GP Flashcards
Most common cause of androgen deficiency
Klinefelter Syndrome (47 XXY)
What are the physical features of Klinefelter syndrome
Tall, reuduced facial and body hair, small testes, breast development, feminine fat distribution
What is the hormone profile of Klinefelter syndrome
Low testosterone, high FSH and high LH
Causes of Gynaecomastia
Testicular cancer Klinefelter syndrome Androgen deficiency Cirrhosis breast cancer hyperthyroidism Chronic renal failure Alcohol
What is Kallman Syndrome
X linked syndrome with anosmia, hypogonadism and colour blindness
Hypothalamic failure: Low FSH
What are the findings on ECG for pericarditis
widespread concave ST elevation
PR depression
What imaging is needed for pulsatile tinnitus?
CT Angiography
As per the National Standards governing medical fitness to drive how long should a pt be seizure free before they can be judged fit to return to driving a private vehicle?
6 months
What are the criteria for metabolic syndrome
HDL<1 (men) <1.3 (women) triglycerides >/=1.7 BP >/=130/85 elevated waist circumference fasting sugar >5.5
what animal is brucellosis associated with
Feral pigs
What scan do you do for pagets disease
bone isotope scan
what vaccinations are at 18 months
MMRV
Hib
Dip, tetanus, pertussis (infanrix)
What vaccinations are at 4 years
Infanrix IPV
ATSI pneumovax 23 and Hep A
What vaccinations at 12-13 years
Gardasil 9
Boostrix
What vaccinations at 14-16 years
Men ACWY
when is zostavax recommended on the schedule
70-79 years
causes of erythema multiforme
HSV Idiopathic food additives medications - penicillins TB Lymphoma SLE
causes of erythema nodosum
IBD, COCP, Sarcoidosis, Streptococcal infection, HIV
Causes for raised CA125
Ovarian cancer endometriosis pregnancy cirrhosis SLE breast cancer fibroids
RIsk factors for ovarian cancer
Family history no pregnancies Obesity older age gene mutations
HASBLED
Hypertension Abnormal liver or renal function Stroke Bleeding history Labile INRs Elderly >65 years Drugs - antiplatelets
Pericarditis causes
TB SLE post myocardial infarction uraemia post coronary intervention HIV
Coeliac antibodies
TTG-IgA, DDP-IgG
Treatment for balanitis
Soak in warm slt water
barrier cream
antifungal cream - clotrimazole (if candida)
do not retract foreskin
CKD risk factors
Age >60 Smoker Diabetes Hypertension CVD History of AKI ATSI
Treatment for H pylori
- Esomeprazole 20mg orally BD for 7 days
- Amoxicillin 1g orally BD for 7 days
- Clarithromycin 500mg orally BD for 7 days
IBS treatment options
- Hyoscine butylbromide
- Mebeverine
- Amitriptyline
treatment for addison crisis
IV hydrocortisone 100mg
Superficial BCC treatment options
- Excise 5mm margins
- Double freeze thaw cryotherapy
- Imiquimod (Aldara) 5% topically at night 5 times a week for 6 weeks
- Photodynamic therapy
Examination findings for haemochromatosis
Bronze skin
arthritis
testicular atrophy
hepatomegaly
Which part of the scaphoid is at risk of AVN
proximal scaphoid
Causes of skin hyperpigmentation
Addisons Haemochromatosis Cushing Syndrome Hyperthyroidism Pregnancy
Managment of venous dermatitis
Leg elevation measure ABI if ABI ok apply compression stockings up to knee regular waslk betamethasone 0.05% daily regular walks/exercise daily moisturiser frusemide 40mg daily
Management of keratosis pilaris
urea cream 10% topically daily
use pumice stone while bathing
topical retinoid: tretinoin 0.025%
reasurrance no treatment required
Drugs that can cause hyponatremia
SSRI
Hydrochlorothiazide
SNRIs
Carbamazepine
Treatment for neuroleptic malignant syndrome
Bromocriptine
Symptoms of neuroleptic malignant syndrome
lead pipe rigidity bradykinesia tremor hyperthermia tachycardia hypertension drowsiness
what scan do you want for myasthenia gravis
CT chest for thymoma
Examination findings for intracranial hypertension
Papilloedema, abducens nerve palsy and reduced visual acuity
managment of dystonia
benztropine
Treatment of bronchiectasis exacerbatiob
Amoxicillin 1g TDS for 14 days
First line treatment for peripheral neuropahty diabetes
amitriptyline 25mg nocte
Investigations to consider in allergic rhinitis
RAST
skin prick testing
Physical Examination allergic rhinitis
Darkened circles around eyes
transverse nasal crease
pale swollen inferior turbinates
red oedematous eyelids
peripheral vertigo nystagmus direction
horizontal
Examination for parotid glad sialolithiasis
Examination for parotid stones include palpation of buccal mucosa and inspection and palpation of Stenson’s duct (adjacent to 2nd upper molar)
Management of sialolithiasis
- Apply moist heat
- Massage the gland
- Manage pain with NSAIDs
Suck on hard tart candies to encourage saliva flow
Management of sialadenitis
- Antibiotics : fluclox 500mg QID for 10 days
- Warm compresses
- Salivary gland massage
Sialogogues to increase saliva flow eg pilocarpine
features of barotrauma
• Retraction
• Redness
• Fluid
Pain, tinnitus, vertigo
PID Treatment
- Ceftriaxone 500mg in 2mL lidocaine IM
- Metronidazole 400mg BD 14 days
- Doxycycline 100mg 12 hourly for 14 days
Actinic Keratosis treatment
- Flurouracil 5% cream topically once or twice daily for 2-4 weeks on the face or 3-6 weeks on arms and legs
- Imiquimod 5% cream topically at night 3 times weekly for 3-4 weeks
- Or Ingenol Mebutate 0.05% gel topically for 2 days
Treatment for pitted keratolysis
• Clindamycin 1% topically BD for 10 days
Cold sore treatment
- Famciclovir 1500mg stat OR
* Acyclovir cream 5% 5 times a day 5 days
what is needed for CVD assessment
age, sex, smoking status, total cholesterol and HDL–C, systolic blood pressure (SBP)
