June 20-2, 2021

Question 1

21M new patient, right shoulder pain 8/52 ago, fall snowboarding, x-ray 2 weeks post, sling 5 days only, was advised Ortho: 3ddx

Answer 1

• incomplete healing middle third right clavicle due to initial non-compliance
• acromioclavicular joint sprain
• rotator cuff muscle strain

Question 2

21M new patient, right shoulder pain 8/52 ago, fall snowboarding, x-ray 2 weeks post, sling 5 days only, was advised Ortho, his osteopath requested MRI, 3 issues to discuss

Answer 2

• repeat x-ray is indicated
• MRI is not currently needed
• MRI would be private
• refer to sports med physician

Question 3

21M new patient, right shoulder pain 8/52 ago, fall snowboarding, x-ray 2 weeks post, sling 5 days only, was advised Ortho, 6/52 later, ongoing pain, wants oxycodone, 4mx options?

Answer 3

• risks of long term opioid use
• long term opioid is ineffective
• use regular paracetamol
• use regular meloxicam
• refer psychology
• refer physiotherapy

Question 4

22F, irregular periods, heavy/painful, 3-4 a year, last one 6/52 ago, thinning hair, no meds, obese, BMI 32. 5 hx?

H,I,K, O, Q, S

Answer 4

• recent unprotected sex?
• nipple discharge?
• acne?
• contraception?
• fhx of PCOS?
• cold intolerance?

Question 5

22F, irregular periods, heavy/painful, 3-4 a year, last one 6/52 ago, thinning hair, no meds, obese, BMI 32. 3 Mx of PCOS?

Answer 5

weight loss 5-10%

• stat metformin 500mg
• start oral OCP

Question 6

22F, irregular periods, heavy/painful, 3-4 a year, last one 6/52 ago, thinning hair, no meds, obese, BMI 32. 6 bloods to ask for?

Answer 6

FSH
Free androgen index
LH
Pelvic U/S
Sex hormone binding globulin
TFTs
bHCG

Question 7

3M with barking cough, no pmhx, no meds, 4 signs to assesss severity of presentation?

Answer 7

• central cyanosis
• decrease level of consciousness
• respiratory accessory muscle usage
• stridor

Question 8

3M with barking cough, no pmhx, no meds, mild croup, 2 mx

Answer 8

• single dose prednisolone 1mg/kg

- return if increasing stridor, SOB

Question 9

3M with barking cough, no pmhx, no meds, mild croup worsening, not unsettled and drowsy, 4 immediate mx?

Answer 9

• call for urgent ambulance transfer to ED
• nebulised adrenaline
• minimal handling
• oral dexamethasone (0.6mg/kg)
• supplemental oxygen to maintain sat >94%

Question 10

3M with barking cough, no pmhx, no meds, mild croup, hospital, now back home, mum is upset, 3 things

Answer 10

• listen empathetically
• explain nature of croup and how severity can change
• discuss case with medical defence organisation