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Jana, aged 17 years, comes to your practice to talk to you about effective contraception. She has been sexually active with a male partner for the past three months, using condoms most of the time. She does not want to become pregnant at this time and has not been pregnant previously. She has regular menstrual cycles, bleeding for four days every 30–32 days, and her last menstrual period (LMP) was 12 days ago. Jana and her partner have consistently used condoms since her LMP. Before you discuss all available options with Jana, you decide to check for contraindications to the more effective options. 1. What are important contraindications to initiating a contraceptive implant? 2. What are the contraindications to initiating an intrauterine device (IUD)? 3. What are important contraindications to initiating a combined hormonal contraceptive method, such as the combined oral contraceptive pill? 4. How will you respond to Jana’s question about implant insertion today? 5. What might be causing the bleeding? 6. If no abnormal causes for bleeding are detected, what management options would you suggest? 7. What would you tell Jana about the bleeding patterns she may experience while using the 19.5 mg and the 52 mg levonorgestrel-containing IUDs? 8. What information would you provide to Jana, including explaining possible complications with insertion? #Week25_Case2
certificate Diya, aged 29 years, is a regular patient of your practice. She is generally well and has only attended for minor illnesses in the past. Today she presents requesting a medical certificate for work, as she has not been able to attend for the past three days because of her menstrual symptoms. Her periods have become increasingly heavy, and Diya has been taking a couple of days off work every month as she worries about accidents while she is in the office. 1. What further information would you like to determine as part of your history-taking? 2. What examinations would you perform? 3. What is the differential diagnosis at this stage? 4. What investigations would you request? 5. Based on your findings, what are Diya’s main issues? 6. What treatment would you recommend for the cause of Diya’s heavy periods? 7. As Diya is planning to start her family soon, what other options does she have to manage her symptoms in the interim? 8. What would you tell Diya and Michael about their concerns regarding fertility and pregnancy? 9. What permanent treatment options are available to address Diya’s condition? #Week25_Case1
Naomi brings her baby boy Hamish, aged 35 days, to see you. Hamish has a runny nose and cough and has been vomiting for one day, mostly following excessive coughing episodes. He has no fever. Hamish was born at term as the second child of the family via normal vaginal delivery. His birth weight was 3 kg. Neither Naomi nor Hamish had any complications following the birth. Hamish was born in early summer and there were no current local outbreaks of viral infections (ie influenza or coronaviruses). Naomi and Hamish’s father, Campbell, do not have any history of atopy, hay fever, allergies or asthma. 1. What further history with regard to Hamish’s immunisations would you like to obtain from Naomi? 2. Would you arrange any investigations? If so, what tests would you order? 3. What further questions would you ask? What information would you need to diagnose his condition? 4. What is your diagnosis? 5. How would you confirm your diagnosis? 6. What treatment would you recommend? 7. How would you treat contacts of the patient? 8. Is immunisation available for this respiratory illness? If so, what are the current recommendations?
9. Can maternal immunity offer protection from neonatal respiratory disease? #Week24_Case5
