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KFP Flashcards

1
Q

Initial pregnancy consult examination? (9)

A 
- Always
	○ BP
- Initial visit
	○ Height, weight, BMI
	○ Dental check
	○ Thyroid exam
	○ CVD - listen for murmurs
	○ Breast Exam  
	○ Abdomen - uterus size
	○ CST if due
	○ Urine - proteinuria (or ongoing if high BP, renal disease)
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2
Q

Investigations for initial pregnancy consult? (9)

A

(BFG CRUSHH)

○ Blood group
○ FBE

○ Genetic screening

○ CST
○ Rubella
○ Urine MCS
○ Syphilis
○ Hepatitis B/C
- HIV

NOT INCLUDED = Abdo blds + thyroid (UEC, LFT, TSH)

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3
Q

Initial Pregnancy visit - Management advice (6)

A
  • Influenza vaccine at any time (even if patient had for that year)
  • Iodine 150mcg daily
  • Folic acid 0.5mg daily (or 5mg if high risk)
  • 30 mins exercise, mod exercisex5 ○
  • Diet - Avoid Vitamin A, mercury, caffeine (2 cups coffee)
  • CST
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4
Q

Who gets an early OGTT in pregnancy? (7)

And when?

A

14 weeks

DM, PCOS, ATSI, PHx, BMI >30, age 40+, multiple pregnancy, previous impaired fasting BGL,

Ethnicities - SE Asian, Maori, Pacific Islanders

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5
Q

RF for PE? (6)

A 
Pregnancy
BMI >30
Malignancy
Immobilisation/Recent surg
COCP
Thrombophilia
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6
Q

Relevant history prior to breast ca consult? (8)

A
  1. Previous breast problems/Ix/Rx
  2. FHx
  3. Pregnancy history
  4. Recent breast trauma
  5. Nipple changes
  6. Nipple discharge, ducts + bleeding
  7. Breast pain
  8. Breast lump
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7
Q

Mod risk breast ca screening demographics and Mx?

A
  • 1 of below = Normal Risk
  • 2 of below = Moderate risk and increase screening

> 2 relatives (same side)
First degree relative
<50 yo at Dx

  • Annual screening from 40yo
  • Repeat every 1-2 years until 50, then go to normal
  • Refer to family cancer clinic for genetic testing
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8
Q

High risk breast ca screening demographics and Mx?

A

(Two first degree <50yo)

- Family cancer clinic

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9
Q

Nipple trauma/crack Mx (5)

A
  1. Feed from non sore breast first
  2. Pump express on affected side to maintrain supply
  3. Simple analgesia
  4. Break suction with finger when feeding
  5. Referral to lactation consultant for optimal fit
  6. Hydrogel to nipples or breast milk to soften before feed
  7. Ice pack to nipples when not feeding
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10
Q

Engorged breast Mx (4)

A
  1. Avoid giving baby other fluids
  2. Cold packs after feeding
  3. Wake baby for feed if more than 4 hours
  4. Use a good comfortable bra
  5. Simple analgesia
  6. Massage breast towards nipple whilst feeding
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11
Q

Mastitis non pharm Mx (4)

A
  1. Paracetamol
  2. Express after feeds if still in pain
  3. Drain affected side first
  4. Cold packs after feeds
  5. Lactation consultant to optimise fit
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12
Q

Nipple Pain DDx (6)

A
  1. Poor positioning/latching (most common cause)
  2. Breast pump (shield wrong size/suction too high)
  3. Breast engorgement
  4. Nipple vasospasm (worse with cold)
  5. Eczema/Psoriasis
  6. Mastitis
  7. Candida
  8. HSV
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13
Q

Intermenstrual bleeding causes (6)

A
  1. Recently starting contraception, missed pills, continuous use of active pills without having regular withdraw bleeds
  2. Medicines impacting on OCP metabolism (st john’s wort, grapefruit juice)
  3. Cervical/Endometrial cancer
  4. Cervical ectropion
  5. Uterine polyp
  6. PID/STI’s
  7. Pregnancy implantation
  8. PCOS
  9. Vaginal trauma
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14
Q

Post-coital bleeding causes (5)

A
  1. Cervical cancer
  2. STI (chlamydia commonly)
  3. cervical polyps
  4. cervical ectropion
  5. atrophic vaginitis
  6. Vaginal or vulval cancer
  7. Vaginal trauma
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15
Q

Causes of splenomegaly (5)

A 
CHF
Cirrhosis
Amyloidosis
Thalassaemia
Leukemia
Portal vein aneurysm
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16
Q

Causes of primary amenorrhoea (6)

A
  • Constitutional delay in puberty
  • Prolactinoma
  • Mullerian Agenesis - imperforate hymen
  • Turner Syndrome - gonadal dysgenesis
  • Pregnancy
  • PCOS
  • Eating disorders (anorexia nervosa)
  • Adrenals - Hypothyroidism, Hyperthyroidism, CAH
  • Ovarian tumour
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17
Q

Investigations of primary amenorrhoea (6)

A
  1. FSH, LH, testosterone (PCOS), prolactin, TFT, b-hcg

2. Pelvic US

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18
Q

Causes of secondary amenorrhoea (6)

A
  1. Pregnancy
  2. Lactation
  3. Menopause/Premature ovarian failure
  4. Contraception SE
  5. PCOS
  6. Hyperthyroidism
  7. Prolactinoma
  8. Excessive exercise
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19
Q

Investigations of secondary amenorrhoea (6)

A
  1. FSH, LH, estradiol, prolactin (only if nipple discharge), TFT, b-hcg
  2. Pelvic US
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20
Q

Contraindications for COCP (9)

A
  1. Pregnancy
  2. Migraines with aura
  3. PHx VTE or FHx <45 yo with VTE
  4. PHx Oestrogen dependent tumours (breast, ovarian)
  5. CVD
  6. DM > 20years duration
  7. Severe liver cirrhosis
  8. Smokers >35 yo (>15 cigarettes/day) or quit in last year
  9. Breastfeeding <6 weeks postpartum
  10. Uncontrolled HTN
  11. Multiple CVD RF’s
  12. Postpartum up to 6 weeks
  13. Thrombogenic mutations (factor V Leiden, Protein C and S deficiencies)
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21
Q

Side effects of COCP (5)

A
  1. Breakthrough bleeding
  2. Nausea, headache,
  3. breast tenderness
  4. Abdominal bloating, fluid retention
  5. Acne, excess body hair
  6. Mood swings, depression,
  7. decreased libido
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22
Q

CI to implanon? (4)

A
  • Breast cancer in last 5 years
  • Developing stroke/IHD during use
  • Severe Liver disease
  • Unexplained suspicious vaginal bleeding
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23
Q

SE of Depot Provera (4)

A
  • Delayed return of fertility (up to 1 year following cessation)
  • Persistent menstrual irregularity
  • Slight increase in osteoporosis (long term use)
  • Weight gain (3kg in first year)
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24
Q

CI to IUD (5)

A
  • Previous PID, ectopic
  • Breast Ca Hx
  • Current chlamydia infection
  • Malformation of the uterus
  • Unexplained vaginal bleeding - suspicious
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25
Q

SE/Risks of Mirena? (4)

A
  • Breakthrough bleeding
  • Expulsion
  • Uterine wall performation on insertion (0.1%)
    Increased risk of ectopic pregnancy and PID
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26
Q

Colposcopy referral indications (4)

A
  • HPV 16/18 detected
  • HSIL detected
  • HPV any type in immune-deficient
  • Recurrent HPV present - 3rd time (3 strikes)
    ○ Only 2 strikes if:
    □ 50+yo
    □ ATSI
    - Overdue for screening by 2+ years
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27
Q

Who is not eligible for self collection CST? (4)

A

Pregnancy
Discharge/Bleeding/symptoms
Previous high risk
<30yo

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28
Q

Dysmenorrhoea Ix (4)

A
  • bhCG
  • Transvaginal U/S
  • FBE: infection,
  • STI screen
  • CST
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29
Q

Dysmenorrhoea causes (6)

A
  1. Endometriosis/Adenomyosis
  2. PID
  3. Fibroids/Uterine leimyoma
  4. Ovarian cyst
  5. Cervical stenosis
  6. Retained tampon
  7. Endometrial ca
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30
Q

Dyspareunia causes (6)

A 
Vaginismus 
Vulvodynia
Endometriosis
PID/STI
Vaginal atrophy
Dermatological - lichen planus/sclerosus, psoriasis
Cervical ectropion
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31
Q

What groups of people need early OGTT? (6)

A 
DM
PCOS
ATSI
PHx GDM
Age 40+
BMI >30
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32
Q

Causes of infertility (8) - Female

A
  • Endometriosis
  • PCOS
  • Fibroids/Polyps
  • PID/STI’s
  • Premature menopause
  • Hypothyroidism
  • Prolactinoma
  • Illicit drugs
  • Recent Depot Provera
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33
Q

Subfertility Ix to consider - female (7)

A
  1. Day 1-3 FSH and estradiol – Checks for ovarian reserve
  2. Day 21 progesterone - anovulation
  3. Prolactin - if discharge
  4. Free androgen index + free testosterone
  5. TFT’s
  6. HIV/Rubella
  7. Anti Mullerian Hormone - contraversial
  8. Pelvic US - 5-10 of cycle
  9. STI screen
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34
Q

