Random things Flashcards
Recommended daily calcium intake
at least 1300mg/day
antivirals for genital herpes
valaciclovir 500mg Q12H for 10 days; if rapid improvement can stopa t 5 days
treatment for genital warts
- imiquimod 5% cream, 3x per week until warts resolve (usuually 8-16 weeks)
- podophyllotoxin 0.5% paint, BD for 3 days, repeated weekly, until warts resolve (usually 4-6 weeks)
- leave them be
- cryotherapy
Supporting smoking cessation
ask assess advise assist arrange follow up
Rotterdam criteria
if 2 present, PCOS diagnoses
- history of oligo/anovulation
- hyperandrogrenism
- polycystic ovaries on USS (12 or more follicles 2-99mm, and/or increased ovarian volume)
live vaccines
japanese encephalitis Imojev MMR varicella MMRV oral rotavirus zoster lBCG typhoid (oral)
Testing for typhoid
Blood and stoop culture; serology not helpful
Medications that cause hyponatremia
CARDISH Chemotherapy Antidepressants, antipsychotics, anticonvulsants, anti inflammatory drugs (cox2 inhibitors) Recreational drugs - ecstasy Diuretics Inhibitors - ACEi, ssris Sulfonylureas Hormones desmopressin, oxytocin, hypnotics (temazepam)
Automatic high cv risk
Diabetics >60 Atsi >74 Moderate or above Ckd (45) Fh Cholesterol >7.5 Bp >180/>110 Diabetes with microalbuminuria
TSH ranges for replacement
<60 aim 0.5-2.5 > 60 aim 1-5 >80 aim 4-6 pregnancy 1st trimester 0.1-2.5 2nd trimester 0.2-3 third trimester 0.3-3
timing for pertussis PCR
up to 4 weeks of cough
serology can become positive after 2 weeks
LFT analyss cholestasis versus hepatocellular damage
cholestasis ALP >200 and ALP >3x ALT
hepatocellular damage ALT >200 and ALT >3x ALP
enzym inducing anti-epileptics
carbamazepine, phenobarbitone, phenytoin, primidone and topiramate (when 200mg or more a day)
gout MCS from joint aspirate
negative birefringence, needle shaped crystals, blue crystals
Who is at high risk of diabetes?
AUSDRISK >12 >40yo and overweight IFG 1st degree relative with diabetes personal hx CV event high risk ethnicity history GDM women with PCOS antiphyscotics ATSI
What testing do you have to do for patients who are at high risk of diabetes?
every 3 years FBG or HbA1c
Diabetes HbA1c
> 6.5
OGTT results
IFG 6.1-6.9 pre glucose
IGT >7.8-11 2hr after glucose
fasting >7 or 2hr >11.1 = diabetes
T score level for osteoporosis
<-2.5
Z score level
z score <-2 warrants invesitgation for secondary causes of bone loss; recommended in <50yo, premenopausal
testing for Addison’s disease
short synacthen test (aka ACTH stimulation test)
low morning serum cortisol
Hypoglycemia management
Rule of 15
BSL <4mmol/L
give 15g quick acting CHO (1/2 can non diet soda)
wait 15mins, then repeat
if not rising - repeat
provide long acting CHO if next meal >15mins away (i.e. tub of yoghurt)
test BSL every 1-2 hours for next 4 hours
severe hypoglycemia management
glucagon 1mg IM or subcut
IV fglucose 50% 20mL (10% in child)
Diabetes screening recommendation
screen everyone >40 with AUSDRISK every 3 years
ATSI >18yo annual blood test
high risk otherwise test every 3 years
Graves disease antibodies
TSH receptor Ab positibe, TPO Ab often positive
Hashimoto’s thyroiditis abs
TPO antibodies +
Prep effectivness time frames
7 days to for receptive anal
21 days for receptive vaginal and IVDU
points about Prep
safe in pregnancy and breastfeeding
test within 7 days of starting for HIV
very effective as long as no missed pills
regular reviews - 30 days, then every 90 days
can impair renal function, BMD, liver function
SE - HA, nausea
complications of CF
pancreatic exocrine insufficiency/steatorrhea FTT sinusitis nasal polyposis meconium ileus diabetes mellitus infertility hyponatremic dehydration
COPDX
case finding and confirm diagnoses/severity optimise function prevent deterioration develop plan of care manage eXacerbations
aspect of management
pharmacotherapy rehabilitiation programs action plan self management co-morditities exercise vaccination nutrition smoking prascevns
severity in COPD
mild 60-80% FEV
moderate 40-59% FEV predicted
severe <40% predicted
