May 22nd-2, 2021

Question 1

35F 6/12 abdo, pain, bloating, fatigue, father bowel ca age 63, ego, iron supplement pen, BMI 33, 3ddx

Answer 1

• irritable bowel syndrome
• inflammatory bowel syndrome
• coeliac disease
• bacterial overgrowth
• ovarian cancer
• helicobacter pylori

Question 2

35F 6/12 abdo, pain, bloating, fatigue, father bowel ca age 63, ego, iron supplement pen, BMI 33, 4 hx

b,d,o,p,s

Answer 2

• symptoms increase with gluten?
• unintended weight loss?
• diarrhoea?
• per rectal bleeding?
• fhx of coeliac?

Question 3

35F post sx termination or preg, 9/7 post, foul smelling discharge, 3ddx

arc,d,e

Answer 3

-endometritis
-infected retained products of conception
-pelvic inflammatory disease
-

Question 4

35F, 9 weeks, wants MTOP, 200km away from hospital, 2 contraindications

Answer 4

• distance from nearest hospital

- unknown location of pregnancy ?ectopic

Question 5

39F, amenorrhoea for last 6/12, hx of irregular, no sex, reg neg, G1P1, DVT post # 20ya, BMI 28, receding hairline. 4 ddx?

a,b,d,j

Answer 5

• polycystic ovarian syndrome
• premature ovarian syndrome
• hypothyroidism
• prolactinoma

Question 6

39F, amenorrhoea for last 6/12, hx of irregular, no sex, reg neg, G1P1, DVT post # 20ya, BMI 28, receding hairline. 4 future complications of ovarian failure premature?

Answer 6

• infertility
• osteoporosis
• depression
• atrophic vaginitis

Question 7

20F primp, 6/52 post birth of daughter, feeding issues, losing weight, feeds every 4-6hours, unsettled, sore nipples, husband is pilot away, alone, tired, baby is well, 5 aspects of management

Answer 7

• offer psychology support
• increase feed frequency to 2-3 hourly
• lactation consultant
• assess self harm/harm to baby
• carer’s leave for husband
• review in 1/52
• organise 6 week immunisations
• moving closer to family

Question 8

20F primp, 18/52 post birth of daughter, husband concerned, signs of psychosis, 1 mx

Answer 8

organise involuntary admission under mental health act

Question 9

23F recent d/c inpatient MH, 3/12 hallucinations, isolation, poor self care, now voluntary 2/52 paliperidone depot, local MH clinic, schizophreniform disorder, enrolled TAFE, 3 further hx

Answer 9

• any grandiose delusions?
• low mood?
• illicit drugs?

Question 10

23F recent d/c inpatient MH, 3/12 hallucinations, isolation, poor self care, now voluntary 2/52 paliperidone depot, local MH clinic, schizophreniform disorder, enrolled TAFE, 3/12 later lactating, single diagnosis
d,f,l

Answer 10

paliperidone induced hyperprolactinaemia

Question 11

23F recent d/c inpatient MH, 3/12 hallucinations, isolation, poor self care, now voluntary 2/52 paliperidone depot, local MH clinic, schizophreniform disorder, enrolled TAFE, 3/12 later lactating,2 mx?

Answer 11

• discuss with community mental health team to decrease paliperidone
• add small dose aripiprazole in consultation with community mental health team

Question 12

16F, amenorrhoea, nil pmhx , not sexually active, has secondary sex characteristics, 6 ddx?

Answer 12

• PCOS
• functional hypothalamic amenorrhoea
• turner’s syndrome
• hypothyroidism
• imperforate hymen
• prolactinoma

Question 13

16F, amenorrhoea, nil pmhx , not sexually active, has secondary sex characteristics, 5 hx

Answer 13

• elite sports?
• family history of amenorrhoea
• weight gain
• hirsutism
• cyclical abdo pain?
• galactorrhoea?
• cold intolerance

Question 14

16F, amenorrhoea, nil pmhx , not sexually active, has secondary sex characteristics, 4 investigations

Answer 14

FSH
LH
pelvic U/S
TFTs
prolactin