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322 Cards in this Set
- Front
- Back
2 main causes of autonomic dysreflexia
+ 3 other causes |
distended bladder
faecal impaciton UTI pressure sore ingrown toenail |
|
S+S of AD? (8)
|
HTN
bradycardia sweating >lesion level flushing face, neck, shoulders headache blurred vision nasal congestion piloerection (myhydriasis if lesion >T1) |
|
AD in Pts with S/C lesion affecting which level or higher?
|
T6
|
|
AD: _______ prevails below SCI, _________ prevails above SCI
|
sympathetic
parasympathetic |
|
Mgmt of AD (2)
|
Rx underlying cause
if persist, lower BP with sublingual nifedipine or glycerin trinitrate |
|
Name for ingrown toenail
|
Onychocryptosis
|
|
Likely organism involved in ingrown toenail?
|
Staph
|
|
Indications for using ABx in ingrown toenail
|
suppuration from lateral nail fold or cellulitis around toe
|
|
Empirical ABx if using for ingrown toenail?
|
Di/flucloxacillin
OR Cephalexin |
|
Advice to prevent ingrown toenails? (3)
|
-soak foot in warm water
-proper nail trimming technique -appropriate footwear (no pointy toes or high heels) |
|
Conservative mgmt of ingrown toenail
|
Nail edge lifted out of lateral fold, moistened with EtOH soaked cotton wool, packed beneath nail bed so elevated.
Granulation tissue Rx with silver nitrate, corticosteroids or liquid nitrogen |
|
Surgical Rx of ingrown toenail
|
wedge resection or complete removal of toenail with destruction of germinal matrix
|
|
5 stages of iron poisoning
|
1) <6-8hr: acute GI injury (vomiting, diarrhoea)
2) Resolution of GI Sx (Fe absorbed and metabolised) 3) 6-12hr: cellular toxicity - anion gap metabolic acidosis - heart, lung, other organ dysfunction 4) 24h: Hepatic injury 5) GI scarring |
|
Toxic dose of iron
|
low risk <20mg/kg
possibly lethal >60mg/kg |
|
What is Ipecac?
|
gastric irritant and centrally mediated emesis (for toxin ingestion - no longer recommended)
|
|
what is the name of the chelating agent
given for iron overdose? |
deferoxoamine
|
|
Rx: mild-mod acne
|
topical Rx:
retinoid (Isotrentinoin) [comedolytic] and benzoyl peroxide [antibacterial] if persistent, add Clindamycin |
|
Rx: mod-severe papulopustular +/- trunk
|
oral ABx
- doxcycline - minocycline (use with topical stuff too) |
|
Rx: severe cystic or recalcitrant acne
|
SPECIALIST Rx
- Spirinolactone - Isotretinoin (Roaccutane) - Dapsone |
|
What sort of pill can females take if 1st line acne Rx doesn't work?
|
combined OCP with 3rd gen progestogen (Diane) = cyproterone acetate - ethinyloestradiol
(don't use progesterone or levogesterol) |
|
OCP/injectable/implantable hormones:
Can you give to a 16 year old without parental consent? |
Yes if deemd competent by her Dr to give informed consent
|
|
What does HEADSS stand for?
Why do this screen in young person who present with acne? |
Home
Education, Employment Eating, Exercise Activities + peer relationships Drug use/cigarettes/EtOH Sexuality Suicide/self-harm/depression/mood Because acne can cause low self esteem, bullying, depression, drug/cig/EtOH use |
|
Probability Dx for faints, fits and funny turns (3)
|
anxiety
vasovagal syncope postural hypotension |
|
Serious disorders not to be missed for faints, fits and funny turns (6)
|
arrythmias
aortic stenosis TIA SOL infective endocarditis hypoglycaemia |
|
What temp should water be to clean up blood?
|
warm or cold
NOT hot or boiling as this can cause coagulation and the coagulum may protect microorganisms from destruction |
|
You can write the death certificate of a Pt if you feel 'comfortably' satisfied as to probable cause of death and you have seen the Pt within _____ months of their death?
|
6
|
|
DDx: sore throat, fever, night sweats, enlarged tonsils with yellow-white exudate and tender swollen cervical LNs (9)
|
tonsillitis
GAS pharyngitis infectious mononucleosis peri-tonsillar abscess retropharyngeal abscess epiglottitis gonococcal pharyngitis diptheria HIV |
|
does a cough and runny nose alongside enlarged tonsils suggest viral or bacterial cause?
|
viral
|
|
What are the (4) Centor criteria and what can you use it for to suggest a likely Dx when fever/enlarged tonsils?
|
1) cervical adenopathy
2) absence of cough 3) tonsillar exudate 4) fever >38 3/4 suggests bacterial infection (strep) |
|
What on the FBC suggests infectious mono?
|
increased WCC with lymphocytosis + atypical lymphocytes
|
|
Other than FBC, what other blood test can you do to test for infectious mono?
