May 23rd, 2021 Flashcards
3M bitten by cat, right forearm, 3 examination findings
- foreign body in the wound
- paralysis of hand, wrist
- neurovascular damage
- deep puncture wound
3M bitten by cat, right forearm, 1cm wound, 5 mx?
- irrigate with normal saline
- paracetamol 15mg/kg, PO, QID, PRN
- commence antibiotics, amoxicillin/clavulanic acid BD for 3/7
- early review in 2-3 days if infection develops
- remove foreign bodies
- elevate and immobilise for 48-72hours
3M FOOSH, clavicle #, middle 3rd
- broad arm sling right arm for 2 weeks
- paracetamol 15mg/kg, PO, QID, PRN
3M bitten by cat, right forearm, bruises let upper arm, back of torso, 3 ddx
- non-accidental injury
- accidental injury
- coagulopathy, von-willebrands’s
- platelet disorder
- leukaemia
3M bitten by cat, right forearm, bruises let upper arm, back of torso, 4 first line investigations initially
FBE
APTT
PT/INR
Fibrinogen
3M bitten by cat, right forearm, bruises let upper arm, back of torso, no underlying cause, 1 mx
mandatory reporting to child protection unit for concern of non-accidental injury
7F with 1/7 hx abdo pain, off food, RUQ, increased RR, URTI, no rash, immunised, not cooperative, no trauma, bowels NAD 6ddx
F, E
- diabetic ketoacidosis!
- acute appendicitis
- right lower lobe pneumonia
- urinary tract infection
- mesenteric adenitis
- gastroenteritis
7F with 1/7 hx abdo pain, off food, RUQ, increased RR, URTI, no rash, immunised, not cooperative, no trauma, bowels NAD RLL pneumonia, 4 clinical features of severity?
- O2 saturations less than 92-94%
- altered conscious state
- increased use of accessory muscles of respiration
- marked tachycardia
- tachypnoea
7F with 1/7 hx abdo pain, off food, RUQ, increased RR, URTI, no rash, immunised, not cooperative, no trauma, bowels RLL pneumonia, 38.5, RR 35, 98%RA, 3mx
- paracetamol, PO, 15mg/kg, QID, PRN
- amoxicillin 30mg/kg(max 1G), TDS for 5 days
- early review in 24-48hours
42M chronic pain from MVA, wants you to be new GP, ran out of oxySR and patch prescriptions, 6 immediate steps
- with permission contact previous/GP to verify
- check safe script
- explain legally not allowed to prescribe S8s without permit
- assess Marco’s injury
- assess for signs of misuse: IV track marks
- unable to prescribe until verified not a drug seeker
42M chronic pain from MVA, wants you to be new GP, ran out of oxySR and patch prescriptions, 8 long term management
- wean temazepam from 10mg-5mg
- wean buprenorphine to 15microg/hour
- wean oxySR to 20mg, PO, BD, aim to cease
- wean tramadol to 100mg, PO, BD
- prescribed paracetamol 1G, PO, QID
- prescribe a TCA: amitriptyline 10mg, PO, nocte
- refer for psychological support
- refer to chronic pain physiotherapist
- discuss return to work plan
42M chronic pain from MVA, wants you to be new GP, ran out of oxySR and patch prescriptions, 8 long term management good, ongoing sleep disturbance, 3ddx
- post traumatic stress disorder
- anxiety
- chronic insomnia
- opiate withdrawal
42M chronic pain from MVA, wants you to be new GP, ran out of oxySR and patch prescriptions, 8 long term management good, ongoing sleep disturbance, 5 hx
- active avoidance of accident reminders
- anhedonia
- depressed thoughts
- use of illicit substance
- sleep disorder, ?snoring
- caffeine use?
30F first time mum, 1/12 old son, concerned milk supply dropping, 4 hx son is getting enough milk
- feed frequency is appropriate
- gaining appropriate weight 150-200g per week
- producing 5-8 wet nappies a day
- settling well after feeds
- one soft stool per day
- wake for feeds by themselves
30F first time mum, 2/12 old son, concerned tender red area in left lower outer quadrant left breast, 5 mx features
- continue to feed as normal on left breast
- 500mg, flucloxacillin, QID, PO, for 5/7
- paracetamol, 1G, PO, QID, PRN
- check positioning/latching
- refer lactation consultant
- cold compress after feeding