Causes of infertility (6) - Male

A 
- STI
○ Mumps
- Varicocele
- Testicular ca
- Klinefelter syndrome
- Recent radio/Chemotherapy
○ Testicular injury
- Low sperm count
- Poor sperm motility
- Hyperprolactinemia
- Hypogonadotrophic hypogonadism (Kallman)
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35
Q

Premature menopause secondary risks? (4)

A 
Osteoporosis
CVD
Infertility
Depression
Autoimmune disease
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36
Q

Lifestyle advice for menopause? (6)

A
  1. Loose fitted clothing, avoid waxing/shaving
  2. Weight loss + exercise
  3. Avoid smoking, ETOH, spicy foods
  4. 1300mg calcium diet/day
  5. 400IU Vit D daily
  6. Yoga
  7. CBT
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37
Q

Cyclical combined HRT options (2)

A

Mirena IUD + daily 0.75mg oestradiol gel

12 days 200mg micronised progesterone + daily 0.75mg oestradiol gel

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38
Q

Continuous combined HRT options (2)

A

Mirena IUD + daily 0.75mg oestradiol gel

25 days 100mg micronised progesterone + daily 0.75mg oestradiol gel

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39
Q

CI to HRT? (6)

A 
○ 60+ yo	
○ Previous breast cancer
○ Previous endometrial cancer
○ Uncontrolled HTN
○ High risk VTE/Stroke
○ Undiagnosed vaginal bleeding
- Significant liver disease (relative)
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40
Q

Increased risks with HRT (5)

A

Cancers - breast and ovarian
VTE/Stroke
CVD

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41
Q

SE of HRT (3)

A

○ Breast tenderness
○ Change in menstrual bleeding
○ Nausea + bloating
- Irritation of skin if using patches

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42
Q

Types of Rx for menopause? (5)

A
  • HRT
  • tibolone
  • clonidine
  • gabapentin/pregabalin
  • SSRI/SNRI
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43
Q

Causes of menorrhagia? (8)

A 
PCOS 
Pregnancy/Miscarriage
Hyperprolactinaemia
Thyroid dysfunction (hypo)
Uterine fibroids (leiomyomas)
Polyps
Endometriosis/Adenomyosis 
Cancers: uterine and cervical
PID
Endometritis
Coagulation disorders
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44
Q

Investigations for menorrhagia? (8)

A 
Pregnancy test
TFT
FBE
iron studies
bhCG
coag studies (APTT, INR, fibrinogen)
STI screen
CST
US Pelvis - day 5-10
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45
Q

Treatment options for menorrhagia? (6)

A
  1. TXA oral 1g 6-8hrly for first 3-5 days
  2. NSAID
  3. COCP
  4. Mirena
  5. Medroxyprogesterone 150mg IM every 12 weeks
  6. Norethisterone 5-10mg QID until bleeding settles
  7. Endometrial ablation
  8. Hysteroscopy D+C
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46
Q

When to refer menorrhagia? (6)

A
  • Fibroids >3cm
  • Persistent bleeding >6 months despite treatment
  • Tamoxifen use
  • > 12mm thickness in pre-menstrual
  • PCOS
  • Suspected endometriosis/adenomyosis
  • Concurrent dysmenorrhoea
  • Polyps
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47
Q

Miscarriage Ix? (5)

A 
Group and hold
Transvaginal pelvic US
Serial hcg - 48hrs
FBE
Kleihauer (if more than 10 weeks)
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48
Q

Risk Factors for miscarriage (6)

A 
Advanced maternal age
Smoking
Illicit drugs
Overweight/Underweight
T2DM
Previous miscarriages
Septate uterus
Hyperthyroidism
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49
Q

Risk Factors for Ovarian Ca (5)

A
  • Nulliparity
  • FHx
  • Mirena use
  • Smoking
  • HRT use
  • NIL breastfeeding
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50
Q

Secondary risks with PCOS? (4)

A
  1. T2DM
  2. Infertility
  3. CVD
  4. Endometrial cancer
  5. Hirsutism/Acne
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51
Q

PCOS Mx (7)

A
  • If BMI >25, aim for 5-10% weight reduction
  • Exercise 30 mins x5
  • COCP
  • Metformin XR 1000mg daily
  • Quit smoking
  • OGTT every 3 years
  • BP checked annually
  • Lipids every 2 years (or yearly if abnormal)
    Depression screen
    Laser for hair
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52
Q

What infectious diseases in children need to stay away from pregnant women? (6)

A

TORCH PVZ

Toxoplasmosis
Other - Hep B
Rubella
CMV
Herpes Simplex

Parvovirus
Varicella
Zika

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53
Q

Postpartum visit things to ask (10)

A
  1. Labour, birth, complications, bleeding, progress since discharge
  2. Pain: perineum/ CS
  3. Breast issues: feeding/ pain
  4. Bowels/Bladder Urinary and faecal incontinence - pelvic floor exercises
  5. Intercourse and dyspareunia
  6. Bleeding
  7. Fevers
  8. Tiredness and fatigue
    - anaemia, postpartum depression, thyroid disease
  9. Safety and intimate partner violence
  10. Mental health/ sleep/ mood
  11. Social: substances (avoid ETOH with BF)
  12. Contraception
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54
Q

Pre-Eclampsia symptoms? (4)

A
  1. Headache
  2. Visual disturbance
  3. Epigastric pain
  4. Confusion
  5. Nausea/vomiting
  6. Retrosternal chest pain
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55
Q

Pre-Eclampsia examination (5)

A 
1. Abdominal palpation
		○ Foetal lie, fundal height, presentation
		○ RUQ/epigastric tenderness
2. Foetal HR
3. Tendon reflexes - hyperreflexia
4. Clonus
5. Urinalysis - proteinuria
6. Mental State Examination
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56
Q

Increased risks of pregnancy if diabetic? (5)

A
  1. Miscarriage/Stillbirth
  2. Macrosomia
  3. Shoulder dystocia
  4. Pre-eclampsia
  5. Preterm
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57
Q

Investigations to ALWAYS order preconception? (5)

A
  1. FBE
  2. Ferritin
  3. Genetic carrier screening
  4. Rubella
  5. Varicella
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58
Q

Preconception things to ask (8)

A

FLIP
Fertility issues
Lifestyle - exercise + diet, folic + iodine
Immunisations/Infections - STI’s, MMR, VZV
PMHx/psychosocial - domestic violence etc

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59
Q

Causes of early pregnancy bleeding? (5)

A
  1. Implantation bleeding (First 2 weeks only)
  2. Ectopic pregnancy
  3. Molar pregnancy
  4. Miscarriage
  5. Cervical ectropion/polyps/cancer
  6. PID/STI
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60
Q

Causes of late pregnancy bleeding? (6)

A
  1. Placenta praevia
  2. Placental abruption
  3. Vasa praevia
  4. Bloody show from ROM
  5. Cervical trauma/polyps/cancer/ectropion
  6. Uterine rupture
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61
Q

Causes of vulvovaginitis (7)

A
  1. Candidiasis
  2. Bacterial vaginosis
  3. HSV
  4. Irritant dermatitis
  5. Atrophic vaginitis
  6. Lichen planus
  7. Lichen sclerosus
  8. Psoriasis
  9. Trichomoniasis (if discharge too)
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62
Q

Non-pharm Mx of vulvovaginitis? (3)

A
  1. Loose Cotton underwear
  2. Non-soap cleanser
  3. Barrier cream/emolient
  4. Avoid vulval irritants (steroids, unless dermatitis, lichen planus/sclerosus)
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63
Q

CHADSVA

A 
Congestive HF 
HTN 
Age >75 (2) 
Diabetes 
Stroke/TIA (2) 
Vascular disease 
Age 65-74
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64
Q

Post AMI medications + dose (5)

A 
Aspirin 100mg daily 
Clopidogrel 75mg daily 
Atorvastatin 80mg daily 
Perindopril 2.5mg daily 
Atenolol 25mg daily
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65
Q

Automatically high risk and cannot use calculator (7)

A 
Diabetic >60yo 
ATSI >74yo 
Diabetic + microalbuminuria 
Moderate/severe CKD 
Familial hypercholesterolemia 
Total cholesterol >7.5 
SBP >180
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66
Q

Acne options + dose (5)

A
  • Benzoyl Peroxide 5% daily
  • Adapalene 0.1% daily
  • Doxycycline 100mg daily
  • Spironolactone 25mg
  • COCP
  • Minocycline 50mg bd
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67
Q

Secondary causes of HTN (6)

A 
OSA
Conn's, 
Cushing's 
Phaeochromocytoma
CKD, 
Fibromuscular Dysplasia
Coarctation of Aorta (kids)
Acromegaly
Thyrotoxicosis
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68
Q

When to treat Erythema Nodusum and Mx? (4)

A

Only if symptomatic as most resolve in 3-8 weeks

  • NSAID’s
  • Rest
  • Leg elevation
  • Cease COCP
  • Prednisolone 25mg daily for 2 weeks and taper
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69
Q

Psoriasis Rx options (4)

A
  1. Coal tar preparation 1%
  2. Mometasone furoate 0.1%
  3. Betamethasone diproprionate 0.05% daily for 2 weeks
  4. Calcipotriol topical cream daily
  5. UV phototherapy
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70
Q

Melasma Mx (4)

A
  • SPF 50+ sunscreen daily
  • Change to progesterone only contraception
  • Camouflage make up
  • Hydroquinone 2% cream bd for 2-4 months
    +/- tretinoin 0.025% cream topically daily
    (CI pregnancy)
  • Laser
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71
Q