|
reactive heterophile antibodies
|
|
What bacteria mostly causes pharyngitis? (you can throat culture for it or Ag test)
|
Group A beta-haemolytic Streptococcus pyogenes
|
|
Rx for acute pharyngitis/tonsillitis caused by strep?
|
Paracetamol/NSAIDs
NB: ABx NOT required unless high risk group for rheumatic fever e.g Indigenous NB: do not use aspirin in children |
|
If ABx are required in acute pharyngitis/tonsillitis caused by strep, what is used? What must not be used and why?
|
Penicillin
DO NOT USE amoxicillin or ampicillin since it can cause a rash if the Pt actually has infectious mono (and not strep) |
|
What are you worried about with strep pharyngitis/tonsillitis in Indigenous communities?
|
Rheumatic fever
|
|
What organism causes Q fever?
What is it? |
Coxiella burnetti
Obligate i/c Gr-ve bacterium |
|
Primary source of human infection of Q fever? (3)
Spread through what? (3) acquired how? |
most common hosts = cattle, sheep, goats
spread esp through productions of parturition, urine and faeces acquired through inhalation or ingestion of aerosolised particles containing the organism |
|
Acute infection of Q fever leads to (3)?
|
flu like illness
pneumonia hepatitis |
|
Chronic infection with Q fever leads to what? (1)
|
Endocarditis
|
|
Q fever is usually a self limiting disease and clears within ___ weeks
|
Two
|
|
5As strategy for smoking cessation
|
ASK and identify smokers
ADVISE about risk + benefit ASSESS motivation to quite ASSIST/ADDRESS barriers ARRANGE follow up w/i one wk of quitting and one month after |
|
Smoker is dependent if (3)
|
-smoke w/i 30mins of waking
- >15cig/d -Hx of of w/drawal Sx in previous quit attempts |
|
3 meds for smoking cessation
|
Bupropion
Varenicline NRT |
|
Mechanism of action: Bupriopion
|
selective inhibitor of NAd + Dopamine reuptake
|
|
Possible complications of Q fever (4)
|
Chronic fatigue
Infective endocarditis Miscarriage Neuro complications |
|
Symptoms of most people with Q fever?
|
60% asymptomatic
otherwise, high fever and flu-like illness |
|
Diagnostic test for Q fever (5)
|
1) indirect immunofluorescence
acute: phase II Ag:IgM 1:50 + phase II Ag:IgG 1:200 Chronic: phase I Ag:IgG 1:800 low or absent phase II Ag IgM 2) FBC: leukocytosis, anaemia, thrombocytopaenia 3) incr ALT, AST 4) incr alk phos 5) incr ESR |
|
Rx for acute, troublesome Q fever
|
Doxycycline
|
|
Rx for chronic Q fever (endocarditis)
|
Doxycycline + hydroxychloroquine
|
|
How many days do you have before you must enter cases of Q fever onto notifiable diseases database?
|
5 working days
|
|
Varenicline mechanism of action
|
partial agonist of alpha4beta2 neuronal nicotinic ACh Rs
|
|
More efficacious: Bupriopion, Varenicline, NRT?
|
Varenicline
|
|
Bupriopion SEs (4)
|
headache
dry mouth nausea insomnia |
|
Contraindication to Bupropion (2)
|
Seizure disorder
MAOIs |
|
Varenicline SEs (4)
|
nausea (40%)
abnormal dreams headache insomnia |
|
Varenicline: contraindication (1)
|
end stage renal disease
|
|
NRT: SEs (4)
|
increased BP
tachycardia dizziness insomnia |
|
NRT: contraindication (1)
|
phenylketonuria
|
|
Can you use NRT patches during pregnancy?
|
Nicotine = Category D - can harm foetus.
But less harmful than cigarettes. Gum, inhaler (less dose) better If patch, only during waking hours |
|
Other name for shingles?
|
Herpes Zoster
|
|
in Herpes Zoster, does pain or rash come first?
|
rash then dermatomal pain
|
|
Tests to confirm Herpes Zoster (3)
|
1. PCR for varicella DNA in fluids and tissues (best)
2. immunohistochemistry from cells scraped from base of lesion - detects viral glycoprotein 3. vesicular fluid culture |
|
Antiviral Rx in Shingles can be used when?
|
within 72 hours of onset of vesicles
|
|
What antiviral in Herpes Zoster?
|
Famciclovir
(or Valaciclovir or Aciclovir) |
|
Rx (other than antiviral) for Herpes Zoster (3)
|
1. bathe with saline to remove crusts + exudate
2. nonadherent dressing (prevent infectivity) 3. analgaesia |
|
Postherpetic neuralgia management (4 x 'step up' approach)
|
1. paracetamol
2. paracetamol mod-release 3. Prednisolone 4. Amitriptylline or oxycodone |
|
Zostavax vax in children?
|
No.
