GP Flashcards

1
Q

Most common cause of androgen deficiency

A

Klinefelter Syndrome (47 XXY)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the physical features of Klinefelter syndrome

A

Tall, reuduced facial and body hair, small testes, breast development, feminine fat distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the hormone profile of Klinefelter syndrome

A

Low testosterone, high FSH and high LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of Gynaecomastia

A
Testicular cancer
Klinefelter syndrome
Androgen deficiency 
Cirrhosis
breast cancer
hyperthyroidism 
Chronic renal failure
Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Kallman Syndrome

A

X linked syndrome with anosmia, hypogonadism and colour blindness
Hypothalamic failure: Low FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the findings on ECG for pericarditis

A

widespread concave ST elevation

PR depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What imaging is needed for pulsatile tinnitus?

A

CT Angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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?

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the criteria for metabolic syndrome

A
HDL<1 (men) <1.3 (women)
triglycerides >/=1.7
BP >/=130/85
elevated waist circumference
fasting sugar >5.5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what animal is brucellosis associated with

A

Feral pigs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What scan do you do for pagets disease

A

bone isotope scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what vaccinations are at 18 months

A

MMRV
Hib
Dip, tetanus, pertussis (infanrix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What vaccinations are at 4 years

A

Infanrix IPV

ATSI pneumovax 23 and Hep A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What vaccinations at 12-13 years

A

Gardasil 9

Boostrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What vaccinations at 14-16 years

A

Men ACWY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when is zostavax recommended on the schedule

A

70-79 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

causes of erythema multiforme

A
HSV
Idiopathic
food additives 
medications - penicillins 
TB
Lymphoma
SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

causes of erythema nodosum

A

IBD, COCP, Sarcoidosis, Streptococcal infection, HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes for raised CA125

A
Ovarian cancer
endometriosis
pregnancy
cirrhosis
SLE
breast cancer 
fibroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

RIsk factors for ovarian cancer

A
Family history
no pregnancies
Obesity 
older age 
gene mutations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HASBLED

A
Hypertension
Abnormal liver or renal function
Stroke
Bleeding history 
Labile INRs
Elderly >65 years
Drugs - antiplatelets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pericarditis causes

A
TB
SLE
post myocardial infarction
uraemia
post coronary intervention
HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Coeliac antibodies

A

TTG-IgA, DDP-IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Treatment for balanitis

A

Soak in warm slt water
barrier cream
antifungal cream - clotrimazole (if candida)
do not retract foreskin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

CKD risk factors

A
Age >60 
Smoker
Diabetes
Hypertension
CVD
History of AKI 
ATSI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment for H pylori

A
  • Esomeprazole 20mg orally BD for 7 days
  • Amoxicillin 1g orally BD for 7 days
  • Clarithromycin 500mg orally BD for 7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

IBS treatment options

A
  • Hyoscine butylbromide
  • Mebeverine
  • Amitriptyline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

treatment for addison crisis

A

IV hydrocortisone 100mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Superficial BCC treatment options

A
  • Excise 5mm margins
  • Double freeze thaw cryotherapy
  • Imiquimod (Aldara) 5% topically at night 5 times a week for 6 weeks
  • Photodynamic therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Examination findings for haemochromatosis

A

Bronze skin
arthritis
testicular atrophy
hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which part of the scaphoid is at risk of AVN

A

proximal scaphoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Causes of skin hyperpigmentation

A
Addisons
Haemochromatosis
Cushing Syndrome
Hyperthyroidism
Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Managment of venous dermatitis

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Management of keratosis pilaris

A

urea cream 10% topically daily
use pumice stone while bathing
topical retinoid: tretinoin 0.025%
reasurrance no treatment required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Drugs that can cause hyponatremia

A

SSRI
Hydrochlorothiazide
SNRIs
Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Treatment for neuroleptic malignant syndrome

A

Bromocriptine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Symptoms of neuroleptic malignant syndrome

A
lead pipe rigidity
bradykinesia
tremor
hyperthermia
tachycardia
hypertension
drowsiness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what scan do you want for myasthenia gravis

A

CT chest for thymoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Examination findings for intracranial hypertension

A

Papilloedema, abducens nerve palsy and reduced visual acuity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

managment of dystonia

A

benztropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Treatment of bronchiectasis exacerbatiob

A

Amoxicillin 1g TDS for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

First line treatment for peripheral neuropahty diabetes

A

amitriptyline 25mg nocte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Investigations to consider in allergic rhinitis

A

RAST

skin prick testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Physical Examination allergic rhinitis

A

Darkened circles around eyes
transverse nasal crease
pale swollen inferior turbinates
red oedematous eyelids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

peripheral vertigo nystagmus direction

A

horizontal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Examination for parotid glad sialolithiasis

A

Examination for parotid stones include palpation of buccal mucosa and inspection and palpation of Stenson’s duct (adjacent to 2nd upper molar)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Management of sialolithiasis

A
  • Apply moist heat
    • Massage the gland
    • Manage pain with NSAIDs
      Suck on hard tart candies to encourage saliva flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Management of sialadenitis

A
  • Antibiotics : fluclox 500mg QID for 10 days
    • Warm compresses
    • Salivary gland massage
      Sialogogues to increase saliva flow eg pilocarpine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

features of barotrauma

A

• Retraction
• Redness
• Fluid
Pain, tinnitus, vertigo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

PID Treatment

A
  • Ceftriaxone 500mg in 2mL lidocaine IM
  • Metronidazole 400mg BD 14 days
  • Doxycycline 100mg 12 hourly for 14 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Actinic Keratosis treatment

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Treatment for pitted keratolysis

A

• Clindamycin 1% topically BD for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Cold sore treatment

A
  • Famciclovir 1500mg stat OR

* Acyclovir cream 5% 5 times a day 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what is needed for CVD assessment

A

age, sex, smoking status, total cholesterol and HDL–C, systolic blood pressure (SBP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How long after an acute MI can you not drive for

A

2 weeks

4 weeks post cabg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Cardiac tamponade

A

Hypotension, Raised JVP, Muffled heart sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Digoxin Effect on ECG

A
  • Downsloping ST depression
    • Shorted QT interval
      Flattened, inverted or biphasic T waves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

causes of inverted T waves

A
  • Normal in children
    • Myocardial ischaemia and infarction
    • Bundle branch block
    • Ventricular hypertrophy
    • Pulmonary embolism
    • Hypertrophic cardiomyopathy
      Raised ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

causes of left ventricular hypertrophy

A
  • Hypertension
    • Aortic Stenosis
    • Aortic regurgitation
    • Mitral regurgitation
    • Hypertrophic cardiomyopathy
      Coarctation of the aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

causes of bradyarrhythmias

A
  • Drugs: BB, Ca
    • raised ICP
    • Ischaemic heart disease
    • Hyperkalaemia
      Hypothermia
      Hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

causes of RBBB

A
• pulmonary hypertension
	• atrial septal defect
	• rheumatic heart disease
	• myocarditis
	• Brugada syndorme
pulmonary embolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

causes of LBBB

A
• aortic stenosis
	• IHD
	• hypertension
	• dilated cardiomyopathy
	• anterior MI
	• primary degenerative disease (fibrosis) of the conducting system
	• Hyperkalemia
Dignoxin toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Hypertrophic Cardiomyopathy

A

Shortness of breath, palpitations, bifid apical beat and increased intensity of systolic murmur on valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Management of Familial Hypercholesterolaemia

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Erysipelas

A

• streptococcus pyogenes infection of the deep dermis and subcutis
treatment relies upon IV benzylpenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

erythrasma treatment

A

Fusidate sodium 2% BD for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

causes of erythromelalgia

A

diabetes, polycythaemia ruba vera, connective tissue disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Hot tub folliculitis

A

Caused by pseudomonas

Ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Management of guttate psoriasis

A
  1. Mometasone 0.1% cream daily for 2-6 weeks
    1. Daivobet (calcipotriol + betametasone)
    2. Coal tar topical 1% gel/emulsion OR LPC 6% + salycilic acid 3% cream. BD for 1 month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

causes of hairy tongue

A
• 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

medical mx of hidradenitis suppurativa

A

doxycycline 50 to 100 mg orally, once daily for 6 weeks, then review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

palmar hyperhidrosis

A

Iontophoresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Itch with normal skin

A
• 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Causes of balanitis

A

Chemical irritation: urine trapping, soiled nappies, soap residue
Physical trauma: forcible retraction
Candida nappy rash in infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

commonest causes of priapism in children?

A

sickle cell disease (65%), leukaemia (10%) and trauma (10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Differentials for jaundice and weight loss

A
  • Head of pancreas cancer
    • Cholangiocarcinoma
    • Choledocholelithiasis
    • Alcoholic hepatitis
    • Viral hepatitis
    • Primary biliary cirrhosis
    • Hepatocellular carcinoma
      Hepatic metastatsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Causes of unconjugated bilirubinaemia

A
  • Haemolysis
    • Ineffective erythropoiesis
      Impaired hepatic uptake or conjugation of bilirubin: Gilbert, Crigler-Najjar syndrome
      Physiological: breast milk jaundice, neonatal jaundice
      Iatrogenic: drug eg gentamicin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

causes of conjugated bilirubinaemia in neonate

A
  • Biliary atresia
    • Neonatal hepatitis
      Metabolic (galactosaemia, fructose intolerance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

causes of uncongugated bilirubin in neonate

A
phyioological jaundice
breast milk jaundice
breast feeding jaundice
sepsis
Haemolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Pancreatic cancer risk factors

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Morton neuroma mx

A

• Use of metatarsal insoles/inserts in shoes
• Wearing broad toed shoes
• Corticosteroid injection in the affected area
Surgical removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

referral of paediatric inguinal hernia

A

○ 2 days <6 weeks
○ within 2 weeks for child <6 months and
2 months for >6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Indications to use a syringe driver

A
• Persistent nausea and vomiting
	• Dysphagia
	• Bowel obstruction
	• Coma
	• Poor absorption of oral drugs
Patient preference
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

spinal mets pain mx options

A
  • Radiotherapy
    • Paracetamol
    • Morphine syrup
    • Bisphosphonate therapy
    • NSAIDS
      Dexamethasone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Investigations in Hypertrophic cardiomyopathy

A

Echo, ECG, 24 hour holter monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Pancreatitis causes

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

tumour markers for testicular cancer

A

LDH, AFP and HCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

risk factors for gastric cancer

A
  • Smoking
    • Intestinal metaplasia of stomach
    • Atrophic gastritis
    • Increasing age
    • H pylori
    • Previous partial gastrectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

risk factors for testicular cancer

A

• 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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

drugs that can trigger psoriasis flares

A

lithium, beta blockers, chlorquine, hydroxychloroquine and interferon alfa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

First line treatment of trunk and limb psoriasis

A

LPC 6% + salicylic acid 3% cream BD for 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Factors that aggravate psoriasis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Scalp psoriasis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Triad of signs in grAVES DISEASE

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

pyoderma gangrenosum is associated with

A

Inflammatory bowel disease

More commonly UC

Rheumatoid arthritis

Leukaemia

Hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

digital myxoid cyst treatment

A

Aspiration of contents
Sclerosant injection
Cryotherapy

Surgical removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

most risk gene mutation for haemochromatosis

A

C282Y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

what is lichen sclerosis associated with

A

Vulval cancer
Hashimoto’s thyroiditis
Vitiligo
Pernicious anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

causes of facial flushing

A
menopause
rosacea
phaeochromocytoma
carcinoid syndrome
food additive
alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

tinea corporis

A

tebinafine 1% daily for 7-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Anaphylaxis adrenaline dose

A

0.5mls of 1:1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

treatment for funnel web spider bite

A

pressure immobilisation bandage

anti venom if required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Initial treatment of symptomatic ascites

A

spironolactone 50-100mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Management of ascites

A

• 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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Ichthyosis

A

fish scale skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Management of Anal Fissure

A

○ Avoid hard stools
○ Warm salt baths after bowel movements
GTN ointment 0.2% topically 3-4 times a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Non pharmacological mx for Hidradenitis Suppurativa

A
  • wear loose clothing
    • stop smoking
    • eat healthily and lose weight, if appropriate.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

antibiotics options for Hidradenitis Suppurativa

A

Clindamycin 1% lotion topically BD if mild

doxycyline 100mg daily for 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what is Wernicke’s Encephalopathy associated with

A

Generally associated with chronic hazardous alcohol use, but also occurs in associated with bariatric surgery, cancer and recurrent vomiting or chronic diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Box Jellyfish first aid

A

Vinegar and remove tentacles
ice packs
analgesia
(anti venom available)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

psychosocial reasons behind opioid dependency

A
depression
unemployment
use of other substances
negative life events
social isolation
low self esteem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

management of paediatric clavicle fracture (middle third)

A

broad arm sling for 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

weber A ankle fracture

A

WBAT in boot

fracture below

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

risk factors for DDH

A

female, 1st born child, family history, breech presentation, oligohydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Treatment for severs disease

A
  • Rest
  • Well fitting shoes
  • Icepacks
  • Gel heel pads
  • Calf stretches
  • Pain usually settles within 6-12 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what is a toddlers fracture

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

How to reduce pulled elbow?

