June 24th 2021 Flashcards
16F, sexual assault, vaginal penetration, ejaculated on dress, no condom, no oral/anal, denies discharge/dysuria, upset, no sig pmhx, immunised, never sexually active. 5 issues.
a,c,d,i,k,l,n,m
- discuss if any other injuries
- offer emergency contraception
- discuss option of attending sexual assault health service for forensic examination
- discuss option of reporting to police
- discuss possible STI and need for investigations
- assess psychosocial supports
16F, sexual assault, vaginal penetration, ejaculated on dress, no condom, no oral/anal, denies discharge/dysuria, upset, no sig pmhx, immunised, never sexually active. 3 emergency contraceptions
copper IUD - 5 days
- ulipristal 30mg: 5 days
levonorgestrel: 72-96 hours
8M, mouth breathing when sleeping, pmhx eczema, viral induced wheeze, steroid cream PRN, flixotide 50microgBD. 4 hx?
- snoring?
- any periods of apnoea?
- daytime fatigue
- hx of hay fever?
- any speech/language developmental issues
8M, mouth breathing when sleeping, pmhx eczema, viral induced wheeze, steroid cream RPNR, flixotide 50microgBD. 7 physical exam findings?
- restlessness
- dry lips
- boggy inferior turbinates
- tonsillar hypertrophy
- nasal speech
- wheeze
- crowded lower teeth
- receding chin
8M, mouth breathing when sleeping, pmhx eczema, viral induced wheeze, steroid cream RPNR, flixotide 50microgBD. 3 common causes of mouth breathing beside rhinosinusitis
- inferior turbinate hypertrophy
- deviated septum
- adenoid hypertrophy
- recurrent URTI
8M, mouth breathing when sleeping, pmhx eczema, viral induced wheeze, steroid cream RPNR, flixotide 50microgBD. allergic rhinosinusitis, using intranasal corticosteroids, epistaxis, worried intranasal and inhaled is too much
- studies confirm concurrent use is safe
- improved allergic rhinitis
- can use nasal oil
62M p/w 7/12hx of progressive right arm weakness, left hand as well, easily fatigued, can’t complete full day of work. pmhx left knee OA, htn, tarsal tunnel. on panadolSR and perindo5, non-smoker, social ETOH. no Fhx. 8 hx questions:
- pattern of onset - ?acute
- muscle pain?
- associated limb paraesthesia?
- muscle wasting?
- previous episodes of weakness?
- joint joints?
- dyspnoea
- dysphagia
- resting tremor?
- lead exposure
62M p/w 7/12hx of progressive right arm weakness, left hand as well, easily fatigued, can’t complete full day of work. pmhx left knee OA, htn, tarsal tunnel. on panadolSR and perindo5, non-smoker, socialETOH. no Fhx. 4 ddx?
motor neuron disease
cervical myloradiculopathy
myasthenia gravis
multiple sclerosis
thyrotoxicosis
B12 deficiency
lead poisoning
62M p/w 7/12hx of progressive right arm weakness, left hand as well, easily fatigued, can’t complete full day of work. pmhx left knee OA, htn, tarsal tunnel. on panadolSR and perindo5, non-smoker, socialETOH. no Fhx. likely MND, worried about family,2 points
given no fhx, likely sporadic MND
-lifetime risk in first degree relatives is 1-3%
55F dyspareunia, 3 years of vulval itch, now waking up at night, 1 partner for past 30y, denies discharge, fevers, dysuria, LMP was 18/12 ago, not on hormonal therapy, normal CST 12/12 ago, pmhx: htn, dietDMII, no meds, lost 20kg intentionally. 4 ddx?
- atrophic vaginitis
- atopic dermatitis
- lichen Planus
- lichen sclerosis
- psoriasis
55F dyspareunia, 3 years of vulval itch, now waking up at night, 1 partner for past 30y, denies discharge, fevers, dysuria, LMP was 18/12 ago, not on hormonal therapy, normal CST 12/12 ago, pmhx: htn, dietDMII, no meds, lost 20kg intentionally. likely lichen sclerosis, 3 conditions associated?
- vulval cancer
- hashimoto’s
- vitiligo
- pernicious anaemia
55F dyspareunia, 3 years of vulval itch, now waking up at night, 1 partner for past 30y, denies discharge, fevers, dysuria, LMP was 18/12 ago, not on hormonal therapy, normal CST 12/12 ago, pmhx: htn, dietDMII, no meds, lost 20kg intentionally. 3 mx?
- confirm dx with punch biopsy
- super-potent topical corticosteroid: betametasone diproprionate 0.05%
- long term surveillance for vulval carcinoma
- refer to dermatologist
- use non-soap cleanser