How long after an acute MI can you not drive for
2 weeks
4 weeks post cabg
Cardiac tamponade
Hypotension, Raised JVP, Muffled heart sounds
Digoxin Effect on ECG
- Downsloping ST depression
- Shorted QT interval
Flattened, inverted or biphasic T waves
- Shorted QT interval
causes of inverted T waves
- Normal in children
- Myocardial ischaemia and infarction
- Bundle branch block
- Ventricular hypertrophy
- Pulmonary embolism
- Hypertrophic cardiomyopathy
Raised ICP
causes of left ventricular hypertrophy
- Hypertension
- Aortic Stenosis
- Aortic regurgitation
- Mitral regurgitation
- Hypertrophic cardiomyopathy
Coarctation of the aorta
causes of bradyarrhythmias
- Drugs: BB, Ca
- raised ICP
- Ischaemic heart disease
- Hyperkalaemia
Hypothermia
Hypothyroidism
causes of RBBB
• pulmonary hypertension • atrial septal defect • rheumatic heart disease • myocarditis • Brugada syndorme pulmonary embolism
causes of LBBB
• aortic stenosis • IHD • hypertension • dilated cardiomyopathy • anterior MI • primary degenerative disease (fibrosis) of the conducting system • Hyperkalemia Dignoxin toxicity
Hypertrophic Cardiomyopathy
Shortness of breath, palpitations, bifid apical beat and increased intensity of systolic murmur on valsalva
Management of Familial Hypercholesterolaemia
• Pts must be started on statin straight away - 40mg atorvastatin
• Test close family relatives: cascade testing
• Immediately high risk CVD
• Dietician referral: low fat diet
• Exercise: 30 mins/day
Refer to lipid specialist
Erysipelas
• streptococcus pyogenes infection of the deep dermis and subcutis
treatment relies upon IV benzylpenicillin
erythrasma treatment
Fusidate sodium 2% BD for 14 days
causes of erythromelalgia
diabetes, polycythaemia ruba vera, connective tissue disease
Hot tub folliculitis
Caused by pseudomonas
Ciprofloxacin
Management of guttate psoriasis
- Mometasone 0.1% cream daily for 2-6 weeks
- Daivobet (calcipotriol + betametasone)
- Coal tar topical 1% gel/emulsion OR LPC 6% + salycilic acid 3% cream. BD for 1 month
causes of hairy tongue
• Poor oral hygiene • Smoking or chewing tobacco • Drinking alcohol • Cocaine • Chlorhexidine or peroxidase-containing mouthwash • Coloured beverages, including coffee • Dehydration • Hyposalivation (dry mouth) Radiation therapy
medical mx of hidradenitis suppurativa
doxycycline 50 to 100 mg orally, once daily for 6 weeks, then review
palmar hyperhidrosis
Iontophoresis
Itch with normal skin
• Cholestasis • Chronic renal insufficiency /uraemia • Iron deficiency • Polycythaemia rubra vera • Hyperthyroidism/ hypothyroidism • Diabetes • Hyperparathyroidism • Malignancy ;lymphoma, multiple myeloma, leukaemia • Drug induced - statins, ACEI, diuretics, recreational drugs • Hyperparathyroidism • Neurological condition: cerebral infarct, brain abscess, MS, Parkinson's HIV, Hep C
Causes of balanitis
Chemical irritation: urine trapping, soiled nappies, soap residue
Physical trauma: forcible retraction
Candida nappy rash in infants
commonest causes of priapism in children?
sickle cell disease (65%), leukaemia (10%) and trauma (10%)
Differentials for jaundice and weight loss
- Head of pancreas cancer
- Cholangiocarcinoma
- Choledocholelithiasis
- Alcoholic hepatitis
- Viral hepatitis
- Primary biliary cirrhosis
- Hepatocellular carcinoma
Hepatic metastatsis
Causes of unconjugated bilirubinaemia
- Haemolysis
- Ineffective erythropoiesis
Impaired hepatic uptake or conjugation of bilirubin: Gilbert, Crigler-Najjar syndrome
Physiological: breast milk jaundice, neonatal jaundice
Iatrogenic: drug eg gentamicin
- Ineffective erythropoiesis
causes of conjugated bilirubinaemia in neonate
- Biliary atresia
- Neonatal hepatitis
Metabolic (galactosaemia, fructose intolerance)
- Neonatal hepatitis
causes of uncongugated bilirubin in neonate
phyioological jaundice breast milk jaundice breast feeding jaundice sepsis Haemolysis
Pancreatic cancer risk factors
• Smoking
• obesity (body mass index >30 kg/m2)
• heavy alcohol use (>4 standard drinks/day)
• long-standing diabetes (>5 years)
one first-degree relative (FDR) with pancreatic cancer, BRCA1 gene carrier status, Lynch syndrome and familial adenomatous polyposis
Morton neuroma mx
• Use of metatarsal insoles/inserts in shoes
• Wearing broad toed shoes
• Corticosteroid injection in the affected area
Surgical removal
referral of paediatric inguinal hernia
○ 2 days <6 weeks
○ within 2 weeks for child <6 months and
2 months for >6 months
Indications to use a syringe driver
• Persistent nausea and vomiting • Dysphagia • Bowel obstruction • Coma • Poor absorption of oral drugs Patient preference
spinal mets pain mx options
- Radiotherapy
- Paracetamol
- Morphine syrup
- Bisphosphonate therapy
- NSAIDS
Dexamethasone
Investigations in Hypertrophic cardiomyopathy
Echo, ECG, 24 hour holter monitor
Pancreatitis causes
Idiopathic Gallstones (60%) Ethanol (20%) Tumours Scorpion stings microbiological: mumps, CMV, mycoplasma Autoimmune: SLE, PAN, Crohn's Surgery/ trauma Hyperlipidemia, Hypercalcemia, Hypothermia Emboli or Ischaemia Drugs/ Toxins
tumour markers for testicular cancer
LDH, AFP and HCG
risk factors for gastric cancer
- Smoking
- Intestinal metaplasia of stomach
- Atrophic gastritis
- Increasing age
- H pylori
- Previous partial gastrectomy
risk factors for testicular cancer
• cryptorchidism, with cancer developing in both the undescended and the contralateral testicle
• subfertility (small, soft testes)
• Caucasian ethnicity
• family history of testicular cancer
• previous contralateral tumour
• human immunodeficiency virus infection (untreated)
Down syndrome.