A

Fully pronate forearm and then flex the elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

skin prick testing

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

symptoms of orbital blowout fracture

A

pain (especially on vertical movement), local tenderness, diplopia (especially on vertical gaze), eyelid swelling and crepitus after nose blowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Examination of orbital blowout fracture

A
  • 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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Monteggia fracture

A

fracture of the ulna shaft with dislocation of the radial head at the elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Galleazi fracture

A

fracture of the distal radial shaft with dislcoation of the ulnar with its articulation at the distal radial head
(widened distal radioulnar joint)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Colles fracture

A

transverse fracture of the distal radius with dorsal displacement
(dinner fork deformity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Smith Fracture

A

distal radial fracture with volar (palmar displacement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

nerve likely to be impacted with humeral shaft fracture

A

radial nerve (wrist drop, sensory impairment dorsum of hand)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

type 1 Supracondylar fracture mx

A

Immobilisation in an above-elbow backslab in 90 degrees elbow flexion with sling for 3 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Bennet Fracture

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Fractured surgical neck of humerus mx

A

Triangular sling
When pain subsides (10–14 days), encourage pendulum exercises in the sling
Aim for full activity within 8–12 weeks post-injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Jones Fracture

A

Fracture at the base of the 5th metatarsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Mallet finger

A

Injury to the extensor digitorum at its distal insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Initial measures to manage priapism

A
  • Cold shower
    • Oral pseudoephedrine 120mg
      Walk up and down stairs/gentle jog
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

complications of priapism

A
  • May cause permanent damage to erectile tissue
    • Erectile dysfunction
      Possible disfigurement of penis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

bacterial sinusitis abx

A

Amoxicillin 500mg TDS for 5 days

Allergy (doxycycline 100mg BD 5 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Signs of Addisons

A
Hyperpigmentation
postural hypotension
tachycardia
dry mucous membranes
vitiligo
decreased body hair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Diagnosis of Addison’s

A
short synacthen
(ACTH stimulation )
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Aspects of self care for pts with addisons

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What to measure when monitoring a pt with adrenal insufficiency

A

Measure sodium, potassium and plasma renin

plasma renin upper normal = good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Cushing’s Disease

A

adrenocorticotropic hormone–producing pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Clinical Features of Cushing’s Syndrome

A
• 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Testing options for Cushing’s Syndrome

A
  • Late night salivary cortisol (2 measurements)
  • 24 hour urinary free cortisol (2 measurements)
    Overnight 1mg dexamethasone suppression test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

causes of diabetes insipidus

A
• Post operative (hypothalamic -pituitary ) - transient 
• Tumours
• Infections
Infiltrations
• trauma
• Anorexia nervosa 
Familial and congenital disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Causes of SIADH

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

carcinoid syndrome

A

Flushing, diarrhoea, bronchospasm

Classic Triad: skin flushing, diarrhoea, valvular heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

antibodies in post partum thyroiditis

A

antithyroid peroxidase antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

what change do you make to thyroxine dose in pregnancy

A

increase by 25% at 6 weeks

test TSH 4-6 weeks during 1st trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

iodine dose in prengancy

A

150MCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

TSH aim for pts younger than 60

A

0.5-2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

De Quervain Thyroiditis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Treatment for De Quervain Thyroiditis

A

Ibuprofen

Prednisolone 40mg daily, tapering over 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

common causes of goitre

A
• Hashimoto thyroiditis
• Graves disease
• Familial or sporadic multinodular goitre
• Iodine deficiency
• Follicular adenoma
• Colloid nodule or cyst
Thyroid cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Suppurative Thyroiditis

A

caused by an infection of the thyroid gland (usually bacterial) and is rare but potentially life-threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

DDx for painful anterior neck lump

A
• 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Riedel’s Thyroiditis

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

what is thyroglobulin useful for

A

Thyroid cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

anti thyroid drug for primary hyperthyroidism

A

carbimazole 15mg bd

second line = propylthiuracil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

what to warn pts about carbimazole

A

can cause agranulocytosis: seek medical assistance if acute malaise, fever or infection (usually severe pharyngitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

symptoms of thyrotoxicosis treatment

A
  • propranolol 10mg BD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Clinical Features of severe hypomagnesaemia

A

tetany, muscle weakness, cardiac arrhythmas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

causes of raised anion gap metabolic acidosis

A
Raised Anion Gap: Failure of H+ excretion (KUSSMAUL)
	• Ketosis
	• Uremia
	• Salicylate poisoning
	• Methanol posioning
	• Ethylene poisoning
	• Uremia
	• Lactic Acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

causes of normal anion gap metabolic acidosis

A

Normal Anion Gap = Loss of bicarbonate

  • diarrhoea
  • renal tubular acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Causes of Hypomagnesaemia

A
poor oral intake
diarrhoea
PPIs
extensive bowel resection
hypercalcaemia
diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Causes of high Magnesium

A
- Excessive intake
		○ Antacids
		○ Enemas
		○ IV infusion
	- Decreased excretion
		○ Renal failure
		○ Volume depletion
		○ Familial hypocalciuric hypocalcaemia
	- Rhabdomyolysis
Lithium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Hypercalcaemia

A
Primary Hyperparathyroidism, Familial Hypercalciuric Hypercalcaemia and neoplasia
vitamin D toxicitity 
	• Drugs: thiazide diuretics 
	• Paget disease
	• Williams syndrome 
	• Prolonged immobilisation
	• Sarcoidosis
Milk-alkali syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

ECG features of hypokalaemia

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What indicates good asthma control?

A

Daytime symptoms <=2 days/week
Need for reliever <= 2 days/wee
no limitation of activity
No symptoms during night or on waking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Risk factors for asthma exacerbations

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Risk factors for life threatening asthma flare

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

in a child what are the indications to prescribe a preventer?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

what is symbicort

A

budenoside/formoterol

asthma low.mid dose 200/6 BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Maintenance asthma treatment children 1-5 years

A

Children 1 -5
Step 1: Salbutamol
Step 2: Fluticasone propionate 50mcg BD
Step 3: Refer to respiratory physician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Maintenance asthma treatment >6 years

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

causes of hypocalcaemia

A
  • Hypoalbuminaemia
    • Renal failure
    • Hypoparathyroidism
    • Drugs: anticonvulsants, bisphosphonates
    • Vitamin D deficiency
    • Malignancy
    • Acute pancreatitis
      Rhabdomyolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

How to assess for diabetic peripheral neuropathy?

A

• 10g monofilament pressure sensation at metatarsal joints
• Ankle reflexes
• Vibration sensation with 128Hz tuning fork
Pinprick sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

what is the maximum safe dose of lignocaine with adrenaline

A

The maximum safe dosage for lignocaine 1% (also known as lidocaine) with adrenaline is 7mg/kg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

who is eligible for self collected cervical cancer screening

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

what causes slow central vision loss

A

macular degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

what diet is good for macular degeneration

A

diet rich in fish containing omega 3 fatty acids and dark green leafy veg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

When to refer CKD to nephrologist

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Non pharmacological management of AF

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Treatment for phimosis

A

Topical corticosteroid (hydrocortisone 1%) TDS for 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Bloods wanted in Addison’s

A

EUC, Cortisol, BGL, adrenocortiotropic hormone

diagnose: short synacthen test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

dihydropyridine calcium channel blocker

A

Amlodipine

Nifedipine MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

non dihydropyridine calcium channel blocker

A

diltiazem, verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

non pharmacological mx of BPSD

A

-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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

medical managment for BPSD

A

• Risperidone 0.25mg PO, BD (max 2mg day)

OR olanzapine 2.5mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

COPDX

A
• Case finding and confirm diagnosis
• Optimise function
• Prevent Deterioration
• Develop a plan of care
Manage eXacerbations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Normal pressure hydrocephalus

A

urinary incontinence, gait disturbance, and dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

facial and flexural seborrheic dermatitis treatment

A

hydrocortisone 1% + clotrimazole 1% cream once or twice daily until skin is clear or for up to 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

most likely organism to cause croup

A

Parainfluenza virus type 1.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Which type of tremor is MOST commonly associated with thyrotoxicosis?

A

postural tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

most common acute ECG findings of takotsubo cardiomyopathy

A

ST segment elevation in the praecordial leads and T-wave inversion in most leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Diagnostic criteria for diabetes

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

Impaired fasting glucose numbers

A

• HBA1c 6-6.4%

5.5-6.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

what can cause an abnormally low HBA1c

A
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).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Abnormally high HBA1c can be caused by

A

iron deficiency anaemia
• splenectomy
• alcoholism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

When to dose reduce metformin

A

Reduce dose by 50% with eGFR 30-60

Contraindicated in eGFR <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Management of severe hypoglycaemia

A

IM glucagon 1mg into thigh, buttock or upper arm
If IV access - 50% glucose 20mls
Recheck BGL in 15 mnutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Management of hypoglycaemia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

BGL targets in diabetes

A

4-7 fasting

5-10 post prandial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

GDM glucose tolerance test cut offs

A

fasting >5.5

2 hours >8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

Infant complications GDM

A
• 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

Pregnancy complications GDM

A
- Increased risk of
		○ Pre eclampsia
		○ Hypertension
		○ Early delivery
		○ Induction of labour
C section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

pneumococcal vaccine for at risk condition

A

give prevenar 13 then 12 months later give pneumovax 23 then 2nd dose at least 5 years later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

when do ATSI get prevenar

A

give prevenar 13 at 50 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

side effects of metformin

A

GI adverse effects
lactic acidosis
B12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

which diabetic drug to avoid if previous pancreatitis

A

DPP4 and GLP-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Medications for osteoporosis

A

Alendronate 70mg weekly oral on empty stomach
60mg denosumab 6 monthly SC
5mg IV zolendronic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

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

A

=1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

Risk factors for osteoporosis

A
Rheumatoid arthritis
coeliac disease
premature menopause
kidney disease 
prolonged steroid use (>3months of >7.5mg/day) 
hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

post partum endometritis abx

A

Amoxicillin + clavulanic acid BD 7 days

if severe to hospitalfor IVAbx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

cut off endometrial thickness post menopause

A

4mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

cut off endometrial thickness pre menopause

A

12mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

Risk factors for endometrial cancer

A
Obesity
Diabetes
Nulliparous 
Hypertension
On exogenous oestrogens 
Late menopause 
PCOS
Tamoxifen exposure 
Endometrial thickness >8mm 
Family history of endometrial or colon cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

what kind of drug is mirabegron

A

Beta adrenergic agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

oral progestogen option for HMB

A

Norethisterone 5mg TDS day 1-21 of cycle (r/v in 6 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

Absolute contraindications for PDE5 inhibitors

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

Example of LABA/LAMA combination

A
Spiolto Respimat (tiotropium/ olodaterol 2.5./2.5) 
2 inhalations daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

Example of LABA/LAMA/ICS

A

Trelegy Elipta (FUV) : fluticasone furoate/umeclidinium/vilanterol 100/62.5/25mcg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

Dementia Screening Tools

A

• mini mental state examination MMSE
• GP assessment of cognition (GPCOG)
RUDAS: Rowland Universal Dementia Assessment Scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

Non pharmacological mx of dementia

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

Investigations required if both testes are impalpable

A

• Karyotype
• Serum electrolytes (CAH babies can have low sodium)
Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

Why should undescended testes be fixed?

A
• Impaired fertility
		○ Temperature is higher in abdomen than scrotum 
	• Cancer
		○ Seminoma increased 5-10 times 
	• Trauma
		○ More likely to tort
Poor self image
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

second line agent in cholesterol mx

A

ezetimibe 10mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

prostatitis treatment

A

Trimethoprim 300mg daily for 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

how to calculate number needed to treate

A

inverse of absolute risk reduction

100/ARR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

list 2 meds for BPH from different classes

A

Tamsulosin (alpha blocker)

Dutasteride (5 alpha reductase inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

fertile window

A

5 days prior to ovulation + day of ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

McCune Albright Syndrome

A

genetic disorder of bones, skin pigmentation and hormonal problems along with premature puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

most common cause of ambiguous genitalia

A

congenital adrenal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

Examination features of hypothyroidism

A
non pitting oedema
bradycardia
goitre
hair thinning
ataxia
peripheral neuropathy
slow relaxing reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

stigmata of anaemia

A
pallor
angular stomatitis
tachycardia
flow murmur
koilonychia
glossitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

first sign of puberty in males?

A

testicular enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

HSP Follow up

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

Anaphylaxis adrenaline dose

A

10 microgram/kg or 0.01 mL/kg of 1:1000 (maximum 0.5 mL), i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

ASD Red Flags

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

Genetic conditions that are linked to ASD

A
• 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

Red flags with sudden onset hearing loss

A

• Concurrent head trauma
• Neurological signs or symptoms
Unilateral middle ear effusion (post-nasal space must be examined)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

Clinical Features of redback spider evenomation

A
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

what is tinea cruris?

A

Jock itch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

Differentials for tinea cruris

A

• Candidal intertrigo
• Seborrheic dermatitis
• Flexural psoriasis
Erythrasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

otodex

A

dexamethasone, framicidin, gramicidin

3 drops TDS for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

treatment of perforated tympanic membrane with otorrheoa

A

amoxicillin 15mg/kg TDS for 5 days

panadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

Investigation for acoustic neuroma

A
  • MRI brain with gadolinium including internal auditory meatus views
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

Secondary causes of restless legs syndrome

A
  • Anaemia (common)
    • Iron deficiency (common)
    • Uraemia
    • Hypothyroidism
    • Pregnancy
    • Drugs (antihistamines, anti emetics, lithium)
    • Multiple sclerosis
    • Parkinsons disease
    • Peripheral neuropathy (diabetes,amyloid, motor neuron disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

Non pharmacological mx for restless legs

A

• 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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

when should babies be able to sit independently by?

A

9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

when should kids be toilet trained by

A

before 3 years old (day time)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

Components of safety plan

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

Poor prognostic factors of rheumatoid arthritis

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

what indicates clinical remission of rheumatoid arthritis

A

• Symptom relief
• Normalisation of inflammatory markers
Absence of joint swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

How to monitor rheumatoid arthritis

A
• ESR/CRP
	• Number of tender swollen joints
	• Duration of early morning stiffness
	• Functional assessment
Visual analogue scale for patinet reported global assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

things to discuss regarding methotrexate

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

DDX for fracture of 5th metatarsal

A
  • Midfoot joint sprain
    • Peroneal tendon tear
      Lateral ankle ligament sprain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

Lis Franc Injury

A
• 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

factors other than ckd that increase urine albumin excretion

A
  • UTI
    • High dietary protein intake
    • CCF
    • Acute febrile illness
    • Heavy exercise within 24 hours
    • Menstruation
    • Genital discharge or infection
      Drugs: NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

how long does it take for prep to be effective

A

7 days in males

21 days in females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q

waht drug is prep

A

tenofovir/emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

Adie Syndrome

A

at least one dilated pupil, which does not constrict in response to light, loss of deep tendon reflexes and abnormalities of sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

possible presentations of cystic fibrosis

A
  • Chronic cough
    • Steatorrhoea
    • Failure to thrive
    • Sinusitis
    • Nasal polyposis
    • Meconium ileus
    • Diabetes mellitus
    • Infertility
      Hyponatremic dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
260
Q

Retinitis Pigmentosa

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
261
Q

osteoid osteoma

A
• Benign bone forming tumour
	• Small radiolucent nidus 
	• painful area often in the tibia or femur
	• often causes night pain
relieved by NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
262
Q

specificity calculation

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
263
Q

negative predictive value

A

probability that people with negative screening test really dont have the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
264
Q

treatment for neonatal cephalic pustulosis

A

Ketoconazole 2% cream topically BD until clear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
265
Q

most common side effect of TURP

A

retrograde ejaculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
266
Q

what is the extra vaccine that pre term infants <28 weeks need?

