Answer to Q9/1: D
Bleeding piles, bleeding diverticulae and carcinoma of the large bowel can all cause sufficient bleeding to result in an iron deficiency anaemia which would give a hypochromic microcytic pattern on microscopic examination of the blood.
Normocytic normochromic anaemia is more likely to be caused by chronic disease such as chronic renal failure. It could also result from marrow suppression due to drugs or myelofibrosis or combined Fe/B12 deficiency.
Answer to Q9/2: A
DVT and pulmonary embolism are associated with an underlying diagnosis of cancer, particularly cancer of visceral organs such as the pancreas. Recurrent DVT is associated even more strongly with metastatic disease. There is no strong association between the other conditions listed and recurrent DVT, although smoking in combination with the oral contraceptive pill is a risk factor for DVT.
Answer for the question posted on sept 4 (consent of immunisation) is B
Consent is legally valid if all of the following have been fulfilled. The:
person giving consent has the legal and intellectual capacity to do so
consent is given voluntarily
consent is given after explanation of the benefits and risks of the relevant vaccine(s)
person giving consent has had suitable opportunity to find out further relevant information
A child's parent or legal guardian usually has the authority to provide vaccination consent. In this instance, a person is a child if they are under 18 years of age in all Australian states or territories except:
New South Wales where a person under 14 years of age is defined as a child
South Australia and the Northern Territory where a person under 16 years of age is defined as a child
Children of particular maturity and age may be able to consent to vaccination. State and territory immunisation service provider guidelines should be consulted for information on consent from children. Children who refuse vaccinations consented to by their parent/legal guardian should have their wishes respected and the parent/guardian informed.
Consent needs to be documented in the person's medical records. When a vaccination program is explained and consented to at a visit and agreed to vaccinations are provided at other visits, explicit verbal consent is required before each vaccination at the subsequent visits irrespective of whether the original consent was verbal or written.
On pneumococcal vaccine,
The correct response is (a).
Provided they are well, babies born preterm should be immunised according to the standard schedule, beginning at birth, and without correction for prematurity. Preterm babies have adequate antibody responses to most vaccines and are at increased risk for vaccine-preventable diseases. So babies still in hospital at 2 months after birth should be given DTPa, hepatitis B, Haemophilus influenzae type b (Hib), IPV, pneumococcal conjugate, and rotavirus vaccines.
Preterm babies may not respond optimally to hepatitis B, Hib and pneumococcal vaccination. Babies born before 28 weeks gestation (and some other babies) require an extra dose of PRP-OMP and pnemococcal vaccines. It is recommended that babies born before 32 weeks gestation (and those weighing less than 2000 g at birth) receive hepatitis B vaccine at 0, 2, 4 and 6 months and then a booster at 12 months. The 12-month booster can be left out if the anti-HBs response is measured at 7 months and found to be 10 mIU/mL or greater.
Preterm babies who continue to experience health issues at 6 months should receive influenza vaccination - especially if the problems are cardiac, neurological or respiratory.
Up to the age of 2 months, babies born before 37 weeks should be vaccinated using the same needle gauges and insertion angles as full-term babies but a 16 mm length needle should be used rather than 25 mm. Routine vaccinations in preterm babies in hospital can cause increased apnoea. Routine vaccinations are not associated with increased apnoea in babies at home and are not associated with increased Sudden Infant Death Syndrome (SIDS) risk.
Thursday, September 11, 2008
Monday, September 8, 2008
Age Care/Anaemia/DVT
Q9/1
Greta J. is a frail 82 year old patient who presents with a two month history of increasingly severe dyspnoea on exertion. You do a full blood count, and find that it shows a normochromic normocytic anaemia. Which of the following is most likely to show this result on FBE?
a) Bleeding piles
b) Diverticulitis
c) Carcinoma of the large bowel
d) Chronic renal failure
Q9/2
Albert S. developed a deep vein thrombosis in his right leg two months ago. In spite of warfarin therapy, he now has one in his left leg. You are worried that this might be a sign of some other underlying pathology. Which of the following conditions is associated most strongly with the development of recurrent DVTs?
a) Metastatic disease Correct
b) Cigarette smoking
c) Testosterone replacement therapy
d) Varicose veins
For easy reference, I am beginning to code the question: Q9/1 means Question 1 of September, ... Quote the reference code in your answer. I shall also begin to give the answer as a new post instead of adding in as comments. I shall also try to post the answer before the question is hidden under older post.
