MISC Flashcards
BP
GEN POP: > 18 screening 2 yearly.
MOD RISK: 6-12 monthly
HIGH RISK: 6-12 weekly
EXISTING : 6 monthly.
CHOL
GEN POP: > 45, 5 yearly.
ATSI : > 35
LOW RISK: 5 yearly
MOD RISK: 2 yearly
HIGH/EXISTING: 6 monthly-12 monthly
DM
- Dx > 7 fast BSL;
- Dx > 11.1 Random BSL;
- Dx >6.5 HBA1c,
- Dx >7 + 11 OGTT
- 2 occasions
SCREEN w AUSDRISK: 3 yrly > 40, ATSI > 18.
HIGHER RISK : FASTING BSL/HBA1c 3 yearly
= >40 w obesity,
AUSDRISK > 12,
first degree relatievs w DM,
high risk race,
CVA/CVD,
women w GDM, (but normal OGTT post partum)
women w PCOS,
anti-psychotics
CKD
screen only if high risk: BP, ACR, eGFR 1-2 yearly.
= smoking,
BMI > 30
FHx CKD
DM
HTN
ATSI > 30
CVD/CHD/PVD
history AKI.
Impaired OGTT/fasting BSL/preDM
Impaired:
HBa1c 6-6.4–> repeat 1 year.
fasting BSL 5.5-6.9 –> OGTT
12 monthly fasting glu/HBA1c
OGTT NON PREGNANT
OGTT:
1) < 7.8 at 2 hours, but impaired fasting = IFG.
then retest in 1 year.
2) < 7 fasting, but >7.8- 11 2 hour = IGT .
then retest 1 year.
3) >7 + >11 = DM.
GDM
RF: previous GDM, hyperglycaemia; previously elevated BSL, hx IGT, > 40, ATSI, FHx DM in primary relatives/sister w GDM, prepregnancy obesity > 30, fetal macrosomia in previous pregnancy, PCOS, use of drugs causing hyperglyceamia.
High risk = test 12 weeks; otherwise 24-28 per guidelines
no HBA1c Dx, > 5.5% –> OGTT
GDM Dx at > 12 weeks
criteria:
fasting BSL >5.5
2 hour > 8
(can also have DM in pregnancy, > 7 fasting, >11 2 hour / random).
repeat OGTT 6-12 weeks post partum.
Behavioural modification
- ask, advise, asses, assist, arrange f/u # precontemplation: GP to raise doubt and increase patient preception of risk and problems w current behaviour. # contemplative: weigh up pro/con of change w the patien and work on helping tip balance: - exploring ambivalence, alternative. - identify reasons or chagne/risks of not changing - increase confidence w ability to change. # preparation: goal setting, SMART #maintenance: identify and use strategies to prevent relapse # relapse: renew process of contemplation and action without demoralisation.
PCV
GEN POP:
- >70 should receive prev13.
- or at tiem fo diagnosis w at risk condition (asplenia, immunosupp, lung path).
- otherwise child = x 3.
ATSI
- < 5yo = x 4 + pneumo23 at 4.
- >50, prev13
+ 12 mo later pneumo23 + 2nd 23 at 5yr
Catch up
1) Previous 23 dose.
• 1 dose of prev13 12mo after last 23 dose
- … only need 2 lifetime adult doses of pneumo23.
2) no previous pneumo 23 dose
- prev 13 asap, then pneumo23 + also give another 23, so total 2 doses – but needs to be at least 5 years after the previous 23, and at least 12 months post prevenar13
• Can given 2-12 months later if needed between 13 and 23.
smoking cessation
ax readiness to quit
use the scale – how much to do you want to quit? how much do you think you will be able to quit?
ax nicotiene dependence (>10/day, craving/withdrawls, < 30 mins from waking).
ask about past experiences/concerns.
SMART goal
non pharma
- behavioural support w regular appts
- counselling: Quitline
- cbt: deep breathe, drink water, do somethign else.
- best evidence: behavioural support + pharmacotherapy.
NRT
10/day = 21, > 10 = use also lozenger/gums.
1 x 12 week course on pbs; more for atsi/ctg
caution w post CVasc event. pregnancy try cold turkey first then rx.
varenicline: champix
12 weeks, starter pack + then contuing pack
dream/nausea/constipaton ; reduce w renal impairement.
can do up to 24 weeks on PBS and not smoking by 12.
nortriptyline
bupropion
- not w pregnancy, seizures, MAOI or EDs.