A

extra pneumococcal at 6 months

+ booster 23vPPV at 4-5 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
267
Q

Hep B vaccine changes in preterm <32 weeks and <2kg

A

give booster dose at 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
268
Q

if born to hep B positive mother what should baby get

A

hep B vaccine at birth and Hep B immunoglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
269
Q

How to prevent diverticulitis

A
  • Exercise
    • BMI <30
    • Avoid smoking
    • Limit red meat consumption
      High fibre diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
270
Q

Screening Questions to assess risk of falls

A
  • 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?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
271
Q

Falls prevention strategies

A

• 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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
272
Q

ottawa foot xr rules

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
273
Q

Underlying causes carpal tunnel syndrome

A
• Idiopathic
Pregnancy
Diabetes
Hypothyroidism
Rheumatoid arthritis
Gout 
Acromegaly 
Repetitive activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
274
Q

what calcium channel blockers cant go with beta blockers

A

non dihydropyridine (diltiazem and verapamil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
275
Q

how much gluten is needed to ahve bfore the tests

A

6 weeks of 3-6 g of gluten daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
276
Q

Kernig’s sign

A

Positive when the thigh is bent at the hip and knee at 90 degrees and extend the knee : get pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
277
Q

Diseases that anterior uveitis is associated with

A
  • Ankylosing spondylitis
    • Psoriatic arthritis
    • Inflammatory bowel disease
    • Sarcoidosis
    • Syphilis
      Ocular tuberculosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
278
Q

abx treatment for travellers diarrrhoea

A

azithromycin 1g PO stat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
279
Q

Treatment for latent TB

A

Isoniazid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
280
Q

syphilis test of cure

A

3,6,12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
281
Q

what antipsychotic to use for BPSD or delirium in parksinsons patients

A

quetiapine 25mg PO stat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
282
Q

when to screen for primary aldosteronism

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
283
Q

investigations for high risk bowel cancer

A

IFOBT every 2 years from 35 to 44

scope 5 yearly from 45 to 74

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
284
Q

smoking and inflammatory bowel disease

A

Smoking is a risk factor for Crohn’s disease and is associated with more severe disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
285
Q

definition of macroalbumninuria

A

males >25

females >35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
286
Q

microlalbuminuria

A

males 2.5-25

females 3.5-35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
287
Q

private licence eyesight standards

A

one or both eyes at least 6/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
288
Q

commercial licence eyesight standards

A

better eye at least 6/9 AND worse eye at least 6/18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
289
Q

causes for bitemporal hemianopia

A
Pituitary adenoma
Craniopharyngioma
Meningioma
Malignant sellar tumour
Sellar benign mass - cyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
290
Q

Non pharmacological mx for acne

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
291
Q

side effects of PDE5 inhibitors

A

headaches, flushing, dyspepsia, nasal congestion, backache and myalgia
may cause transient retinal effects: blurred vision, blue-green colour tinge and light sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
292
Q

Contraindications to using PDE5 inhibitors

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
293
Q

Adverse effects of clozapine

A
  • Myocarditis
    ○ Monitor troponin
    • Agranulocytosis
      EPSE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
294
Q

Causes of thrombocytopenia

A
medication induced
chronic liver disease
vitamin B12 deficiency
SLE
lymphoma 
HIV
Pregnancy
ITP
artefact
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
295
Q

Examination features of acute angle closure glaucoma

A
mid dilated pupil
pupil poorly responsive to light
decreased visual acuity 
red conjunctivae
cloudy cornea
increased intraocular pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
296
Q

risk factors for life threatening asthma flare

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
297
Q

ICS/LABA for children

A

fluticasone 50/salmeterol 25mcg 2 puffs BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
298
Q

Imiquimod dose for genital warts

A

Imiquimod 5% cream 3x weekly at bedtime until warts resolve – 8-16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
299
Q

treatment for initial gential herpes

A

valaclovir 500mg BD for 5-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
300
Q

treatment for episodic genital herpes

A

valciclovir 500mg BD for 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
301
Q

Norethisterone dose in HMB

A

Norethisterone 5mg 2-3x daily on 1-21 days of a 28 day cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
302
Q

podophyllotoxin dose for genital warts

A

0.05% paint BD for 3 days repeated weekly until warts resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
303
Q

mx for Meniere’s disease

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
304
Q

vitilgo treatment

A
do nothing
cosmetic camoflague
bethamethasone dipropionate 0.05% cream 
phototherapy
pimecrolimus 1% cream (body folds and face)
calcipotriol + betamethasone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
305
Q

Qs to ask about stress/urge incontinence

A
parity
vaginal deliveries
family history of incontinence
smoking history
excessive caffeine intake
vaginal atrophy
recent weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
306
Q

how long to contact trace gonorrhoea partners?

A

2 MONTHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
307
Q

Surgical bariatric interventions

A

sleeve gastrectomy
Roux en y gastric bypass
biliopancreatic diversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
308
Q

smoking cessation management

A

Agree on quit plan/quit day
Discuss strategies for managing triggers and removing barriers to success
Refer to Quitline
Motivational interviewing if not ready/unsure
Arrange follow up
Pharmacotherapy

309
Q

painless vision loss differentials

A
retinal detachment
vitreous haemorrhage
optic neuritis
central retinal artery occlusion
central retinal vein thrombosis
310
Q

causes of transient monocular vision loss

A
Giant cell arteritis 
Carotid artery disease: thromboembolism, stenosis 
Retinal vein occlusion 
Retinal vasospasm
Optic nerve compression by tumour
Idiopathic amaurosis fugax 
Acute angle closure glaucoma
311
Q

transient binocular vision loss

A

Migraine (positive visual phenomenon - scintillations, visual lines)
Occipital tumour
Papilloedema
Vertebrobasilar insufficiency

312
Q

risk factors for progression of diabetic retinopathy

A
Existing DR
Poor glycaemic control
Raised BP
Duration of diabetes >10 years
Microalbuminuria
Dyslipidaemia 
Anaemia
pregnancy
313
Q

Strategies to delay onset and progression of Diabetic retinopathy

A

Optimise BGL
Control BP
Add fenofibrate
Treat hypercholesterolaemia

314
Q

Patient education for insulin commencement

A
Self management: timing and frequency of SMBG, timing of meals, dose adjustment
Impact of diet, particularly carbohydrate content
Impact of physical activity
Hypoglycemia management 
Insulin delivery techniques
Weight management 
Sick day management  
Drivers license notification 
Apply to NDSS for syringes/lancets etc
315
Q

options for peripheral neuropathy

A

amitriptyline
pregabalin
topical nitrate spray

316
Q

Examination required once pregnant

A

BP, dental exam, thyroid exam, breast exam, cardiovascular exam, CST

317
Q

infant complications of diabetes

A
congenital heart disease
preterm birth
macrosomia
respiratory distress
hypoglycaemia
polycythaemia 
hyperbilirubinaemia
318
Q

risks associated with long term use of PPIs

A
Interstitial nephritis
Hypomagnesaemia
Increased risk of pneumonia 
Increased risk of C Dif, campylobacter and other GI infections 
Impaired nutrient absorption 
Risk of fracture 
Possible interactions with clopidogrel,
Increased risk of cardiac events
319
Q

Non pharmacological mx of reflux

A

eating smaller meals
drinking fluids mostly between meals rather than with meals
avoiding lying down after eating
avoiding eating or drinking for 2 to 3 hours before bedtime or vigorous exercise
elevating the head of the bed (if symptoms occur at night)
stopping smoking.

320
Q

uric acid target level

A

<0.36 (<0.3 if gouty tophi)

321
Q

Non pharmacological mx of gout

A
• Keep well hydrated
• Proper footwear to avoid trauma
• Advise against driving while in pain
• Monitor urate level
• Cardiovascular risk modification 
• Maintain healthy body weight 
Low purine diet - give pt list of high purine foods to avoid  (shellfish, alcohol, meat) 
weight loss
322
Q

prevention of renal stones

A
· good hydration: drink to a level where the urine produced is clear, 
· Low salt and low oxalate diet 
· Low protein diet
· Normal calcium intake
Foods high in oxalate
	• chocolate
	• tea
	• strawberries
	• cola
	• rhubarb
	• spinach
	• beetroot
	• peanuts
323
Q

EBV complications

A
Jaundice/liver failure
Splenic rupture
Airway obstruction 
Encephalitis
Pneumonia
Pancreatitis
Myocarditis 
Chronic active EBV infection
324
Q

what tests are required to monitor methotrexate?

A

Full blood count, renal function and liver function tests.

325
Q

How to deal with purple crying?

A

Explain purple crying

Use a sleep/cry diary to explain the infant’s cry/sleep/feeding patterns

Encourage parents to recognize signs of tiredness (frowning, clenched hands, jerking arms or legs, crying, grizzling) Establish pattern to feeding/settling/sleep

Aim to settle the baby for daytime naps and night-time sleep in a predictable way (eg, quiet play, move to the bedroom, wrap the baby, give the baby a brief cuddle, then settle in the cot while still awake)

Avoid excessive stimulation - noise, light, handling. Excessive quiet should also be avoided. Most babies find a low level of background noise soothing.

	• Darken the bedroom for daytime sleeps
	• Carry baby in a papoose in front of the chest
	• Baby massage/rocking/patting
	• Gentle music
	• Respond before baby is too worked up Give the primary carer permission to rest once a day without the need to carry out household chores. Have somebody else care for the baby for brief periods to give the parent/s a break
326
Q

macular papular rash in traveller

A
secondary syphilis
acute HIV seroconversion
measles
rubella
dengue
Zika
Chikungunya
Typhoid
327
Q

Jarish Herxheimer reaction

A

• a common reaction to treatment in patients with primary and secondary syphilis.
• It is a mild reaction with fever, headache, malaise, rigors and joint pains that starts a few hours after treatment and lasts for several hours.
• It is not an allergic reaction.
Occurs 6-12 hours post injection

328
Q

timing for TOC syphilis

A

Repeat syphilis serology at three, six and 12 months to confirm cure

329
Q

Syphilis in pregnancy

A
  • Higher rates of prematurity
    • Low birthweight
    • Stillbirth
    • Perinatal mortality
    • Congenital syphilis
      ○ Deafness
      ○ Bone deformity
      Neurological sequelae
330
Q

Treatment options for post herpetic neuralgia

A
  • Paracetamol 1g PO QID
    • Ice massage
    • Amitriptyline 10mg nocte
    • Gabapentin 100mg nocte
    • Topical lignocaine 5% patch
    • Tramadol 100mg daily
      TENS for at least 2 weeks
331
Q

Behcet disease

A
  • Rare disease
    • Painful mouth ulcers, genital ulcers, eye problems and skin lesions
      Autoimmune disorder
332
Q

Herpetic whitlow treatment

A

valaclivoir 1g BD 7 days

333
Q

treatment for dermatitis herpetiforms

A

dapsone

334
Q

treatment for pyogenic granuloma

A

Curettage and cauterisation
Laser surgery
Cryotherapy
Imiquimod

335
Q

mx of lichen planus

A

• Explanation and reassurance
• Usually resolves over 6-9 months, leaving discoloured marks without scarring
Topical moderate to very potent corticosteroids

336
Q

Sentinel facial features of fetal alcohol syndrome

A

short palpebral fissure length (distance between the inner and outer corners of one eye)
Smooth philtrum
Thin upper lip

337
Q

cradle cap treatment

A

No treatment required, is self-limiting and will resolve
Apply regular baby oil to scalp
Wash with baby shampoo
Egozite – salicylic acid based lotion

338
Q

Non pharmacological mx of rosacea

A
Minimise sun exposure 
Use soap free cleanser
Apply green tinted foundation 
Avoid topical corticosteroids
Minimise factors that cause flushing
339
Q

Guttate psoriasis mx

A
  1. Mometasone 0.1% cream daily for 2-6 weeks
  2. Daivobet (calcipotriol + betametasone)
  3. Coal tar topical 1% gel/emulsion OR LPC 6% + salycilic acid 3% cream. BD for 1 month
340
Q

complications of erysipelas

A

sepsis, cerebral abscess and venous sinus thrombosis

341
Q

granuloma annulare is associated with

A

autoimmune thyroiditis , diabetes, lymphoma

342
Q

Incubation period of dengue fever

A

4-7 days

343
Q

Managment of AC joint injury

A

Rest shoulder for 48-72 hours following injury
Broad arm sling
Analgesia: panadol, neurofen
Ice shoulder

344
Q

Complications of AC joint injury

A
  • Post trauma osteoarthritis
    • Chronic pain syndrome
    • Cosmetic deformity
    • Shoulder impingement
      Clavicular instability
345
Q

Symptoms of leptospirosis

A

Fever, headaches, chills, severe muscle pain, reddened eyes

346
Q

Treatment for Ramsay Hunt Syndrome

A
Valaclovir 1g TDS for 7 days
Prednisolone 75mg for 5 days
Eye patch
Artificial tears 
Opioid analgesics
Anticonvulsants such as gabapentin and pregabalin
Refer to neurologist 
Advise patient they are infectious and should avoid contact with any immunocompromised people
347
Q

Contraindication for home oxygen

A

Smoking: no smoking for 6 weeks

Hypercapnia

348
Q

traveller’s diarrhoea treatment

A

Azithromycin 1g PO stat
If fever/bloody stools then
Azithromycin 500mg orally once daily for a further 2 days

349
Q

acute heart failure tx

A
• Increase frusemide dose
• Commence ACEI perindopril 2.5mg
• Commence 25mg spironolactone 
• Salt restrict 5g/day
• Fluid restrict 1.5 Lday
• Daily weights
• Review in 72 hours
Refer to cardiac rehab program
350
Q

treatment required for giant cell arteritis if hisotry of visual loss

A

IV methylprednisolone

351
Q

giant cell arteritis managment

A

Commence prednisolone 50mg daily, long term
Aspirin 100mg daily
Urgent referral to ED for ophthalmologist review

352
Q

vaginal prolapse mx pre referral

A

avoid triggers of prolapse - hevy lifting
avoid constipation
pelvic floor physio
weight loss if overweight
explain mechanical nature of condition, not harmful
(pessary)

353
Q

medications to regulate cycle in PCOS

A

Ethinylestradiol/levongestrel 30/150mcg daily
Metformin 250mg BD daily
Norethisterone 5mg for the same 12 days per month

354
Q

long term mx of PCOS

A

diabetes screening with HBA1c every 1-3 years
Monitor for depression/anxiety/disordered eating
Discuss possible sub fertility/potential family planning issues
Cycle regulation - COCP/cyclical progestins/iUD/metformin
Assessment of cardiovascular disease/annual BP/fasting lipids
Hirsutism management - physical hair removal
Aim for 5-10% loss of weight
Regular exercise 30 mins per day
Monitor for sleep apnoea

355
Q

symptoms of lithium toxicity

A

Tremor, hyper reflexia, ataxia, rigidity, drowsiness, confusion, coma, seizures, myoclonus, nausea, vomiting , diarrhoea

356
Q

risk factors for chronic lithium accumulation

A
Impaired kidney function
Dehydration
>50 years
Previous lithium toxicity 
Drug interactions (ACEI, ARBs, NSAIDs, loop and thiazide diuretics) 
Lithium induced nephrogenic diabetes insipidus 
Intercurrent illness
Thyroid dysfunction
357
Q

extrapyramidal side effects

A

dystonia
parkinsonism
tardive dykinesia
akathesia

358
Q

antipyschotic side effects

A
weight gain
sedation
sexual dysfunction
anticholinergic effects: blurred vision, dry mouth, constipation, urinary retention
postural hypotension, 
ECG changes Q – T interval
cataracts: quetiapine and chlorpromazine 
EPSE
359
Q

side effects of anticholinergic medication

A

falls, confusion, cognitive decline, dry mouth, constipation and urinary retention

360
Q

treatment of paraphimosis

A

Urgent transfer to ED
Anaesthetise penile head with ring block
Apply circumferential pressure to glans of penis
Apply intermittent ice to head of penis to reduce swelling
Aspirate blood from head of penis with needle

361
Q

another name for penile lichen sclerosis

A

Balanitis Xerotica Obliterans

362
Q

what class of medication is dutasteride

A

5 alpha reductase inhibitor

363
Q

most common side effect from TURP

A

retrograde ejaculation

364
Q

ddx for breast lump in male pt

A
Cancer
Lipoma
Epidermoid cyst
Gynaecomastia - unusual to be unilateral 
Fibroadenoma
Trauma related - haematoma, fat necrosis
365
Q

treatment options for male baldness

A

No treatment
Topical minoxidil 2-5%
Finasteride 1mg PO daily
Oral dutasteride

366
Q

Indications for intermittent ‘in and out’ urethral catheterisation

A

Relieving urinary retention
Drainage of post void residual urine
Urethral stricture dilation
Obtaining sterile urine specimens

