June 16th 2021

Question 1

46M minor arm laceration, ETOH, HTN, stage 2 CKD, intoxicated, 4 physical exam to assess level of intoxication

a,k,l,m,d,c

Answer 1

• ataxia?
• tachycardia
• decreased consciousness
• disinhibited behaviour
• memory impairment

Question 2

46M minor arm laceration, ETOH, HTN, stage 2 CKD, intoxicated, 3 long term pharmacological

Answer 2

acamprosate 666mg, TDS, PO
naltrexone: 50mg, daily
disulfrim 100-300mg, daily

Question 3

7/12old M, first child, growth and development, not yet rolling, smaller penis, right cryptorchidism, c-section, Guthrie-NAD, changed to bottle, floppy when held, 25-50th centiles, head lag. 4ddx

Answer 3

Prader-Willi syndrome
spinal Muscular atrophy
muscular dystrophy
Down’s syndrome

Question 4

7/12old M, first child, growth and development, not yet rolling, smaller penis, right cryptorchidism, c-section, Guthrie-NAD, changed to bottle, floppy when held, 25-50th centiles, head lag. one next step?

Answer 4

referral to developmental paediatrician for genetic testing

Question 5

7/12old M, first child, growth and development, not yet rolling, smaller penis, right cryptorchidism, c-section, Guthrie-NAD, changed to bottle, floppy when held, 25-50th centiles, head lag. now 9/12, 3 immunisations

Answer 5

infanrix hexa
prevenar 13
influenza
bexsero

Question 6

67M diabetic review, well, AF, bilateral knee OA, TIA 3ya, 25py, on metforminXR2gBD, gliclazideXR60mg, rosuvastatin20, perindo5, apixa5, panadolSR,TDS, BP 126/69, HR 78, BMI 24.6, lesion right forearm growing past 6/12: single mx plan?

Answer 6

-excisional biopsy with 3-5mm margins

Question 7

67M diabetic review, well, AF, bilateral knee OA, TIA 3ya, 25py, on metforminXR2gBD, gliclazideXR60mg, rosuvastatin20, perindo5, apixa5, panadolSR,TDS, BP 126/69, HR 78, BMI 24.6, lesion right forearm growing past 6/12: 3 risks discuss prior to excision

Answer 7

• risk of infection
• bleeding due to apixaban
• need for further excision depending on margins

Question 8

67M diabetic review, well, AF, bilateral knee OA, TIA 3ya, 25py, on metforminXR2gBD, gliclazideXR60mg, rosuvastatin20, perindo5, apixa5, panadolSR,TDS, BP 126/69, HR 78, BMI 24.6, now needs knee TKR, med changes prior to surgery

Answer 8

• withhold apixaban 48-72 hours prior to surgery
• withhold metformin morning of surgery only
• withhold gliclazide morning of surgery

Question 9

19M kicked out of father’s house, spends time in his room with blinds down, sleeps til late afternoon, online TAFE, distressed, TV newsreaders inserting thoughts into his head. 6 hx

Answer 9

• illicit drug use?
• auditory/visual hallucinations?
• low mood?
• elevated mood?
• delusions of persecution?
• family history of schizophrenia?
• suicidal ideation?

Question 10

19M kicked out of father’s house, spends time in his room with blinds down, sleeps til late afternoon, online TAFE, distressed, TV newsreaders inserting thoughts into his head. 4 organic causes?

Answer 10

• intracranial lesion
• illicit substance use
• head injury
• thyrotoxicosis
• CNS infection
• temporal lobe epilepsy

Question 11

19M kicked out of father’s house, spends time in his room with blinds down, sleeps til late afternoon, online TAFE, distressed, TV newsreaders inserting thoughts into his head. on risperidone, 3 bloods to check when on antipsychotics?

Answer 11

prolactin
fasting BSL
Cholesterol