June 2nd 2021

Question 1

65M self-d/c 2/7 ago, dyspnoea/productive cough increasing past 3/12, denies fever, night sweats, weight loss, 30py smoking, childhood asthma, new COPD, how to manage with 3 pharma

Answer 1

• commence LAMA - tiotropium bromide
• ongoing SABA - Salbutamol
• start LABA: salmeterol
• prednisolone

Question 2

26F who is 12/40, fatigue and constipation, feeling cold, phx vitiligo, anxiety, 2 previous miscarriages, delayed tendon reflexes, how to treat hashimoto’s
d, l

Answer 2

• replacement thyroxine immediately 75mcg, po, daily
• early referral to endocrinologist in 1-2 weeks
• repeat TFTs in 4 weeks
• hypothyroidism in preg needs close monitoring

Question 3

Keratoacanthoma margins are?

Answer 3

3-5mm

Question 4

ddx for keratoacanthoma?

Answer 4

SCC
nodular BCC
cutaneous metastasis
nodular melanoma

Question 5

32F 34/40 preg, mild lower abdo pain, light PV bleeding, 2nd child died in utero at 37/40, low lying placenta, 3ddx
e,h,i,d

Answer 5

• placenta previa
• placenta abruptio
• premature labour - early show

Question 6

50M aboriginal, deranged LFTs, drinks, smokes, gout 2ta, fhx t2dm, stroke, no reg meds, BP 160/90, BMI 32 waist 110cm: 4 ddx for liver mixed LFT picture

Answer 6

• alcoholic hepatitis
• fatty liver disease
• chronic hep B
• heriditary haemachromatosis
• autoimmune hepatitis
• wilson’s disease

Question 7

30F 24/24 severe upper abdo pain, vomiting, nausea, BOx1, Mirena, sex no condoms, smokes 20pd, 4-6cans beer, GORD, anxiety/dep, tender epigastrium, BP 95/60,HR: 112, BSL: 4, uBHCG-neg, FWT-neg, 3 ddx

c,f,h,i,lk

Answer 7

• perforated peptic ulcer
• acute pancreatitis
• acute cholangitis
• acute gastritis
• acute cholecystitis

Question 8

30F 24/24 severe upper abdo pain, vomiting, nausea, BOx1, Mirena, sex no condoms, smokes 20pd, 4-6cans beer, GORD, anxiety/dep, tender epigastrium, BP 95/60,HR: 112, BSL: 4, uBHCG-neg, FWT-neg, 3 immediate management prior to transfer to hospital

Answer 8

• large bore IV cannula x2 cubital fossae
• analgesia, 2.5mg-5.0mg, morphine, IV
• 0.9% normal saline 500mL-1000L, IV bolus
• nil by mouth
• ondansetron 4-8mg, IV

Question 9

76M, 1/12 hx fatigue, anorexia, early satiety, pruritus, weight loss, night sweats, NAFLD, IHD, HTN, cholesterol , back pain, aspirin, atorva40, perindo5, paracetamol 1G, PRN, lives alone, wife died 5ya, BP 140/85, HR 75 regular, pale conjunctiva and scleral icterus, mass extending up under left rib margin, 3 ddx

c,e,,H, K

Answer 9

• head of pancreas carcinoma
• hepatocellular carcinoma
• gastric carcinoma

-CML

Question 10

76M, 1/12 hx fatigue, anorexia, early satiety, pruritus, weight loss, night sweats, NAFLD, IHD, HTN, cholesterol , back pain, aspirin, atorva40, perindo5, paracetamol 1G, PRN, lives alone, wife died 5ya, BP 140/85, HR 75 regular, pale conjunctiva and scleral icterus, mass extending up under left rib margin, now gout great toe, 2 pharmacy treatment

Answer 10

• local corticosteroid injection into 1st MTPJ left foot
• prednisolone 15-30mg for 3-5 days
• colchicine 1mg initially then 500microg 1 hour later