367
Q

Secondary causes of hyperuricaemia

A
Renal failure 
Lead poisoning 
Solid organ transplant
Tumour lysis syndrome 
Hypothyroidism 
Lesch-Nyhan syndrome
368
Q

causes of raised ferritin

A
Iron Overload
	•  haemochromatosis
	• Transfusional iron overload 
	• Alpha thalassaemia 
	• Chronic liver disease: NAFLD, ALD, Hep B, Hep C 
	• Excess parenteral iron 
Other cause
	• Chronic alcohol consumption 
	• Metabolic syndrome
	• Obesity
	• Diabetes
	• Malignancy
	• Infection 
Inflammatory conditions
369
Q

SLE examination features

A
  • Arthritis
    • Malar rash
    • Discoid lupus erythematous rash
    • Oral ulcers
    • Alopecia
    • Pericardial rub
    • Raynaud phenomenon
      Pleural effusion/rub
370
Q

Indications for AAA Repair

A

Symptomatic
Male >5.5
Female >5

371
Q

mx for osgood schlatter disease

A

• Ice packs
• Ibuprofen
• Modification of activity
○ Stop high impact exercise: jumping and running
○ Avoid painful activities for 2 weeks
• Advise quadriceps stretching program
Self limiting average 12 months (symptoms resolve with skeletal maturity)

372
Q

treatment for schistosomiasis

A

praziquantel

373
Q

Grover’s Disease

A
Transient Acantholytic Dermatosis 
Rash on Chest and back 
	- Middle aged
	- Caucasian man
	- Pruritic papulovesicular rash
	- Hot humid weather
Betamethasone valerate 0.02%
374
Q

Bisphosphonate admin info

A
  • Do not take with calcium and vitamin D supplement
  • Take first thing in the morning on empty stomach
  • Remain upright for at least 30 minutes
    Avoid food or drink 30 minutes post dose
375
Q

Adverse effects of isotretinoin

A
  • Potent teratogen: must use contraception
    • Dry lips
    • Early flare of acne before it starts to improve
    • Cheilitis
    • Sun sensitivity, wear daily sunscreen
    • Dry skin
    • Facial erythema
    • Lethargy
    • Myalgia and joint stiffness
    • Cant take with tetracyclines due to risk of intracranial hypertension
      (pancreatitis, rectal bleeding, paronchyia, tinnitus) are all possible adverse effects of isotretinoin but are not as common as chelitis.
376
Q

macular cherry red spot

A

central retinal artery occlusion

377
Q

pilar cyst

A

scalp cyst

378
Q

dose for IM ceftriaxone for meningitis in child

A

50mg/kg

379
Q

malignancies associated with dermatomyositis

A

breast
lung
colon
Ovarian

380
Q

what is palmoplantar pustulosis associated with?

A

psoriasis, autoimmune diseases: coeliac, thyroid, t1dm, streptococcal tonsillitis

381
Q

dairy farmer hand lesion

A

milkers nodule - parapox virus

382
Q

sheep farmers hand nodules

A

orf

383
Q

rash after sun exposure

A

polymorphic light eruption

384
Q

mx of onycholysis

A

Keep nails short
Keep hands out of water
Mild soap free wash
Avoid inserting objects beneath nail

385
Q

malignancy that acanthosis nigricans is related to

A

stomach cancer

386
Q

Head lice treatment

A

Permethrin 1% topically, leave on for a minimum of 10 minutes, wash and repeat treatment in 7 days
Wet combing post treatment to check for live lice
Wet combing should be repeated weekly for several weeks after treatment to look for recurrence / monitor for recurrence / monitor for treatment failure
Wash all bedding in hot water
Exclude from school until treatment commenced

• Notify the school of the condition (1)
• School exclusion is not needed once treatment has commenced (1)
A child with head lice does not need to be sent home from school immediately as long as treatment is commenced on the same day (1)

387
Q

painful penile ulcer

A

chancroid

388
Q

what ages constitute premature heart disease

A

Premature = men <55, women <60

389
Q

what statin to start (and dose) in FHH

A

40mg atorvastatin

390
Q

information about screening for FHH

A

1) Relatives should all have their fasting cholesterol checked
2) Early detection and intervention can prevent premature CVD
3) Children as young as 8-10 years old need to be tested

391
Q

PID tx (meds and non pharmacological)

A

• ceftriaxone 500 mg in 2 mL of 1% lignocaine intramuscular injection, or 500 mg intravenous, immediately
plus
• metronidazole 400 mg orally, twice daily for 14 days
plus
• doxycycline 100 mg orally, twice daily for 14 days

- Contact trace partners for past 6 months
- No sex for 7 days
- Avoid alcohol with metronidazole 
- Review in 3 days to ensure response to treatment  Arrange test of cure after 3 months
392
Q

medication for vestibular neuritis

A

• IV rehydration
• prochlorperazine (Stemetil) 12.5mg IM (if severe) but may slow recovery
• Metoclopramide or ondansetron
• A short course of corticosteroids often promotes recovery
Pred 1mg/kg up to 75mgPO for 5 days then taper over 15 days and stop

393
Q

pleural effusion causes

A
  • Heart failure (90%)
    • Hypoproteinaemia eg nephrotic syndrome
    • Liver failure with ascites
    • Constrictive pericarditis
    • Hypothyroidism
    • Ovarian tumour - right sided effusion (Meigs syndrome)
Exudate
Causes
	• Infection - bacterial pneumonia, pleurisy, empyema, TB, viral 
	• Malignancy - bronchial carcinoma, mesothelioma, metastatic
	• Pulmonary infarction
	• Connective tissue diseases (SLE, RA) 
	• Pancreatitis
	• Lymphoma
	• Sarcoidosis
HIV with parasitic pneumonia
394
Q

peripheral causes of vertigo

A
BBPV
Neuronitis/labrynthitis
menierre' disease
Choleasteatoma
Acoustic Neuroma
Ramsay hunt syndrome
395
Q

central causes of vertigo

A
cerebellar infarction
cerebellar haemorrhage
Vertebrobasilar insufficiency
Vestibular migraine
MS
396
Q

mx for TMJ dysfunction

A
• Education and reassurance
	• Rest the joint 
	• Soft diet
	• Avoid clenching 
	• Physio 
	• Massage affected muscles 
Aspirin and paracetamol
397
Q

Erectile dysfunction examination

A
  • Penile plaques
  • Small testicular size
  • Lack of body hair
  • Gynaecomastia
  • Enlarged prostate
  • Lower limb neurological. Deficits
    Weak peripheral pulses
398
Q

Medications to commence in euvolemic heart failure

A

ACEI - perindopril 2.5-5mg
Bisoprolol

add later: Spironolactone

399
Q

Medications to commence in congested heart failure

A

Frusemide
ACE: 2.5mg perindopril
25mg spironolactone

later: bisoprolol

400
Q

Physical Exam Findings in Systemic Sclerosis (scleroderma)

A

CREST syndrome
Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly and Telangiectasia

telangiectasia
calcinosis
Sclerodactyly
Thinning of lips 
abnormal nail fold capillaries 
Raynaud phenomenon
Digital ulcers
401
Q

Hypertension physical examination

A

Tachycardia/irregular pulse
Displaced apex beat/added heart sounds - a sign of cardiac enlargement
Basal crepitations/raised JVP - cardiac failure
Carotid/renal/abdomen/femoral bruits - arterial disease
Palpation of renal angle for enlarged kidneys
Abnormalities of the optic fundi: retinal haemorrhages, papilloedema
Goitre/hyper reflexia/exopthalmos - hyperthyroidism
Elevated waist circumference/BMI
Neck circumference >40cm: OSA
Skin hyperpigmentation/moon facies/buffalo hump
Urinalyis/dipstick for proteinuria

402
Q

if eGFR come back <60 what do you do

A

repeat in 7 days

if stable repeat twice within 3 months

403
Q

If elevation on urine ACR what is next step

A

repeat twice within next 3 months

404
Q

Factors other than CKD that increase urine albumin excretion

A
  • UTI
    • High dietary protein intake
    • CCF
    • Acute febrile illness
    • Heavy exercise within 24 hours
    • Menstruation
    • Genital or infection
      Drugs: NSAIDs
405
Q

Managing end stage CKD (not on dialysis)

A
  • Aim BP <130/80
    • Review renal function every 1-3 months
    • Advise low salt diet <6g/day
    • Protein 0.75g-1/kg/day
    • Referral to dietician for individualised diet
    • Advise moderate exercise 30 mins/5 days a week
    • Ensure immunisations are up to date
    • Discuss advanced care directive/end of life care
      Monitor calcium and phosphate
406
Q

Causes of confusion in end stage renal failure

A
Uraemic encephalopathy
Urinary tract infection
Subdural haematoma 
Cerebrovascular accident
Hypo/hypercalcaemia
407
Q

what level of potassium should be referred to ED

A

> 6.5

408
Q

DDx for morning tiredness

A
• Anxiety/depression
	• Poor sleep hygiene
	• Chronic sleep restriction
	• Narcolepsy 
	• Insomnia
	• sleep apnoea
Delayed sleep phase disorder
409
Q

what is delayed sleep phase disorder?

A

Delayed sleep phase disorder (DSPD), which is characterised by late wake times and a significant delay in sleep onset times when compared with conventional sleep times, is commonly seen in adolescents and young adults.

410
Q

OSA mx

A
  • Continuous positive airway pressure
    • Weight loss 5-10%
    • Positional therapy - sleep on side/raise head of bed/positional devices
    • Mandibular advancement splint
    • Notify road licencing authority
    • Smoking cessation
    • Avoid alcohol
411
Q

types of glomerulonephritis

A

Post streptococcal GN
IgA nephropathy
Rapidly progressive GN
Henoch-Schonlein purpura

412
Q

diseases associated with nephrotic syndrome

A

• Minimal change glomerulonephritis
Focal segmental glomerulonephritis
Membranous glomerulonephritis
SLE

413
Q

Analgesic Nephropathy

A

• Papillary necrosis and chronic interstitial nephritis caused by the long term consumption of analgesic agents
• Most pts are >45 years
• Usually no symptoms
• But can have flank pain or haematuria
• Daily consumption of analgesic medicines for 2 consecutive years
Paracetamol most implicated

414
Q

Presentation of polycystic kidney disease

A

Pain in abdomen / flank / back due to enlargement of cysts, bleeding, UTI or nephrolithiasis
Haematuria (self-limiting, lasting up to one week)
Polycystic kidneys are susceptible to injury
Hypertension (diastolic)
Palpable flank mass, hepatosplenomegaly
Renal failure

415
Q

extra renal complications from polycystic kidney diseaae

A
• Berry aneurysms (10%)
	• Hepatic + pancreatic cysts (33%)
	• Cardiac valve disease (MV prolapse)
	• Diverticulosis
	• Abdominal wall and inguinal hernias
Seminal vesicle cysts
416
Q

DDx for proteinuria

A
Diabetic nephropathy
Hypertensive nephropathy
Multiple myeloma
Structural kidney disease- polycystic kidneys
Nephrotic syndrome
Amyloidosis
417
Q

History qs for sore nipples

A

• Onset of nipple pain within first few days of birth or new onset
○ First few days = most often poor latch
○ Infectious causes occur later
• Breast feeding: when milk came in ?adequate supple
• Frequency/duration of feeding
• Use of breast pump/nipple shields/pads
• Current medications
• History of yeast infections
• History of dermatitis/psoriasis
• History of breast surgery
• Raynauds - can predispose to nipple vasospasm
Low mood

418
Q

miconazole gel frequency for baby

A

QID

419
Q

fluconazole dose for nipple candidiasis

A

fluconazole 150mg every 2nd day for 3 doses

420
Q

what comes after the fluconazole in nipple candidiasis

A

nystatin 1,000,000 units TDS and miconazole gel to nipples QID

421
Q

Non pharmacological mx for nipple candida

A

• Sterilise dummy every day
• Keep nipples dry
Sanitise hands regularly

422
Q

mx of patella fracture

A

For nondisplaced or minimally displaced and an intact extensor mechanism (can straight leg raise) non operative treatment may be suitable
Zimmer knee splint for 5-6 weeks - can weight bear in splint

423
Q

what is mononeuritis multiplex associated with?

A
• Diabetes mellitus
	• Vasculitis
	• Amyloidosis
	• Direct tumour involvement- lymphoma, leukaemia
	• Polyarteritis nodosa
	• Rheumatoid arthritis
	• SLE
Paraneoplastic syndromes
424
Q

sinusitis red flag history

A
Change in vision/diplopia
Severe headache
Focal neurological signs - third nerve palsy, 6th nerve palsy, facial numbness
Significant/recurrent epistaxis
Neck mass/ cervical lymphadenopathy
Weight loss
Meningism
Change or hearing/ear pain
425
Q

Most common causes of excessive crying and vomiting in well infant

A

Lactose overload
Cows milk protein intolerance
purple crying

426
Q

Clinical features of cows milk protein allergy

A
Significant vomiting
Feeding difficulties
Diarrhoea with mucus or blood
Poor weight gain
Extensive eczema
First-degree family history of atopy
427
Q

mx of cows milk protein allergy

A

2 week trial of extensively hydrolysed formula or dairy +/- soy elimination diet
Refer to paediatrician

428
Q

what diseases can silica dust cause?

A
Silicosis
Chronic Bronchitis
Lung Cancr
Emphysemia
Scleroderma
429
Q

differential diagnosis for reticulonodularity

A

sarcoidosis, silicosis, tuberculosis and lymphangitis carcinomatosis.

430
Q

Sarcoid physical exam finding

A

lung crackles, lymphadenopathy, hepatosplenomegaly, polyarthritis, rash, uveitis, erythema nodosum

431
Q

Spirometry findings ILD

A

○ Reduced FVC
○ Normal or decreased FEV1
○ Normal or increased FEv1/FVC (>70-80%)
Decreased diffusion capacity

432
Q

DDx for cavitating lung lesion

A

• Pulmonary Tuberculosis
• Lung Abscess
• Lung cancer
• Non tuberculosis mycobacterial infection
• Fungal infection
• Sarcoidosis (but mediastinal lymphadenopathy too)
Lymphoma

433
Q

predictors of progression from chronic hep B to cirrhosis

A

• High HBV viral load.
• Recurrent exacerbations.
• Older age (longer duration of infection).
• Habitual alcohol consumption.
• Concurrent infection with HCV.
• Infection with hepatitis delta virus (HDV) or HIV.
HBV genotype C.

434
Q

what are the phases of hepatitis B infection?

A

Phase 1: immune tolerance
• High HBV DNA (often >170,000,000)
• Normal LFTs
• HbeAg positive

Phase2: Immune clearance
• High HBV DNA
• Abnormal LFTs
• HbeAg positive

Phase 3: Immune Control

- Low HBV DNA
- Normal LFTs
- HbeAg negative 
- Anti Hbe positive 
Phase 4: Immune escape 
	- High HBV DNA
	- Abnormal LFTs
	- HbeAg neg
Anti Hbe pos
435
Q

what stages of hep B do not require tx

A

Immune tolerance and immune control

436
Q

Bleeding disorder differentials

A
• Von Willebrand disease
	• Haemophilia
	• Idiopathic thrombocytopenia
	• Hereditary haemorrhagic telangiectasia
	• Bone marrow failure/leukaemia
	• Underlying liver disease
Trauma/intimate family violence
437
Q

5 Hs of Haemophilia

A
  • Haemathroses
    • Haematomas
    • Haematochezia
    • Haematuria
    • Head haemorrhage
438
Q

Hereditary haemorrhagic Telangiectasia

A

s an inherited disorder that causes abnormal connections, called arteriovenous malformations (AVMs), to develop between arteries and veins. The most common locations affected are the nose, lungs, brain and liver.
• These AVMs may enlarge over time and can bleed or rupture, sometimes causing catastrophic complications.
• Spontaneous and unprovoked nosebleeds, sometimes on a daily basis, are the most common feature. Persistent bleeding from the nose and the intestinal tract can result in severe iron deficiency anemia and poor quality of life.
Also known as Osler-Weber-Rendu disease, hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder that you inherit from your parents. Its severity can vary greatly from person to person, even within the same family.

