Preventative Health

Question 1

Absolute CV risk factors (8)

Answer 1

Gender
Age
Systolic BP
Smoking status
Total cholesterol
HDL cholesterol 
Diabetes
ECG LVH

Question 2

Modifiable CV risk factors

Answer 2

Smoking status
BP
Serum lipids
Waist circumference and BMI
Nutrition
Physical activity level
Alcohol intake

Question 3

Non-modifiable CV risk factors

Answer 3

Age
Sex
Family history of premature CVD
Social history incl cultural identity, ethnicity, and SES

Question 4

Automatic high risk CVD (6)

Answer 4

Diabetes and age >60
Diabetes with microalbuminuria
Moderate to severe CKD (eGFR <45)
Previous dx of familial hypercholesterolemia
SBP >=180 or DBP >=110
Serum cholesterol >7.5

Question 5

High risk for kidney disease (8)

Answer 5

Smoking
Obesity
Family history of kidney failure
Diabetes 
HTN
ATSI age >30
Established CVD, coronary heart disease, or PVD
History of acute kidney injury

Question 6

Kidney disease screening tests (3)

Answer 6

BP
ACR - if positive, repeat twice over two months
eGFR - if <60, repeat within 7 days

Do every 1-2 years - annually for HTN and DM

Question 7

When may eGFR be unreliable? (7)

Answer 7

Acute changes in renal function
Dialysis
Certain diets (vegetarian, high protein, recent ingestion of cooked meat)
Extremes of body size
Muscle diseases (overestimate) or high muscle mass (underestimate)
Children <18
Severe liver disease

Question 8

Travel health areas

Answer 8

Safe food and water
Immunisations (3R’s - routine, required, recommended)
Avoid animal bites
Avoid mosquito bites
Travel insurance
Chronic disease management
Traveller’s diarrhea management (oral rehydration, etc)
Basic medical kit
Air travel safety, DVT prevention
Safe sex
Register travel at smartraveller.gov.au and subscribe to travel advisories of countries visiting

Question 9

Diabetes mellitus diagnosis criteria

Answer 9

Symptomatic with fasting BSL at or greater than 7.0 or random at or above 11.1 mmol/L OR HbA1c at or above 6.5% (48mmol/mol)

OR

Asymptomatic with TWO abnormal blood glucose tests

Question 10

AUSDRISK criteria (10)

Answer 10

Risk of developing diabetes in 5 years (LOW 5 or lower, INTERMEDIATE 6-11, HIGH 12 or higher)

Age group
Gender
Ethnicity(Indigenous, Pacific Islander, Maori) and country of birth (Asia, Middle East, Northern Africa, Southern Europe)
1° relatives with diabetes
Previous high sugar 
On hypertension medication
Current smoker
Fruit/veg everyday
At least 2.5 hr of exercise per week
Waist measurement + Asian or Indigenous

Question 11

3 C’s of measles

Answer 11

Cough
Coryza
Conjunctivitis
(with fever)

2-4 day prodrome before rash typically
Infectious from day before prodrome to 4 days after rash onset

Previously vaccinated people may present atypically

Question 12

Pre-Op Anaesthetics History (5-6) and Exam (4)

Answer 12

Past hx of anaesthetics issues
Family hx of anaesthetics issues
Reflux
Teeth
Exercise tolerance (2 flights of stairs)
Fasted (on the day)

Mallampati score
Jaw opening
Thyro-mental distance (at least 7cm from thyroid to tip of jaw with head extended)
Neck mobility

Question 13

Drugs that commonly cause Stevens-Johnson syndrome

Risk factors

Answer 13

Allopurinol
Carbamazepine
Lamotrigine
“-oxicam” anti-inflammatories
Phenytoin
Sulfa drugs
Sertraline
Phenobarbital 

Viral infections
Weakened immune system
Previous hx of SJS
Family hx of SJS
Chinese people with certain HLA genes

Question 14

Safety planning steps (8)