Venous Ulcer Mx (5)

A
  • Compression bandage 40mmHg
  • Foam dressings twice/weekly
  • Stop smoking
  • Keep elevated
  • Weight reduction
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72
Q

Vitiligo Mx (4)

A

Pimecrolimus 1% cream (if on face)
Betamethasone diproprionate 0.05% daily for 3 months
Cosmetic camoflauge
Phototherapy

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73
Q

Wart Rx (4)

A
  • Salicylic acid 40% daily
  • Podophyllotoxin 0.5% paint (Anogenital warts)
  • Cryotherapy
  • Curettage
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74
Q

Who to screen 3 yearly for T2DM? (FBGL) (7)

A
  • High risk AUSDRISK >12
  • PCOS
  • FHx (1st degree)
  • Gestational diabetes
  • Antipsychotics use
  • 40yo + overweight
  • Indian/Pacific Islanders
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75
Q

Metabolic Syndrome Dx

A

Elevated waist circumference
>102cm men >88cm women and 3 of:

  • Triglycerides >1.7
  • HDL <1.0
  • SBP >130/85
  • FBGL >5.5
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76
Q

12 monthly T2DM investigations (6)

A 
HbA1c
UEC's
Hb
fasting lipids
B12 if on long-term metformin
uACR
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77
Q

Addison’s Mx/prevention of crisis (4)

A

Wear an alert bracelet/necklace
Increase glucocorticoids during illness
Carry injectable hydrocortisone when away from medical care
Recognise early features of adrenal crisis (severe cortisol deficiency - vomiting, dec LOC, dehydration)

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78
Q

Long-term Steroid SE’s (7)

A 
C – Cataracts
U – Ulcers
S – Striae, Skin thinning
H – Hypertension, Hirsutism
I – Immunosuppression, Infections
N – Necrosis of femoral heads
G – Glucose elevation
O – Osteoporosis, Obesity
I – Impaired wound healing
D – Depression/mood changes
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79
Q

Hyperglycaemia causes (non-diabetics) (4)

A
  • Trauma/Surgery
  • AMI/CVA
  • Endocrine
    • Cushing’s
  • Medications
    • Thiazide
    • Diuretics
    • Beta-blockers
    • Clozapine/Olanzapine
    Acute/chronic pancreatitis
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80
Q

Secondary causes of Osteoporosis (9)

A
  • Malabsorption e.g., coeliac disease
  • Eating disorders
  • Male hypogonadism
  • CLD
  • CKD
  • Hyperparathyroidism/Hyperthyroidism
  • Medications e.g., steroids >3 months, anticonvulsants, prolonged Depo Provera, prolonged proton-pump inhibitors (PPIs).
  • Cushing’s syndrome
  • Metabolic bone disease s (e.g., Paget’s disease, fibrous dysplasia, osteogenesis imperfecta, osteomalacia)
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81
Q

Lifestyle Mx of Osteoporosis (5)

A
  • Stop/reduce smoking and alcohol
  • Weight-bearing exercise
    ○ Reduces falls from balance and strength
  • Stop steroids
  • Vitamin D above 75 or 30 mins sunlight/day
  • Calcium rich diet - 1300mg daily
  • Prevention of falls
    ○ Improve vision
    ○ Household risks
    ○ Review medications
    ○ Walking aids
  • Suggest hip protectors
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82
Q

Indications for Osteoporosis Rx (4)

A
  • Minimal trauma # at hip/vertebrae
  • Minimal trauma with T < -1.5
  • T score < -2.5
  • Fracture Risk Calculator
    ○ >5% hip fracture
    >20% fracture anywhere else
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83
Q

Contraindications to ear syringe (5)

A
  • <10yo
  • perforated TM
  • Active AOM
  • Hx of ear surgery
  • Hearing loss
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84
Q

Complications of Infectious Mononucleosis (5)

A
  • Splenic rupture
  • Liver failure
  • Pneumonia
  • Haemolytic anaemia
  • Glomerulonephritis
  • Airway compromise
  • Pancreatitis
  • Myocarditis
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85
Q

When to give ABx for acute otitis media (6)

A

HIGH RISK

  • <2yo with bilateral AOM
  • Immunocompromised
  • <6 months old
  • Perforated/CSOM
  • Systemically unwell
  • Remote/ATSI
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86
Q

What makes tonsillitis likely to be bacterial? (5) (2 of 5)

A

2 of:

Temp >38
Tender cervical lymph nodes
Tonsillar exudate
No cough
3-14yo
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87
Q

Complications of tonsillitis (4)

A
  • Quinsy (peritonsillar abscess)
  • Acute rheumatic fever
  • Post strep GN
  • Reactive arthritis
  • Otitis media
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88
Q

Causes of CLD (6)

A 
NAFLD
Alcohol
Haemochromatosis
Chronic Hepatitis B/C
Hypothyroidism
Coeliac
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89
Q

Gastroscopy indications for GORD (5)

A
  • Anaemia, weight loss,
  • haematemesis, vomiting, dysphagia,
  • Changing severity of symptoms
  • Inadequate response to treatment
  • Diagnostic clarification
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90
Q

Complications of haemochromatosis (5)

A
  • Cardiomyopathy
  • Infertility
  • Hypothyroidism
  • Diabetes
  • Chronic Liver Disease
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91
Q

Chronic Hep B Mx (4)

A 
Stop smoking + ETOH
Condoms during sex
Ensure vaccinations UTD
6 monthly hepatocellular surveillance (USS + AFP)
Annual Hep B serology
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92
Q

IBD Rx (5)

A
  • 5 ASA (Sulfasalazine, Balsalazide, Mesalamine, Olsalazine)
  • Abx
  • Steroids course
  • Azathioprine/MTX/6MP (Mercaptopurine) - all immunosuppressive
  • AntiTNFa (anti-cytokines to reduce inflammation)
  • TPN
  • Surgery
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93
Q

Causes of pruritis without rash (5)

A
  • CKD
  • Cholestasis
  • Psychogenic
  • parkinson’s
  • Thyroid
  • Leukemia
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94
Q

Causes of Acute Pancreatitis (7)

A

I GET SMASHED

Idiopathic
Gall stones
ETOH
Trauma
Steroids
Mumps
Autoimmune
Scorpion/Spider bites
Hyperlipidemia/Hypercalcaemia
ERCP
Drugs
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95
Q

When can you break consent? (4)

A
  • Patient permission
  • Mandatory by law
  • Necessary discussion with other health professional
  • Duty to public health
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96
Q

Causes of poor health outcomes in ATSI? (5)

A 
Lower health literacy
Mistrust in western medicine
Lower financial situation
Overcrowding
High incidence of ETOH, smoking
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97
Q

Disability Pension Criteria (3)

A
  • intellectual, cognitive, neurological, sensory or physical impairments
  • Permanent
  • Sig functional impairment
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98
Q

Taxi discount criteria (4)

A
  • Risk of falls and cannot take public transport
  • Continence concerns
  • Recent strokes
  • Dementia/Cognitive
  • Blindness
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99
Q

Health Assessment Criteria (6)

A
  • 45-49 yo at risk of developing chronic disease
  • 40-49 yo T2DM Ax if high risk on AUSDRISK
  • 75+ yo - Permanent residents of residential aged care facilities
  • Intellectual disability
  • ATSI (annual)
  • Refugees and other humanitarian entrants
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100
Q

What components make a screening program worthwhile (4)

A
  • Important health problem
  • Understand disease progression
  • Simple, safe and economic
  • Needs to have effective treatment available
  • Benefits outweigh harm
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101
Q

TATT investigations (7)

A 
FBE
UEC
LFT's
TSH
ESR/CRP
BGL
Ferritin
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102
Q

Risk Factors for DVT (5)

A
  • Pregnancy
  • Post major surgery
  • Immobility
  • Obesity
  • COCP use
  • Smoking
  • Previous VTE
  • Varicose veins
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103
Q

Multiple myeloma Ix (4)

A
  • Serum protein electrophoresis/ Serum free light chain analysis
  • 24 hour urine collection for protein electrophoresis
  • Bone marrow aspirate
  • Urine Bence Jones Protein
  • PET scan
  • Skeletal survey
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104
Q

Causes of splenomegaly (4)

A 
CHF
Cirrhosis
Amyloidosis
Thalassaemia
Leukemia
Portal vein aneurysm
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105
Q

Medical high risk conditions for pneumococcal (11)

A
  • PHx pneumococcal disease
  • <28 weeks gestation
  • Immunocompromised
  • Cochlear implants
  • Intracranial shunts
  • Chronic Lung Disease and severe asthma
  • Chronic Renal Disease/ Liver Disease
  • Cardiac disease
  • Trisomy 21
  • Diabetes
  • Smoking (current or in the immediate past)
  • ETOH (>6 standard drinks/day for males and >4 standard drinks/day females)
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106
Q

What steps to take when there is cold chain breach (4)

A
  • Make list of patients who have received dose from batch
  • Contact Public Health Unit
  • Do not use further vaccines until advised, move and label them
  • Make incident report
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107
Q

Fever and rash in returned traveller DDx (5)

A 
Dengue fever
Chikungunya (West Africa)
Measles
HIV
Zika
Scrub Typhus
QLD tick typhus
Ross River Virus
Barmah Forest Virus
Meningococcal
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108
Q

Malaria symptoms (4)

A 
Dark Urine
Diarrhoea
Fever
Myalgia
Nausea
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109
Q