439
Q

RFs for B12 deficiency

A
Autoimminue gastritis - pernicious anaemia
Gastrectomy
Terminal ileal resection
Vegan diet
Bariatric surgery
atrophic gastritis
metformin
Coeliac 
Chronic alcoholism
440
Q

Examination for LUTS male

A

Vital signs
Cardiovascular examination – inc signs of cardiac failure
Abdominal examination – palpable bladder
Genital Examination: phimosis or meatal stenosis
DRE – prostate size, tenderness, nodularity: should be rubbery and smooth
Anal tone and sensation
Lower limb neurological examination- to exclude neurological causes of bladder dysfunction

441
Q

Complications of BPH

A
Acute Urinary retention
Recurrent UTIs
Obstructive uropathy
Incontinence
Bladder stones
442
Q

Risk factors for thunderstorm asthma

A
hypersensitivity to rye grass pollens
seasonal allergic rhinitis
asthma
not taking ICS preventer
being outdoors during thunderstorm in pollen season
443
Q

what is screened for in heel prick test?

A

Phenylketonuria
Congenital hypothyroidism
Cystic Fibrosis
Galactossemia

444
Q

most common cause of neonatal conjugated jaundicae

A

biliary atresia

445
Q

Spodylolisthesis

A

definition: defect in pars interarticularis causing a forward slip of one vertebra on another
usually at L5-S1, less commonly at L4-5

446
Q

presentation of spondylolisthesis

A
Stiff waddling gait
Increased lumbar lordosis
Tender prominent spinous process of slipped vertebrae
Limited flexion
Hamstring tightness or spasm
447
Q

mx of spondylolisthesis

A

• Strict flexion exercise program

Avoid extension of spine

448
Q

Reasons to do HMMR

A

• 5 or more medications
More than 12 doses of medication per day
Recent significant changes made to medications
Medications requiring therapeutic monitoring
Symptoms suggestive of adverse drug reaction
Suspected non compliance
Sub optimal response to treatment
Difficulty managing own medications
Dementia
Pt has lots of different doctors
Recent discharge from hospital

449
Q

Causes of unstable INR

A
nutritional status
medication adherence
genetic variation
drug interactions
smoking and alcohol use
renal, hepatic and cardiac function 
hypermetabolic states
450
Q

what foods to avoid with warfarin

A

kale, spinach, brussel sprouts, collards, asparagus, green tea

451
Q

OSA history/clinical features

A
  • Recent weight gain
    • Nasal patency/obstruction/trauma/rhinitis
    • Alcohol intake pre bed
    • Family history of sleep apnoea
    • History of gasping/choking
    • Daytime sleepiness
    • Impact on driving
    • Morning headaches
    • Decreased concentration
    • Irritability/low mood
      Sexual dysfunction
452
Q

OSA examination

A
  • BMI
    • Neck circumference
    • BP
    • Assess mandible for retrognathia
    • Check nasal patency
    • Tonisllar hypertrophy
      Cardiovascular exam
453
Q

causes of thyrotoxicosis

A

Toxic multinodular goitre
toxic adenoma
exogenous thyroid hormone
De Quervains thyroiditis

454
Q

causes of hypothyroidism

A
Hashimotos
thyroiditis
iodine deficiency
amiodarone
Reidels thyroiditis 
post ablative therapy/surgery
455
Q

symptoms of agraunulocytosis from carbimazole

A

Patients should be educated to suspend antithyroid therapy and obtain a neutrophil count if they develop mouth ulcers, fever, sore throat or other symptoms suggestive of infection

456
Q

treatment for acute mania

A

olanzapine 10mg

457
Q

Rheumatic fever exam findings

A
• Tonsillar exudate
	• Erythema marginatum
	• Polyarthritis
	• Sydenham chorea 
	• Systolic cardiac murmur
Palpable subcutaneous nodules
458
Q

blood clot screening tests

A

Antiphospholipid syndrome
factor 5 leiden mutations
protein C and S mutations
Prothrombin mutation

459
Q

clinical features of Marfan

A

• tall stature, long limbs with significantly increased arm span and reduced upper to lower body segment ratio
• long fingers (arachnodactyly)
• joint laxity and flat feet
• Pectus chest deformity and kyphoscoliosis
• long narrow face with deep set eyes, a high narrow palate and dental crowding
• mitral valve prolapse
• dilation of the ascending aorta in 50% of children, which requires drug therapy to prevent or delay development of aortic dissectionand rupture, aortic regurg
• aortic coarctation
• ectopia lentis (dislocation of the lens, often upward); lens subluxation
• myopia
retinal detachment

460
Q

cerebellar ataxia

A

Gait ataxia, Dysdiadochokinesis, dysmetria, limb ataxia, intention tremor, scanning speech

461
Q

causes of cerebellar ataxia

A

Acute ataxia
• Minutes to hours
• Medical emergency
• Toxins, medications, infections, ischaemic or haemorrhagic stroke

Subacute
• Days to weeks
• Atypical infections, chronic exposure to toxins or medications, alcohol abuse, vitamin deficiencies, autoimmune disorders, systemic metabolic disorders, paraneoplastic cerebellar degeneration

462
Q

infectious period for measles

A

Cases are infectious from slightly before the beginning of the prodromal period, usually 1 days prior to symptoms
They continue to be infectious until 4 days after the onset of the rash.

463
Q

urgent lab tests for measles

A

Nose or throat swab for measles PCR
AND urine for measles PCR
+ if possible measles serology

464
Q

4 year old vaccinations

A

Diptheria, tetanus, pertussis, polio

465
Q

18 month vaccinations

A

Hib
MMRV
Diptheria, tetanus, pertussis

466
Q

gradual loss of vision with haloes around lights at nights

A

cataract

467
Q

painles slow loss of central vision

A

macular degeneration

468
Q

mx of severe croup

A

0.5ml/kg of 1:1000 adrenaline to a maximum of 5ml (5mg) undiluted AND 0.6mg/kg (max 12mg) dexamethasone IM/IV/PO.

469
Q

when to refer COPD to specialist

A
age <40
O2 <92% when well
more than one chest infection per year
diagnostic uncertainity
haemoptysis
rapid detrioration
ankl;e oedema
bullous lung disease on CXR
470
Q

common adverse effect of azathioprine

A

mouth ulcers

471
Q

Pericarditis treatment

A

Restriction of exercise
Colchicine 500mcg BD for 3 months
AND
Aspirin 1000mg, TDS for one to weeks with tapering course

472
Q

who should be screened via blood test for diabetes

A
AUSDRISK >12
GDM
PCOS
Antipsychotics
previous cardiovascular event
473
Q

treatmetn of hot tub folliculitis

A

ciprofloxacin

474
Q

when is depo provera considered late

A

14 weeks or more (need alternative contraception if been sexually active)

475
Q

what kind of nipple discharge is worrying for cancer

A

unilateral, spontaneous, bloody or serous from a single duct should raise concern for breast cancer.

476
Q

When to start ICS in COPD

A

recommended in patients with 2 or more exacerbations per year which require treatment with antibiotics or oral corticosteroids AND those with a FEV1 of 50% or less.

477
Q

what risk of breast cancer does BRCA gene carry

A

70% risk

478
Q

which BRCA gene is higher risk for ovarian cancer

A

BRCA1: 45% risk

BRCA 2= 15% risk

479
Q

options to use in renal impairment for palliative care

A

Buprenorphine, fentanyl and methadone are the opioids of choice in patients with severe kidney impairment

480
Q

most common side effect of varenicline

A

nausea

481
Q

Tall +Facies ( large ears, long narrow face) + intellectual disability + large testes

A

Fragile X syndrome

482
Q

risk factors for biliary colic

A
Older age >50 years
Female
Pregnancy
Obesity
Rapid weight changes
Ethnicity
483
Q

Risk factors for groin hernias

A

• family history
• chronic obstructive pulmonary disease
• Smoking
• low body mass index,
• chronically raised intra-abdominal pressure
and collagen vascular disease

484
Q

what makes a bite wound high risk

A

“presentation to medical care is delayed by 8 hours or more
the wound is a puncture wound that cannot be debrided adequately
the wound is on the hands, feet or face
the wound involves deeper tissues (eg bones, joints, tendons)
the wound involves an open fracture
the patient is immunocompromised (eg due to asplenia or immunosuppressive medications), or has alcoholic liver disease or diabetes
the wound is a cat bite.”

485
Q

mx of fibro

A
Pharmacotherapy
	• Low dose TCAs: amitriptyline 10-25mg nocte / dosulepin
	• Duloxetine
	• Milnacipran
	• Pregabalin/gabapentin 

Nonpharmcological
• Patient education - pain experienced is real but not caused by tissue damage
○ Not progressive or deforming disease
Regular graded aerobic exercise

486
Q

what kind of ankle sprain causes Pain reproduced with external stress and dorsiflexion

A

syndesmosis sprain

487
Q

what does a mortise XR reveal for syndesmosis injury

A

widening of space between tibia and fibula

488
Q

DDx for localised heel pain

A
plantar fasciitis
achilles tendinopathy
atrophic heel pad
retrocalcaneal bursitis
tibialis posterior tendinopathy
489
Q

what organ does lithium effect in pregnancy (of baby)

A

heart

490
Q

what medications require higher dose folic acid

A

valproate and carbamazpeine

491
Q

what genetic tests are done for thrombophilia

A

Factor V Leiden and prothrombin variant genetic testing.

492
Q

what monitoring is required for dapsone?

A

Need to monitor for side effects: haemolytic anaemia, methaemoglobinaemia
Need CBE, glucose-6-phosphate dehydrogenase enzyme levels and renal and liver function testing

493
Q

PJP tx

A

Trimethoprim + sulfamethoxazole

494
Q

Examination features for IBD

A
  • Arthritis/enthesitis
    • Episcleritis/iritis
    • Erythema nodosum
    • Pyoderma gangrenosum
    • Anaemia: pallor of conjunctivae
    • Abdominal mass
    • Evidence of weight loss
      Perianal fistula, skin tags
495
Q

Q fever treatment

A

doxycyline 100mg BD for 14 days

496
Q

Complications of Q fever

A
  • Chronic Q fever
    • Chronic fatigue syndrome
    • Endocarditis
    • Chronic hepatitis
    • Osteomyelitis
      Alcoholic intolerance
497
Q

Side effects of 5 flurouracil

A
Soreness / pain / discomfort (1)
Itchiness / irritation (1)
Burning sensation (1)
Stinging sensation (1)
Weeping (1)
Crusting of the skin (1)
Sores / ulcers  / ulceration (1)
Blistering (1)
Skin peeling (1)
Skin cracking (1)
Allergic contact dermatitis / dermatitis (1)
Photosensitivity / increased sensitivity of the skin to the sun (1)
Hyperpigmentation / skin redness (1)
Hypopigmentation (1)
Rash (1)
Scarring (may be permanent) (1)
498
Q

When is DNA testing for Fragile X syndrome available iwht MBS rebate

A

exhibits intellectual disability, ataxia, neurodegeneration, or premature ovarian failure consistent with an FMR1 mutation
has a relative with an FMR1 mutation.

499
Q

inheritance pattern of fragile X

A

X linked dominant inheritance pattern

500
Q

some of the tests in newborn screening

A

CF
PKU
Neonatal hypothryoidism
galactossemia

501
Q

genetic arrhythmia syndromes

A

Long QT syndrome
Brugada
Catecholaminergic Polymorphic VT
(Autosomal dominant)

502
Q

Inheritance of neurofibromatosis

A

Autosomal dominant

503
Q

clinical features of Neurofibromatosis

A
6 or more café-au-lait macules
Freckling in skin folds
Lisch nodules in the iris of the eye
Multiple neurofibromas
Learning difficulties
504
Q

Genetic conditions that are linked to ASD

A
  • 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)
505
Q

List 3 autosomal recessive conditions

A

cystic fibrosis (CF), spinal muscular atrophy (SMA) and Tay-Sachs disease (TSD)

506
Q

X linked conditions

A

fragile X syndrome (FXS), haemophilia A and B, and Duchenne muscular dystrophy.

507
Q

what genetic conditions are more common in Ashkenazi Jewish community?

A

These include Tay Sachs disease, cystic fibrosis, familial dysautonomia, Canavan disease, glycogen
storage disease 1A, mucolipidosis type IV, Niemann-Pick disease, Fanconi anaemia and Bloom
syndrome

508
Q

Inferior myocardial infarction is supplied by what coronary artery?

A

right coronary artery

509
Q

Side effects of donepezil

A

urinary incontinence, vivid dreams, dyspepsia

anticholinesterase inhibitor

510
Q

RFs for Bells palsy

A
• Pregnancy
• Pre eclampsia
• Obesity
• Hypertension
• Diabetes
Upper respiratory illnesses
511
Q

Causes of facial weakness

A
stroke
bells palsy
ramsay hunt syndrome
parotid tumour
cholesteatoma
sarcoidosis
512
Q

treatment for enuresis

A
Bed alarm
do not punish child
reward/praise child for acheiving dryness
advise against fluid restriction 
eliminate caffeinated beverages
desmopression for school camps
513
Q

Symptoms of rickettsial infection

A
fever
headache
muscle aches
swollen lymph glands
cough
rash
514
Q

treatment for typhoid fever

A

Azithromycin 1g 5-7 days

515
Q

what corneal finding is blepharitis associated with?

A

marginal keratitis

516
Q

ddx for facial pain and nasal congestion

A
bacterial rhinosinusitis
nasopharyngeal carcinoma
sinus abscess
cluster headache
rhinitis medicamentosa
517
Q

Gout triggers

A

Alcohol, Diet high in purines, Trauma, dehydration, systemic illness with fever, sugary soft drinks, fasting, aspirin

518
Q

diagnosis options for Cushing’s syndrome

A

24 hour urinary free cortisol, Dexamethasone suppression test

519
Q

Diagnosis of carcinoid syndrome

A

• 24 hour urine levels of 5-HIAA (hydroxyindoleacetic acid) , the end product of serotonin metabolism
Plasma chromogranin A/hepatic ultrasound

520
Q

alcoholic hepatitis lft ratio

A

AST:ALT 2:1

521
Q

what is the koebner phenomenon?

