GP Flashcards

Question

What are the recommended guidelines for osteoporosis screening in middle-aged adults?

Answer 1

Review fracture risk factors for women aged >45 years and men aged >50 years. The RACGP recommends that women aged 50-69 years and men aged 70-74 years have a bone mineral density test at least once.

Answer 2

The RACGP recommends that all adults perform monthly self-examination for skin cancer and visit a healthcare professional for a full-body skin examination at least every two years.

Answer 3

The RACGP recommends that women aged 50-74 years have a mammogram every two years.

Answer 4

The RACGP recommends that men aged 50-69 years make an informed decision about prostate cancer screening after discussing the benefits and harms with their healthcare provider.

Answer 5

The RACGP recommends that middle-aged adults receive recommended immunizations, including influenza vaccine every year, pneumococcal vaccine if indicated, and tetanus-diphtheria-pertussis vaccine every 10 years.

Answer 6

The recommended vaccination schedule for older adults in Australia includes a yearly influenza vaccine, a one-time dose of pneumococcal vaccine (if not previously vaccinated), and a shingles vaccine.

Answer 7

Answer: The recommended interval between two doses of the shingles vaccine is two to six months.

Answer 8

Answer: The recommended interval between the pneumococcal vaccine and any previous dose or doses is at least five years.

Answer 9

Yes, older adults can receive the shingles vaccine even if they have had shingles before, as the vaccine can help prevent future episodes or reduce the severity of symptoms.

Answer 10

How do Shingrix and Zostavax differ in their composition? Answer: Shingrix is a recombinant zoster vaccine that contains a piece of the herpes zoster virus, while Zostavax is a live attenuated vaccine that contains a weakened form of the virus. Which vaccine is more effective in preventing shingles? Answer: Shingrix is more effective in preventing shingles compared to Zostavax, with an efficacy rate of over 90% compared to about 50% for Zostavax. How many doses of Shingrix are required and what is the interval between doses? Answer: Shingrix requires two doses, with an interval of 2 to 6 months between doses. How many doses of Zostavax are required and what is the interval between doses? Answer: Zostavax requires one dose only. Who can receive Shingrix? Answer: Shingrix is recommended for adults aged 50 years and older, including those who have previously received Zostavax. Who can receive Zostavax? Answer: Zostavax is recommended for adults aged 60 years and older who have not received the shingles vaccine before.

Answer 11

Some risk factors for falls in older adults include history of falls, muscle weakness, gait and balance disorders, visual impairment, cognitive impairment, polypharmacy, home hazards, and chronic medical conditions such as arthritis, osteoporosis, and stroke.

Answer 12

Some recommended strategies for preventing falls in older adults include exercise programs to improve strength, balance and mobility, medication review and management, vision assessment and correction, home safety assessment and modification, and management of chronic medical conditions.

Answer 13

Home hazards can be addressed by conducting a home safety assessment, which may involve identifying and removing tripping hazards, improving lighting and visibility, installing handrails and grab bars, and using non-slip surfaces and footwear. Simple modifications such as removing clutter, securing loose rugs, and keeping commonly used items within reach can also help reduce the risk of falls.

Answer 14

According to the RACGP Red Book guidelines, the following individuals are considered to be at high risk of falls: 1. Older adults aged 65 years and older, particularly those who have experienced a fall in the past year 2. Individuals with medical conditions that affect balance, mobility, or cognitive function, such as Parkinson's disease, stroke, dementia, or peripheral neuropathy 3. Individuals taking multiple medications, especially those with sedative, hypnotic, or psychotropic effects 4. Individuals with visual impairment, particularly those with decreased contrast sensitivity, depth perception, or visual acuity 5. Individuals living in environments with hazards that increase the risk of falls, such as uneven surfaces, cluttered spaces, or inadequate lighting.

Answer 15

The key risk factors for dementia include age, genetics, cardiovascular risk factors (such as hypertension, diabetes, and hyperlipidemia), head injury, and low educational attainment.

Answer 16

The recommended screening tools for cognitive impairment in primary care include the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).

