, immunocompromised, kids <6mths age. (=PEP - withiin 72 hrs exposure)

Close contact = same room for 30 mins

40
Q

Mycoplasma genitalium
-Ix
-Rx

A

NAAT PCR - FPU, vaginal/endocervical/rectal swab (pharyngeal infection uncommon, mostly from genital contact)

Rx - doxycyline 100mg BD 7/7 + azithromycin 1g stat then 500mg for 3/7
(Moxifloxacin 400mg daily for 7/7)

Test of cure 2-3 weeks (no sex ‘til then)

Mostly asymptomatic - no routine screening recommended

41
Q

Pertussis - definition of close contact
-When to start Rx
-Rx options

A

-Family & household members
-F2F exposure (within 1 metre) for at least 1 hour

Start Rx within 3 weeks of symptom onset

  1. Azithromycin 500mg d1, 250mg daily for another 4/7
  2. Clarithromycin 500mg BD 7/7
42
Q

Pertussis - who to give antibiotic prophylaxis?
(kids - 4 criteria, adults - 4 criteria)

A

Children:
-Age <6 months OR
-<3 doses pertussis vaccine OR
-Household member age <6 months OR
-Attend childcare in same room as infant <6 months

Adults (regardless of immunisation status):
-Expectant parents in last month of pregnancy OR
-Health care worker in maternity hospital or newborn nursery OR
-Childcare worker in close contact with infants <6 months OR
-Household member aged <6 months

43
Q

Morphine dose for palliative dyspnoea

A

1-2.5mg Q4hrly IR
OR 5-10mg MR BD

44
Q

Reasons for intentional medication non-adherence (8)

A

○ Fear
○ Side effects
○ Cost
○ Misunderstanding
○ Too many meds
○ Lack of symptoms
○ Depression
○ Mistrust

45
Q

Signs of sepsis - eTG (5)

A

-Impaired consciousness
-Hypoxaemia
-Hypotension
-Tachypnoea >22
-Blood lactate >2

46
Q

Reduced cognition/Dementia/memory DDx (9)

A

-Delirium 2ndary to infection
-Depression
-CVA
-eTOH withdrawal/intoxication
-Subdural haematoma
-Brain cancer
-Vit B12 deficiency
-Hypothyroidism
-Hyponatraemia

47
Q

Symptoms (7)/signs (5) of strangulation

A
  • Symptoms
    ○ Neck pain, coughing
    ○ Difficulty swallowing/breathing
    ○ Hoarse voice
    ○ Bladder/bowel incontinence
    ○ LOC/memory loss
    ○ Visual changes
    ○ Seizures
    • Signs
      ○ Subconjunctival haemorrhage
      ○ Petechiae above site of application of force
      ○ Bruising/abrasions to neck
      ○ Raspy/hoarse voice
      ○ Swelling of neck/face/tongue
48
Q

secondary Restless leg syndrome aetiology DDx (5)

A

Iron deficiency
CKD
Pregnancy
Meds (e.g antidepressants)
Thyroid dysfunction

49
Q

Syphilis in pregnancy Rx steps (5)

A

○ Benzathine benzylpenicillin 1.8g (=2.4 million units)
○ Re-check RPR in 4 weeks time –> need >2 fold drop in RPR titre from 1:128
○ Also repeat RPR at 28 weeks, 36 weeks and delivery
○ Post-delivery - 3, 6, 12 month repeat testing
○ Contact tracing & notification

50
Q

Syphillis management - ?main reaction
?Clin features
?management

A

Jarisch-Herxheimer reaction
* Reaction 6-12 hours after syphilis Rx - fever, headache, rigors, joint pain
* Symptoms controlled w/ analgesics and rest

51
Q

Syphilis stages and clin. features

A

Primary - chancre (painless genital/anal/oral ulcer), incubation period 10-90 days, spont. heals.
Inguinal lymphadenopathy
Highly infectious

Secondary - systemic symptoms, fever/malaise/headache/lymphadenopathy
Rash - trunk, palms/soles
Alopecia or mucous patches
Incubation period 2-24 weeks
Highly infectious

Early latent (<2 years)/late latent (>2 years) - late = no longer infecitous to partners but can still have vertical transmission

Tertiary - Cx incl. destructive skin lesions (gummas), CVS or neurological disease

Many asymptomatic (up to 50%)

52
Q

Alcohol withdrawal symptoms/signs (7)

A

○ Anxiety/panic attachs
○ Tachycardia
○ Diaphoresis
○ Nausea/vomiting
○ Dilated pupils
○ Tremor
○ Delirium tremens - agitation/hallucinations/gross tremors/seizures

Give 100mg IV thiamine for 5 days, then oral.
Esp. if treating hypogylcaemia, before giving glucose (risk of Wernicke’s encephalopathy)

53
Q

People NOT suitable for eToh home detox program (6)

A

○ History of alcohol-related seizures or delirium tremens
○ Risk of suicide
○ Inadequate availability of social support/requirement for daily care or supervision
○ Polypharmacy misuse
○ Severe liver disease
○ Advanced age

54
Q

Initial evaluation of mild chronic elevated aminotransferases (5)

A

-Review Medications/recreational drugs
-Alcohol abuse?
-Serology for Hep B/C
-Haemachromatosis screen (iron studies)
-Fatty liver w/ USS

2nd line Ix - autoimmune hep screen, TFTs, coeliac serology

55
Q

Fitness to Drive - minimum non-driving periods for:
* AMI
* TIA
* Cardiac arrest
* Diabetic severe hypoglycaemic event
* Stroke

A
  • AMI - 2 weeks (private), 4 weeks (commercial)
    • TIA - 2 weeks (private), 4 weeks (commercial)
    • Cardiac arrest - 6 months (P&C)
    • Diabetic severe hypoglycaemic event - 6 weeks
    • Stroke - 4 weeks (private), 3 months (commercial)

  • Sleep apnoea - any = must have conditional licence
56
Q

Fitness to Drive Guidelines - conditional or unconditional licence?:
-Diabetes diet controlled
-Diabetes OHGs
-Diabetes on insulin

A

-Diabetes diet controlled - no licence restriction
-Diabetes OHGs - Private: not fit for unconditional if end-organ Cx or recent hypo. Commercial: must be conditional w/ endo r/v
-Diabetes on insulin: Private: conditional w/ 2yearly review. Commercial: conditional w/ annual endo r/v

57
Q

Fitness to Drive Guidelines - minimum visual acuity:
-Private licence
-Commercial licence

A
  • Private - minimum 6/12 bilat (for unconditional licence)
    • Commercial - better eye min 6/9, worse eye min. 6/18
58
Q

Diagnosis?

Cognitive impairment + urinary incontinence + gait disturbance

A

normal pressure hydrocephalus

Exams :) (20 decks)

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