June 6th 2021

Question 1

5F, 1/7 hx of fevers&abdo pain, vomitx1, flat, clingy, vaccinated, no meds, temp 38.3, HR 120, abdo exam: soft generalised tenderness, alert/cooperative, 3ddx

Answer 1

• gastroenteritis
• appendicitis
• diabetic ketoacidosis

Question 2

5F, 1/7 hx of fevers&abdo pain, vomitx1, flat, clingy, vaccinated, no meds, temp 38.3, HR 120, abdo exam: soft generalised tenderness, alert/cooperative,dipstick positive for leaks and nitrites, 2mx

Answer 2

• paracetamol 15mg/kg, QID, PO, PRN
• cephalexin 7-10days
• follow up in 48 hours to ensure response to abx
• send clean catch urine for MCS

Question 3

5F, 1/7 hx of fevers&abdo pain, vomitx1, flat, clingy, vaccinated, no meds, temp 38.3, HR 120, abdo exam: soft generalised tenderness, alert/cooperative,dipstick positive for leaks and nitrites, vulvovaginitis, 4mx

Answer 3

• wear loose cotton underwear
• avoid soap/bubblebath
• nappy rash cream
• review in 2-3 days for response

Question 4

5F, fell off climbing equipment into bars, onto vagina, 3 hx

Answer 4

• height of the fall
• ability to pas urine/open bowels
• ongoing bleeding

Question 5

5F, fell off climbing equipment into bars, straddle injury, 3mx of perineum injury

Answer 5

• walt water baths
• barrier creams
• paracetamol 15mg/kg
• ice packs
• reduce strenuous activity

Question 6

32F, first time mum 6/52 postpartum check, normal vaginal delivery at 39+6, need sutures for episiotomy, no other complications, BMI on d/c 32, fully breastfeeding, phx anxiet/dep on sertraline ceased, quit smoking 12/12 ago, fhx of Grave’s, 8 important points to discuss

Answer 6

• contraception
• wound healing
• post-natal depression screen -Edinborough score
• vaccinations for Bub
• if lochia has ceased
• any nipple or breast pain?
• pelvic floor exercises
• ensure she is still not smoking
• alcohol abstinence while breast feeding
• safe at home?
• continence issues

Question 7

32F, first time mum 6/52 postpartum check, normal vaginal delivery at 39+6, need sutures for episiotomy, no other complications, BMI on d/c 32, fully breastfeeding, phx anxiet/dep on sertraline ceased, quit smoking 12/12 ago, fhx of Grave’s, 13 on edinborough score, 4 mx

Answer 7

• risk assessment for Suzanne’s safety
• risk assessment for baby’s safety
• refer to mother baby unit
• refer for psychological support
• explore social support network

Question 8

32F, first time mum 6/52 postpartum check, normal vaginal delivery at 39+6, need sutures for episiotomy, no other complications, BMI on d/c 32, fully breastfeeding, phx anxiet/dep on sertraline ceased, quit smoking 12/12 ago, fhx of Grave’s, 3/52 later, baby crying a lot, difficult to settle, 5 points of discussion

Answer 8

• reassure, this is purple crying
• self-resolves in 3-4 months
• sleep/wake diary
• routine for naps and sleep
• baby massage

Question 9

40M, one day after returning from Brazil, away 2/12, hiking rainforests, felt hot, sweaty, nausea on plane home, ?STI, multiple women on travels, yellow fever, but declined all other vaccinations, unsure about childhood vaccinations, malerone for malaria prophylaxis, no pmhx or meds. 10hx questions

Answer 9

• unprotected sex?
• receptive anal sex with men?
• drinking tap water?
• eating street food?
• IV injection of illicit substances?
• rash?
• abdominal pain?
• myalgias?
• headaches
• jaundice
• compliance with malaria prophylaxis
• history of contact with animals?

Question 10

40M, one day after returning from Brazil, away 2/12, hiking rainforests, felt hot, sweaty, nausea on plane home, ?STI, multiple women on travels, yellow fever, but declined all other vaccinations, unsure about childhood vaccinations, malerone for malaria prophylaxis, no pmhx or meds. widespread mucolopapular rash, 5ddx besides secondary syphilis?

Answer 10

• measles
• rubella
• chikungunya
• dengue
• acute HIV seroconversion
• zika
• typhoid fever

Question 11

40M, one day after returning from Brazil, away 2/12, hiking rainforests, felt hot, sweaty, nausea on plane home, ?STI, multiple women on travels, yellow fever, but declined all other vaccinations, unsure about childhood vaccinations, malerone for malaria prophylaxis, no pmhx or meds. has secondary syphilis: 5 mx

Answer 11

• notify department of health
• advise no sexual contact for 7/7 post treatment
• benzathine penicillin 1.8G, IM stat
• contact tracing 6/12 prior to dx
• no sex with partners from past 6 months until tested and treated
• warn about Jarisch-Herxheimer reaction post benzathine penicillin injection

Question 12

72M, 2/7 hx of back pain, nausea, lethargy, not reg meds, no immunisations past decade, rash noted. 1 dx

Answer 12

-left mid thoracic Herpes zoster

Question 13

72M, 2/7 hx of back pain, nausea, lethargy, not reg meds, no immunisations past decade, rash noted. 2 pharmacological Mx

Answer 13

• 1G valacyclovir, TDS, PO, 7/7
• 100mg gabapentin, Po, nocte
• 10mg, amitriptyline, po, nocte

Question 14

72M, 2/7 hx of back pain, nausea, lethargy, not reg meds, no immunisations past decade, rash noted. post-herpetic neuralgia, 5 Rx options

Answer 14

• topical lidocaine patches
• gabapentin 100mg
• pregabalin 25-75mg
• amitriptyline 10mg
• paracetamol
• ice massage

Question 15

72M, 2/7 hx of back pain, nausea, lethargy, not reg meds, no immunisations past decade, bilateral hands have +++actinic keratosis, 4 Rx options

Answer 15

• fluorouracil 5%, TOP, BD, 3-6 weeks
• imiquimod 5%, TOP, 3 times weekly 3-4 weeks
• photodynamic therapy
• ingenol meditate 0.05% gel for 2/7