Answer 17

Have you noticed any changes in your memory or thinking abilities? Have you experienced any difficulty with daily tasks, such as cooking, cleaning, or managing finances? Have you noticed any changes in your mood or behavior, such as becoming more irritable, anxious, or depressed? Have you had any recent falls or accidents? Have you noticed any changes in your sense of direction or ability to navigate familiar places? Have family members or friends expressed concern about your memory or thinking abilities?

Answer 18

Infants: The first dose of the hepatitis B vaccine is recommended within the first 24 hours of life, followed by two more doses at 2 and 6 months of age. Unvaccinated adults: two adult doses

Answer 19

Routine HPV vaccination for adolescents: The HPV vaccine is recommended for routine use in both boys and girls at age 12-13 years. The vaccine is given as a 2-dose series with a 6- to 12-month interval between doses. Adolescents who start the vaccine series at age 14 years or older require a 3-dose series. Catch-up HPV vaccination for older adolescents and young adults: HPV vaccine catch-up programs are available for individuals who missed getting vaccinated during the routine vaccination period. For individuals aged 14-19 years, a 2-dose series with a 6- to 12-month interval between doses is recommended. For individuals aged 20-26 years, a 3-dose series is recommended.

Answer 20

Routine MMR vaccination for children: The MMR vaccine is recommended for routine use in children at 12 months of age. A second dose is recommended at 18 months of age or older, typically given at 4 years of age. Catch-up MMR vaccination for older children and adults: MMR vaccine catch-up programs are available for individuals who missed getting vaccinated during the routine vaccination period. Individuals born during or after 1966 who have not had two documented doses of MMR vaccine, or who do not have evidence of immunity to measles, mumps, and rubella, should receive the MMR vaccine.

Answer 21

Routine DTPa vaccination for children: The DTPa vaccine is recommended for routine use in children at 2, 4, and 6 months of age, with booster doses at 18 months and 4 years of age. Catch-up DTPa vaccination for older children and adults: DTPa vaccine catch-up programs are available for individuals who missed getting vaccinated during the routine vaccination period. Individuals who have not completed the primary DTPa vaccination series or who have not received a booster dose in the past 10 years should receive the vaccine.

Answer 22

Routine dTpa vaccination for adolescents: A single dose of dTpa vaccine is recommended for all adolescents at 14 to 16 years of age, as part of the National Immunisation Program (NIP) schedule. Routine dTpa vaccination for adults: Adults who have not received a dTpa booster dose in the past 10 years should receive a single dose of dTpa vaccine. This is recommended for all adults aged 50 years and over, and for some occupational groups such as healthcare workers.

Answer 23

Meningococcal B vaccine: This vaccine is recommended for individuals at increased risk of meningococcal disease, including infants and young children, adolescents, and individuals with certain medical conditions. Meningococcal ACWY vaccine: This vaccine is recommended for individuals at increased risk of meningococcal disease, including adolescents and young adults, and individuals with certain medical conditions. Pneumococcal vaccine: This vaccine is recommended for adults aged 65 years and over, and individuals with certain medical conditions. Varicella (chickenpox) vaccine: This vaccine is recommended for individuals who have not had chickenpox and are at increased risk of infection, including healthcare workers, pregnant women, and individuals with certain medical conditions. Hepatitis A vaccine: This vaccine is recommended for individuals at increased risk of hepatitis A infection, including travelers to areas with high rates of infection, men who have sex with men, and individuals with certain medical conditions. Hepatitis B vaccine: This vaccine is recommended for individuals at increased risk of hepatitis B infection, including healthcare workers, individuals with certain medical conditions, and individuals who engage in high-risk behaviors. Human papillomavirus (HPV) vaccine: This vaccine is recommended for females and males aged 12 to 13 years as part of the routine vaccination program, but is not funded for older age groups.

Answer 24

Individuals at increased risk of STIs should undergo screening at least annually according to the RACGP guidelines. Increased-risk individuals include people who inject drugs, sex workers, FN people, men who have sex with men, or those who have unprotected anal sex or multiple sex partners.

