192 Scenarios

Clinical Discipline/Organ System:          Progress Test Topic:
Text to find:    in Title:  Description:  Learning Points:  Diagnoses:  
TitleDescription
6 week checkA mother brings her Māori baby for their 6 week postnatal checks and to discuss his immunisations.
D/O: General Practice (•••), Paediatrics (•••)
PTT: Child health
AAA screeningYour Primary Healthcare Organization (PHO) is debating the pros and cons of screening for abdominal aortic aneurysm (AAA). You are asked to prepare a position paper for the Board.
D/O: Population Health (•••), General Practice (••)
PTT: General duties
Abdominal or inguinal lumpAn 8 month old NZ European boy comes to his GP as his mother has noticed he has a 'lump in the lower part of his tummy on the right'.
D/O: Genitourinary System (•••), Paediatrics (•••), Digestive System (••), General Practice (••), General Surgery (••)
PTT: Child health
Abnormal cervical smear resultA 31 year old Māori woman has recently had a routine cervical smear and the result shows a low grade squamous intraepithelial lesion (LSIL). She has come to her GP to discuss the result.
D/O: Anatomical Pathology (•••), General Practice (•••), Obstetrics & Gynaecology (•••), Reproduction & Development (•••)
PTT: Women's health
Accidental overdoseAn 82 year old Māori man attends the Emergency Department feeling awful. He has recently had his medication list changed but he has been using both his old and new blister packs.
D/O: Clinical Biochemistry (•••), Clinical Pharmacology (•••), Emergency Medicine (•••)
PTT: Seriously ill patient
Acute abdominal painYou are on your surgical placement when a 40 year old NZ European woman presents to the Emergency Department with sudden onset abdominal pain. She finds the pain severe and she has been vomiting. She has no relevant medical history. You go to see her with the surgical registrar.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Obstetrics & Gynaecology (•••), Emergency Medicine (••), General Practice (•)
PTT: Digestive, Seriously ill patient
Acute abdominal pain in children and adolescentsAn 8 month old Māori boy comes to the Emergency Department with intermittent screaming episodes and becoming pale, accompanied by curling his legs. His mother thinks his tummy is rigid and says he passed some mucous into his nappy that morning.
D/O: Digestive System (•••), General Surgery (•••), Paediatrics (•••), Emergency Medicine (••), General Practice (••)
PTT: Child health, Digestive
Acute chest painA 75 year old Māori man presents to the Emergency Department with central chest pain. It has been present for the past 40 minutes and came on while he was resting. He feels terrible.
D/O: Cardiology (•••), Cardiovascular System (•••), Emergency Medicine (•••)
PTT: Cardiovascular, Seriously ill patient
Acute kidney injuryA 65 year old NZ European man who was admitted to the Surgical High Dependency Unit after an emergency repair of his abdominal aortic aneurysm (AAA) is noted to be passing only small amounts of urine. He has a history of hypertension and type 2 diabetes.
D/O: Genitourinary System (•••), Renal Medicine (•••), General Surgery (•)
PTT: Renal
Acute or chronic red eyeA 56 year old hypermetropic (long sighted) Chinese woman presents to an emergency GP with a painful red right eye, which began earlier in the evening. She also complains of nausea. On examination the right pupil is fixed and mid-dilated, and the cornea is slightly hazy. To palpation the right eye feels hard in comparison with the left eye.
D/O: Ophthalmology (•••)
PTT: Eyes
Acute presentation of diabetes mellitusA 17 year old NZ European man presents to the Emergency department complaining of abdominal pain and passing lots of urine. He has vomited twice and is breathing rapidly with deep sighing breaths. The blood glucose is 27 mmol/L and serum ketones are strongly positive.
D/O: Endocrinology (•••), Emergency Medicine (••), Digestive System (•)
PTT: Seriously ill patient
Acute psychosisAn eighteen year old Māori music student presented with her parents to their GP. Her parents had noticed that she had become progressively withdrawn and would sit in her room for several hours; she no longer maintained previous friendships. She had stopped attending her university course two months previously and seldom played the piano. She paced at night and was often heard 'talking to herself'; and possibly 'talking to voices'. She accused the family of plotting against her and said that the CIA was monitoring all her moves. She repeatedly drew the curtains checking that there were no surveillance vehicles outside. When a neighbour's family visited and left the car on the kerb for two days, she was convinced that she was being monitored and she approached the neighbour, threatening to 'teach the CIA a lesson'.
D/O: Psychiatry/Health Psychology (•••)
PTT: Mental health
Acute severe testicular painA 16 year old NZ European boy presents with severe pain in his left testis associated with some swelling. It started an hour ago and is excruciating. He has otherwise been well in the past.
D/O: Genitourinary System (•••), Urology (•••), General Surgery (••), Anatomical Pathology (•), Infectious Diseases (•)
PTT: Renal
Acute trauma to the eyeA 23 year old NZ European male presents to an Emergency Department with reduced vision, severe pain and redness in his right eye. Wet concrete had sprayed into the eye from a concrete hose approximately 2 hours earlier. His vision is poor and the right eye feels harder than the left eye to palpation
D/O: Emergency Medicine (•••), Ophthalmology (•••)
PTT: Eyes
Acutely painful limbA 65 year old Indian man is brought into the Emergency Department after waking up with severe pain in his right leg. He has never had this pain before. You are oncall with the vascular surgical registrar and go to see him. You find out that he has an 'irregular heartbeat' for which he takes aspirin.
D/O: Cardiology (•••), Cardiovascular System (•••), General Surgery (••), Emergency Medicine (•), Musculoskeletal System (•)
PTT: Seriously ill patient
Adrenal crisisA 45 year old NZ European man presents to his GP as he has been feeling very unwell for some time. He feels dizzy when he stands up, has lost weight and a cousin who has not seen him for a year has commented that his skin is becoming darker.
D/O: Endocrinology (•••), Clinical Biochemistry (••)
PTT: Homeostasis
Adult eczemaA 23 year old NZ European woman with lifelong atopic dermatitis presents to her GP with a rash on her hands 6 months after starting her apprenticeship as a hairdresser. She gives a history of having a rash at the site of costume jewellery (e.g. earrings).
D/O: Dermatology (•••), Immunology (••)
PTT: Skin
Adult with abdominal massA 52 year old NZ European woman presents to her GP with bloating of her abdomen, worsening over the last few months associated with intermittent diarrhoea and 5kg weightloss. Her brother and father were diagnosed with bowel cancer in their 40's.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Oncology (•••), Radiology (•••), General Practice (•)
PTT: Digestive
Agitated and combative patientA 68 year old NZ European man, with no fixed abode, presents under police escort to the Emergency Department agitated and aggressive. He has presented on previous occasions as intoxicated on alcohol, sedated and non-confrontational. He has also sometimes presented with physical symptoms that can’t be medically explained with the hope of acquiring an overnight stay in hospital. However, on this presentation he has threatened to punch you and the nursing staff when you discussed the need for him to stay in the Emergency Department for further investigations.
D/O: Clinical Biochemistry (•••), Emergency Medicine (•••), Psychiatry/Health Psychology (••)
PTT: Homeostasis
AlcoholThe government has established an inquiry into the damage to health caused by alcohol, and steps that can be taken to prevent harm. Your specialist college wishes to make a submission and you have been asked to prepare the first draft.
D/O: Population Health (•••), Gastroenterology & Hepatology (••), Psychiatry/Health Psychology (••)
PTT: General duties
Alcohol and drug dependence disordersA 54 year old NZ European male, recently separated from his wife, is a general surgeon working at a large metropolitan hospital. He also has a part-time private practice. He is seen in the Emergency Department with a history of having arrived at a work-related social event earlier in the evening in a 'slightly intoxicated' state, and then being found collapsed and comatose in the male toilets two hours later. A colleague called an ambulance. On examination, he has an impaired Glasgow Coma Score of 12 while no neurological localising signs are detected. His breath smells of alcohol and alcohol blood levels are twice the driving limit (160 mg/dL). His blood glucose is normal. There is no paracetamol in his blood and urine toxicology results for other drug metabolites are negative. His estranged wife, who is the next of kin identified on his medical records, confirms that he drinks heavily. She reports that, as of late, he has started his first glass of wine in the morning, 'to steady his nerves'. On average, he drinks about two bottles of white or red wine per night. His drinking increases on weekends, and at these times he often becomes inebriated. His busy work schedule and heavy drinking patterns resulted in their recent separation. They remain amicable however, and his wife has encouraged him to seek help for his drinking. You go to see him after he regains consciousness and start to discuss his drinking habits.
D/O: Psychiatry/Health Psychology (•••), Emergency Medicine (••), Digestive System (•), Gastroenterology & Hepatology (•), Neurology (•)
PTT: Mental health
Altered level of consciousness in a childA 3 year old Samoan girl is brought by ambulance to Emergency Department. She is breathing by herself, groaning and only responding to pain. Her mother says she has had a 'fit' at home.
D/O: Emergency Medicine (•••), Nervous System (•••), Neurology (•••), Paediatrics (•••)
PTT: Neurological
Altered level of consciousness in an adultA 28-year-old Māori man presents following a motor vehicle crash in which he was an unrestrained driver. Following a lucid interval, he is unresponsive on arrival to the Emergency Department. He has a dilated right pupil and his best motor response is abnormal flexion to painful stimulus. His blood pressure starts to rise and heart rate begins to fall.
