To Remember Flashcards
Corticosteroid for face, axillae and groin
Hydrocortisone 1% ointment topically once daily until skin completely clear
Steroid for widespread low grade inflammation of trunk/limbs
If more severe or in flexures
Triamcinolone acetonide 0.02% topically daily until skin clears
Mometasone furorate 0.1% ointment topically until skin clears
Steroid for fingers, lichenified wrists/ankles
Mometasone furorate 0.1% ointment topically until skin clears
Steroid for scalp dermatitis
Mometasone furorate 0.1% lotion topically once daily until skin is clear
Evidence based falls prevention strategies (5)
Balance exercises for 2 hours/week
vitamin D supplementation to achieve a level of >60nmol/L
Psychoactive medication withdrawal
Home occupational therapy assessment for home modifications as indicated
Optimise vision
Risk factors for chronic kidney disease (9)
- Diabetes mellitus
- Cardiovascular disease
- Hypertension
- Obesity
- smoking
- history of acute kidney disease
- ATSI
- family history of kidney failure
- Age >60
What investigations to do if confirmed abnormal eGFR (9)
Urine ACR confirmatory ECU FBE ESR CRP Fasting lipids Fasting glucose Urine mcs for dysmorphic red cells, casts and crystals KUB ultrasound
Neonatal jaundice exam (7)
- alertness
- signs of infection
- dehydration
- poor weight gain/weight loss >10% of birth weight
- birth trauma - cephalhaematoma, significant bruising
- Level of icterus
- hepatosplenomegaly
History for neonatal jaundice (5)
- <48 hours - suggests haemolysis
- > 3 days more likely pathological
- weight loss >10% of birthweight
- Maternal blood group and viral serology
- Family history of haemolytic disease (ABO, G6PD, spherocytosis)
- dark urine or pale stools (biliary obstruction)
Investigations for neonatal jaundice
- Serum bilirubin split into unconjugated and conjugated bilirubin
- FBE/film/Reticulocyte count (haemolysis)
- Blood group and direct antibody test (haemolysis)
Management of neonatal jaundice
- if conjugated bilirubin >15%, dark urine or pale stool- refer gastro/ED (biliary atresia)
- if unwell -> ED
- If haemolysis - discuss with haematologist
- If in treatable range or borderline -> ED
- If prolonged jaundice >2 weeks/>3 weeks preterm without obvious cause - urine mcs, reducing substances, TFT, G6PD
- ensure baby feeding well and arrange follow up
Causes of unconjugated hyperbilirubinaemia (8)
- physiological jaundice - should resolve in 2 weeks (3 weeks in preterm)
- breastmilk jaundice - may continue for many weeks
- sepsis - usually unwell, check urine
- Haemolysis from ABO, rhesus incompatibility - early onset
- bruising/cephalohaematoma -> red cell destruction
- GIT obstruction or ileus e..g pyloric stenosis
- Prematurity
- hypothyroidism (screened in newborn screening test)
Presents day 2 - 2 weeks of age, often begins on face and spreads to affect trunk and limbs. Palms and soles not usually affected. Combination of erythema to us macules, papules, as pustules. TYpically lasts several days
Erythema toxicum neonatorum
Classification criteria for PMR (need 4 points)
Mandatory criteria
- Age =/> j50
- Bilateral shoulder aching
- Abnormal CRP or ESR
Additional criteria
- Morning stiffness >45mins (2 points)
- Hip pain or reduced ROM (1 point)
- Negative RA or anti-CCP (2 points)
- Absence of peripheral synovitis (1 point)
- Ultrasound findings: various findings can add an extra point
Ultrasound findings of bilateral shoulder abnormalities or abnormalities in one shoulder and hip significantly improve sensitivity and specificity
Biochemical evidence of cirrhosis (4)
- thrombocytopenia
- low albumin
- prolonged PT
- prolonged INR
SNAP for osteoporosis prevention
- no smoking
- 1300mg ca per day and adequate safe sun exposure
- no more than 2 standard drinks/day
- weight bearing activity 2-3 times a week moderate - vigorous intensity
- maintain healthy BMI
When there is concern of osteoporotic spinal fracture which imaging modality is recommended?
