Practice Questions Flashcards
29 year old female No known PMHx Nil regular medications New relationship Wants to go back on COCP Up to date with CST
What are the 5 most important questions in hx to explore before prescribing her COCP?
FHx of thromboembolic event
Could she be pregnant/last menstrual period
Does she smoke
Current breast feeding
New pattern of headache to suggest migraine
Previous compliance issue with pill
29 year old female No known PMHx Nil regular medications New relationship Wants to go back on COCP Up to date with CST
What are 2 important findings in physical exam that you would need to document in her medical record?
BMI/Weight
Blood pressure
What are 3 management options for tinea/pityriasis veriscolor?
Topical ketoconazol/clotrimazole/selenim suffice/terbinafine (shampoo/cream) for 2/52
Advise that moistre is the usual underlying cause of this yeast-infection
Explain that the discolouration will take long time to resolve
Oral fluconazole/itraconazole
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
In assessing this patient, what further information do you need to ask (List 6)
Family hx of Prostate Ca
Haematuria
Rapid deterioration of symptoms
Impact on quality of life
Dysuria
Constipation
Incomplete emptying sensation
Polyuria/Polydipsia
Weight loss
Bone pain
Possibility of STI
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
Apart from BPH, give 5 more likely differential diagnoses for this presentaiton
Prostate cancer
Urethral stricture
Overactive bladder
Infections: Urinary tract infection
Interstitial cystitis
Bladder stone
Diabetes
Polydipsia /Excessive fluid intake
Constipation
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
Give the main 4 relevant features of physical exam to identify the cause of his presentation
Abdominal examination for bladder size
External genitals examination
DRE
Neurological examination of perineum/lower limb
Vital signs
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
In addition to urinary tract US, what investigations would you order to assess a man with moderate to severe LUTS (List 4)
Urinanalysis & MSU for MCS if UA positive
Fasting glucose
UEC
PSA
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
What are the main findings in urinary tract US that will assist you in your management of this patient? (List 4)
Estimate prostate size (normal is <25cc)
Estimate residual volume (>100ml may require further ix)
Exclude bilateral hydronephrosis 2nd to chronic retention
Exclude bladder stones and larger bladder tumours
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
Examination and Ix are consistent with a diagnosis of moderate BPH. What are the 2 pharmacological treatment options you may consider
Alpha blockers - tamsulosin, prazosin
5-alpha reductase inhibitors - finasteride, dutasteride
Combination therapy - tamsulosin/dutasteride
Anticholinergic - oxygbutynin, solifenacin
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
What are 4 possible long-term complication of BPH if left untreated?
Acute urinary retention
Recurrent UTIs
Macroscopic haematuria
Chronic urinary retnetion
Bladder stones
Bilateral hydronephrosis with renal impairment
19 year old female Ground crew for Qantas Attends for pre-employment health assessment PMHx: long-standing mild-moderate asthma Meds: Salbutamol - OTC Non-smoker
In order to assess asthma control level - what are 4 important questions you need to ask?
Frequency of daytime sx
Frequency of reliever use
Frequency of night time sx
Limitation on exercise tolerance
19 year old female Ground crew for Qantas Attends for pre-employment health assessment PMHx: long-standing mild-moderate asthma Meds: Salbutamol - OTC Non-smoker
Based on further hx and assessment you decide to start this patient on a preventer
What are 7 main features of asthma management?
Education about chronic nature of asthma requiring lifelong treatment
Preparing an asthma action plan
Immunisation for common respiratory infections including influenza
Educaiton on proper use of asthma devices
Annual spirometry
Regular review to assess control level
Identify and avoid asthma triggers
Keeping diary of PEFR
Regular daily exercise 30min/day
Maintaining the optimal body weight
19 year old female Ground crew for Qantas Attends for pre-employment health assessment PMHx: long-standing mild-moderate asthma Meds: Salbutamol - OTC Non-smoker
Based on further hx and assessment you decide to start this patient on a preventer.
Patient re-presents in 4 weeks for planned review. Sx are consistent with sbuoptimal asthma control
What are 6 possible cause of her poor response to treatment?
