June 17 2021

Question 1

76F, urinary incontinence, HTN on perindo5. 6 hx questions

Answer 1

• parity?
• any element of urge?
• dysuria?
• worse with coughing, laughing?
• caffeine intake?
• nocturia?
• constipated?
• increased frequency?

Question 2

76F, urinary incontinence, HTN on perindo5. 3 ddx?

Answer 2

• urinary tract infection
• weak pelvic floor muscles
• overactive bladder syndrome
• bladder cancer
• constipation
• DM2

Question 3

76F, urinary incontinence, HTN on perindo5. passing urine once an hour, 3-4times nocturne, urge when gets home, some stress incontinence, 4 cups tea, 1-2 glasses wine with dinner and cup of tear before bed. 4 physical findings or office tests

Answer 3

• urine dipstick to look for leukocytes
• pelvic organ prolapse?
• anthropomorphic measurements for BMI
• abdominal exam, suprapubic tenderness
• fingerprick BSL

Question 4

76F, urinary incontinence, HTN on perindo5. passing urine once an hour, 3-4times nocturne, urge when gets home, some stress incontinence, 4 cups tea, 1-2 glasses wine with dinner and cup of tear before bed. 4 non-pharmacological

Answer 4

• bladder training
• pelvic floor exercises
• continence therapist
• maintain BMI between 18-25
• decrease caffeinated drink through day
• decrease alcohol intake before bed

Question 5

23F new patient, painful lump in genital area 1/52, larger, no fever. 3 things to discuss before performing examination.

Answer 5

• explain what is involved, if uncomfortable can stop at anytime
• offer chaperone
• obtain verbal consent to perform genital examination

Question 6

23F new patient, painful lump in genital area 1/52, larger, no fever. single mx?

Answer 6

-semi-urgent referral to gynecologist for marsupialisation

Question 7

23F new patient, painful lump in genital area 1/52, larger, no fever. 4/12 later, new rash(macular with herald patch), 4 ddx?

Answer 7

• pityriasis rosea
• guttate psoriasis
• tines corporis
• discoid eczema

Question 8

3 Mx of left perthes disease

Answer 8

• urgent referral to orthopaedic surgeon for review
• activity limitation, no high impact
• paracetamol 15mg/kg QID, PO, PRN

Question 9

3 issues to discuss when parents formal complaint about delayed dx of perthes to practice?

Answer 9

• discuss with medical defence organisation
• discuss case and complaint with other GPs involved
• offer face to face appointment with those involved to discuss her concerns

Question 10

58F, pmhx HTN, hyperChol, left TKR, presents with upper abdo pain and nausea 12/24, vomitx2, BP 130/75, HR90. 5 ddx?

Answer 10

• acute viral gastroenteritis
• acute pancreatitis
• biliary colic
• peptic ulcer disease
• small bowel obstruction

Question 11

58F, pmhx HTN, hyperChol, left TKR, presents with upper abdo pain and nausea 12/24, vomitx2, BP 130/75, HR90. 6/12 later, now RUQ pain, LFTs bile:45, GGT: 439, ALP: 285. 6 ddx

Answer 11

• choledocholithiasis
• ascending cholangitis
• biliary colic
• cholangiocarcinoma
• head of pancreas cancer
• cholelithiasis

Question 12

58F, pmhx HTN, hyperChol, left TKR, presents with upper abdo pain and nausea 12/24, vomitx2, BP 130/75, HR90. 3mx for digital mxyoid pseudocyst?

Answer 12

• refer to plastics for surgical mx
• needle aspiration
• steroid injection
• cryotherapy