June 19-2,2021

Question 1

34F facial rash, worsening, non-tender, likely melasma, 6hx?

Answer 1

• OCP use?
• level of sun exposure
• family history of melasma
• anywhere else on body?
• any treatments so far?
• pregnancy history
• skin phenotype

Question 2

34F facial rash, worsening, non-tender, likely melasma, , 4 mx?

Answer 2

• change to non-oestrogen contraception
• sunscreen, restrict sun exposure
• topical retinoids
• hydroquinone 2% cream, BD, 2-4/12
• cosmetic camouflage

Question 3

56M aboriginal , more tired with sheep shearing, gained 4.5kg, BMI 32, BP 136/83, HR 84. 5ddx:

a,b,c,g,h,m,n,t,k

Answer 3

• Obstructive sleep apnoea
• undiagnosed dMII
• hypothyroidism
• depression
• chronic kidney disease

Question 4

56M aboriginal , more tired with sheep shearing, gained 4.5kg, BMI 32, BP 136/83, HR 84. dx of DMII, 12/12 later, urinanalysis bloods and protein: 5 Ix

Answer 4

-urine ACR
-UEC
-renal tract u/s
-urine MCS
-FBE
-CRP
urine red cell morphology

Question 5

55F, LMP 9/12 ago, hot flushes, drenching night sweats 12/12, worse, low mood, dyspareunia, non-smoker, CST mammogram 5ya, BP 127/86, PV - vaginal atrophy. 4 pharma

A,B,G,H,I,K,LM

Answer 5

• transdermal estrogen patch+cyclical progesterone
• venlafaxine
• gabapentin
• Mirena IUD

Question 6

How long to use cyclical HRT from LMP?

Answer 6

2 years now!

Question 7

55F, LMP 9/12 ago, hot flushes, drenching night sweats 12/12, worse, low mood, dyspareunia, non-smoker, CST mammogram 5ya, BP 127/86, PV - vaginal atrophy. grandma died breast ca at 55, 2 advice

Answer 7

• reassure no contraindication with fhx of breast ca

- specific fhx does not increase her risk of breast ca babove general population

Question 8

19F, acne vulgaris, 4 Pharma options?

Answer 8

• topical retinoids
• topical clindamycin
• oral doxycycline
• referral term for isotrenitoin
• OCP
• benzylperoxide

Question 9

19F, acne vulgaris, non pharma?

Answer 9

• use non soap cleanser
• avoid oil-based cosmetics
• oil-free sunscreen
• avoid hot/humid environments eg. sauna
• do not pick/squeeze pimples

Question 10

19F, acne vulgaris, on isotrenitoin, 4 side effects

Answer 10

• strict contraception as is potent teratogen
• skin/lip/eyes/oral mucosa drying and flaking
• more sensitive to UV, needs sunscreeen
• may cause myalgia/joint stiffness
• may initial flare before improvements

Question 11

24F, pre-conception consult, 6 issues

Answer 11

• prenatal supplement
• timing of intercourse
• CST up to date
• offer pre-conception genetic carrier screening
• screen intimate partner violence
• dietary advice and restrictions
• screen smoking
• ensure immunity to rubella/varicella