Practice Exam Review Flashcards
Rx for anal fissure
Glyceryl-trinitrate 0.2% ointment topically
Causes of clubbing
Bronchiectasis
Interstitial lung disease
Granuloma annulare
Dorsum of fingers, handstand feet
Women
Place pink of skin coloured circles with smooth raised surface around the edge
Respond months to years
Associated with diabetes
May respond to topical/intralesional cortisone but often ineffective
Early primary open-angle glaucoma
Symptoms uncommon
Patient becomes aware of visual field loss when optic nerve atrophy is marked
May complain of missing stairs, portions of works missing, difficulty driving
Wolff-Parkinson-White syndrome
Delta wave and shortened PR interval
1% will develop life threatening arrhythmia
Seizure > 5 minutes
Midazolam 0.3mg/kg bucally or half dose for IV
How to titrate medications in palliative care in naive patients
Titrate with PRN oral morphine
morphine immediate release 2-5mg orally 1 hourly prn. Max 3 consecutive hourly doses or 6 doses in a 24 hour period
Calculate the total amount of opioid taken in previous 24 hours and give as
Morphine modified release (Kapanol)
OR continue immediate release opioid. Calculate 1/6 or the total amount of opioid taken in previous 24 hours and give that amount 4 hourly as regular immediate release opioid dose
If increase in regular opioid dose is required determine the number of breakthrough doses in prev 24 hours and response. If more than three breakthrough doses are necessary in a 24 hour period and have provided relief, add the dose amounts to the regular 24 hour dose
Don’t increase regular opioid by more than 50% at one time.
Prescribe regular laxative
In terminal phase can changing to sub cut injection or infusion
Reasons to use an alternative opioid to morphine in pall care
- Mod - severe kidney impairment -> buprenorphine or fentanyl
- Severe liver impairment
- Allergy
- Unacceptable dose related affects
- Difficulty swallowing
- Poor adherence to therapy and a transdermal patch is required
Opioid dose for breakthrough pain
1/12 - 1/6 of total amount of opioid taken in previous 24 hours immediate release
When changing opioids what to do
- Calculate total opioid taken in previous 24 hours
- Convert to appropriate opioid dose for new route of administration
- Start with 50-75% of calculated euqianalgesic dose then adjust to response
Fatigue, weight loss, tachycardia, hypotension, hyperpigmentation
Addison’s disease (hypocortisolism/)
Features suggesting RA (11)
- FHx
- Early morning stiffness >1 hour
- Swelling 5 or more joints
- Symmetry
- Bilateral compression tenderness of metatarsophalangeal joints
- RF
- Anti-CCP
- Symptoms present for longer than 6 weeks
- Bony erosions evident on xrays of wrists, hands or feat (uncommon in early disease)
- Raised inflam markers
- Rheumatoid nodules
Management of RA
- Induce clinical remission ASAP
- Maintain clinical remission
- Develop self management plan for exacerbation while awaiting specialist review
- Vaccinations UTD
- Monitor bloods (ADRs)
- Monitor for atherosclerosis, osteoporosis, depression, vasculitits, peptic ulcer disease, lung disease, neuropathy, Atlanta-axial involvement
- Educate need for long term treatment
- Lifestyle managment - exercise, Mediterranean diet, smoking cessation
Guardia
Tinidazole 2g stat
Cryptosporidium parvum
- travel to SE Asia, particularly India
- abdo pain, fatigue, flatulence, anorexia, fever, nausea, LOW
- self limited except when immunocompromised
Strongyloides
- consumption of contaminated water or infected soil (barefeet)
- usually asymptomatic but get present with diarrhoea
- Chronic infections can result in Strongyloides hyper infection syndrome
- Screen travellers with persistent diarrhoea or eosinophilia
Non parasitic causes of persistent diarrhoea in the traveller
- coeliac disease
- clostridium difficult
- med induced
- hyperthyroidism
- IBD
- post infectious lactase deficiency
- carbohydrate malabsorption
- colorectal cancer
Genu Valgum knock knees when is it physiological
Between 2-6
Reaches max at about 3 then gradually improves (straight at about 6-7)
Follow up required if intermalleolar separation is 10cm
Femeroacetabular impingement
Anterior hip pain - deep pain worse after periods of sitting
Iliotibial band syndrome
Pain on the lateral aspect of the knee where the band passes over the lateral femoral condyle
Red flags for hoarseness
- Smoking
- Dysphasia,
- Odynophagia
- Otalgia
- Stridor
- Haemoptysis
- Recent fevers, night sweats and LOW
- > urgent referral to an otorhinolaryngologist
History for hoarseness
- Heart burn
- Recent URTI
- Steroid inhaler (gargling post)
4.Recent surgery or trauma to neck or chest as RLN may have been damaged - Recent intubation
- Hypothyroidism
- Neuro diseases
- RA
9 Professional voice user
Examination hoarseness (7)
- Say AHHH for as long as possible. < 8 seconds likely pathological
- Cough - if breathy and ineffective - suggests poor glottis closure and impairment of vocal cord movement
- Stridor
- Lung expansion and auscultation
- Oral cavity and oropharyngeal exam
- CN
- Neck and thyroid for masses
When to refer for hoarseness
Persistent hoarseness for more than 3 weeks
ASD
- Impaired social communication and interaction
- Limited interests
- Repetitive behaviours
DD, ID., ASD
Developmental delay, intellectual disability, autism spectrum disorder and congenital abnormalities
What to order
Chromosomal microarray + fragile X syndrome screening with referral to a paediatrician
Who to refer dysmorphic patient to
Genetic services
Contraindications for the COCP
History of stroke, IHD, DVT, PE, HTN Migraine with aura Diabetes Liver disease >35 and smoker Obese
SCC
Fast growing keratitis tender lesion
Often indurated
Won’t clear with liquid nitrogen
May be mistaken for eczema
Bowen disease
Slowly growing red patch typically on legs of women
Maybe misdiagnosed as eczema
Treatment for tinea capitus
Oral terbinafine once daily for 4 weeks
What can be treated with topical terbinafine 1% cream daily for 1-2 weeks (4)
Recent onset localised tinea of:
- Trunk
- Limbs
- Face
- Between digits
Dose of oral terbinafine
250mg once daily for 2 weeks
what to use oral terbinafine for: (6)
- established tinea
- widespread tinea
- tinea which has been inappropriately treated with steroid
- not responded to topical
- on scalp, palms or soles
- inflammatory, hyperkeratotic or vesicular
How to treat tinea capitus
Oral terbinafine 250mg daily for 4 weeks
Treatment of onychomycosis
- confirm with clipping prior to treatment by micro
- oral terbinafine 250mg once daily for 12 weeks for toes and 6 was for fingernails
Post inflammatory hyperpigmentation and Melasma treatment
Hydroxyquinone 2% applied topically BDfor 2-4 months
