Interpretation of Investigations

16 year old, overseas student from Philipines sees you for poor
exercise
tolerance, tiredness and dizziness. She has to use 10 pads per day
with her
periods. She is also a strict vegetarian. You organized the following
tests:
Haemoglobin
MCV
Platelet
Iron
Transferrin saturation
Ferritin

80 g/L (130-170)
70 fL (80-100)
160 (150-400)
6 umol/L (10-30)
0.11 (0.15-0.5)
6 ug/L (20-450)

What is the most appropriate course of action:

a) Give blood transfusion
b) Refer for gastroscopy
c) Dietitian referral
d) Start iron replacement
e) Consider hormonal manipulation

Clinical Decision Making

16 year old, waitress, sees you for vaginal discharge. Says it is
yellow and smells fishy. Broke up with her boyfriend last week
(caught him cheating with another girl). Claims she has latex allergy.
What would be the best course of action?
a) Refer her to Sexual Health Clinic
b) Get details of her boyfriend for contact tracing
c) Obtain vaginal swabs and wait for results
d) Obtain vaginal swabs and treat for both gonorrhoea and
chlamydia
e) Advise her to have intra-uterine device in future

Clinical Decision Making

24 year old, just married two months ago, LMP 6 weeks ago. Sees
you for lower tummy cramps and spotting. Feeling faint last few
hours.
Observations:
BP 120/60 mmHg
HR 100 bpm regular
Looks pale
Tender over right lower quadrant
She says she cannot tolerate speculum examination.
What is the next best course of action?
a) Admit to hospital and wait for ultrasound scan
b) Urgent Surgical consult for possible appendicitis
c) Ensure good iv access and fluid resuscitation
d) Admit to ward for analgesia
e) Rush her to theatre

Clinical Management
60 year old, smoking horse-trainer, sees you for breast lump.
Increasing in size but no pain. However noticing more back pain
(thought related to occupational hazard).
Clinical examination:
5 cm hard mass in right upper quadrant breast
Peau dorange
Another discreet mass in ipsilateral axilla
What would you do for her back pain?
a) Obtain plain films
b) Give her non-steroidal anti-inflammatory drugs
c) Organise CT of chest, abdomen and pelvis
d) Check for paraproteinaemia

Clinical Management
45 year woman, pre-menopausal with spotting. More noticeable after
intercourse. Last PAP smear was over 10 years ago. Speculum
examination (and PAP smear done):

What should you do next?

a) Repeat PAP smear in 3 months
b) Urgent referral for Gynaecology assessment
c) Organise for pelvic ultrasound scan
d) Give course of antibiotics
e) Give course of oral contraceptive pills

Clinical Judgement
18 year old just given birth two days ago. Baby crying and not
latching properly to breast. She notices bloody discharge from her
nipple. Mother had breast cancer, and she is convinced she has
cancer.
What is the next step be?
a) Give her antidepressants
b) Urgent psychiatry referral
c) Prescribe emollients and nipple shield
d) Genetic testing for BRCA gene
e) Give course of flucloxacillin