D/O: Emergency Medicine (•••), Nervous System (•••), Neurology (•••), Intensive Care Medicine (••), Neurosurgery (••), Anaesthesiology (•)
PTT: Seriously ill patient
AmenorrheaA 21 year old NZ European woman is referred to a gynaecologist as she has not had her menses for the last 6 months. She is also troubled by increasing hair growth affecting her face.
D/O: Endocrinology (•••), Obstetrics & Gynaecology (•••), Reproduction & Development (•••)
PTT: Women's health
AnaemiaA 38 year old Indian woman presents to her GP with a 3 month history of worsening fatigue. She has been a vegetarian for the last 12 months. She has regular menstrual periods and no history of menorrhagia. A blood test shows a low haemoglobin of 83 g/L. Her creatinine is elevated at 180 µmol/L.
D/O: Haematology (•••), Digestive System (••), Medical Genetics (••)
PTT: Blood and lymph, Digestive
Annual eye screen for patient with diabetesA NZ European man with diabetes of 15 years duration presents for an eye screen. He is blind in one eye following unsuccessful surgery for diabetic eye disease and now presents with pre-proliferative retinopathy in his remaining eye.
D/O: Endocrinology (•••), General Practice (•••), Ophthalmology (•••)
PTT: Eyes, Homeostasis
Anxiety disorderYou are attached to a psychiatry outpatient clinic where a 50 year old South African married businessman sees the Consultant Psychiatrist you are shadowing complaining of feeling uptight, tense and questions whether he is heading for a 'nervous breakdown'. On three occasions in the past month, he thought that he was having a heart attack because of sharp chest pains and shortness of breath. Twice he went to the Emergency Department (ED) for treatment. Blood investigations and an ECG were normal and he was sent home both times with reassurance. On the last occasion the ED doctor thought that he was having a panic attack and suggested that he visit your outpatient clinic. He is fearful of having another similar episode. His mother gave him a tranquilizer (he has the name 'Ativan' written on a piece of paper which he shows you) and says that it made him calm and relaxed; he wants your Consultant to prescribe these for him. He also adds that he sleeps poorly. His GP diagnosed essential hypertension three years ago and he has been stabilised on a beta-blocker.
D/O: Psychiatry/Health Psychology (•••), General Practice (••)
PTT: Mental health
ArrhythmiasA 64 year old NZ European man is brought to the Emergency Department by ambulance. He had collapsed, temporarily lost consciousness and was observed to become pale at the time of collapse. When the ambulance crew arrived, it was noted that his pulse rate was very rapid.
D/O: Cardiology (•••), Cardiovascular System (•••)
PTT: Cardiovascular, Seriously ill patient
Before school checkDuring your GP attachment you attend the 'Before-School' check with the practice nurse on a 4.5 year old Samoan boy, with his father attending. His father mentions that his son does not like to play with other children and plays with the same dinner-plate, holding it as a steering wheel and repeatedly turning it around in his hands. He also likes to watch their garden windmill for prolonged periods and dislikes going with the family to their large social church gatherings. His father says he is not speaking as much as his siblings did at the same age.
D/O: General Practice (•••), Paediatrics (•••), Psychiatry/Health Psychology (••)
PTT: Child health
Bipolar affective disorderYou are on call with the psychiatric registrar who is contacted by the Emergency Department to review a 19 year old, single NZ European man who works as an apprentice panel beater. He arrives accompanied by three 'mates' who describe him as a 'bit mental' and 'over the top'. He is half-shaved but casually attired; and he is easy to engage. He denies being ill but describes how he is going to find a niche in motor vehicle engineering that would revolutionise the car industry. He describes sitting up late at night with 'thousands of ideas', capturing these in a journal. Consequently, he only sleeps 3-4 hours per night and claims that he doesn't need more than this. His appetite has been poor but he reasons that this was because he was 'on a roll'. Friends describe him as more than usually talkative, loud, restless and irrational at times and say that he becomes irritable when this is pointed out, accusing his friends of turning on him as they are jealous of his pending fortunes.
D/O: Psychiatry/Health Psychology (•••)
PTT: Mental health
BlistersA 75 year old Chinese man presents to the Emergency Department in winter with blisters and a red blotchy rash. Ten days ago he was started on carbamazepine for painful diabetic neuropathy.
D/O: Clinical Pharmacology (•••), Dermatology (•••), Immunology (••)
PTT: Skin
Bowel obstructionA 68 year old NZ European/Māori man presents to the Accident and Medical Centre with vomiting and abdominal distension. He has also noted that his bowels have not moved for 4 days and he is not passing wind.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••)
PTT: Digestive, Seriously ill patient
Breast lump and screeningA 51 year old NZ European woman, who is menopausal and taking combined hormone therapy, presents to her GP. She has a breast lump and is worried about cancer
D/O: Anatomical Pathology (•••), General Surgery (•••), Oncology (•)
PTT: Women's health
BurnsAn 87 year old Māori man is brought in by ambulance after a house fire. He has visible severe burns over the majority of his body. His family is in attendance and he is being managed in a side room. You are asked to take notes for the consultant who is going to review the patient.
D/O: Plastic Surgery (•••), Emergency Medicine (••), Palliative Medicine (••)
PTT: Seriously ill patient, Skin
Child or adolescent with a headacheA mother brings her 8 year old NZ European/Chinese boy to their GP because of headache. This has been present for 4 months and is particularly severe when he gets home from school. He is unable to describe the character of the pain and experiences them most days. He is missing at least 2 days of school each week. He has no other systemic symptoms.
D/O: General Practice (•••), Paediatrics (•••), Psychiatry/Health Psychology (•••)
PTT: Mental health
Child with abnormal gaitA Somali woman brings her 2 year old son to the GP, because her husband is concerned about the way he is walking. His mother wears a veil for religious reasons.
D/O: Musculoskeletal System (•••), Orthopaedics (•••), Paediatrics (•••), General Practice (••)
PTT: Musculoskeletal
Child with abnormal pubertyA mother brings her 13 year old NZ European daughter to see their GP. She is concerned that her daughter has no breast development and has not had menarche.
D/O: Endocrinology (•••), Genitourinary System (•••), Paediatrics (•••)
PTT: Child health
Child with disorder of eliminationA 7 year old NZ European boy is brought to see you as he wets his bed most nights and has some problems with constipation. His father says that he also wet his bed to age 6 years and there are no other medical concerns.
D/O: Paediatrics (•••), General Practice (••), Psychiatry/Health Psychology (••)
PTT: Child health
Child with generalised swellingA three year old Tongan boy is brought to clinic with periorbital swelling. His mother has noticed it over 5 days when he gets up in the morning. There is swelling around his ankles and more recently she has noted swelling of his scrotum.
D/O: Genitourinary System (•••), Paediatrics (•••), Renal Medicine (•••)
PTT: Child health, Renal
Child with red swelling around one eyeA 6 year old NZ European boy presents with a warm red swelling around the right eye of 24 hours duration, to the extent he is unable to open the eye himself. He is feeling unwell, off his food, and his mother is worried that he has been 'quiet' for the last few hours. She has come to you seeking antibiotics.
D/O: Ophthalmology (•••), General Practice (••), Infectious Diseases (••), Paediatrics (••)
PTT: Eyes
Child with respiratory distressA 2 year old Māori boy presents to the Emergency Department with a 2 day history of coughing. He has a low grade fever, rapid breathing and audible wheeze. He is with two female caregivers. This is his fifth attack of cough and wheeze.
D/O: Paediatrics (•••), Respiratory System (•••), Emergency Medicine (••)
PTT: Child health
Child with sore jointsA 5 year old Niuean girl is brought to the local Emergency Department as she has difficulty walking. On examination she has tenderness in her left ankle and her right knee is tender and swollen.
D/O: Hauora Māori (•••), Orthopaedics (•••), Paediatrics (•••), Rheumatology (•••)
PTT: Child health, Musculoskeletal
Childhood obesityThe Board of Trustees at the local primary school seeks your advice, as a senior doctor in the town, on what they perceive to be a serious issue; the number of overweight children in the school.
D/O: Epidemiology (•••), Paediatrics (•••), Population Health (•••), Hauora Māori (••)
PTT: Child health, General duties
Chronic abdominal pain in children and adolescentsA 7 year old NZ European boy who has had ill-defined abdominal pain almost daily for 3 months, is seen by his GP. His father thinks he has lost a little weight and is lethargic.
D/O: Digestive System (•••), Paediatrics (•••), Psychiatry/Health Psychology (••)
PTT: Child health
Chronic bowel motility problemsA 35 year old South African man presents to his GP with alternating loose stools and constipation. He has not lost any weight but finds his symptoms distressing, because they have been present for a few months.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Oncology (•)
PTT: Digestive
Chronic illness in paediatricsA 12 year old Samoan girl presents to Emergency Department with her mother after a fall from her wheelchair during a seizure. They have a recent outpatient clinic letter which outlines her past medical history to include spastic quadriplegic cerebral palsy from birth; she is wheelchair-bound and fully dependent for all self-cares. She has epilepsy and global developmental delay and is nonverbal. She has had a gastrostomy for night feeding since 4 years of age and has orthopaedic problems including scoliosis and tendoachilles contractures. She has bronchiectasis with two previous episodes of severe pneumonia, the last of which 6 months ago required a prolonged admission and she now remains on nocturnal VPAP (variable positive airway pressure). She attends the local intermediate school via satellite class and has multiple community services involved in her schooling, transport and therapy.