Answer 25

The recommended STI screening tests for pregnant women according to the RACGP guidelines include chlamydia, gonorrhea, syphilis, and HIV.

Answer 26

The appropriate follow-up measures for individuals who test positive for STIs according to the RACGP guidelines include treatment with antibiotics or antiviral medications, partner notification and treatment, retesting after treatment, and counseling on safe sex practices.

Answer 27

The appropriate timing for STI screening after exposure to a high-risk sexual partner is 2-3 weeks after exposure for chlamydia and gonorrhea, and 4-6 weeks after exposure for syphilis and HIV, according to the RACGP guidelines.

Answer 28

Chlamydia and gonorrhea: MSM should be screened for chlamydia and gonorrhea annually at a minimum, or more frequently if they have multiple sexual partners or engage in high-risk sexual behaviors. Syphilis: MSM should be screened for syphilis annually, or more frequently if they have multiple sexual partners or engage in high-risk sexual behaviors. HIV: MSM should be offered a HIV test at least once a year, or more frequently if they have multiple sexual partners or engage in high-risk sexual behaviors. Hepatitis B: MSM should be vaccinated against hepatitis B, and those who are not vaccinated should be offered testing for hepatitis B at least once in their lifetime. Hepatitis C: MSM should be offered a hepatitis C test at least once in their lifetime, and more frequently if they engage in high-risk behaviors such as injection drug use or sharing of sex toys.

Answer 29

According to the RACGP guidelines, CVD absolute risk assessment should be done at least every 2 years for individuals aged 45-74 years (or from 35 years for FN people), and more frequently if there are significant changes in the person's risk factors or health status.

Answer 30

1. <45 years with no known risk factors for CVD 2. Known history of CVD, including heart attack, stroke, or angina 3. >60 years old and have diabetes 4. Have chronic kidney disease (eGFR<45) 5. Diagnosis of familial hypercholesterolaemia 6. SBP ≥160 mmHg or DBP≥110 mmHg 7. Total cholesterol consistently ≥7.5 mmol/L 8. Diagnosis of atrial fibrillation

Answer 31

For patients without diabetes or target organ damage: BP < 140/90 mmHg For patients with diabetes, kidney disease or target organ damage: BP < 130/80 mmHg

Answer 32

Total cholesterol: < 4.0 mmol/L (high risk) ; 5.5 mmol/L (general) LDL-cholesterol: < 1.8 mmol/L (high risk) ; 2.0 mmol/L (general) HDL-cholesterol: > 1.0 mmol/L Triglycerides: < 2.0 mmol/L

Answer 33

<10% CVD risk: if BP>160/110mmHg 10-15% CVD risk: if SBP>140mmHg and/or DBP>90mmHg >15% CVD risk or clinically determined high risk: commence antihypertensive along with lipid therapy

Answer 34

1. Established CVD, regardless of lipid levels 2. Primary hypercholesterolaemia with an LDL-C ≥4.0 mmol/L 3. A high absolute CVD risk (≥15% risk of a CVD event over the next 5 years) and an LDL level ≥2.0 mmol/L 4. Diabetes with an LDL-C ≥2.0 mmol/L, or an LDL-C ≥1.8 mmol/L in the presence of additional risk factors such as albuminuria or smoking 5. Intermediate absolute CVD risk (10-15% risk of a CVD event over the next 5 years) and an LDL-C level ≥3.5 mmol/L, particularly if they have additional risk factors such as smoking or a family history of premature CVD.

Answer 35

AUSDRISK (Australian Type 2 Diabetes Risk Assessment Tool) is a risk assessment tool used to identify individuals at high risk of developing type 2 diabetes. The tool includes the following factors: Age Gender Country of birth Family history of diabetes History of high blood glucose Physical activity levels Fruit and vegetable intake Smoking status Alcohol consumption High blood pressure Waist circumference/BMI

Answer 36

Risk factors for type 2 diabetes include obesity, physical inactivity, family history of diabetes, high blood pressure, high cholesterol, and smoking.

