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305 Cards in this Set
- Front
- Back
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what is the medical name for an ingrown toenail?
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onychocryptosis
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what is the most common organism responsible for onychocrytosis?
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Staph aureus
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if infected, what topical antibiotic should one use for onychocryptosis?
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Flucloxacillin (or cicloxacillin or cephalosporin)
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what is the non-surgical treatment of onychocryptosis?
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1) soak in antibacterial solution for 30min/day; 2) silver nitrate applied to granulation tissue; 3) bandaid applied for cross tension on skin
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what are some surgical options for onychocryptosis?
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1) phenolization (ablates offending tissue); 2) vandebos procedure (remove flanking tissue); 3) wedge resection
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at what dose/kg does iron toxicity begin?
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10mg/kg
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what are some complications of iron toxicity?
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bowel obstruction; stomach ulceration; N/V; organ toxicity (brain/liver); metabolic acidosis
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what preventative measures can be taken to prevent onychocryptosis?
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a) cut nails with a straight edge, b) avoid poorly fitting shoes
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what is the name of the chelating agent given for iron overdose?
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deferoxoamine
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if one has intentionally ovedosed on pharmaceuticals, what drug should always be tested for?
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paracetamol, the most commonly overdosed drug (if intentional)
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how much iron is in an average iron tablet?
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100mg (105mg to be exact)
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in an poisoning emergency, should one use salt water to induce vomiting?
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no, this it to be avoided
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what is the approximate lethal dose of iron for a 2-year old?
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3g
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to avoid bowel obstruction with iron poisoning, what should be administered?
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a laxative (polyethylen glycol: movicol or macrogol)
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why should ipecac be avoided in managing poisoning?
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it is only effective for a short time frame after ingestion, and poisoning may suppress gag reflex
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what is the antedote for paracetamol poisoning?
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N-acetyl cysteine
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how does iron poisoning present?
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vomiting, haematemesis, abdominal pain, coma, convulsions, shock, metabolic acidosis, hepatic failure
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what are the two main management points for iron toxicity?
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1) gastric lavage/whole bowel irrigation, 2) chelating agent
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in a poisoning emergency, what can be ingested to reduce absorption?
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activated charcoal (50g, which should be commenced within first hour)
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what amount of time should a patient be monitored for effects of poisoning, from a pharmaceutical?
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for 5 half-lives of the poison ingested
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the national immunization program targets protection against what infections?
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HAV, HBV, Diptheria, tetanus, pertussis, haemophilus influenzae type b, polio, pneumococcus, rotavirus, measles, mumps, rubella, meningococcal C, varicella zoster, HPV
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is immunization of varicella zoster (chicken pox) recommended for pregnant women?
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no, a woman should not receive during pregnancy, or in the month before becoming pregnant
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is there a link between immunization and autism?
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no, this 'evidence' was derived from a poorly designed, small trial
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does vaccination provide complete protection against chicken pox?
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no, there is still a small chance of developing chicken pox
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what is the contraindication for vaccination, if a child is sick?
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fever, over 38.5 degrees
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is there a disadvantage to chickenpox vaccination if the child has possibly contracted the virus naturally?
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no
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how often do complications occur in children who contract chicken pox?
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1% of the time (rarely serious)
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what is the incubation period for chicken pox?
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14-16 days
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do vaccines suppress the immune system?
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no; one should be no more susceptible to other infections than usual
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what is a general contraindication to vaccination
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immunocompromised individuals, including those receiving steroids
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does the vaccination against chickenpox affect the chance to developing shingles later?
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yes, it is much less common to develop it (even than with natural immunity), but it may still occur
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what two arrhythmias are commonly linked to cardiac syncope?
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ventricular tachycardia and bradycardia
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what time frame must a doctor have seen a patient within in order to sign their death certificate?
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within 6 months
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what are two main requirements to be met before a doctor signs a death certificate?
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1) must be certain of cause of death; 2) must not be a suspicious death that should be referred to the coroner
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70% of sore throats are caused by?
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viral pharyngitis
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what antibiotic is given for bacterial tonsillitis?