D/O: Paediatrics (•••), Nervous System (••), Neurology (••), Orthopaedics (••), Respiratory Medicine (••), Musculoskeletal System (•), Respiratory System (•)
PTT: Child health
Chronic kidney disease / asymptomatic worsening renal functionA 45 year old Māori man is referred to you from by his GP. He was diagnosed with diabetes 15 years ago and routine monitoring of his renal function demonstrates a steadily increasing serum creatinine level. Renal ultrasound reveals small echogenic kidneys. His blood pressure is 150/92 mmHg.
D/O: Genitourinary System (•••), Renal Medicine (•••), Ethics (••)
PTT: Renal
Chronic limb painA 95 year old NZ European woman comes to see you at your GP practice. She has noticed that her legs hurt when she walks. It is much worse when going uphill and she has to stop on the way to the shops and rest. She says she has taken 'loads of tablets' since her heart attack five years ago. You notice an ulcer on her leg.
D/O: Cardiovascular System (•••), General Surgery (•••)
PTT: Cardiovascular
Chronic liver diseaseA 45 year old NZ European man presents to the General Medical Clinic after being told he has abnormal blood tests. He has been feeling 'run-down' for some time. He thinks he has lost some weight and his friends remark that he is 'yellow'. Recently his legs and abdomen have become swollen and he seems to bruise easily.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), Anaesthesiology (•), General Surgery (•)
PTT: Digestive
Chronic shortness of breathA 65 year old Tongan woman presents to the Emergency Department with worsening shortness of breath over the last 24 hours. She is well known to the department needing hospital admissions two to three times per year. She says that she is always short of breath and has difficulty getting to the shops but things are currently much worse than usual. She is breathless at rest today. There has been an increase in her daily sputum production. She has a 30 pack-year smoking history but stopped 5 years ago.
D/O: Respiratory Medicine (•••), Respiratory System (•••), Cardiology (••), Cardiovascular System (••), Infectious Diseases (•)
PTT: Respiratory
Chronic sputum productionA 25 year old NZ European woman, who has recently moved into the area, presents to your GP clinic with an increase of her cough and sputum production and recurrent small haemoptyses (about a teaspoon in volume). She has a history of cough and purulent sputum production since early childhood.
D/O: Respiratory Medicine (•••), Respiratory System (•••), Immunology (••), Infectious Diseases (••), Medical Genetics (••), Microbiology (••)
PTT: Respiratory
Chronic upper abdominal symptomsA 33 year old NZ European woman presents to her GP with fatigue, dyspepsia and acid reflux. Her symptoms have been slowly developing over the past couple of months. You take a history and examine her. After presenting your findings to the GP they ask you how you would like to manage her symptoms.
D/O: Digestive System (•••), General Practice (•••), Gastroenterology & Hepatology (••), General Surgery (•)
PTT: Digestive
Clinical auditAn audit in your primary care practice was undertaken to evaluate quality of care for different groups of patients. Māori and non-Māori patients in the enrolled population had approximately the same average number of visits per year. In comparison to non-Māori, Māori women were less likely to have a current smear and mammogram and Māori children were less likely to be up-to-date with immunisations. Māori patients with diabetes were less likely to have regular checkups and on average had less well-controlled diabetes. Enrolled Māori patients were less likely to have had a cardiovascular disease (CVD) risk assessment, and Māori patients with CVD were less likely to be on recommended therapy. Referral for laboratory and radiological investigation was less common for Māori patients.
D/O: Epidemiology (•••), Hauora Māori (•••), Population Health (•••)
PTT: General duties
Compromised airwayA 54 year old Tongan man with known nut allergy presents with difficulty breathing. His throat feels swollen and he is very distressed. It all started when he ate at a restaurant.
D/O: Emergency Medicine (•••), Immunology (•••), Intensive Care Medicine (•••), Otorhinolaryngology (•••), Anaesthesiology (•)
PTT: ENT, Seriously ill patient
Congenital hearing lossA 4 month old Māori baby is sent to paediatric outpatients as he failed his newborn audiology screen and missed his planned repeat testing. His mother is concerned that he does not hear and he is not babbling or laughing.
D/O: Nervous System (•••), Otorhinolaryngology (•••), Paediatrics (•••)
PTT: Child health
ContraceptionA 36 year old NZ European woman, with three children, comes to her GP because she wants to know what contraceptive options are available to her. She smokes 15 cigarettes a day.
D/O: General Practice (•••), Obstetrics & Gynaecology (•••), Reproduction & Development (•••)
PTT: Women's health
Daytime sleepinessA 40 year old truck driver who weighs 160kg presents after a minor road traffic crash. He ran into the car in front of him while waiting at traffic lights; he thinks he 'nodded off'. He experiences morning headaches and reports excessive daytime sleepiness. His blood pressure is 180/105 mmHg.
D/O: Respiratory Medicine (•••), Respiratory System (•••), Cardiology (•), Cardiovascular System (•)
PTT: Respiratory
Deep vein thrombosisWhile on your GP placement you see a 45 year old NZ European woman who has just returned from holiday in London. She has noticed that her left leg has become swollen and painful. This has never happened to her before but her sister has had a 'clot in the leg' in the past. During the consultation, the GP remembers that she started the patient's 15 year old daughter on the combined oral contraceptive pill a few weeks ago, without her mother's knowledge.
D/O: General Practice (•••), Haematology (•••), Clinical Pharmacology (••), Ethics (••), Radiology (••)
PTT: Blood and lymph
Delirium / dementiaYou are on call with the orthopaedic house officer and are called to see an 84 year old NZ European woman who has recently returned from the operating theatre after having her femoral neck fracture repaired. She has become 'very confused' and the nursing staff are having difficulties keeping her in bed. You find her trying to climb out of bed despite having surgical drains and a catheter in place. She demands to be left alone and asks to stop being 'tortured'. Her son arrives in the ward after being called by staff and he is able to calm her to some extent but both the son and the ward staff want to know what should be done if this happens again and the son can't attend. You check the most recent investigation results and note that her serum sodium is slightly reduced at 133 mmol/L and the urine is cloudy, has WBC present, and has grown E. Coli.
D/O: Geriatric Medicine (•••), Psychiatry/Health Psychology (•••)
PTT: General duties
Dementia / disturbance of memory / cognitive functionA 70 year old NZ European man attends the GP clinic with his middle-aged daughter. The daughter, who lives in the same town as him, is concerned about her father's memory and asks you if he is developing Alzheimer's disease. The man has been a patient of yours for some time; he has been active and independent and his health has always been good. You have not seen him since his wife died 18 months ago.
D/O: General Practice (•••), Geriatric Medicine (•••), Nervous System (•••), Neurology (•••), Psychiatry/Health Psychology (••)
PTT: Neurological
Diabetes in pregnancyA 35 year old NZ European woman is 28 weeks pregnant. She has an abnormal one hour glucose challenge test (polycose) and her midwife refers her to the obstetrician for review.
D/O: Endocrinology (•••), Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Paediatrics (•)
PTT: Women's health
Diabetes insipidusYou are on your GP placement and are asked to see a 19 year old NZ European woman who has been drinking lots of water for the past couple of months. She can't go anywhere without a bottle of water. She says she does this because she is always going to the toilet and gets up 3-4 times each night to drink. She has normal body weight.
D/O: Endocrinology (•••), Renal Medicine (•)
PTT: Homeostasis
DiarrhoeaA 35 year old Moriori man from the Chatham Islands, who works as a chef, visits his GP with 3 days of abdominal cramping and diarrhoea. He reports that last weekend he went to the Kai Iwi lakes with a tramping club; they had a barbecue and he enjoyed fresh spring water, grilled chicken and potato salad.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), Infectious Diseases (•••), Microbiology (•••)
PTT: Digestive, Infectious disease
DiplopiaA 66 year old Māori woman presents with intermittent double vision which has been gradual in onset, but steadily worsening and has now become constant. She had cataract surgery 2 years ago with good vision in each eye postoperatively and she has had reasonably controlled type 2 diabetes for 10 years.
D/O: Neurology (•••), Ophthalmology (•••), Endocrinology (••)
PTT: Eyes
Dislocated jointA 23 year old Samoan man attends the Emergency Department after dislocating his shoulder playing rugby. His friend who is a doctor has tried unsuccessfully to relocate the shoulder. The emergency nurse practitioner is managing the case and you are helping them.
D/O: Emergency Medicine (•••), Musculoskeletal System (•••), Orthopaedics (•••)
PTT: Musculoskeletal
Disruptive behaviour disorderAn 8 year old NZ European boy is brought by his mother to see you in your General Practice. The staff at her son's school have insisted that she seek help with managing his behaviour after he hit another child with a stick at school. She tells you that her son has been disruptive in class, is making poor progress with reading, gets into fights in the playground at lunchtimes, and is friends with other 'trouble-makers'. At home he is often disobedient, fights with his younger brothers, and never settles to any activity for long. He has always been a very active child and his behaviour has been worse since his father left the marriage 18 months ago.