drugs that can trigger psoriasis flares
lithium, beta blockers, chlorquine, hydroxychloroquine and interferon alfa
First line treatment of trunk and limb psoriasis
LPC 6% + salicylic acid 3% cream BD for 1 month
Factors that aggravate psoriasis
Streptococcal tonsillitis
Injuries - cuts, abrasions
Sun exposure in 10%
Obesity
Smoking
Excessive alcohol
Stressful event
Medications: lithium, beta blockers, anti malarias, anti inflammatories
Stropping oral steroids
Scalp psoriasis
Methylprednisolone aceponate 0.1% lotion topically, once daily until skin is clear
If response is inadequate after 2 weeks change to
Betamethasone dipropionate 0.05% lotion topically BD for 6 weeks
Triad of signs in grAVES DISEASE
Pretibial myxoedema
Ophthalmopathy (prominent eyes due to deposition of myxoedema behind the orbit)
Acropachy (swelling of distal digits with overgrown nail plates that may lift off the nail bed; similar to clubbing)
pyoderma gangrenosum is associated with
Inflammatory bowel disease
More commonly UC
Rheumatoid arthritis
Leukaemia
Hepatitis
digital myxoid cyst treatment
Aspiration of contents
Sclerosant injection
Cryotherapy
Surgical removal
most risk gene mutation for haemochromatosis
C282Y
what is lichen sclerosis associated with
Vulval cancer
Hashimoto’s thyroiditis
Vitiligo
Pernicious anaemia
causes of facial flushing
menopause rosacea phaeochromocytoma carcinoid syndrome food additive alcohol
tinea corporis
tebinafine 1% daily for 7-14 days
Anaphylaxis adrenaline dose
0.5mls of 1:1000
treatment for funnel web spider bite
pressure immobilisation bandage
anti venom if required
Initial treatment of symptomatic ascites
spironolactone 50-100mg daily
Management of ascites
• sodium restriction
• adequate protein and energy intake
• diuretics
• large-volume paracentesis and intravenous albumin for severe or refractory ascites
• transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites
liver transplantation for refractory ascites.
Ichthyosis
fish scale skin
Management of Anal Fissure
○ Avoid hard stools
○ Warm salt baths after bowel movements
GTN ointment 0.2% topically 3-4 times a day
Non pharmacological mx for Hidradenitis Suppurativa
- wear loose clothing
- stop smoking
- eat healthily and lose weight, if appropriate.
antibiotics options for Hidradenitis Suppurativa
Clindamycin 1% lotion topically BD if mild
doxycyline 100mg daily for 6 weeks
what is Wernicke’s Encephalopathy associated with
Generally associated with chronic hazardous alcohol use, but also occurs in associated with bariatric surgery, cancer and recurrent vomiting or chronic diarrhoea
Box Jellyfish first aid
Vinegar and remove tentacles
ice packs
analgesia
(anti venom available)
psychosocial reasons behind opioid dependency
depression unemployment use of other substances negative life events social isolation low self esteem
management of paediatric clavicle fracture (middle third)
broad arm sling for 2 weeks
weber A ankle fracture
WBAT in boot
fracture below
risk factors for DDH
female, 1st born child, family history, breech presentation, oligohydramnios
Treatment for severs disease
- Rest
- Well fitting shoes
- Icepacks
- Gel heel pads
- Calf stretches
- Pain usually settles within 6-12 months
what is a toddlers fracture
Toddler fractures occur in young ambulatory children (from 9 months to 3 years).
A toddler’s fracture is a spiral or oblique undisplaced fracture of the distal shaft of the tibia with an intact fibula. The periosteum remains intact and the bone is stable. These fractures occur as a result of a twisting injury. Septic arthritis and osteomyelitis should be excluded.
How to reduce pulled elbow?
Fully pronate forearm and then flex the elbow
skin prick testing
- Avoid antihistamines 4 days prior to test
- Carries a low but serious risk of side effects
- Not useful for food additives
The size of the skin prick reaction odes not correlate with severity of allergic manifestations
symptoms of orbital blowout fracture
pain (especially on vertical movement), local tenderness, diplopia (especially on vertical gaze), eyelid swelling and crepitus after nose blowing
Examination of orbital blowout fracture
- epistaxis, ptosis, localised tenderness
- restricted eye movements, particular on vertical gaze, resulting in diplopia
- complete eye examination looking for evidence of ocular injury, e.g. hyphema, subconjunctival hemorrhage, retro-orbital hemorrhage, retinal detachment and vitreous hemorrhage.
- check for infraorbital nerve involvement — anesthesia of the affected cheek, and the upper teeth and gums on the affected side. this nerve passes along the floor of the orbit and be stretched or otherwise damaged.
- palpate the eyelid for crepitus
- there may be no other significant facial injury.
Monteggia fracture
fracture of the ulna shaft with dislocation of the radial head at the elbow
Galleazi fracture
fracture of the distal radial shaft with dislcoation of the ulnar with its articulation at the distal radial head
(widened distal radioulnar joint)
Colles fracture
transverse fracture of the distal radius with dorsal displacement
(dinner fork deformity)
Smith Fracture
distal radial fracture with volar (palmar displacement)
nerve likely to be impacted with humeral shaft fracture
radial nerve (wrist drop, sensory impairment dorsum of hand)
type 1 Supracondylar fracture mx
Immobilisation in an above-elbow backslab in 90 degrees elbow flexion with sling for 3 weeks.