Answer 37

The recommended screening frequency for type 2 diabetes is every three years for people aged 40-49 years, and every one to two years for people aged 50 years and older, or those with additional risk factors.

Answer 38

According to the RACGP guidelines, the following individuals are considered at high risk of developing type 2 diabetes: - Age over 40 years and being overweight or obese - AUSDRISK>12 points - Family history of T2D - History of gestational diabetes or polycystic ovary syndrome - High blood pressure, high cholesterol or other lipid disorders, or cardiovascular disease - History of impaired glucose tolerance or impaired fasting glucose - On antipsychotics - High-risk population group, including Aboriginal and Torres Strait Islander peoples, Pacific Islanders, and individuals from South Asian, Middle Eastern, or North African backgrounds.

Answer 39

Fasting plasma glucose (FPG): A person is diagnosed with diabetes if their FPG level is equal to or greater than 7.0 mmol/L after an overnight fast of at least 8 hours. 2-hour oral glucose tolerance test (OGTT): A person is diagnosed with diabetes if their glucose level is equal to or greater than 11.1 mmol/L two hours after ingesting a 75g glucose load. HbA1c: A person is diagnosed with diabetes if their HbA1c level is equal to or greater than 6.5%.

Answer 40

<5.5 mmol/L: diabetes unlikely 5.5-6.9 mmol/L: may need to perform OGTT (impaired glucose tolerance) >7 mmol/L: diabetes likely

Answer 41

1. Determine the patient's risk factors for CKD, including age, family history, hypertension, diabetes, cardiovascular disease, smoking, obesity, and a history of kidney disease or kidney injury. 2. Check for BP, urine ACR, and eGFR. 3. If ACR is positive, arrange two further samples within next 3 months (preferably first morning void) 4. if eGFR<60, repeat within 7 days Acute reduction of eGFR => possible AKI Stable reduced eGFR +/- elevated urine ACR => CKD staging

Answer 42

Stage 1: Kidney damage with normal or high eGFR (90 or above) Stage 2: Kidney damage with mildly decreased eGFR (60 to 89) Stage 3: Moderately decreased eGFR (30 to 59) Stage 4: Severely decreased eGFR (15 to 29) Stage 5: Kidney failure (eGFR less than 15 or dialysis) It's important to note that kidney disease can also be classified based on the presence of albuminuria (excess protein in urine).

Answer 43

The categories for males are: Normal: ACR < 2.5 mg/mmol Microalbuminuria: ACR 2.5-25 mg/mmol Macroalbuminuria: ACR > 25 mg/mmol The categories for females are: Normal: ACR < 3.5 mg/mmol Microalbuminuria: ACR 3.5-35 mg/mmol Macroalbuminuria: ACR > 35 mg/mmol

Answer 44

Men with a family history of prostate cancer (diagnosed <65yo) Men with a family history of breast cancer (BRCA1/2 gene)

Answer 45

The RACGP does not recommend routine prostate-specific antigen (PSA) screening for prostate cancer. Instead, they recommend individualized decision-making, taking into account a patient's risk factors and values.

Answer 46

Early-stage prostate cancer usually has no symptoms. Symptoms may include difficulty urinating, frequent urination (especially at night), blood in the urine or semen, pain during ejaculation, and pain or stiffness in the lower back, hips, or thighs.

Answer 47

Prostate cancer can be diagnosed using a combination of PSA blood test, digital rectal examination (DRE), and prostate biopsy. A biopsy is required to confirm the presence of cancer.

Answer 48

Treatment for prostate cancer can have side effects, including urinary incontinence, erectile dysfunction, and bowel problems. The severity and duration of side effects depend on the type of treatment and the individual patient.

Answer 49

Normal PSA (Prostate-Specific Antigen) values can vary depending on age, with the average values increasing as men get older. According to the RACGP guidelines, normal PSA values for men aged 50-69 years old are typically less than 3 ng/mL. However, it's important to note that PSA values can also be affected by factors such as prostate size, medication use, and recent sexual activity, and that PSA testing should be interpreted in the context of other clinical factors.

