May 30th 2021 Flashcards
32F, 7/52 hand wrist feet stiffness, likely RA, as GP, 4 continuing measures of disease activity
- CRP/ESR
- number of tender and swollen joints
- duration of early morning stiffness
- functional assessment
32F, 7/52 hand wrist feet stiffness, likely RA, started methotrexate 1/12 ago, back for repeat, next review is in 2/12, 4 points of discussion
- confirm adherence with dosing regimen
- safe sex/contraception
- folic acid supplement weekly
- sun protection: photosensitivity
- influenza vaccine
- recommend no alcohol
16F, 2/7 of left mid foot pain, inverted foot, unable to weight bear, swollen ankle, base of 5th tender, 4 ddx
- left ankle inversion sprain of lateral ligaments
- left base of 5th avulsion fracture
- mid-foot joint sprain
- left peroneal tear
16F, 2/7 of left mid foot pain, inverted foot, unable to weight bear, swollen ankle, base of 5th tender, 2 mx
- 1G paracetamol
- non-weight-bearing as necessary progressing to partial-full per 3-4 weeks
78F 1/7 of left lower limb pain, no hx falls, fever, trauma, lives alone with 2 dogs, PhD CKD, htn, Osteoporosis, declined dialysis 3ya, on irbesartan, diltiazem 240mg, calcium 600mg, vitamin D3, denosumab, paracetamol, eGFR 3/12 ago was 23, ACR: 48.6, today vitals stable, BMI 26, LL red, purring, warm: U/S acute DVT, does not want hospital, 3mx steps
- commence oral warfarin with subcut enoxaparin subcut for 5 days until therapeutic INR achieved for 2/7
- educate on how to administer enoxaparin
- remain mobile/ambulate as tolerated
- risk of bleeding due to anticoagulant
78F 1/7 of left lower limb pain, no hx falls, fever, trauma, lives alone with 2 dogs, phx CKD, htn, Osteoporosis, declined dialysis 3ya, on irbesartan, diltiazem 240mg, calcium 600mg, vitamin D3, denosumab, paracetamol, eGFR 3/12 ago was 23, ACR: 48.6, today vitals stable, BMI 26, LL red, purring, warm: U/S acute DVT, does not want hospital, 6 mx for her CKD?
- discuss advanced care plan
- aim BP <130/80
- kidney function review every 1-3 months
- low salt diet <6G/day
- referral to dietician
- monitor calcium and phosphate levels
- monitor FBE for anaemia
78F 1/7 of left lower limb pain, no hx falls, fever, trauma, lives alone with 2 dogs, phx CKD, htn, Osteoporosis, declined dialysis 3ya, on irbesartan, diltiazem 240mg, calcium 600mg, vitamin D3, denosumab, paracetamol, eGFR 3/12 ago was 23, ACR: 48.6, BMI 26, BP 200/100, lower back pain, dipstick protein and nitrites, 4 ddx
- pyelonephritis
- subdural haematoma
- cerebrovascular accident
- uraemic encephalopathy
28M 2/7hx of genital rash, open relationship with female, trying to conceive, 4 M&F partners past 3 months, no STI screen, unknown immunisation, 2 genital warts over scrotum, no urethral discharge, new HIV positive: 4 points of discuss
a,d,f,g,j,i
- commencement of antiretrovirals is essential
- he should discussion with partner regarding conceiving
- refer to sexual health centre
- notifiable condition
- needs monitoring of CD4 and viral load
- must use barrier protection
28M 2/7hx of genital rash, open relationship with female, trying to conceive, 4 M&F partners past 3 months, no STI screen, unknown immunisation, 2 genital warts over scrotum, no urethral discharge, 2 points for contact tracing
- he can contact directly
- anonymous text based services: letthemknow.au
- assist from sexual health support service
28M 2/7hx of genital rash, open relationship with female, trying to conceive, 4 M&F partners past 3 months, no STI screen, unknown immunisation, 2 genital warts over scrotum, no urethral discharge, the female partner wants PrEP, how to council: 5 points:
- needs neg HIV test 7 days before commencing PrEP
- needs adequate renal function eGFR>60
- PrEP is safe in prep and breastfeeding
- needs PrEP for 21 days for adequate protection
- regular bloods 1/12, then 3monthly
- screen for other STIs
11/12F breathing, struggled since born, ‘mucous-y’ child, bronchiolitis x3 with hospital, now below 3rd centile weight, spontaneous wet cough, bilateral basal creps, 6 ddx besides CF
- chronic pneumonia
- recurrent bronchiolitis
- protracted bacterial bronchitis
- primary ciliary dyskinesia
- immunodeficiency
- bronchiectasis
11/12F breathing, struggled since born, ‘mucous-y’ child, bronchiolitis x3 with hospital, now below 3rd centile weight, spontaneous wet cough, bilateral basal creps, dx with CF, mum concerned about older children and future pregnancy, 3 points:
- older children should be tested for CF
- 1 in 4 chance of future children having CF, autosomal recessive
- option for genetic counselling
11/12F breathing, struggled since born, ‘mucous-y’ child, bronchiolitis x3 with hospital, now below 3rd centile weight, spontaneous wet cough, bilateral basal creps, besides cough: 4 possible presentations for CF
- failure to thrive
- pancreatic exocrine insufficiency
- meconium ileus
- sinusitis
16F, unprotected sex last night, does not want parents to find out, asymptomatic, first sexual encounter, no pmhx, no reg meds, no allergies: 6 priorities
- reassure doctor-patient confidentiality unless significant risk to herself/other/harming patient
- engage in non-judgemental approach
- assess if Gillick competent
- inquire if sex was consensual
- offer emergency contraception
- discuss safe sex: condoms
- discuss STI screen in 1-2 weeks
16F, unprotected sex last night, does not want parents to find out, asymptomatic, first sexual encounter, no pmhx, no reg meds, no allergies: 3 emergency contraception options
- levonorgestrel 1.5mg single dose
- referral for copper IUD
- ulipristal 30mg, PO, state
