Gout

Gout

Key points:

1. Gout is the most common inflammatory arthritis with a prevalence of about 2% in Australasia.
2. Key steps in the development of gout are 1)chronic hyperuricemia 2) monosodium rate monohydrate 3)interaction between the crystals and the inflammatory system, which is primarily responsible for the clinical features. 
3. Definition of hyperuricemia: serum rate level > 0.42
4. Hyperuricemia is caused by medications and genetic predisposition
5. Only 20% of patients with hyperuricemia develop gout 
6. Definite diagnosis can only be achieved via synovial fluid analysis. This needs to be done before recommending hypouricemic drug therapy.
7. Management of acute gout:
1. 
8. There is an increase risk of gout when the patient is started on rate lowering therapy. Patients can be started on low dose colchicine 0.5 mg daily or daily NSAID or 5mg prednisolone. Usually prophylaxis is required for around 3-6 months.
9. Serum rate target is less than 0.36 mmol/L, however for patients with a large rate crystal load (as reflected by the presence of tophi) erosions or chronic joint deformity due to gout, the target is a serum rate of less than 0.3 mol/L/
10. Diet and lifestyle modification alone usually is inadequate to lower serum urate level.
11. Allopurinal hypersensitivity syndrome occurs with greater frequency in the setting of renal insufficiency, advanced age, HLA B58:01 positivity and higher initial doses but can occur in their absence. The syndrome usually occurs in the first 12 weeks of exposure, and thus the development of rash during this period should prompt immediate cessation of allopurinol, assessment of liver and renal function, and for the possibility of hypersensitivity. 
12. Probenecid is another agent which can be used as rate lowering agent. But the patient needs to have renal function > 30-40ml/min. Because of the marked increase in urinary uric acid in the early phase of treatment, good hydration and urinary alkalisation are appropriate. 

Perinatal depression 101

Key facts about perinatal depression

1.  "It takes a village to raise a baby" Explore helps which are available (husband, mother and friends)
2. Edinburgh postnatal depression scale (EPDS) can be used to screen for postnatal depression. A score > 10 is suggestive of possible depression.
3. Don't forget risk assessment and physical problems such as mastitis, urinary tract infection and thyroid dysfunction.
4. beyondblue postnatal depression screening program reported that 16% of women have depression in the postnatal period. (Postnatal depression is common)
5. SSRI (sertraline) is reported to be present in low concentrations in breast milk, has little transfer to the infant and poses few risks of side effects in the child.
6. Paroxetine should be avoided in women of child-bearing age.
7. When stopping antidepressants, reduce it over a period of time (6 months)

REST Course key points

REST COURSE 

I attended the REST (Rural emergency skills training) course over the weekend. It is decided for doctors who are not emergency physicians and want to have a structured approach to an emergency situation. 

Some key points I got from the course:

1. Use DRSABCD in all emergency situations. Write down this on a white board and try to be prepared as much as you can. 
1. D: Danger 
2. R: Response (AVPU) Response to pain = PU = may require intubation 
3. S: send for help! or SHAVE = Sugar, haemorrhage, adrenaline, VT/VF and Epilepsy
4. A: Airway + Cervical spine 
5. B: Breathing, Oxygen, Pulse oximeter, RR, Ausculation 
6. C: Circulation. Blood pressure, HR, Cap Refill, IV access
7. D: Disability. Pupil and spine 
2. Must know adrenaline dose 
1. only use IV adrenaline in someone who is dead 
2. Anaphylaxis: adult 0.5 ml in 1:1000
3. Anaphylaxis: paediatric 0.1ml/kg in 1: 10,000
4. Arrest: adult 1 ml in 1:1000
5. Arrest: paediatric 0.1 ml/kg in 10,000
3. Protecting the cervical spine is important. When in doubt, put the cervical spine collar on. 
4. Defibrillation: 200 J. Use it early in VT/VF
5. Protecting the airway is important but it doesn’t always require intubation to improve breathing. Try guedel or LMA. 
6. Fluid bolus formula is 20mg/kg
7. Paediatric weight calculation for 1 year or above (age +4) x 2 
8. Don’t forget to check sugar 
9. intraosseous can be placed medial to tibial tuberosity 1 cm below the articular surface
10. Don’t forget the 4Hs and 4Ts. Haemorrhage, hypoxia, Hypokalaemia/hyperkalaemia, Hypothermia. Tension pneumothorax, Tamponade, Toxins, Thrombosis 

Colorectal cancer screening in Australia

Colorectal cancer screening

1. Colorectal cancer screening is currently recommended for asymptomatic and average risk individuals at the age of 50 or above every 2 yearly until the age of 74 with repeated negative findings. 
2. NBCSP is still at the rolling out stage, it will be completed by 2020.
3. Colorectal cancer has a good 5 year survival rate if it is detected early (stage A 90% and stage B 70%)
4. NBCSP uses immunochemical testing and it does not require any dietary or medication restriction. 
5. NBCSP FOBT does not pick up upper GI bleed. 
6. The screening strategy for asymptomatic individuals depend on their risk level. 
7. 
8. A positive FOBT does not mean that the person has cancer. The risk of colorectal cancer from a positive FOBT test is around 5%.
9. Try to use every opportunity you have to promote cancer screening. 
10. History and examination is still important in cancer screening program. 

Introduction

Hi,

I am a struggling GP registrar. (By struggling, I mean really struggling.) The purpose of this blog is to motivate myself to write study notes. The study notes will fulfil two purposes. The first one is that it will help to fulfil my training requirement. The second one is that I actually have something to go back to before the exam.

I only write down brief notes for each topic, usually are in point forms to remind myself some basic principles of medicine and basic management of certain conditions. Hopefully you will find this blog as helpful as I do.