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penicillin, as most commonly strep
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if strep/mono suspected, when should one recommend the patient commence penicillin?
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2-3 days after presentation, if symptoms have not improved
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what is the complication of concern associated with strep throat?
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later development of rheumatic heart disease
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what features are seen with glandular fever to differentiate it from Strep throat?
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night sweats, and sometimes petichial palatal haemorrhaging
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what clinical features indicate pharyngitis is of viral origin?
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gastro involvement, runny nose, myalgia
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why is a throat swab not definitive in diagnosis of strep throat?
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30% of the pop'n will culture strep even if asymptomatic
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what clinical test may be performed to differentiate strep from mono?
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rapid antigen testing
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why is amoxycillin contraindicated in mononucleosus
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nearly every will develop a rash (interaction of virus and antibiotic that is not understood)
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does one have to put a diagnosis on a medical certificate?
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no, it is not required, and does require the permission of the patient
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can one back-date a medical certificate?
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no, it is illegal
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it is important to have a low threshold for strep throat treatment, to avoid future complications of?
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rheumatic heart disease
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what is mononucleosus (glandular fever) caused by?
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Epstein-Barr Virus
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what blood test should be investigate if glandular fever is suspected?
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LFTs, as similar picture to hepatitis is seen
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what is the most common knee pain seen in young athletes, and how does it present?
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Osgood-Schlatter disease, with tenderness over the tibial tuberosity (inserted of patellar tendon)
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what is the treatment of Osgood-Schlatter disease?
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rest and NSAIDs, note for sports, steroid injections (optional); physiotherapy and orthopaedic surgery if persistant
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the most common diagnosis for a young athlete presenting with knee pain, which worsens on climbing stairs and kneeling, is?
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Osgood-Schlatter disease
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what investigations should be ordered for sports-related joint pain?
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a) ultrasound and b) X-ray
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who is best to advise an athlete on when it is ok to return to sport, after an injury?
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the physiotherapist
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what aid should be considered to prevent recurrence of a knee injury?
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knee brace
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Patellofemoral pain syndrome is colloquially called?
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Runner's knee
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Patellofemoral pain syndrome presents as?
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Anterior/Anteriomedial knee pain, which is worse with running/jumping/stairs. Develops both acutely or insidiously
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What three sports are conducive to Osgood-Schlatter disease?
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Basketball, Soccer, Gymnastics
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What pathology is seen in Osgood-Schlatter disease?
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Callus formation at the tibial tuberosity, and ossicles in the tendon
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The most common cause of heel pain in young atheletes is?
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Calcaneal apophysitis
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What causes Calcaneal apophysitis?
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repetitive microtrauma on the calcaneus, from the Achilles tendon
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Which aspect of the elbow is most commonly affected by 'Little League Elbow'?
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The medial aspect, due to valgus stress
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If a baseball player complains of a sudden pop and pain after a throw, what is the likely injury?
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An avulsion fracture
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How long should a pitcher rest if suffering from Little League Elbow/Shoulder?
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4-6 weeks, depending on severity (ensure gradual return to activity)
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The American Academy of Orthopaedic Surgeons recommends children should not exceed how many pitches per week?
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200 pitches/week
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A vertebral stress fracture commonly seen at level L4-5 in athletes is?
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Spondylolysis
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How should spondylolysis be assessed?
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Ex: lower back pain with extension or standing on 1 leg; decreased flexibility of hamstrings. Ix: radiographs (usually negative), bone scintigraphy/CT/MRI
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How is vertebral spondylolysis managed?
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rest, physio, NSAIDs, braces, bone stimulators (surgery in rare, persistent cases)
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An injury which is caused by seperation of subchondral bone and articular cartilage from surrounding tissue is known as?
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Osteochondritis Dissecans
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Osteochondritis Dissecans may present (after an insidious onset) as?
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Locking, Catching and Decreased ROM of a joint
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What imaging modalities should be used for osteochondritis dissecans of the knee?
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radiograph (include tunnel view) and MRI
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After physical therapy and rest, when should MRI be repeated to assess osteochondritis dissecans?
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After 3 months
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is acne due to poor hygeine or diet?