A

Appearance of new skin lesions on areas of cutaneous injury in otherwise healthy skin

Psoriasis is the most researched condition that exhibits the Koebner phenomenon and can be used to aid diagnosis

522
Q

Differentials for chronic productive cough in child

A
• Protracted bacterial bronchitis
	• Primary ciliary dyskinesia
	• Immunodeficiency 
	• Chronic/recurrent aspiration 
	• Interstitial lung disease 
	• Cardiac disease
	• Recurrent bronchiolitis
	• Tuberculosis 
Alpha-1 anti trypsin deficiency
523
Q

tx for protracted bacterial bronchitis

A

amoxclav BD 2 weeks

524
Q

Clinical features of acromegaly

A
• Acral overgrowth (enlarged extremities nose, ears, jaw, hands, feet) 
	• Soft tissue changes
	• Impaired glucose tolerance
	• Increased sweating
	• Neuropathy
	• Arthritis 
	• Hypertension
	• Cardiomyopathy
	• Sleep apnoea
Giganitsm
525
Q

Diagnosis of acromegaly

A

Increased serum growth hormone concentration that does not suppress during an oral glucose tolerance test and
an elevated plasma insulin like growth factor 1 concentration (IGF-1)

526
Q

waht are the enzyme inducing anti epileptic drugs

A

carbamazepine, phenobarbitone, phenytoin, topiramate

527
Q

what contraception can be used for women taking enzyme inducing anti epileptic drugs

A

copper IUD
Mirena
depot medroxyprogesterone acetate

528
Q

which seizure drugs need higher folate dose

A

carbamazepine or lamotrigine

529
Q

organic causes of constipation in child

A
cows milk protein allergy
coeliac disease
hypothyroidism
cystic fibrosis
Hirschprung's disease
spinal cord abnormality - myelomeningocele
530
Q

Scheurmann’s Disease

A
• Aka scheuermann's kyphosis 
	• Increased rounding posture of the spine that leads to a hunchback or slouching posture
	• Cause is unknown
	• Runs in families 
	• Develops in adolescence 10-15 years
	• More common in boys 
Thoracic pain
531
Q

after xr next imaging for stress fracture

A

MRI

532
Q

Family screening for coeliac disease

A

• Risk is 10% if family member affected
• Screen with HLA DQ2/8 and coeliac serology
Screening can be delayed until 4 years old if well and symptom free

533
Q

treatment for oesophageal spasm

A

May be precipitated or exacerbated by gord
Treat first
Can try ingestion of warm water at onset of attack
GTN 400mcg sublingual
If severe frequent symptoms
Diltazem 180mg SR daily
Isosorbine dinitrate

534
Q

What diseases can psuedogout be associated with

A
• Haemochromatosis
	• Hyperparathyroidism 
	• Hypomagnesemia
	• Hypophosphatemia
Familial hypocalciuric hypercalcaemia
535
Q

Side effects of dopamine agonists

A
• Nausea
	• Hallucinations
	• Dizziness (inc postural hypotension) 
	• Excessive sleepiness
	• Headache
	• Insomnia
	• Peripheral oedema
	• Depression
Impulse control disorders behavioural adverse effects—these include pathological shopping, eating, hoarding, gambling, sexual preoccupation, medication abuse and punding (incessantly doing and undoing a project [eg fixing an engine, organising a wardrobe]). Do not use dopamine agonists in patients with a history of impulse control disorders (including problem gambling).
536
Q

Charcot-Marie Tooth Syndrome

A

inherited autosomal dominant polyneuropathy with an insidious onset from puberty. Clinical features include weakness in the legs, variable distal sensory loss and muscle atrophy giving the ‘inverted champagne bottle’ appearance of the legs.

537
Q

Familial Periodic Paralysis

A

An autosomal dominant skeletal muscle disorder. Clinical features:
young patient (usually adolescent)
day after vigorous exercise awakens with weakness in limbs (for 4–24 hours)
flaccid paralysis/loss of deep tendon reflexes
Related to potassium levels—measure during symptoms. Classify as high, low or normal.

538
Q

Causes of ptosis

A
  1. 3rd cranial nerve palsy—ptosis, eye facing ‘down and out’, dilated pupil, sluggish light reflex
  2. Horner syndrome—ptosis, miosis (constricted pupil), ipsilateral loss of sweating
  3. Mitochondrial myopathy—progressive external ophthalmoplegia or limb weakness, induced by activity—no pupil involvement
    Myasthenia gravis—ptosis and diplopia, no pupil involvement
539
Q

dementia + myoclonus + ataxia

A

Creutzfeldt–Jakob disease

540
Q

instantaneous: headache ± vomiting ± neck stiffness

A

subarachnoid haemorrhage

541
Q

typical facies (temporalis atropy and frontal balding) + muscle weakness esp. hands (± myotonia) + cataracts

A

myotonic dystrophy

542
Q

leg weakness + ataxic gait + clumsiness (appears about 12 years)

A

Friedrich ataxia

543
Q

Investigations for erectile dysfunction

A

Bloods: CBE, EUC, Morning testosterone, glycated haemoglobin or fasting blood glucose, lipid panel
If testosterone low: repeat free testosterone, LH and prolactin

544
Q

jone’s fracture mx

A

Definitive treatment involves a short leg non-weight bearing cast for 6-8 weeks and repeat x-ray to confirm evidence of healing.

545
Q

what investigation is best for lung cancer?

A

CT chest with contrast

546
Q

What are the main effects of snakebite evenomation

A

• Paralysis
• Myolysis
• Renal failure
Coagulopathy

547
Q

DDx for osgood schlatter disease

A
  • Patellofemoral pain syndrome
    • Patella tendonitis
    • Sinding-larsen-Johansen syndrome
    • Infra patella bursitis
548
Q

patella tendinopathy

A

“jumpers knee” is a common cause of infrapatellar pain. Pain is usually maximal at the patellar attachment and proximal tendon and is aggravated by jumping or hopping. On examination there is local tenderness over the patellar tendon, and thickening or nodules may be palpable.

549
Q

Complications of sinusitis

A
Pre-septal cellulitis (1)
Orbital cellulitis (1)
Orbital abscess (1)
Sub-periosteal abscess (1)
Cavernous sinus thrombosis (1)
Osteomyelitis (Frontal or Maxillary Bones) (1)
Meningitis (1)
Encephalitis (1)
Cerebrospinal fluid leak (1)
Epidural/subdural/brain abscess (1)
Encephalitis (1)
550
Q

after a febrile seizure what are the risk factors for developing epilepsy

A

• family history of epilepsy
• any neurodevelopmental problem
• prolonged or focal febrile seizures
• febrile status epilepticus
No risk factors: 1% risk of developing epilepsy (similar to population risk)
Risk increases with more risk factors, up to 10%

551
Q

status epilepticus treatment

A

10mg intranasal midazolam

552
Q

what are the indications for referral to burns unit

A

Burns with associated inhalation injury
Burns >10% of total body surface area
Burns to special areas – face, hands, major joints, feet and genitals
Full thickness burns >5% total body surface area
Electrical burns
Chemical burns
Circumferential burns of limbs or chest
Burns with associated trauma
Burns in patients with pre-existing illness or disability that could adversely affect patient care and outcomes
Suspected nonaccidental injury in children or vulnerable people
Burns in the elderly and in children <12 months of age
Small area burns in patients with social problems, including children at risk
Burns occurring in pregnant women

553
Q

causes of abducens nerve palsy

A
Idiopathic (2)
Diabetic Mononeuropathy (2)
Microvascular ischaemic nerve palsy (2)
Multiple sclerosis (2)
Intracranial tumour / Intracranial malignancy / Space occupying lesion (2)
Cerebral Aneurysm (2)
Migraine Headache (2)
Post-viral mono-neuropathy (2)
Cerebrovascular Accident (2)
Complicated otitis media/mastoiditis (2)
Cavernous sinus thrombosis (2)
Giant Cell Arteritis / Vasculitis (2)
554
Q

what scores are used in palliative care to measure patients performance status

A

Australian-modified Karnofsky Performance Scale (AKPS)
Eastern Cooperative Oncology Group (ECOG)

An AKPS score of less than 40 or an Eastern Cooperative Oncology Group (ECOG) performance status score of 3 correlates to a median survival of around 3 months for patients with advanced cancer.

555
Q

indications for referral of asymptomatic renal stone

A

• stone size >5 mm
• single kidney (congenital or postoperative)
• occupational need to be stone-free (eg airline pilot, military)
• chronic obstruction
recurrent urinary infections.

556
Q

what makes someone at high risk of recurrence from renal stones

A

• early onset of urolithiasis (younger than 20 years of age)
• a family history of stones
• disease-associated stones (eg hyperparathyroidism, genetic conditions)
• anatomical abnormalities (eg single kidney, PUJ obstruction)
previous or concurrent renal calculi.

557
Q

in acute renal colic who needs referral to urologist

A

· Stones >7 mm
· Patients who have been trialling conservative management for three weeks and have not passed their stone, as renal damage becomes more likely after six weeks of failed passage.
· Patients who have ongoing pain despite adequate oral analgesia
· patients who have passed stones but have ongoing blood in the urine should be referred to a urologist for investigation of haematuria, preferably with three urine cytology tests and a CT IVP.

558
Q

how is absolute fracture risk calculated

A

FRAX (Australia) or Garvan Fracture Risk Calculator (Garvan)

559
Q

Radiographic hallmarks of osteoarhritis

A

• Joint space narrowing
• Subchondral sclerosis
• Subchondral cysts
Osteophytes

560
Q

causes of acute haemarthroses of knee

A

Intra articular fracture
ACL rupture
Patella dislocation

561
Q

Inability to straighten knee

A
Injury to quadricep tendon
Injury to patella tendon
Fracture of patella
Loose body from chondral or subchondral defect 
ACL tears (swelling) 
Meniscus tear
562
Q

How to manage pelvic girdle pain in pregnancy

A

Management
Activity modification
- Pelvic support garments

Practical advice for minimising pain
- Wear low heeled shoes
- Physiotherapy
- Reduce non essential weight bearing activities: climbing stairs/long periods of standing
- Avoid standing on one leg
Avoid movements involving hip abduction (getting in and out of cars, baths, or squatting

563
Q

what muscle does trendelenburg test test?

A
Gluteus medius (hip adductors) 
nwb hemipelvis drops if abnormal
564
Q

causes of olecranon bursitis

A
  • Repetitive pressure
    • Overuse injury
    • Tophaceous gout
      Rheumatoid arthritis
565
Q

mx of hyphaema

A
  • Eye patch
    • Bed rest
    • Elevation
      Opthal review
566
Q

red back spider evenomation symptom/signs

A

malaise, lethargy, nausea, vomiting, hypertension, irritability (especially in children), agitation (especially in children), fever and priapism. Patients can also experience pain and local / regional signs.

567
Q

what happens to pulse pressure in raised intracranial pressure

A

widens

568
Q

mx of Duputyren’s contracture

A
• Watchful waiting/observe/nil action
	• Hand therapy/occupational therapy 
	• Reduce alcohol
	• Collagenase injections
	• Needle fasciotomy
Surgical release
569
Q

XR findings of pagets disease

A
  • Sclerosis
    • Trabeculation
    • Cortical thickening
570
Q

Multiple myeloma CRAB

A

Calcium
Hypercalcaemia, presenting with abdominal pain, constipation, polyuria
Renal failure
Uraemic symptoms, fluid overload
Anaemia and other cytopenias
Leukopenia/neutropenia, with increased risk of infections
Thrombocytopenia with increased risk of bleeding
Bone pain and bone fractures

571
Q

how to reduce breast cancer risk

A

Current RACGP guidelines advocate for physical activity, adequate folate, a Mediterranean diet, normal body mass index (in post-menopausal women only) and decreased alcohol consumption to reduce breast cancer risk.

572
Q

when do you review fracture risk factors

A

males >50

women >45

573
Q

When to prescribe 5mg folate pre conception

A
diabetes
BMI >30
valproate and carbamazepine
history of child with NTD
malabsorption disorder
574
Q

what triptan is good for rebound headache

A

naratriptan

575
Q

Risk factors for glaucoma

A
  • Age
  • Race (higher in black)
  • Family history
  • Diabetes
    Hypertension
576
Q

treatment for acute angle closure glaucoma

A
  • Urgent referral to hospital via ambulance for ophthalmology review
  • Analgesia - morphine
  • Do not patch the eye
  • Get patient to lie flat
  • Nil by mouth
    Give antiemetic if nauseas
577
Q

topical medications for glaucoma

A
  • Beta blocker – timolol 0.5% 1 eye drop 1-2x daily
  • Prostaglandin analogue – Latanoprost 0.005% 1 eye drop daily
  • Alpha-2 agonists – Brimonidine 0.15% 1 drop twice a day
    • Unsuitable for severe CVD
  • Carbonic anyhydrase inhibitors – Brinzolamide 1% 1 eye drop twice a day
578
Q

Charles Bonnet Syndrome

A
  • experience of complex visual hallucinations in a person with partial or severe blindness
    • vivid, complex recurrent visual hallucinations
579
Q

BPSD pharmacological treatment

A

Risperidone 0.25mg PO, BD (max 2mg day)

580
Q

What are the MOST IMPORTANT high risk features (of recurrence or metastasis) of SCC?

A

• High risk anatomical sites: head, neck
• Tumour diameter >20mm
• Immunosuppression
• Occurrence in sites of previous trauma or pathology
• Rapid growth
• Ill defined margins
• Symptoms that indicate perineural invasion (tingling, pain, paraesthesia)
• Fixation to underlying structures
• Recurrent or incompletely excised tumours
Regional lymphadenopathy

581
Q

Risk factors for melanoma

A
• >100  common melanocytis naevi
	• >5 Dysplastic naevus 
	• Family history of melanoma
	• Blistering sunburns as child or adolescent
	• Previous melanoma or non melanoma skin cancer
	• Fair complexion and tendency to burn
	• Marked solar skin damage
Immunodeficiency
582
Q

when do melanomas need to referred for sentinel node biopsy

A

when >1mm thick

583
Q

most common side effect of acamprosate

A

transient diarrhoea

584
Q

what is the medication you can use for alcohol dependence in cirrhosis

A

acamprosate

585
Q

what blood test abnormalities are found in alcoholism

A
  • Elevated INR
    • Decreased albumin
    • Decreased folate and B12
    • Abnormal EUC and creatinine
    • Elevated GGT
    • AST:ALT 2:1
    • Macrocytosis
    • Decreased calcium, magnesium and phosphate levels
      Elevated ferritin
586
Q

What are the extra articular manifestations of ankylosing spondylitis

A
Atlanto-axial subluxation
Anterior uveitis
Apical lung fibrosis
Aortic incompetence
Amyloidosis (kidneys)
Autoimmune bowel disease (UC)
(psoriasis, cauda equina)
587
Q

How to assess severity of bronchiolitis

A
Behaviour
Respiratory rate
Use of accessory muscles
Oxygen saturation
Apnoeic episodes
feeding
588
Q

heart failure precipitants

A
H: hypertension
	E: Endocarditis
	A: Anaemia
	R: Rheumatic Heart Disease
	T: Thyrotoxicosis
	F: Failure to take meds
	A: Arrythmias
	I: infection/ ischaemia/ infarction
	L: lung problems
	E: Endocrine (phaechromocytoma/ hyperaldosteronism)
D: dietary indiscretions

Pulmonary Embolism

589
Q

Heart Failure Classes

A

I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

590
Q

heart failure signs

A
• Elevated JVP
• Third heart sound
• Laterally displaced apex beat
• Hepatojugular reflex
• Weight gain
• Peripheral oedema
Pulmonary crackles 
Ascites 
murmur
tachycardia
591
Q

treatment course for PPIs

A

take 4 week course

step down to 2nd daily dosing

592
Q

buckle fracture treatment

A

removable wrist splint for 3 weeks

593
Q

Adolescent HEEADSSS

A
Home
Education/Employment
Eating Exercise
Activities 
Drugs and Alcohol
Sexuality and Gender
Suicide Depression Self harm
Safety
594
Q

Differentials for infantile haemangioma

A
  • Vascular malformation - present at birth and persist with no proliferative or involutional phase
    • Vascular tumours - pyogenic granuloma
    • Locally aggressive tumours - Kaposi sarcoma
      Malignant tumours - angiosarcoma
595
Q

What makes bruising concerning for NAI?

