Check Study Program

Tom, aged 76 years, has been given an appointment as a ‘walk in’ patient. He seems somewhat distressed and a little angry. You have seen him previously for mild alcohol-induced cirrhosis without coagulopathy, organomegaly or varices. Tom’s son has been living with him for six months. His son uses methamphetamine. They had an argument last night about his son’s methamphetamine use, and Tom’s son hit him with a stick of wood to his upper body (Figures 1–3) and pressed a knife against his neck (Figure 4). 1. How would you describe the injuries to Tom, as shown in Figures 1–4? 2. Given Tom’s current presentation, what other forms of elder abuse might you look for? How would you go about identifying them? 3. What steps would you take to ensure Tom’s safety? 4. What would be your approach if a police officer requested a statement from you about the cause of Tom’s injuries? #Week29_Case3

#Domestic_Violence_Respond

Tracy, aged 36 years, attends your clinic. You notice she has not been to the clinic for almost 12 months, when she last attended seeking assistance regarding difficulties in her marriage that were causing her to become depressed. Tracy has no children and works full time as a nurse. She has come today to request a medical certificate for work, as she is in pain. She tells you she fell over last night and hurt her arm after she tripped over her dog. She has a noticeably hoarse voice. When you ask about this, she denies any upper respiratory tract infective symptoms. You can see part of a bruise between her collarbones, at the top of her blouse, and a small subconjunctival haemorrhage. 1. How would you examine Tracy? 2. What further questions would you ask about the injuries? 3. How would you approach this, and what further questions could you ask? 4. What is ‘choking’, and to what is Tracy actually referring? What would you look for specifically on examination after this disclosure? 5. What are your immediate concerns and how would you manage them? 6. What other elements of IPV might you ask about to complete a risk assessment regarding Tracy’s going home? 7. What advice would you give Tracy regarding her safety, and what additional information could you provide? #Week29_Case2

#Injury_Documentation_Approach

#Sexual_Assault_Framework

Ryoko, aged 14 years, comes to see you in your practice on Monday morning. She usually sees a different general practitioner (GP) but requested an urgent appointment. Ryoko looks worried and upset. She tells you that at a party on the weekend a boy from school forced her to have sex. 1. What are your goals for this consultation? 2. What are the important elements to elicit on history? 3. What constitutes child sexual abuse? 4. What is your next step? 5. Should you examine Ryoko’s genitals in this consultation? 6. What tests should be offered to Ryoko? 7. What treatment should you provide in this consultation, and what follow-up does Ryoko require following this sexual assault? 8. Should you notify a child protection agency about Ryoko? 9. Are you mandated to notify police about the reported sexual assault? 10. How does the perpetrator’s age affect your advice and management? #Week29_Case1

Don’t forget to get your 8-hour CPD points in GP learning.

Raafe, aged three years, is Faraz and Leisha’s first child. They have just moved to your area from another city in Australia. Leisha brings Raafe to you to register as a new patient and for an influenza vaccination. You notice Raafe is not yet talking and appears rather unsteady on his feet. He has somewhat distinctive facial features, with low-set ears and a scar on his chest. Leisha asks if you could organise a referral for Raafe to a cardiologist at the local hospital. It appears that Raafe may have developmental delay. This, his distinctive facial features and his previous surgery are all red flags for a rare disease. After updating Raafe’s immunisation and his age- appropriate health check, you recommend the family arrange a long appointment to allow you to conduct a comprehensive health assessment. 1. In view of your suspicion that Raafe may have an underlying rare disease (of which over 80% have a genetic basis), what key points would you cover on history and examination? 2. What would be some suitable points to cover in a management plan for Raafe, with his history of complex medical and developmental conditions and your suspicion of an underlying rare diagnosis? 3. How could you discuss with the family that you are concerned that Raafe may still have an underlying rare genetic diagnosis and recommend a referral to a clinical genetics service? 4. What other referrals and supports would you consider for Raafe and his family at this stage? How might you approach Leisha’s question about the chance of recurrence of Raafe’s condition in another child? 5. How do you respond to Leisha’s question about The Australian Undiagnosed Disease Network? #Week28_Case3

#Rare_Disease_Communication_Tips

Lucas, a boy aged 16 years, has recently moved to the area and is seeking a regular general practitioner. He is quiet and fidgets with a toy during his appointment with you. His mother, Jackie, accompanies him and explains that he has an intellectual disability and has recently been diagnosed with a rare disease, Raynaud-Claes syndrome. Jackie would also like to discuss options for support for her and the rest of her family to help with the impacts of this recent diagnosis. 1. What key areas would you explore during your initial medical history? 2. Recognising Lucas’s intellectual disability, how would you adapt your communication techniques? 3. Raynaud-Claes syndrome is a rare disease that you are unfamiliar with. Where can you access information to educate yourself on this disease and on best management for Lucas? 4. How can you support the mental health and wellbeing of Lucas and his family now and as he transitions into the adult system? 5. As a young person with an intellectual disability, what supports are available for Lucas’s ongoing care? #Week28_Case3