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KFP > June 11th 2021 > Flashcards

June 11th 2021 Flashcards

1
Q

58F childcare worker, 2-3/12 vaginal discomfort, menopausal, denies itch, PV bleeding or discharge, some dyspareunia, heavy dragging sensation and palpable lump, prolapses with coughing. 4 risk factors?

A
  • advanced Age
  • increased number of pregnancies
  • younger age at first pregnancy
  • obesity
  • chronic cough
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2
Q

58F childcare worker, 2-3/12 vaginal discomfort, menopausal, denies itch, PV bleeding or discharge, some dyspareunia, heavy dragging sensation and palpable lump, prolapses with coughing. 4 mx before referring to specialist

A
  • pelvic floor physiotherapy
  • avoid heavy lifting
  • avoid constipation
  • lifestyle - maintain healthy weight
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3
Q

64M acute severe lower back, left flank pain, nausea/diaphoretic, phx HTN, gout, ramipril, allopurinol, smoker, 10SD a day, 4 ddx

b,d,H,i

A
  • left renal calculi
  • pyelonephritis
  • vertebral fracture
  • paraspinal spams
  • ruptured abdominal aortic aneurysm
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4
Q

64M acute severe lower back, left flank pain, nausea/diaphoretic, phx HTN, gout, ramipril, allopurinol, smoker, 10SD a day. 3 things for renal calculi prevention

A
  • adequate daily hydration
  • compliance with gout medication
  • low sodium diet
  • low oxalate diet
  • low protein diet
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5
Q

23yo, irregular periods, difficulty losing weight, acne, hair on chin/upper lip, menarche age 11, denies menorrhagia/dysmenorrhoea, LMP 6/12 ago, non smoker, 1SD, no other PMHx, uses topical retinoids only. 6 possible causes

A
  • polycystic ovarian syndrome
  • pregnancy
  • hyperprolactinaemia
  • hypothyroidism
  • cushing’s
  • hypothalamic amenorrhoea
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6
Q

23yo, irregular periods, difficulty losing weight, acne, hair on chin/upper lip, menarche age 11, denies menorrhagia/dysmenorrhoea, LMP 6/12 ago, non smoker, 1SD, no other PMHx, uses topical retinoids only. 3 mx options

A
  • metformin Xr 500mg, daily
  • levonorgestrel mirena intrauterine device every 5 years
  • oral contraceptive pill ethynylestradiol/levonogestrel 30/150microg, PO, same time every day
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7
Q

23yo, irregular periods, difficulty losing weight, acne, hair on chin/upper lip, menarche age 11, denies menorrhagia/dysmenorrhoea, LMP 6/12 ago, non smoker, 1SD, no other PMHx, uses topical retinoids only. 6 long term mx of PCOS

A
  • discuss possible subfertility
  • aim weight loss 5-10%
  • diabetes screening with Hba1c every 1-3 years
  • monitor for depression
  • cycle regulation with OCP
  • hirsutism mx, physical hair removal
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8
Q

60M aboriginal, acute large volume haematemesis, 300km from hospital, phx of alcoholism, CKD, chronic liver, depression, t2DM, noncompliant with 500mg metformin BD. 5 ddx

A
  • ruptured esophageal varices
  • bleeding peptic ulcer
  • erosive duodenitis
  • coagulopathy
  • mallory weiss tear
  • gastric cancer
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9
Q

60M aboriginal, acute large volume haematemesis, 300km from hospital, phx of alcoholism, CKD, chronic liver, depression, t2DM, noncompliant with 500mg metformin BD. 6 hx

A
  • melaena
  • recent NSAIDs use
  • unintended weight loss?
  • epigastric pain
  • symptoms of anaemia
  • smoking history
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10
Q

60M aboriginal, acute large volume haematemesis, 300km from hospital, phx of alcoholism, CKD, chronic liver, depression, t2DM, noncompliant with 500mg metformin BD. pallor, BP 90-50, HR: 120, 6 immediate management

A
  • 2 large bore IV cannulas cubital fossa
  • 1L normal saline, IV, bolus
  • Oxygen to maintain saturations between 92-94%
  • IV PPI infusion: 80mg pantoprazole
  • call nearest gastroenterology service
  • urgent transfer via air ambulance to tertiary centre
  • continuous vital sign monitoring
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11
Q

60M aboriginal, acute large volume haematemesis, 300km from hospital, phx of alcoholism, CKD, chronic liver, depression, t2DM, noncompliant with 500mg metformin BD. 4 reasons does want to leave country?

A
  • distance of nearest hospital is away from family/country
  • distrust of western medicine
  • language barrier
  • perceived cost
  • poor health literacy
  • previous bad experience
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12
Q

60M aboriginal, acute large volume haematemesis, 300km from hospital, phx of alcoholism, CKD, chronic liver, depression, t2DM, noncompliant with 500mg metformin BD. he refuses to go. 3 mx

A
  • explain the seriousness of his condition -possibility of death
  • involve aboriginal health worker
  • explore reasons why he does not want to go
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KFP (47 decks)

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