Bennet Fracture
- fracture of the base of the first metacarpal bone which extends into the carpometacarpal joint
- Intra articular fracture
- most common type of fracture of the thumb
- nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint
Fractured surgical neck of humerus mx
Triangular sling
When pain subsides (10–14 days), encourage pendulum exercises in the sling
Aim for full activity within 8–12 weeks post-injury
Jones Fracture
Fracture at the base of the 5th metatarsal
Mallet finger
Injury to the extensor digitorum at its distal insertion
Initial measures to manage priapism
- Cold shower
- Oral pseudoephedrine 120mg
Walk up and down stairs/gentle jog
- Oral pseudoephedrine 120mg
complications of priapism
- May cause permanent damage to erectile tissue
- Erectile dysfunction
Possible disfigurement of penis
- Erectile dysfunction
bacterial sinusitis abx
Amoxicillin 500mg TDS for 5 days
Allergy (doxycycline 100mg BD 5 days)
Signs of Addisons
Hyperpigmentation postural hypotension tachycardia dry mucous membranes vitiligo decreased body hair
Diagnosis of Addison’s
short synacthen (ACTH stimulation )
Aspects of self care for pts with addisons
• Medicalert bracelet
• Increase glucocorticoid dose during illness
• Recognise early features of adrenal crisis (nausea, vomiting, dehydration, hypotension)
• Carry injectable hydrocortisone when away from medical care
Carry a wallet card with details about condition
What to measure when monitoring a pt with adrenal insufficiency
Measure sodium, potassium and plasma renin
plasma renin upper normal = good
Cushing’s Disease
adrenocorticotropic hormone–producing pituitary adenoma
Clinical Features of Cushing’s Syndrome
• Proximal muscle wasting and weakness • Central obesity, buffalo hump on neck • Cushing facies: plethora, moon face, acne • Weakness • Hirsutism • Abdominal striae • Thin skin, easy bruising, • Hypertension • Hyperglycaemia • Menstrual changes • Osteoporosis • Psychiatric changes, especially depression backache
Testing options for Cushing’s Syndrome
- Late night salivary cortisol (2 measurements)
- 24 hour urinary free cortisol (2 measurements)
Overnight 1mg dexamethasone suppression test
causes of diabetes insipidus
• Post operative (hypothalamic -pituitary ) - transient • Tumours • Infections Infiltrations • trauma • Anorexia nervosa Familial and congenital disorders
Causes of SIADH
• stress (pain, nausea, post-surgical)
• malignancy (lung (bronchial carcinoma), pancreas, lymphoma)
• CNS disease (inflammatory, haemorrhage, tumour, Guillain-Barré syndrome)
• respiratory disease (TB, pneumonia, empyema)
• drugs (SSRIs, vincristine, chlorpropamide, cyclophosphamide, carbamazepine, nicotine, morphine, DDAVP, oxytocin)
Hypothyroidism
carcinoid syndrome
Flushing, diarrhoea, bronchospasm
Classic Triad: skin flushing, diarrhoea, valvular heart disease
antibodies in post partum thyroiditis
antithyroid peroxidase antibodies
what change do you make to thyroxine dose in pregnancy
increase by 25% at 6 weeks
test TSH 4-6 weeks during 1st trimester
iodine dose in prengancy
150MCG
TSH aim for pts younger than 60
0.5-2.5
De Quervain Thyroiditis
inflammation of the thyroid that results in transient thyrotoxicosis followed by hypothyroidism and usually a subsequent return to euthyroidism
pain, fever, malaise
(near absent uptake on thyroid scan), marked increase in ESR
Treatment for De Quervain Thyroiditis
Ibuprofen
Prednisolone 40mg daily, tapering over 2-4 weeks
common causes of goitre
• Hashimoto thyroiditis • Graves disease • Familial or sporadic multinodular goitre • Iodine deficiency • Follicular adenoma • Colloid nodule or cyst Thyroid cancer
Suppurative Thyroiditis
caused by an infection of the thyroid gland (usually bacterial) and is rare but potentially life-threatening
DDx for painful anterior neck lump
• De Quervain's thyroiditis (subacute granulomatous thyroiditis) • Suppurative or infectious thyroiditis • Skin infection/cellulitis • Infected sebaceous cyst/thyroglossal cyst • Haemorrhage into thyroid nodule • Graves disease • Traumatic thyroiditis Thyroid node harbouring thyroid cancer
Riedel’s Thyroiditis
- A very rare condition where dense fibrotic tissue replaces thyroid parenchyma and extends to involve adjacent tissues (trachea, esophagus, parathyroid glands, RLN)
- Hard, stony, woody, painless goitre
what is thyroglobulin useful for
Thyroid cancer
anti thyroid drug for primary hyperthyroidism
carbimazole 15mg bd
second line = propylthiuracil
what to warn pts about carbimazole
can cause agranulocytosis: seek medical assistance if acute malaise, fever or infection (usually severe pharyngitis)
symptoms of thyrotoxicosis treatment
- propranolol 10mg BD
Clinical Features of severe hypomagnesaemia
tetany, muscle weakness, cardiac arrhythmas
causes of raised anion gap metabolic acidosis
Raised Anion Gap: Failure of H+ excretion (KUSSMAUL) • Ketosis • Uremia • Salicylate poisoning • Methanol posioning • Ethylene poisoning • Uremia • Lactic Acidosis
causes of normal anion gap metabolic acidosis
Normal Anion Gap = Loss of bicarbonate
- diarrhoea
- renal tubular acidosis
Causes of Hypomagnesaemia
poor oral intake diarrhoea PPIs extensive bowel resection hypercalcaemia diuretics
Causes of high Magnesium
- Excessive intake ○ Antacids ○ Enemas ○ IV infusion - Decreased excretion ○ Renal failure ○ Volume depletion ○ Familial hypocalciuric hypocalcaemia - Rhabdomyolysis Lithium
Hypercalcaemia
Primary Hyperparathyroidism, Familial Hypercalciuric Hypercalcaemia and neoplasia vitamin D toxicitity • Drugs: thiazide diuretics • Paget disease • Williams syndrome • Prolonged immobilisation • Sarcoidosis Milk-alkali syndrome
ECG features of hypokalaemia
- Increased P wave amplitude
- Prolongation of PR interval
- Widespread ST depression and T wave flattening/inversion
- Prominent U waves (best seen in the precordial leads V2-V3)
- Apparent long QT interval due to fusion of T and U waves (= long QU interval)
What indicates good asthma control?