Indications for HIV PrEP (3)

A

HIV negative patients with mod risk (exposure in last 6 months of)

  • Shared injection with HIV+ or MSM
  • Condomless receptive anal or vaginal sex with HIV+ or MSM
  • MSM with rectal STD/syphillis
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110
Q

Ix to do before HIV PrEP (4)

A
  • Negative HIV antibodies and p24 antigen
  • UEC’s
  • Pregnancy test
  • Hep A/B/C and other STI’s

Will need ongoing CD4 count and viral load

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111
Q

Government funding for influenza vaccine (5)

A 
○ 6months – 5yo
○ Pregnant women
○ 65yo+
○ 6 months + with medical condition
- ATSI
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112
Q

BPH symptoms Mx (5)

A
  • Reduce caffeine/ETOH
  • Tamsulosin
  • Reduced evening fluid intake
  • Pelvic floor exercises
  • Treat constipation/fibre intake
  • Finasteride
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113
Q

Erectile Dysfunction causes (5)

A
  • Neurogenic (MS, Parkinson’s)
  • Vasculogenic (CVD, DM, smoking)
  • Psychogenic
  • Anatomical (Peyronie’s, Phimosis, Micropenis)
  • Hormonal abnormalities/Hypogonadism
  • Substances
  • Smoking/ETOH/Drugs/Medications
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114
Q

Erectile Dysfunction Ix (4)

A

Need to assess for CVD

  1. FBGL
  2. F cholesterol
  3. FBE
  4. UEC

Consider:
LFT’s
LH (high = gonadal failure, low =hypothalamic failure)
Testosterone

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115
Q

Gynaecomastia Ix (4)

A
  • serum testosterone
  • LH (hypogonadism)
  • FSH
  • TFT’s (hyperthyroidism)
  • oestradiol (Leydig cell)
  • serum hcg (testicular germ cell tumour)
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116
Q

SPC insertion CI’s (4)

A
  • Bleeding disorders
  • Pregnancy
  • Severe obesity
  • Lower abdo scar tissue
  • Pelvic cancer
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117
Q

4 common symptoms of ovarian ca

A
  • bloating
  • pelvic/abdo pain
  • early satiety
  • urinary frequency
  • constipation
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118
Q

NEXUS criteria for XR ?c-spine fracture (4)

A 
Midline cervical tenderness
Altered mental status
Focal neurological deficit
Evidence of drug/ETOH intoxication
Presence of other injury severe enough to mask neck pain
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119
Q

Ottawa knee XR rules (4)

A

Any of

Age >55
Unable to WB
Fibular head tenderness
Patellar tenderness
Can't flex knee to 90 degrees
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120
Q

Chickenpox complications (5)

A 
Bacterial skin infection
Dehydration from vomiting/diarrhoea
Pneuomina
Exac of asthma
Disseminated varicella infection
Thrombocytopenia
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121
Q

When to give zoster immunoglobulin (3)

A

High risk patient within exposure of 96 hours

  • Pregnant woman
  • Neonates
  • Immunocompromise

Check immunity first

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122
Q

Major Criteria for Acute Rheumatic Fever

A

CASES

  • Carditis
  • Arthritis
  • Subcutaneous nodules
  • Erythema marginatum rash
  • Sydneham chorea
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123
Q

Minor Criteria for Acute Rheumatic Fever

A

FACT

  • First degree heart block
  • Arthralgia
  • CRP/ESR - elevated
  • T >38
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124
Q

Bechet’s disease signs (4)

A

Mouth ulcers
Uveitis/Conjunctivitis
Arthritis
Genital sores

Treated with steroids

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125
Q

Triggers for Gout (4)

A 
ETOH
Soft drink
Red meat
Medications - diuretics
Trauma
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126
Q

RF for gout (4)

A

Male
Pacific Islander
ATSI
FHx

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127
Q

Acute gout options (4)

A
  1. NSAID - naproxen 500mg bd 3-5 days
  2. Low dose colchicine
    a. 1mg immediately, then 0.5mg 1 hour later
  3. Prednisolone
    a. 30mg daily 3-5 days
  4. ICS injection (if only 1 or 2 joints) Methylprednisolone acetate 40mg
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128
Q

Osteomyelitis RF (5)

A
  • recent trauma or surgery
  • immunocompromised patients
  • illicit IV drug use
  • poor vascular supply
    systemic conditions such as diabetes
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129
Q

Raynaud’s Phenomenon Mx (4)

A
  • CCB - e.g, amlodipine or felodipine
  • Stop smoking
  • Avoid beta blockers
    Use warm clothes/gloves
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130
Q

Causes of Raynaud’s Phenomenon (4)

A

• SLE
Scleroderma
• RA
Thyroid disorders

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131
Q

Cutaneous systemic sclerosis features (5)

A 
CREST
Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telengiectasias
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132
Q

Idiopathic intracranial hypertension RF (4)

A
  • Females
  • Pregnancy
  • OCP
    Doxycycline
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133
Q

Migraine characteristics (4)

A
  • Unilateral
  • Pulsatile
  • Mod-severe pain
  • Impacting routine
134
Q

Migraine triggers (4)

A 
Stress
Insomnia
Fatigue
Sunlight
Salty food
135
Q

Conditions associated with mononeuritis multiplex? (4)

A 
T2DM
SLE
RA
Amyloidosis
Vasculitis
136
Q

Peripheral Neuropathy examination findings (4)

A

10g monofilament sensation
Ankle reflexes
Vibration - 128Hz tuning fork
Pinprick sensation

137
Q

Restless Legs Syndrome Ix (4)

A

As associated with iron def, CKD and T2DM

  • FBE
  • HbA1c/FBGL
  • UEC’s
  • Iron studies
138
Q

Cataracts RF (4)

A
  • Smoking
  • Age
  • T2DM
    Excessive ETOH consumption
139
Q

Non LFT Ix findings in CLD (3)

A

Thrombocytopenia
Low albumin
INR increased
Hyponatraemia

140
Q

Decompensated Liver disease signs (3)

A

Ascites
Easy bruising
Peripheral oedema
Jaundice

141
Q

Alcohol related liver disease specific findings (3)

A

Dupuytren’s contracture
Proximal myopathy
Parotidomegaly

142
Q

Secondary conditions/states to cirrhosis (5)

A 
Variceal haemorrhage
Spontaneous bacterial peritonitis
Hepatocellular carcinoma
Hepatic encephalopathy
Ascites
Hepatorenal syndrome
143
Q

Genital warts Mx options (4)

A
  • No need for treatment if not causing discomfort
  • Cryotherapy
  • Imiquimod 5% cream, alternate days until warts resolve
    OR
  • Podophyllotoxin 0.5% paint, bd for 3 days followed by a 4-day break; repeat weekly until warts resolve.
144
Q

Sudden onset crying in infant DDx (5)

A 
UTI
AOM
Volvulus/Intussusception
Hair torniquet on fingers/toes
Raised intracranial pressure
Trauma
Corneal Abrasion
145
Q

Motor weakness in child DDx (4)

A

Spinal Muscular Atrophy
Duchenne’s Muscular Dystrophy
Prader Willi Syndrome
Cerebral Palsy

146
Q

Investigations to monitor for antipsychotics (5)

A 
FBE
Prolactin
FBGL
ECG
Lipids
147
Q

Urinary incontinence Examination (4)

A 
BMI - elevated
Abdo - palpable bladder/mass
Pelvic organ prolapse
Incontinence on coughing
Assessment of pelvic floor contraction
148
Q

Pharm for Overactive Bladder Syndrome (4)

A
  • Oxybutynin 5mg tds
  • Darifenacin
  • Estradiol pessary - 10mcg weekly
    Mirabegron 25mg daily
149
Q

Rheumatoid Arthritis Mx (3)

A
  • NSAID’s
  • Fish oil daily
  • Physiotherapy
  • Rest from exacerbating activities
  • Quit smoking
  • Early referral to derm/pred commencement
150
Q

4 factors to ensure before giving zoledronic acid in GP

A
  • Adequate Vit D
  • Adeqaute calcium
  • eGFR >35
  • Well hydrated patient
151
Q

Erythema Nodusum causes (4)

A 
Sarcoidosis
Crohn's
Idiopathic
COCP
Pregnancy
Strep Infection
152
Q

Papilloedema causes (4)

A
  • Intracranial mass
  • Venous malformation
  • Idiopathic Intracranial Hypertension
  • Hypertensive Retinopathy
  • Diabetic Retinopathy
  • Optic neuritis
  • Central Retinal Vein Occlusion
153
Q

Vitreous haemorrhage presentation (4)

A
  • Sudden
  • Often unilateral
  • Floaters/Flashes
  • Blurred vision -> Vision loss
  • Hx of trauma/DM
154
Q

Benign Rolandic Epilepsy presentation? (4)

A
  • Most common school age epilepsy
  • 3-13 yo
  • Simple focal seizure
  • Speech arrest
  • Usually night time
  • Preservation of consciousness
155
Q

SIMPLE Febrile convulsions criteria? (4)

A
  • Associated with fever
  • 6 months - 6 years old
  • Generalised with no focal neurology
    < 10 minutes
156
Q

HEADS DS Ax

A 
Home environment
Education
Activities
Drugs
Sexuality

Dieting/Exercise
Suicide/Safety

157
Q

Dementia blds to order? (9)