pneumococcal vaccinations in at risk patients
1 dose 13 at diagnoses (at least 2 months after any previous dose 13)
1 dose 23 12 months after 12, or at 4yo (whichever is later)
2nd dose 23 at least 5 years later
or ATSI 13 at 50, then 23 1 yr later and 23 again 5 years later
non ATSI >70 = single 13
age zostavax
70-79
asthma stepwise management
- as needed SABA
- ICS + PRN SABA
- ICS + LABA
- consider referal; ICS + LABA (medium high dose)
- refer
BAse decisions on last 4 weeks
good control of asthma
daytime symptoms <2 days per week
SABA needed <2 days per week
no night symptoms
ICS doses in adults
low budesonide 100-200
medium 500-800
high >800
aged 1-5 stepwise asthma
- SABA PRN
- ICS low dose or montelukast
- ICS low dose + montelukast or high dose ICS - consider referral
- referral for add ons
astham stepwish management in 6-11yo
- SABA PRN
- ICS low dose or montelukast
- ICS high paediatric dose,
ICS/LABA low dose, ICS + montelukast - consider referral - referral
SMART therapy
low dose budesonide-formoterol
rapihaler 100/3 2 puffs or turbuhaler 200/6 1 inhalation
when needed
acute asthma attack
adults 12 puffs slabutamol
8 puffs ipratropium
if severe do both, start oxygen to target sats 93-95%
if life threatening
2xsalbutamol nebs + 1x ipratropium neb
start oxygen
reassess within minutes; repeat doses in 20-30mins
add ons:
- IV magnesium sulfate 10mmol IV over 20 minutes
- steroids
acute asthma doses in kids
1-5yo: 2-6 puffs slabutamol 6-11yo: 4-12 puffs piratroprium 4 puffs in 1-5yo, 8 puffs >6yo 1/2 neb doses in >5yo add ons: - IV Mg So4 0.1mmol/kg pred 1mg/kg aim sats 95% in kids
consider adrenaline in asthma when…
?anaphylaxis as ddx
if unresponsive, cannot inhale bronchodilators, peri-arrest
kids >6yo steroid doses
fluticasoen (flixotiode) 100-200 is low dose, >200 high
budesonide (pulmicort) 200-400 low dose, >400 high dose
ddx splenomegaly
Massive - CML myelofibrosis moderate - "PLTS" portal HTN lymphoma leukemia thalassemia Mild hemolytic anemia EBH, IE SLE sarcoidosis infiltration
symptoms of nasopharyngeal carcinoma
neck mass
nasal obstruction with epistaxis
serous otitis media
red flags sinusitis
unilateral bleeding cacosmia menignism altered neurology frontal swelling orbital involvement - diploplia, decreased VA etc
teen assessment
Home Education & employmen Eating and exercise Activities Drugs and alcohol Sexuality and gender Suicide, depression & self harm Safety
Risk factors for open angle glaucoma
increased age black family history diabetes HTN myopia (near sightedness) steroid use prior vitreous surgery
medication classes and examples for open angle glaucoma
topical beta blockers - timolol
topical prostaglandins - latanoprost
alphra adrengeric agonists - brimonidine
topical carbonic anhydrase inhibitors - dorzolamide
tests before starting immunosuppression
Hep B/C, MMRV serology, quantiferon tuberculosis
red flag system breast cancer
- two relatives on same side
- first degree relative
- relative <50
1 flag = moderate risk, no action - flags = consider referral; annual mammograms from 40yo maybe if 1st degree relative with breast can <50
managament missed OCP
<24hrs take as usual
>24hours or missed more than one pills - take as usual and add extra protection for 7 days
if <7 pills left in packet - skip sugar pills and add 7 days condoms
if missed >1 pill missed in first seven days or new pack, or start the pack >7 days late - consider emergency contraception, + condoms 7 days
uliprsital acetate cautions
reduced effect on BMI >30 (but better than LNG EC)
use up to 120hours
delay hormonal contraception for 5 days (or reduced UPA effectiveness)
acronym for enquiring about abuse
WHO LIVES
listen closely with empathy and without judgement
Inquire about needs and concerns
Validate and show you understand and believe them
Enhance safety, discuss a plan to protect themselves
Support with referrals and follow up
antibodies in Post partum thyroiditis
TPO Ab high titre, normal ESR
Graves disease Abs
TSH R Ab +. TPO Ab often+ also
different causes of vertigo based on duration
