General/Misc Flashcards
Side effects of corticosteroids (broad categories) - 9
• HTN
• Obesity
• T2DM
• Cataracts
• Fractures
• Osteoporosis
• CVS disease
• GIT symptoms
Poor wound healingTreatment of renal colic (oral opioids of choice, expulsion therapy)
1) Tapentadol 50mg IR or Tramadol 50-100mg PO
Expulsion therapy = tamsulosin if >5mm stone/distal segment
ADHD history questions (different aspects of history) (4)
- Impact on function
- Difficulty concentrating
- Mood, anger/irritability (often associated w/ ODD)
- Adulthood - dropping out of courses/work difficulties/relationship dysfunction
Hep C treatment goal
Cure OR sustained virologic response (SVR) [undetectable plasma HCV RNA >12 weeks post-end of treatment]
Hep C investigations:
- For diagnosis
- Work-up for +ve pts
-When to refer
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
MAFLD monitoring frequencies
- Without cirrhosis
- With cirrhosis
W/o cirrhosis - 2-3 yearly
With cirrhosis - 6 monthly surveillance for HCC w/ USS + AFP
Anaphylaxis management steps (6)
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
When to commence allergenic foods (egg/dairy/peanut) in kids
At ~6 months, not before 4 months
This reduces risk of development of later allergy
HIV PrEP High risk criteria (4)
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)
Tests before starting PrEP
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
HIV PrEP practice points
- ?Duration for effectiveness
- Common side effects
- ?Ongoing monitoring required
- 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
Genital herpes acute treatment
- Episodic dose
- Recurrent dose
Valaciclovir 500mg BD 5-10 days
Valaciclovir 500mg BD 3 days
Valaciclovir 500mg daily for 6 months
Pelvic inflammatory disease empirical Rx (3)
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
Gender affirming hormone therapy - initial baseline Ix
- FBE
- UEC
- LFT
- Fasting lipids
- Fasting glucose
- Baseline oestradiol
- Baseline testosterone levels
Gender affirming hormone therapy (feminising) - treatment options (3)
- Oestradiol (patch or oral)
- Progesterone (?breast development, risk of CVD/clots/weight gain)
- Anti-androgen therapy (spironolactone or cyproterone - affects fertility)
Gender affirming hormone therapy - timelines for changes to take effect (feminising and masculinising)
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!)
PDE-5 inhibitors patient advice/counselling on how to use (6 points)
-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
PDE-5 inhibitors patient advice/counselling on how to use (6 points)
-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
Gonorrhoea management steps (6 points)
-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
ATSI factors for non-compliance/non-attendence to hospital (7)
-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
Pred dose for:
1. Gout
2. PMR
3. GCA
4. Bell’s Palsy
- 15-30mg for 3-5 days
- 15mg daily for 4 weeks –> taper
- 40-60mg daily (+aspirin)
- 1mg/kg (max 75mg) daily for 5 days
Meningitis pre-hospital Abx (adult & kids doses)
- Ceftriaxone 2g IV/IM (50mg/kg)
- Benzylpenicillin 2.4g IV/IM (60mg/kg)
Withhold if urgent transfer available
Autism - who can diagnose?
Psychiatrist/Clin Psych
?Paeds
Bloods & other AH assessments for autism prior to referral
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
Tourette’s syndrome hx. questions (8)
○ 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
DSM criteria for Tourette’s syndrome
○ ≥2 motor tics + ≥1 vocal tic for >1 year
§ Less than 1 year = provisional tic disorder
§ No vocal tics = chronic tic disorder
Tourette’s management features (4)
-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
ADHD DSM Criteria
○ 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
ADHD management features (2)
-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
Complex regional pain syndrome Rx - medication classes (5)
-Oral opioids (eTG?)
-SNRIs
-TCAs
-Gabapentinoids
-?Ketamine (specialist), ?corticosteroids
Ascorbic Acid (Vit C) - used for prevention, 500-1000mg daily for 50 days
Common sources of pain in cerebral palsy (5)
○ Dental pain
○ GORD
○ Constipation
○ Muscle spasms/MSK injuries
Pressure injuries
Cystic Fibrosis - ?inheritance pattern
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
Familial hypercholesterolaemia - inheritance pattern?