Answer 50

Prostate cancer: PSA levels are generally higher in men with prostate cancer. Benign prostatic hyperplasia (BPH): BPH is a non-cancerous enlargement of the prostate gland that can cause an increase in PSA levels. Prostatitis: Prostatitis is inflammation of the prostate gland and can cause elevated PSA levels. Recent ejaculation: PSA levels may be elevated for a short time after ejaculation. Certain medications: Certain medications, such as finasteride and dutasteride, which are used to treat BPH, can cause a decrease in PSA levels. However, if prostate cancer is present, these medications may make it harder to detect by lowering PSA levels.

Answer 51

The screening recommendations for average-risk individuals for colorectal cancer include a fecal occult blood test (FOBT) every 2 years from the age of 50 years.

Answer 52

The screening recommendation for high-risk individuals is a colonoscopy every 5 years, from the age of 50 or 10 years younger than the age of the first diagnosis of CRC in the family. Consider doing FOBT in the intervening years.

Answer 53

Individuals with no personal history of bowel cancer, colorectal adenomas, IBD, or family history of CRC. Or has a family history of CRC, but the age of diagnosis >55yo.

Answer 54

Asymptomatic individuals with family history of CRC diagnosed <55yo.

Answer 55

The symptoms of colorectal cancer can include changes in bowel habits, blood in the stool, abdominal pain, unexplained weight loss, and fatigue.

Answer 56

The RACGP recommends that women aged 50-74 years have a mammogram every two years. Women aged 40-49 years can also have mammograms, but the frequency and timing of screening should be based on individual risk assessment. Women over 75 years of age should discuss the benefits and risks of continued screening with their doctor.

Answer 57

Breast cancer can be diagnosed through a combination of physical examination, imaging tests (such as mammogram, ultrasound, or MRI), and biopsy (removal of a small amount of tissue for examination under a microscope).

Answer 58

Self-examination: Individuals should be advised to perform regular self-examinations of their skin, looking for any changes in the size, shape, color, or texture of existing moles or the appearance of new ones. Professional skin examination: Clinicians should perform a full skin examination on patients who present with symptoms or risk factors, and those who request a skin check. This should include examining all areas of the skin, including the scalp, soles of the feet, and between the fingers and toes. High-risk groups: Patients with a personal or family history of skin cancer, fair skin, a history of severe sunburn, immunosuppression, or a high number of moles should be considered at high risk and may require more frequent skin examinations. Imaging techniques: In certain cases, imaging techniques such as dermoscopy or total body photography may be used to aid in the detection of skin cancer. Education and prevention: Patients should be educated about the importance of sun protection, including wearing protective clothing, hats, and sunglasses, seeking shade, and applying sunscreen regularly.

Answer 59

Cervical screening should start at age 25 years for people who have a cervix or two years after having sexual intercourse. Women aged 25-74 years who have ever been sexually active should have a Cervical Screening Test (CST) every five years. Women aged 70-74 years who have had regular screening in the previous 10 years should have an exit CST. If they have not had regular screening in the previous 10 years, they should be screened two years after their last Pap test.

Answer 60

All women aged 70 years and older should be screened for osteoporosis. Women aged 50–69 years who have risk factors for osteoporosis should also be considered for screening. Men aged 70 years and older who have risk factors for osteoporosis should be considered for screening. Individuals aged 50 years and older who have sustained a low-trauma fracture should be assessed for osteoporosis. Bone density testing is recommended for all individuals who have sustained a fragility fracture, regardless of age. Individuals taking long-term glucocorticoid therapy should be considered for bone density testing. Individuals with other conditions associated with osteoporosis (e.g. hyperparathyroidism, malabsorption syndromes) should also be considered for bone density testing.

Answer 61

Cholesteatoma Otoscopic image of the left tympanic membrane. Encrustation and darkening of the epithelium can be seen in the posterior upper quadrant marginal to the pars flaccida (arrow). The localization and findings indicate a cholesteatoma.

Answer 62

Atopic dermatitis, also called atopic eczema, the most common inflammatory skin disease worldwide, presents as generalised skin dryness, itch, and rash.