- reduce etOH required.
- 9 week course; caution w concurrent SSRI use
etOH
1) all about 6 months, need support, CBT, regular review, trusted supply
A) disulfiram 100mg OD
- cannot drink! bad reaction, inc. seizures/flushing/cvasc/autonomic,r elated to malabsorption
- need to be generally fit and well
B) acamprosate 666mg, 333mid + nocte
- really excreted
- not in acute periods of w/drawl
C) naltrexone
- not good for opiate concurrent use
- reduced pleasurable FX so good for binge drinking
- LFT monitoring pre/post.
glaucoma - chronic
IOP > 22
peripheral vision loss, usually has a FHx, usually incidental finding and open angle.
RF” advancing age, FHx, african descent, previous trauma, short sightedenss (myopia), systemic HTN, long term steroid use.
screening : > 40 = 2-5 yearly screening. if FHx then from 30 yo.
timolol BD. vs. latoprost OD. vs. OT
glaucoma - acute
IOP > 22
acute red eye w peripheral field loss, severe haeadche, photophobia, sometimes halos around lights
age > 60. fhx of same. female. myopia.
ED
opiaiod/antiemetic to stop vomitting
if ophthalm not available immediately: timolol drops; and acetazolamide/manniotrl
cataract
Sx vary depending on degree/site.
main cause of monocular diplopia, can also get halos around lights.
Cause: age, DM, smoking, steroids, RTx, TORCH, trauma, uveitis, dystrophia myotonic, galctosaemia.
OE: reduced red refelx, reduced VA, normal direct pupillary light reflex.
Prevent: sunglasses. control RF as above
Rx: ophthalm
NIPT
> 10/40 to about 14/40
about $350
cell free DNA + trisomy 21, 18, 12 + turners/kleinferlters + geneder
about 98-99% sensitivity
if negative, 1: 20 000 trisomy change, if positive –> almost diagnostic.
but its screening, rare, but there are flase negatives –> amnio/cvs.
also need to repeat uss , for morph.
takes 2 weeks for results
CFTS
9-13+6/40
trismony 13 (patau , 1st week, intel/birth), 18 (edwards - fatal pre birth/within first yr), 21.
85%-90% detection rate.
if high risk –> amnio/cvs. (1:20 will ahve pos diagnostic, otherws will be negative).
so screen positive rate is about 5% (NIPT 0.1%)
cocp adjustment
- nausea = reduce oestrogen, take at night, change to LARC, exclude pregnancy
- breast tenderness= reduce O/P, change P. consider alt. cocp : yasmin/yas
- bloating: reduced O. change P (yasmin/yas)
- headache : reduce O and or P change.
- dysmenorrhoea: skips sugar pills, increase/change P.
- decreased lipido: no evidence one type will change this over another
- BTB: increase O (to 30mcg/35mcg); change P type if already on 35. try alt.
- depression: not well linked, consider changing P
- weight loss: not well inked.
good for acne: yas, yasmin, diane/brenda/juliette (all the same)
Fibromyalgia
- non inflammatory MSK pain + fatigue, cognitive clouding, sleep changes
- not diurnal, constant pain
- RF: women, 40-50, anxiety history (IBS/headaches/urinary frequency)
- OE:
- pain on both sides, UL and LL, axial skeleton.
- tender digital palpation at > 11/18 specific sites.
- Ix: no specific – exclude alt w autoimmune screen.
- Mx:
- reassurance re: no inflammatory – not doing damage.
- ‘oversensitised alarm’ going off for pain –> need to ‘muffle’ it
- goal = manage pain, not remove it. improve QL
- ex phys, increase coping, CBT, goodsleep, educate family.
- can trial
- endep
- dulox 30-120
- pregab 25-75
*
Perma +
- Positive emotion:
- What have you gotten through, what makes you happy, what makes you smile
- Engaement
- Hobby/distraction/routine
- Releationship
- Who supports you/cares about you
- Meaning
- What gives you a sense of purpose
- Achievement
- What are you proud of? What have you gotten through?
- +
- Diet
- Exercise,
- Smoking
- alcohol
- sleep
- sleep
FM non pharma
- reassurance
- graded eerobic exercise program to improve fatigue/pain
- reduce situational stressors./ CBT coping strategies
- good sleep practices
- family education
chronic fatigue
- controversial diagnosis
- persisting fatigue with variet of somatic + cognitive symptoms
- diagnosis: presence of unexlpained persistent or relapsing fatigue,
- 6/12.