Answer 14

Recognise warning signs and triggers
Create a safe environment 
Identify reasons to live
Things I can do by myself
People and places I can connect with
Personal contacts
Professional contacts
Follow-up and review

Question 15

Waist circumference - risk range for men and women

Answer 15

Men 94-102cm, greatly increased risk >102

Women 80-88cm, greatly increased risk >88cm

Question 16

SCOFF questions

Answer 16

Make yourself SICK when you feel uncomfortably full?
Worry you have lost CONTROL over how much you eat?
Recently lost more than ONE stone (6.35kg) in 3 months?
Believe you are FAT when others say you are too thin?
Would you say FOOD dominates your life?

2 or more suggest an eating disorder

Question 17

Pre-anaesthetic check (5)

Answer 17

GA +/- FH
GORD
Exercise tolerance
Teeth
Fasting

Question 18

High risk of T2DM (7)

Answer 18

Previous IGT or IFG
CVD (e.g. AMI, angina, PVD, stroke)
Age 35 or older from Pac Islands, Indian subcontinent, or China
Age 40 or older with BMI over 30 or HTN
Gestational DM
PCOS
Antipsychotics or steroids

Question 19

Red flags at 6 months (6)

Answer 19

Not smiling or squealing in response to people.
Not starting to babble.
Not reaching for and holding toys.
Hands frequently clenched.
Not rolling.
Not holding head and shoulders up when on tummy.

Question 20

Red flags at 9 months (8)

Answer 20

Not sharing enjoyment with others using eye contact or facial expression.
No gestures.
Not using 2-part babble, e.g. gaga.
Unable to hold and/or release toys.
Cannot move toy from one hand to another.
Not sitting without support.
Not moving, e.g crawling.
Does not take on weight well on legs when held by an adult.

Question 21

Red flags at 12 months (10)

Answer 21

Does not notice someone new.
Does not play early turn-taking games, e.g. peekaboo, rolling a ball.
No babbled phrases that sound like talking.
No response to familiar words.
Majority of nutrition still liquid/puree.
Cannot chew solid food.
Unable to pick up with index finger and thumb.
Not crawling or bottom shuffling.
Not pulling to stand.
Not standing holding on to furniture.

Question 22

Febrile seizures: simple vs complex (4)

Answer 22

Simple is fever plus all:
Generalised tonic-clonic
Duration less than 10min
Complete recovery within 1 hour
Does not recur in the same febrile illness

Usually occurs between 6 months and 5 years.
In 3% of healthy kids
Normally associated with simple viral infections
No risk factors: 1% risk of epilepsy (same as general pop)

Question 23

Acute rheumatic fever diagnosis (major and minor criteria)

Answer 23

Initial:
2 major or 1 and 2 minor plus evidence of preceding GAS infection (elevated antiDNase or ASOT or throat swab)

Recurrent:
2 major or 1 and 1 or 3 minor plus evidence of GAS

Major (high risk):

• carditis
• polyarthritis, aseptic monoarthritis, or polyarthralgia
• chorea
• subcutaneous nodules

Minor (high risk):

• monoarthralgia
• fever 38°C or higher
• ESR or CRP >30
• prolonged PR on ECG

Question 24

Acute rheumatic fever management

Answer 24

NOTIFIABLE DISEASE!!!

Benzathine benzylpenicillin IM single dose (900mg/2.3mL in adults)
OR
If compliance ok then phenoxymethylpenicillin (kids 15mg/kg up to) 500mg bd for 10 days
OR cephalexin (25mg/kg up to) 1g bd for 10 days
OR azithromycin (12mg/kg up to) 500mg daily for 5 days

For arthritis or severe arthralgia, use aspirin 50-60mg/kg in 4 to 5 divided doses OR naproxen 5-10mg/kg up to 625mg bd.

In kids, flu shot is advised to reduce virus-induced Reye syndrome with aspirin. Consider stopping in acute viral illness.