Non contrast CT
3 behaviours indicative of pain
- Facial expressions - frowning, sadness, grimacing
- Body language - guarding, rigidity, fidgeting, pacing, altered gait
- Vocalisations - crying out, pain noises, moaning, groaning, verbal aggression
Non-pharmacological managementof pain
CBT Physiotherapy/regular exercise Education about source of pain Emotional support Ensuring warm and comfortable, reducing lighting and surrounding noise Heat Walking devices Massage
What are the 5 steps to mental wellbeing
- Be active
- Keep learning
- Be giving to others - acts of kindness can improve mental health
- Take notice - be mindful of the present moment
- Stay connected
Management of anxiety disorder
Psycho education re nature of anxiety, its purpose and how it can present
Psychological treatment - CBT
SSRIs
Suicide assessment questions
Suicidal thinking Plan Lethality Means to carry out plan Past history of attempted suicide Suicide of a family member
DSMV-5 criteria for schizophrenia
Hallucinations
Delusions
disorganised speech
Grossly disorganised or catatonic behaviour
Negative symptoms e.g. diminished emotional expression
+
Impairment of work, interpersonal relations or self-care for a significant period
Last for a continuous period of 6 months
Schizoaffective disorder and bipolar or depressive disorder with psychotic features have been ruled out
Non-pharmacological prevention of falls (10)
- Postural hypotension managment
- address under nutrition
- Manage incontinence
- Manage visual impairment
- Manage hearing impairment
- Exercise program to improve strength, balance, endurance and flexibility
- Tai chi
- refer to PT for mobility assisting devices
- Refer to podiatrist for appropriate footwear
- Refer to OT for home assessment and environment modifications
Pharmacological prevention of falls (6)
- Deprescribe where possible, including pharmacist review of medication where appropriate
- reduce/cease psychotropic drugs
- Review medications with dehydrating effect - diuretics/laxatives
- Vitamin D supplementation if deficient
- ensure B12 sufficient
- Manage other medical conditions
Post fall assessment (5)
- History, PMHx, mechanism, mobility levels
- identify sites of injury
- Examine vision, gait, balance and lower extremity joint function
- Neuro exam
- Cardiovascular exam including postural BP
Signs of frailty
- Unintentional weight loss >4kg in past year
- Self-reported exhaustion
- Weakness (reduced grip strength)
- Slow gait speed
- Low physical activity
Reversible causes of incontinence (7)
Delirium Infection Pharmaceuticals Psychological Excess fluid Restricted mobility Stool impaction
Basic investigations for incontinence
Urine MCS
Bladder chart over 3 days
Portable bladder scan for measurement of post-void residual - residual >100 may require ix
Or KUB USS
Side effects of oxybutinin (4)
Dry mouth
Constipation
Urinary retention
Cognitive impairment
Steps to help family care for family member with dementia
- refer to geriatrician for consideration of cholinesterase inhibitor - memantine
- Refer to My Aged Care for assessment for home domestic assistance and home care packages
- discuss advanced care directives
- Discuss enduring power of attorney
- Discuss enduring guardianship
- Refer to dementia support groups
- Discuss respite care services
Information to give - signs and symptoms of dementia
- time course and prognosis
- sources of financial and legal advice and advocacy
- medicolegal issues including driving
- how to join a support group
- information regarding
- Alzheimer’s Australia, Carers Australia, Aged Care Assessment Teams and My Aged Care
Differential diagnosis of cognitive decline, changed behaviour (4)
Dementia
Depression
Delirium
Drugs
Who is at risk of cystic fibrosis
Northern European or Ashkenazi Jewish Ancestory
Family history of CF/CF mutation
Partner affected or known carrier
Partner from Northern European / Ashkenazi Jewish ancestory who are consanguineous
Men with infertility secondary to congenital absence of vas deferens
Test couple for carrier status preconception or in first trimester
Who is at risk of fragile x
Children or adults of either sex with:
Developmental delay including disability of unknown cause
Attention hypersensitivity disorder
Speech and language problems
Social and emotional problems such as aggression or shyness
History of premature menopause <40
Adults with ataxia, balance problems and Parkinsonism
Relative with fragile X mutation
Who is at risk of haemoglobinopathies
Southern European African Middle Eastern Chinese Indian subcontinent Central and southeast Asian Pacific Islander New Zealand Maori South American Caribbean Some North Western Australian and NT ATSI
At risk of familial hyper cholesterol anemia and what to do (6)
Premature IHD men <55, women < 60 First degree relative with hx of same TC >7.5mmol/L LDL cholesterol >4.9mmol/L First degree relative with hx of same Tendon xanthomata or arcus cornealis age <45
-> assess probability using Dutch Lipid Clinic Network criteria
Offer referral to lipid disorders clinic of Dutch Lipid Clinic Network score =/>3
Who is at risk of hereditary haemochromotosis and what to do
All first degree relatives of person homozygous for C282Y or compound heterozygous C282Y/H63D -> >18 yo HFE gene analysis, transferrin sat and ferritin. If has above test all first degree relatives Consider in Chronic fatigue Arthritis ED Early menopause HCC Cardiomyopathy Liver disease -> serum ferritin and transferrin saturation
Family history screening questionnaire (9)
- IHD before age 60
- Diabetes
- Melanoma
- Bowel cancer before age 55
- More than 1 relative with bowel cancer at any age - first and second degree relatives*
- Prostate cancer before age 60
- Ovarian cancer
- Breast cancer before age 50
- More than one relative on the same side with breast cancer at any age. *
Children, siblings, parents, grandchildren, nieces, nephews, aunts, uncles, grandparents
Preventative counselling advice age 14-19
- Assess for risky behaviours
- Promote oral health
- Ask about smoking and provide strong anti-smoking message
- Use models of care that facilitate transition of patients with chronic health conditions/disability from paediatric services to primary care with access to adult specialist care
When and how often to screen for falls risk. What to ask. (3)
From age 65. Annually or 6 monthly if at increased risk
- Have you had 2 or more falls in the last 12 months
- Are you presenting following a fall
- Are you having difficulty with walking or balance
Assessment of falls history (10)
- Detailed history of fall inc fear of falling
- Polypharmacy
- Impaired gait, balance and motility
- Foot pain, deformities, unsafe ;footwear
- Home hazards
- Bifocal or multifocal glasses
- Incontinence
- Recent d/c from hospital
- Chronic illness such as stroke, Parkinson, MS，impaired cognitive impairment/demetia
- Vitamin D deficiency
Assessment of falls exam (7)
1. V/A including cataracts 2 reduced a visual fields 3. Muscle weakness] 4. Neuro impairment 5. Cardiac dysrhythmias 6. Postural hypotension 7. Six metre walk, sit to stand
If impairments following a fall
- GPCOG
- Activities of daily living and home assessment by OT
- Falls risk assessment tools
- If unsteady - gait and mobility assessment by physiotherapist
Falls risk interventions
- Prescribe or refer for home exercise or community exercise program targeting balance which may include strength and endurance must specifically challenge balance and be done for 2 hours per week
2.
