June 15 2021

Question 1

8F, for asthma action plan, asthma 2ya, winter daily salbutamol use, no other pmhx, immunised, home with smoker parents, NKDA, has allergic rhinitis. 4 risk factors for life threatening flare

Answer 1

• poor asthma control
• exposure to tobacco smoke
• poor engagement with treating doctor
• poor adherence to asthma action plan
• parent unequipped to manage asthma emergency

Question 2

8F, for asthma action plan, asthma 2ya, winter daily salbutamol use, no other pmhx, immunised, home with smoker parents, NKDA, has allergic rhinitis. 5 features to prescribe a preventer

Answer 2

• previous hospitalisations
• more than 2 presentations to ED
• needing oral corticosteroids for >2 flares
• flare up more than once every 6 weeks
• nighttime asthma symptoms >2 a month
• restricting sleep
• restricting activity

Question 3

8F, for asthma action plan, asthma 2ya, winter daily salbutamol use, no other pmhx, immunised, home with smoker parents, NKDA, has allergic rhinitis. 7 mx steps

Answer 3

• start montelukast 5mg, PO, nocte
• new asthma action plan
• educate on how to recognise and manage symptoms
• identify and avoid triggers
• avoid exposure to passive smoking
• influenza vaccine
• review in 4 weeks
• carry reliever at all times
• needs spacer at all times
• take 4 puffs salbutamol before exercise

Question 4

8F, for asthma action plan, asthma 2ya, winter daily salbutamol use, no other pmhx, immunised, home with smoker parents, NKDA, has allergic rhinitis. Preventers ?stunt growth, 2 points of discussion

Answer 4

• children on steroids attain normal adult height or 1cm less
• uncontrolled asthma itself can contribute to poor growth

Question 5

8F, for asthma action plan, asthma 2ya, winter daily salbutamol use, no other pmhx, immunised, home with smoker parents, NKDA, has allergic rhinitis. on preventer fluticasone 50microg, still has morning symptoms, 3 step ups?

Answer 5

• fluticasone/salmeterol 50/25microg, 2 puffs, BD
• add montelukast, PO, 5mg nocte
• increase to fluticasone 125microg, 2 puffs, INH, BD

Question 6

15F presents with mother, dysuria 2/7, discomfort in groin/abdomen, started trimethoprim300 yesterday, feels achy and unwell. 2 steps prior to examining

Answer 6

• offer to see Morgana alone to explore ?sexual history
• limits of confidentiality
• ask for consent to examine her
• offer chaperone

Question 7

15F presents with mother, dysuria 2/7, discomfort in groin/abdomen, started trimethoprim300 yesterday, feels achy and unwell. lesions on labial minora, clustered, ulcerated 3 other ddx beside genital herpes

Answer 7

• aphthous ulcers
• contact dermatitis
• syphilis

Question 8

15F presents with mother, dysuria 2/7, discomfort in groin/abdomen, started trimethoprim300 yesterday, feels achy and unwell. recent sex with male of her age, uses condoms. 7 mx steps

Answer 8

• commence valacyclovir, 500mg, BD, PO, 5-10 days
• no sex until lesions are healed
• paracetamol
• further STI testing, chlamydia
• urine bHCG
• cease trimethoprim
• discuss recurrent nature of genital herpes
• offer lignocaine topical gel

Question 9

18F presents with mother, dysuria 2/7, discomfort in groin/abdomen, started trimethoprim300 yesterday, feels achy and unwell. now has genital warts, 3mx

Answer 9

• imiquimod 5% cream, 3x/week until resolve
• podophyllin toxin 0.5% paint, BD for 3days
• no need to be treated unless causing discomfort
• cryotherapy