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Maddox is a previously well boy aged three years. He is brought to your practice by his parents, who report he has had worsening red eyes for the past 24 hours. 1. What further history would you like to know about Maddox’s red eyes? 2. What are some red flags and important diagnoses you would want to exclude as you conduct your consultation? 3. How would you examine Maddox and his eyes? 4. Having ruled out any red flags, what conditions might be causing Maddox’s red eyes? 5. How would you differentiate between viral, bacterial and allergic conjunctivitis in order to exercise prudence with antibiotic stewardship? 6. Under what circumstances would you perform any investigations on a child with discharging red eyes? 7. What treatment would you advise for Maddox? 8. What advice would you give to Maddox’s parents? #Week30_Case1
If you are interested, You can go through the focus articles of this month AJGP which is Medicolegal and related to this check. Do not forget to do the Clinical Challenge to get your CPD points.
Kabir, aged 75 years, is a retired accountant who presents to you following suspension of his car licence by the licensing authority. He is accompanied by his wife, Jasleen. You have been Kabir’s general practitioner (GP) for two decades. Other than bilateral cataract surgery three years ago and essential hypertension, which is well managed with hypotensive medication, his medical history is unremarkable.
Kabir is irate and tells you that police had reported him to the licensing authority after he got lost driving home at night two months ago. He is annoyed and does not understand what the fuss is all about. He tells you that, other than a collision when he was aged in his 40s, which was not his fault, and a couple of speeding fines, he has a good driving record. He tells you that the loss of his licence has negatively affected his independence and curtailed his activities. 1. Why is fitness to drive an important medical issue? 2. Should Kabir have reported these events to the licensing authority? 3. How would you assess Kabir? 4. What will you recommend to the licensing authority in terms of Kabir’s fitness to drive? 5. What are some of the challenges in assessing fitness to drive in the general practice setting? 6. Are you ultimately responsible for determining Kabir’s fitness to drive? #Week29_Case5
Roberto, aged 85 years, was a resident of an aged care facility. His past medical history included hypertension and a stroke, and he had recently been diagnosed with type 2 diabetes and chronic lymphocytic leukaemia (CLL). Approximately 20 years ago he underwent an epidural anaesthetic for a minor surgical procedure, which was complicated by a spinal epidural haematoma. This caused an injury to his spinal cord, leaving him with ongoing bladder dysfunction and occasional urinary tract infections. A week ago, you visited Roberto as he became unwell with a fever and complained of pain when passing urine. He was treated with antibiotics, but a day later he started to complain of some loin pain and ‘the shakes’. He declined hospital admission. You visited Roberto the next morning and advised the facility team that he had pyelonephritis and was probably septic. An ambulance was called, but Roberto’s condition quickly deteriorated. By the time the ambulance arrived, he had died. 1. Is this death reportable to the Coroner? 2. What are the circumstances that require a death to be reported to the Coroner? 3. Why might this death be reportable to the Coroner? 4. Why might this death not be reportable to the Coroner? 5. Under which reportability criteria might Roberto’s death be reportable? 6. Is there a requirement to report all deaths resulting from trauma? Does this apply if there has been a significant amount of time since the trauma? 7. How frequently are deaths in Australia reported to Coroners? 8. If you determine that Roberto’s death is not reportable to the Coroner, how might you formulate the cause of death? 9. Would you be in a position to complete the Medical Certificate of Cause of Death (MCCD) if you had not previously treated Roberto? 10. To what extent is wording important on an MCCD? #Week29_Case4