A

FBE, UEC, LFT’s, CMP, TFT’s, FBGL, lipids, B12, folate

158
Q

Anorexia nervosa admission criteria (5)

A 
BP <80
HR <50
QTc >0.45
Temp <35.5
Hypokalaemia
Postural drop >20
159
Q

Schizophrenia criteria

A

> 6 months of two or more:

  • Delusions
  • Hallucinations
  • Disorganised speech
  • Disorganised behaviour
  • Negative symptoms
160
Q

Schizophreniform disorder criteria

A

1-6 months of two or more: (1 must be top 3)

  • Delusions
  • Hallucinations
  • Disorganised speech
  • Disorganised behaviour
  • Negative symptoms
161
Q

Causes of hypercalcaemia (4)

A 
Malignancy
Vit D toxicity
Hyperthyroid/Hyperparathyroid
Thiazides
Sarcoidosis
Conn's
162
Q

Causes of hypomagnesemia (4)

A

○ GI - diarrhoea, malabsorption
○ ETOH
○ Diabetes
- Diuretics, PPI’s

163
Q

Causes of hypermagnesemia (3)

A
  • Excessive intake - antacids, supplements
  • Kidney impairment
  • Rhabdomyolysis
  • Lithium
164
Q

Excluding medications, causes of hyperkalaemia? (3)

A

Haemolysis of sample
Kidney failure
Addison’s
Rhabdomyolysis

165
Q

Nephritic Syndrome features (5)

A
  • Oliguria
  • Protein +
  • HTN
  • Haematuria

Mx = ED

166
Q

Causes of nephrotic syndrome? (4)

DAVID

A

Minimal change, focal segmental glomeurlosclerosis, membranous

DAVID

Diabetes
Amyloidosis
Vasculitis
Infection (Hep)
Drugs (NSAID's)
167
Q 
Proteinuria causes (7)
HMPH DINGO MEDS
A

HTN
Multiple myeloma
PCKD
Hepatitis

Diabetes
Infection - UTI
NSAID's
Glomerular - FSGS, minimal change, membranous
Orthostatic

Menstruation
Exercise
Diet
SLE

168
Q

What drugs to avoid on a sick day?

SADMANS

A 
Sulfonylureas
ACEi
Diuretics
Metformin
ARB's
NSAID's
SGLT2i
169
Q

What RF do we need to do renal check for annually? (5)

A 
Age >60
ATSI >30
DM
HTN/CVD
Smoker
Obese BMI >30
FHx CKD
PCKD/GN
170
Q

Symptoms of CKD (4)

A
  • Pruritis
  • Restless legs
  • Dyspnoea
  • Lethargy
  • Nocturia/Haematuria
171
Q

CKD referral criteria? (4)

A

CKD 4 or 5 (<30 eGFR)
Persistent sig albumin >30
>25% drop in eGFR sustained in 12 months
Uncontrolled HTN with CKD - already on 3 BP meds

172
Q

Long-term CKD, what history and O/E on r/v (5)

A
  • IUTD
  • Low salt diet <6g/daily
  • Exercise 30 mins x5
  • Stop smoking
  • BP <130/80
  • BMI <25
173
Q

CKD review, Ix (6)

A 
UEC's + uACR - frequency depends on CKD level
Annual:
FBE
lipids
glucose
Calcium
Phosphate
Parathyroid hormone (eGFR <45)
174
Q

When might eGFR be unreliable? (4)

A
  • Pregnancy (use creatinine instead)
  • AKI
  • Dialysis
  • CLD
  • High muscle index/extreme body size
  • Children
175
Q

When might uACR be unreliable?

A
  • UTI/STI
  • Menstruation
  • Acute illness
  • NSAID’s
176
Q

Kidney stones workup/Ix (6)

A
  1. CTKUB vs renal US (pregnant + children)
  2. UEC
  3. Serum uric acid
  4. Serum calcium +/- parathyroid hormone
  5. Stone analysis
  6. Urine MCS
177
Q

Kidney stones. When do we need to refer OR ED (4)

A 
Stones >6mm
Nil stone passed after 4/52
Single kidney
Renal impairment
Systemic infection signs/UTI
178
Q

Kidney stones <6mm conservative Mx (5)

A
  • Fluid intake to maintain 2L urine output daily
  • Low sodium/protein diet
  • CT KUB or XR in 4/52 if no stone found by patient
  • Tamsulosin 400 mcg daily for 4 weeks
  • Monitor for infective signs/deterioration
179
Q

Overactive bladder syndrome non-pharm Mx (5)

A
  • Bladder training
  • Avoid caffeine
  • Quit smoking
  • Weight loss
  • Avoid excess fluid intake
  • Pelvic floor exercises
  • Maintain soft and regular bowel motions
180
Q

Bladder training advice

A

○ Find longest day interval that patient can go without voiding
○ Then go when waking and before bed, and try to space out during the day by interval
○ Distraction techniques
○ Increase interval by 15 mins every 1-2 weeks

181
Q

When is vomiting during feeds concerning? (4)

A

Best question is: what are they like when they vomit? Happy or distressed?

Refusing to feed
Cough/Wheeze (resp)
Faltering growth
Haematemesis
Projectile
Bile
Bulging fontanelle
182
Q

Causes of lung cavitation? (5)

A 
Pulmonary TB 
Abscess
Malignancy
Sarcoidosis
Fungal pneumonia
Lymphoma
183
Q

Medications + duration to WH before spirometry

A

SABA 4 hours
SAMA 12 hours
BD LABA 24 hours
daily LABA/LAMA’s 36 hours

184
Q

Medical conditions that are CI spirometry (5)

A
  • Pneumothorax
  • Haemoptysis of unknown origin (TB)
  • Recent AMI
  • Thoracic aneurysms
  • Recent abdo/thoracic surgery
185
Q

Obstructive causes of spirometry (5)

A
  • COPD
  • Asthma
  • Cystic Fibrosis
  • Bronchiolitis
  • Bronchiectasis
  • Alpha 1 antitrypsin deficiency
186
Q

Restrictive causes of spirometry (5)

A
  • Pulmonary Fibrosis
  • Obesity
  • Neuromuscular disorders
  • Sarcoidosis
  • Diaphragmatic hernia
  • Ascites
187
Q

Triggers of asthma (6)

A
  • viral infection
  • cold weather
  • pollen
  • dust
  • animal hair
  • exercise
  • smoking
  • food
188
Q

When to commence ICS in asthma? (5)

A
  • Flare ups within every 6 weeks
  • > 2 past year requiring ED, oral corticosteroids
  • Persistent symptoms (daytime >2 per week, night time >2 per month)
  • Hospitalisations
  • Limitation of activity/sleep
189
Q

Reasons for poor asthma control? (4)

A 
Poor inhaler technique
Medications not increased enough
Incorrect diagnosis
Trigger exposure
Lack of understanding of asthma action plan
190
Q

Bronchiectasis prevention Mx (4)

A
  • Minimise resp infection exposure
  • Immunisations
  • Stop smoking
  • Exercise
  • Airway clearance with pulmonary rehab
191
Q

Clubbing NOT found in?

  • Bronchiectasis
  • Sarcoidosis
  • Lung Cancer
  • COPD
  • Interstitial Lung Disease
  • Cystic Fibrosis
  • Empyema
  • Pertussis
  • TB
A

SPC

  • Sarcoidosis
  • Pertussis
  • COPD
192
Q

Resp referral indications for COPD patient (6)

A
  • Rapid decline in function
  • Frequent chest infections
  • Haemoptysis
  • Ankle oedema
  • SpO2 <92% - for possible home O2
  • COPD <40yo
    Bullous lung disease on CXR or CT
193
Q

Indications for home O2? (4)

A

Long-term use, exercise, nocturnal or travel

O2 use >16 hours/day based on ABG
SpO2 <85% whilst flying
SpO2 <88% on 6 min walk test
SpO2 <89% for 30% of night

194
Q

Croup assessment (4)

A

CROW Stridor

Conscious state
RR
O2 sats
WOB - Accessory muscle use
Stridor at rest

HOWEVER, O2 sats are too late a sign in mild croup

195
Q

Triggers of urticaria? (5)

A
  • Exercise
  • new foods
  • medications
  • bite/sting
  • animals/latex/materials
  • infections (virus/cold)
196
Q

Dementia non-pharm Mx (5)

A
  1. my aged care r/f
  2. advanced care planning
  3. webster pack/home medicines review
  4. carer support/respite (social work)
  5. no driving until OT/specialist Ax
197
Q

Colonoscopy referral indications? (5)

A
  1. positive FOBT
  2. Unintentional weight loss >10% in 3 months
  3. Unexplained iron deficiency
  4. Change in bowel habit >50yo
  5. nocturnal diarrhoea
  6. Unexplained PR bleeding
  7. FHx of bowel cancer (immediate member)
198
Q

Bowel cancer non-pharm prevention? (4)

A

No smoking
No ETOH
BMI 18-25
Avoid red meat

199
Q

Causes of paeds chronic mouth breathing? (4)

A

Inferior nasal turbinate hypertrophy
Adenoid hypertrophy
Deviated nasal septum
Allergic rhinitis

200
Q

When to send pneumonia pt to hospital? (7)

A

Any of

HR >100
RR > 22
Sats <92%
Confusion
SBP <90
Multilobar Involvement on CXR
Blood Lactate Concentration >2mmol/L
201
Q

Patient groups who need high folic acid? 5mg (5)

A

DM, BMI >30, poor absorption (IBD)
Hx/FHx of NTD
Anti-epileptics
Thalassaemia

202
Q

When is aspirin indicated in pregnancy? (4)

A
  • PHx of pre-eclampsia
  • T1DM/T2DM
  • Multiple pregnancy
  • Renal disease, chronic hypertension
  • Autoimmune diseases such as SLE and antiphospholipid syndrome
203
Q

First trimester screening for pregnancy?

