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CaseA woman, 52 years of age, presented with a complex medical history, including chronic liver disease, transjugular intrahepatic portosystemic shunting, stage 1 oesophageal varices and depression. The relevant medications were slow-release and immediate-release oxycodone, and a selective...

Emergency medicine: the principles of practice 6th editionGordian Fulde, Sascha Fulde Australia: Elsevier ISBN 9780729541466, $99.95Emergency medicine: the principles of practice 6th edition is a reference text that covers a broad range of topics a junior emergency doctor or medical student could...

Challenge 1 – Non-adherenceTypically, multidrug regimens are necessary among patients with T2DM to manage hyperglycaemia and the associated risk factors of hypertension and dyslipidaemia.1 In these patients, non-adherence is a major concern. It has been demonstrated that non-adherence is higher...

Figure 1. Blue-grey hyperpigmentation on sun-exposed skin of the faceQuestion 1What is the most likely diagnosis?Question 2What is the differential diagnosis?Question 3What skin related adverse effects could occur with amiodarone?Question 4What are the treatment options for this case presentation...

Data from the Australian Medical Treatment Survey 1990–91, and from BEACH (Bettering the Evaluation and Care of Health), were analysed to detect changes in the management rate of PAD since 1990. Figure 1 shows that management decreased significantly between 1990–91 and 2003–08 for all general...

More times than I can count, a single comment at the right moment has opened up new perspectives on problems that previously seemed insurmountable. More times than I have realised, witnessing the skillful handling of difficult situations has provided guidance for my own challenges.When I was a...

The impact of nocturia on quality of lifeNocturia has a profound impact on quality of life, being comparable to gout, hypertension, diabetes and angina in terms of disease burden2Nocturia typically becomes bothersome to patients when it occurs more than two times per night3The severity of sleep...

When the interview was completed and the patient went back to the ward, the tutor asked me how I felt. I wasn't in the habit of asking myself that question, so it took me a few moments to process. I realised that I felt terribly, terribly sad. The other students admitted to feeling the same.The...

Intravenous (IV) access is a key component in the management of emergencies and significantly unwell patients. At a remote local hospital, two experienced general practice anaesthetists had difficulty securing an adequate IV site in a severely shocked obstetric patient with a major haemorrhage...

Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the multiple choice questions of the RACGP Fellowship exam. The quiz is endorsed by the RACGP Quality Improvement and Continuing Professional Development Program...