Works in abattoir Fevers, sweats, chills, LOW Headache Fatigue Athralgias Myalgia Abnormal LFTs ?diagnosis
Q fever
What is Q fever?
Zoonotic disease
Gram negative Coxiella burnetii
Transmitted by domestic ruminants
Treatment for acute Q fever
Doxycycline 100mg bd
DDx for Q fever
Ross river virus Barmah first virus Dengue Epstein Barr virus Legionella Psittacosis Flu CMV Mycoplasma Leptospirosis Brucellosis
What complications can result from Q fever
- Chronic Q fever
- Post Q fever fatigue syndrome
- Endocardititis
- chronic granulomatous hepatitis
- osteitis/osteomyelitis
- alcohol intolerance
How to use 5-fluorouracil for actinic keratosis
- apply with gloves, thin layer to whole area once or twice daily
- Continue treatment until there is a marked inflammatory response - stage of ulceration
- initial therapy usually 3-4 weeks
How to counsel for 5-fluorouracil use
- side effects include, reddening, pain, itch, burning, stinging, crusting, blistering, sores, peeling, cracking
- less common side effects - hyperpigmentation/hypopigmentation, scarring
- get redness after 3-5 days and peeling, blistering and cracking and development of sores after 11-14 days.
- Healing takes 1-2 months
- avoid sun exposure
- avoid contact with mouth, eyes, nostrils
What are the essential steps for treating hepatitis C? (12)
- Serology positive -> PCR, genotype,
- HCV treatment history - regimen and response
- Potential for non-adherence
- EtOH history (risk factor for cirrhosis)
- Check drug-drug interactions
- Pregnancy discussion
- BMI - NAFLD is a risk factor for cirrhosis
- Signs of chronic liver disease
- FBE - low platelets suspect portal hypertension
- LFTs and INR: low albumin, raised bilirubin and raised INR suggest cirrhosis
- HBV, HIV and HAV serology. If hbv and hbv negative - immunise. Refer if HBV or HIV pos
- Cirrhosis assessment - fibroscan or APRI score (<1). If present refer
Pneumonia vs acute bronchitis. What suggests pneumonia?
Sats <95% HR >100 Temp >37.8 Creps, poor air entry, bronchial breath sounds and dullness to percussion Rigours Pleuritic chest pain Tachypnoea at rest
Pneumonia vs acute bronchitis what suggests bronchitis
- Fever usually subsides within a few days
- unlikely to have rigours, tachycardia or tachypnoea at rest
- wheeze
- creps that resolve with coughing
Treatment of CAP
- Decide if needs to go to hospital
- tachycardia, tachypnoea, hypotension, sats <92%
- acute onset confusion
- multilobar involvement
- blood lactate >2mmol/L
- social circumstances, age, comorbidities, able to take oral meds
- OR CRB65 = acute confusion, RR =/>30, BP<90/60, age =/>65. 0 don’t admit, 1-2 consider, 3-4 urgent admission
Empiric treatment for CAP
And in rural communities
If mycoplasma or chlamydophila suspected
Amoxicillin 1g PO 8 hourly.If improved after 2-3 days treat for 5 days. If slow clinical response treat for 7.
Procaine benzylpenicillin 1.5g IM daily. Length of treatment same.
Doxycycline 100mg bd or clarithromycin 500mg bd
R/v within 24 hours. If not improving assess if needs hospital or start combination therapy
Define low severity CAP in children
- minimal tachypnoea
- no tachycardia
- O2 =/>95%
Treatment low severity CAP in children
- consider performing respiratory virus PCR (difficult to differentiate viral)
- amoxicillin 25mg/kg 8 hourly for 3 days
- reassessment 48-72 hours