seconds - BPPV
mins -hrs Menieres, vestibular migraine
days - vestibular neuritis
days - weeks : CVA, vertebrobasilar insufficiency
HINTS exam - peripheral if
+ (abnormal) head impulse test
no nystagmus, or nystagmus that is unidirectional and horizontal
NO vertical skew
Menieres treatment
low sodium diet 2-3g/day
avoid caffeine
hydrochlorothiazide
referral to auidologist for hearing aid
referral to exercise pysiology for vestibular rehab program
referral to ENT for iutnratympanic injection, + pressure therapy, surgery
vitiligo treatment
avoid sunburn
cosmetic camouflage
does not need treatment
mometasone 0.1% furoate 0.1% cream TOP
if face/body folds: pimecrolimus 1% cream TOP BD for 3 months
OR for not on face
calcipotriol+betamethasone dipropionate 5+500microg/g ointment TOP daily for 3 months
vitiligo treatment
red flags bowel cancer risk screening levels
4 flags = moderate risk
2nd degree relative any age = 1 flag
1st degree relative >55 = 2 flags
first degree relative <55 = 4 flags
moderate risk bowel cnacer screening
iFOBT every 2 yrs from 40-49
colonoscopy every 5 years from 50-74yo
aspirin 2.5 years from 50-70
bipolar 2
Depression + hypomania, no need for manic episode
contact tracing time frame gonorrhea
2 months
contact tracing chlamydia
6 months
contact tracing syphilis
primary - 3 months + duration of symptoms
secondary - 6 months + duration of symptoms
early latent syphilis - 12 months
contact tracing hep B/C
6 months prior to onset of acute symtpoms
management hyphaema
manage bleeding tendency eye shield over eye elevate pt's head to 30degree maintain be drest cyclopegia if not globe ruputre control N/V agghressively managfe pain - TOP and orals opthalmology
fundoscopy finding in retinal vein occlusion
sunset storm
fundoscopy finding in retinal artery occlusion
cherry red spot + pale fundus
ddx papilledema
malignant HTN
rasid ICP (eg, tumor, IIHT, CVST)
optic neuritis
optic nerve tumour
fundoscopy finding hypertensive retinopathy
AV nicking copper wiring cotton wool patchy retinal hemorrhage optic disc swelling hard exudate
diabetic retinopathy fundoscopy findings
microaneurysms dot and blot haemorrhages cotton wool spots neovascularisation - at disc esp * if treatment will have evidece of photocoagulation hardf exudates
treatment for bacterial keratitis if delayed referral or vision threatened
ciprofloxacin 0.3% eye drops 1-2 drops into affected eye, every 15mins for 6 hrs; then hourly for 48hours then every 4 hours until healed
RFs macular degeneration
smoking increased age family history caucasion obesity CV disease
cirrhosis on excam
spider naevi
palmar erythema
gynaecomastia
splenomegaly
cirrhosis on pathology tests
thrombocytopenia
low albumin
prolonged PT/INR
AST:PLT ratio >1.0
treatment of keratosis pilaris
urea 10% cream TOP 1-2 BD after bathing
alpha-hydroxy acids (lactic acid 10-20%) TOP nocte
causes of skin hyper-pigmentation
addisons disease cushing syndrome ectopic ACTH syndrome hyperthyroidism haemochromatosis cirrhosis of the liver porphyria chronic kidneyt failure malnutrition/malabsorption pregnancy
ABCDE melanoma
Asymmetry Border Color Diameter >6mm Evolving
non pharm treatment of rosacea
minimise factors that cuase flushing low irritant skin care products and sunscreen use emollient soap free cleanser green tinted foundation avoid topical corticosteroids
rosacea pharm treatment
- metronidazole 0.75% gel once or twice daily 6-12 weeks
if severe - doxycycline 50-100mg PO for up to 8 weeks, repeat as required; consider minocycline if doxy not tolerated or inadequate response
flushing ddx
menopause rosacea emotional stress hot/spicy food or beverages high fever alcohol exercise wind hot baths drugs - eg. CCBs, tamoxifen, opioids food additives neurologicla disorder - eg PArkinsons carcinoid syndrome paeochromocytoma systemic mastocytosis
type of tinea
cruris - groin pedis - foot corporis - body manuum - hands capitis - scalp
causes erythema nodosum
sarcoidosis strep infection hep B infection TB chlamydia IBD - Crohn's drugs - OCP
