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Greg, aged 37 years, presents to you for the first time to discuss gender-affirming hormone therapy (GAHT). Greg has been seeing a psychologist for 12 months to support them coming to terms with their gender incongruence and to ‘come out’ to friends and family. Greg reports a 23-year history of gender incongruence with indications of gender dissonance since early childhood, which worsened during and after puberty. Greg used hard work, alcohol, smoking, tattoos and exercise to distract and suppress these feelings of gender dissonance and to try and fit into the world as a man. Greg would like to start hormone therapy as soon as possible. 1.How would you approach the assessment and work-up of Greg before initiating hormone therapy? 2.What investigations would you perform, and would you have any other recommendations before you start hormone therapy? 3.What options for hormone therapy would you discuss with Amy for her to consider before the next review? 4.How does this new information affect your plan to start Amy on hormone therapy today? 5.What hormone therapy do you prescribe for Amy, and what do you tell her that she can expect? 6.What would you include in your ongoing monitoring and review plan for Amy? #Week16_Case1
It seems there is no feedback or CPD point from RACGP for the 2018-2021 checks.However, I share MCQs in a PDF file and highlight my answers.Let me know if you choose different options.🌹
Arianne, aged 73 years, presents with a six-month history of pain in her left knee. Her medical comorbidities include hypertension, hypercholesterolaemia, type 2 diabetes and gastro- oesophageal reflux disease. She takes oral medications for these conditions. Arianne’s body mass index (BMI) is 43 kg/m2, and she is a non- smoker. She is a retired librarian who lives with her husband. She enjoys gardening and reading. 1.What is your differential diagnosis for Arianne’s knee pain? 2.What features on history and examination would help you determine the diagnosis? 3.What treatment would you recommend for Arianne? 4.When would you consider referral to an orthopaedic surgeon for consideration of a knee replacement? 5.What steps would you take to optimise Arianne pre- operatively, if she were to undergo a knee replacement? 6.How would you address Arianne’s concerns? 7.What are the rehabilitation goals following a knee replacement? 8.What features on history and examination would suggest that there is something wrong with the knee replacement? #Week15_Case5
Sharmeen is an athletic girl, aged 16 years, who is brought in to see you by her mother. Sharmeen has been complaining of hip pain, and her physiotherapist has recommended that she is ‘checked out’ to make sure there is nothing going on with her hips. She is a keen dancer and has a big performance in a few months’ time. There is no history of injury. 1.What questions would you ask Sharmeen, and what history would you seek to elicit? 2.What would you look for on examination to find a cause for Sharmeen’s pain? 3.What are the key differential diagnoses for Sharmeen? 4.What imaging investigations would you arrange for Sharmeen? 5.What can you see on Sharmeen’s X-ray (Figure 1)? What is your diagnosis for Sharmeen? 6.How would you manage Sharmeen? 7.Is it likely that Sharmeen’s siblings may also experience hip dysplasia? #Week15_Case4