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no, neither
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how should one practice basic hygeine in cleaning the face?
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wash with soap/water twice daily and moisturize after
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how long does medication take for an effect on acne?
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can take weeks to months
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how does benzoyl peroxide work?
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antibacterial and increases turnover rate of skin
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how do topical retinoids work?
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teratogenic, and kills rapidly dividing cells
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what topical antibiotics are used for acne?
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clindamycin; sometimes tetracyline
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how long should one trial topical medications before providing oral medication for acne?
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4-8 weeks
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how long does one take oral tetracycline for acne?
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8 weeks, or sometimes longer
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what are alternative oral medications for females, for acne?
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OCPs, or anti-androgens
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when should a patient be referred to a dermatologist for acne?
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for severe, scarring acne
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what advice needs to be given to patient commencing roaccutane?
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isoretinoin (retinoid) is C/I in pregnancy, hepatic impairment, hypervitaminosis and interaction with tetracyclines
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what advice needs to be given to a patient before commencing OCPs?
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inc risk of DVTs (esp if smoker), lack of protection against STIs (barrier protection)
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what is the psychological screen for a teenager suffering from acne?
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HEADSS - home, education, activities, drugs, sexuality, suicide
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at what age are youth considered mature enough to have independant consults with a GP?
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age 14
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can one prescribe the OCP to a 16 year old girl in Australia without parental consent
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yes
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what is the first line, non-prescription recommendation for teenage acne?
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benzoyl peroxide (2-10%, start low & go slow)
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what is the HEADSS screen, used to assess a teenagers wellbeing?
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Home; Education/Employment; Activities; Drugs; Sexuality; Suicide/Depression
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when do the Ottawa ankle rules indicate one should get an Xray for a possible fracture?
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tenderness on posterior tip of either lateral or medial malleolus, or unable to bear weight at accident/time of presentation
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what first aid should be done for an ankle injury?
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NSAIDs for pain; RICE
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if someone is injured on their way to work, are they eligible for Medical Workcover?
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Yes, in NSW 'Journey and Workbreak claims' are valid
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what are three red flags for back pain?
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1) age <20 or >60; 2) worsens when supine; 3) non-mechanical pain; 4) weight loss; 5) nighttime pain; 6) thoracic pain; 7) HIV positive; 8) IVDU; 9) immune suppression; 10) steroid use; 11) history of carcinoma; 12) structural deformity; 13) widespread neurological deficit
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how long does 'acute' back pain last for?
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6 weeks is not uncommon, but should start to improve in this time if one has been remaining mobile
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when should one order imaging for back pain?
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if any red flags are present
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what organism causes Q fever, and where does it come from?
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Coxiella burnetii, from farm/domestic animal contact
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what is the minimum infectious dose of Q fever, and how long can it remain alive on surfaces?
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1 bacterium (the most infectious bacterium known to man), and can remain on surfaces for 60 days
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how is Q fever contracted?
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contact with infected animal secretions, or inhalation of endospores
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what is the normal incubation period for Q fever?
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2-3 weeks
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Q fever leave half of patients symptomatic for 1-2 weeks, with what clinical features?
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mild flu-like symptoms (fever, malaise, perspiration, headache, myalgia, joint pain, anorexia, upper respiratory problems, dry cough, pleuritic pain, chills, confusion, GI upset)
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what is the major complication of Q fever?
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development of pneumonia, which can progress to ARDS (early in infection); granulomatous hepatitis; retinal vasculitis; endocarditis (if chronic)
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how is Q fever diagnosed?
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serology or PCR (check LFTs, and TEE for heart)
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how is Q fever treated?
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doxycycline, & quinolone (for complicated cases)
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is vaccination against Q fever available?
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yes: Q-vax (offer to butchers, farmers, abattoir workers)
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what is the mortality of untreated Q fever?
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10% (due to endocarditis)
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How is Q fever treated in pregnant women?
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5 weeks of co-trimoxazole
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Is Q fever a notifiable disease?
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Yes, doctors must contact the Public Health Unit (PHU
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what does PTA stand for?
