Check Study Program

Christina, aged 72 years, is a Greek retiree. She is asymptomatic, but at a routine optometry review her optometrist told her that she has macular degeneration and needs to take nutritional supplements to stop her going blind. A review of Christina’s medical record identifies risk factors for macular degeneration including hypertension, dyslipidaemia, cigarette smoking, family history of macular degeneration and Northern European/Greek ancestry. Christina is very upset and wants to know what she should do. 1.How would you approach the consultation? 2.What is your advice to Christina? 3.Are there any lifestyle modifications that can slow the progression of AMD? 4.How would you approach the consultation? 5.What is your management plan? 6.What is your advice? 7.What are the goals of this consultation? 8.What is your management plan? #Week23_Case1

#BPH_Combination_Tx

#BPH_Medications

Linh, aged 58 years, is an office worker who presents to you and tells you he has ‘troubles with the waterworks’. For several months he has been waking up throughout the night to urinate and reports a reduced flow, which can take a while to initiate. When he has alcoholic drinks, he needs to go to the toilet frequently and with some urgency. On one occasion recently he could not get to the toilet in time and wet his pants. Linh is worried about the possibility of this happening again. 1.What is your initial approach to this presentation? 2.What is the most likely diagnosis, and the differential diagnoses? 3.What would you check when examining Linh? 4.What investigations would you carry out on Linh? 5.How would you manage Linh’s symptoms? 6.What would be the indications for referring Linh for urological review? 7.What surgical treatment options are available to Linh if he does not respond to medications? #Week22_Case5

#Prostate_Cancer_IPACED

#Prostate_Cancer_IPACED

Paul, aged 52 years, comes to see you for a prostate check. He heard a doctor on the radio saying men over 50 years of age should talk to their doctors about having a check for prostate cancer. Paul says he is well and takes no medications. He has been married for seven years and has two children. Paul has no lower urinary tract symptoms. He would like to know what is involved in being tested for prostate cancer. 1.How common is prostate cancer in Australia? 2.What are the factors that increase a man’s risk of developing prostate cancer? 3.What is the role of a DRE in general practice for prostate screening in a man with no symptoms? 4.What are the PSA testing recommendations, considering a man’s age, risk and comorbidities? 5.Why could ordering a PSA test to screen for the early detection of prostate cancer in a man with no symptoms, such as Paul, be considered ‘controversial’? 6.What are the specific harms a patient should be aware of when considering a PSA test? 7.What would you advise Paul? #Week22_Case4

#Bladder_Cancer_Dx

A complete physical examination should be performed in patients with bladder cancer, including a digital rectal examination in males and a bimanual examination of the vagina and rectum in females. Although the physical examination is unremarkable in most patients, abnormal findings that can be seen include the following: ● A solid pelvic mass may be felt in advanced cases. ● Induration of the prostate gland can sometimes be felt on digital rectal examination if the bladder cancer involves the bladder neck and invades the prostate. An attempt to palpate the base and lateral walls of the bladder should be made, looking for induration or fixation. ● Inguinal adenopathy can be present, although the inguinal region is not a common site of node metastases. ● Nodularity in the periumbilical region can be seen in advanced lesions involving the dome of the bladder. This is often seen with urachal cancers, which typically are adenocarcinomas rather than urothelial tumors. ● Abdominal examination may reveal the presence of substantially enlarged para-aortic lymph nodes or hepatic metastases. #Bladder_Cancer_Exam

Manjusha, aged 68 years, presents with a recent history of urinary symptoms. She complains of increased voiding frequency, up to 12–14 times a day, as well as 2–3 times at night. She has significant urinary urge but no incontinence, although she is careful to void before she leaves the house and has started to restrict her social outings. She feels as though she is passing smaller amounts of urine than normal each time, and she never feels completely empty. Manjusha has some mild dysuria but no gross haematuria or urethral discharge. She thinks her urinary flow is normal. 1.What other parts of the history are relevant? 2.What conditions would you include as part of the differential diagnosis? 3.What is the value of point-of-care urinalysis in the assessment of voiding symptoms? 4.Why might a repeat MSU be useful, and how would you instruct Manjusha to collect an MSU sample? 5.What other investigations would you order? 6.What diagnosis is important to rule out? 7.How would you proceed? 8.What are the most common types of bladder cancer, and how is bladder cancer treated? #Week22_Case3