June 9th 2021 Flashcards
78F, hx HTN, mild dementia, odema/arythema both legs few months, not responding to abx, systemically well, no fevers. 2ddx
-venous stasis dermatitis
-pretibial myxedema
lipodermatosclerosis
-contact dermatitis
78F, hx HTN, mild dementia, odema/arythema both legs few months, not responding to abx, systemically well, no fevers. likely venous stasis dermatitis, 4 mx
- elevate legs when sitting or in bed
- potent topical steroid: bethamathasone 0.05%
- graduated compression stockings up to knees (if normal ABI)
- measure ABI
- daily moisturiser
- regular walks/exercise
78F, hx HTN, mild dementia, odema/arythema both legs few months, not responding to abx, systemically well, no fevers. likely venous stasis dermatitis, 5 complications
- hospital acquired infections - pneumonia
- falls
- delirium
- pressure sores
- DVT
- constipation
- insomnia
- deconditioning
- malnutrition
21M, recent immigrant from papua new guinea, ongoing cold, 8/52 productive cough, episode of blood streaked sputum, otherwise well no ETOH or smoking. 4 most likely ddx?
a,f,g
- primary tuberculosis
- atypical pneumonia
- pertussis
- bronchiectasis
- bronchitis
68M unilateral headache, pain 2/7 ago, persistent throbbing left temple, no usual headache, on statin, omeprazole PRN, afeb, HR:82, bp 138/87, O2 98%RA, 1 most likely dx?
left sided giant cell arteritis
68M unilateral headache, pain 2/7 ago, persistent throbbing left temple, no usual headache, on statin, omeprazole PRN, afeb, HR:82, bp 138/87, O2 98%RA, , likely GCA, 5mx
- 40-60mg, PO, prednisolone, daily to start for 4 weeks
- referral to rheumatologist
- low dose aspirin 100mg, po, daily
- regular review of ESR
- warn of possible vision impact if untreated
- side effects of weight gain on corticosteroid
4F vomiting 4/24 ago, cannot tolerate much fluids, no diarrhoea, no urinary symptoms, well yesterday, no sick contacts, no dehydration today. 1 single ddx?
acute viral gastroenteritis
4F vomiting 4/24 ago, cannot tolerate much fluids, no diarrhoea, no urinary symptoms, well yesterday, no sick contacts, no dehydration today. 4 important causes not to be missed?
- diabetic ketoacidosis!!!
- poisoning
- head injury
- appendicitis
- bowel obstruction
- sepsis
4F vomiting 4/24 ago, cannot tolerate much fluids, no diarrhoea, no urinary symptoms, well yesterday, no sick contacts, no dehydration today. likely gastro, 5 features of mx
- encourage frequent oral hydration
- exclude from kindergarten until 48/24 after last vomit
- hand hygiene
- warn about alarming signs that need review
- antiemetic - ondansetron 4mg
- reassure usually self resolving
37F 6/7 hx left-sided facial pain, periodic, lasts a few seconds each time, sharp short, dentist NAD, neuro-NAD, asthma on preventer only, otherwise well. single most liekly dx?
left sided trigeminal neuralgia
37F 6/7 hx left-sided facial pain, periodic, lasts a few seconds each time, sharp short, dentist NAD, neuro-NAD, asthma on preventer only, otherwise well, 4 mx including ix
- MRI brain
- carbamazepine MR 100mg, BD, PO
- avoid triggers - cold
- non-urgent referral to neurologist
52F, travel consult to east Timor - cultural exchange, will go to rural, hx of diet controlled hyperC, impaired glucose tolerance, allergic rhinitis, non smoker, 1-2SD, other than immunisation, 5 general advice
- avoid fresh non-cooked produce
- bottled water only including teeth brushing
- bed nets for mosquito protection
- wear long-sleeve and long pants when in rural areas
- beware of animal exposure for rabies
- avoid risky behaviour - road safety
- carry a first aid kit
- chemoprophylaxis for malaria
52F, travel consult to east Timor - cultural exchange, will go to rural, hx of diet controlled hyperC, impaired glucose tolerance, allergic rhinitis, non smoker, 1-2SD, other than immunisation, 5 malaria risk advice
- chemoprophylaxis for malaria - malarone
- -bed nets for mosquito protection when sleeping
- wear light coloured long-sleeve and long pants when in rural areas
- regular bug spray containing DEET
- avoid perfumes and aftershaves
- avoid activity at dusk/dawn