A

Dating scan (>8 weeks)

Screening =
○ Maternal serum test - PAPP-A, hcg (9-13 wks)
○ Nuchal thickness ultrasound (11-13 wks)

OR

Non-Invasive Prenatal Test (10+wks)

204
Q

Which of these are benign? (3)

  • Atypical lobular hyperplasia and lobular carcinoma in situ (LCIS)
  • Atypical ductal hyperplasia
  • Intraductal papilloma
  • Fat necrosis
  • Mammary duct ectasia
  • Radial scar or complex sclerosing lesion
A
  • Fat necrosis
  • Mammary duct ectasia
  • Radial scar or complex sclerosing lesion
205
Q

Signs of breast cancer (6)

A
  1. Thickening of ridge
  2. Breast or nipple asymmetry
  3. Skin changes as dimpling, redness
  4. Nipple changes
  5. Nipple discharge
  6. Unilateral breast pain
206
Q

Breast thrush (Rx only)

A
  1. Mother = flucanozole 150mg every 2nd day for 3 doses,
    then nilstatin 100, 000 units tds and micanozole QID on nipples
  2. Infant with micanozole oral gel QID 7 days, then once daily for 1 week
207
Q

When can’t you use PERC rule? (3)

A

PERC gross person (obese, amputated, cancer) C for cancer

Active cancer
Amputated limb
Morbid obesity

208
Q

When can’t you use Well’s score? (3)

A

Well person (pregnant, arm, 30 days) weLL for lower limb

Upper limb suspected
Pregnancy
>30 day’s since presentation

209
Q

Intermenstrual bleeding Ix (4)

A

bhCG
coags
Co-test
STI screen

Consider US Pelvis

210
Q

Post-coital bleeding Ix (4)

A

bhCG
coags
Co-test
STI screen

Consider US Pelvis

211
Q

Post-menopausal bleeding causes (4)

A
  1. Endometrial cancer
  2. Cervical/Endometrial polyp
  3. Cervical cancer
  4. Vaginal atrophy
212
Q

3 Emergency contraceptions, dose and time frame

A
  1. Levonorgestrel 1.5mg <3days
  2. Ulipristal acetate 30mg <5 days
  3. Copper IUD <5 days
213
Q

Increased risks of COCP (4)

A

VTE
Stroke/MI
Gall bladder disease
Cervical cancer

214
Q

Pyelonephritis admission criteria (4)

A

inability to tolerate oral therapy
fever (38°C or higher)
systemic symptoms (eg tachycardia, nausea, vomiting)
sepsis or septic shock

215
Q

Mild-moderate asthma attack features?

A

Sats >94%

Able to walk and talk in one sentence

216
Q

Severe asthma attack features?

A

Sats 90-94%

iWOB

217
Q

Critical asthma attack features?

A

Reduced consciousness
Cyanosis
Sats <90%
Poor respiratory effort

218
Q

Calcium scoring indications (3)

A

45-75
Intermediate risk
Asymptomatic

219
Q

Examination in fitness to drive? (5)

A 
Hearing assessment
Visual acuity
Visual field
Insight into cognition
Co-ordination
MSE
BGL
Peripheral neuropathy
220
Q

Conditions/Events that can impact fitness to drive (6)

A 
OSA
AMI
Stroke
Hypoglycaemia
Dementia
Co-ordination/Parkinson's
Vision problems/Cataracts
Epilepsy
221
Q

Cataracts RF? (5)

A 
Smoking
ETOH
Sunlight exposure
Age
T2DM
High dose corticosteroids
222
Q

Causes of flashes/floaters? (6)

A

Anything that “tugs” on retina

Retinal detachment
Vitreous haemorrhage
Posterior Vitreous detachment
Posterior uveitis
Retinoblastoma/Tumour
Optic neuritis
Migraines
TIA/Stroke
223
Q

Deranged LFT’s causes (8)

A

1) Panadol poisoning
2) non-alcoholic fatty liver disease
3) Hep B/C
4) Autoimmune hepatitis
5) Haemochromatosis
6) Wilson’s disease
7) Alpha-1 antitrypsin deficiency
8) Alcoholic liver disease
9) Coeliac disease
10) Hypothyroidism
11) Malignancy
12) PSC
13) PBC

224
Q

First line investigations for abnormal LFT’s (4)

A

Liver US
Hep B serology
Hep C serology
iron studies (haemochromatosis)

2nd line = AMSA, ANA, SPEP, TSH (hypothyroid), coeliac,

225
Q

Causes of oral candida? (3)

A 
Smoking
Dentures
Diabetes
ICS use
Poor oral hygiene
226
Q

MDD DSM criteria

A
  • 2 weeks of depressed mood AND/OR anhedonia with at least 3 of sleep/appetite/energy/suicidal/concentration
  • causes sig distress/impairment
227
Q

Cannabis overdose symptoms? (4)

A

Red eyes
Increased hunger
Sedation
Euphoria

228
Q

Methamphetamine overdose symptoms? (3)

A

Agitation
Sweating
Hallucinations

229
Q

Stable angina prevention Rx options (4)

A
  1. Atenolol 25mg daily
  2. Amlodipine 2.5mg daily
  3. glyceryl trinitrate patch 5mg for maximum 14hours/day
  4. Nicorandil 5mg bd
230
Q

Stable angina with LVEF <40%? Rx changes? (2)

A

Use heart specific beta blocker

Avoid heart specific CCB (because decreases output)

231
Q

What CCB’s to avoid with beta blockers? (2)

A

Verapamil and Diltiazem

232
Q

Non-pharm Mx of delirium? (5)

A 
Identify and avoid triggers
Time orientation aid (clock in room)
Regular leisure/exercise
Low stimulating environment
Speak calmly to reassure patient
233
Q

3 investigations for haematospermia

A
  • urine MCS
  • FBE
  • coag studies
234
Q

Differentials for sudden collapse in child? (8)

A 
Seizure
Breath-holding spell
Pseudoseizure
Conversion disorder
Drug withdrawal
Drug intoxication
Migraine syndrome
Vasovagal
Cardiogenic - arrhythmia
Cataplexy
Narcolepsy
Anaphylaxis
Intracranial bleed
Hypoglycaemia
Meningitis
235
Q

Common causes of confusion - nursing home? (5)

A 
Unrecognised Patient Abuse
Poor sleep
Unrecognised pain
UTI
Constipation
Depression
Sensory deficits (hearing/vision)
Paranoid delusions
236
Q

Non-pharm pain Mx for chronic pain? (4)

A 
Physiotherapy
Psych - CBT
Acupuncture
TENS machine
Nerve ablation
237
Q

Hydradenitis suppurativa Mx? (4)

A
  • Loose clothing
  • Stop smoking
  • Lose weight
  • Topical clinda/Doxycycline oral 100mg daily for 6 weeks
238
Q

Bronchiolitis assessment? (6)

A

RAW FOB

RR
Apnoeic episodes
WOB

Feeding
Oxygen sats
Behaviour

239
Q

Asthma assessment? (4)

A

Mild-moderate - can walk and talk in sentences

COWS

Conscious state
Oxygen sats <94% = severe
WOB
Speaking - sentences

240
Q

CAP assessment in paediatric?

A

COW TT

Conscious state
Oxygen sats
WOB

Tachycardia
Tachypnoea

241
Q

Peripheral arterial disease Mx? (5)

A
  • ACEi
  • Graded exercise regime
  • Stop smoking
  • Statin - max tolerated therapy
  • Aspirin 100mg daily or clopidogrel 75mg daily
  • Podiatrist for foot care
242
Q

Concussion Mx? (4)

A
  • Most take 1-4 weeks to recover
  • Gradual return to sport (2 weeks after contact sport)
  • Gradual return to school (1-2 days of rest)
  • Follow up in 1 week
  • Analgesia (Panadol) and ondansetron
243
Q

Concussion referral to ED criteria? (5)

A
  • Signs of skull or basal skull fracture
  • Focal neurological deficit
  • Any GCS <8
  • Failure to return back to normal >4 hours after incident
  • Suspected non accidental injury
  • Seizure
244
Q

Measles investigations?