D/O: Paediatrics (•••), Psychiatry/Health Psychology (•••), General Practice (••)
PTT: Child health, Mental health
Dizziness and vertigoA 45 year old Chinese female who helps run her family's furniture store comes to see her GP. She is a frequent attender and on this visit she complains of dizziness, ringing in her ears and feeling like she's veering to one-side when walking. Her medication history reveals she is taking a herbal remedy prescribed by a traditional Chinese medicine consultant.
D/O: Nervous System (•••), Neurology (•••), Otorhinolaryngology (•••), General Practice (••)
PTT: ENT
DysphagiaA 72 year old Māori man, who smokes, presents with difficulty swallowing. This has been getting worse for the past 3 months and he has lost 6 kg of weight.
D/O: Anatomical Pathology (•••), Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Neurology (••), General Practice (•), Otorhinolaryngology (•)
PTT: Digestive
DysuriaAn 18 year old European woman presents to the student health clinic with burning discomfort when she passes urine. She has recently started university and has a new boyfriend. They have been having sex without using condoms.
D/O: General Practice (•••), Genitourinary System (•••), Infectious Diseases (•••), Microbiology (•••), Obstetrics & Gynaecology (••)
PTT: Infectious disease
Eating disordersYou see a 17 year old female NZ European high school student with her mother at the general practice where you are based. You sit in on the consultation with the GP. She is a gymnast and in her penultimate year of high school. Her coach had met with you to discuss her concerns. She had noted progressive weight loss over the past 6 months despite her always having been a thin person. At a recent gymnastics competition, her coach saw a large container of docusate sodium (Coloxyl) tablets in her kit bag. In view of her noticeable weight loss, the coach wanted to withdraw her from further competitions until she had gained a 'better weight'. The coach also worried that she would set a bad example to the younger gymnasts. Her mother has long been aware of her daughter's weight issues and only made occasional comments expressing her concerns. Her daughter, however, was typically dismissive of these and became irritable when these were raised. The patient's mother has spoken to her friends and most reported that their teenage daughters were very focused on their appearance, changing body shapes (particularly around menarche) and were embarking on weight management strategies. This had partially reassured her until the coach raised the issue. When she and the coach discussed this issue with her daughter, she became tearful and agreed to see her doctor. She admitted that she used laxatives on a daily basis as part of a weight control regime in addition to vigorous exercise workouts at the gym and at home. She mentioned that she has made herself vomit after eating in order to lose weight. The GP calculates her body mass index (BMI) to be 15kg/m2.
D/O: Paediatrics (•••), Psychiatry/Health Psychology (•••), Endocrinology (••), Clinical Biochemistry (•)
PTT: Mental health
Elevation of prostate-specific antigenA 65 year old Dutch male, a retired plumber, has a history of a slow stream of urine and needing to get up to void once or twice in the night. He has been referred to the Urology Outpatient Clinic after a blood test showed an elevated prostate-specific antigen.
D/O: Genitourinary System (•••), Urology (•••), Epidemiology (••)
PTT: Renal
Epilepsy / seizureA 20 year old Tongan rural community lifeguard is brought to the Emergency Department after having an apparent convulsive episode at the life saving club. She has a past medical history of depression for which she takes antidepressant medications. She drinks alcohol frequently. She has a contusion on her right temple after hitting her head when she collapsed.
D/O: Nervous System (•••), Neurology (•••), Emergency Medicine (••)
PTT: Neurological
EpistaxisAn 86 year old NZ European woman calls an ambulance when she develops a nose bleed that 'just won’t stop'. Her daughter, who lives with her, has tried pinching the end of her nose but that has not helped. She is taken into the Resuscitation Room. You are asked to obtain some more information from the daughter. She tells you that her mother has been complaining of a blocked nose for the past few months and has had intermittent small nose bleeds.
D/O: Emergency Medicine (•••), Otorhinolaryngology (•••)
PTT: ENT
Facial swelling and itchy rashA 30 year old NZ European man comes in to the Emergency Department with a widespread itchy rash that has been present for several days. This morning he also woke up with swollen eyelids and lips.
D/O: Dermatology (•••), Immunology (•••)
PTT: Skin
Failure to thriveA 10 month old NZ European infant girl attends the paediatric outpatient department because the Plunket nurse and her mother are concerned that she is not gaining enough weight. Her weight at the age of 6 months was on the 25th percentile and now is on the 2nd percentile.
D/O: Paediatrics (•••), Immunology (••)
PTT: Child health
Falls and collapsesA 77 year old NZ European woman presents to the Emergency Department. She lives at home, with a stressed family. She has mild cognitive impairment. There is a vague history from the ambulance officer of the patient falling earlier that day. She appears emaciated with fingerprint bruising on her inner arms. She has a bruised eye and smells of urine and faeces. As the medical student, you observe the emergency doctor assess the patient.
D/O: Emergency Medicine (•••), Geriatric Medicine (•••)
PTT: General duties
Family with a genetic disorderDuring a clinical attachment you see a 64 year old NZ European man who has recently been diagnosed with Huntington's disease. He is with his daughter who asks you about her chance of having Huntington's disease and her chance of passing it on to her own children. She would like to know about genetic testing for this disorder
D/O: Medical Genetics (•••), Neurology (•)
PTT: Neurological
Febrile infantA 6 month old Chinese/Samoan baby girl is brought in as she has a fever of 39°C. She has been unwell for 2 days, has a rapid pulse and has not had a wet nappy for 24 hours.
D/O: Emergency Medicine (•••), General Practice (•••), Infectious Diseases (•••), Paediatrics (•••)
PTT: Child health
Febrile returning travellerA 28 year old Canadian man has recently arrived in Auckland from a 2 month holiday in Laos. Whilst in Laos he visited jungle and rural areas, swam in rivers and had a sexual liaison with a German backpacker. He visits his GP with intermittent fever, sweats, lethargy and loose bowel motions. His symptoms have been present for 5 days.
D/O: Infectious Diseases (•••), Microbiology (•••), Ethics (•), Haematology (•)
PTT: Infectious disease
Fetal healthA 37 year old nulliparous NZ European woman presents to her GP when 8 weeks pregnant. Antenatal blood tests are arranged and she is offered prenatal screening for chromosomal abnormalities. The screening test is positive and her GP refers her to the specialist obstetric clinic.
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Medical Genetics (••), Paediatrics (••)
PTT: Women's health
Fever and a new murmurA 39 year old Samoan/Niuean man presents with a fever and lethargy for the past 2 weeks. On examination he has a fever, splinter haemorrhages and an early diastolic murmur.
D/O: Cardiology (•••), Cardiovascular System (•••), Infectious Diseases (•••), Microbiology (•••)
PTT: Cardiovascular, Infectious disease
Fever and adenopathyA 27 year old NZ European man presents with fever, drenching sweats and malaise for the last 8 days. He also complains of a sore throat and anorexia for the last 2 days. On examination he has mildly enlarged tonsils, widespread cervical, axillary and inguinal lymphadenopathy, but no hepatosplenomegaly.
D/O: Infectious Diseases (•••), Microbiology (•••), Otorhinolaryngology (•••), Haematology (••)
PTT: Infectious disease
Fever and headacheA 17 year old NZ European man presents with a severe headache and a fever. He was well yesterday and played football after school. On examination he is sleepy, febrile, tachycardic and has neck stiffness.
D/O: Infectious Diseases (•••), Microbiology (•••), Intensive Care Medicine (••), Paediatrics (••), Nervous System (•), Neurology (•)
PTT: Infectious disease, Seriously ill patient
Flank pain and dysuriaA 35 year old Tongan woman presents with severe right sided flank pain radiating down to her groin, pain while passing urine, and haematuria. She had a similar episode 6 years ago.
D/O: Genitourinary System (•••), Infectious Diseases (•••), Urology (•••), Emergency Medicine (••), General Surgery (••), Renal Medicine (•)
PTT: Renal
Food allergy in paediatricsAn 18 month girl arrives in the Emergency Department via ambulance. Within minutes of having a bite of toast with peanut butter, she started coughing and became breathless. She also has chronic eczema which seems to flare and become itchy after she eats eggs.
D/O: Immunology (•••), Paediatrics (•••), Dermatology (••), Otorhinolaryngology (••)
PTT: Blood and lymph, Child health, Seriously ill patient
Forearm / wrist injuryA 24 year old male Māori forestry worker presents with severe and worsening left forearm and wrist pain after crushing his forearm between two heavy logs of wood at work. An X-ray shows comminuted mid-shaft fractures of the radius and ulna. He develops compartment syndrome. This is not diagnosed immediately and despite surgical decompression he goes on to suffer serious disability.
D/O: Musculoskeletal System (•••), Orthopaedics (•••)
PTT: Musculoskeletal
FractureA mother presents to the Emergency Department with her 2 year old NZ European child who is not using their right arm.
