New content quiz June 2015

The recommended antibiotics in this situation are: cefotaxime 50 mg/kg IV 6-hourly and amoxy/ampicillin 50 mg/kg IV 6-hourly. (link)

In this situation gentamicin 4 – 7 mg/kg IV for the first dose AND flucloxacillin 2 g IV 4-hourly should be given. The gentamicin dose should be reduced in patients with known or likely pre-existing renal impairment (e.g. >80 years of age) to 4-5mg/Kg, however do not delay gentamicin administration to determine renal function. In patients hypersensitive to penicillins, replace flucloxacillin with cephazolin 2 g IV, 6-hourly. In patients with immediate hypersensitivity to penicillins, or likely MRSA replace flucloxacillin with vancomycin 25 -30 mg/kg IV as a loading dose. In patients at risk of infection with a multidrug-resistant Gram-negative organism or in tropical regions of Australia where infection with Burkholderia pseudomallei is possible use meropenum 1g IV 8 hourly. (link)

People who have documented HepB immunity do not require any further therapy to prevent Hep B infection, regardless of the infectivity of the source. (link)

A CXR in an aspirated endobronchial foreign body: may demonstrate the foreign body, but may also be normal; may demonstrate features of gas trapping if foreign body causes endobronchial obstruction demonstrated by failure of the affected sided to deflate on expiration or when patient placed on affected side. (link)

An elevated GGT alone is 50 – 90% sensitive for chronic alcohol abuse and is < 50% specific. It is >90% specific if combined with elevated levels of carbohydrate-deficient transferrin. (link)

An MCV > 96fL is approximately 50% sensitive and 95% specific for heavy alcohol use. (link)

Few children meet the full diagnostic criteria of conduct disorder prior to 10 years of age, however some features of conduct disorder are usually evident by early school age such as aggressive tendencies, impulsivity or failure to comply with requests. Features overlap with ADHD and oppositional–defiant disorder. Antisocial personality disorder develops in approximately 45% of patients. (link)

It is estimated that in patients with an eGFR of 30mL/min CIN occurs in about 15% of cases in patients
who have had IV contrast for a CT scan, but this is not changed by contrast administration. The estimated risk of requiring dialysis is only approximately 0.12%. (link)

The risk of requiring dialysis following intravenous contrast for a CT scan in a patient with a creatinine clearance of 30ml/min is approximately 0.12% (link)

90% of people with hazardous drinking are not alcohol dependent, so are not at risk of withdrawal. Withdrawal is likely with abstinence if > 20 standard alcoholic drinks per day. Men are at risk if consumption > 80g/day or AUDIT score >4 and women are at risk if consumption > 60g/day or AUDIT score > 3. (link)

Compared with THC, synthetic cannibinoids cause an increased risk of sympathomimetic effects, seizures and acute kidney injury. (link)

Zuclopenthixol (accuphase) is given as a 50-150 mg IM (1-3mL) injection and can be be repeated in 1-2 days, with a maximum of 4 doses or a total dose of 400mg. It has an onset of action at 2-4 hours, causes maximum sedation at 8 hours and has a 48 hour duration of effect. It is not usually used in drug naive patients and is not intended for long-term use. (link)

The bulging fissure sign on CXR represents expansive lobar consolidation causing fissural bulging by large amounts of inflammatory exudate. It is classically associated with right upper lobe consolidation due to Klebsiella pneumonia, however is also common in pneumococcal pneumonia. (link)

A normal A-C joint can move up to 6mm in anterior, posterior, and superior directions under load. (link)

The upper limit of normal for the scapholunate interosseous distance in an adult is 4mm (link)