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post-traumatic amnesia
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How many days must a person score 12/12 in the Westmead PTA scale to be considered recovered from PTA?
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3 consecutive days
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if someone cannot remember events around an accident for 24 hours, how is it classified? How about 7 days?
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24 hours: 'moderate'; 7+ days: 'severe'
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what is DAI?
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diffuse axonal injury (proportional to speed at which one is travelling)
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what does TBI stand for?
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traumatic brain injury
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seizures are not uncommon after a TBI. After what time would one consider them likely to be of chronic concern?
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occurence after 7 days
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why is anger management an important part of rehab for someone with a TBI?
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if there is frontal lobe involvement, or memory loss, anxiety and anger issues are common and poorly recognized by affected individuals
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what is a yellow flag for back pain?
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for those suffering from chronic back pain, continuing psychological stressors and fulfilling a 'sick role' have a poor prognostic outcome
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what examination should be performed for chronic back pain?
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feet (flat footedness), knee, hip, back
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what weight limit should be imposed on lifting in an individual with chronic back pain?
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20kg
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what is basic therapy for someone with chronic back pain?
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NSAIDs for medication (Celebrex); low-dose opioids; CBT for pain tolerance and functionality
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how does a neuroma affect amputees?
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growth of nerves toward stump can contribute to stump pain and may require steroid injection or resectioning
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what is the first line medication for phantom pain? Second line?
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TCAs ('dirty' but cheap); second line - gaba-pentin (anti-epileptic; well-tolerated but expensive)
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aside from medication, what can be done for management of phantom limbs?
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education for patient and family; stump massage; artificial limbs
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what may be injected into a neuroma, for stump pain?
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steroids
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how much does a 'C-leg' cost? Is it covered for all patients?
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approximately $70K. It is covered for those that lose their leg to trauma
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in a spinal cord injury, at what level does a patient need to be educated about autonomic dysreflexia?
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around T6, and above
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what are the most common exacerbators of autonomic dysreflexia?
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UTIs (from catheters) and constipation
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how is autonomic dysreflexia managed?
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sit patient up and remove restrictive clothing; address trigger (ie. Catheter); examine for pressure areas; GTN spray; monitor BP every 5 minutes until resolved
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what can be used as an alternative to GTN sublingual spray if it is contraindicated in someone who requires relief from autonomic dysreflexia?
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Captopril
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if UTIs are common with self-catheterization, what can be done to modify management?
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increase frequency of self-cath; oxybutinin to relax bladder
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what secondary prevention is available for strokes?
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low-dose aspirin; smoking cessation; exercise promotion; alcohol reduction; control diabetes; treat sleep apnea; treat dyslipidaemia
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when assessing someone's progress from autonomic dysreflexia, how often should the person's BP be checked?
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every 5 minutes
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what medication can be prescribed for an overactive bladder?
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oxybutin (relaxes bladder)
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what grade of pressure areas requires immediate bedrest?
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grade 2 (dermal involvement/blisters), as it can progress quickly
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what is a grade 4 pressure area?
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bone exposed with/without bone infection
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what is the minimum grade of a pressure area, if bone is exposed?
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grade 3
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how is chlamydia and gonorrhea diagnosed?
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first-catch urine (FCU) is cultured or used for NAAT
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how does gonorrhea appear on microscopy?
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gram-negative intracellular dipplococci
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when should gonorrhea be treated?
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immediately in all clinically suspected cases
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what is the first line treatment for gonorrhea?
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ceftriaxone 500mg IMI (in 2ml 1% lignocaine), with 1g azithromycin PO
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is there a legal obligation to inform sexual contacts for gonorrhea/chlamydia?
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yes, as it poses a risk to their future health
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resistance to which antibiotics has been documented for gonorrhea?
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cephalosporins, penicillins, tetracyclines
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is there a risk of contracting STIs from oral sex?
|
yes, most commonly herpes simplex virus (HSV), but HIV is rare
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if one contracts an STI during pregnancy how should it be managed?
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antibiotic treatment; C-section reduces chance of contact
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what are the risks to the neonate with gonococcal infection?