disease associated with granuloma annulare
diabetes
pityriasis rosacea
herald patch
salmon pink scaly eruption
christams tree pattern
if itchy betamethasone valerate 0.02% cream TOP once daily
pityriasis types
rosea - christmas tree pattern
vesicolor- patchy yeast
alba - white
treatment pityriasis versicolor
miconazole 2%shampoo once daily leave for 10mins then wash off for for 10 days
econazole 1% solution TOP to wet skin, leave povernight for 3 nights
if unresponsive fluconazole 400mg PO STAT
non pharm management elevated choldesterol
reduce saturated and trans fat
use monosaturated and polyunsaturated fats to replace saturated fats
improve soluble fiblre intake
plant sterols enriched diary products
target HbA1c
7% usually, but can be individualised
Psychosis signs and symtpoms
alogia/poverty of content thought blocking loosening of association tangentiality clanging word salad perseveration
psychosis signs
delusions
hallucinations
thought disorgnaisation
agitation/aggression
types of delusions
persecutory grandiose erotomanic somatic delusions of reference delusions of control
PTSD versus ASD
1 month is cut off
screened for in heelprick test
phenylketonuria congenital hypothyroidism cystic fibrosis (only detects 95%) galactosemia other rare disorders of metabolism
causes jaundice in neonates
early - sepsis, hemolysis (blood extravasation, isoimmunisation)
within 2 weeks - BM jaundice, brusing, spesis, dehydration, physiological
>2 weeks - sepsis, hemolysis (G6PD), dehydration, hypothyroidism
hepatitis
biliary atresia
anti-HBc
total hep B core Ab: indicates exposure to Hep B ()previous or ngoing)
anti-HBs
Hepatitis B surface antibody: immunity; either immunised or previous infection with recovery
igM antiHBc
IgM antibody to hep B core antigen = acute infection
Hep B sAg
Hep B surface antigen = high levels during acute or chronic Hep B, indicates person is infectious
examination questions
ensure general comfort/explain steps
inspection
palpation
adequate exposure
reasons for DMMR
5 or more regular medications >12 doses of medication per day recent significant changes to medications narrow theraputic range of meds symptoms suggestive of SEs sub-optimal response to treatment suspected non-compliance difficulty managing meds becuase of language/literacy cnogitive difficulties attends a number of doctors recent DC from hospital
sodium intake in heart failure
<2g/day
CAUSES OF thyrotoxicosis
toxic multi-nodular goitre
toxic adenoma
exogenous thyroid hormone
subacute thyroiditis/de Quervain thyroiditis
treatment of mania first line meds
- olanzapine 10-15mg PO daily
1. risperidone 2mg PO daily
IgM
acute, then usually reduces
IgG
takes time to develop and then persists
diagnostic criteria in PTSD
need all of A
A. exposure to event
B. intrusion symptoms - at least once i./e. flashbacks
C. avoidance
D. negative alterations in cognition - at least 2; persistent guilt, disassociative amnesia
E. alteration in arousal/reactivity - at least 2 of - hypervigilance, irritable
F. duration of distrubance > 1/12
G. causing impairment/significant distress
H. Not attributable to substances
Lithium monitoring
serum lithium every 3-6 months
electrolytes and eGFR 3-6 months
TSH 6-12 months
Ca every 12 months - screen for hyperparathyroidism
causes hyponatremia - hypervolemia
heart failure, renal failure, liver cirrhosis, nephritic syndrome
evolemia causes hyponatremia
SIADH - drugs, malignancy hypothyroidism psychogenic polydipsia pain nausea
hypovolemic causes hyponatremia
vomiting/diarhea burns thiazides hypopituitarism adrenal insufficivnency
ddx schizophrenia
schizophreniform - >1/12, but <6/12
Schizoaffective disorder - major mood episodes also
delusional disorder - not criterai for schizophrenia disease
brief psychtic episode < 1 month
schizotypal personatlity disrder - “persavive pattern”
major depressive disorder with psuychotic features
bipolar depression with psychotic features
medical ddx psychosis
delirium - electrolytes endo - thyroid hepatic/uremic encephaloptahty SLE, MS acute intermittent porphyria dementia with Lewy bodies space occupying lesions vit B12 def
