Treatment of impetigo in endemic settings
Single IMdose of benzathine benzylpenicillin
Other option - oral bactrim
Pt with cellulitis, states previous prophylaxis to penicillin
Oral bactrim for 5/7
Pt with anaphylaxis, Rx steps + doses (6)
- Remove trigger
- Position flat or sitting
- Adrenaline
- Adults: 0.5mg (0.5ml of 1:1000)
- Paeds: 10mck/kg (0.01ml/kg of 1:1000) - Rpt adrenaline 5mins if needed
Shock - IV access
- Fluid bolus
Mx Steps in ITP (5)
- Avoid anti-platelets or NSAIDs
- Advise retricting contact sports
- Advise present to ED if significant bleeding or severe headache
- Advise rpt FBE in 1wk
- Provide written information
DDx for UGI bleed/haematemesis (6)
- Bleeding peptic ulcer
- Ruptured oesophageal varice
- Erosive oesophagitis
- Mallory-Weis tear
- Gastric or oesoph cancer
- Angiodysplasia
When to stop DOAC prior to surgery
Any high risk/major op = Withhold for 48hrs (ie last dose 3 days prior to surgery)
- Recommence 48-72hrs post op
Snake bite in rural ED. Pt in shock. Immediate management (6)
- Seek urgent advice from poisons information or toxicologist
- Apply pressure bandage over entire limb
- Immobilise the patient
- Obtain 2x large bore cannula in cub fossa
- Administer fluids
- Appropriate analgesia
Non-pharma management options for IBS? (6)
- Use food diary to indentify triggers to avoid
- Refer to dietician for low FODMAP diet plan
- Refer to pyschologist for CBT
- Advise meal portion control
- > 30g fibre intake (if constipated)
- Refer to hypnotherapist for gut base hypnotherpay for refractory symptoms
What drug mistake to AVOID in anaphylaxis
Do not give anti-histamine
Can drop BP
38M with T21 brought in by carer. Been aggressive recently. DDx (7)
- Mental illness - depression
- Environmental - abuse
- GI disturbance - constipation
- infection - UTI
- Geri - early onset dementia
- Unrecognized pain
- Sleep disturbance
KFP Emergency situation - common marks (4+4)
- Call ED/relevant specialist for advice
- Insert 2x large bore cannulas
- Give 1L NS bolus immediately
- Give relevant medication to case
Other common
- oxygen
- group+hold
- NBM
- Analgesia
Pharmacological options for smoking cessation (4)
- NRT - LA
- Varenicline (champix) - grade up to BD over 1wk, for 12wks
- Bupropion oral daily
- Oral nortriptyline
KFP: Hx to assist with further treatment of chronic wound? depends on what info has already been given (6)
- Smoking status
- Tetanus immunisation status
- ?Reduced sensation
- Claudication
- Any discharge?
- What has been tried so far
Features of venous ulcer (4)
- Varicosisty or venous eczema/flare
- Lipodermatosclerosis - hard skin, inverted wine bottle
- Haemosiderin staining
- Oedema
Patient non compliant with treatment, options to improve their involvement (not relevant to all patients) (6)
- Educate about poor outcomes of poor compliance
- Arrange a Webster pack
- Organise a HMR
- Arrange home visits (GP or nursing)
- Involve family with patients permission
- Involve aboriginal health worker
Factors in evidence based medicine
Overlap of
- Best available evidence
- Doctors judgement
- Patients value
Reviewing medical lit/evidence
- what makes the study strong (VALID) (4)
- does it have an appropaite PICO (is the patient applicable, is the intervention what we want, do we care about this outcome)
- is it blinded (and to what extent)
- is it randomised (and did this work - are the patient groups similar)
- p<0.05 = statistically significant. comment on both statistical significance and then if also clinically significant
Delivering bad news/results (6)
- Setting - need anyone else, organise long appt
- Perception - what do they know OR expecting
- Deliver Knowledge - simple and short
- Empathy - acknowledge
- Summarise - simple plan, summarize, written info
- Follow-up - within 1 wk
Four concerns that would trigger mandatory report to AHPRA for colleague
- impairment
- intoxication whilst practicing
- sexual misconduct
- significant departure from accepted standards
TH appt, personal attended funeral, asking for sick cert for sick leave for last 10 days
Steps? (5)
- Offer condolences
- Explain medical certificate only for medical illness
- Explain might be eligble for personal leave
- Offer letter of support
- Offer F2F follow-up to assess further
KFP: Patient with high risk hx+ex for eg. cancer. You send for investigations but they dont attend follow-up.
What actions may you take to follow this up? (5)
- Contact patient urgently because of possible serious underlying pathology
- Sen registered letter to request urgent contact as serious consequences of delay
- Contact NOK and request that patient contact me
- Check with local hospital if pt admitted
- Check with emergency services to see if they have attended her
Conta-indications for bupropion (3)
- Hx of Seizures
+ during abrupt withdrawal from ETOH + BZD - Eating disorders
- Irreversible MAO-inhibitors
19yo with CP + ID, some communication difficulties. What methods could you employ to support pt with communication (6)
- Speak directly to pt
- Avoid medical jargon
- Use visual aids
- Ask simple yes/no questions
- Involve family member if relevant
- Check regularly that they have understood
Pt requesting permanent disability paperwork for short term injury - alternative supports you can offer (4)
- Medical cert for time off
- Centrelink certificate for alt income
- Letter support to income protection if have any
- Work cover cert if appropiate
