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GP gauntlet #4 (under-developed paeds, ocular, pneumonias)

elliptic's version from 2018-05-20 04:01

Some paediatrics

Question Answer
Features of a complex febrile seizure1. focal features (at onset or during the seizure) 2. longer than 15 minutes 3. recurrence within the same febrile illness 4. incomplete recovery within 1 hour.

Ocular drugs

Question Answer
Local anaestheticAmethocaine 0.5% (aka tetracaine). Lasts 10-20 minutes. Never give to patients to take home.
FluorosceinUse cobalt blue light to highlight areas of increased fluoroscein uptake.
MydriaticTropicamide 1% (0.5% for neonates). To dilate pupil to facilitate examination of the fundus. Takes 15 minutes to work; don't drive for a few hours or longer after exam while blurred vision. Can precipitate acute angle closure glaucoma; warn patients to report and acute eye discomfort. (Normal for drops to sting for a few seconds after instillation.)
AntibioticChloramphenicol drops (0.5%) or (1%). Use ciprofloxacin drops for pseudomonal keratitis. For acute bacterial conjunctivitis and prophylaxis against bacterial infection following minor ocular trauma. Dosage for all topical ocular antibiotics is QID for 1 week unless directed otherwise by ophthalmologist.
AntiviralAcyclovir ointment for keratitis; requires ophthal input / follow-up; typical dosage 5x/day.
Ocular lubricanthypromellose drops or gel. Gel lasts longer but may blur vision.
CycloplegicHomatropine 2%, for comfort in flash burns or corneal FB.
Important immediate steps in managing acute angle glaucoma1. Immediate referral to ophthalmologist. 2. IV or PO Acetazolamide 500mg. 3. Check IOP hourly

Typical pneumonias (risk factors; differential features)

Question Answer
S. pneumoniaeAge <2 or >65, splenectomy/sickle cell anaemia, CLL/MM, post-influenza, COPD/smokers. Features: rusty sputum; single shaking chill. Bacteraemia in 25-50%; somtimes associated with pleural effusions.
H. influenzaeAge <2, COPD, EtOH abuse, post-influenza. Features: pleural effusions common, bacteraemia.
S. aureusMetastatic infection in IVDU or pts with infected IV catheters. Post-influenza; CF; aspiration in hospital. Features: pleuritic chest pain, pneumatocoeles, cardiac murmurs.
K. pneumoniaeEtOH abuse, COPD, neonates, nosocomial. Features: currant jelly sputum; bulging fissures; lung necrosis.

Atypical pneumonias (clinical features; lab/radiographic features)

Question Answer
M. pneumoniaURTI symptoms; bullous myringitis; haemolytic anaemia; myocarditis; meningoencephalitis. Cold haemagglutinins, occasional pleural effusion.
Legionairres diseaseRelative bradycardia; abdo pain; NVD, haematuria, confusion. Abnormal LFT and GFR; increased CK; occasional pleural effusion.
Q feverRelative bradycardia; tender hepatomegaly; endocarditis. Abnormal LFT's.