Not for people <50 |
|
Can you get Zostavax if you've already had Varivax?
|
No
|
|
Can you use Zostavax for prevention of primary varicella infection?
|
No
|
|
Can you get chicken pox from someone with shingles?
|
Yes
|
|
How is varicella spread?
|
air-borne transmission of droplets from URT or vesicle fluid from skin lesions of varicella or zoster
|
|
The period of infectivity of varicella?
|
from 48h before onset of rash til cursing of all lesions
|
|
How long post-exposure can you give Varivax?
|
Within 3 days (up to 5)
|
|
What is ZIG?
Who can use it? For what? |
Zoster Ig
For immunocompromised ppl Prevention of varicella within 96h of exposure (ie during incubation period) |
|
What types of problems do people have after severe traumatic brain injury (4)?
|
1. Neurological impairment (motor, sensory, autonomic)
2. Cognitive impairment 3. Personality + behavioural changes 4. Lifestyle consequences e.g unemployment, r/ship breakdown, loss of independence |
|
What are yellow flags in the context of continuing pain?
|
psychosocial indicators suggesting increased risk of progression to long term distress, disability and pain
|
|
Back pain is chronic if it persists > how many wks?
|
12
|
|
Aims of mgmt of chronic back pain? (3)
|
decrease pain
improve function decrease disability + work absence |
|
The majority of people with acute back pain will recover w/i how many months, regardless of Rx?
|
3
|
|
Pharmacological Rx of back pain?
(goal = reduce not abolish pain) (1st line) (2nd line) |
Paracetamol
and/or NSAID (only up to 3wks) if insuff, add one of (for < or = 3wks) - Codeine - Tramadol - Oxycodone |
|
Discharge: chlamydia vs gonorrhoea
|
Chlam: clear
Gon: thick, yellow, purulent |
|
Dysuria: chlamydia vs gonorrhoea
|
C: intermittent, mild
G: +++ |
|
Rx for Gonorrhoea
|
Ceftriaxone (IMI single dose)
(or penicillin + fluoroquinolone if no resistance [but there is in most urban centres in Aus]) |
|
Rx for Chlamydia
|
Azithromycin (1g PO single dose)
|
|
What sort of bacterium is gonorrhoea?
|
gram -ve intracellular diplococci
|
|
Investigations for Chlamydia
|
-1st catch urine for PCR
OR -endocervical smear for PCR of culture |
|
Investigations for Gonorrhoea
|
-1st catch urine or discharge swab for PCR
-Discharge/endocervical swab for gram stain, culture + Sn |
|
Gram stain from swab of terminal urethra in urethritis shows____?
|
PMNs
|
|
Men with urethritis: Rx with ABx immediately or wait for Sn?
|
Immediately
Sn for epidemiology not Rx options |
|
Contact Rx back to a period of ___ months
|
6
|
|
What's in the basic STI screen?
|
blood: HIV, HBV, syphilis
1st void urine or endocervical swab for PCR: chlamydia + gonorrhoea |
|
Which types of HPV cause 90% of genital warts?
Do they cause cervical cancer? |
HPV 6 + 11
No |
|
Which types of HPV cause 70% of cervical cancer?
|
HPV 16 + 18
|
|
What is the bivalent HPV vax?
Which types does it cover? |
Ceravix
16 + 18 |
|
What is the quadvalent HPV vax?
Indicated in girls how old? |
Gardasil
9-26 |
|
Lab Ix for syphilis? (2)
|
serum RPR (rapid plasma reagin) and a specific treponemal test (TPPA)
|
|
Lab Ix for Hep B? (3)
|
serum HBV sAg (acute or chronic)
serum HBV sAb (marker of immunity) serum HBV cAb (marker of recent or past infection) |
|
Lab Ix for HIV? (1) (for screening)
And to Dx? |
HIV 1 & 2 Abs
ELISA or rapid antigen test then confirm with Western Blot |
|
For HIV, post-exposure antiretrovirals need to be given within ___ hours
|
72
|
|
Antiretrovirals (4)
|
Nucleoside Reverse Transcriptase Inhibitor (NRTI)
Nucleotide Reverse Transcriptase Inhibitor (Tenofovir) Non-Nucleotide Reverse Transcriptase Inhibitor (NNRTI) Protease inhibitor (PI) |
|
Symptoms of acute HIV infection? (5)
|
fever
malaise lymphadenopathy maculopapular blanching rash diarrhoea |
|
Difference b/t phantom pain and stump pain?
|
phantom pain- from body part that's no longer there
stump pain - from remaining stump |
|
2 causes of stump pain?
|
1. neuroma (abno growth on damaged nerve endings)
2. prosthesis --> inflamm/irritation |
|
Pain specialists might give these for phantom pain (2)
|
TCAs (amitriptyline)
or anti-epileptics e.g Gabapentin |
|
Diarrhoea: amount in upper GI causes
|
copious
|
|
Diarrhoea: amount in colonic involvement
|
small
|
|
Onset of Diarrhoea within ___ hrs of ingestion of contaminated food suggest pre-formed toxin of ________ or _______
|
6
S. aureus B. cereus |
|
Indications for stool culture in Diarrhoea (7)
|
1. immunocompromised
2. multiple co-morbidities 3. bloody Diarrhoea 4. underlying IBD 5. test for leukocytosis is +ve 6. if reqd to return to work 7. outbreak Ix |
|
Most common cause of Traveller's Diarrhoea
|
ETEC
(enterotoxigenic E. Coli) |
|
Rx of mild Traveller's Diarrhoea (2)
|
fluids: 2-3L over 24h oral rehydration solution
+/- Ioperamide |
|
What is Ioperamide?
