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78 Cards in this Set
- Front
- Back
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what test would you order for a man presenting with purulent urethral discharge
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1st = Gram stain of discharge = Dx
2nd = culture for sensitivity if no discharge do first catch urine In a woman you would do an endocervical swab. Rx = ceftriaxone (gonorrhoea) doxycycline (chlamydia) |
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which STDs are a concern with pregnancy
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Syphilis and HIV can cross placenta
Gonnorhea, Chlamydia, HBV, HSV, HIV cross at birth HIV crosses whilst breast feeding |
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what are the lab tests for HIV
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1. HIV ELISA
2. Confirm with a western Blot 3. Viral load and CD4 count |
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what are the yellow flags of back pain
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belief that pain is severely debilitating
fear avoidance/ inactivity low mood social withdrawal |
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what are the red flags of back pain
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>50 or <20
Hx of cancer fever, chills, weight loss (B Sx) pain worse at night Neuro involvement IVDU recent bacterial infection |
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what is an appropriate management plan for someone presenting for the first time with low back pain
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1. patient education and self care (ice, heat, encourage early return to activity)
2. trial NSAIDs, short course of tramadol or opiod if severe 3. refer to physio if > 4/52 NB. there is no evidence for steroid injections. |
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what is phantom pain and how is it treated?
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pain in a limb that isn't actually there
Rx = gabapentin, amytriptaline etc. |
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What is stump pain and how is it treated?
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Pain in the stump - caused by neuromas - bundles of nerves at the end of stump
Sx - sharp, burning, electric Rx = Nerve blocks, surgery |
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what is the DDx of genital lumps if a woman?
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HPV
condylomalata from 2ndary syphilis Molluscum contagiosum |
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When is Gardasil recommended
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women aged 9-26
1st vaccine at 11 or 12 then at 2 and 6 months. |
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what organism is most commonly involved in 'onychocryptosis'? (ingrown toe)
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Staph aureus
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when is antibiotic Rx required for an ingrown toe (onychocryptosis)
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cellulitis or frank suppuration
Rx = flucloxacillin or cephalexin + topical antiseptic |
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how can onychocryptosis be prevented?
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foot baths
avoid nylon socks change cotton or wool socks square cut of nail and corners project beyond skin fold |
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what are the red iron tablets?
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ferrograd C - 105mg tablet
30 tablets in a bottle |
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what are signs of Iron overdose?
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GI signs (N/V, pain, diarrhea) - after 20mg/kg
Moderate intox - 40mg/kg Severe Intox >60mg/kg |
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what is the dosing of activated charcoal?
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1g/kg
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what drugs are not absorbed well by activated charcoal?
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Acids, alcohols, bromides, cyanides, Iron, Lithium
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what is the antidote for iron overdose (>60mg/kg)
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desferrioxamine (15mg/kg/hr) - chelating agent forms water soluble compounds that are excreted in the urine
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when is ipecac indicated
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remote areas
never in <6 month olds when ingestion is witnessed and it is within 30 minutes |
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what are the treatment options for poisoning
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antidote
dilution with cup of water or milk gastric lavage within 60 minutes aspiration whole bowel irrigation with polyethylene glycol (if severe) |
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what vaccinations are given at birth?
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HBV
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what vaccinations are given at 2 months
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DTP
Hib Polio pneumococcal rotavirus HBV |
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what is the infanrix vaccine and when is it given
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DTP
Hib HBV Polio given at 2, 4, 6 months |
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when is measles mumps rubella vaccine given
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12 months
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when is chicken pox vaccine given
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18 months
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If a child is exposed to VZV and has not been vaccinated should they be offered vaccination
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yes - Varicella vaccine is effective at preventing varicella within 3 days of exposure and may have some success up to 5 days
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what is acamprostate?
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used to treat alcohol dependence
- decreases NMDA activity and increases GABA A activity Requires ETOH abstinence |
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when a child presents with a sore throat what are the likely DDx
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1. Viral URTI (65-85%)
2. Bacterial (group A beta haemolytic strep) - 15-30% |
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what is the centor criteria for Dx of GABS
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- fever >38*
- tonsil exudate - no cough - tender anterior cervical lymphadenopathy |
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what investigations should be ordered on a child with persisting sore throat
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- strep Ag testing
- throat culture - BGL for DM - FBC > raised WBC with neutrophilia = Bacterial > raised WBC with lymphocytosis = infective mononucleosis/EBV - reactive heterophile Ab for EBV |
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what is the treatment for first presentation of child with sore throat, cough and runny nose
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analgesia - 2 soluble aspirin or paracetamol
rest and adequate fluids Only Abx if - severe tonsilitis with features of GABS - existing RHD - scarlet fever - Peritonsillar cellulitis or quinsy use penicillin V - amoxicillin and ampicillin should be avoided in tonsillitis as they may induce rash |
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can a medical certificate be backdated
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no
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what are the requirements of a medical certificate
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name and address of MD
name of patient date of examination, date of issue Dates unfit for school/work |
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when should a knee be XRayed
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isolated patella tenderness
tenderness at head of fibula inability to flex 90* inability to weight bear |
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How should osgood schlatters syndrome be managed?
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- activity modification, RICE, NSAIDs if needed - works in 90%
- long term - strengthening of quads and hamstrings and increase knee flex - if severe may benefit from 7 days in a brace - surgery rare - sometimes if there are bony changes causing disability. |
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what are the 3 principles of management for acne?
