May 15th-2, 2021

Question 1

64F sudden onset severe low back pain, 5ddx?

Answer 1

• osteoporotic crush fracture
• pathological fracture
• bilateral paraspinal muscle strain
• lumbar disc prolapse
• facet joint pain

Question 2

64F sudden onset severe low back pain, 4 mx?

Answer 2

graded exercise program
paracetamol 1G, PO, TDS, PRN
referral to physiotherapy
core strengthening
review in 3-5 days

Question 3

34M 4/52 hx of left scrotal swelling and pain, 3 ddx

Answer 3

• epididymal orchitis
• hydrocele
• varicocele
• hernia
• testicular tumour

Question 4

34M 4/52 hx of left scrotal swelling and pain, 6 examination signs

Answer 4

-solid testicular lump
-transillumination
-palpation of ‘bag of worms’
-reducible lump
-fever
-cough impulse
prehn’s sign
cremesteric reflex

Question 5

60M: intermittent left chest pain, worse after eating, nil SOB/nausea, looks well, overweight: 3 ddx

Answer 5

GORD
peptic ulcer
ischaemic heart disease

Question 6

85F nearby aged care, hypo chromic, microcytic anaemia, 3 further actions?

Answer 6

• contact person who ordered test
• contact the lab
• contact the aged care facility

Question 7

85F nearby aged care, hypo chromic, microcytic anaemia, nominated by nurse, 3 aspects of duty of care

Answer 7

• ensure patient informed of result
• visit patient and manage
• maintain confidentiality
• discuss with her usual GP

Question 8

85F nearby aged care, hypo chromic, microcytic anaemia, 4 causes

Answer 8

• inadequate iron intake -poor diet
• inadequate iron absorption - coeliac
• increased losses -PR bleeding from malignancy
• anticoagulants

Question 9

19F with 6/7 sore throat fever, not improving from abx, ongoing, most likely dx?

Answer 9

epstein-barr virus

Question 10

19F with 6/7 sore throat fever, not improving from abx, ongoing, likely EBV, 3 investigations?

Answer 10

EBV serology
LFTs
FBE

Question 11

19F with 6/7 sore throat fever, not improving from abx, ongoing, likely EBV, 4 management

Answer 11

• avoid contact sports for 2 months
• paracetamol 1G, PO, QID, PRN
• stop penicillin
• drink fluids
• rest
• avoid alcohol

Question 12

36M remote snake bite

3mx first aid

Answer 12

• lie him supine immobilise
• pressure bandage immobilisation
• urgent transfer to hospital via air ambulance

Question 13

36M remote snake bite

4mx

Answer 13

• establish IV access
• venom detection kit
• baseline coagulation studies
• monitor vital signs