June 20, 2021

Question 1

40M, new lump on ear, not itchy/painful, landscape gardener, 4 ddx?

Answer 1

• keratoacanthoma
• nodular BCC
• SCC
• nodular melanoma

Question 2

40M, new lump on ear, not itchy/painful, landscape gardener, 2 initial mx

Answer 2

• semi-urgent referral to plastic surgeon to arrange excision
• punch biopsy to establish dx

Question 3

40M, new lump on ear, not itchy/painful, landscape gardener, wife Renee 40, and at 15/40 prep, first antenatal, genetic testing, 3 pieces of advice

Answer 3

• they would be at increased risk of genetic abnormality due to advanced age
• blood test available for Trisomy 21,18,13
• diagnostic testing such as amniocentesis to confirm is available

Question 4

7M, rural ED, 24/24 increasing R leg pain + fever, aboriginal, lethargic, temp 39.1, HR 175, RR 40, Sa02 96%, RA, right knee pain, non-weight bearing, swollen, pain with active and passive flx/ext. 4ddx

b,c,d,g,i,e

Answer 4

• septic arthritis right knee
• osteomyelitis of femur
• reactive arthritis right knee
• acute rheumatic fever
• haematological malignancy

Question 5

7M, rural ED, 24/24 increasing R leg pain + fever, aboriginal, lethargic, temp 39.1, HR 175, RR 40, Sa02 96%, RA, right knee pain, non-weight bearing, swollen, pain with active and passive flx/ext. now asleep, HR is still 165, 4mx

Answer 5

• arrange urgent transfer to tertiary paed hospital via air ambulance for orthopaedic review
• oxygen to maintain O2 sats between 92-94%
• obtain IV access
• stat dose of IV flucloxacillin
• bolus IV fluid 20mL/kg
• take blood culture, send with patient to base hospital

Question 6

4F, Down syndrome, abdo pain 48/24, diarrhoea, no fever/vomiting, diarrhoea watery/brown, no blood/mucous, increasing abdo pain frequency, 5ddx?

Answer 6

• acute viral gastroenteritis
• bowel obstruction
• acute appendicitis
• bacterial gastroenteritis
• urinary tract infection
• overflow
• coeliac disease

Question 7

4F, Down syndrome, abdo pain 48/24, diarrhoea, no fever/vomiting, diarrhoea watery/brown, no blood/mucous, increasing abdo pain frequency, viral gastro, 2 info to inform nursing home?

Answer 7

• should inform nursing home of Clara’s illness
• no visiting until 48 hours symptom free
• strict hand hygiene

Question 8

4F, Down syndrome, abdo pain 48/24, diarrhoea, no fever/vomiting, diarrhoea watery/brown, no blood/mucous, increasing abdo pain frequency, now back 5/52 later, once a week diarrhoea, 2 investigations

Answer 8

• stool MCS

- coeliac serology

Question 9

78M gradually worsening vision, blurred central vision, 5/12, no pain/irritation, perindo5, atorva20, 25py smoking, BMI 30.2, BP 145/96, 3ddx?

Answer 9

hypertensive retinopathy
diabetic retinopathy
age related macular degeneration

Question 10

78M gradually worsening vision, blurred central vision, 5/12, no pain/irritation, perindo5, atorva20, 25py smoking, BMI 30.2, BP 145/96, 4mx before ophthalmologist ?

Answer 10

• smoking cessation
• weight loss 5-10%
• add amlodipine 5mg to improve BP
• monitor vision at home with Amsler grid, present if acute deterioration

Question 11

78M gradually worsening vision, blurred central vision, 5/12, no pain/irritation, perindo5, atorva20, 25py smoking, BMI 30.2, BP 145/96, likely macular degeneration, has private and commercial license, 2 advice?

Answer 11

• fit for private license

- not fit for commercial license until sees ophthalmologist