D/O: Emergency Medicine (•••), Musculoskeletal System (•••), Orthopaedics (•••), Paediatrics (•••), Radiology (•••)
PTT: Musculoskeletal
Genetic testing informationA 44 year old NZ European woman found relatives she hadn’t known about after embarking on a genealogy project. Many of them had been diagnosed with breast cancer at an early age. She consulted her GP and after counselling underwent genetic testing. Results revealed she had inherited a predisposition to breast cancer that meant she had a 40-80% chance of developing it in her lifetime. She has a sister and two daughters aged 12 and 19 years old.
D/O: Ethics (•••), Medical Genetics (•••), General Practice (••), Oncology (••)
PTT: General duties, Women's health
Glue earA 4 year old Māori girl is brought to the GP by her mother because she is having difficulty hearing. On otoscopy you see bilateral retracted tympanic membranes.
D/O: General Practice (•••), Hauora Māori (•••), Otorhinolaryngology (•••), Paediatrics (•••), Epidemiology (•), Population Health (•)
PTT: ENT
Gout / acute pain and swelling of kneeA 56 year old Samoan man is admitted to hospital with an acute myocardial infarction. He has a history of hypertension treated with a thiazide diuretic, type 2 diabetes that is diet controlled, hyperlipidaemia and high alcohol consumption. Three days following his admission to hospital he develops acute pain and swelling of his knee.
D/O: Musculoskeletal System (•••), Rheumatology (•••), Hauora Māori (••)
PTT: Musculoskeletal
Gradual deterioration in visual acuity over timeA 75 year old, otherwise healthy Indian woman, who drives and reads avidly, notices increasing difficulty seeing road signs and reading the newspaper over six months. Five years previously she had cataract surgery to both eyes which greatly improved her vision. After the cataract operations she noted 'I could see like I was 20 years younger'. Current visual acuity is 6/12 right and 6/24 left with spectacles.
D/O: Ophthalmology (•••), General Practice (••)
PTT: Eyes
Groin lumpYou are on an attachment in a General Practice and are asked to see a 25 year old Samoan man with a lump in his left groin. It has been there for 3 weeks and is not getting any smaller. He is otherwise fit and well.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Oncology (••), General Practice (•)
PTT: Digestive
Gross haematuriaA 56 year old Māori man, who is a smoker and used to work in a clothes dyeing factory, presents with an episode of passing blood and dark red clots in his urine. He has no associated pain or urinary frequency. His GP has referred him urgently to the Urology Outpatient Clinic.
D/O: Genitourinary System (•••), Urology (•••), Renal Medicine (••)
PTT: Renal
Gynaecological abdominal painA 29 year old NZ European/Māori woman presents to the Emergency Department with lower abdominal pain and some vaginal bleeding.
D/O: Obstetrics & Gynaecology (•••), General Surgery (••), Reproduction & Development (••), Genitourinary System (•)
PTT: Women's health
HaemochromatosisA 54 year old NZ European man saw his GP for an insurance assessment. He was incidentally noted to have a very high ferritin level of 1200 ug/L and an increased transferrin saturation of 62%. His past medical history includes central obesity and type 2 diabetes mellitus.
D/O: Medical Genetics (•••), Digestive System (••), Gastroenterology & Hepatology (••), General Practice (••), Haematology (••), Clinical Biochemistry (•)
PTT: Blood and lymph, Digestive
Haemoptysis and abnormal chest X-rayA 65 year old Samoan man returns to the GP clinic where you are on your attachment. He has had a prolonged cough and the GP arranged a chest X-ray which has shown a 2.5 cm diameter cavity within an area of confluent shadowing in the superior segment of the right lower lobe. He has come back for the result and reports that he coughed up some blood recently. He is a long-term smoker and has a heavy consumption of alcohol.
D/O: Respiratory Medicine (•••), Respiratory System (•••), Infectious Diseases (••), Microbiology (••), Oncology (••)
PTT: Respiratory
Hand injuryA 19 year old NZ European male presents with a swollen, painful right hand after falling whilst intoxicated. There is swelling over the back of his hand and he has two small wounds over his 4th and 5th knuckles. He appears angry and gives little extra history.
D/O: Musculoskeletal System (•••), Orthopaedics (•••), Plastic Surgery (•••), Ethics (••)
PTT: Musculoskeletal
Head traumaA 26 year old NZ European male presents to the Emergency Department having received a head-high tackle in a rugby game one hour previously. He was knocked out at the scene and now has ongoing headache. He is repetitively questioning and has a reduced level of consciousness. He has no other injuries.
D/O: Emergency Medicine (•••), Nervous System (•••), Neurosurgery (•••)
PTT: Seriously ill patient
HeadacheA 50 year old NZ European woman presents to her GP with frontal headaches for three months. When her headache is at its worst her vision seems blurred. There have been no other neurological symptoms. She is a married factory worker who is facing redundancy.
D/O: General Practice (•••), Neurology (•••), Nervous System (••), Otorhinolaryngology (•)
PTT: Neurological
Headache, morning stiffness and shoulder painA 70 year old NZ European woman sees her GP with a 6 week history of aching and morning stiffness in the shoulders, hip girdle and neck. This has slowly worsened and in the last 2 days she has developed a severe headache with scalp tenderness. Her body mass index (BMI) is calculated and is 18. You organise an erythrocyte sedimentation rate (ESR) and the result is 66 mm in 1 hour (normal 0-30).
D/O: Musculoskeletal System (•••), Rheumatology (•••), Anatomical Pathology (••)
PTT: Musculoskeletal
Hearing lossA 78 year old Samoan man visits his GP, concerned about his hearing. He is a retired baggage handler and used to work at Auckland International Airport. His family has been complaining that he watches TV with the volume too loud.
D/O: Otorhinolaryngology (•••), Nervous System (••)
PTT: ENT
Heart failureA 82 year old NZ European man is sent to hospital by his GP because of worsening shortness of breath and fatigue. This has been going on for a few weeks now. He has noted that his ankles are swollen and he reports he had a 'heart attack' 5 years ago. He mentions to you that he's lived a good life and 'wants to be allowed to die with dignity and not be stuck on machines keeping him alive'.
D/O: Cardiology (•••), Cardiovascular System (•••), Palliative Medicine (••)
PTT: Cardiovascular
Heavy menstrual periodsA 45 year old NZ European woman presents to her GP with heavy periods for six months. She has completed her family. She is concerned as she is running out of sick leave at work.
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••)
PTT: Women's health
Hip fractureAn 82 year old NZ European woman with a fractured neck of femur is brought to the Emergency Department by her neighbour. The woman is confused and unable to give a history but was found lying in her driveway. Earlier in the day, the neighbour heard the woman arguing with her son over him withdrawing money from her bank account. The medical records show a past history of chronic obstructive pulmonary disease, long-term oral corticosteroid use and surgical removal of a melanoma two years ago. An hour later her son arrives and says that he does not want her to have an operation.
D/O: Geriatric Medicine (•••), Musculoskeletal System (•••), Orthopaedics (•••), Endocrinology (••), Radiology (••)
PTT: Musculoskeletal
Hypercalcaemia and back painA 62 year old woman sees her GP because of worsening lower back pain for the last 2 months. She has tried paracetamol and codeine, with no improvement in pain control. She has lost weight, lost her appetite and has been constipated for the last 3 weeks. Past medical history includes breast cancer treated with mastectomy 2 years ago. She is an ex-smoker with a 40 pack-year history of smoking. A blood test shows an elevated creatinine of 168 µmol/L (normal at 62 µmol/L 6 months ago), elevated adjusted calcium of 2.9 mmol/L and a normal full blood count. The serum IgG is elevated at 31 g/L.
D/O: Clinical Biochemistry (•••), Haematology (•••), Palliative Medicine (•••), Oncology (••), Musculoskeletal System (•)
PTT: Blood and lymph, Homeostasis
HyperthyroidismA 26 year old Māori woman presents to her GP complaining of marked weight loss. She feels irritable and too hot. She has noted a hand tremor that affects her writing.
D/O: Endocrinology (•••)
PTT: Homeostasis
HyponatraemiaAn 83 year old Chinese woman is brought to the Emergency Department by her son. She developed a productive cough in the last week but has become increasingly confused over the last two days. She lives alone and is fully independent. Her past history consists of hypertension for which she is treated with bendrofluazide and mild depression treated with fluoxetine. On examination she has a fever and crackles at the left lung base. Her serum sodium is found to be 121 mmol/L. Previous blood tests in recent months have been normal.
D/O: Clinical Biochemistry (•••), Clinical Pharmacology (••), Geriatric Medicine (••), Infectious Diseases (•)
PTT: Homeostasis
HypothyroidismA 32 year old Chinese woman presented originally with an overactive thyroid gland. She was treated with carbimazole but suffered side effects. She was then treated with radioactive iodine. She attends a follow-up clinic appointment with fatigue, lethargy and feeling cold all the time (despite the summer weather).
D/O: Endocrinology (•••)
PTT: Homeostasis
Infant or child with a murmurA one day old Chinese baby girl is found to be not feeding well. On examination the baby has a systolic murmur and is cyanosed.
D/O: Cardiology (•••), Cardiovascular System (•••), Paediatrics (•••)
PTT: Cardiovascular, Child health
Infant or child with easy bruisingA 3 year old NZ European boy is taken to the GP by his mother because he has a number of bruises on his legs. Recently when he slipped off a step, he developed a large bruise over his buttock. He is otherwise well but had an upper respiratory tract infection 2 weeks earlier.