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opthalmia neonatorum, which can cause blindness within 24 hours (purulent discharge seen in eyes)
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what are the risk to the neonate with a chlamydial infection?
|
pneumonia, otitis media, pharyngitis, conjunctivitis
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what are the three viruses that can cause Infectious Mononucleosus Syndrome?
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1) EBV (mono, aka glandular fever); 2) CMV; 3) HIV seroconversion syndrome
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what possible complications are there from glandular fever?
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while symptomatic, at risk of splenic rupture
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if one suspects they may have been exposed to HIV, what is the time window for post-exposure antiviral prophylaxis?
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24 hours
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what are the two main causes of genital lumps in a young woman?
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HPV (genital warts) and molluscum contagiosum
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at what age is gardisil vaccination recommended?
|
girls between ages 12 - 26 (18-26 done through GPs)
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what percentage of cervical cancer is attributed to HPV?
|
99%
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what percentage of cervical cancers are attributed to HPV subtypes 16 & 18?
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70%
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what is commonly screened for in serum, when investigating STIs?
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Herpes, HBV, HIV
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what is the differential diagnosis for penile discharge?
|
chlamydia, gonorrhoea, non-specific urethritis
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how long should one abstain from intercourse, when receiving treatment for chlamydia or gonorrhoea?
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7 days, after treatment
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is ceftriaxone safe to take if a pregnant woman is infected with gonorrhoea?
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yes, as it is a category B drug
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Molluscum contagiosum is benign, but how would it be treated if the patient wants the contents removed?
|
pierce with 21G needle
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what is the difference between an elixir and a suspension?
|
a suspension does not completely dissolve the substance of interest
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what is an oil-based topical preparation called?
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an ointment
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water-based topical preperations are called?
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creams, or lotions
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what is the acceptable difference in bioequivalence when substituting drugs?
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<10% plasma difference
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in prescriptions, q6h refers to?
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dosing every 6 hours
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the latin abbrev for 'before meals' is?
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ac.
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the latin abbrev for 'after meals' is?
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pc.
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the cost of medications in subsidized, in Australia, by?
|
the Pharmaceutical Benefits Scheme (PBS)
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can a PBS prescription be written on any form?
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no, it must be a PBS form
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how long is a PBS prescription valid for, once written?
|
12 months (some 6 months)
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over-the-counter medications are classified under what schedule?
|
S3
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prescription-only medication is scheduled as?
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S4
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what considerations must be adhered to when writing a prescription for a S8 substance?
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1) only one item per prescription, 2) number of tablets must be written in words
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what STI are 50% of the MSM men (in NSW) who are HIV+, coinfected with?
|
Syphylis (gay epidemic worldwide)
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what percent of the gay men population in Sydney is infected with HIV?
|
15%
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what recreational substances are used more in the homosexual population of Sydney, than the straight?
|
Tobacco, Alcohol and Crystal Meth
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what does nPEP stand for?
|
non-occupational post-exposure prophylaxis
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what is the current medication used for post-exposure prophylaxis, for HIV?
|
Truvada
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how how should someone with HIV have their T-cells/viral load monitored?
|
every 3 months
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what physical examinations should be performed on someone who is being monitored with HIV?
|
BMI/waist/BP, LNs, oral cavity, skin check, DRE (40s onward, for men), Pap smear (annually for women)
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when should ARV Tx be commenced in someone with HIV?
|
consider coinfections (HBV/HCV), and tolerance of individual for SEs and compliance
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in HIV, the constellation of body fat changes (wasting) is called?
|
Lipodystrophy, or Lipoatrophy
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20% of people taking the antiretroviral Nevirapine will develop a rash. How should this be managed?
|
Slow increases in dosage; do not escalate with rash, until it has resolved
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|
what are three AIDS-defining illnesses?
|
Pneumocystis carinii pneumonia (PCP), Kaposi's sarcoma, Esophageal candidiasis, NHL, HIV wasting disease, HIV encephalopathy,Cryptococcosis, Toxoplasmosis, Mycobacterium avium complex (MAC), Pulmonary TB, CMV
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what medication is used for prevention/treatment of PCP, in HIV+ individuals?
