Quiz topic 1 - General Practice and Primary Health Care Academic ...

PCCB Tutorial 7 – Assessment preparation
The final PCCB tutorial will consist of two parts:
A. OSCE practice
B. Clinical Quiz – for short answer question practice
A. OSCE Practice
All students should have prepared one OSCE station for their peers to complete. This involves
creating a ‘case’, preferably based on a patient seen at the PCCB clinic, and designing a marking
sheet for that case.
Students will be divided into 2 groups – each group will run two OSCE stations of 10 minutes each.
For each station:
• The student who has prepared the station will play the patient.
• Another student will interview the patient (the exam candidate)
• A third student will mark the interviewer (the examiner) assisted by a fourth student
At the end of each station, give some feedback.
B. Clinical Quiz
Five clinical scenarios with questions will be discussed by the whole group.
QUIZ TOPIC 1 – THYROID FUNCTION TESTS
A 31 year old man who was previously well presents with a thyroid goitre and palpitations. His GP
ordered thyroid function tests and he has returned for the results, which are as follows:
TSH 0.15 mU/l (ref 0.5-5.0)
Free T4 (thyroxine) 29.2 pmol/l (ref 11.0-21.0)
Free T3 (triiodothyronine) 5.7 pmol/l (ref 3.1-6.0)
1. How would you explain these thyroid function tests to the patient – what could the cause be?
2. Discuss further investigations that might be needed
3. Discuss a brief management plan
Resource
see short article from Australian Prescriber on Thyroid Function Tests, 2011.
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QUIZ TOPIC 2 – BOWEL CANCER SCREENING
A 45 year old woman comes to your general practice to ask you about bowel cancer screening.
1. What questions would you ask her to determine her risk of bowel cancer?
2. She has no personal history and is currently asymptomatic, but based on the answers to her
family history the following genogram is developed. Based on this, what screening, if any, would
you recommend?
3. When is FOBT recommended for the general population?
4. The patient wants you to describe what is involved in having a colonoscopy performed. What would you
advise her? What are the risks?
Resources
Familial aspects of bowel cancer – Cancer Council
QUIZ TOPIC 3 – RHEUMATOLOGY
A 66 year old woman comes to your general practice with 6 months of gradually worsening
bilateral shoulder pain and stiffness and has lost 4kg. There is pain and stiffness in both shoulders
and some pain in her hips. The pain is worse in the morning and can be so severe that she finds it
difficult to wash/comb her hair. There is no history of antecedent injury or different activity at the
time of onset. She has trialled NSAIDs with mild benefit.
She has no personal history of prior joint pains and there is no history of rheumatological disease
in the family. She has been on statin therapy for 3 years for hypercholesterolaemia (but no recent
changes to her medication).
General appearance: fatigued BMI 23, no pallor, pink conjunctivae; Vitals: BP 130/80 HR 72 reg
Shoulder: restricted ROM in all movements, restricted to 60 degrees abduction/flexion (bilateral).
Hips: restricted ROM in all movements (bilateral)
Cardio: Normal S1-S2, nil added; Resp: nad; Abdo: nad; Neuro: nad
No visual changes, no scalp tenderness or tenderness over temporal arteries
1. What are the differential diagnoses?
2. What tests would you order?
3. What are some appropriate management options for this patient?
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QUIZ TOPIC 4 – BREAST LUMP
A 37 year old female presents to you with a left breast lump that she has just noticed in the
shower yesterday for the first time. It is not painful. She is very anxious because she is worried
about cancer. She has no past medical history. She has a 3 year old son who she breast fed for 6
months and then went back to work. She has just finished her menstrual period. She is using
condoms for contraception at present although used the combined oral contraceptive pill for
many years prior to conceiving. She smoked for 5 years until she gave up at the age of 23.
Family history: Maternal aunt diagnosed with breast cancer aged 55years and is still alive.
Paternal Grandmother breast cancer aged 70 years and survived until the age of 80 years. No
family history of any other cancer including ovarian, bowel, prostate, pancreas etc.
1. What would you do on examination?
2. What would the differential diagnosis be for a woman with a discrete lump at this age?
3. Would you do any investigations? What is the triple test?
4. Assuming a benign result now, when should she commence mammogram screening?
Resource
National Breast Cancer Centre – Investigation of a new breast symptom, 2006
QUIZ TOPIC 5 – DIABETES
A 55 year old man presents worried he may have diabetes, as he has developed a fungal groin rash over the
last few weeks and is very tired. He has searched the internet and feels that he has several of the diabetes
risk factors.
1. How would you determine his risk of type 2 diabetes? Are there any online tools that you can use to
assist?
2. What tests would you order to determine whether he has diabetes?
After testing you determine he does have type 2 diabetes.
3. What are the key management points in managing type 2 diabetes? Include in your answer issues around
monitoring, drug and non-drug treatments, health promotion etc.
Resource
For more information about the management of T2 diabetes in general practice, see:
http://www.diabetesaustralia.com.au/Documents/DA/What%27s%20New/12.10.02%2
0Diabetes%20Management%20in%20General%20Practice.pdf
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