A

bruising in children who are not independently mobile
bruising on torseo, genitalia, eyes, neck
bruising that is not over a bony prominence
bruising that is clustered or patterned
bruising with petechiae
bruising that does not fit with the mechanism described

596
Q

Risk factors for dementia

A
older age
family history
traumatic brain injury 
Down syndrome
Elevated CVD risk: HTN, diabetes, obesity, stroke, 
Depression
low level of education
ATSI
Excessive alcohol intake 
sedentary lifestyle
poor social supports
597
Q

important issues to discuss regarding vasectomy

A
  • Permanent nature of the procedure
    • Need at least 3 months until effective
    • Needs a sperm analysis in 3 months
    • Risk of haematoma
    • Risk of infection
    • Risk of formation of sperm antibody
      Small failure risk
598
Q

DDx for bilateral symmetrical sensorineural hearing loss

A

Gentamicin use in the past / Ototoxic medication use in the past (1)
Noise-induced hearing loss (1)
Presbycusis (1)

599
Q

DDX for sensorineural hearing loss

A

Presbycusis
Noise induced hearing loss
Ototoxic medication use - eg gentamicin
Hereditary sensorineural hearing loss
Meniere’s disease (asymmetrical)
Acoustic neuroma/meningioma (Asymmetrical)
Cerebrovascular ischaemia

600
Q

complications of premature menopause

A
infertility
osteoporosis
depression
atrophic vaginitis
increased risk of CVD
accelerated cognitive impairment
increased risk of autoimmune disease
601
Q

hormone profile in Turner syndrome

A

High FSH and LH

602
Q

causes of hypochromic microcytic anaemia

A
TAILS
Thalassemia
Anaemia of chronic disease
Iron Deficiency Anaemia
Lead Poisoining
Sideroblastic Anaemia
603
Q

causes of iron deficiency anaemia

A
inadequate dietary intake
underlying malignancy
anticoagulants
inability to absorb dietary iron
AV malformation of GIT
604
Q

Clinical Features Lead Poisoining

A
Acute
	• CNS toxicity
		○ Fatigue, weakness, headache
		○ Encephalopathy
		○ Cerebral oedema
	• GI effects: abdo pain, nausea, vomiting, constipation
	• Haemolytic anaemia, hepatitis

Chronic
• CNS Effects: poor concentration, headaches, impaired coordination, aggressive behaviour, irritability, intellectual impairment in children
• Muscle weakness, especially of extensor muscle groups of extremeties
• Gastrointestinal effects: abdominal pain, anorexia, constipation, weight loss
• Kidney and cardiovascular: hypertension, hyperuricaemia, gout, nephropathy, kidney impairment, fancono syndrome
• Chronic anaemia, arthralgia, myalgia, reduced fertiltiy, dental caries
gingival lead lines (Burton’s lines)wrist and foot drop

605
Q

Glandular Fever mx

A
  • Rest
    • Paracetamol
    • Ibuprofen
    • Avoid contact sports for 3-4 weeks
    • Avoid kissing others while unwell
    • Avoid alcohol
    • Drink fluids
      Follow up in 7-10 days
606
Q

clinical features of scarlet fever

A

• sudden high fever (above 38.5°C)
• followed by a distinctive rash (red initially, becoming dry and rough with a sandpaper feel),
○ Rash on trunk and limbs
○ Most prominent in skin folds
• facial flushing with circumoral pallor
• tongue discolouration (white initially, becoming red and bumpy [strawberry tongue]).
Pastia’s lines - read streaky lines in axilla and groin

607
Q

first line treatment for cystitis in pregnancy

A

nitrofurantoin 100mg 6 hourly for 5 days

608
Q

mx of CSOM

A

Treatment: dry aural toilet 6 hourly until the external canal is dry
Ciprofloxacin 0.3% drops, 5 drops instilled into affected ear 12 hourly until the middle ear has been free of discharge for at least 3 days
advise to keep ear dry as possible
review weekly

609
Q

DDx for haemolysis, renal dysfunction and neurological findings

A

Thrombotic thrombocytopenic purpura

Haemolytic uremic syndrome

610
Q

mx of CSOM

A

Treatment: dry aural toilet 6 hourly until the external canal is dry
Ciprofloxacin 0.3% drops, 5 drops instilled into affected ear 12 hourly until the middle ear has been free of discharge for at least 3 days

611
Q

Mx of dry TM perforation

A

• <3 months: review regularly
• >3 months
○ Refer to audiology assessment and refer to ENT
○ Hearing loss <20B : review every 3 months
○ Hearing loss 21-30: use hearing support strategies : classroom amplification, speech therapy if required, educational support
Hearing loss >30: refer for hearing aid consult if surgery delayed >6 months

612
Q

otodex ingredients

A

framycetin sulfate, gramicidin and dexamethasone

613
Q

definition of recurrent acute otitis media

A

≥ 3 episodes of AOM in the last 6 months or ≥ 4

episodes in the last year

614
Q

acute otitis media with perforation (ATSI)

A

amoxicillin 25mg BD for 14 days

615
Q

ATSI AOM

A

Amoxicillin 25mg/kg BD for 7 days

616
Q

non ATSI AOM

A

amoxicillin 15mg/kg TDS 5 days

617
Q

5 types of child abuse

A
physical
emotional
sexual
neglect
exposure to domestic and family violence
618
Q

risk factors for child abuse

A

use of hazardous drugs or alcohol during pregnancy
a family violence situation
mental health problems or intellectual disability, which can compromise a parent’s ability to care for their child
poor attachment to the infant
absence of social supports or isolation
unstable housing or financial situation
history of own abuse or neglect or that of another child in the family.

619
Q

Horner’s Syndrome

A

Miosis of the ipsilateral pupil
Ptosis of the ipsilateral upper lid
Anhydrosis of the ipsilateral face

620
Q

causes of acute Horner’s syndrome

A
dissection of the internal carotid artery dissection
	•  brainstem / cerebellar stroke
	•  cervical spondylosis
	•  an apical lung tumour 
 surgery to the chest / neck.
621
Q

conditions associated with increased incidence of adhesive capsulitis

A
• Prolonged immobilization (most significant)
	• Female gender
	• Age >49 yr
	• Diabetes mellitus (5x)
	• Cervical disc disease
	• Hyperthyroidism
	• Stroke
	• Myocardial infarction
Trauma and surgery
622
Q

stages of adhesive capsulitis

A

Painful: gradual onset of diffuse pain (6 weeks to 9 months)
Stiff: Decreased ROM affecting ADLs (4to 9 months)
Thawing: Gradual return of motion (5-26 months)

623
Q

Extra articular features of rheumatoid

A
• cutaneous ulcers
	• rheumatoid nodules
	• episcleritis
	• scleritis
	• pulmonary fibrosis
	• pleuritis
	• peripheral neuropathy: sensory stocking glove
	• splenomegaly
carditis
624
Q

complications of rheumatoid arthritis

A
atherosclerosis
osteoporosis
depression
vascultiis
peptic ulcer disease
pulonary fibrosis 
neuropathy
atlanto axial involvement
625
Q

Complications of Klinefelter Syndrome

A
  • Increased risk of osteoporosis
  • Increased risk of thyroid dysfunction
    Increased risk of diabetes
    Infertility
626
Q

Pharmacological mx of angina

A
  • Metoprolol 25mg BD
  • Nifedipine MR 30mg daily
  • Isosorbide mononitrate 30mg daily
627
Q

treatment for essential tremor

A

propanolol 10mg bd

628
Q

rate control medication AF

A

metoprolol tartrate 25 mg orally, twice daily,

629
Q

when do you start screening for AF

A

from 65

630
Q

what is valvular AF

A

moderate or severe mitral stenosis, or a mechanical heart valve.

631
Q

what medications should someone be on post acute coronary syndrome

A
  • DAPT for at least 12 months
    • 75mg clopidogrel daily
    • 100mg aspirin daily
    • Highest dose of statin
    • ACEI: perindopril 2.5mg
      Beta blocker: atenolol 25mg daily
632
Q

Risk factors for aortic aneursym

A
>65 years
Peripheral vascular disease 
Smoking
COPD 
Hypertension
Marfan and Ehlers- Danlos 
Diabetes 
Family history of AAA
Hyperlipidaemia
633
Q

causes of malnutrition in the elderly

A

poverty, isolation inability to shop/prepare food
delirium, dementia, depression, anxiety, alcoholism, bereavement, endocrine disorders, infection, malignancy , poor dentition, medications, cardiac/resp/GI disease

634
Q

peripheral neuropathy causes

A
• Diabetes
	• Peripheral vascular disease
	• Hypothyroidism
	• Vitamin B12 deficiency 
	• Chronic renal disease 
	• Amyloidosis 
	• HIV infection
	• Alcoholism 
	• Idiopathic
Restless legs syndrome (burning feet)
635
Q

causes of malnutrition in the elderly

A

poverty, isolation inability to shop/prepare food
delirium, dementia, depression, anxiety, alcoholism, bereavement, endocrine disorders, infection, malignancy , poor dentitiion, medications, cardiac/resp/GI disease

636
Q

how long before surgery to hold clopidogrel

A

5-7 days

637
Q

causes of binocular diplopia

A

Cranial - isolated cranial nerve III, IV or VI palsy, combined cranial neuropathy
Cerebrovascular accident
opthalmoplegic migraine
Neuromuscular - mysasthenia gravis, botulism
Muscular - thyroid eye disease, orbital myositis, tumours, myopathies

638
Q

things to discuss newly diagnosed HIV

A

Explain that people with HIV have a normal life expectancy
Explain this is a treatable condition with oral medication
Refer to sexual health clinic to commence anti retroviral medication
Explain that pt must not have sexual intercourse without disclosing HIV status
Explain that HIV is notifiable condition
Need further testing to determine CD4 count and viral load

639
Q

causes of binocular diplopia

A

Cranial - isolated cranial nerve III, IV or VI palsy, combined cranial neuropathy
Neuromuscular - mysasthenia gravis, botulism
Muscular - thyroid eye disease, orbital myositis, tumours, myopathies

640
Q

mx of peripheral arterial disease

A

graded exercise program
aspirin
statin
low fat, low salt diet

641
Q

differentials for intermittent claudication

A

• spinal stenosis
• nerve compression
• Venous claudication
Baker’s Cyst

642
Q

medications for incontinence

A

oxybutynin
solifenacin
oxybutynin

643
Q

strabismus exam

A

positive cover test
unequal red light reflex
unequal light reflex
abnormal head tilt

644
Q

phenoxymethylpenicillin dose for child

A

15mg/kg BD

645
Q

proximal Muscle weakness + pain +violaceous facial rash

A

dermatomyositis

646
Q

Hypotonic infant

A
Prader Willi syndrome
Down Syndrome
Hypoxic Ischaemic Encephalopathy
Spinal muscular atrophy
congenital Muscular dystrophy
Congenital hypothryoidism
647
Q

starting allopurinol

A

start at 50mg for 4 weeks then titrate to urate level

648
Q

what to use if allopurinol is contraindicated

A

febuxostat or probenicid

649
Q

what to prescirbe for bridigng therapy when ceasing panadeine forte for medication overuse headache

A

naproxen MR 750mg daily for 5 days then 3-4 days per week for 2 weeks then stop

650
Q

prophylaxis for tension type headache

A

amitriptyline 10mg daily at night

651
Q

if pityriasis versicolor is unresponsive to topical treatment

A

fluconazole 400mg oral

652
Q

Nappy rash treatment

A

use absorbent disposable nappies
use soap substitute
zinc barrier cream
hydrocortisone 1% + nystatin cream BD

653
Q

secondary causes of hyperhidrosis

A
  • Fever
    • Thyrotoxicosis
    • Acromegaly
    • Diabetes
    • Phaechromocytoma
    • Drugs: alcohol/narcotics/antidepressants
    • Parkinsons
      Lymphoma
654
Q

what virus causes roseola infantum

A

human herpes virus 6

655
Q

how long to exclude Scarlet fever from childcare

A

until 24 hours of antibiotics

656
Q

when to refer knock knees

A

refer if >8 years old and >8cm Intermalleolar space

657
Q

when to refer bow legs

A

if >3 years old
if intercondylar space >6cm
asymmetrical
pain

658
Q

when to screen for diabetes (ages)

A

every 3 years from 40 years

ATSI: yearly from 18 (with blood test)

659
Q

when to start absolute cardiovascular risk assessment

A

every 2 years from 45

ATSI: from 35

660
Q

when to measure lipids

A

5 years from 45

ATSI 5 years from 35

661
Q

what number BP do you start medication regardless of risk

A

160/100

662
Q

for someone with moderate CVD risk post lifestly change what BP number requires treatment

A

140/90

663
Q

when is air travel safe post spont pneumothorax

A

6 weeks

664
Q

when is air travel safe post traumatic pneumothorax

A

14 days

665
Q

driving after a stroke

A

• After a stroke a private vehicle driver cannot drive for at least 4 weeks and a commercial vehicle driver cannot drive for at least 3 months
• Before starting to drive again the patient must be assessed for residual impairments that could affect the functions needed to drive safely
• Particular concerns are sensory and/or visual inattention
• Refer patients with significant neurological, cognitive or perceptual impairments for a driving assessment supervised by an OT
• Refer patients with hemianopia to ophthalmologist
After a TIA private drivers cant drive for 2 weeks and commercial 4 weeks

666
Q

DDx for bloody diarrhoea in child

A
• Ulcerative colitis 
• Crohn’s disease 
• Clostridium difficile infection / Pseudomembranous colitis 
• Juvenile polyp 
• Bacterial gastroenteritis 
• Coeliac disease 
• Henoch-Schönlein purpura 
Amoebic gastroenteritis
667
Q

DDx for ankle oedema

A
• Congestive heart failure
	• Liver failure
	• Venous insufficiency 
	• OSA
	• Renal disease 
	• Lymphoedema
	• Medication induced
		○ Amlodipine
Pre tibial myxoedema  (Grave's disease)
668
Q

DDx child joint pain

A
• Rheumatic fever
	• Juvenile idiopathic arthritis
	• Ross river virus
	• Leukaemia 
Parvovirus associated arthritis
669
Q

DDx for burning feet

A
  • Diabetic neuropathy
    • Arterial claudication secondary to peripheral vascular disease
    • Chillblains
    • Psychogenic
    • B12 deficiency
    • Erythromelalgia
    • Bilateral tarsal tunnel syndrome
      Bilateral mortons neuroma
670
Q

localised folliculitis treatment

A

mupirocin 2% BD for 5 days

671
Q

most common causes of onycholysis

A
  • Repetitive trauma
    • Overzealous manicure
    • Prolonged immersion of nails in water
672
Q

mx of chill blains

A

• Elevate
• Warm gradually to room temperature in warm water
• Thin socks and closed toe shoes
• Betamethasone 0.05% ointment in OV twice daily
• Apply GTN topical spar or ointment
Can use nifedipine SR 20mg

673
Q

Rheumatic Fever prevention

A

• IM benzathine benzylpenicillin every 28 days for:
o 10 years after most recent episode of ARF, or until 21 years (whichever is longer)
o Until 35 for mod RHD
o Until 40 or lifelong for severe rheumatic heart disease

674
Q

how to diagnose eryhthrasma

A

clinical diagnosis
pink under wood lamp
send skin scrapings for microscopy: corynebacterium minutissimum

675
Q

non healing ulceration lower eyelid

A

BCC

676
Q

mx of dacrocystitis

A

Hot compress
Analgesics
Massage the sac and duct
Abx: cefalexin 500mg QID

677
Q

DDX for cholestatic LFT picture

A
Biliary obstructionL gallstone, cholangiocarcinoma, head of pancrease cancer
Drug related cholestasis
primary biliary cirrhosis
primary sclerosing cholangitis
alcoholic cirrhosis 
viral hepatitis
678
Q

causes of thrombocytosis

A
• Essential thrombocytosis
	• Polycythaemia vera
	• Primary myelofibrosis 
	• Chronic myeloid leukaemia
	• Myelodysplastic syndromes
	• Acute myeloid leukaemia 
Familial thrombocytosis
679
Q

2 medical contraindications for vaccination

A

anaphylaxis

immunodeficiency for vaccines with live viruses

680
Q

treatment for UTI in infants <3 months

A

IV antibiotics

681
Q

waht nerve is most injured with Monteggia?

