Other Flashcards
Lithium side effects
Tremor
Weight gain
2D:Dizziness
Dehydration
2H: hypothyroidism
Hair loss
Azithromycin side effects
Nausea/vomit
Stomach upset
Steroid side effect
Weak bones
Thinning of hair
Weight gain
HTN
DM
Gynecomastia in males
Papilloedema
Glaucoma
Chlamydia symptoms & complications
Assymptomatic 50%
Symptoms: (5)
1.Pain: Testicular/pelvic
2.Bleeding: Postcoital /intermenstrual
3.Discharge: Urethral/ vaginal
4.Dysuria
5.Anorectal symptoms
Complications: (5)
1.Epididymoorchitis
2.PID
3.Reactive arthritis (arthralgia, hypertrophic rash on soles, circinate balanitis, psoriatic rash
can’t see=Conjunctivitis, Anterior Uveitis)
4.Ectopic pregnancy
5.Infertility
Carbamezepine side effects
TAD:
Tinnitus
Ataxia
Diplopia
Ethosuxemide side effects
GIT: N/V/D
Anorexia
Rash
Side effects of Mood Stabilizer: Adult and Fetal
Side effects of Anti-Psychotic
Mood stabilizers SE: (3)
1.Tremors
2.increased Thirst
3.Heartbeat abnormalities
In babies: (5)
1.NTD
2.Developmental prob.
3.Heart defects,
4.Breathing
5.Liver
Antipsychotics SE: (5)
1.Drowsiness, Sleepiness
2.Weight gain
3.Risk for DM
4.Constipation
5.Stiffness
Specialist will adjust the dose.
1.Acute Dystonia (1-5D): muscle spasm
2.Parkinsonism: 1-4wk:
Rigidity,
Bradykinesia, Tremor
Tx: Change Anti-psychotic /Crossover
Diphenhydramine
3.Akathisia: 5-60Days
Restlessness,
Irresistible desire to move around
Tx: Propranolol, Diazepam, Benztropine
4.Neuroleptic Malignant Syndrome (wks-months):
Fever, unstable BP,
Rigidity,
Myoglobulinemia
Tx: Bromocriptine, Dantrolene
5.Tardive Dyskinesia (months-yrs):
Involuntary face/upper limb movement
Tx: Change medication
Conditions in which dopamine agonist is used
Bromocriptine:-
1.Parkinson
2.NMS (Neuroleptic malignant syndrome)
3.Pituitary Adenoma:
Bi-temporal hemianopia
Hyperprolactinemia
4.Breast abscess/post-partum psychosis: to stop lactation
MHA(Mental Health Act) definition
Victoria’s Mental Health Act 2014:
MHA (Mental Health Act) places people with a mental illness at the ‘center of decision making’ about their treatment and care.
It protects the ‘rights, dignity and autonomy’ (secrecy) of people with mental illness.
MMSE definition
Mini-Mental State Examination (MMSE) is a bedside test with a set of 11 questions
that doctors commonly use to check for:
cognitive impairment: (problems with
Thinking
Communication
Understanding
Memory).
