June 22nd, 2021

Question 1

48F, 48/24 LIF pain, worsening, avoiding meds, temp 37.4, HR 76, BP 132/86, no guarding or rebound, DRE: no masses of blood, pmhx impaired BSLs, abnormal CST, never overdue, 6 hx questions

Answer 1

• PR bleeding?
• last menstrual period
• Fhx of ovarian cancer
• nausea
• diarrhoea?
• unintentional weight loss
• dysuria
• fever?

Question 2

48F, 48/24 LIF pain, worsening, avoiding meds, temp 37.4, HR 76, BP 132/86, no guarding or rebound, DRE: no masses of blood, pmhx impaired BSLs, abnormal CST, never overdue, likely uncomplicated diverticulitis, 2 indications for abx?

Answer 2

• immunocompromised
• not improving after 72 hours
• right sided diverticulitis

Question 3

48F, 48/24 LIF pain, worsening, avoiding meds, temp 37.4, HR 76, BP 132/86, no guarding or rebound, DRE: no masses of blood, pmhx impaired BSLs, abnormal CST, never overdue, latest CST is HPV not 16/18 with pLSIL again, single mx?

Answer 3

repat HPV test in 12 months

Question 4

48F florist, 5/12 history vulval discomfort, trialed steroid creams/tea tree oil, pmhx right knee OA, meniere’s, takes fish oil/paracetamol, intermittent dysuria/burning in labia: 6 ddx?

Answer 4

• vulvovaginal candidiasis
• STI - herpes simplex virus
• dermatitis
• lichen sclerosus
• atrophic vaginitis
• lichen Planus
• vulvodynia

Question 5

48F florist, 5/12 history vulval discomfort, trialed steroid creams/tea tree oil, pmhx right knee OA, meniere’s, takes fish oil/paracetamol, intermittent dysuria/burning in labia, low vaginal swab: pseudohyphae: 4mx

Answer 5

• clotrimazole 2% intravaginally nocte for 3/7
• non-soap cleanser
• avoid douches
• cease steroid creams

Question 6

3M recurrent rash, unsettled after dinner last night, large red spots on thigh, away overnight, then today again re-appeared on chest and arms, no pmhx, immunised. urticaria 5hx

Answer 6

• first episode?
• timing in relation to food intake
• recent viral infection?
• recent medication use?
• bite or sting?
• contact with animals?

Question 7

75M retired truck driver, last time boostrix 2/12 ago, happy, on apixaban5BD, metoprolol25mgBD -AF, perindo5, atorva40, unsteady on feet, denies vertigo, not moving well, high falls risk, 3 screening questions

Answer 7

• 2 or more falls past 12 months?
• had a fall today?
• difficulty with walking?

Question 8

75M retired truck driver, last time boostrix 2/12 ago, happy, on apixaban5BD, metoprolol25mgBD -AF, perindo5, atorva40, unsteady on feet, denies vertigo, not moving well, high falls risk, MMSE 21/30, 4 ddx?

Answer 8

• dementia
• depression
• delirium
• infection - UTI
• hypothyroidism
• ubstance use
• space occupying lesion

Question 9

75M retired truck driver, last time boostrix 2/12 ago, happy, on apixaban5BD, metoprolol25mgBD -AF, perindo5, atorva40, unsteady on feet, denies vertigo, not moving well, high falls risk, MMSE 21/30, likely Alzheimer’s 3 meds

Answer 9

memantine
galantamine
donepezil
rivastigmine

Question 10

75M retired truck driver, last time boostrix 2/12 ago, happy, on apixaban5BD, metoprolol25mgBD -AF, perindo5, atorva40, unsteady on feet, denies vertigo, not moving well, high falls risk, MMSE 21/30, Alzheimer’s, 4 long term non-pharma considerations

Answer 10

• advance care planning
• assess fitness to drive
• aged care assessment
• webster pack
• assess safety at home
• carer support and respite

Question 11

76F, memory concerns, writing notes around the house, checking stove is off, lives alone, iADLs. 8 risk factors

a,b,f,h,i,l,m,u,v

Answer 11

Fhx of Alzheimer's dementia
past history of stroke
phx DM2
hypertension
-hypercholesterolaemia
smoking history
depression
infection
previous traumatic brain injuries
-excessive ETOH intake

Question 12

76F, memory concerns, writing notes around the house, checking stove is off, lives alone, iADLs. mild cognitive impairment, 4 mx issues

Answer 12

• advance care planning
• assessment for driving
• creating a will
• encourage exercise: 30min per day
• appointing power of attorney medical/financial