Random Flashcards
Acne Management
mild acne - topical benzoyl peroxide - tretinoin or adapalene gel - OCP - washes containing salicylic acid - light/laser therapy moderate acne - add tetracycline or doxycycline for 6 months - consider anti androgen therapy in women un responsive to the pill e.g. cyproteterone acetate or spironolactone - isotretinoin severe acne - refer to dermatologist
Acute Otitis Media Management
If > 12 months no abx for first 24-48 hours then review
If < 12 months amoxicillin TDS for 5 days
What are the criteria for abx treatment for sinusitis?
need 3 of the following:
- persistent purulent discharge > 7 days
- facial pain
- poor response to decongestants
- tenderness over the sinuses
What are the symptoms for alcohol withdrawal?
anxiety insomnia craving hallucinations irritability vivd dreams confusion seizures
What are the examination finding for alcohol withdrawal?
diaphoresis mydriasis tachycardia hypertension low grade fever
What are the red flag features of back pain?
young patient elderly patient not resolving for greater than 3 months neurology febrile severe night pain unexplained weight loss significant trauma IV drug use use of anticoagulants use of corticosteroids cauda equina features saddle anaesthesia bowel/bladder symptoms bilateral neurological deficit
What are the indications for imaging in back pain?
red flags (XR)
doesn’t resolve with conservative management (XR)
possible cauda equina (MRI)
possible spinal canal stenosis (MRI)
What family history of bowel cancer is required for colonoscopy rather than FOBT?
one first degree relative diagnosed before 55
two first degree relatives at any age
risk of FAP or Lynch syndrome
What is the pharmacological treatment for BPH?
duodart - an alpha antagonist and a 5 alpha reductase inhibitor
What is the most common pathogen for bronchiolitis?
RSV
What are the indications for admission for bronchiolitis?
requires respiratory support - significant increase in work of breathing
requires oxygen - if saturation is <90% with associated increased WOB
requires fluid resuscitation - if intake is less than 50% of normal
if patient is very young
if it is day 1 of the illness
if parent is not comfortable at home caring for child
How often should patients have their CV risk calculated?
Every 2 years after 45 or 35 if ATSI
What factors are used to calculate CV risk?
Age Sex Smoking status Total and HDL cholesterol Systolic BP Diabetes LVH (on ECG)
What are the indications for colposcopy?
2 x LSIL HSIL smear reported as invasive carcinoma, glandular neoplasia, adenocarcinoma suspicious symptoms cervix suspicious of invasive disease
Which patients should be screened for CKD?
Smoking more than 40 years Hypertension Obesity FHx Diabetes ATSI over 30
What are the goals of management for CKD?
BP less than 130/85 if proteinuria <1g BP less than 125/75 if proteinuria >1g cholesterol total <4 LDL <2.5 fasting blood sugar <6.7 HbA1c < 7% Hb 110-120 potassium <6 bicarb > 22 phosphate < 1.75 no smoking alcohol < 2 standard drinks per day
When should you refer to a nephrologist for CKD?
haematuria eGFR < 30 rapidly declining kidney function significant proteinuria >1g poorly controlled hypertension diabetes with kidney impairment and an eGFR < 60
What are the contraindications for the COCP?
undiagnosed vaginal bleeding CV disease, stroke, TIA previous VTE focal migraines with aura active liver disease hormone dependent cancer drug interaction - e.g. carbamazepine if breastfeeding is not well established can make it drop off
What are the common side effects of the COCP?
breast tenderness nausea breakthrough bleeding headaches mood changes
What are the benefits of the COCP?
contraception less acne less hirsuitism regular periods lighter periods less painful periods timed periods no periods if you wish reduced endometrial cancer, polyps, fibromyomas reduces endometriosis prevents ectopic pregnancy (unlike IUD) reduces ovarian cysts reduces ovarian cancer no change in breast cancer - does not increase the risk with the dose of oestrogen reduces benign breast disease reduces pre menstrual syndrome (progestogen withrdrawl)
What are the key steps in COPD management?
confirm diagnosis optimise function prevent deterioration develop a self management plan treat exacerbation
What is the most common pathogen of croup?
parainfluenza virus
What are the risk factors for DDH?
breech presentation female baby oligohydramnios big baby first born baby family history swaddling/wrapping
What are the diagnostic criteria for T2DM?
FBG > 7
OGTT > 11.1
HbA1c > 6.5
At what HbA1c should insulin be used?
> 8.5
What are the causes of dysmenorrhoea?
primary dysmenorrhoea endometriosis adenomyosis intracavity mass - polyp, fibroid cervical stenosis imperforate hymen non communicating uterine horn post endometrial ablation PID pelvic adhesions
What is the management of ectopic pregnancy?
conservative
medical (methotrexate)
surgical
What are red flag signs in a child with a fever?
pale mottled skin doesn't wake or stay awake when roused high pitched cry tachypnoea chest indrawing decrease tissue turgor age less than 3 months non blanching rash bulging fontanelle neck stiffness focal neurological signs focal seizures
What are the indications for gastroscopy in GORD?
anaemia dysphagia odynophagia haematemesis + meleana unexplained weight loss vomiting older age >50 chronic NSAID use severe frequent symptoms FHx of upper GI or colorectal cancer short history of symptoms
What is the maximum treatment time for carbimazole?