first generation antipsychotics
chlorpomazine
haloperidol
2nd generation antipsychotics
ariprazole/abilify cloazpine olanzapine quetiapine risperidone paliperidone
side effects of antipsychotics
pseudoparkinsonism
acute dystonia
akathisia
tardive dyskinesia
delirium pharmacological management
- hapoeridol 0,5mg PO STAT
- olanzapine 2.5mg PO STAT
- risperidone 0.5mg PO STAT
if IM - haloperidol 0.5mg IM, olanzapine 2.5mg IM
drugs to avoid in parkinsons
haloperidol
metoclopramide
drugs that cause delirium
anticholinergics benzos opioids steroids NSAIDs dopaminerdis - levodopa soltalol/propanolol alcohol, drugs
anticholinergic drugs
sedating antihistmaines - doxylamine oxybutyning antipsychostics TCAs - endep benztropine prochlorperazine hyoscine hydrobromide
delirium prevention
hydration, nutrition pain relief sleep visual/heaqring mimpairment avoid restraints lighting quiet singlew rooms clock and calendar family
improving medication compliance
webster pack eudcation re outcome of poor ocmpliance HMR home visit nurse subsidies for medications involve appropriate nurses - AHW, diabetic educator involve family with permission
TIME acronym for ulcer management
Tissues, Infectionm, Moisture, Edge
ABI measurements
<0.5 arterial disease, >0.9 venous diease
hydrogels - examples and use
solosite; increase wound moisture, use in dry, scabbed, necrotic wounds
film dressings - example and use
opsiyte/tegarderm - don’t absorb or create moisture, but can keep moistuyre in; use if nil to low level exudate
hydrocolloid dressing - example and use
eg duoderm/comfeel; give soft moisture bed; use in low to moderate exudate
abdorbent fibre/hydroactive polymners/polyurethane foams - eg and uses
eg. kaltostat, use in high exudating wounds to manage moisture without maceration
medications for dementia
donepezil
galantamine
rivastigmine
memantine
causes of abnormal uterine bleeding
PALM-COEIN Polyp Adenomyosis Leiomyoma Malignancy and hyperplasia Coagulopathy Ovulatory dysfunction Endometrial Iatrogrenic Not yet classified
topical treatment lichen sclerosus
betamethasone diproprionate 0.05% in optimized vehicle BD until itch resolves then wean
complications of snake bites
coagulopathy
neurotoxicity - ptosis first sign
myotoxicity - rhabdomyolysis
acute kidney injry
treatment of meningitis pehospital transfer
ceftriaxone 50mg.kg p to 2g; IM or IV
breast cancer red flags risk categories
1 = avg risk 2 = moderate risk = annual mammogram >40yo, if relatives diagnosed <50yo
breast cancer red flags
2 relatives with breast cancer on same side of family
first degree relative
relative <50yo
levonorgestrel emergency contraception
1.5mg PO ASAP
within 96 hours
if BMI >26 or 70kg consider 2x dose
interacts with liver inducers - give 2x dose
Ulipristal acetate
30mg PO STAT within 5 days decreased effect if BMI >30/>85kg don't 2x dose interacts with liver enzymes stop OCP for 5/7 don't give with steroids
Implanon true name
Etonogestrel implant 68mg subdermally
normal PR interval
3-5 small squares
120-200msec
normal QRS
2.5 small squares
70-100msec
QTc
M <440msec
F <460msec (12 small sqauers)
pathological Q wave
first negative defelction after P wave needs to be >1 small square wide >2mm deep leads V1-V3 25 % QRS depth
Rheumatic fever diagnostic criteria - how many required
initial - needs 2 major OR 1 major and 2 minor
AND evidence of step pyogenese infection
recurrent - 2 major, or 1 major + 1 minor, or 3 minor
Major manifestations of acute rheumatic fever
carditis polyarthritis or aseptic monoarthritis chorea erythema marginatum subcutaneous nodules
minor manifestations of acute rheumatic fever
high risk pt - monoarthralgia fever >38 ESR/CRP >30 prolonged PR all others polyarthralgia fever >38.5 ESR >60, CRP >30 prolonged PR
sensitivity
= true +/true positive + false negative (i.e. everyone with diease)
specificity
true negatives/false positives + true negatives (i.e. all those who do not have disease)
haemochromatosis genotypes
C282Y - homo righ risk
H63D
