June 22-2, 2021

Question 1

67F, factory hand, asthma, pmhx htn, hyperC, GORD, anxiety, currently on flutica/salmet250/25 2BD, salbutamol 100mcg2-4PRN, telmisar40, atova20, PPI20, oxazepam30, 42py smoking, 15/day, walk 100m only, needed steroids/abx. 4 points to discuss to address poor response to pharmacotherapy

Answer 1

• inhaler technique
• assess adherence to medication dosages
• suggest spacer
• discuss smoking cessation
• add tiotropium
• written asthma action plan

Question 2

67F, factory hand, asthma, pmhx htn, hyperC, GORD, anxiety, currently on flutica/salmet250/25 2BD, salbutamol 100mcg2-4PRN, telmisar40, atova20, PPI20, oxazepam30, 42py smoking, 15/day, walk 100m only, needed steroids/abx.when refer to Resp physician? 3 indications

Answer 2

• diagnostic clarification
• multiple exacerbations needing oral steroids
• needing oxygen therapy
• optimising therapy if poor response to standard therapy

Question 3

48M postal worker, wants c-scope, overweight, 24hBP-115/82, PPI20PRN, social smoker 3-4ETOHweekends.4 hx beside fhx

Answer 3

• PR bleeding
• change in bowel habit
• unintentional weight loss
• hx of IBS
• previous FOBTs/c-scopes

Question 4

48M postal worker, wants c-scope, overweight, 24hBP-115/82, PPI20PRN, social smoker 3-4ETOH weekends. brother bowel cancer at age 54. 3 advice

Answer 4

• FOBT age 40-49
• c-scope every 5 years from 50-74
• Aspirin 100mg, daily for 2.5 years between age 50-70

Question 5

48M postal worker, wants c-scope, overweight, 24hBP-115/82, PPI20PRN, social smoker 3-4ETOHweekends, 4 advice to reduce risk?

Answer 5

• cease smoking
• weight loss: BMI-18-25
• limit alcohol
• aspirin 100mg for 2.5 years between 50-70
• diet: low in red meat

Question 6

25F childcare worker, first CST, got 3HPV vaccines, sexually active, 10cig/day, 4-5ETOH, phx genital herpes, PRNValacyclovir. Intermenstrual bleeding last 3/12. 10hx questions

Answer 6

• length of menstrual cycle
• frequency of intermenstrual bleeding
• volume of intermenstrual bleeding
• condom usage?
• dyspareunia?
• post-coital bleeding?
• maloderous vaginal discharge?
• fever?
• rash?
• Last menstrual period?
• hormonalcontraception?
• fhx of breast cancer?
• previous pregnancies and outcome?

Question 7

25F childcare worker, first CST, got 3HPV vaccines, sexually active, 10cig/day, 4-5ETOH, phx genital herpes, PRNValacyclovir. Intermenstrual bleeding last 3/12. 6ddx?

Answer 7

• cervical polyp
• cervical ectropion
• cervical cancer
• STI - gonorrheoa
• pregnancy
• endometrial hyperplasia

Question 8

25F childcare worker, first CST, got 3HPV vaccines, sexually active, 10cig/day, 4-5ETOH, phx genital herpes, PRNValacyclovir. Intermenstrual bleeding last 3/12. 4 general indications for CST?

Answer 8

• early sexual debut before age 14 without HPV vaccines
• persistent deep dyspareunia
• unexplained intermenstrual bleeding
• post-coital bleeding
• unexplained vaginal discharge

Question 9

25F childcare worker, first CST, got 3HPV vaccines, sexually active, 10cig/day, 4-5ETOH, phx genital herpes, PRNValacyclovir. Intermenstrual bleeding last 3/12. CST showed HPV not16/18, LBC possible LSIL with endocervical compnent. 3 mx?

Answer 9

• refer to gynecologist for colposcopy
• pelvic ultrasounds between day 5-10 of cycle
• STI for chlamydia