Vulnerable populations


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Clinical challenge

Volume 45, No.10, 2016 Pages 771-772

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 four Category 2 points (Activity ID:62958). Answers to this clinical challenge are available immediately following successful completion online at 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 suggested answers or completions. Select the most appropriate statement as your answer.

Case 1

Clarke is attending for his general practice registrar orientation session today at your medical practice, which is located in a low socioeconomic status (SES) suburb. An important component of his orientation will be to outline the impact of SES on the range of presentations he is likely to encounter. In preparing your thoughts, you consider the published broader Australian experience.

Question 1

Which one of the following age groups presenting for consultation are low SES patients less likely to attend than high SES patients?

  1. 75+ years
  2. 65–74 years
  3. 45–64 years
  4. 25–44 years

Question 2

Which one of the following consultations is more common for low SES patients?

  1. Upper respiratory tract infections
  2. Immunisation
  3. Pap smear
  4. Oral contraception
  5. Hypertension

Question 3

Which one of the following correctly describes the rate of general practice management of psychological problems in low as opposed to high SES patients?

  1. More management
  2. Less GP counselling
  3. More psychologist referral overall
  4. Lower psychologist referrals for patients aged more than 55 years

Question 4

Which one of the following correctly describes the rate of general practice management of chronic problems in low as opposed to high SES patients?

  1. Managed less often
  2. Higher prescribing of medications
  3. Equal pathology tests ordered
  4. More specialist referrals

Case 2

Matilda, 38 years of age, is a mother of three who presents with concerns that her eldest daughter, Clarissa, who is now nearly 15 years of age, is ‘going off the rails.’ Matilda is particularly worried that Clarissa may become pregnant.

Question 5

Which one of the following is not a risk factor for unplanned teenage pregnancy?

  1. Living in suburbia
  2. Born to a teenage mother
  3. Disrupted home life
  4. Sexual abuse survivor
  5. Already a teenage mother

Question 6

Which one of the following is the most effective form of contraception for preventing unplanned teenage pregnancy?

  1. Long acting reversible contraceptive (LARCS)
  2. Condoms
  3. Oral contraceptive pill
  4. Postcoital emergency contraception

Question 7

Should an unplanned teenage pregnancy occur, antenatal care requires additional processes and attention. Which one of the following is not important in this context?

  1. Assess nutritional adequacy.
  2. Screen for sexually transmissible infections and bacterial vaginosis at first antenatal visit.
  3. Screen routinely for alcohol and substance use.
  4. Teach about signs and symptoms of preterm labour.
  5. Leave contraceptive advice till after delivery.

Question 8

Which one of the following is not appropriate postpartum advice for an unplanned teenage pregnancy?

  1. Discourage return to school to facilitate bonding with the baby.
  2. Facilitate home visitation by nurse for enhanced support.
  3. Screen regularly for alcohol and substance use, violence and mood disorders.
  4. Provide access to smoking cessation.
  5. Reinforce contraceptive options.

Case 3

Your practice is considering an invitation to provide medical care to young people living in out-of-home care. As they typically have numerous and complex health needs and worse health outcomes than their peers who grow up within a family of origin, you are keen to familiarise yourself with the issues before making a commitment.

Question 9

Which one of the following healthcare issues is less common in those living in out-of-home care?

  1. Dental problems
  2. Underweight
  3. Asthma
  4. Sexually transmissible infections
  5. Substance abuse disorder

Question 10

The prevalence of diagnosable mental disorder in children living in out-of-home care, compared with their peers in the general population, is higher by a factor of:

  1. 2
  2. 3
  3. 4
  4. >4

Question 11

The likelihood of young people under a child protection order being under youth justice supervision in the same year, compared with their peers in the general population, is higher by a factor of:

  1. 5
  2. 10
  3. 15
  4. 20
  5. >20


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Clinical challenge