Answer 63

Chronic plaque psoriasis Large, well-demarcated, red, scaly and thickened areas of skin. It is most likely to affect elbows, knees, and lower back but may arise on any part of the body.

Answer 64

Multiple small scaly erythematous lesions are visible. This appearance is typical of guttate psoriasis and is most often precipitated by group A streptococcal infection.

Answer 65

A scaly, erythematous plaque surrounded by multiple, partly confluent, follicular papules is visible on the skin of the antecubital fossa. Features include lichenification, dry skin, scaling, fissuring, post-inflammatory hyp/hyper pigmentation This finding is characteristic of chronic eczema

Answer 66

Nail pitting in psoriasis Multiple, small round depressions are seen in the nails.

Answer 67

Nail pitting and onycholysis are typical features of psoriasis with nail involvement.

Answer 68

Molluscum contagiosum is a common poxvirus skin infection of childhood that causes localised clusters of umbilicated epidermal papules.

Answer 69

The typical exanthem of infectious mononucleosis is an acute, generalised maculopapular rash. A more intense and extensive cutaneous eruption appears in up to 90% of patients with infectious mononucleosis 2–10 days after starting antibiotics. The rash usually resolves within a week of discontinuing the antibiotic.

Answer 70

This is pityriasis versicolor. It is a benign infection of the skin common in hot/humid climates. Flaky discoloured patches appear on the chest and back. Pityriasis versicolor is caused by mycelial growth of fungi of the genus Malassezia.

Answer 71

An asymmetric nodule (~1 cm in diameter) with central ulceration, and rolled out edges. This appearance is typical of nodular basal cell carcinoma.

Answer 72

Basal cell carcinoma A pearly nodule with central atrophy and peripheral telangiectatic vessels is visible on the front of the nose.

Answer 73

flat, eczematous (scaly) plaque with a pearly border with multiple microerosions. A plaque with raised borders and crusting is the typical appearance of superficial basal cell carcinoma

Answer 74

Seborrhoeic keratosis Multiple darkly pigmented papules/plaques, sharply demarcated, and soft Greasy, wax-like, and “stuck-on” appearance

Answer 75

Seborrhoeic keratosis

Answer 76

Actinic keratosis The entire hairless portion of the scalp is covered with telangiectasia, light brown papules, and yellow-brownish, hyperkeratotic plaques.

Answer 77

Actinic keratosis Multiple scaly lesions on erythematous skin are visible.

Answer 78

Cutaneous SCC

Answer 79

Malignant melanoma A hyperpigmented, slow-growing lesion can be seen on the medial border of the sole. The lesion is asymmetric, has an irregular border and variable pigmentation, and is ∼8 mm in diameter. This lesion fulfills the A (asymmetry), B (border irregularity), C (color variegation), D (diameter >6 mm), and E (evolving lesion; increase in size) criteria for diagnosing malignant melanoma. The diagnosis should be confirmed by performing a full-thickness biopsy of the lesion.

Answer 80

Lentigo maligna A 3-cm large, irregularly pigmented macule with irregular borders and surrounding mottling is visible. This appearance is suggestive of lentigo maligna. However, dermoscopy should be performed to further assess and classify the lesion.

Answer 81

Healthy tympanic membrane

Answer 82

Acute otitis media: Note inflammation, bulging of TM and loss of anatomical landmarks

Answer 83

Eczema herpeticum A vesicular eruption with multiple monomorphic, circular, partially confluent lesions, many of which show central umbilication is seen on the right shoulder of a patient with atopic dermatitis. Eczema herpeticum is considered a dermatological emergency and treatment with oral or IV acyclovir must be initiated quickly.

Answer 84

Erythema multiforme Target (bull's-eye) lesions are located on the lower right arm and hand. The lesions consist of three layers: a blue livid center, pale intermediate zone, and a dark red peripheral rim. Some exhibit central blistering.

Answer 85

Herpes Zoster

Answer 86

Influenza, at anytime during pregnancy Pertussis, 20-32 weeks

GP Flashcards

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