June 3rd 2021 Flashcards
64F, 6/52 hx of nasal discharge/facial pain, worse past 2 weeks, double sickening, febrile and unwell, 20py smoking, vitals normal, 4 questions to exclude serious cause
- severe headache
- any vision changes?
- any meningism?
- hearing changes?
- severe epistaxis
64F, 6/52 hx of nasal discharge/facial pain, worse past 2 weeks, double sickening, febrile and unwell, 20py smoking, vitals normal, rhino sinusitis, 2 pharma
Amoxicillin 500mg, PO, TDS, 5/7
Paracetamol 1G, Po, QID
64F, 6/52 hx of nasal discharge/facial pain, worse past 2 weeks, double sickening, febrile and unwell, 20py smoking, vitals normal, 1 investigation
CT scan sinuses
14F, recurrent headaches, last 12-24hours, throbbing, unilateral, severe can’t go school, 2-3 each month, nausea, vomiting, 3 further questions psychosocial?
- bully at school? cyber?
- abuse at home?
- gender identity issues
- body image disturbances?
- excessive night screen time?
14F, recurrent headaches, last 12-24hours, throbbing, unilateral, severe can’t go school, 2-3 each month, nausea, vomiting,, 1 single diagnosis
migraine without aura
14F, recurrent headaches, last 12-24hours, throbbing, unilateral, severe can’t go school, 2-3 each month, nausea, vomiting,2 Pharma treatment
ibuprofen 10mg/kg, PO, at start of headache, then 4-6 hours later
-sumatriptan 10-20mg intranasally
24M, left lower limb pain post ankle# 11/52 ago skiing overseas, flown back to Aus for ORIF, aspiration pneumonia, ICU 1/52, d/c 7/52 ago, physio, on oxySR 30mg, Po, BD, paracetamol, meloxicam, oxyIR 5mg, PO, PRN, ongoing pain in left leg, cold, prickly, burning, oedema, erythema, non-varicose superficial vein swelling, medial calf/tenderness on palpation, lack of hair on left calf, single likely diagnosis?
D,HA,G
-complex regional pain syndrome left lower limb
24M, left lower limb pain post ankle# 11/52 ago skiing overseas, flown back to Aus for ORIF, aspiration pneumonia, ICU 1/52, d/c 7/52 ago, physio, on oxySR 30mg, Po, BD, paracetamol, meloxicam, oxyIR 5mg, PO, PRN, ongoing pain in left leg, cold, prickly, burning, oedema, erythema, non-varicose superficial vein swelling, medial calf/tenderness on palpation, lack of hair on left calf, 4 Pharma changes for opioid weaning
- change to paracetamol/codeine 500/30mg, QID, PRN
- commence amitriptyline 5mg, Po, nocte
- increase meloxicam to 15mg, PO daily
- commence pantoprazole 40mg, Po, daily
53F, 2/7 hx left facial pain, woke from sleepy can’t work, can’t localise, jaw/temple, denies facial weakness, gardener, no reg meds, 20py smoking, non-drinker, 4 ddx
- left sided trigeminal neuralgia
- ramsay hunt syndrome/shingles
- migraine
- left sided giant cell arteritis
- sinusitis
- TMJ syndrome
- dental pain
53F, 2/7 hx left facial pain, woke from sleepy can’t work, can’t localise, jaw/temple, denies facial weakness, gardener, no reg meds, 20py smoking, non-drinker, 5 hx
- rash in/around the ears?
- changes in vision?
- jaw claudication?
- type of pain?electric/shooting?
- recent fever?
- grinding teeth
- shoulder/hip girdle pain
53F, 2/7 hx left facial pain, woke from sleepy can’t work, can’t localise, jaw/temple, denies facial weakness, gardener, no reg meds, 20py smoking, non-drinke, ESR is 120, 3 immediate management:
- start prednisolone 40-60mg, po, daily
- aspirin 100mg, po daily
- urgent referral to rheumatologist
- urgent referral to vascular surgeon for temporal artery biopsy
72M hispanic, elevated eye pressure, hx of T2DM, on metformin XR 1G, Hba1C 5.9%, perindopril 10mg, atorvastatin 40mg, dutasteride/tamsulosin 400/500mcg, BPH, denies headaches, visual changes, BP 120/80, HR 82, BMI 28, 3 risk factors
advanced age
diabetes
hypertension
72M hispanic, elevated eye pressure, hx of T2DM, on metformin XR 1G, Hba1C 5.9%, perindopril 10mg, atorvastatin 40mg, dutasteride/tamsulosin 400/500mcg, BPH, denies headaches, visual changes, BP 120/80, HR 82, BMI 28, 3 topical meds for open angle glaucoma
- topical beta blocker: timolol
- topical prostaglandins, latanoprost
- alpha adrenergic agonist: brimonidine
14M, 2/12 lower abdo pain, fatigue, weight loss 3kg, no constipation, diarrhoea, vomiting, generalised, worse after meals, more pain, phx asthma, enjoys school, no bullying tired all the time, sleep during the day, no food allergies, 10 hx questions
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a,c,d,f,g, h, i
- nature of pain
- illicit drug use
- recent fever
- rashes?
- trauma?
- PR bleeding?
- aphthous ulcers?
- body dysmorphia?
- low mood?
- sexually active?
- polyuria/dipsia
14M, 2/12 lower abdo pain, fatigue, weight loss 3kg, no constipation, diarrhoea, vomiting, generalised, worse after meals, more pain, phx asthma, enjoys school, no bullying tired all the time, sleep during the day, no food allergies, 7ddx
- leukaemia/lymphoma
- anorexia nervosa
- coeliac disease
- hyperthyroidism
- depression
- diabetes mellitus type 1
- inflammatory bowel disease
- adrenal insufficiency
- illicit drug use