|
antimotility (use in Diarrhoea)
|
|
First Aid Rx for sprained ankle (ligament injury)
|
Rest
Icepacks every 1-2h for 10mins Compression bandage Elevation to decrease swelling + NSAID |
|
Subsequent Rx for ankle sprain?
|
refer to physio for restoration of ROM and proprioception training
Supportive taping during early phase of return to activity after a sprain is useful |
|
Ottowa Ankle Rules:
an ankle xray series is only reqd if there is.... |
Pain in malleolar zone
PLUS any of these: - bony tenderness at posterior edge of the fibula between the tip of lateral malleolus and a point 6 cm from the tip -bony tenderness in the posterior edge of the tibia between the tip of medial malleolus and a point 6 cm from the tip -inability to weightbear, both immediately and in front of the clinician |
|
Ottowa Ankle Rules:
an foot xray series is only reqd if there is.... |
any of
- bony tenderness at base of 5th metatarsal - bony tenderness at the navicular (medial) - inability to weight bear both immediately and in ED |
|
What is an incisional biopsy?
|
removes a subtotal portion of the area of interest
|
|
What is a punch biopsy?
|
a form of incisional biopsy undertaken with a circular blade.
allows histopath examination of complete depth of a lesion |
|
What is a shave biopsy?
What sort of lesions should it never be used for? |
For superficial lesions.
A scalpel blade used parallel to surface. Deeper components excluded. - suspected melanocytic lesions |
|
What sort of biopsies do suspected melanocytic lesions require?
|
full thickness biopsy
|
|
What nerve can be damaged in the superficial layers of the s/c tissue plane when there is a lesion around the temple?
|
Frontal branch of facial nerve
|
|
What nerve can be damaged in the superficial layers of the s/c tissue plane when there is a lesion overlying the jaw?
|
Marginal mandibular branch of facial nerve
|
|
What nerve can be damaged in the superficial layers of the s/c tissue plane when there is a lesion in the posterior triangle of the neck?
|
Spinal accessory nerve
|
|
Elliptical skin excisions are best orientated along lines of _____ ______?
|
minimal tension
- utilises increased skin laxity + disguises scars |
|
If any lesion is considered to be a melanoma, which sorts of biopsies should be initially avoided as they may invalidate accurate lymphatic mapping and sentinel node assessment?
|
wide excision
local flap surgery |
|
Where should adrenaline not be combined with lidocaine?
|
digits and ears
|
|
Systemic rxns to local anaesthetics primarily involve which systems (2)?
|
CNS
cardiovascular system |
|
CNS toxicity from local anaesthetics: progression of symptoms? (3)
|
dizzy + parasthaesia --> tremors -> tonic clonic Sz
|
|
What can local anaesthetics do to the heart? (1)
|
arrhythmias
|
|
Dose of lignocaine in plain solution
|
3mg/kg
|
|
Dose of lignocaine with adrenalin
|
7mg/kg
|
|
Dose of Bupivocaine as plain soln?
|
2mg/kg
|
|
Dose of Bupivocaine with adrenalin?
|
2mg/kg
|
|
When should sutures on the face come out?
|
4-7d
|
|
How long can sutures in the lower limbs be left in?
|
<14d
|
|
Sutures placed within the dermis and are soluble are called?
|
braided polyglactic acid (Vicryl)
|
|
Sutures that are placed externally through the skin surface and need to be removed are called?
|
monofilament nylon
|
|
What sort of skin graft do you use if aesthetic considerations are not important (larger defects)
|
Split skin grafts
- partial thickness of skin |
|
What sort of skin grafts are used on the face?
|
Full thickness skin grafts
|
|
3 donor sites of full thickness skin grafts for the face?
Where there? |
behind ear
supraclavicular fossa groin crease - because they can be repaired themselves by direct suture closure because of mobility of skin at these sites |
|
Most common cancer for males (by incidence)
|
prostate
|
|
Most common cancer for females (by incidence)
|
breast
|
|
Most common cancer (by mortality)
|
lung
|
|
how much iron is in an average iron tablet?
|
105mg
|
|
what is the approximate lethal dose of iron
for a 2-year old? |
3g
|
|
to avoid bowel obstruction with iron poisoning, what should be administered?
|
a laxative (polyethylen glycol: movicol or macrogol)
|
|
what is the antedote for paracetamol poisoning?