A

Throat/Nose PCR
Urine PCR
Measles serology

245
Q

Gender changing therapy Ix (5)

A 
FBE
UEC
LFT
fasting lipids/glucose
oestradiol
testosterone
246
Q

Male to female types of therapy (3)

A

Feminising hormone therapy

Androgen reducing therapy

247
Q

Home med review indications? (6)

A 
5+ meds/day
12+ doses/day
Recent sig change
Recent discharge from hospital
Concerns for poor compliance
Concerns for cognition
Sub-optimal response
Therapeutic monitoring
248
Q

Memory loss DDx (4)

A

Dementia’s
MDD
Stroke
ETOH abuse

249
Q

Delirium Ix (7)

A 
FBE
UEC
LFT
TSH
BGL
ECG
O2
Calcium

CTB if old

250
Q

Institutions to contact for doctor workplace issues (5)

A 
College of specialty
AMA
AHPRA
Human Resources
FairWork
251
Q

Thrombophlebitis screen? (5)

A

Protein C and S
Antiphospholipid antibodies
Prothrombin gene mutation
Factor V Leiden

252
Q

Restrictive lung pattern causes (4)

A 
Coal workers pneumoconiosis
Asbestosis/Silicosis
Idiopathic Pulmonary Fibrosis
Hypersensitivity pneumonitis
Sarcoidosis
253
Q

Underlying conditions that can lead to carpal tunnel? (5)

A 
Idiopathic
pregnancy
DM
hypothyroidism
gout
rheumatoid arthritis
repetitive work with flexed wrists
254
Q

RF for dupuytren’s contracture? (5)

A 
Smoking
COPD
Alcoholism
Liver cirrhosis
T2DM
Heavy manual labour
255
Q

Causes of pericarditis (4)

A 
SLE
viral
HIV
Trauma
AMI
Vaccine
256
Q

Thyroid disorders referral? (5)

A
  • Pregnancy
  • Cardiac problems
  • Goitre/nodule
  • Unresponsive to therapy
  • Under 18yo
257
Q

De Quervain’s thyroiditis Rx? (3)

A

NSAID
Pred 40mg daily for 2 weeks
Propanolol 10mg bd

258
Q

Canadian c-spine criteria? (5)

A
  1. > 65
  2. paraesthesia
  3. Dangerous mechanism - fall >3m, axial load, MVA rollover/ejection
  4. c-spine tenderness
  5. unable to rotate 45 degrees
259
Q

ATSI Incentives? (4)

A

ATSI Health assessment
Closing the Gap
Integrated Team Care Program
Indigenous Health - Practice Incentive Program

260
Q

When to report a death to the coroner? (5)

A 
Unidentifiable patient
Suspicious death
Unknown/Unexpected cause of death
Following a healthcare procedure
Result after injury/violent
In police custody
Held in care (eg mental health facility)
261
Q

When to notify AHPRA of colleague conduct? (3)

A

REASONABLE BELIEF - observed

sexual conduct with patient
intoxication/drugs
impairment causing harm to patient
malpractice

262
Q

Reasons to end the doctor-patient relationship (4)

A
  • Sexual advance
  • Physical threat
  • Forged documents (eg certificate)
  • Theft from practice
  • Repeated missed appointments
  • Failure to pay for services
263
Q

When is it inappropriate to end the doctor patient relationship? (2)

A 
During acute illness
Contractual care (through workplace)
264
Q

Causes of acute vision loss? (7)

A 
Acute closed angle glaucoma
Retinal detachment
Vitreous haemorrhage
Central retinal artery occlusion
Central retinal vein occlusion
Orbital cellulitis
Temporal arteritis
Optic neuritis
Idiopathic Amaurosis fugax
Tumour (optic on nerve)
TIA
265
Q

Causes of chronic vision loss? (7)

A 
Chronic open angle glaucoma
Macular degeneration
Diabetic retinopathy
Hypertensive retinopathy
Cataracts
Refractive error
Presbyopia
Pituitary Adenoma
266
Q

Diplopia causes (6)

A 
Retinoblastoma
Cataracts
Graves' disease
Optic neuritis
Migraine
Multiple sclerosis
Strabismus
Refractive Error
267
Q

Eye discharge cause (6)

A 
Conjunctivitis
Nasolacrimal duct obstruction
Blepharitis
Keratitis
Peri/Orbital cellulitis
Foreign body
268
Q

XR findings for OA? (4)

A
  1. Subchondral sclerosus
  2. Narrow joint space
  3. Osteophytes
  4. Subchondroal cysts
269
Q

Limping toddler DDx

A 
Transient synovitis
Acute myositis
Toddler's fracture
DDH
NAI/Trauma
Septic/OM
Cancer
270
Q

3 ways to make sure patient’s don’t miss bad results

A
  • Computer based recall system
  • practice to develop automatic system when abnormal results are marked
  • protocol for doctors to cover for colleague absences
271
Q

DDx for 3 days of delusion symptoms (4)

A
  • Schizophreniform
  • Substance use
  • Schizoaffective
  • Manic episode of bipolar
  • Delusional disorder
  • Encephalitis
  • Brain occupying lesion
  • Brief psychotic disorder
  • Schizotypal personality disorder
272
Q

Mx morton neuroma (4)

A

Wide based shoes
Surgical excision
Metatarsal insoles
ICS injection

273
Q

Determining high risk of blood borne infections? (4)

A 
MSM
Overseas tattoos
Overseas transfusion
IV drugs
Sexual partner with blood borne infections
274
Q

Needlestick injury blds?

A

HIV, Hep B, Hep C

275
Q

Allergic conjuncitivitis non pharm Mx? (3)

A

Cool compress
Don’t rub eyes
Avoid triggers

276
Q

RF endometrial cancer (6)

A 
Unopposed oestrogen
Tamoxifen
Early menarche
Late menopause
Nulliparity
PCOS
Obesity
T2DM
FHx breast/ovarian ca
277
Q

How to improve compliance Aboriginal patient? (4)

A

Involve Aboriginal health care worker
Arrange Webster pack
Arrange home medication review
Arrange home visit bu district nurses/DNE
Organise access to closing the gap medication subsidy
Involve family member
Education on poor outcomes

278
Q

Ulcer examination? (5)

A 
Infection
Hair loss (arterial)
Peripheral pulses
Sensation/VIbration/Proprioception/Reflexes
ABI
Assess gait
Assess footwear
Joint deformity
279
Q

Leg Ulcer, What Hx questions? (5)

A 
Smoking status
Reduced sensation
Pain
What wound care has he tried
Systemic symptoms - fever
Claudication - arterial
History DVT
Discharge
Swelling
280
Q

Otitis externa Mx? (5)

A 
Dry toileting QID
Topical sofradex 3 drops tds for 7 days
Paracetamol
Keep dry using ear plugs 
Acetic acid + isopropyl alcohol drops after exposure to water (prevention)
281
Q

Scleroderma Ex findings?

A

CREST

Calcinosis
Raynaud's
Esophageal dysfunction
Sclerodactyly (thickened skin)
Telangiectasia
282
Q

Waking up tired DDx (5)

A 
Depression
OSA
Insomnia
Narcolepsy
Delayed sleep phase disorder
Illicit drugs
Hyperthyroidism
Anaemia
283
Q

Reasons for doing a CST early? (4)

A

Intermenstrual bleeding
Post-coital bleeding
Unexplained persistent D/C
Early sexual debut <14yo

284
Q

T2DM Screening

A

Annually

- Pre-diabetes
- ATSI >18yo
     3 yearly
	- >40yo (AUSDRISK only)
	- High risk AUSDRISK >12
	- PCOS
	- FHx (1st degree)
	- Gestational diabetes
	- Antipsychotics
	- >40yo and overweight
Indian/Pacific Islanders
285
Q

Haemorrhoids Mx? (3)

A

Fibre
Fluid
Avoid straining
Go only when urge to defecate

286
Q

Broad causes of mouth ulcers? (6)

A 
Infections
Trauma
GI disease
Nutritional deficiencies
Cancer
Immunodeficiency (HIV)
Contact/Irritant causes
287
Q

AF causes/RF (6)

A
  • Thyrotoxicosis (Hyperthyroid)
    • PE
    • HTN
    • Heart Failure, AMI, Valvular Heart Disease
    • ETOH
    • Surgery
    • Infection
      Dehydration
288
Q

History points of adequate breastmilk supply? (4)

A

5+ wet nappies
150g+/week
Waking spontaneously for feeds
Settling well after feeds

289
Q

Acute Rheumatic Fever Ix? (6)

A 
Anti-streptolysin titre
Anti DNase B 
Throat swab
ESR
Echo
ECG
FBE
290
Q

GAD symptoms (need 3 of 6)

A
  • Restlessness/on edge feeling
  • easily fatigued
  • difficulty concentrating
  • irritability
  • muscle tension
  • sleep disturbance
291
Q

Reasons for ambulatory BP (5)

A

® Nocturnal HTN
® Whitecoat HTN
® Masked HTN (normal clinic reading, but high amb)
® HTN despite treatment
® Pt’s with high CVD risk (even with normal clinic readin)
Episodic HTN

292
Q

ATSI STI screen?

A

Annual:
Syphillis, Chlamydia, Gonorrhoea

Consider:
Hep B, HIV, Hep C

293
Q

Which populations get STI Hep A tested too?

A

MSM, IVDU, sex workers (NOT ATSI)

294
Q

4 types of interstitial lung disease?