Daytime symptoms <=2 days/week
Need for reliever <= 2 days/wee
no limitation of activity
No symptoms during night or on waking
Risk factors for asthma exacerbations
poor adherence poor inhaler technique lack of asthma action plan any asthma exacerbation within past 12 months exposure to tobacco smoke allergic rhinitis poor symtpom control
Risk factors for life threatening asthma flare
• Poor asthma control
• Admission to hospital in preceeding 12 months
• History of intubation for acute asthma
• Over-use of short acting beta2 agonist reliever
• Poor adherence to asthma action plan
• Exposure to tobacco smoke
• Frequent failure to attend appointments
Parent/carer unequipped to manage asthma emergency
in a child what are the indications to prescribe a preventer?
- Episode of life threatening asthma requiring hospital/ICU
- More than 2 ED presentations
- Requiring oral corticosteroids for more than 2 flares
- Flare up more than once every 6 weeks
- Night time symptoms more than twice per month
- Asthma symptoms restrict activity
- Asthma symptoms restrict sleep
Day time symptoms more than once per week
what is symbicort
budenoside/formoterol
asthma low.mid dose 200/6 BD
Maintenance asthma treatment children 1-5 years
Children 1 -5
Step 1: Salbutamol
Step 2: Fluticasone propionate 50mcg BD
Step 3: Refer to respiratory physician
Maintenance asthma treatment >6 years
Step 1: Salbutamol
Step 2: Fluticasone propionate 50-100mcg BD
Step 3: Fluticasone propionate 125-250mcg BD OR fluticasone propionate + salmeterol 100+50mcg BD OR ICS + monteleukast
causes of hypocalcaemia
- Hypoalbuminaemia
- Renal failure
- Hypoparathyroidism
- Drugs: anticonvulsants, bisphosphonates
- Vitamin D deficiency
- Malignancy
- Acute pancreatitis
Rhabdomyolysis
How to assess for diabetic peripheral neuropathy?
• 10g monofilament pressure sensation at metatarsal joints
• Ankle reflexes
• Vibration sensation with 128Hz tuning fork
Pinprick sensation
what is the maximum safe dose of lignocaine with adrenaline
The maximum safe dosage for lignocaine 1% (also known as lidocaine) with adrenaline is 7mg/kg.
who is eligible for self collected cervical cancer screening
• those who have never participated in the NCSP and are 30 years or over
those who are overdue for cervical screening by 2 years or more and aged 30 years or over
what causes slow central vision loss
macular degeneration
what diet is good for macular degeneration
diet rich in fish containing omega 3 fatty acids and dark green leafy veg
When to refer CKD to nephrologist
stage 4 or 5 CKD of any cause
•persistent significant albuminuria (ACR ≥30 mg/mmol)
•decline in eGFR of >25 mL/min/1.73 m2over a six-month period–Because there can be variation of up to 15–20% between consecutive individual eGFR measurements, the decline should be confirmed on at least three separate readings.
•glomerular haematuria with macroalbuminuria
•CKD with hypertension where target blood pressure is difficult to achieve despite treatment with at least three antihypertensive agents.
Non pharmacological management of AF
Weight management:aim 10% loss for BMI <27 Screen and manage sleep apnoea exercise: 210 mins per week Aim BP <130/80 Aim HBA1c<6.5% Lipids Smoking cessation Alcohol:less than or equal to 3 std/week
Treatment for phimosis
Topical corticosteroid (hydrocortisone 1%) TDS for 1 month
Bloods wanted in Addison’s
EUC, Cortisol, BGL, adrenocortiotropic hormone
diagnose: short synacthen test
dihydropyridine calcium channel blocker
Amlodipine
Nifedipine MR
non dihydropyridine calcium channel blocker
diltiazem, verapamil
non pharmacological mx of BPSD
-identify and reduce triggers of aggression
- Provide reassurance to patient
- Calm, low stimulating environment
- Positive reinforcement for good behaviour
- Provide familiar environement- photos of family
- Time orientation aids: whit board with time and day
- Massage
Regular leisure activities eg arts
medical managment for BPSD
• Risperidone 0.25mg PO, BD (max 2mg day)
OR olanzapine 2.5mg daily
COPDX
• Case finding and confirm diagnosis • Optimise function • Prevent Deterioration • Develop a plan of care Manage eXacerbations
Normal pressure hydrocephalus
urinary incontinence, gait disturbance, and dementia
facial and flexural seborrheic dermatitis treatment
hydrocortisone 1% + clotrimazole 1% cream once or twice daily until skin is clear or for up to 2 weeks
most likely organism to cause croup
Parainfluenza virus type 1.
Which type of tremor is MOST commonly associated with thyrotoxicosis?
postural tremor
most common acute ECG findings of takotsubo cardiomyopathy
ST segment elevation in the praecordial leads and T-wave inversion in most leads
Diagnostic criteria for diabetes
single elevated FBG ≥7.0 mmol/L
• single HbA1c ≥6.5%
• a random blood glucose ≥11.1 mmol/L.