Rx for children?
Autosomal dominant
Refer to specialist for consideration of cascade testing (of 1st deg relatives)
Start low dose statin before age 10
Triggers/sources for behaviour change in ID/Dementia (9)
○ Sleep disturbance
○ Environmental change
○ Medication changes
○ Physical/sexual abuse
○ Anaemia/thyroid disorders
○ Dental pain
○ Mental health issues
○ Hearing/visual deterioration
-?Infection
Genetic carrier screening - conditions tested (3)
-Fragile X syndrome
-Spinal muscular atrophy
-Cystic Fibrosis (CF)
Fragile X syndrome ?inheritance pattern
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
Huntington’s Disease - ?inheritance pattern
Autosomal dominant
-Genetic testing if asymptomatic -> clinical geneticist
-Confirmatory genetic testing if symptomatic - neurologist/psychiatrist
Hepatitis A -population groups recommended for vaccination
-Travellers to endemic areas
-ATSi children
-Chronic liver disease
-MSM
-Injectable drug users
-Incarcerated populations
- ↑Occupational risk
Hep A - infectious period?
Management principles?
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
Measles
-management steps
-?Who needs immunoglobulin
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
Mycoplasma genitalium
-Ix
-Rx
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
Pertussis - definition of close contact
-When to start Rx
-Rx options
-Family & household members
-F2F exposure (within 1 metre) for at least 1 hour
Start Rx within 3 weeks of symptom onset
- Azithromycin 500mg d1, 250mg daily for another 4/7
- Clarithromycin 500mg BD 7/7
Pertussis - who to give antibiotic prophylaxis?
(kids - 4 criteria, adults - 4 criteria)
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
Morphine dose for palliative dyspnoea
1-2.5mg Q4hrly IR
OR 5-10mg MR BD
Reasons for intentional medication non-adherence (8)
○ Fear
○ Side effects
○ Cost
○ Misunderstanding
○ Too many meds
○ Lack of symptoms
○ Depression
○ Mistrust
Signs of sepsis - eTG (5)
-Impaired consciousness
-Hypoxaemia
-Hypotension
-Tachypnoea >22
-Blood lactate >2
Reduced cognition/Dementia/memory DDx (9)
-Delirium 2ndary to infection
-Depression
-CVA
-eTOH withdrawal/intoxication
-Subdural haematoma
-Brain cancer
-Vit B12 deficiency
-Hypothyroidism
-Hyponatraemia
Symptoms (7)/signs (5) of strangulation
- 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
- Signs
secondary Restless leg syndrome aetiology DDx (5)
Iron deficiency
CKD
Pregnancy
Meds (e.g antidepressants)
Thyroid dysfunction
Syphilis in pregnancy Rx steps (5)
○ 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
Syphillis management - ?main reaction
?Clin features
?management
Jarisch-Herxheimer reaction
* Reaction 6-12 hours after syphilis Rx - fever, headache, rigors, joint pain
* Symptoms controlled w/ analgesics and rest
Syphilis stages and clin. features
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%)
Alcohol withdrawal symptoms/signs (7)
○ 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)
People NOT suitable for eToh home detox program (6)
○ 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
Initial evaluation of mild chronic elevated aminotransferases (5)
-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
Fitness to Drive - minimum non-driving periods for:
* AMI
* TIA
* Cardiac arrest
* Diabetic severe hypoglycaemic event
* Stroke
- 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
Fitness to Drive Guidelines - conditional or unconditional licence?:
-Diabetes diet controlled
-Diabetes OHGs
-Diabetes on insulin
-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
Fitness to Drive Guidelines - minimum visual acuity:
-Private licence
-Commercial licence
- Private - minimum 6/12 bilat (for unconditional licence)
- Commercial - better eye min 6/9, worse eye min. 6/18
Diagnosis?
Cognitive impairment + urinary incontinence + gait disturbance
normal pressure hydrocephalus