D/O: Haematology (•••), Paediatrics (•••)
PTT: Blood and lymph
Infant or child with pallorA 12 month old Samoan boy is brought to see you by his grandmother and mother. His grandmother is visiting and hadn't seen him for 4 months; she has noticed that he is pale and has encouraged his mother to take him to the doctor.
D/O: Haematology (•••), Paediatrics (•••)
PTT: Blood and lymph
Infant with an altered light reflexA 6 week old NZ European baby boy, having his 6 week GP check-up has absence of the red reflex in the right eye. On examination the child is alert and has no objection to occlusion of the right eye, but he has objection to occlusion of his left eye. He has a full range of extraocular motility.
D/O: Ophthalmology (•••), Paediatrics (•••)
PTT: Eyes
Infant with jaundiceA 5 week old NZ European baby girl is referred to medical services as the postnatal midwife has noted she is jaundiced. The baby is breast feeding but not gaining weight well.
D/O: General Surgery (•••), Paediatrics (•••)
PTT: Child health
Infant with strabismusA 2 year old Māori boy presents with a 4-6 week history of the eyes turning in ('cross-eyed') intermittently, but becoming more frequent. The parents note this is particularly obvious when the child is looking at near objects, or is tired. On examination the child's vision measures 6/24 in each eye, with a 30 prism dioptre alternating esotropia, increasing to 50 dioptres for near. Cycloplegic refraction shows hypermetropia of +8 dioptres for each eye.
D/O: Ophthalmology (•••), Paediatrics (•••)
PTT: Eyes
Infant with vomiting and diarrhoeaA 4 month old Indian girl who has had vomiting and diarrhoea for 18 hours presents to hospital. She is alternately irritable and drowsy and is assessed to be severely dehydrated with poor peripheral circulation.
D/O: Digestive System (•••), General Practice (•••), Paediatrics (•••), Emergency Medicine (••), Gastroenterology & Hepatology (•)
PTT: Child health
Infectious disease outbreakYour General Practice looks after a large residential aged care facility. One weekend, when on call, you are phoned by the manager of the facility. She reports that four of the residents have acute symptoms of diarrhoea and vomiting.
D/O: Epidemiology (•••), Infectious Diseases (•••), Microbiology (•••), Population Health (•••)
PTT: General duties, Infectious disease
InfertilityA 28 year old NZ European woman has been trying to conceive for 2 years without success. Her partner is 34 years old and they have sexual intercourse regularly. He attends the clinic with her.
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Genitourinary System (••), Ethics (•)
PTT: Women's health
Inflammatory low back painA 25 year old NZ European man presents to his GP with low back pain. The pain has been present for more than 18 months but increased in intensity over the last 3 months. There is pronounced early morning stiffness lasting over 2 hours and nocturnal pain such that he is awake most nights. Ibuprofen relieves his symptoms. He has a past medical history of a painful red eye on two separate occasions and bilateral Achilles tendonitis. There is no family history of arthritis, but his sister has Crohn's disease. He smokes 20 cigarettes per day and works as a forklift driver in a warehouse.
D/O: Musculoskeletal System (•••), Rheumatology (•••)
PTT: Musculoskeletal
Irritable infantA 2 month old NZ European boy is brought to the Emergency Department in the middle of the night by his mother. She is concerned because since about two weeks of age he has been much more irritable than her first child and has been crying for 2 hours tonight. He is gaining weight and feeding well otherwise.
D/O: Paediatrics (•••), Emergency Medicine (••)
PTT: Child health
Itching childAn 8 year old Māori boy is admitted to the paediatric ward with an generalised itchy red scaly eruption. He has had atopic eczema since he was 3 months old and has required multiple courses of antibiotics and been admitted for incision and drainage of an abscess 10 months ago. He has previously experienced boils and he has had courses of antibiotics in addition to topical steroids and anti-scabies treatment without success. The boy's skin is dry, thickened and excoriated with crusted areas about the knees and ankles.
D/O: Dermatology (•••), General Practice (•••), Hauora Māori (•••), Immunology (••), Infectious Diseases (••), Paediatrics (••)
PTT: Skin
Knee injuryA 26 year old Cook Island male presents with pain and swelling of his right knee after a twisting injury sustained over the weekend whilst playing rugby league. He has noticed that the knee seems to 'give way' since the injury.
D/O: Musculoskeletal System (•••), Orthopaedics (•••)
PTT: Musculoskeletal
Knee painA 70 year old Māori woman with a 1 year history of worsening knee pain underwent a left total knee joint replacement 6 weeks ago. She is a local kaumātua, helping to run a training programme for Māori youth, and usually plays bowls twice a week. She now presents with 5 days of increasing pain and swelling in this knee. She had a rigor and when she measured her temperature last night it was 38.8°C. Her left knee is markedly swollen, hot to touch and she cannot walk because of the pain.
D/O: Musculoskeletal System (•••), Orthopaedics (•••)
PTT: Musculoskeletal
LabourA 16 year old G2P0 Māori woman presents at 38 weeks pregnant in early labour. While being transferred to the Labour and Birthing Suite she tells you her 'waters broke'. Her labour progresses quickly and she starts pushing. The midwife becomes concerned and calls the obstetrician when she notices fetal heart rate decelerations
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Paediatrics (••)
PTT: Women's health
Late pregnancy complicationsA 34 year old Korean woman on the antenatal ward is 33 weeks pregnant, in her second pregnancy. The midwife calls you because she has developed abdominal pain and feels unwell.
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Paediatrics (•)
PTT: Women's health
Lymphadenopathy and splenomegalyA 60 year old man presented to his GP for a repeat prescription of his usual medications. On examination, he was found to have palpable lymph nodes (up to 2cm in size) in his cervical, axillary and inguinal regions. The spleen was palpable 4cm below the costal margin. On further questioning, he told his GP that he first noticed some lymph nodes in his neck about 6 months ago, but they had not changed in size or troubled him. He felt well in himself. A full blood count showed a lymphocytosis of 15 x 109/L and the presence of smear cells.
D/O: Haematology (•••), Immunology (•••), General Practice (••), Anatomical Pathology (•), Ethics (•)
PTT: Blood and lymph
Major depressive episodeYou have a regular patient at your practice, an 87 year old NZ European widow and retired school principal, whom you see about every three months. She has a history of controlled hypertension. She has two adult children who live overseas and with whom she has occasional contact. She presents with complaints of initial, middle and terminal insomnia, progressive weight loss, memory and concentration difficulties, and worry over the past six months. She relates these changes to her dog’s recent serious illness, but notes the dog survived. She adds that if her dog died she'd have little to live for. She denies being depressed claiming she 'doesn't agree with depression - I have no time for self-pity!' She reports drinking 2-3 glasses of sherry at night. She is very worried about 'electric shock therapy' which she hears that doctors use to treat 'old people with problems' because she considers it 'torture'.
D/O: Psychiatry/Health Psychology (•••), General Practice (••)
PTT: Mental health
Medically unexplained physical symptomsWhile on your Medicine attachment you are asked to see a 28 year old NZ European woman who is suffering from chest pains. She is in the Radiology Department undergoing an X-ray when you come to see her on the ward so you decide to review her electronic patient record. You are shocked to find she has a huge number of presentations with visits to multiple outpatient clinics and many discharge summaries from different hospitals. You also have time to review her blood tests and ECG which are all unremarkable. When she has returned from her X-ray you go to speak with her. She explains that she is constantly unwell and no one has been able to correctly diagnose her. She says the problems have been present for years and can present in a variety of different ways; she has presented with abdominal pain, dyspepsia, pelvic pain and headaches. Things definitely got worse when she lost her job 3 years ago.
D/O: General Practice (•••), Psychiatry/Health Psychology (•••)
PTT: Mental health
MenopauseA 52 year old NZ European woman presents to her GP with hot flushes, night sweats, mood swings and lack of energy. These complaints have been present for the last 3 months and are increasing in intensity and severity. Her menstrual cycle is irregular with intervals between 1 and 3 months.
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Endocrinology (••)
PTT: Women's health
Musculoskeletal lumpA 15 year old Samoan boy presents, to a specialist clinic you are attending, with a slowly enlarging lump on his left proximal tibia. It has recently become mildly tender but there are no other signs of inflammation or infection. Subsequent medical evaluation reveals this to be a malignant musculoskeletal tumour.
D/O: Musculoskeletal System (•••), Oncology (•••), Orthopaedics (•••), Paediatrics (•••), Palliative Medicine (•••)
PTT: Musculoskeletal
Neck injuryA 24 year old NZ European female is brought into the Emergency Department after a high-speed motor vehicle crash. She was an unrestrained front-seat passenger. She is thought to have sustained significant head and neck injuries.
D/O: Emergency Medicine (•••), Ethics (•••), Musculoskeletal System (•••), Neurosurgery (•••), Orthopaedics (•••)
PTT: Musculoskeletal, Neurological
Neck lumpA 72 year old NZ European man comes to the Pre-Admission Clinic before a knee replacement operation. During the examination you notice a lump in his neck. He says that he has not noticed it and feels well.