(if symptomatic one reading = diabetes,if notsymtpomatic need 2 separate occasions)
Impaired fasting glucose numbers
• HBA1c 6-6.4%
5.5-6.9
what can cause an abnormally low HBA1c
anaemia – haemolytic anaemia – congenital (eg spherocytosis, elliptocytosis) – haemoglobinopathies – acquired haemolytic anaemias (eg drug-induced, such as with dapsone, methyldopa) • recovery from acute blood loss • blood transfusions, iron infusions • chronic blood loss • chronic renal failure (variable).
Abnormally high HBA1c can be caused by
iron deficiency anaemia
• splenectomy
• alcoholism.
When to dose reduce metformin
Reduce dose by 50% with eGFR 30-60
Contraindicated in eGFR <30
Management of severe hypoglycaemia
IM glucagon 1mg into thigh, buttock or upper arm
If IV access - 50% glucose 20mls
Recheck BGL in 15 mnutes
Management of hypoglycaemia
if BGL <4
give 15g of quick acting carbohydrate -half glass of fruit juice
recheck BGL in 15 minutes
if next meal more than 15 mins away give long acting carb eg sandwich
recheck bgl in 2-4hours
BGL targets in diabetes
4-7 fasting
5-10 post prandial
GDM glucose tolerance test cut offs
fasting >5.5
2 hours >8
Infant complications GDM
• Congenital anomalies of cardiovascular/CNS • Preterm birth • Perinatal asphyxia • Macrosomia • Respiratory distress • Hypoglycaemia • Hypocalcaemia • Polycythaemia • Low iron • Hyperbilrubinaemia • Transient hypertrophic cardiomyopathy • Fetal death Shoulder dystocia
Pregnancy complications GDM
- Increased risk of ○ Pre eclampsia ○ Hypertension ○ Early delivery ○ Induction of labour C section
pneumococcal vaccine for at risk condition
give prevenar 13 then 12 months later give pneumovax 23 then 2nd dose at least 5 years later
when do ATSI get prevenar
give prevenar 13 at 50 years
side effects of metformin
GI adverse effects
lactic acidosis
B12 deficiency
which diabetic drug to avoid if previous pancreatitis
DPP4 and GLP-1
Medications for osteoporosis
Alendronate 70mg weekly oral on empty stomach
60mg denosumab 6 monthly SC
5mg IV zolendronic acid
if someone has a minimal trauma fracture at a site other than hip or spine what does the T score need to be to start treatment
=1.5
Risk factors for osteoporosis
Rheumatoid arthritis coeliac disease premature menopause kidney disease prolonged steroid use (>3months of >7.5mg/day) hyperthyroidism
post partum endometritis abx
Amoxicillin + clavulanic acid BD 7 days
if severe to hospitalfor IVAbx
cut off endometrial thickness post menopause
4mm
cut off endometrial thickness pre menopause
12mm
Risk factors for endometrial cancer
Obesity Diabetes Nulliparous Hypertension On exogenous oestrogens Late menopause PCOS Tamoxifen exposure Endometrial thickness >8mm Family history of endometrial or colon cancer
what kind of drug is mirabegron
Beta adrenergic agonist
oral progestogen option for HMB
Norethisterone 5mg TDS day 1-21 of cycle (r/v in 6 months)
Absolute contraindications for PDE5 inhibitors
- Recent MI, stroke or life threatening arrythmia within the last 6 months
- Resting hypotension BP<90/50
- Hypertension >170/100
- Unstable angina or angina with exertion
- Severe congestive heart failure
- Nitrates or nitric oxide donors
Known hereditary retinal disorders (sildenafil and vardenafil only)
Example of LABA/LAMA combination
Spiolto Respimat (tiotropium/ olodaterol 2.5./2.5) 2 inhalations daily
Example of LABA/LAMA/ICS
Trelegy Elipta (FUV) : fluticasone furoate/umeclidinium/vilanterol 100/62.5/25mcg)
Dementia Screening Tools
• mini mental state examination MMSE
• GP assessment of cognition (GPCOG)
RUDAS: Rowland Universal Dementia Assessment Scale
Non pharmacological mx of dementia
• Education regarding diagnosisAnd progressive nature
Review driving ability and report to relevant authorities
Organise aged care assessment services
Discuss advanced care directive
Organise Webster packs
Cease any drugs that could be causing cognitive impairment
○ Anticholinergics, psychotropics (esp benzodiazepines)
Assess safety at home
Refer to Alzheimer’s Australia
Consider carer support and respite
Referral to specialist dementia service
Investigations required if both testes are impalpable
• Karyotype
• Serum electrolytes (CAH babies can have low sodium)
Ultrasound
Why should undescended testes be fixed?
• Impaired fertility ○ Temperature is higher in abdomen than scrotum • Cancer ○ Seminoma increased 5-10 times • Trauma ○ More likely to tort Poor self image
second line agent in cholesterol mx
ezetimibe 10mg
prostatitis treatment
Trimethoprim 300mg daily for 2 weeks
how to calculate number needed to treate
inverse of absolute risk reduction
100/ARR
list 2 meds for BPH from different classes
Tamsulosin (alpha blocker)
Dutasteride (5 alpha reductase inhibitor)
fertile window
5 days prior to ovulation + day of ovulation
McCune Albright Syndrome
genetic disorder of bones, skin pigmentation and hormonal problems along with premature puberty
most common cause of ambiguous genitalia
congenital adrenal hyperplasia
Examination features of hypothyroidism
non pitting oedema bradycardia goitre hair thinning ataxia peripheral neuropathy slow relaxing reflexes
stigmata of anaemia
pallor angular stomatitis tachycardia flow murmur koilonychia glossitis
first sign of puberty in males?