Greta J. is a frail 82 year old patient who presents with a two month history of increasingly severe dyspnoea on exertion. You do a full blood count, and find that it shows a normochromic normocytic anaemia. Which of the following is most likely to show this result on FBE?
a) Bleeding piles
b) Diverticulitis
c) Carcinoma of the large bowel
d) Chronic renal failure
Q9/2
Albert S. developed a deep vein thrombosis in his right leg two months ago. In spite of warfarin therapy, he now has one in his left leg. You are worried that this might be a sign of some other underlying pathology. Which of the following conditions is associated most strongly with the development of recurrent DVTs?
a) Metastatic disease Correct
b) Cigarette smoking
c) Testosterone replacement therapy
d) Varicose veins
For easy reference, I am beginning to code the question: Q9/1 means Question 1 of September, ... Quote the reference code in your answer. I shall also begin to give the answer as a new post instead of adding in as comments. I shall also try to post the answer before the question is hidden under older post.
Friday, September 5, 2008
Confidentiality
16 year old girl, came to you on the first occasion to obtain emergency contraception. On second occasion, she request for OCP and told you that she would not like her parents to know about her taking the pills. 2 days later, the mother came with the empty packs of OCP which she found in the dustbin. She was agitated and wanted to know what her daughter was given. How would you respond? Give reasons to support your response.
This is a short case that came out in Part II, 2008. Shoot now and see how close you get to the target. It is beTTer to make mistakes now. Interactive exercise is essential for part II. Those going for part I should also start preparing for part II because you are only given 2 to 3 months after the Part I to prepare for Part II. Bear in mind that confidentially is another favourite post-grad topic, it can come out in KFP or Single Best Answer!
This is a short case that came out in Part II, 2008. Shoot now and see how close you get to the target. It is beTTer to make mistakes now. Interactive exercise is essential for part II. Those going for part I should also start preparing for part II because you are only given 2 to 3 months after the Part I to prepare for Part II. Bear in mind that confidentially is another favourite post-grad topic, it can come out in KFP or Single Best Answer!
Thursday, September 4, 2008
Consent for vaccination
Those areas of weakness that we tend to dislike are often the favourites in postgraduate exams. One of these area is the regarding the consent. Another one is regarding confidentiality (I will look out for this and post it later. BTW, I would like to aknowledge that all these posting are adopted from gplearning provided by racgp. Nevertheless, we can make it more interesting here by interacting with one another.
Which one of the following is correct regarding valid consent for vaccination?
a) Consent of a parent or legal guardian is required for vaccination of all Australians under 16 years of age
b) Explicit verbal consent is required at all follow-up vaccination visits even when written consent to the vaccination plan has recently been given
c) The person giving consent no longer needs to have the opportunity to seek further information for consent to be valid
d) Valid consent is automatically fulfilled if a 14-year-old child says they will have a vaccination even though they don't want to and their parents are forcing them into it
The answer and explanation shall be given as one of the comments after 5 responses by 5 different candidates.
Which one of the following is correct regarding valid consent for vaccination?
a) Consent of a parent or legal guardian is required for vaccination of all Australians under 16 years of age
b) Explicit verbal consent is required at all follow-up vaccination visits even when written consent to the vaccination plan has recently been given
c) The person giving consent no longer needs to have the opportunity to seek further information for consent to be valid
d) Valid consent is automatically fulfilled if a 14-year-old child says they will have a vaccination even though they don't want to and their parents are forcing them into it
The answer and explanation shall be given as one of the comments after 5 responses by 5 different candidates.
Pneumococcal vaccine
What about pneumococcal vacccine? The questions is asked in Australian context. Wonder whether it is the same here. You may post your comment to clarify the matter.