A

radial nerve

682
Q

developmental coordination disorder

A

problems with motor coordination that interfere with function in academics, social integration or recreation

683
Q

Munchausen syndrome by proxy

A

parent or guardian creates an illness in a child so that the perpetrator gets benefit

684
Q

causes of intoeing

A

medial femoral torsion
internal tibial torsion
metatarsum varus

685
Q

W sitting position

A

femoral torsion

686
Q

Signs of adequate milk supply

A
  • Weight gain 150-200g/week
    • At least 5 wet nappies per day
    • At least one soft stool per day
    • Settling well after feeding
      Waking spontaneously for feeds
687
Q

How to increase milk supply

A
  • Hold baby skin to skin at breast
    • Breast feed frequently -2 to 3 hourly
    • Make sure good attachment: refer to lactation consultant
    • Switch feed: offer each breast twice
    • Express after breast feeds
      Domperidone 10mg TDS
688
Q

Causes of reduced milk supply

A
  • Timed breastfeeds and top ups
    • Poor fit and hold
      Medical causes
    • PCOS
    • Hypothyroidism
    • Retained products of conception
      Breast abnormalities
    • Insufficient glandular tissue
    • Previous breast surgery
      Medications
    • OCP, cabergoline, aripiprazole
      Smoking and alcohol
      Mastitis
      Pregnancy
      Infant factors
    • Cleft palate
    • Prematurity
      Neurological disorders
689
Q

when is rhesus immunoglobulin needed in first trimester?

A

Chorionic villus sampling
Miscarriage
Abortion (either medical or surgical)
Ectoptic pregnancy

690
Q

Rhesus doses

A

The dose is 250IU by deep IMI for single gestation pregnancies and 625IU for multiple pregnancies.

691
Q

what percentage of lung cancer is the result of smoking

A

About 90% of lung cancer in males and 65% in females is estimated to be a result of tobacco smoking.

692
Q

when to give first measles vaccine if baby is travelling to measles endemic area

A

6 months

693
Q

how to diagnose dermatitis herpetiformis

A

Skin biopsy for histopathology and direct immunofluorescence

694
Q

what antiemetic to use in Parkinsons

A

domperidone

695
Q

vague knee pain with locking in child

A

osteochondritis dissecans

696
Q

risk factors for pitted keratolysis

A
hot humid environment
occlusive footwear
diabetes
hyperhidrosis
immunodeficiency
keratoderma
697
Q

treatment for calluses and corns

A

pare back skin then apply salicyclic acid plasters

698
Q

cervical lymphadenopathy

A
  • TB lymphadenitis
    • Lymphoma
    • Metastases
    • Bartonella infection
    • Acute toxoplasmosis
    • CMV
    • EBV
      Non tuberculosos mycobacterium infection
      Acute HIV
699
Q

Definition of AIDs

A

HIV +ve plus one or more of the clinical diseases that are a feature of AIDS, e.g. PJP, KS or CD4 <200.

700
Q

AIDS definining illnesses

A
karposi sarcoma
oesophageal candidiasis
CMV retinitiis
pneumocystis jiiroveci pneumonia
Burkitt Lymphoma
701
Q

ddx for someone with cough and fever in HIV

A
  • Pneumocystis jirovecii pneumonia
    • Pulmonary TB
    • Atypical pneumonia
    • Lymphoma
    • Lung cancer
      Kaposi Sarcoma
702
Q

Clinical Manifestations of B12 deficiency

A
  • Hyper pigmentation
    • Jaundice
    • Vitiligo
    • Glossitis
    • Anaemia
    • Areflexia
    • Cognitive impairment
    • Irritability
    • Loss of proprioception and vibratory sense
      Peripheral neuropathy
703
Q

best test for pernicious anaemia

A

intrinsic factor antibodies

704
Q

in folate and B12 deficiency why should B12 be replaced first?

A

to prevent subacute combined degeneration of the spinal cord

705
Q

Who gets erythrasma

A
  • Warm climates
    • Skin of colour
    • Diabetes
    • Obesity
    • Poor hygiene
      excessive sweating
      Advanced age
706
Q

Instructions for corticosteroid use

A

once daily
apply liberally, not sparingly
apply to all areas of inflammation, then apply emollient elsewhere
use until dermatitis is gone and skin is clear

707
Q

treatment of perianal streptococcal dermatitis

A

cefalexin 25mg/kg BD 10 days

708
Q

End stage drug for heart failure

A

Sacubtril/valsartan

709
Q

what cholesterol number makes you automatically high risk

A

> 7.5

710
Q

causes of high prolactin

A
Prolactinoma
Pregnancy
medication: SSRIs
Hypothyroidism
Stress
711
Q

preventative treatment for cluster headache

A

verapamil 80mg TDS for 2 weeks then taper

712
Q

gout flare prophylaxis when commencing allopurinol

A

500mcg daily

713
Q

contraindications to cardiac stress testing

A

acute MI, new LBBB, high risk unstable angina, asymptomatic severe AS, uncontrolled arrhythmia, unstable heart failure, acute PE, acute aortic dissection

714
Q

contraindications to perfomring spirometry

A
• Hemoptysis of unknown/ active TB
	• Pneumothorax
	• Unstable angina pectoris
	• Recent myocardial infarction
	• Thoracic aneurysm 
	• Recent eye surgery within 2 weeks
	• Active TB
Recent abdominal or surgical procedures
715
Q

what drugs increased serum urate levels

A

aspirin and diuretics

716
Q

treatmetn of non severe pyelonephritis in adults

A

Amoxicillin + clavulanic acid 875/125mg BD for 14 days

717
Q

12 month ATSI vaccines

A

Men ACWY
MMR
Pneumococcal
Men B

718
Q

18 month ATSI vaccines

A

MMRV
Hib
Diptheria, tetanus, pertussis
Hep A

719
Q

ATSI 6 month vaccines

A

Infanrix Hexa

Pneumococcal

720
Q

ATSI 4 year old vaccines

A

Infanrix IPV

Hep A

721
Q

when is Men B given

A

2,4,12 months

722
Q

what vaccines would a child with DOwn syndrome get at 6 months

A

Infanrix hexa
Pneumococcal
meningococcal B

723
Q

methotrexate side effects

A
stomatitis
alopecia
diarrhoea
nausea
flu like symptoms 
SOB
hepatotoxicitiy
724
Q

long term complications of polymylagia rheumatica

A

Giant cell arteritis
depression
chronic pain syndrome
Stroke

725
Q

treatment for polymylagia rhuematica

A

prednisolone 15mg for 4 weeks then taper

726
Q

What is a Z score

A

The Z-score is the number of standard deviations a person’s BMD varies from the age- and sex-matched mean BMD. A Z-score below –2.0 is below the expected range and warrants investigation for a secondary cause of low bone density. Z-scores are recommended for reporting BMD in premenopausal women, men younger than 50 years, and children.

727
Q

requirements to give zoledronic acid

A

eGFR>35
vitamin D >50
calcium normal range
well hydrated

728
Q

what are the crystal deposition related disorders associated with hyperuricaemia

A

gout
urate nephropathy
nephrolithiasis

729
Q

DDx for febrile child with stridor

A

croup
bacterial tracheitis
quinsy
epiglottitis

730
Q

causes of an obstructive LFT picture

A
Obstructive Cholestasis
	- Acute cholecystitis
	- Cholelithiasis/biliary colic
	- Choledocholithiasis: gallstone in common bile duct
	- Ascending cholangitis
	- Cholangiocarcinoma
	- Carcinoma of head of pancreas
	- Primary biliary cirrhosis
	- Primary sclerosing cholangitis 
Hepatocellular Cholestasis 
	- Drug related cholestasis
	- Alcohol related liver disease 
	- Viral hepatitis A,B, C: can also cause intra hepatic cholestasis 
Cholestasis of pregnancy
731
Q

most specific liver enzyme

A

ALT

732
Q

Risk factors for BCC

A
Fair skin that readily burns 
History of high accumulated sun exposure 
severe, multiple sunburns
Ionising radiation treatment 
immunosupression 
family history of skin cancers 
solarium use
733
Q

Abx choice for mild diabetic foot infection

A

dicloxacillin 500mg QID

734
Q

features of a diabetic ulcer to suggest infection

A
local swelling
local warmth
local tenderness
erythema extending more than 0.5cm from wound
purulent discharge
735
Q

what are the 3 main zoonoses

A

Brucellosis
Leptospirosis
Q Fever

736
Q

when to do TOC for gonoccal pharyngeal, anal or cervical infection

A

2 weeks after treatment completed

retest 3 months after exposure

737
Q

croup assessemnt

A
behaviour
stridor
respiratory rate
accessory muscle use 
(o2 sats)
738
Q

thrush pharmacological tx

A

clotrimazole 2% cream intravaginally for 3 nigths

739
Q

causes of urticaria

A
idiopathic
infections
medications
contact allergy
allergic reaction
bites and stings 
physical triggers: exercise
740
Q

examination of child with chronic mouth breathing

A
  • Dry lips
    • Receding chin
    • Deviated septum
    • Boggy inferior turbinates
    • Allergic conjunctivitis
    • Crowded lower teeth
    • Tonsillar hypertrophy
    • High arched palate
    • Glue ear
    • Wheeze
    • Nasal speech
      Tooth decay
741
Q

common causes of mouth breathing in children

A
Rhinosinusitis
Inferior turbinate hypertrophy
deviated nasal septum 
adenoid/tonsillar hypertrophy
recurrent URTI
nasal polyposis (rare)
742
Q

DDx for progressive chronic arm weakness

A
Multiple sclerosis
Motor neurone disease
Cervical myeloradiculopathy
myasthenia gravis 
chronic inflammatory demyelinating neuropathy
inclusion body myositis
thyrotoxicosis
vitamin B12 deficiency
lead poisoning
743
Q

itchy vulvitis post menopausal

A
lichen sclerosis
lichen planus
atrophica vaginitis
psoriasis
irritant contact dermatitis
atopic dermatitis
744
Q

DDx dyspareunia

A
  • Endometriosis
    • Vaginismus
    • Inadequate lubrication
    • Vaginal atrophy
    • Vulvodynia
    • STI
    • Pelvic inflammatory disease
      Interstitial cystitis
745
Q

lichen sclerosis mx

A

• Refer to gynaecologist for confirmation of diagnosis with biopsy
• Treated initially with very potent topical corticosteroids
○ Clobetasol proprionate
○ Diprosone OV 0.05% daily for 4 weeks
• Goal-return skin to normal colour and texture which can take up to 6 months
• Long term maintenance therapy is required in 85% of patients as lichen sclerosis rarely remits
○ Maintenance with betamethasone dipropionate 0.05% once or twice a week
• Avoid vaginal irritants: soap, tight clothing
• Regular application of emollients
Examine patients every 6-12months for carcinoma surveillance

746
Q

when to refer pericarditis to hospital

A

high fever over 38 degrees
large pericardial effusion
cardiac tamponade
failure to respond to aspirin/NSAIds in 7 days

747
Q

causes of limp in toddler

A
transient synovitis
acute myositis
toddlers fracture
DDH 
NAI
748
Q

DDX for leukocoria

A
Retinoblastoma
Congenital Cataract 
Coats disease
Retinal detachment
Retinopathy of prematurity
749
Q

SGLT2 example

A

Dapagliflozin

750
Q

DPP4 Example

A

Sitagliptin 100mg

751
Q

mx of blue bottle

A

Wash with sea water
Remove tentacles by hand or wash them off with sea water
Immerse in hot water for 20 minutes

752
Q

Symptoms of Irukandji Syndrome

A
  • Severe generalised back, abdominal and muscle pain and muscle cramps
    • Chest pain
    • Anxiety
      Headache, nausea, vomiting
753
Q

Priapism treatment

A

urgent urology input
corporal aspiration
intracavernous injection of Phenylephrine

754
Q

Sinusitis physical exam

A

unilateral sinus tenderness
inspect nasal cavity for polyposis
decreased visual acuity
neck stiffness

755
Q

DDx for neck lump in neonate

A
brachial cyst 
lymphoma
pseudotumour of sternocleidomastoid
rhabdosarcoma
lymphadenopathy
756
Q

adverse effects of topical corticosteroids

A

cutaneous atrophy
telangiectasias
striae

757
Q

what medications lower testosterone

A

anabolic steroids
opiates
glucocorticoids

758
Q

treatment for legionella pneumonia

A

azithromycin 500mg for 3-7 days

759
Q

what is the screening for high risk cat 3 bowel cancer

A

ifobt every 2 years from 35-44

scope 5 yearly from 45-74

760
Q

Lynch syndrome increases risk fo which cancer

A
Bowel cancer
Endometrial cancer
Ovarian cancer
Stomach cancer
Hepatobiliary cancer (liver/gallbladder)
Urinary tract cancer
Renal and urinary tract cancer
Pancreatic cancer
Brain cancer
Skin (sebaceous adenoma, sebaceous epithelioma, or sebaceous carcinoma and keratoacanthoma)
Small bowel cancer
761
Q

causes of angular chelitis

A

poor fitting dentures
B12 deficiency
Chron disease
atopic dermatitis

762
Q

causes of atrophic glossitis

A
nutritional deficiencies (iron, b12, folic acid)
dry mouth 
sjrogen syndrome 
oral candida infection
coeliac disease
763
Q

treatment for giardia

A

Metronidazole 2g daily for 3 days

764
Q

PICO

A

Population, Intervention, Comparator, Outcome

765
Q

what sleep apnoea scores are needed for sleep study

A

STOP Bang >=4

ESS >=8

766
Q

what lobe issue would cause a receptive aphasia

A

temporal lobe

difficulty with recognising faces, aggressive behaviour, identifying objects

767
Q

treatment for stable VT

A

amiodarone 300mg IV over 20 minutes

768
Q

unstable bradyarrhythmia treatment

A

atropine 0.5mg IV

769
Q

Indications for referral of asymptomatic renal stones include:

A

• stone size >5 mm
• single kidney (congenital or postoperative)
• occupational need to be stone-free (eg airline pilot, military)
• chronic obstruction
recurrent urinary infections.