testicular enlargement
HSP Follow up
• If initial urinalysis is normal or only reveals microscopic haematuria, review clinically and check BP/urinalysis:
○ Weekly for the first month after disease onset
○ Fortnightly from weeks 5-12
○ Single reviews at 6 and 12 months
Anaphylaxis adrenaline dose
10 microgram/kg or 0.01 mL/kg of 1:1000 (maximum 0.5 mL), i
ASD Red Flags
Does not babble or coo by 12 months of age
Does not gesture (point, wave, grasp) by 12 months of age
Does not say single words by 16 months of age
Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age
Has any loss of any language or social skill at any age
Genetic conditions that are linked to ASD
• Fragile X syndrome (1) • Rett syndrome (1) • Williams syndrome (1) • Angelman syndrome (1) • Landau-Kleffner syndrome (1) • Prader-Willi syndrome (1) • Tuberous sclerosis (1) • Chromosomal abnormalities / chromosomal inversions / chromosomal duplications (only 1 of these options will be awarded 1 mark) Metabolic conditions (1)
Red flags with sudden onset hearing loss
• Concurrent head trauma
• Neurological signs or symptoms
Unilateral middle ear effusion (post-nasal space must be examined)
Clinical Features of redback spider evenomation
Radiating pain to draining lymph nodes / chest / abdomen / back (any of = 2 marks) Unusual distribution of diaphoresis, e.g. isolated to affected limb (2) Headache (2) Nausea / Vomiting (2) Hypertension (2) Irritability / agitation (2) Muscle twitches / fasciculation (2) Fever (2) Priapism (1)
what is tinea cruris?
Jock itch
Differentials for tinea cruris
• Candidal intertrigo
• Seborrheic dermatitis
• Flexural psoriasis
Erythrasma
otodex
dexamethasone, framicidin, gramicidin
3 drops TDS for 7 days
treatment of perforated tympanic membrane with otorrheoa
amoxicillin 15mg/kg TDS for 5 days
panadol
Investigation for acoustic neuroma
- MRI brain with gadolinium including internal auditory meatus views
Secondary causes of restless legs syndrome
- Anaemia (common)
- Iron deficiency (common)
- Uraemia
- Hypothyroidism
- Pregnancy
- Drugs (antihistamines, anti emetics, lithium)
- Multiple sclerosis
- Parkinsons disease
- Peripheral neuropathy (diabetes,amyloid, motor neuron disease)
Non pharmacological mx for restless legs
• Mental distraction during symptomatic periods, crosswords when resting
• Exercise/stretching before bed
• Warm baths during symptomatic periods
• Keep legs cooler than body for sleep
• Reduce alcohol
• Replace iron so ferritin is at least 50
Cease medications that could be contributing (eg antihistamines)
when should babies be able to sit independently by?
9 months
when should kids be toilet trained by
before 3 years old (day time)
Components of safety plan
warning signs protective factors/reasons to live making a safe space things that can be done to distract self people and place to connect with professionals she can connect with
Poor prognostic factors of rheumatoid arthritis
• young age of onset
• high RF titre,
• elevated ESR
• activity of >20 joints at presentation
• Anti ccp positivity
• smoking
• Extra articular disease manifestation
• Long disease duration at presentation >3-6 months
• Early radiological bone erosions
Early functional impairment
what indicates clinical remission of rheumatoid arthritis
• Symptom relief
• Normalisation of inflammatory markers
Absence of joint swelling
How to monitor rheumatoid arthritis
• ESR/CRP • Number of tender swollen joints • Duration of early morning stiffness • Functional assessment Visual analogue scale for patinet reported global assessment
things to discuss regarding methotrexate
• Compliance - weekly dosing
Discuss safe alcohol consumption - no more than 1-2 drinks once or twice weekly
Discuss contraception
Discuss drug interactions with folate antagonists (trimethoprim)
Discuss vaccinations that are recommended - pneumococcal/ influenza
Advise no live vaccines
Discuss ongoing requirement for regular monitoring of liver/kidney/fbe
Ensure taking folic acid supplement weekly
Discuss sun protection strategies due to risk of photosensitivity
DDX for fracture of 5th metatarsal
- Midfoot joint sprain
- Peroneal tendon tear
Lateral ankle ligament sprain
- Peroneal tendon tear
Lis Franc Injury
• Injuries to the tarsometatarsal joint • Pain and swelling in the midfoot following acute trauma • Unable to weight bear or stand • Plantar ecchymosis Refer all to orthopaedics
factors other than ckd that increase urine albumin excretion
- UTI
- High dietary protein intake
- CCF
- Acute febrile illness
- Heavy exercise within 24 hours
- Menstruation
- Genital discharge or infection
Drugs: NSAIDs
how long does it take for prep to be effective
7 days in males
21 days in females
waht drug is prep
tenofovir/emtricitabine
Adie Syndrome
at least one dilated pupil, which does not constrict in response to light, loss of deep tendon reflexes and abnormalities of sweating
possible presentations of cystic fibrosis
- Chronic cough
- Steatorrhoea
- Failure to thrive
- Sinusitis
- Nasal polyposis
- Meconium ileus
- Diabetes mellitus
- Infertility
Hyponatremic dehydration
Retinitis Pigmentosa
- Primary degeneration of the retina
- Hereditary condition
- Degeneration of rods and cones
- Displacement of melanin containing cells from the pigment epithelium into the more superficial parts of the retina
Features
- Begins as night blindness in childhood
- Visual fields become concentrically narrowed
- Blind by adolescence
Irreversible course
osteoid osteoma
• Benign bone forming tumour • Small radiolucent nidus • painful area often in the tibia or femur • often causes night pain relieved by NSAIDs
specificity calculation
true negative/ everyone without the condition
Specificity is defined as the ability of a test to correctly detect those people without the disease (a true negative) and this is calculated with: [D / (B + D)] x 100.
negative predictive value
probability that people with negative screening test really dont have the disease
treatment for neonatal cephalic pustulosis
Ketoconazole 2% cream topically BD until clear
most common side effect of TURP
retrograde ejaculation
what is the extra vaccine that pre term infants <28 weeks need?
extra pneumococcal at 6 months
+ booster 23vPPV at 4-5 years of age
Hep B vaccine changes in preterm <32 weeks and <2kg
give booster dose at 12 months
if born to hep B positive mother what should baby get
hep B vaccine at birth and Hep B immunoglobulin
How to prevent diverticulitis
- Exercise
- BMI <30
- Avoid smoking
- Limit red meat consumption
High fibre diet
Screening Questions to assess risk of falls
- Have you had 2 or more falls in the past 12 months?