|
Co-trimoxazole (CTX)
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Kaposi's sarcoma is caused by what virus?
|
Human herpes virus 8 (HHV8), an STI
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How does Kaposi's sarcoma present?
|
Angiogenic lesions: multiple, painless plaques/nodules that tend to appear around lines of skin cleavage
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how is Kaposi's sarcoma treated?
|
HAART (highly active antiretroviral therapy), radiotherapy (for local symptoms), chemotherapy (liposomal doxorubicin)
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what is the most common cause of dysphagia/odynophagia in HIV patients?
|
oral thrush
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how is oral thrush managed, in HIV patients?
|
Fluconazole (200mg stat, then 100mg daily for 2/52, then 50mg until resolved)
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cerebral toxoplasmosis (in HIV patients) is caused by which organism?
|
Toxoplasma gondii
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changes in personality (in HIV) may be attributed to what pathologies?
|
HIV encephalopathy; Cerebral toxoplasmosis; Malignancies; HAND (HIV associated neurocog disorders)
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what complications can arise with HIV and subsequent CMV infection?
|
mainly retinitis (floaters and retinal detachment); colitis; ventriculitis; pneumonia (rare)
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is the MMSE an effective screen for HIV associated neurocognitive disorders?
|
no, as it is designed for Alzheimer's Disease, and different structures are affected in HAND
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the HAND spectrum consists of ANI, MND and HAD. What do they stand for?
|
(ANI) Asymptomatic Neurological Impairment; (MND) Mild Neurocognitive Disorder; (HAD) HIV associated dementia
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what is the most common cause of occult bacteraemia in children?
|
pneumococcus
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in assessing a child for toxaemia, what does ABCD stand for?
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Alertness/Activity; Breathing; Circulation; Dehydration
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what are common infections that should be investigated if a child >3mo has a fever?
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UTI or Pyelonephritis
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how often should a parent be asked to assess their child's ABCDs?
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every 4-6 hours
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what is the natural history of a respiratory illness in a child?
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1) 4 days of fluctuating fever, 2) 4 days of fluctuating activity, 3) early running nose/sore throat, 4) 4 weeks of dry (then productive) cough
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how long does a cough usually persist after a child has a viral respiratory infection?
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4 weeks
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what is the natural history of a gastrointestinal infection in children?
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1) [0-6hrs] frequent vomiting, w/o blood/bile, 2) [6-30hrs) decrease in frequency of vomiting, 3) [6-30hrs] diarrhoea begins, and may persist for weeks
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what is a child with a GI infection most at risk of?
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dehydration!
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which grows faster, nodular or superficial spreading melanoma?
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Nodular grows faster
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what feature of melanoma on the foot can make detection difficult?
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It is not uncommon for these melanomas to lack pigment
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where is the most common site for melanomas on men?
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on the trunk (chest and back)
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where is the most common site for melanomas in women?
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on the arms and legs
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when is melanoma most common, in life?
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age is a risk factor, and melanoma is more likely later in life
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if melanoma is diagnosed on excision biopsy, should further excision be performed?
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yes, to widen the margins
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should blood tests and CT scan be performed after positive melanoma biopsy results?
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No, this is not necessary
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what should patients with positive melanotic biopsies be advised?
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lifetime monitoring is required, and lymph nodes around excision should be self-checked every 4 months
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how is a sentinel node biopsy performed?
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using a combination radioactive substance and blue dye, under local/GA; a lymphoscintogram is used for imaging
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which melanoma patients are offered sentinel node biopsy and what survival benefits does it offer?
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any patient with a Breslow thickness >1mm, but there is no evidence that it changes survival
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if a positive sentinel node biopsy occurs, is there evidence for benefit from adjuvant chemotherapy?
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none known to date
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in longitudinal melanonychia, should all lesions be biopsied?
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No
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longitudinal melanonychia is more common in what skin types?
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Those with darker skin
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what is melanoma called when it is responsible for longitudinal melanonychia?
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subungual melanoma
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what are some distinguishing features of melanoma, from naevus, in longitudinal melanonychia?
