Check Study Program

Malek, aged 81 years, lives in a residential aged care facility (RACF) at which you have provided care for several years. He is reasonably well functioning and describes having a good quality of life. You are called to assess Malek as he has been reporting worsening shortness of breath, abdominal pain and vomiting over the past fortnight. Malek has a significant past medical history of: • mesothelioma, diagnosed three years ago after suffering a pleural effusion – according to his last oncology review several months ago, he has been responding well to ongoing first-line chemotherapy • chronic back pain • hypertension • asthma. 1.What are your possible differential diagnoses for Malek’s symptoms? 2.What further information and physical examinations would you like to obtain from Malek in relation to his symptoms? 3.What further information would you seek from the radiology, oncology and surgical teams to assist with determining Malek’s treatment options, both now and in the future? 4.On Malek’s return to the RACF, what considerations or conversations would you like to have in regard to his future care? 5.What management plans could you enact in the RACF to help control these symptoms? 6.How would you respond to Malek’s wife and family about their concerns? 7.How would you manage Malek at this stage? #week18_Case5

#Hematuria_Approach

Fargass, aged 72 years, is a retired painter who presents after one episode of painless macroscopic haematuria, which lasted for two days before resolving. He has no difficulty voiding and no symptoms of a urinary tract infection (UTI). He is an ex-smoker of 20 pack-years who stopped smoking 15 years ago. Apart from occasional paracetamol, he takes no medications and has no known medical comorbidities. 1.What are the important factors in history-taking when diagnosing haematuria? 2.What tests would you recommend? 3.What are common side effects of TURBT? 4.What would be the normal treatment plan for Fargass? 5.Why is intravesical Bacillus Calmette-Guérin (BCG) treatment recommended, and how effective is it? 6.What are common side effects of BCG treatment? 7.What are the best options for management of Fargass? 8.What other issues are relevant for Fargass? 9.What follow-up should Fargass have to ensure that recurrence and complications of cystectomy are identified early? #Week18_Case4

#Oesophageal_Cancer_Recovery

#Oesophageal_Cancer_TX

#Oesophageal_Cancer_DX_TX

#Oesophageal_Cancer_Presentation_Referral

#Oesophagogastric_cancer #Early_Detection #Prevention

Ruiqing, a South-East Asian woman aged 63 years, enjoys reasonable general health. Ruiqing is an ex-smoker, ceased 10 years ago but with a 38 pack- year history of smoking. She has had hypertension for eight years, treated with telmisartan, and you previously noted that her glycated haemoglobin has been at the upper limit of normal over the past two years. You previously recorded her height as 161 cm and her weight as 71 kg (body mass index [BMI] 27 kg/ m2); however, you noted that any weight she carried appeared to be intraperitoneal and you felt that she probably had metabolic syndrome. You have repeatedly counselled her on the need for weight loss and have suggested dietetic and exercise-based strategies. She has seemed receptive but has had minimal success in reducing her weight over a few years. Ruiqing presents today for a repeat script for telmisartan. It has been six months since her previous consultation, and when she enters the room it is obvious that she has lost a significant amount of weight. 1.Are the ‘conventional’ BMI limits for overweight and obesity accurate in a patient with a South-East Asian background? If not, how is overweight and obesity assessed in patients of this ethnicity? 2.What investigations would you undertake? 3.What differential diagnoses would you consider? 4.What are the risk factors for gastric cancer? 5.Is Ruiqing at risk for any form of nutritional deficiency after her surgery? If so, which one(s)? #Week18_Case3

#Scrotal_Lump_Ddx