- Are you presenting following a fall?
Are you having difficulty with walking or balance?
- Are you presenting following a fall?
Falls prevention strategies
• Exercise programs/Balance exercises for 2 hours/week (Tai Chi) (1)
• Vitamin D supplementation to achieve a level of >60nmol/L (1)
• Medication review/Psychoactive medication (benzodiazepine) withdrawal/tapering (1)
• Home occupational therapy assessment for home modifications as indicated (1)
Optimise vision/Expedite cataract surgery (1)
ottawa foot xr rules
pain in the mid foot zone and any one of the following
- bone tenderness at the base of the 5th metatarsal OR
- bone tenderness at the navicular bone OR
- an inability to bear weight
Underlying causes carpal tunnel syndrome
• Idiopathic Pregnancy Diabetes Hypothyroidism Rheumatoid arthritis Gout Acromegaly Repetitive activity
what calcium channel blockers cant go with beta blockers
non dihydropyridine (diltiazem and verapamil)
how much gluten is needed to ahve bfore the tests
6 weeks of 3-6 g of gluten daily
Kernig’s sign
Positive when the thigh is bent at the hip and knee at 90 degrees and extend the knee : get pain
Diseases that anterior uveitis is associated with
- Ankylosing spondylitis
- Psoriatic arthritis
- Inflammatory bowel disease
- Sarcoidosis
- Syphilis
Ocular tuberculosis
abx treatment for travellers diarrrhoea
azithromycin 1g PO stat
Treatment for latent TB
Isoniazid
syphilis test of cure
3,6,12 months
what antipsychotic to use for BPSD or delirium in parksinsons patients
quetiapine 25mg PO stat
when to screen for primary aldosteronism
sustained BP >150/100 BP >140/90 on 3 different medications hypertension and hypokalaemia hypertension and adrenal incentaloma hypertesnion and sleep apnoea all hypertensive first degre relatives of pt with primary aldesteronism
investigations for high risk bowel cancer
IFOBT every 2 years from 35 to 44
scope 5 yearly from 45 to 74
smoking and inflammatory bowel disease
Smoking is a risk factor for Crohn’s disease and is associated with more severe disease
definition of macroalbumninuria
males >25
females >35
microlalbuminuria
males 2.5-25
females 3.5-35
private licence eyesight standards
one or both eyes at least 6/12
commercial licence eyesight standards
better eye at least 6/9 AND worse eye at least 6/18
causes for bitemporal hemianopia
Pituitary adenoma Craniopharyngioma Meningioma Malignant sellar tumour Sellar benign mass - cyst
Non pharmacological mx for acne
use mild non soap cleanser daily avoid oil based cosmetic products use an oil free sunscreen daily do not pick/squeeze pimples avoid humid environments where face is exposed to steam eg sauna/spa
side effects of PDE5 inhibitors
headaches, flushing, dyspepsia, nasal congestion, backache and myalgia
may cause transient retinal effects: blurred vision, blue-green colour tinge and light sensitivity
Contraindications to using PDE5 inhibitors
Recent MI, stroke or life threatening arrythmia within the last 6 months
Resting hypotension BP<90/50
Hypertension >170/100
Unstable angina or angina with exertion
Severe congestive heart failure
Nitrates or nitric oxide donors
Known hereditary retinal disorders (sildenafil and vardenafil only)
Adverse effects of clozapine
- Myocarditis
○ Monitor troponin- Agranulocytosis
EPSE
- Agranulocytosis
Causes of thrombocytopenia
medication induced chronic liver disease vitamin B12 deficiency SLE lymphoma HIV Pregnancy ITP artefact
Examination features of acute angle closure glaucoma
mid dilated pupil pupil poorly responsive to light decreased visual acuity red conjunctivae cloudy cornea increased intraocular pressure
risk factors for life threatening asthma flare
• Poor asthma control
• Admission to hospital in preceeding 12 months
• History of intubation for acute asthma
• Over-use of short acting beta2 agonist reliever
• Poor adherence to asthma action plan
• Exposure to tobacco smoke
• Frequent failure to attend appointments
Parent/carer unequipped to manage asthma emergency
ICS/LABA for children
fluticasone 50/salmeterol 25mcg 2 puffs BD
Imiquimod dose for genital warts
Imiquimod 5% cream 3x weekly at bedtime until warts resolve – 8-16 weeks
treatment for initial gential herpes
valaclovir 500mg BD for 5-10 days
treatment for episodic genital herpes
valciclovir 500mg BD for 3 days
Norethisterone dose in HMB
Norethisterone 5mg 2-3x daily on 1-21 days of a 28 day cycle
podophyllotoxin dose for genital warts
0.05% paint BD for 3 days repeated weekly until warts resolve
mx for Meniere’s disease
aim low sodium 2-3g/day avoid caffeine commence hydrochlorothiazide refer to exercise physiologist for vestibular rehab program refer to ENT for surgery refer to audiologist for hearing aid
vitilgo treatment
do nothing cosmetic camoflague bethamethasone dipropionate 0.05% cream phototherapy pimecrolimus 1% cream (body folds and face) calcipotriol + betamethasone
Qs to ask about stress/urge incontinence
parity vaginal deliveries family history of incontinence smoking history excessive caffeine intake vaginal atrophy recent weight gain
how long to contact trace gonorrhoea partners?
2 MONTHS
Surgical bariatric interventions
sleeve gastrectomy
Roux en y gastric bypass
biliopancreatic diversion