- not attributable to exertion.
- with significant functional impairmeent
- must be at leat 4 / 8
- post exertional amalaise alsting > 24 housr
- unfreshing sleep
- impaired memory or cocnentration
- muscle pain
- joint pain without swelling/erythema
- headache of new type/severity
- tender cervical/axillary LN
- sore throat.
- peak incidence 20-40 yo. women > men.
- ?post viral, altered immune function, neuropsych, enviro toxins/imms reactions all theoretical causes. no firm evidence fo any of these.
- difficult prognostication.
- Mx: MDT input
nephritic syndrome
- moderate to severe HTN
- haematuria
- GFR reduction usually mod/severe
due to
- post stre GP
- can be AKI (or nephrotic)
- IGA nephropathy (happens while you have the sore throat!)
Nephrotic syndrome
- cause:
- minimal change GN(most common cause)
- secondary: SLE / Dm / drugs
- BP mildly increased or normal
- normal/mild reduction to GFR
-
proteinuria
- ( >3.5g/day)
- hypoalbuminaemia
- oedema (facial)
bladder
- overactive = nocturia, increased urgency, consider oxybutynin. but a diagnosis of exclusion
- interstitial cystitis = cystological Dx; discomfort w bladder filling meaning they PU more often, only thing to relive that feeling
- incontinence
- stress - pelvic physio, weight loss.
- urge - same as for stress –> old more each time. consider pessary/oxybutynin for urge.
- mixed
- remember for all: fluid/caffine intake, smoking, oestrogen status, obesity. relation to intercourse (interstitial)
- remember for incontience: med SFX: alpha adrenergic, antidept, ccb, antihistmaine = sfx.
scrotal lump
- hydrocele - painless, gradual increase in size.
- epidydimal cyst - all ages, common, usuaully pea sized at top of teste, Rx w OT. benign
- varicocele - swelling of vein about teste. starts after puberty. can affect fertility. Rx w OT
- spermatocele - benign. contain sperm/sperm like cells. usually connected to teste.
- hydatdi of morgagni - lump / cyst at top of teste, movable.only painful if they twist. dont need Rx unless twist/Sx
- epidydmitis - obvious. STI.
- orchitis - obvious, dont forget mumps/rubella
- torsion - obvious.
- undescended teste - bloc off LHS inuignal + touch w R, should reach down to the bottom of scrotum, without pressure - then when you release shoudl pop back up. wait for 3/12 if palpable –> dont uss, then uss if still not there and refer.
remember undescended teste can also (ontop of interfility) cause cancer RF.
Hearing loss
conductve = bone > air
sensory = air + bone both reduced
mild = 20-40 (background noise issue)
mod = 40-60 (miss most convo, child = poor pronunciation)
severe = 60-90 (wont hear most speech, child = =delayed speech )
age related = mild/mod high frequency snhl both ears
uniltaeral SNHL = always think ddx acousitc neuroma
nsaids general
- naproxen 250-500 BD safest for Cvasc (Cox 1). (MR will increase GIT build up)
- diclofenax 25 - 50 BD/TDS (non selective) = safer for GIT but higher CVasc risk so avoid here. .
- cox 2 = better for GIT, try to avoid w Cvasc
- celexocib (100-200mg, OD to BD)
- meloxican (7.5-15mg, OD).
- most unsafe for cvasc = meloxican 15mg.
potentially can use fish oil - but in ghigh qquantities of tablets, up to 3 capsules OD.
PMR
morning stiffness >45 mins. hip girdle dicomfort. bilateral shoulder. proximal weakness. no other joints. > 2 weeks usually
pain improves post shower/activity.
Dx: Sx, raised ESR/CRP, rapid response to pred 15mg OD (BIRD CRITERIA).
+ negative RF/CCP
Mx: reduce pred down by 2.5 every 4-8 weeks. educate: long course; monthly blood initially. relapse common. gentle tapering required.
associated GCA- you know this. OE: bitermporal artery tenderness/pulselessness.
osteochondritis dissecans
child/adolescet.
pain/swelling at joint, brough on by sports.
can be knee/elbow/ankle.
Dx w XR
sometimes heals alone, if severe then can separate and float around –> OT
sen spec
