The joy of life

January/February 2017

Clinical Challenge

Volume 46, No.1, January/February 2017 Pages 79-80

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: 82694).

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 2017–19 triennium; therefore, the previous months’ answers are not published.

Case 1

Janine is a regular patient at your practice. She is 31 years of age and generally well. She presents for a Pap smear and mentions that she has ceased her contraceptive pill as she and her partner wish to start a family. You are pleased to have this opportunity to implement some health promotion strategies with Janine prior to conception.

Question 1

Prior to any investigations, which of the following supplements can you recommend Janine commence?

  1. Calcium and folate
  2. Folic acid and iodine
  3. Iron and vitamin D
  4. Vitamin B12 and folic acid
  5. Vitamin D and iron

You recognise the importance of managing any concurrent medical conditions to ensure optimal outcomes for a pregnancy.

Question 2

Which one of the following conditions is most prevalent in pregnancy in contemporary Australian general practice?

  1. Anxiety
  2. Diabetes mellitus
  3. Hepatitis B or C
  4. Thrombophilias
  5. Thyroid conditions

Janine has a normal body mass index (BMI) but has had problems with her weight in the past. She asks how much weight she is likely to gain during her pregnancy.

Question 3

The recommended range of weight gain during pregnancy for a woman with a normal BMI is:

  1. 5–10 kg
  2. 6–11 kg
  3. 10–15 kg
  4. 10.5–14 kg
  5. 11.5–16 kg.

You wish to enhance Janine’s ability to cope with any of the minor issues that might arise during her pregnancy, such as musculoskeletal pain.

Question 4

Which one of the following strategies is least likely to promote Janine’s active engagement in her antenatal care?

  1. Avoiding mentioning potential problems until they arise
  2. Suggesting perinatal education classes
  3. Providing instruction in appropriate exercise
  4. Offering a list of trustworthy websites

Case 2 

You have been struck by the impact of lifestyle on the health of the majority of your patients and wish to further explore the relatively new field known as lifestyle medicine to see what it may have to offer your clinical practice.

Question 5

According to your research, metaflammation is:

  1. a form of low-grade, systemic, chronic inflammation
  2. not related to metabolic inflammation
  3. related only to obesity
  4. thought to be the cause of many chronic diseases.

Question 6

The three most commonly considered anthropogens in contemporary Australian general practice are:

  1. nutrition, activity and smoking
  2. nutrition, occupation and smoking
  3. relationships, nutrition and inadequate sleep
  4. social inequity, activity and smoking
  5. technopathology, activity and nutrition.

Question 7

In the hierarchy of chronic disease determinants, which of the following would be considered medial or ‘midstream’ determinants?

  1. Alcohol/drugs
  2. Obesity
  3. Smoking
  4. Sociocultural environment
  5. Stress

Question 8

You decide to adopt a systems approach to your management of chronic disease in your day-to-day management of patients. This involves all of the following except:

  1. an awareness that feedback can influence outcomes
  2. considering determinants of disease more broadly, beyond the clinical sector
  3. determining the cause of the illness and managing the cause
  4. recognising that multiple determinants interact with each other.

Case 3

Rosa, a widow aged 70 years, presents complaining of pain in her knees from osteoarthritis. She is overweight and admits she has not been eating very well since the death of her husband 12 months ago. She does not have a driver’s licence and finds it difficult to communicate with taxi drivers, so tends to stay at home. Her garden used to bring her joy, but she is finding it increasingly difficult to manage.

Question 9

Which health condition group accounts for the greatest total disease burden (disability-adjusted life years) in those aged 65–74 years?

  1. Cancer
  2. Cardiovascular
  3. Endocrine
  4. Musculoskeletal
  5. Respiratory

You decide Rosa might benefit from a health assessment as part of your management strategy.

Question 10

Health assessments for older people:

  1. are more beneficial for those with high mortality risk
  2. only need to be performed once
  3. do not help slow decline in physical function
  4. may reduce nursing home admissions
  5. should focus on disease only.

Question 11

Which one of the following strategies takes into account likely barriers to change?

  1. Advising increased exercise
  2. Arranging a home visit from the community dietitian
  3. Referral to a private dietitian
  4. Suggesting she join the local bowls club

Case 4

Gary, 48 years of age, is a patient at your practice. He is overweight and has borderline hypertension but currently takes no medications. Gary has presented today for a routine check up, his first visit in over 12 months. You use this opportunity to assess all aspects of his health, including sexual health. Gary reveals that he has just commenced a new sexual relationship and is having some difficulties achieving an erection.

Question 12

The following classes of medication may all cause sexual difficulties except:

  1. antibiotics
  2. antidepressants
  3. antihistamines
  4. antihypertensives
  5. antipsychotics.

Question 13

Which one of the following investigations would be considered first line for investigation of sexual difficulties in this patient?

  1. Cholesterol/lipid profile
  2. Liver function test
  3. Prolactin
  4. Thyroid stimulating hormone
  5. Urinalysis

Question 14

Phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction are used for longer than 6–12 months by approximately what percentage of patients?

  1. 80%
  2. 50%
  3. 30%
  4. 10%

Correspondence afp@racgp.org.au

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