18 months
Immunisation Schedule
Birth - hepatitis B 2, 4 and 6 months - hepatitis B - DTP - Hib - polio - pneumococcal - rotavirus 12 months - Hib - MenC - MMR 18 months - MMRV 4 years - DTP - polio 10-15 - DTP - HPV 65 - influenza - pneumococcal
What are common vaccine side effects?
injection site reactions (pain, swelling, redness) mild fever shivering fatigue headache joint and muscle ache
What are the goals of lipid treatment?
Total cholesterol < 4
HDL > 1
LDL < 2
TG < 2
What is the non pharmacological management of a lipid disorder?
diet
decrease alcohol
regular exercise
cessation of smoking
What is the pharmacological management of a lipid disorder?
initial treatment: statin if LDL not sufficiently reduced add one of: - ezetimibe - nicotinic acid - bile acid binding resin if triglycerides remain elevated consider one of: - fenofibrate - nicotinic acid - fish oil
What are the side effects of statins?
GIT side effects
myalgia
measure LFTs and CK at baseline
repeat LFT at 6-8 weeks and then every 6 weeks for 6 months
What are the risk factors for osteoporosis?
female sex age family history smoking high alcohol intake vitamin D deficiency low BMI (<20) recurrent falls low physical activity immobility cushings hyperthyroidism hyperparathyroidism hypogonadism inflammatory disorders rheumatoid arthritis malabsorption coeliac CKD chronic liver disease corticosteroids anti epileptic anti androgen excessive thyroxine
What are the indications for a DEXA bone scan?
any fracture following minimal trauma
spine wedge fracture
presence of major risk factors
What are the rotterdam criteria for PCOS?
oligomenorrhoea/amenorrhoea
irregular cycle >35 days or < 21 days indicating anovulation
hyper androgenism (clinical or biochemical signs)
elevated serum testosterone and free androgen index
US findings
12 or more follicles or increased ovarian volume >10cc
What is the management for H Pylori?
clarithromycin and amoxicillin as part of triple therapy with a PPI for 7-14 days
What antibiotics are used to treat PID?
azithromycin, ceftriaxone, metronidazole
What are the features of a good screening program?
the condition:
- important health problem
- recognisable latent or early symptomatic stage
- natural history of the condition should be understood
the test:
- simple, safe, precise and validated
- acceptable to the target population
- the distribution of test values in the target population should be known and a suitable cut-off level defined and agreed upon
the treatment:
- effective for patients identified, with evidence that early treatment leads to better outcomes
- agreed policy on who should be treated and how they should be treated
the outcome:
- there should be evidence of improved mortality, morbidity or quality of life because of the test
- benefits of screening outweigh harm
- the cost should be economically balanced
consumers
- should be given informed evidence so they can make an informed choice
What is the centor criteria for diagnosing strep pharyngitis?
Old CAFE old: age < 15 = 1 point age > 44 = -1 point C: cervical lymphadenopathy = 1 point A: absence of cough = 1 point F: fever = 1 point E: exudate on tonsilts = 1 point If -1 to 1 point - don’t test and don’t give antis If 2-3 points - test and if positive give antis if 4-5 - treat empirically with antis
What questions should you ask in a sexual history?
Current sexual activity Gender and number of partners Contraception (including barrier contraception) Immunisation status RFs for blood borne viruses - IVDU - tattoos - piercings symptoms - vaginal discharge - urinary symptoms - dyspareunia
Which TIA patients should have stroke risk assessed? (ABCDD tool)
Age > 60 = 1 point
Bp > 140/90 = 1 point
Unilateral weakness = 2 points
Speech impairment = 1 point
Duration over 60 mins = 2 points over 10 mins = 1 point
Diabetes = 1 point
If score is over 4 do urgent brain and carotid imaging
What are the red flags for headache?
acute/subacute time course focal neurology fever confusion altered mental state neck stiffness progressive vomiting personality change worse in the morning seizure post head injury
bacterial pathogens of sinusitis
step pneumoniae haemophilus influenzae moraxella catarrhalis staph aureus strep pyogenes
things to ask on history for sinusitis
facial pain - often refers to teeth, ears obstruction (nasal blockage) discharge from nose (purulent) smell changes headache cough (worse at night) bad breath signs of complication - visual changes or meningitic symptoms
examination findings for sinusitis
facial tenderness on palpation
purulent discharge
signs it has spread to the orbit
signs of meninigism
indications for CT in sinusitis
suspected malignancy
history of trauma
diagnosis not straight forward
adjunctive treatments for sinusitis
analgesia
nasal saline irrigation
intranasal corticosteroids
nasal decongestants (limited to 3 days use)
when to refer to a specialist for sinusitis
lack of response to abx persistence of severe symptoms recurrence (4 or more episodes in a year) underlying anatomical abnormalities immunocompromised orbital or intracranial complications
complications of sinusitis
orbital - cellulitis, abscess
intracranial - meningitis, abscess