|
N-acetyl cysteine
|
|
what are the two main management points
for iron toxicity? |
1) gastric lavage/whole bowel irrigation
2) chelating agent |
|
in a poisoning emergency, what can be
ingested to reduce absorption? |
activated charcoal (50g, which should be
commenced within first hour) |
|
is immunization of varicella zoster
(chicken pox) recommended for pregnant women? |
no, a woman should not receive during
pregnancy, or in the month before becoming pregnant |
|
what is the contraindication for
vaccination, if a child is sick? |
fever, over 38.5 degrees
|
|
what is the incubation period for chicken pox?
|
14-16 days
|
|
what is a general contraindication to
vaccination |
immunocompromised individuals,
including those receiving steroids |
|
does the vaccination against chickenpox
affect the chance to developing shingles later? |
yes, it is much less common to develop it
(even than with natural immunity), but it may still occur |
|
what two arrhythmias are commonly linked
to cardiac syncope? |
ventricular tachycardia
bradycardia |
|
70% of sore throats are caused by?
|
viral pharyngitis
|
|
if strep/mono suspected, when should one
recommend the patient commence penicillin? |
2-3 days after presentation, if symptoms
have not improved |
|
what features are seen with glandular fever
to differentiate it from Strep throat? |
night sweats, and sometimes petichial
palatal haemorrhaging |
|
what blood test should be investigate if
glandular fever is suspected? |
LFTs, as similar picture to hepatitis is seen
|
|
what is the most common knee pain seen in
young athletes, and how does it present? |
Osgood-Schlatter disease, with tenderness
over the tibial tuberosity (inserted of patellar tendon) |
|
what is the treatment of Osgood-Schlatter
disease? |
rest and NSAIDs, note for sports, steroid
injections (optional); physiotherapy and orthopaedic surgery if persistant |
|
what investigations should be ordered for
sports-related joint pain? (2) |
ultrasound
xray |
|
how do topical retinoids work?
|
teratogenic, and kills rapidly dividing cells
|
|
what topical antibiotics are used for acne?
|
Clindamycin
|
|
how long should one trial topical
medications before providing oral medication for acne? |
4-8wks
|
|
How long does one take oral ABx for acne for?
|
> or = 8wks
|
|
if someone is injured on their way to work,
are they eligible for Medical Workcover? |
Yes, in NSW 'Journey and Workbreak
claims' are valid |
|
what is the normal incubation period for Q
fever? |
2-3wks
|
|
is vaccination against Q fever available?
|
yes: Q-vax (offer to butchers, farmers,
abattoir workers) |
|
Is Q fever a notifiable disease?
|
Yes, doctors must contact the Public Health Unit
|
|
what examination should be performed for
chronic back pain? |
feet (flat footedness), knee, hip, back
|
|
what weight limit should be imposed on
lifting in an individual with chronic back pain? |
20kg
|
|
what may be injected into a neuroma, for
stump pain? |
steroids
|
|
if UTIs are common with
self-catheterization, what can be done to modify management? |
increase frequency of self-cath; oxybutinin
to relax bladder |
|
what secondary prevention is available for
strokes? |
low-dose aspirin; smoking cessation;
exercise promotion; alcohol reduction; control diabetes; treat sleep apnea; treat dyslipidaemia |
|
when assessing someone's progress from
autonomic dysreflexia, how often should the person's BP be checked? |
every 5 mins
|
|
if one contracts an STI during pregnancy
how should it be managed? |
antibiotic treatment; C-section reduces
chance of contact |
|
what are the risks to the neonate with
gonococcal infection? |
opthalmia neonatorum, which can cause
blindness within 24 hours (purulent discharge seen in eyes) |
|
what are the risk to the neonate with a chlamydial infection? (4)
|
pneumonia
otitis media pharyngitis conjunctivitis |
|
how long should one abstain from
intercourse, when receiving treatment for chlamydia or gonorrhoea? |
7 days, after Rx
|
|
is ceftriaxone safe to take if a pregnant
woman is infected with gonorrhoea? |
Yes (Cat B)
|
|
what STI are 50% of the MSM men (in
NSW) who are HIV+, coinfected with? |
syphilis
|
|
3 drug regiment for post-exposure prophylaxis of HIV (after receptive anal intercourse)
|
2 x NRTIs (e.g Tenofovir)
+ PI OR NNRTI |
|
which grows faster, nodular or superficial
spreading melanoma? |
nodular
|
|
what feature of melanoma on the foot can
make detection difficult? |
It is not uncommon for these melanomas to
lack pigment |
|
where is the most common site for
melanomas on men? |
trunk (chest and back)
|
|
where is the most common site for
melanomas on women? |
arms and legs
|
|
if melanoma is diagnosed on excision
biopsy, should further excision be performed? |
yes, to widen the margins
|
|
what should patients with positive
melanotic biopsies be advised? |
lifetime monitoring is required, and lymph
nodes around excision should be self-checked every 4 months |
|
which melanoma patients are offered
sentinel node biopsy and what survival benefits does it offer? |
any patient with a Breslow thickness
>1mm, but there is no evidence that it changes survival |
|
if a positive sentinel node biopsy occurs, is there evidence for benefit from adjuvant chemotherapy?
