Public exam review KFP Flashcards
21 yo male Emigrated from Papua new Guinea Prolonged cough Haemoptysis DDx
- TB (systemic symptoms, cough)
- Bronchiectasis (chronic productive cough)
- PE (history of travel, DVT, pleuritic CP)
- Goodpasture Syndrome (nephritis, systemically unwell)
- Granulomatosis with polyangiitis (arthritis, glomerulonephritis, epistaxis)
- Lupus pneumonitits
- Sarcoidosis (causes interstitial lung disease)
21 yo male Emigrated from Papua new Guinea Prolonged cough Haemoptysis Initial Hx
- SOB
- CP
- SPutum
- fever, chills, LOW
- History of travel
- DVT
- blood in urine
- arthritis
- other bleeding
21 yo male Emigrated from Papua new Guinea Prolonged cough Haemoptysis Ix (8)
- CXR or CT if considering malignancy (not this pt)
- sputum MCS, acid fast bacilli and fungal culture (cytology if risk)
- FBE
- HIV
- Mantoux
- CTPA if think PE
- EUC (renal impairment)
- urine dipstick for blood
62 year old woman
Hx asthma and HTN
lower back pain after lifting books
Most likely differential diagnoses
osteoporotis fracture
muscle spasm
facet joint pain
disc rupture
62 year old woman
Hx asthma and HTN
lower back pain after lifting books
Investigations
- Lumbar spine xray
others based on history
62 year old woman
Hx asthma and HTN
lower back pain after lifting books
Managment
- offer high quality education - without clinical risk factors serious pathology is uncommon
- encourage return to normal activity
- encourage phsycial exercise
- Paracetamol
diseases that woud give red flags for lower back pain that require imaging
- fracture
- malignancy
- infection
- spondyloarthropathy
- cauda equina (MRI)
elderly female patiet with suspected cardiac failure
non-pharmacological management
- daily weight
- fluid restriction 1.5-2L
- refer to dietitian for low salt diet < 2g/day
- educate for fluid overload signs
- educate for dehydration signs
- refer for cardiac rehab
- LOW if bmi >35
- moderate intensity exercise training
How to manage fluid balance in heart failure
- ai for patient to achieve a stable weight - be euvolaemic using lowest possible dose of diuretic
- avoid being too dry
- daily weight after waking and emptying bladder and record in weight and symptoms diary
- educate fluid overload signs - sob, feeling bloated, swelling of limbs, tighntess of clothes, decreased appetite
- educate dehydration signs - unwell, fatigue, decreased urine output, dizziness
- weight change of 2kg or more over 2 days - assess for signs and symptoms of dehydration or fluid retention, assess compliance, review biochem, adjust frusemide, increase by 50%, monitor biochem and K in response
- limit fluids to 1.5-2L per day
- sodium intake <2g per day
Assessment of suspected heart failure (5)
- EUC/LFT
- FBE
3 ECG
4CXR
5 Diagnosis confirmed or uncertain -> echo
drug treatment of heart failure reeduced ejection fraction
- Perindopril arginine 2.5mg daily/candesartan 4mg -> 32mg
- spironolactone 25mg daily ->50mg (unless K >5 or Crcl<30
- when stable bisoprolol 1.25mg daily, doubling 2 weekly to 10mg
uptitrate beta blocker fisrt unless congested
repeat echo in 3-6 months - change ace to ARNI if LVEF <40
- consider ivabradine if HR >70 and LVEF +/<35
General management of CHF
- educate what is heart failure
- drug management advice - what each drug is for
- fluid management advice
- sodium restriction advice
- regular assessment of depression
- obesity managment advice
- refer to dietitian to provide advice on not becoming nutritionally deficient and K and Na content of food
8 physical activity support
32 yo male severe unilateral facial pain 4
- trigeminal neuralgia
- paraxysmal hemicrania
- dental pain
- cluster headache
trigeminal neuralgia history
- servere brief lancinating pain in trigeminal nerve distribution
- often triggered by cold stimulis, chewing, brushing teeth, talkingf
- may have ipsilateral numbness
- no other neurological complaints
trigeminal neuralgai examination
usually normal
may have numbness in trigeminal nerve distribution
paroxysmal hemicrania history
- unilateral sidelocked headache /facial pain
- associated with autonomic symptoms - rhinorrhoea, tearing, sweating, congestion, puffy/swollen eye, aural fullness, pstosis
paroxysmal hemicrania exam
normal between attacks
trigeminal neuralgia treatment
carbamazapine CR 100mg nocte increasing by 100mg every 2 weeks up to 300mg bd
- microvascular decompression of the trigeminal nerve
- carbamazapine can cause drowsiness, Steven Johnson syndrome, drug reaction with eosinophila and systemic symptoms
- carbamazapine makes OCP less effective - recommend 2 forms of contraceptive
paroxysmal hemicrania treatment
indomethacin
monitor renal function