Papilloedema causes
10= 2Tumors, 3Infections,
Trauma, Bleed/clot,
HTN: uncontrolled/IIH,
Med (CILT)
▪Tumors: 2
Brain tumor
Spinal cord tumor
▪Infections: 3
Encephalitis, Meningitis: (Inflammation of the brain)
Brain Abscess
▪Trauma:
head injury
▪Bleeding & Clotting
Bleeding in brain
Blood clot or a problem within certain vein
▪HTN: 2
Uncontrolled, life threatening HTN
Idiopathic intracranial hypertension
▪Drugs (CILT=)(Corticosteroid, isotretinoin, lithium, tetracycline)
HRT:-
1.Contraindications
2. Risks
3. Benefits
4. Inv
5. SE
6. Symptoms
Contraindications:-(6)
1.Bleeding: Undiagnosed vaginal
2.Clotting or stroke Hx
3.Active Liver disease
4.Heart- heart attack, uncontrolled blood pressure
5.Diabetes, Cholesterol
6.Hx of BOW (breast, ovarian, womb cancer)
Risks:-(5)
1.Thromboembolic disease:
2.DVT
3.Stroke
4.Gall bladder disease
5.Cancer-(BOW):Breast,Ovarian,Womb
Benefits:- (protective against)
1.Alzheimer’s diasease
2.Bowel cancer
Inv:- (8)
1. FBC, UEC, LFT
2. BSL, lipid profile
3.FSH, LH, estrogen
(FSH: main predicter, FSH & LH increase, Estrogen decreases)
4.Mammogram and HPV
Side effects:-(5)
1.Headache
2.Nausea
3.Breast tenderness
4.Bloating
5.Breakthrough bleeding
*Cyclical HRT for Peri-menopausal:-
continuous Estrogen for 28 days and Progesterone for last 14 days
VPRUS:
1.Vasovagal-
hot flushes,
heavy sweating
2.Psychological- mood changes,
sleep changes, depression
3.Reproductive-
vaginal dryness, itchiness, discharge
4.Urine symptoms-
burning and stinging
frequency
lump down below
5.Somatic-
muscle aches and pains
bone pain
Hx of fracture
HX of osteoporosis
Benzodiazepine Withdrawal Sx,
Eg of short acting & long acting Benzo.
Sx: (7)
irritability
sweating
tremors,
seizures,
confusion,
abdominal pain, N/V/D
Temazepam, Oxazepam : short-acting
Diazepam: long-acting
OSA Qs
STOP BANG + USA-AF
Snore
Tiredness
Obstruction (Apnea)
Pressure (BP)
BMI
Age >40
Neck size >17cm
Gender: M
URTI
Allergic Rhinitis
Asthma
School performance
FHx of sleep apnea
PEx OSA
GA: active/ alert/ drowsy? Adenoid facies? Any dysmorphic features( DS)? Any mouth breathing?
Vitals and Growth chart
E + ENT:
EYE: redness/ discharge/ watering
EAR: discharge? TM changes?
NOSE: discharge? Nasal crease?
With speculum: deviated septum? Pale, congested mucosa? Turbinate hypertrophy? Polyp/
FB/ Ulcer?
THROAT: any bad odor?
Pharyngeal erythema? Throat Congestion? Tonsillar hypertrophy or exudates? uvular deviation?
Adenoidal hypertrophy?
(Mallampati)
NECK: LN
Finish off with RESPIRATORY & CVS
Mallampati Score:
Class 1: Faucial pillars, soft palate and uvula could be visualized.
Class 2: Faucial pillars and soft palate could be visualized, but uvula was masked by the base of the tongue.
Class 3: Only soft palate could be visualized
Class 4: Cannot be visualized at all.
[Results are due to enlarged tonsils or adenoids / poor Myofunctional activity (swallowing pattern and tongue position at rest) and tongue-tie)]
Celiac Dx: Physical exam
Pallor
Mouth ulcers
Dermatitis herpetiformis
Pruritic, red, papulo-vesicular Lesion commonly on: Shoulders, Elbows, and Knees
(due to IgA deposits (anti-epidermal transglutaminase) in the upper dermis)
Short stature
Abdominal distension
Causative organism:
Croup
Bronchiolitis
Epiglottits
Virus:-
1.Croup- Parainfluenza virus
2.Bronchiolitits- RSV: Respiratory syncitial virus
Bacteria:-
3.Epiglottitis- Hemophilus influenza type B
Symptoms of DKA/
Hypoglycemia Qs
10=
1)confusion, drowsiness
2)blurring of vision
3)chest pain, palpitations
4)nausea or vomiting, tummy pain
5)tingling, numbness or weakness
DMARDs Side effects
N/V/D
Hairfall
prone to Infections
Urinary difficulty: Hx & Ddx
(think urinary and TRUSTAEI)
Hx:
Confidentiality
HOPC, (Other urine Q): open Q, Incontinence Q, amount
Pain: groin /tummy/ genital area
Trauma?
