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

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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.
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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
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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.
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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.
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