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history of enlarging area; involvement of proximal/lateral nail folds; irregular width bands of pigmentation
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what features indicate a melanonychia is due to subungual haematoma, not melanoma?
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presence of red-blue pigment; sparing of pigmentation in proximal nail fold
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after excision of a melanoma, how long is it recommended a woman wait to become pregnant?
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2-5 years, because of moderately high risk of recurrence
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what chemotherapy agent is commonly used for metastatic melanoma?
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cyclophosphamide; melanoma is not responsive to common chemotherapy regimens
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how often should one return for follow-up check ups after excision of an SCC?
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every 6 months, for 2 years
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what proportion of BCCs are pigmented?
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7%
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blue-grey nodules/nests are characteristic of what skin lesion?
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pigmented BCC
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what benign skin lesion(s) may fit the ABCDs of melanoma?
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Dysplastic naevi
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what is the medical name for the common freckle?
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ephelis
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what pigmented skin lesion appears 'stuck on' and often has multiple miliary cysts?
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Seborrhoeic keratosis
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do any benign keratotic skin lesions not respond to cryotherapy?
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no, sub and solar keratosis both do
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a scar-like, thickened skin lesion that often occurs after an inflammatory event is called?
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dermatofibroma
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when should one excise a haemangioma?
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when it has a sudden increase in size, or a cutaneous angiosarcoma is suspected
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what size of congenital naevi is at increased risk of progressing to melanoma?
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one that is >20cm or covers >5% of the body surface
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a cluster of naevi is called?
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spilus naevi
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what is that big patch of mildly pigmented skin on Sean's back called?
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Café au Lait spot
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what type of SCC responds well to cryotherapy, if a 3mm margin is used?
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Bowen's disease (SCC in situ)
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According to 2004-05 data, what percent of Australian men are overweight? Women?
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40% of Australian men; 25% of Australian women
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How much weight does the average smokers gain in the first year after quitting?
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5-6kg
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What medications commonly contribute to weight gain?
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Diabetic medications, Steroids, antidepressants, psychotropics
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What is the one-year relapse rate when converting to a low-fat diet?
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50%
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Are meal-replacement programs an effective way of losing weight?
|
Programs (eg. Weight Watchers, Jenny Craig) that use meal-replacement as their core are effective
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What is the mainstay of non-pharmaceutical weight loss?
|
Diet control (reduced calories, focusing on fats)
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How much of one's daily energy expenditure is accounted for by the thermic effect of food?
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About 10%
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What percent of one's daily energy expenditure is accounted for by basal metabolic rate?
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60-70%
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If one is to not change their diet, how much exercise must they do to see a 2kg weight loss over 1 year?
|
3-5 hours of intense exercise per week
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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
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What psychotropic medications actually contribute to weight loss? When are they contraindicated?
|
SNRIs. C/I: CVD
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GPs should address SNAP for patients who are overweight. What risk factors does SNAP stand for?
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Smoking; Nutrition; Alcohol; Physical activity
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What is first line treatment for hypertension?
|
1) ACE-I/ARB or 2) CCB or 3) low-dose thiazide
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Why should one be cautious in prescribing an ACE-I and diuretic together, for HTN?
|
When combined with an NSAID, they can cause ARF
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What is second line treatment for HTN?
|
Augment first line treatment with another first line treatment (eg. ACE-I + CCB)
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|
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What end organ damage can occur with HTN?
|
Kidneys; Heart (LVH/LHF); Eyes (retinopathy)
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What is the target level for TGs?
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<1.5mmol/L
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What is the target level for LDL?
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<2.5mmol/L
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What is the target level for HDL?
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>1mmol/L
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What lifestyle factors should be addressed in HTN?
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1) exercise (30min/d), 2) dietary salt (<4g/d), 3) alcohol (<2SD/d), 4) smoking
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|
What is the definition of osteoporosis?
|
BMD T-score of <2.5
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What is the definition of osteopenia?
|
BMD T-score between 1.0-2.5
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What investigation is used to determine Bone Mineral Density?
|
DXA (DEXA)
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What dietary and supplement requirements should be recommended to someone with osteopenia?
|
Calcium, and vitamin D supplements
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|
What is first line therapy for osteoporosis?
|
Bisphosphonates
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|
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Which supplement does NOT have to be taken after meals: calcium citrate or calcium carbonate?
|
Calcium citrate (as it doesn't require an acidic environment for absorption)
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What advice should be given to a patient that is starting bisphosphonates, about taking their medication?