D/O: Anatomical Pathology (•••), Endocrinology (•••), General Practice (•••), Otorhinolaryngology (•••), General Surgery (••), Haematology (••)
PTT: ENT
Needlestick injuryA final year NZ European medical student sustains a needlestick injury whilst scrubbed up with his consultant general surgeon. The patient is a New Zealander undergoing an elective procedure. He is concerned that he may have been exposed to an infectious disease.
D/O: Emergency Medicine (•••), Infectious Diseases (•••)
PTT: Infectious disease
Neonatal stridorA 3 week old Cook Island Māori infant is seen by her GP. The Plunket nurse is concerned about stridor, which has been present almost all the time since birth.
D/O: Otorhinolaryngology (•••), Paediatrics (•••), Respiratory System (•••), General Practice (•)
PTT: Child health
Neuromuscular disease / generalised muscle weaknessA 36 year old NZ European woman presents to her GP with generalised fatigue, weakness and dysarthria. She has no significant past medical history.
D/O: Nervous System (•••), Neurology (•••), Palliative Medicine (•)
PTT: Neurological
Non-specific back painA 50 year old NZ European male presents with low back pain of two weeks duration. His symptoms interfere with his work, personal life and nighttime rest.
D/O: General Practice (•••), Musculoskeletal System (•••), Nervous System (•••), Neurology (•), Orthopaedics (•)
PTT: Musculoskeletal
ObesityA 42 year old NZ European woman comes for a follow-up GP visit because she recently had blood tests that have shown abnormal liver function. She is obese and complains of irregular periods and fatigue for a few months. She feels her mood is low. Her blood pressure is 156/94 mmHg and there is glucose in her urine.
D/O: Digestive System (•••), Endocrinology (•••), Gastroenterology & Hepatology (•••), General Practice (•••), General Surgery (•)
PTT: Digestive
OsteomyelitisA ten year old Niuean child presents with a 2 day history of limp from a painful knee. He had chicken pox over a week ago, weighs 70 kg and is 140 cm tall.
D/O: Infectious Diseases (•••), Microbiology (•••), Musculoskeletal System (•••), Orthopaedics (•••), Paediatrics (••)
PTT: Musculoskeletal
Out of hospital cardiac arrestA 60 year old Indian man is brought to hospital by ambulance. He had collapsed whilst out shopping and a bystander started cardiopulmonary resuscitation (CPR) straight away as he had no pulse. He was picked up by the paramedics after 12 minutes of CPR and took 8 minutes to arrive at the Emergency Department resuscitation room, where you are a medical student shadowing the Emergency Department registrar.
D/O: Cardiovascular System (•••), Emergency Medicine (•••), Intensive Care Medicine (•••), Ethics (••)
PTT: Seriously ill patient
Overdose in a child or adolescentA 2 year old NZ European girl is brought to Emergency Department. She has been drowsy since her mother found her with an empty bottle of paracetamol syrup at home.
D/O: Clinical Pharmacology (•••), Paediatrics (•••), Emergency Medicine (••)
PTT: Digestive
Painful hands in the coldA 37 year old NZ European woman presented to her GP with a recent history of painful 'weak' hands. She has also been quite lethargic the last few weeks, complains of low mood and aches all over her body. She has had Raynaud's phenomenon since her early teens which she manages by avoiding cold exposure and she is not prescribed any regular medications. On examination she has a positive Tinel's sign bilaterally.
D/O: Musculoskeletal System (•••), Rheumatology (•••)
PTT: Musculoskeletal
PancytopeniaA 28 year old man presents to the Emergency Department after being unwell with fever (temperature up to 39.7°C), extreme lethargy, and petechial haemorrhages in his skin for the last 5 days. He is usually fit and well. While he is being assessed, his blood pressure drops to 80/55 mmHg and his heart rate climbs to 134 beats per minute. His full blood count shows marked pancytopenia with haemoglobin 76 g/L, platelets <10 x 109/L, and no detectable segmented neutrophils. In the blood film a number of large, immature cells are observed.
D/O: Haematology (•••), Oncology (•)
PTT: Blood and lymph
PanhypopituitarismA 30 year old South African man sees his GP because he is feeling very tired and has reduced libido. He recently failed his vision test when renewing his driver's licence.
D/O: Endocrinology (•••), Neurology (•), Neurosurgery (•)
PTT: Homeostasis
Patient with jaundiceA 67 year old Cook Island Māori man presents to his GP after his wife commented that he had 'gone yellow'. He has recently been feeling fatigued and suffers from bouts of abdominal pain, especially after eating. The GP asks if you can take a history before they see the patient. You speak to him and he tells you that his stool is pale and his urine is dark.
D/O: Digestive System (•••), General Surgery (•••), Gastroenterology & Hepatology (••)
PTT:
Penetrating chest traumaA 23 year Indian medical student is brought by ambulance to the resuscitation room of the Emergency Department after a high-speed road traffic crash. He has major injuries including a fence post lodged in his chest. There is evidence of splenic trauma.
D/O: Emergency Medicine (•••), General Surgery (•••), Respiratory System (•••), Ethics (••)
PTT: Seriously ill patient
Perianal pathologyA 27 year old Chinese/Samoan man presents to the General Surgical Clinic with bleeding from his anus and pain on passing a bowel motion. He has noticed this for the past 6 months and has had occasional constipation. He has never experienced faecal incontinence. The referral letter from his GP also indicates some fatigue and weight loss.
D/O: Digestive System (•••), General Surgery (•••), General Practice (••), Gastroenterology & Hepatology (•)
PTT: Digestive
Personality disorderYou are on your Emergency Medicine placement. You see a 36 year old single NZ European man who is a frequent attender at the Emergency Department. He has presented following multiple cuts to both wrists; a repeated presentation. He reports that his mood is low but this is not consistent with his affect. He appears irritable and sensitive at times. Poor relationships existed with his parents and three siblings; he states ‘they have given up on me’. He was inconsistent when asked about his personal safety, suggesting admission would be safest. He had a history of childhood sexual abuse by an uncle. He reported problematic alcohol use. Current medications include antidepressant, mood stabiliser and antipsychotic medications. Attendance at community clinics has been erratic with multiple non-attendances. With the patient's consent, you contact his parents who are relieved to have received the phone call. They had been worried about their inability to contact him; they report extensive involvement and support of their son.
D/O: Psychiatry/Health Psychology (•••), General Practice (••), Emergency Medicine (•)
PTT: Mental health
Pimples and rash on the faceA Samoan woman of 17 years presents to her GP with a red rash on the face with spots. She has become very self-conscious and uses makeup to cover the blemishes.
D/O: Dermatology (•••), General Practice (•••)
PTT: Skin
PneumoniaYou visit an 80 year old NZ European woman with the GP you are shadowing. She has a fever and is coughing up purulent sputum. She is in a private hospital because of advanced dementia and has been a resident for the past 3 years. A mobile chest X-ray taken in the private hospital shows 'confluent shadowing in the left lower lobe and a left-sided pleural effusion'. The GP sends her to the local Emergency Department and contacts her family. The patient has an advance directive stating that if she becomes very unwell she should not be 'kept going by machines', although her family is not comfortable with letting her die at present.
D/O: Geriatric Medicine (•••), Infectious Diseases (•••), Microbiology (•••), Respiratory Medicine (•••)
PTT: Respiratory
PolycythaemiaA 54 year old man presents to his GP with headache and lethargy for 2 months. He is overweight with a body mass index (BMI) of 32, and has been smoking a packet of cigarettes each day for the last 20 years. No abnormalities are detected on neurological examination but on examination of the abdomen you can tip the edge of the spleen on deep inspiration. A full blood count shows an elevated haemoglobin of 203 g/L and elevated haematocrit of 0.61. The WBC is normal but platelets are elevated at 603 x 109/L.
D/O: Haematology (•••), Respiratory Medicine (•)
PTT: Blood and lymph, Respiratory
Postmenopausal bleedingA 55 year old Indian woman presents to her GP complaining of lower abdominal pain and bloating. Her periods stopped 14 months ago but recently she has had some vaginal bleeding. Her body mass index (BMI) is 32kg/m2
D/O: Obstetrics & Gynaecology (•••), Oncology (••), Reproduction & Development (••)
PTT: Women's health
Postoperative careAn 80 year old NZ European woman is on the orthopaedic ward after a complicated operation to fix her fractured hip. She is nauseated, her catheter is no longer draining urine and she is in a lot of pain.
D/O: Anaesthesiology (•••), Cardiovascular System (•••), Renal Medicine (•••)
PTT: General duties, Homeostasis
Postoperative complicationsA 75 year old Chinese woman had an anterior resection (large bowel operation) 4 days ago. She develops fever, abdominal pain and has not opened her bowels since surgery. She has an intravenous cannula in her forearm and one in her foot. She also has an indwelling urinary catheter. Her heart rate is 130 beats per minute, her blood pressure has fallen to 90/50 mmHg, and her temperature is 38.3°C. She is breathing rapidly. You are the on call junior doctor and are asked to review her.