monitor GI symptoms
29 year old hamstring history
3 predisposing factors for hastring injury
- deconditioning
- high intensity exercise
- obesity
erythema nodosum causes (5)
1) inflammatory bowel disease
2. gastrointestinal salmonella infection
3. giardia
4. COCP
5. streptococcal throat infection
6. EBV infection
7. Pregnancy
8. sarcoidosis
9. idiopathic
what does erythema nodosum look like
acute erruption of single or multiple erythematous nodules
non-blanching, poorly demarcated
1-10cm
Look like bruises
erythema nodosum treatment
- treat underlying condition
- NSAIDs
- compression stockings
- bed rest
- leg elevation
DDx erythema nodosum
non-accidental injury
polyarteritis nodosa
gout acute treatment 4
- intraarticular corticosteroid injection
- ibuprofen for 3-5 d
- colchicine 1mg inititially then 500micrg 1 hour later
- pred 15mg for 3-5 d
non-pharm mx of gout 7
- less meat/purine rich food
- cease etoh
- adequate hydration
- exercise
- avoid sugary soft drinks
- weight reduction
- quit smoking
S, N -avoid purine rich food + sugary drinks , alcohol, exercise, weight reduction, adeequte hydration
suspect thyroid solitary nodule. risk factors for malignaancy 8
- LOW
- night sweats
- Rapid growth
- recent hoarseness
- History of obesity (risk for thyrioid ca()
- Fhx
- smoking hx
- radiation exposure
33 yo. no period for 3-I 4 mo. causes (8))
Exercise induced hypothalamic amennorhoea
Pregnancy
Premature Menopause
Hyperthyroidism
Prolactinoma
Hyperprolactinaemia secondary to Risperidone
Hyperprolactinaemia secondary to Sertraline
PCOS
What lifestyle factors lead to increased BP
Limited physical activity Obesity Smoking Alcohol Recreational drugs Diet Stress Disruption of circadian rhythms
planning for future care if patient unable to make own decisions (5)
Appointing a medical power of attorney Creation of an Advanced Health Directive Creation of a Health Summary for the patient Establishing a MyHealthRecord ACAT assessment
Key components in a suicide safety plan 8
Identifying signs that the person is deteriorating
Creating a list of personalised internal coping strategies
Involving friends and family in distracting the adolescent from suicidal ideation
Involving the family in problem solving in a crisis
Contacting mental health clinicians
Restricting the adolescent’s access to lethal means
Given crisis phone number for professional agencies
Arrange follow up in 1-7 days
Management of eating disorderb(9)
- educate re risks of eating disorder (cardiac arrhythmia, dental caries, depression, osteoporosis, death)
- Refer to statewide eating disorder service for psychotherapy to treat eating disorder
- Encourage family to attend family therapy
- Monitor electrolytes esp K and hydration
- Regular ECG to monitor for arrythma, prolong QT
- Monitor weight
- Restoration of normal weight for height and age
- Identification and managment of any contributing facmily or personal problems
- supplement vit D and calcium
management of gdm
all with women early pos OGTT -> diabetes clinician
Screen pos for GDM in 2nd trimester_>
- refer to CDE +/-
- obstetric physician/endocrinologist/obs MO
depending of control, need for pharmacological therapy and presence of co-morbidities
- 6 week post natal OGTT
consideration for ATSI sexual health (4)
- consider self collection
- Offer option of having an Aboiginal Health Worker present for the consult
- Use Culturally sensitive support services for contract tracing
- consider trichomoniasis
migraine (7)
- unilateral
- throbbing
- aura
- photophobia
5 nausea
6 lasts 4-72 hours - agravated by routine physical activity
tension type headache (5(
1 bilateral 2 pressure/tightness 3 mild-moderate intensity 4 may have photophobia. 5 no nausea
trigeminal autonomic neuralgias
1 unilateral
2 sidelocked
3 unilateral autonomic features - tearing, cojunctival injection, ptosis, nasal stiffiiness, rhinorrhoea, ear fulness, tinnitus, facial flushing, sweatng
4 possible photophobia
cluster headache
autonomic symptoms
trigeminal distribtion usually
extremely pain, last for 15min -3hrs. Often same time of day. Indometacin doesn’t work.
treatment - high flow oxygen 15L for 15mins, I/N sumatriptan 20mg to contralateral nostril
preventative treatment - verapamil
short acting unilateral neuralgiform headache with conjunctival injection and tearing
autonomic symptoms trigeminal distribtuion moderate to severe last for 1s - 10minutes series of stabs at least once a day Rx. - lamotriigine
hemicrania continua
continueous unilateral pain for ever
moderate severity with exacerbation
autonomic features
responsive to indometacin
paroxysmal hemicrania
autonomic features
2-30mins upto 2 hours
MRI
indometacin