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Take on an empty stomach, remain upright and avoid other other medications for 30min afterward
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If a patient has had a good response to bisphosphonate treatment, how long should they be taken before being reassessed?
|
5-10 years
|
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What are major risk factors for osteoporosis? (list three)
|
>70 OR >60yo + any of the following factors: FHx; smoking; high alcohol intake; low calcium diet; low body weight; recurrent falls; sedentary lifestyle for many years
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|
Teriparatide is a synthetic version of what hormone (hint: used in treatment of osteoporosis)
|
parathyroid hormone (PTH)
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What low impact exercise is proven to be excellent for prevention of osteoporosis and falls?
|
Tai Chi
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|
What modification can be made to improve eye sight in the elderly, and thus reduce risk of falls?
|
Cataract surgery
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|
|
If an elderly person is anxious about falling, what therapy should be used to address this?
|
CBT (avoid anxiolytics!)
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|
|
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
|
|
|
HSV-1 is typically the oral form of the virus, but why is the incidence on the rise genitally?
|
Due to increased rate of oral sex
|
|
|
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)
|
|
|
Do condoms protect from genital herpes?
|
They reduce the risk, but not completely
|
|
|
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]
|
|
|
Should antivirals be used for suppressive therapy in genital herpes?
|
In patients who suffer regular/severe occurances
|
|
|
How soon should antivirals be commenced, if experiencing prodromal symptoms of genital herpes, to be of most benefit?
|
Within 72 hours
|
|
|
Is contact tracing required for genital herpes?
|
No, thought it is encouraged
|
|
|
Can acyclovir be used to treat herpes during pregnancy?
|
Yes, it is not teratogenic
|
|
|
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 & 2) 2hr BGL from 7.8-11mmol/L
|
|
|
What is the mechanism of action of metformin?
|
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
|
|
|
What is the mechanism of DPP-IV inhibitors?
|
"Gliptins" prevent the breakdown of incretins (GLP-1 and GIP, gastric inhibitory peptide), thereby inhibiting glucagon release, increasing insulin release and slowing gastric emptying.
|
|
|
What side effects are commonly experienced with Gliptin diabetic medication?
|
upper respiratory tract symptoms, headache, nausea
|
|
|
The target range for a diabetic's BGL is?
|
4-6mmol/L
|
|
|
The target range for a diabetic's HbA1c is?
|
<7%
|
|
|
What is Friedwald's formula (for LDL-C)?
|
LDL-C = TC - HDL-C - (TG/2.2)
|
|
|
What is the target range for a diabetic's total cholesterol?
|
<4mmol/L
|
|
|
Target range for a diabetic's blood pressure?
|
<130/80
|
|
|
What are the symptoms of hypoglycaemia?
|
Tachycardia, sweating, anxiety, confusion
|
|
|
What are the symptoms of hyperglycaemia?
|
Polydipsia, Polyuria, weight loss, dehydration, disorientation
|
|
|
How often should a diabetic go for eye exams?
|
Every 2 years
|
|
|
When should a diabetic be referred to a nephrologist?
|
When their 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 percent of children with asthma live in homes with smokers?
|
40%
|
|
|
In asthma, airflow limitation is considered reversible if baseline FEV1 > 1.7L and post-dilator FEV1 is ...?
|
At least 12% greater than baseline
|
|
|
In asthma, airflow limitation is considered reversible if baseline FEV1 < 1.7L and post-dilator FEV1 is ...?
|
at least 200mL greater than baseline
|
|
|
What are the ABCDs of melanoma?
|
Asymmetry; Border irregularity; Colour variability; Diameter greater than 6mm
|
|
|
What are the two negative features that must be absent for melanoma?
|
Symmetry and 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, they aren't
|
|
|
are the majority of superfical spreading melanomas pigmented?
|
Yes, they are
|