A

Idiopathic Pulmonary Fibrosis
Asbestosis/Silicosis
Hypersensitivity Pneumonitis
Sarcoidosis

295
Q

DEXA indications (6)

A

> 70 yo
Or:

○ Minimal trauma fracture/confirmed vertebral fracture on XR
○ Early menopause <45yo/Hypogonadism
○ >3 months glucocorticoid use
○ Coeliac/malabsorption disorder
○ Inflammatory arthritis
○ Hyperparathyroidism/Hyperthyroidism
CLD/CKD
296
Q

Facial pain DDx? (6)

A
  • TMJ dysfunction
    • Dental infection
    • Facial migraine
    • Sinusitis
    • Trigeminal Neuralgia
    • Glossopharyngeal neuralgia
    • Temporal arteritis
    • Multiple sclerosis
297
Q

Facial weakness DDx? (7)

A

Neuro

- Stroke
- GBS
- MS
- Bell's (idiopathic)
- Ramsay Hunt Syndrome (rash / VZV)

Ear

- AOM
- Otitis externa
- Cholesteatoma
- Acoustic neuroma

ID

- Mumps, Rubella
- EBV
- Sarcoidosis

Malignancy

- Parotid tumour
- Cutaneous cancer of face
- Lymphoma
- Cerebral tumour
298
Q

Haematospermia DDx (4)

A
  • Trauma
    • Prolonged sexual intercourse
    • Malignancy - prostate, bladder, testicular, urethral
    • Pain on ejaculation = tract obstruction or prostatitis
    • TB, schistomiasis
    • Bleeding disorders
    • HTN, CLD
    • Idiopathic
  • STI
  • UTI
299
Q

Haematuria DDx (6)

A

Mimics

- Menstruation
- Rifampicin, Nitrofurantoin
- Trauma
Renal
	- Malignancy
	- GN 
		○ Post-strep, IgA nephropathy
	- Hypertensive nephropathy
	- Analgesic nephropathy (panadol,NSAIDs)
	- PCKD
	- Renal stones
	- Prostatitis/BPH
	- UTI/Pyelonephritis/Cystitis
	- Angiomyolipoma
300
Q

Haemoptysis DDx (5)

A
  • URTI
    • Bronchitis
    • Chest contusion
    • PE
    • APO
    • TB
    • Pneumonia
    • Bronchogenic carcinoma
    • Bronchiectasis
    • Foreign Body
301
Q

Headache DDx (6)

A
  • Migraine
    • Chronic daily headache
    • Benign intercranial hypertension
    • Tension headache
    • Cluster headache
    • Temporal arteritis
    • Medication overuse headache
    • Intracranial lesion
    • Cervicogenic headache
    • Sinusitis
    • Meningitis
    • Trigeminal neuralgia
    • SAH
    • Post-coital headache
302
Q

Urinary incontinence/frequency DDx? (5)

A 
DM
UTI
Bladder cancer
Constipation
Overactive Bladder Syndrome
Pelvic organ prolapse
303
Q

Muscle weakness DDx (6)

A

Non-neurological

- Hyperparathyroidism
- Thyrotoxicosis
- B12 def
- Coeliac
- Polymyositis
- Dermatomyositis
Neurological
	- GBS
	- MND
	- Parkinson's
	- Stroke
MS
304
Q

Neck mass DDx (5)

A 
Thyroid causes - thyroiditis, TMNG
Thyroglossal cyst
branchial cleft cyst
lymphadenopathy
Lymphoma
Cancer - pharyngeal, thyroid
Sebaceous cyst
305
Q

Nipple Pain DDx (6)

A
  • Poor positioning/latching (most common cause)
    • Blocked duct
    • Inappropriate use of breast pump (shield wrong size/suction too high)
    • Infant with strong suck vacuum
    • Biting nipple
    • Tongue tie
      ○ Functional limitation with inability to protrude tongue over lower lip
    • High-arched palate

Physiological

- Breast engorgement
- Nipple vasospasm
- Hormonal sensitivity due to vasospasm

Dermatological
- Eczema/Psoriasis

Infection
- Mastitis
- Candida
Herpes Simplex

306
Q

Neonatal Jaundice causes (5)

A

○ ABO incompatibility
○ Hereditary spherocytosis
○ G6PD deficiency

  • Inadequate breastfeeding (dehydration)
    • Breastmilk jaundice - (unknown aetiology - ?unsaturated fatty acids inhibit glucoronyl transferase)
    • Haemolysis (causes above)
    • Breakdown of cephalohaemtoma/bruising
  • Hepatitis
  • Biliary Atresia - serious
  • UTI
    Hypothyroidism
307
Q

Restless Legs Syndrome Non pharm Mx (4)

A
  • Warm shower
  • Distraction (crossword)
  • Iron supps if needed
  • Regular sleep times
  • Nil caffiene
  • Nil ETOH
  • Exercise 150mins
308
Q

Worrying features of neck pain? (6)

A 
Sig trauma
Fever
Constant pain
Down's history
History of Ca
Night sweats
Age >50
Multiple site pain
Neurlogical symptoms
Ripping/tearing sensation
309
Q

Hyperhidrosis Mx (4)

A

Antiperspiration with aluminium hydroxy
Iontophoresis
Botox injections
Sympatheticectomy

310
Q

Cluster headache features (4)

A

Tearing
Unilateral (only affecting same side)
Severe
Male

311
Q

Causes of poor glucose control? (5)

A 
Obesity
Poor compliance
Illness
Antipsychotic use
Inadequate dose
Sedentary lifestyle
312
Q

Smoking assessment questions? (4)

A 
Time until first cigarette
Amount/day
Withdrawal symptoms/cravings
Previous attempts
Readiness to change
313
Q

Steps for quitting smoking for GP? (6)

A
  1. Assess motivation/motivaitonal interviewing
  2. Quit date
  3. Quitline referral
  4. Identify/remove barriers
  5. NRT + varenicline
  6. Follow up in 1-4 weeks
314
Q

Causes of APO? (4)

A 
AMI
PE
Infection
Fluid overload
Anaemia
AF
315
Q

DDx for behavioural changes in child? (5)

A 
Depression/Anxiety
ADHD
Autism
Hearing impairment
OSA
NAI
316
Q

Additional blds for malnutrition to do? (5)

A 
Vitamin A
Selenium
Zinc
INR
albumin
blood film
317
Q

RF for osteoporosis (7)

A
  • Female
    • Age
    • Smoking
    • ETOH
    • Calcium/Vitamin D deficiency
    • Steroid use
    • Low BMI
    • Low exercise levels
    • Caffeine
    • T2DM
    • Premature menopause or post-menopausal
      Causes increased bone resorption due to low estrogen
318
Q

Secondary causes of osteoporosis? (6)

A

□ Malabsorption e.g., coeliac disease
□ Eating disorders
□ Male hypogonadism
□ CLD
□ CKD
□ Hyperparathyroidism/Hyperthyroidism
□ Medications e.g., steroids, anticonvulsants, prolonged Depo Provera, prolonged proton-pump inhibitors (PPIs).
□ Cushing’s syndrome
Metabolic bone disease s (e.g., Paget’s disease, fibrous dysplasia, osteogenesis imperfecta, osteomalacia)

319
Q

DEXA indications (6)

A
  • > 70 yo
    • Or:
      ○ Minimal trauma fracture/confirmed vertebral fracture on XR
      ○ Early menopause <45yo/Hypogonadism
      ○ >3 months glucocorticoid use
      ○ Coeliac/malabsorption disorder
      ○ Inflammatory arthritis
      ○ Hyperparathyroidism/Hyperthyroidism
      CLD/CKD
320
Q

NAFLD Mx (non pharm) (4)

A 
Weight loss
Exercise
ETOH abstinence
Referral to dietitian
Consider liver US/biopsy
321
Q

Thrombocytopenia causes? (6)

A
  • Pregnancy
    • ITP
    • SLE
    • CLD
    • Medications - trimethoprim, doxycycline, vancomycin
    • Lymphoma
    • HIV/Hep C
      B12 deficiency
322
Q

Thrombocytopenia initial screen (5)

A

FBE, blood film, APTT, PT/INR, fibrinogen

323
Q

Causes of “burning” in toes bilaterally (5)

A 
Diabetic neuropathy
Chilblains
B12 deficiency
Arterial claudication
Erythromelalgia
324
Q

Meniere’s Mx? (5)

A

Acute attack
- Stemetil +/- anti-emetic

Chronic attack
	- Limit
		○ ETOH
		○ Caffeine
		○ Salt - <3g/day
	- Vestibular rehab
	- Diuretics- HCT 25mg daily
         - Betahistine
325
Q

IBS Rx? (3)

A

Hyoscine butlybromide
TCA - amitryptyline
Loperamide

326
Q

What blds to check after commencing antipsychotic?

A

6 months later:

BGL, lipids, prolactin, FBE

327
Q

Abnormal breast discharge DDx?

A 
Breast ca
Eczema
Duct papilloma
Duct ectasia
Prolactinemia
Drugs (OCP, antipsychotics)
328
Q

Causes of high prolactin? (4)

A 
Pregnancy
Prolactinoma
Medications - antipsychotics
Hypothyroidism
Breast stimulation from lactation
329
Q

Motion sickness Mx (5)

A
  • Distraction techniques - hard lozenge
    • Reduced sensory stimuli - eg closing eyes
    • Front seat in car, or sitting in wings of plane
    • Sitting upright
  • Avoid greasy food/eating close to travel time
  • Prochlorperazine 10mg daily PRN
  • Ondansetron 4mg tds
330
Q

Coeliac long-term Mx? (5)

A
  1. Education - Gluten-free diet
    1. DEXA bone scan
    2. Monitor and correct nutritional deficiencies
    3. Suggest screening and Ax of all first-degree relatives
    4. Dietitian review
      Annual review
331
Q

Things you need to do with patient or document to formulate a mental health care plan? (6)

A 
Provisional diagnosis
Discussion of goals
Discussion of treatment options
Arranging referrals
Plan for crisis
Psychoeducation provision
332
Q

Causes of urge incontinence (Male) (4)

A 
- Neurogenic
		○ MS
		○ Stroke
		○ Parkinson's
	- BPH
	- Prostatitis
	- Psychosocial
	- Idiopathic
	- UTI
	- Bladder Stones
	- Malignancy

Artha (4 decks)

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