Poor technique with use of asthma devices
Poor compliance with medication
Prescribed preventer not sufficient/inappropriate
Ongoing exposure to triggers (stress/allergens)
Underlying pathology other than asthma
Wrong diagnosis
Occupational exposure to triggers at the airport
6/52 old female baby attends 6-week check with Mum
Uncomplicated pregnancy.
Born at term
NVD
O/E: Mild jaundice in sclera, face and upper trunk
No jaundice at birth or in early newborn period
Mum not sure when jaundice started
What further hx will you ask (6)?
Stool colour(2)
Urine colour (2)
Has been unwell/fever (2)
Is she breastfed (2)
Feeding frequency/wet nappies (1)
FHx of haemolytic disease/G6PD, spherocytosis (1)
FHx of Gilbert Sx (1)
Weight gain since birth (1)
Hx of maternal hepatitis (1)
Has she had the heel prick test at birth (1)
6/52 old female baby attends 6-week check with Mum
Uncomplicated pregnancy.
Born at term
NVD
O/E: Mild jaundice in sclera, face and upper trunk
No jaundice at birth or in early newborn period
Mum not sure when jaundice started
Bloods show: FBC/EUC - normal
Total serum bilirubin 180 (NR<200), conjugated fraction 68 (NR <34)
What is the single most likely diagnosis?
Neonatal cholestasis
Biliary atresia
6/52 old female baby attends 6-week check with Mum
Uncomplicated pregnancy.
Born at term
NVD
O/E: Mild jaundice in sclera, face and upper trunk
No jaundice at birth or in early newborn period
Mum not sure when jaundice started
Bloods show: FBC/EUC - normal
Total serum bilirubin 180 (NR<200), conjugated fraction 68 (NR <34)
What is your next single management step?
Urgent referral to Paediatric team
78 year old female, aged care facility
PMHx:
Controlled HTN
Mild dementia
Ongoing oedema and erythema over both lower legs for a few months.
Failed to respond to oral antibiotics.
Systemically well, normal vital signs, no fever
Photo: bilateral lower limb erythema with occasional vesicles
What are the 2 most likely differential diagnoses that can explain this presentation?
Stasis (venous) dermatitis (2)
Contact dermatitis (1)
Lipodermatosclereosis (1)
Pretibial myxedema (1)
78 year old female, aged care facility
PMHx:
Controlled HTN
Mild dementia
Ongoing oedema and erythema over both lower legs for a few months.
Failed to respond to oral antibiotics.
Systemically well, normal vital signs, no fever
Photo: bilateral lower limb erythema with occasional vesicles
What are 4 features of management based on provisional diagnosis
Measure ABPI to assess arterial suplly (1)
Graduated compression stockings (2)
Elevate feet when sitting/in bed (2)
Apply a potent topical steroid (Bethametasone Diproprionate 0.05%) (2)
Take regular walks /exercise (1)
Use a moisturising cream (1)
Vascular surgeon opionion re: vascular veins (1)
Soap free wash (1)
Frusemide 40mg/daily (1)
78 year old female, aged care facility
PMHx:
Controlled HTN
Mild dementia
Ongoing oedema and erythema over both lower legs for a few months.
Failed to respond to oral antibiotics.
Systemically well, normal vital signs, no fever
Photo: bilateral lower limb erythema with occasional vesicles
What are 5 possible iatrogenic complications that this patient may face should they go to hospital?
Hospitla acquired infections - UTI, pneumonia, cannula site (2)
Falls in an unaccustomed environment (2)
Delirium/confusion (2)
Medication errors (2)
Pressure sores (2)
Thromboembolism/DVT (1)
Mental health issues - depression (1)
Constipation (1)
Deconditioning (1)
Insomnia (1)
Malnutrition (1)
21 year old male, migrant from PNG 'cannot shake this cold' 8/52 of productive cough with blood Nil regular meds Nil PMHx
Give 4 most likely diagnoses for this presentation
Pulmonary tuberculosis (4)
Pertussis (3)
Bronchiectasis (3)
Bronchitis/Post-infective cough (3)
Asthma flare due to exposure in new environment (2)
Post-nasal drip/Rhinosinusitis (2)
Pneumonia (1)
GORD (1)