Bleed, Discharge, Rash, Vesicle
as/ Fever, N/V, Itchiness
Swelling, Lump
Neuro: Tingling, Numbness
Sexual Hx
HIV
Ca Q: LOW/A
TMAC
PM/SHx/FHx: Prostate, Stones, STI, HIV
SADMA
Dx:
Chlamydia, Gonorrhea
Ddx:
Syphilis , HSV, HIV, other causes for urinary difficulty like UTI,
pyelonephritis, prostatitis, glomerulonephritis, urethritis,
cancer(less likely)
Hypertensive Retinopathy stages, complications, Inv
1.Silver wiring
2.AV nipping
3.Flamed hemorrhages and cotton wool spots
4.Papilloedema and macular star
Complications: (7)
1.visual disturbances,
2.Memory loss,
3.Stroke
4.Heart failure, heart attack
5.May associate with diabetes (nerve damage).
6.Damage to kidneys,
7.Impotency
Inv:-
1.FBC, UEC, LFTs
2.TFTs,
3.BSL,
4.Lipid profile,
5.ECG and ECHO
6.Urine tests
7.USG abdomen- (Adrenal tumours)
8.Doppler for renal arteries
9.Dexamethasone suppression test. (Cushing)
10.ARR- Aldosterone to renin activity ratio. (Conn syn/Hyperaldosteronism)
What can I do to help reduce the risk SIDS ?
-Sleep baby on their back
-Keep head and face uncovered
-Keep baby smoke free before and after birth
-Provide a safe sleep environment night and day
-Sleep baby in a safe cot in parents’ room
-Breastfeed baby
RFx ovarian CA
Risk factor-(6)
1.Early menarche
2.Nulliparity
3.Infertility
4.PCOS
5.Endometriosis
6.Family history
Protective factor-(3)
1.Chronic anovulation (opp of early menarche)
2.Breast feeding: decreases the risk of breast and ovarian cancer (as pregnancy protective)
3.OCP (PCOS Tx)
Complications/ signs of blood transfusion reaction
Signs of Blood transfusion reaction:
MINOR: (9)
1.Fever
2.Chills,
3.Headache,
4.Malaise,
5.SOB,
6.abdominal pain,
7.back pain,
8.dark urine
9.Flushing of face,
Major:
Cerebral Vasoconstriction (rare complication): 2-7 D after procedure
Breech vaginal delivery risks and Mx
If breech presentation
were diagnosed prior to labor , ultrasound would have been of value to:
1.check your baby’s size,
2.type of breech presentation
3.check whether the fetal neck is extended.
However, as you are already in labor, ultrasound examination will probably be difficult to arrange
urgently.
Risks of
Breech Delivery: (5)
1.Fetal distress/ Asphyxia/CTG abnormality
2.Cord prolapse
3.Hip or shoulder dislocation
4.Fracture (femur, humerus and clavicle)
5.Prolonged /Obstructed labour esp if Big baby
Mx:-
As soon as your Membranes rupture, we would do a Vaginal examination to: (2)
1.Exclude Cord prolapse
2.Confirm the Type of breech presentation.
Continuous CTG monitoring:
to pick up any abnormalities during Labor and Delivery.
Immediate Caesarean section if: (2)
1.slow progress/ inadequate progress of labor
2.fetal distress /CTG abnormality
Reassurance: (But do not be stressed, a successful outcome
of labor can be anticipated with your condition.)
Hysteroscopy indication
=7
1.Polyp
2.Fibroid
3.Adhesions
4.Defects of uterus
5.IUD- DUB
6.Fertility problems-Subfertility- SHG
7.PPH
DM pt with Hypoglycemia Qs, Red Flags
can ask q regarding:
HOPC: what symptoms u had b4 hospitalisation?