Major clinical manifestations of invasive pneumococcal disease (IPD) include pneumonia, meningitis and bacteraemia without focus. Vaccination against the causative organism, Streptococcus pneumoniae, is available. Which one of the following statements is correct?
a) Pneumococcal polysaccharide vaccine 23-valent (23vPPV) is recommended as an annual injection for the same group of patients who should receive influenza vaccine
b) Pneumococcal conjugate vaccine 7-valent (7vPCV) is recommended for all Australian children aged less than 2 years
c) Revaccination with 23vPPV should be avoided in adults because of increased risk of increased adverse reaction rates and no improvement in antibody titres
d) An 18-24-month booster of 7vPCV should be used for children who are Aboriginal and Torres Straight Islander (ATSI) and living in the Northern Territory,
Queensland, South Australia or Western Australia
Major clinical manifestations of invasive pneumococcal disease (IPD) include pneumonia, meningitis and bacteraemia without focus. Vaccination against the causative organism, Streptococcus pneumoniae, is available. Which one of the following statements is correct?
a) Pneumococcal polysaccharide vaccine 23-valent (23vPPV) is recommended as an annual injection for the same group of patients who should receive influenza vaccine
b) Pneumococcal conjugate vaccine 7-valent (7vPCV) is recommended for all Australian children aged less than 2 years
c) Revaccination with 23vPPV should be avoided in adults because of increased risk of increased adverse reaction rates and no improvement in antibody titres
d) An 18-24-month booster of 7vPCV should be used for children who are Aboriginal and Torres Straight Islander (ATSI) and living in the Northern Territory,
Queensland, South Australia or Western Australia
Rotavirus vaccination
Still on rotavirus. Try this
New mum, Charlene, asks a lot of questions about rotavirus vaccine as she has not heard of it. Which of the following statements is true?
a) The monovalent rotavirus vaccine should be given in two doses at about 2 months and 4 months of age - both doses need to be received before the age of 7.5 months
b) The pentavalent rotavirus vaccine should be given in two doses at about 2 months and 4 months of age - both doses need to be received before the age of 7.5 months
c) One of the rotavirus vaccines available in Australia is not a live attenuated virus vaccine
d) An infant's food consumption does not need to be restricted before or after receiving either of the available rotavirus vaccines
New mum, Charlene, asks a lot of questions about rotavirus vaccine as she has not heard of it. Which of the following statements is true?
a) The monovalent rotavirus vaccine should be given in two doses at about 2 months and 4 months of age - both doses need to be received before the age of 7.5 months
b) The pentavalent rotavirus vaccine should be given in two doses at about 2 months and 4 months of age - both doses need to be received before the age of 7.5 months
c) One of the rotavirus vaccines available in Australia is not a live attenuated virus vaccine
d) An infant's food consumption does not need to be restricted before or after receiving either of the available rotavirus vaccines
Cold chain/vaccines another favourite question!
Try this, it may come out in the coming exam. This question is picked up from gplearning. As far as I could remember it did not appear in Part 1 2008 exam. Cold chain was asked in KFP if I am not mistaken. So, this year it may appear in Single Best Answer. Watch out!
In relation to the storage of vaccines, which one of the following statements is true?
a) Most vaccines should be kept frozen during transportation
b) Most vaccines should be refrigerated between 2 and 8°C
c) Vaccines should be removed from their packaging prior to storage
d) Vaccines can be stored anywhere in a domestic refrigerator
Again, I shall post the answer and explanation after 5 reponses.
BTW, please get the other candidates you know to participate actively to make this blog more interesting.
In relation to the storage of vaccines, which one of the following statements is true?
a) Most vaccines should be kept frozen during transportation
b) Most vaccines should be refrigerated between 2 and 8°C
c) Vaccines should be removed from their packaging prior to storage
d) Vaccines can be stored anywhere in a domestic refrigerator
Again, I shall post the answer and explanation after 5 reponses.
BTW, please get the other candidates you know to participate actively to make this blog more interesting.
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