|
none known to date
|
|
What is longitudinal melanonychia?
|
melanonychia = black or brown pigmentation of the normal nail plate
Longitudinal melanonychia may be a sign of subungual melanoma |
|
in longitudinal melanonychia, should all lesions be biopsied?
|
no
|
|
longitudinal melanonychia is more
common in what skin types? |
those with darker skin
|
|
what are some distinguishing features of
melanoma, from naevus, in longitudinal melanonychia? |
history of enlarging area; involvement of
proximal/lateral nail folds; irregular width bands of pigmentation |
|
what features indicate a melanonychia is
due to subungual haematoma, not melanoma? |
presence of red-blue pigment; sparing of
pigmentation in proximal nail fold |
|
presence of red-blue pigment; sparing of
pigmentation in proximal nail fold |
2-5 years because of mod-high risk of recurrence
|
|
what chemotherapy agent is commonly used for metastatic melanoma?
|
cyclophosphamide;
melanoma is not responsive to common chemotherapy regimens |
|
how often should one return for follow-up check ups after excision of an SCC?
|
every 6 months, for 2 years
|
|
what proportion of BCCs are pigmented?
|
7%
|
|
blue-grey nodules/nests are characteristic
of what skin lesion? |
pigmented BCC
|
|
what benign skin lesion(s) may fit the ABCDs of melanoma?
|
dysplastic naevi
|
|
what is the medical name for the common freckle?
|
ephelis
|
|
what pigmented skin lesion appears 'stuck on' and often has multiple miliary cysts?
|
Seborrhoeic keratosis
|
|
do any benign keratotic skin lesions not respond to cryotherapy?
|
no, sub and solar keratosis both do
|
|
a scar-like, thickened skin lesion that often occurs after an inflammatory event is called?
|
dermatofibroma
|
|
when should one excise a haemangioma?
|
when there is increase in size, or cutaneous angiosarcoma is suspected
|
|
what size of congenital naevi is at
increased risk of progressing to melanoma? |
one that is >20cm or covers >5% of the body surface
|
|
a cluster of naevi is called?
|
spilus naevi
|
|
what type of SCC responds well to
cryotherapy, if a 3mm margin is used? ) |
Bowen's disease (SCC in situ
|
|
What are the ABCDs of melanoma?
|
Asymmetry; Border irregularity; Colour variability; Diameter greater than 6mm
|
|
What percent of one's daily energy
expenditure is accounted for by basal metabolic rate? |
60-70%
|
|
What is the mechanism of Orlistat producing weight loss? What are the major
side effects? |
Orlistat inhibits lipases (gastric/pancreatic),
causing malabsorption. Consequently, steatorrhoea and faecal incontinence are common side effects |
|
GPs should address SNAP for patients who
are overweight. What risk factors does SNAP stand for? |
Smoking
Nutrition Alcohol Physical activity |
|
What is first line treatment for
hypertension? |
1) ACE-I/ARB or
2) CCB or 3) low-dose thiazide |
|
Why should one be cautious in prescribing
an ACE-I and diuretic together, for HTN? |
When combined with an NSAID, they can
cause ARF |
|
What is second line treatment for HTN?
|
Augment first line treatment with another
first line treatment (eg. ACE-I + CCB) |
|
What end organ damage can occur with
HTN? |
Kidneys; Heart (LVH/LHF); Eyes
(retinopathy) |
|
What is the target level for TGs?
|
<1.5mmol/L
|
|
What is the target level for LDL?
|
<2.5mmol/L
|
|
What is the target level for HDL?
|
>1mmol/L
|
|
What lifestyle factors should be addressed in HTN?
|
1) exercise (30min/d)
2) dietary salt (<4g/d) 3) alcohol (<2SD/d) 4) smoking |
|
What low impact exercise is proven to be
excellent for prevention of osteoporosis and falls? |
Tai chi
|
|
What modification can be made to improve eye sight in the elderly, and thus reduce
risk of falls? |
Cataract surgery
|
|
If an elderly person is anxious about falling, what therapy should be used to address this?
|
CBT (avoid antiaxiolytics!)
|
|
At what number of medications should one consider reviewing and reducing medications, so as to reduce the risk of falling?
|
5 or more
|
|
What is the Timed Up and Go (TUG) test,
and what is it screening for? |
It is the time taken for someone to rise
from a chair, walk 3 metres at their normal pace, then return to their seat. This should be less than 12s, and assesses one's risk of falling. |
|
What is the greatest predictor for risk of falls, in the elderly?
|
Impaired mobility and gait
|
|
What is the incubation period of genital
herpes? |
Typically 2-12 days (sometimes months to years)
|
|
What percent of the population carries HSV-2?
|
20%
|
|
What percent of those infected with HSV-2 are asymptomatic?
|
80%
|
|
Do most transmissions of genital herpes occur during a visible outbreak?