1)Overdose: any change in dosage by you or GP?
2)Skipped meal, change in diet: Did u have a lighter meal or skip your meal altogether?
3)R/O Dehydration:
a.excessive exercise
b.any infec
c.diarrhea
(bcoz infec coz glycemic control prob and hypoNa),
4)Self-care: how often u measure bsl, last checkup
1st time?
Mild symptoms like feeling (4)
hungry,
sweaty,
hand shakes or
funny racing of the heart.
Severe symptoms like (4)
Loss of concentration,
confusion,
fits
or even Loss of consciousness.
C&C GYN invasive procedures
ECTROPION:
1)Cryotherapy
2)Laser Ablation
3)Electrocautery
WARTS:
1)non-invasive…med & injection
2)Cryosurgery
3)Laser
4)Electrocautery
5)Excision
5)Minor Surgery
HPV: (same as Warts except Cone Bopsy)
1)Cryosurgery
2)Laser
3)Electrotherapy
4)Loop excision
5)Excision/Surgery
6)Cone Biopsy: Cone shaped segment
Endometriosis:
1)Medical: Contraceptive methods
2)Laser
3)Electrocautery
4)Laparoscopic Excision
DUB:
1)Medical: Mefenamic/ Contraceptive methods
2)Endometrial laser ablation
3)ElectroDiathermy (Ds: DUB & Diathermy)
4)Excision
5)Hysterectomy
Endometritis:
1)PCM
2)IV Antibx AUGMENTIN + Gentamicin + Metronidazole) and when you start responding then Oral Augmentin
3)IV Oxytocin
+/- IV/IM Ergometrine
4)If RPOC: EUA, Gental Blunt Curettage
5)If Episiotomy: Swab & Restitch
(look out: Electrocautery in Endometriosis, Ectropion, Warts, Electrotherapy in HPV, Electrodiathermy in DUB, Curretage in Endometritis)
Questions of blood thinners:
role-play 76
2. Warfarin counselling- missed INR check, Took pills on travel, type of food(leafy, Vit K, cranberry, binge drinking, (aspirin/NSAID) weakness, HA, B&B?
PEx: Fundoscopy, Turner/Cullen sign, Neuro, UA, ECG
Mx:
Skip 1 dose, Start with 2 mg
Daily INR for 1 week,and adjust dose
Folow up 2 Wkly then 4 Wkly.
role-play 68
4.Apixaban counselling: DVT?/elective?
stop 2D b4 and start 2D after surgery.
Keep blood products ready.
role-play 61
3.Bowel surgery with h/o warfarin: Must INR <1.5
role-play 47
5. Pre-operative counselling of anticoagulant to a pt with DES: Clopidogrel/not + Asprin
add after 78
Symptoms of hyponatraemia
causes of hyponatremia
▪ Symptoms of hyponatraemia – irritability
confusion
weakness
seizures
▪ Causes of hyponatraemia –
V/D
Trauma
Temperature(heat exposure)
H/O Heart failure
Liver failure
Renal failure
increased water intake
(psy: Polydipsia)
SIADH(Syndrome of Inappropriate Diuretic Hormone): Carbamezapine?
Drugs llike Indapamide?
PEx head injury
General appearance
: alert and conscious? GCS?
No racoon eyes, no battle sign,
No hemotympanum ,
no otorrhea or rhinorrhea
Cervical spine exam
: no rigidity , full active and passive movements ,
Spurling’s sign
Cranial nerve exam:
No cerebellar signs
CVS
, respiratory and abdominal exam
C&C: Drugs (1st & 2nd line) & Exclusion
Scarlet fever
Pertussis
Scarlet FeverDrug:
-Penicillin ( Phenoxymethyl ) for 10 days (2nd line oral agent:Cephalexin X 10 days ,
Anaphylaxis to beta beta-lactam antibiotics (penicillin and cephalosporins):Roxithromycin X10 days
Exclusion 24 Hr after Tx started
Pertussis Drug:
Azithromycin 5 D, if allergic Trimethoprim Sulfamethaxazole
Clarithromycin syrup (if cannot swallow)
Exclusion 5 D after Tx started
Hormones responsible for exercise induced amenorrhea.
