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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