Questions for this month’s clinical challenge are based on articles in this issue. The clinical challenge is endorsed by the RACGP Quality Improvement and Continuing Professional Development (QI&CPD) program and has been allocated 4 Category 2 points (Activity ID:43608).Answers to this clinical challenge are available immediately following successful completion online at http://gplearning.racgp.org.au. Clinical challenge quizzes may be completed at any time throughout the 2014–16 triennium; therefore, the previous months’ answers are not published.
Each of the questions or incomplete statements below is followed by four or five suggested answers or completions. Select the most appropriate statement as your answer.
Felipe, a mathematics graduate aged 22 years, presents late one afternoon with a sprained ankle. During the consultation you reflect on the health needs of younger men.
Which of the following statements about Australian men and their health has the strongest evidence base?
- Australian men have a shorter life expectancy than women because of delays in accessing healthcare.
- Male children are less likely to be brought to a general practice than female children.
- Younger Australian men are unlikely to discuss psychological problems with their general practitioner (GP).
- Younger Australian men are less likely to have a regular general practice.
While assessing Felipe’s injury and applying first aid, you enquire after his broader health situation and risk factors. Which of the following is Felipe most likely to be at risk of over the next five years?
- Harm from risk-taking behaviours
- Ischaemic heart disease and cardiovascular problems
- Chronic musculoskeletal injuries
- Respiratory problems
Felipe tells you he has read that Australian men are more at risk of poor health, compared with women. He asks if this is true and what men could do to prevent poor health. What is the best response?
- Men are no more at risk than women if they adhere to preventive health guidelines such as sufficient exercise and screening programs.
- Men are more at risk of reproductive and sexual health problems and should be more aware of this.
- Men have a shorter life expectancy than women and should have yearly check-ups with their GP.
- Men have a shorter life expectancy than women and should examine any gender-reinforced misconceptions about health.
Arthur, a landscaper aged 32 years, presents complaining of hair loss and is worried he will become bald. His father and uncles are bald. You examine him and make a diagnosis of androgenic alopecia.
Which of the following is most characteristic of androgenic alopecia on examination?
- Thinning hair all over the scalp in the absence of metabolic disease or infection
- Thinning hair at the front or top of the scalp with miniaturised hairs in affected areas
- Receding hairline or thinning at the crown with mild erythema in newly denuded areas
- Bald patches towards the front of the scalp, either completely denuded or with one or two ‘exclamation hairs’.
- Gradual hair thinning, as shown by serial photographs taken at the same distance with the same lighting and hairstyle
After discussion, Arthur elects to start finasteride 1 mg daily. Which of the following is a likely adverse effect of finasteride?
- Reduced sperm production
- Sun damage to scalp
- Reversible gynaecomastia
- Prostate hypertrophy
Arthur returns one week later, concerned about Google reports of prostate cancer caused by oral treatments for androgenic alopecia.
Which of the following is true of 5-alpha reductase inhibitors (5ARIs)?
- Recent studies show that dutasteride may slightly increase the incidence of high-grade prostate cancer.
- Recent studies show that dutasteride may slightly decrease the incidence of high-grade prostate cancer.
- Recent studies show that 5ARIs prevent prostate cancer.
- Recent studies cannot exclude a link between finasteride and high-grade prostate cancers.
Honghui is an engineer, 26 years of age. He is a new patient who requests a check-up for sexually transmissible infections (STIs). Honghui has had two months of intermittent dysuria and one week of muscle aches. He has had four male sexual partners in the past six months, the last encounter occurring five weeks ago. Honghui rarely uses condoms.
Which of the following is true of human immunodeficiency virus (HIV) diagnosis and management in Australia?
- Sexual contact between men accounts for the bulk of new cases of HIV in Australia.
- The majority of new HIV diagnoses occur over four years after the time of infection.
- Men who identify as gay are less likely to be offered HIV testing because of GP worries that they may appear prejudiced.
- People who are diagnosed late have reasonable health outcomes because of newer antivirals used in the treatment of HIV.
Which of the following is true regarding Honghui’s management?
- Honghui should be offered a fourth generation HIV test immediately.
- Honghui should delay a fourth generation HIV test for a further six weeks.
- Honghui will benefit from antiviral treatment as post-exposure prophylaxis.
- Honghui is experiencing an HIV seroconversion illness.
Honghui is eventually diagnosed with chlamydia urethritis and is successfully treated for this condition.
Which of the following is true about STIs in Australian men who have sex with men (MSM)?
- MSM who are at higher risk should be offered HIV screening once a year.
- MSM are four times more likely to have infectious syphilis than the general population.
- Lymphogranuloma venereum is a strain of chlamydia becoming regularly detected in HIV negative MSM.
- MSM who are HIV-positive and on antiviral treatment are unlikely to transmit HIV to a sexual partner.
Grant, 51 years of age, is one of your regular patients. His wife Farah and their two sons are also regular patients at your clinic but attend other doctors. At lunchtime, your colleague tells you that Farah had disclosed she was afraid of ‘what Grant might do’ and that she had spent her week’s allowance from Grant.
Which of the following statements best describes domestic and intimate partner violence?
- Domestic violence is linked to societal acceptance of poverty and unemployment.
- Domestic violence is linked to societal acceptance of violence as a way to resolve personal conflicts.
- Boys who witness domestic violence are unlikely to become perpetrators as adults.
- Domestic violence is usually linked to substance abuse and mental illness.
- Domestic violence is linked to anger management problems in the workplace.
One month later, Grant presents to see you for a regular antihypertensive prescription.
Which of the following approaches is best suited to assessing Grant?
- Screening questions for mental illness and substance abuse
- Broad screening questions such as ‘how are things at home?’
- Confronting him with Farah’s recent disclosure
- Waiting for self-disclosure of family problems from Grant
- Sensitive discussion of Grant’s own upbringing
Grant reports arguments at home because he suspects Farah is drinking too much alcohol. He reports becoming angry with her and that he has taken her car keys for the family’s safety.
Which of the following is the best immediate response?
- Further questions to explore Farah’s alcohol intake
- Further questions to explore Farah and Grant’s arguments
- Validating statement acknowledging Grant’s concerns for his family
- Indirect questioning to ascertain Farah’s financial access
- Offer a couples counselling program or psychologist