May 27th 2021

Question 1

3.5F developmental delay, doesn’t follow instructions, can’t communicate, tantrums, two-word sentences, does not turn when called, 8hx

Answer 1

• phx of recurrent ear infections?
• immunisation hx
• current parental smoking
• snoring at night
• pass state-wide hearing screen? (SWISH test)
• recent fevers
• perinatal hospitalisations?
• antenatal concerns? prematurity
• Any developmental issues in older sibilings?

Question 2

3.5F developmental delay, doesn’t follow instructions, can’t communicate, tantrums, two-word sentences, does not turn when called, 3 ddx besides hearing impairment

Answer 2

-autism spectrum disorder
-obstructive sleep apnoea
-global developmental delay
-ADHD
child abuse
-Anxiety

Question 3

3.5F developmental delay, doesn’t follow instructions, can’t communicate, tantrums, two-word sentences, does not turn when called, 5 examinations for development. besides otoscope

Answer 3

• dysmorphic features
• growth parameters: height, weight, BMI
• fine motor skills, pick up a pen
• gross motor skills: observe getting up on bed/chair
• social skills: pointing, eye contact

Question 4

3.5F developmental delay, doesn’t follow instructions, can’t communicate, tantrums, two-word sentences, does not turn when called, sent to ENT, bilateral otitis media with effusion, 4 mx pending review

Answer 4

• refer to audiology for formal hearing test
• refer to speech therapist
• shared book reading
• instruction face to face and close up

Question 5

82M cholesterol, T2DM, HTN, on atorva 40mg, metformin 1000mg, BD, ramipril 7.5mg. 72kg, lost 5kg since last time, BMI now 22. BP: 132/78, BSL: 5.0, anorexia, wife passed 8/12 ago. Flat affect, dog passed 2/52 as well. 10 hx re: weight loss

a,d,f,i,j,k,l,p

Answer 5

• appetite?
• enjoys food?
• early satiety
• how does he get groceries?
• restrict intake for diabetes control
• recent low mood?
• night sweats?
• nausea/vomiting?
• change in bowel habit?
• thyroid symptoms, tremors/cold intolerance?

Question 6

82M cholesterol, T2DM, HTN, on atorva 40mg, metformin 1000mg, BD, ramipril 7.5mg. 72kg, lost 5kg since last time, BMI now 22. BP: 132/78, BSL: 5.0, anorexia, wife passed 8/12 ago. Flat affect, dog passed 2/52 as well. reduce motivation/intake, 3 mx strategies

Answer 6

• encourage to eat 3 meals a day
• eat a variety of foods
• supplement with nutritional shake
• refer to dietician
• fortnightly weighs at the GP to track
• arrange meal delivery service
• engage community cooking classes for seniors

Question 7

19F childcare worker, teary and overwhelmed, grave’s 5ya, no Rx, MHCP 2ya, depression/suicidal ideation, self harm relationship breakdown, psych little effect, recent cutting, research ways to end her life, 6 hx

Answer 7

• current suicidal plan?
• illicit drug use?
• any visual or auditory hallucinations?
• feat of abandonment?
• active grave’s? palpitations?
• symptoms of depression, anhedonia
• previous episodes of mania/hypomania

Question 8

19F childcare worker, teary and overwhelmed, grave’s 5ya, no Rx, MHCP 2ya, depression/suicidal ideation, self harm relationship breakdown, psych little effect, recent cutting, research ways to end her life, 4ddx

Answer 8

• borderline personality disorder
• bipolar disorder
• major depression
• eating disorder/anorexia

Question 9

19F childcare worker, teary and overwhelmed, grave’s 5ya, no Rx, MHCP 2ya, depression/suicidal ideation, self harm relationship breakdown, psych little effect, recent cutting, research ways to end her life, 4mx after TSH 0.02, T4 25

Answer 9

• commence carbimazole 10-20mg, PO 2-3 divided doses
• safety plan around suicidal thoughts/self harm
• review in 48 hours
• give Brooke, mental health triage number
• psychology for dialectical behavioural therapy

Question 10

19F childcare worker, teary and overwhelmed, grave’s 5ya, no Rx, MHCP 2ya, depression/suicidal ideation, self harm relationship breakdown, psych little effect, recent cutting, research ways to end her life, 5 components of a safety plan?

Answer 10

• warning signs
• protective factors/reasons to live
• making safe space
• things to distract
• people and places she can connect
• professionals she can connect

Question 11

52F hysterectomy for fibroid in 3/52, has regular monthly bleeds, OA left knee, AF, HTN, obesity, on atenolol 50mg, apixaban 5mg, celexocib, paracetamol, glucosamine, fish oil, 4 factors re: bleeding

a,b,g, M

Answer 11

• extent of blood loss likely for hysterectomy
• she anaemic
• any kidney disease
• informed about risks/benefits of blood transfusion?

Question 12

52F hysterectomy for fibroid in 3/52, has regular monthly bleeds, OA left knee, AF, HTN, obesity, on atenolol 50mg, apixaban 5mg, celexocib, paracetamol, glucosamine, fish oil, 4 advice for meds

Answer 12

• withhold apixaban 24-48hours prior
• withhold celexocib 3 days prior
• cease glucosamine prior to surgery
• cease fish oil prior to surgery

Question 13

32F, 7 week hands/wrists/feet stiffness/soreness, ESR: 52, anti-ccp: 133, RhF: 42
6 general Indicators for poor progosis for RA?

Answer 13

• RF positivity
• antii-ccp positivity
• > 20 joint swollen at disease presentation
• high disease activity at onset
• elevated ESR
• smoking
• early age onset