June 19th 2021

Question 1

17F aboriginal with dark skin, pmhx: chronic supp OM, grommets, acne. presents with ?pregnancy today, missed period last week, home preg positive.
wants to keep baby, family and boyfriend want abortion: 4 discussion points

a,b,d,g,k,o,p,t,w,i

Answer 1

• the decision is hers to make
• non-directive approach to consult
• offer aboriginal health worker involvement
• ask if she would like family/other supports present
• discuss pregnancy options available
• follow up in 5-7 days
• reassure confidentiality

Question 2

17F aboriginal with dark skin, pmhx: chronic supp OM, grommets, acne. presents with ?pregnancy today, missed period last week, home preg positive.
wants to keep baby, family and boyfriend want abortion. she keeps the baby, baby is now 1 and come in with left eye strabismus-esotropia. 4 examinations

Answer 2

• abnormal light reflexes
• abnormal red reflexes
• movement outwards of affected eye when normal eye covered
• movement back to centre when eye uncovered after covered

Question 3

8F central abdo pain+nausea 4-6/52, mum-depression/relationship breakdown, worse in daytime, no fever, vmoting or diarrhoea, eating nd drinking, happy at school, missed school due to tummy pain, looks well abdo SNT, peri-umbilical tenderness, beside constipation, 5 ddx?

Answer 3

-functional abdo pain
-coeliac
inflammatory bowel disease
-anxiety
-abdominal migraine
-UTI

Question 4

8F central abdo pain+nausea 4-6/52, mum-depression/relationship breakdown, worse in daytime, no fever, vmoting or diarrhoea, eating nd drinking, happy at school, missed school due to tummy pain, looks well abdo SNT, peri-umbilical tenderness, constipation, 2 Pharma?

Answer 4

• movicol junior daily
• paraffin oil daily

lactulose
coloxyl

Question 5

65M acute swollen, painful left knee, since last night, afebrile, knee aspirate. acute gout, 4 Pharma mx

b,d,g,f,h,

Answer 5

• ibuprofen 400mg, po, TDS
• prednisolone 15-30mg, daily for 3-5 days
• colchicine 1mg state, then 500microg 1hr later single dose
• left knee intraarticular steroid injection
• allopurinol 50mg daily for 4 weeks, increase by 50mg every 2-4/52 to achieve target to uric acid level <0.36, max 900mg daily

Question 6

36F, headache for 4/12, lost job, bilateral headaches, behind eyes/forehead, squeezing, panadeine forte, headache worse. 5 ddx

Answer 6

• medication overuse headaches
• tension-type headache
• rhinosinusitis
• migraine
• space occupying lesion
• depression

Question 7

36F, headache for 4/12, lost job, bilateral headaches, behind eyes/forehead, squeezing, panadeine forte, headache worse. 4 mx, Pharma, non-pharma

Answer 7

• cease panadeine forte
• change to NSAID
• refer psycholgoist
• start low dose amitriptyline

Question 8

2mx of pityriasis versicolor?

Answer 8

ketoconazole shampoo
miconazole shampoo
stat dose 400mg fluconazole

Question 9

22F, well, no meds, mum asked her to get ‘Pap smear’, 5 indications for CST today?

Answer 9

• unexplained intermenstrual bleeding
• early sexual debut before 14, before HPV
• post-coital bleeding
• persistent vaginal discharge
• persistent deep dyspareunia

Question 10

22F, well, no meds, mum asked her to get ‘Pap smear’,, 4/12 later, one episode of post-coital bleeding, 4 investigations

Answer 10

• Cervical co-test
• chlamydia endocervical swab
• gonorrhoea endocervical swab
• urine bHCG
• high vag swan
• trichomoniasis high vag swab

Question 11

22F, unprotected sex 4/7 ago, 2 emergency contraception options?

Answer 11

• copper IUD

- ulipristol 30mg stat