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1. unblock follicular ducts - salicylic acid with benzoyl peroxide or retinoic acid
2. decrease bacterial infection in the sebum - tetracyclins or ezythromicin (systemic or topical) 3. decrease sebaceous gland activity - oestrogens, spironolactone, isotretinoin (roaccutane) |
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what drugs can aggrevate acne
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corticosteroids
iodides/bromides lithium anti epileptics quinine |
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what is a good Rx for mild-moderate acne
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tretinoin at night (makes you photosensitive)
Benzoyl peroxide in the morning Review at 3/52 |
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what should be added to benoyl peroxide and nightly tretinoin for moderate to severe papulopustular acne
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oral Abx
- tetracycline or doxycycline Trial for 3-6 months |
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what should be added if acne has not responded to Benzoyl peroxide and tretinoin, and Abx
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- spironolactone (anti androgen)
- Isotretinoin (roaccutane) - women must be on contraception!!!! - OCP - diane = antiandrogen + oestrogen. |
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what is the most common ankle injury
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sprain of the lateral ligaments - from plantar flexion and inversion- 90%
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girl 'rolls' her ankle playing hockey. Examination shows swelling in front of lateral malleolus
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sprained lateral ankle ligament
Do anterior draw and talar tilt test rule out need for Xray - bone tenderness on distal 6cm of fibula or tibula - inability to weight bear Check foot - bone tenderness at 5th metatarsal - bone tenderness at navicular. |
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what is appropriate management of ankle sprain
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Rest - 48 hrs
Ice - 20 min every 3-4 hrs for 48 hrs Compression crepe bandage Elevate to level of hip Analgesia - paracetamol Review at 48 hrs then 7 days special strapping if unstable |
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what is the major cause of back pain that presents to GP
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mechanical back pain- 70%
spondylosis and disc prolapse (6-8%) are next |
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what screening tests may be appropriate in Back pain for a man >50
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Xray, PSA, urine dipstick.
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what organism causes Q-fever
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coxiella burnetti
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what does every abattoir worker have
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Q fever
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How is Q fever diagnosed
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blood test - IgM titres peak at 4-6 weeks
Do LFTs and TOUS if endocarditis is suspected |
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id Q fever notifiable
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yes
- in certain settings (abatoir) workers should be offered Qvax. |
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management of BCC
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<1cm = electrodessication and curretage
>1cm = surgical excision with 1mm margin |
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which form of melanoma has least favourable prognosis
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nodular
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what is the margin needed for melanoma excision
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1cm margin if <1mm Breslow depth
2cm margin if >1mm Breslow depth |
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what is the most common form of melanoma
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superficial spreading
- torso in men - legs in women Dx - usually 30-50yo |
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where are BCCs most commonly found
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75-80% head and neck
remainder on limbs and trunk (areas of UVB exposure) |
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How is SCC treated
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surgical excision with 5mm margin (can be less if frozen section clears margins)
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first line test for male with urethral discharge
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gram stain
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first line test for female if suspect gonorrhea
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endocervical swab for culture and sensitivity
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men without discharge, suspected gonorrhea
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urinalysis of first catch urine - if poitive for leukocytes treat.
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what vaccinations are given at 2, 4 and 6 months
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DTP,
Hib Hep B Polio peumococcal rotavirus |
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when is MMR vaccine given
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12 months and 4 years
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when is varicella vaccine given
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18 months and 12 years
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when is DTP given
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2, 4, 6 months
4 years 15 years |
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what are the old person immunisations?
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influenza and pneumococcal (from 65 if white, from 50 if ATSI)
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what is the window of cover for varicella vaccine
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effective within 3 days of exposure
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when should you report a death to the coroner
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haven't attended GP for 3/12 prior
within 24 hours of anaesthetic held in care in custody accident or injury If you're not confident on cause of death need to report to coroner |
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what is the most common cause of tonsilitis in kids 5-15
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viral (65-85%)
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what should be ordered if glandular fever is suspected
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rapid heterophile Ab testing
Monospot |
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how should viral tonsilitis be treated
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adequate fluid +/- analgesia (soluble aspirin, paracetamol)
if suspect bacterial - rapid strep Ag testing and throat culture. Rx - penicillin V |
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what law states that a person >16 can consent to their own treatment
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guardianship act
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what is the HEADSS screen
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home, hapits
education, employment, exercise accidents, abuse, ambition, activities Drugs, diet depression sexuality suicidality |
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what % of amputees experience phantom limb pain
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60-70%
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pain that is shooting stabbing, boring - in an amputee
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phantom = amytriptaline or gabapentin
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burning, sharp, electric pain at stump of amputee
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stump pain - nerve blocks/ surgery for treatment
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at what level of spinal cord injury are you at risk of autonomic dysreflexia
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t5-6
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how is autonomic dysreflexia managed
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remove stimulus, control blood pressure
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what components are included in the CVD risk calculator
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age, gender, smoking status, total cholesterol/HDL ratio, systolic blood pressure.
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what is 'normal' blood pressure
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<120/80
high normal = 120/80 -140/90 grade 2 = 160/100 - 180/110 grade 3 = >180/110 |
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what is the initial management of HTN
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weight reduction
diet and exercise - at least 30 minutes at least 5 days/week - smoking cessation - male waist <94cm; female waist <80cm - salt restriction <4g/day. |
