New content quiz April 2015

During phase II, the ST elevation that is most commonly present in leads I,II,V5,V6 decreases, however PR depression persists in 60% of cases. The QTc is usually slightly shorter in pericarditis. (link)

Prochlorperazine and promethazine are classified as Category C in pregnancy. All the other agents are considered Category A. (link)

Cost effectiveness analysis is extremely difficult and relies on many assumptions for which the scientific evidence base is often inadequate. This is compounded by the following factors: variation in effectiveness is often high between different patient subgroups; costs may vary widely by practice setting, locality, and nationality, and over time; integration of long-term costs (e.g. development of infrastructure required to provide an intervention in acute situations) into a per-treatment cost through amortisation over the useful life of a given resource is often not performed; opportunity costs are rarely considered; only short term costs of a treatment are often considered; outcomes evaluated may not be patient oriented; individuals bear the burden of adverse health outcomes, yet costs typically are shared by society (e.g., by families, employers, government, premium payers, fellow employees, taxpayers); costs are usually only calculated to the health system – costs to the patient, their families and carers associated with different options are rarely considered; attitudes differ about the extent to which cost should influence treatment decisions for individual patients and who should bear these costs, so are usually highly politicised; significant conflicts of interest among individuals involved in resource-based guidelines are common. (link)

Permethrin 5% cream is usually the first line treatment for non crusted scabies. Benzyl benzoate 25% solution diluted in 3 parts water is an alternative but is more irritating than permethrin and can be used in children < 2 years of age. Ivermectin is contra-indicated in pregnancy and is only authorised for use in Australia in children at least 5 years old and 15kg in weight. 6% precipitated sulphur is the preferred treatment in young babies. (link)

The intravenous form of iron that is able to replace the greatest amount of elemental iron in the body with a single infusion is ferric carboxymaltose. (link)

Frailty is a state of poor physiological & functional reserve characterised by a lack of resilience to stressors and a cumulative decline in multiple physiologic systems. It is associated with: a disproportionate reduction in health/functional status; poor recovery in response to stressors and increased risk of adverse outcomes. It affects 25-50% of people aged >85 years. Common clinical presentations of frailty include: falls; delirium; functional disability; extreme fatigue; weight loss; frequent infections. It is a concept that directs attention away from organ-specific diagnoses (i.e. disease) towards a more holistic view of the patient. (link)

Deprescribing should be considered if there is: polypharmacy; adverse drug reactions; unlikely efficacy; the goals of therapy change e.g. frailty, dementia, palliative care. The principles involve stopping one drug at a time and weaning doses slowly over weeks and months. (link)

Caregiver burden is the extent to which caregivers perceive that care giving has had an adverse effect on their emotional, social, financial, physical, and spiritual functioning. Risk factors for caregiver burden include: female gender; low educational attainment; residing with the care recipient; depression; social isolation; financial stress; higher number of hours spent care giving; and lack of choice in being a caregiver. (link)

When inserting a suprapubic catheter, the correct technique to puncture the full bladder in an adult patient is to insert the  trocar / stylet at a point 2 cm superior to the pubic tubercle in the midline and aim caudally at 10% inclination. (link)

The hourly rate of rapid acting insulin given IV in an adult patient with DKA in whom you wish to achieve normoglycaemia who has a blood glucose of 15mmo/L is approximately 3 Units/hour. (link)

PER 977 is a small, synthetic, water-soluble, cationic molecule that binds to (and inactivates): UFH; LMWH; edoxaban; rivaroxaban; apixaban and dabigatran. (link)

The maximum time following the last ingestion of rivaroxaban that administration of oral activated charcoal should be considered in order to reverse the effects of rivaroxaban is 8 hours. It is 2 hours for dabigatran and 6 hours for apixaban. Whenever possible, invasive procedures should be delayed until at least 12 hours following the last dose of a NOAC.(link)

The traditional indigenous kinship system of kinship is based on 16 ‘skin’ names and all Aboriginal and some non Aboriginal people have these names. The names give every individual a relationship with every other person in the community. These relationships provide a set of rules for everyone to conduct the processes and tasks in their daily lives. The skin names are derived from your mother and are predetermined and follow a cycle. As a result of this system, some family members may need to avoid each other (‘poison’ relationships) or are only permitted to interact in certain ways. (link)

Anxiety disorders are the most prevalent mental health disorders in Australia, affecting 14% (2011) of the population. Affective disorders are the next most common (6.2%), substance-use disorders (e.g. alcohol dependence – 5.1%). Psychotic disorders affect only 0.45% of the population aged 18–64 years. (link)

The tests and appropriate tubes are as follows: chemistry – lithium heparin; cell count – EDTA; cytology – urine specimen container; bedside testing – urine specimen container; culture – blood culture bottle. (link)

Blood staining of ascitic fluid is present in approximately 20% of patients with malignant ascites and 50% of patients with hepatocellular carcinoma (link)

Conditions that usually cause high SAAG ascites include: hepatic cirrhosis; hepatoma, cardiac failure; constrictive pericarditis; Budd Chiari syndrome; fatty liver of pregnancy; myxoedema; and alcoholic hepatitis. (link)

Conditions that characteristically cause a low SAAG ascites include: peritoneal seeding; peritoneal mesothelioma; nephrotic syndrome; and TB. (link)

Gram stain of ascitic fluid is approximately 10% sensitive and only 50% specific for the detection of spontaneous bacterial peritonitis. (link)

Ascitic fluid features suggestive of secondary bacterial peritonitis are: total protein >10 g/L; glucose < 2.8 mmol/L; LDH >the upper limit of normal for serum; polymicrobial positive Gram’s stain of ascitic fluid; elevated amylase; elevated bilirubin; ALP > 240 Units/L. (link)

The most common causes of trauma related death in order of frequency are: deliberate self harm; falls, transport accidents; homicide, fires. (link)

In 2012, the estimated average life expectancy of a 65 year old women in New Zealand was  approximately 85 years of age. (link)

The percentage of Australians who were of normal weight in 2017 was only approximately 30%. (link)