|
No, this doesn't necessarily match when
someone is shedding the virus (though it is recommended to abstain from sex during breakouts) |
|
What are common local symptoms of
genital herpes? |
Rash, tingling, discharge, itch, lumps, hair
loss, ulceration, chafing, cracks, sore, blisters |
|
What medications may be used in the treatment of genital herpes?
|
(antivirals:) valaciclovir, famciclovir,
aciclovir [doses vary, but course is 5-10 days] |
|
How soon should antivirals be commenced,
if experiencing prodromal symptoms of genital herpes, to be of most benefit? |
w/i 72h
|
|
Is contact tracing required for genital herpes?
|
No, though it is recommended
|
|
Can acyclovir be used to treat herpes
during pregnancy? |
yes
|
|
Is there a risk of transmission from mother
to baby during pregnancy? |
30-50% risk of transmission but only during delivery. Opt for a Ceasarean
|
|
Darkfield microscopy showing diplococci is typical of what STI?
|
syphilis
|
|
What results from a OGTT are considered an 'Impaired Glucose Tolerance' (IGT)
|
1) fasting plasma glucose <7mmol/L
and 2) 2hr BGL from 7.8-11mmol/L |
|
What is the mechanism of action of Metformin?
(3) |
1) decreases intestinal glucose absorption
2) increases skeletal/fat glucose uptake 3) decreases gluconeogenesis |
|
What is the mechanism of sulphonylureas?
|
Stimulates insulin release from beta islet cells (acts on KATP channels)
|
|
What is the mechanism of Gliptans
. |
DDP-IV inhibitors prevent the breakdown of
incretins (GLP-1 and GIP, gastric inhibitory peptide), thereby inhibiting glucagon release, increasing insulin release and slowing gastric emptying |
|
The target range for a diabetic's BGL is?
|
4-6mM
|
|
The target range for a diabetic's HbA1c is?
|
<7%
|
|
What is the target range for a diabetic's total cholesterol?
(same as everyone's!) |
<4
|
|
Target range for a diabetic's blood
pressure? |
<130/80
|
|
What are the symptoms of hypoglycaemia? (4)
|
Confusion
Anxiety Sweating Tachy |
|
What are the symptoms of
hyperglycaemia? (5) |
Polyuria
Polydipsia Dehydration Weight loss Disorientation |
|
How often should a diabetic go for eye exams?
|
every 2 years
|
|
When should a diabetic be referred to a nephrologist?
|
eGFR <60
|
|
How often should a diabetic be reviewed by a podiatrist?
|
annually (more frequently if neuropathy present)
|
|
What medication should diabetics take for
primary prevention of macrovascular complications? |
low dose aspirin
|
|
How often should a type 2 diabetic visit their GP?
|
every 4 months
|
|
What are the two negative features that must be absent for melanoma?
|
Symmetry
Solitary colouring |
|
do superficial and nodular melanoma appear similar?
|
no
|
|
which has classic 'ABCD' features of
melanoma, nodular or superficial spreading? |
Superficial spreading does fit the ABCD model
|
|
are the majority of nodular melanomas pigmented?
|
No
|
|
are the majority of superfical spreading melanomas pigmented?
|
yes
|
|
which STDs are a concern with pregnancy?
|
Syphilis and HIV can cross placenta
Gonnorhea, Chlamydia, HBV, HSV, HIV cross at birth HIV crosses whilst breast feeding |
|
what are the lab tests for HIV? (3)
|
1. HIV ELISA
2. Confirm with a western Blot 3. Viral load and CD4 count |
|
what are the red flags of back pain? (7)
|
>50 or <20
Hx of cancer fever, chills, weight loss (B Sx) pain worse at night Neuro involvement IVDU recent bacterial infection |
|
Rx of stump pain (2)
|
nerve block
surgery |
|
what is the DDx of genital lumps if a woman? (3)
|
HPV
condylomalata from 2ndary syphilis Molluscum contagiosum |
|
How many ferrograd C tablets are in a bottle?
|
30
|
|
Is ipecaac ever indicated?
|
if ingestion is witnessed
(but never for child <6mo) |
|
what is the most common ankle injury
|
sprain of the lateral ligaments - from plantar flexion and inversion- 90%
|
|
what is the major cause of back pain that presents
to GP |
mechanical back pain- 70%
spondylosis and disc prolapse (6-8%) are next |
|
What screening tests may be appropriate in Back pain for a man >50 (3)
|
Xray
PSA Urine dipstick |
|
management of BCC
|
<1cm = electrodessication and curretage
>1cm = surgical excision with 1mm margin |
|
which form of melanoma has least favourable prognosis?
|
nodular
|
|
what is the margin needed for melanoma excision
|
1cm margin if <1mm Breslow depth
2cm margin if >1mm Breslow depth |
|
what is the most common form of melanoma?
|
superficial spreading
|
|
where are BCCs most commonly found
|
75-80% head and neck
remainder on limbs and trunk (areas of UVB exposure) |
|
How is SCC treated?
|
surgical excision with 5mm margin (can be less if
frozen section clears margins) |
|
what are the old person immunisations?