High: beta endorphin and catecholamines
Referrals
???
AAA: Arthritis Association Australia
LFA: Lung Foundation Australia
DSAA: Down’s Syndrome Australia
Synapse
Crohns and colitis Australia
Alcohol Anonymous
Crisis Control center (Grief reaction)
Fall prevention clinic
Podiatrist
Speech therapy?
CAT team
IBD helpline
Quit line (for smokers)
Rehab
Speech and language therapists
Physiotherapist
Emotional and Behavioural Therapists
Psychologists
Bulimia support group
Beyond blue
Psycho education?
Social worker
Centrelink
Diabetes Australia
Audiologist: ADHD, Autism
Community Asthma program
Asthma foundation
RCH child health info center: Enuresis/ Asthma
PFLAG: Parents and Friends of Lesbians and Gays: Gender dysphoria
Family Planning Victoria: for Gays
Viral URTI due to Chemo
psy cases
autism: Applied behavior analysis
depression
empty nest syn
anniversary grief reaction
normal grief reaction
adjustment d.
PTSD: CBT,Trauma Based Therapy, SSRI
rape
domestic violence
addictions
mania
ECT counselling
* GAD
2. Superficial cut risk assessment
3. OCD: CBT,Exposure and response prevention, SSRI
Panic disorder with Agoraphobia: CBT,Exposure and systematic desensitization, SSRI
Body dysmorphic disorder
Bulimia Nervosa:
Inv : FBE, ESR/CRP, UEC,ECG Tx:SSRI, bulimia support groups.
Psychiatry 4
1. Substance abuse
* Alcohol 🍷 counselling
* Smoking 🚬 counselling
* Marijuana counselling
* Heroin addiction
* BDZ dependancy
Gender dysphoria
Gay
keep diary
DM
HTN
INR
Allergies incl Hives
Celiac
OCP to be stopped in
HTN
Headache
Breast CA/lump
Cervical CA?
DVT/PE
Ectropion
Vaginal Candidiasis
Tx duration
Orbital Cellulitis 14 D Tx
Mastitis 5 D
Endometritis:
1.Antibiotics- IV (amoxiclav+ gentamicin+metronidazole)
Once IV response then
10 days of Augmentin
2. IV oxytocin (+/- ergometrine)……..
SE Benzodiazepine
The most common side effects of benzodiazepines include:
drowsiness.
light-headedness.
confusion.
unsteadiness (especially in older people, who may fall and experience injuries)
dizziness.
slurred speech.
muscle weakness.
memory problems.
Recurrent candidiasis: RFx
BV Ix
Atrophic Vaginitis Tx
Recurrent candidiasis: 4 episodes or more in 1 year
Causes:
Pregnancy
Immune deficiency states
Medications like steroids
Antibiotics
Oral contraceptive pills
Diabetes
Usage of vaginal douches or creams
BV Ix:
high vaginal swab for microscopic c/s, wet film & PH
Atrophic Vaginitis: Local E cream, TVS for Endometrial wall thickness
Ferrous sulphate syrup SE
1.Teeth staining
2.Constipation
3.Black colored stools
Double or triple Dx cases
Pulmonary edema due to CHF due to fluild overload
Diabetic Ketoacidosis with Dehydration
HF due to Infective Endocarditis
HF due to COA
COPD exacerbation due to Pneumonia/Pneumonia with COPD exacerbation
Cereballar metastases secondary to lung carcinoma
Vasovagal + HypoGlycemia
Peripheral neuropathy+DM retinopathy+Arthritis