(2) |
influenza and pneumococcal (from 65 if white,
from 50 if ATSI) |
|
burning, sharp, electric pain at stump of amputee?
|
stump pain
|
|
what components are included in the CVD risk calculator (6)?
|
age
gender smoking status total cholesterol/HDL ratio systolic blood pressure diabetes |
|
How often should people look for new or changing skin lesions?
|
every 3 mo
|
|
How often should women get mammograms?
From which age? |
every 2 years
50-69 |
|
Under which age are mammograms not recommended?
|
<40
|
|
When should you get Pap smears?
|
every 2 years if ever had sex from 18 years OR up to 2 years after first having sex, whichever is later
|
|
Who gets FOB?
How often? |
every 2 years
50-75 |
|
Are PR exam and PSA routinely recommended?
|
No
|
|
What is the best predictor for new onset diabetes (in terms of obesity)?
|
BMI
|
|
What is the best measure for risk of CVD? (in terms of obesity)
|
waist:height ratio
|
|
What is Phentermine?
(Duromine) |
amphetamine
appetite suppressant |
|
How many people experience depression at some stage in their lives?
|
1/6
|
|
Which medications can --> depression? (6)
|
corticosteroids
IFN Propranolol OCP Isotretinoin LDopa |
|
DSM IV criteria for depression
|
depressed mood for 2 weeks
OR anhedonia for 2 weeks PLUS 4 other symptoms |
|
What is the delay of onset of response for antidepressants to start working?
|
1-2 weeks
(may not see full benefit before 4-6wks) |
|
How long should you be on antidepressants for?
|
6-12mo
|
|
First line antidepressants (groups) (5)
|
SSRIs
NASSA (NAd-Serotonin Specific Antidep) NARI (NAd reuptake inhib) RIMA (reversible inhib or MOA) SNRI (Serotonin + NAd reuptake inhib) |
|
Which class of antidep:
Citalopram Escitalopram |
SSRI
|
|
Which class of antidep:
Fluoxetine Fluvoxamine |
SSRI
|
|
Which class of antidep:
Sertraline Paroxetine |
SSRI
|
|
Which class of antidep:
Mirtazepine |
NASSA
|
|
Which class of antidep:
Reboxetine |
NARI
|
|
Which class of antidep:
Moclobemide |
RIMA
|
|
Which class of antidep:
Venlafaxine |
SNRI
|
|
2nd line antidep
|
TCA
|
|
What class of antidep is potentially lethal if OD?
|
TCA
|
|
Nutrition for diabetics should comprise which proportions of which foods?
|
50% CHO
30% fat 10-20% protein |
|
What glycaemic load should diabetics aim for each day?
|
<80
(low) |
|
Nutrition for diabetics should comprise which proportions of which foods?
|
50% CHO
30% fat 10-20% protein |
|
Which diabetic drugs can --> hypos (3)
|
Sulphonylureas
Repaglinide Insulin |
|
Which diabetic drugs can --> weight gain (2)
|
Sulphonylureas
Glitazones |
|
What glycaemic load should diabetics aim for each day?
|
<80
(low) |
|
When is medication indicated in DMII? (3)
|
lifestyle trial >6wks unsuccessful
symptomatic @ 1st Dx BGL >20 |
|
Which diabetic drugs can --> hypos (3)
|
Sulphonylureas
Repaglinide Insulin |
|
Which diabetic drugs can --> weight gain (2)
|
Sulphonylureas
Glitazones |
|
When is medication indicated in DMII? (3)
|
lifestyle trial >6wks unsuccessful
symptomatic @ 1st Dx BGL >20 |
|
Which diabetic drugs are contraindicated in heart failure because of fluid retention?
|
Glitazones
|
|
First line diabetes drug?
When is it contraindicated? |
Metformin
renal impairment: GFR < 30 |
|
Which class of diabetes drug start with "GLI-"
|
sulphonylureas
|
|
Mechanism of action: Acarbose
|
alpha-glucose inhibitor
inhibits digestion of CHO |
|
"-gliptans" = which class of diabetes drug?
|
DPP-IV inhibitors
|
|
Mechanism of action: Glitazones
|
act on PPAR-gamma Rs in fat cells
increase FA uptake increase glucose uptake decrease hepatic glucose output |
|
When should DMII be put on insulin? (2)
|
symptomatic
or BSL constantly >7 |
|
Insulin as basal therapy.
Which insulin (2) |
Isophane
or Glargine (daily dose of long/intermed acting) |
|
Insulin: premixed
Which insulin (2) |
Humalog
or Analogue (single dose before largest meal or twice daily doses - before breakki and before dinner) |
|
How often should diabetics have an eye review?
|
every 2 years
|
|
How often should neuropathy be checked for in diabetics?
|
check reflexes and sensation at annual review
|