D/O: Cardiovascular System (•••), Digestive System (•••), General Surgery (•••), Infectious Diseases (•••), Ethics (•)
PTT: General duties, Homeostasis
Postpartum careA 24 year old Māori woman presents to her GP with vaginal bleeding 5 weeks after the spontaneous vaginal birth of her healthy baby boy. She is tired, tearful and finds it difficult to bond with her son because she's feeling so 'low'. She stopped breast feeding 2 weeks ago due to breast pain.
D/O: Obstetrics & Gynaecology (•••), Psychiatry/Health Psychology (•••), Reproduction & Development (•••), General Practice (••)
PTT: Mental health, Women's health
Pre-admission and surgical risk assessmentA 69 year old Māori woman attends her appointment at the Surgical Pre-admission Clinic. She is due to have her gallbladder removed. She has had a lot of health problems in the past, including heart and lung disease. However, she has had recurrent bouts of biliary colic and is keen to have the operation.
D/O: Anaesthesiology (•••), Digestive System (•••), General Surgery (•••)
PTT: General duties, Homeostasis
Pregnancy diagnosisWhilst on attachment in a GP clinic you see a NZ European 15 year old who has not had a menstrual period for 2 months. She feels unwell, particularly first thing in the morning. She is healthy and has a regular 30 day menstrual cycle. She has never visited the GP without her parents before.
D/O: General Practice (•••), Obstetrics & Gynaecology (•••), Reproduction & Development (•••)
PTT: Women's health
Preoperative assessment and managementA 74 year old NZ European woman with diabetes is admitted for removal of a bowel tumour, and will require a general anaesthetic. You are on your anaesthetic attachment and are shadowing the anaesthetic registrar. You both go to see the patient preoperatively to assess her fitness for surgery and plan the anaesthesia.
D/O: Anaesthesiology (•••), Cardiovascular System (••), Endocrinology (••), Respiratory System (••)
PTT: Homeostasis
Pupil abnormalityA 42 year old NZ European man presents after one of his friends noticed that his pupils were different sizes (anisocoria). There is no history of pain or trauma and vision is 'normal' in both eyes.
D/O: Ophthalmology (•••), General Practice (••)
PTT: Eyes
Rash on extensor surfaces and joint painsAn 45 year old NZ European man, who is obese, hypertensive, and smokes cigarettes, goes to see his GP about a rash. It has been present for some 20 years on his elbows and knees but is now becoming widespread. This rash bothers him a lot as he feels it is unsightly. On further questioning it becomes apparent that he experiences joint pains of the fingers, wrists and ankles.
D/O: Dermatology (•••), Rheumatology (•••), Immunology (••)
PTT: Musculoskeletal, Skin
Reactive arthritisA 22 year old NZ European man presents to the Emergency Department with knee and ankle pain. He fell down the steps at home during the weekend. Further history reveals he has had burning pain on urination for over a week. On examination he has redness of the eyes, a swollen left knee and tenderness at the heels.
D/O: Musculoskeletal System (•••), Rheumatology (•••), Immunology (••), Infectious Diseases (•)
PTT: Musculoskeletal
Rectal bleedingA 55 year old NZ European man presents to his GP complaining of passing blood when he is passing a bowel motion. You are the trainee intern attached to the clinic and are asked to see him before the doctor. He is concerned because his father was diagnosed with bowel cancer in his 50's. Your own grandfather died of bowel cancer last week.
D/O: Anatomical Pathology (•••), Digestive System (•••), General Practice (•••), General Surgery (•••), Medical Genetics (•••), Oncology (•)
PTT: Digestive
Rest home resident with itching and rashYou have been asked to visit an 81 year old NZ European man with dementia in hospital level care. The nursing staff report that he has become agitated in the last 3 months and has developed an extensive rash that is most severe on the trunk and in the inguinal flexures.
D/O: Dermatology (•••), General Practice (•••), Infectious Diseases (•••)
PTT: Skin
Risk assessment in early pregnancyA 38 year old NZ European woman presents to her GP as she has not had a period for 7 weeks. She has a positive pregnancy test at the clinic. When you examine her, you note a blood pressure of 135/85 mmHg and a body mass index (BMI) of 34.
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••)
PTT: Women's health
Secondary hypertensionA 35 year old NZ European woman visits her GP as she wants to start the oral contraceptive pill. You are asked to take her blood pressure and it is 180/105 mmHg. The GP looks back through her records and notes that her blood pressure was as high as this last time she came for an insurance medical.
D/O: Endocrinology (•••), General Practice (••), Renal Medicine (••), Obstetrics & Gynaecology (•)
PTT: Homeostasis
Self-harmYou are accompanying the Emergency Department registrar when a 24 year old NZ European woman is brought in by a friend. She is drowsy but adamant that she does not want to be in the hospital. Her friend informs you that she was found surrounded by empty paracetamol packs and an empty bottle of vodka. The friend is unable to tell you how long ago she took the pills but they report that she does suffer from depression (though isn't sure if she is prescribed antidepressant medication). When you approach the patient she becomes irritable and demands to leave the hospital, yelling at you that she does not need treating.
D/O: Emergency Medicine (•••), Psychiatry/Health Psychology (•••), Clinical Pharmacology (•)
PTT: Mental health
Shoulder painA 53 year old NZ European female presents with pain in her right shoulder that is worse with movement and restricts her range of motion. She states the pain has been present for the past 6 months and has developed gradually. It has become worse this week after she had a minor fall. The pain is now affecting her occupation as a bartender and causing her to have multiple days off work.
D/O: Musculoskeletal System (•••), Orthopaedics (•••), Rheumatology (•••)
PTT: Musculoskeletal
Skin and soft tissue infectionA 55 year old NZ European man, who is overweight, attends his GP's practice with a painful red rash across his left foot. His foot is warm and swollen and he has an antalgic gait.
D/O: Dermatology (•••), Infectious Diseases (•••), Microbiology (•••), General Surgery (••), Orthopaedics (•)
PTT: Infectious disease, Skin
Skin tumoursA 78 year old NZ European woman presents to her GP with a few months' history of a lesion on her nose. She believes it has slowly been growing since it was first noticeable. It has bled once or twice. As a lifelong keen gardener, she has always enjoyed an outdoor lifestyle.
D/O: Dermatology (•••), General Surgery (•••), Plastic Surgery (•••), Anatomical Pathology (••), General Practice (••), Oncology (•)
PTT: Skin
SLE / fatigue / pain and swelling in the handsA 19 year old Māori woman presents to her GP with painful swollen hands and lethargy. Examination reveals a malar (butterfly) rash. Further investigation demonstrates lymphopenia, an antinuclear antibody (ANA) titre 1:160 (homogenous pattern) and mild proteinuria.
D/O: Musculoskeletal System (•••), Renal Medicine (•••), Rheumatology (•••), Immunology (••)
PTT: Musculoskeletal
Sore throat management in the New Zealand contextA Māori mother brings her 9 year old son to the drop-in sore throat clinic in Dargaville after he complained of a sore throat for a few days. His sore throat is improving and on clinical examination he does not have any coryzal symptoms or fever currently. His mother says that her older son had treatment for “strep throat” a few weeks ago and is allergic to penicillin.
D/O: Infectious Diseases (•••), Microbiology (•••), General Practice (••), Immunology (••), Paediatrics (••)
PTT: Blood and lymph, Child health, Infectious disease
Space occupying lesion / progressive unilateral weaknessA 48 year old Māori man presents with progressive left sided weakness. His partner tells you that he has been increasingly difficult to live with over the last few months with inability to make decisions and is becoming increasingly forgetful.
D/O: Nervous System (•••), Neurology (•••), Neurosurgery (•••), Anatomical Pathology (••), Oncology (••), Infectious Diseases (•)
PTT: Neurological
Stable anginaYou are on your GP placement and you are asked to see a 69 year old Tongan man who has a background of hypertension. He complains of chest pain when he walks and comments that it is particularly bad when he walks up hills or stairs. It gets better when he rests. You note that he is obese.
D/O: Cardiology (•••), Cardiovascular System (•••)
PTT: Cardiovascular
Stroke / TIA / sudden onset unilateral weaknessA 55 year old NZ European man collapsed at work with sudden onset of right-sided weakness. His wife tells you that recently he has had short episodes where he 'can't find the right words'. He has hypertension that is reasonably well controlled and has been a lifelong smoker.
D/O: Nervous System (•••), Neurology (•••), Radiology (•••)
PTT: Neurological
Sudden loss of vision and headacheAn 83 year old NZ European woman presented with a 1 month history of new onset headache, jaw claudication and one day history of sudden loss of vision in the left eye. On examination, she was noted to have reduced vision in the left eye of count fingers only, a left relative afferent papillary defect, constricted visual fields on confrontation testing and a pale swollen left optic nerve. She underwent a temporal artery biopsy which revealed significant inflammation.
D/O: General Practice (•••), Ophthalmology (•••), Rheumatology (••)
PTT: Eyes
Sudden onset severe headacheA 45 year old NZ European woman presents to the Emergency Department with the worst headache of her life. She was sitting at home watching the television and the headache came 'out of the blue'. She is now in the resuscitation room and finds the light very uncomfortable. Her blood pressure is noted to be 180/120 mmHg.
D/O: Emergency Medicine (•••), Nervous System (•••), Neurosurgery (•••)
PTT: Neurological
Sudden onset shortness of breathA 17 year old Tokelauan woman, with a background of asthma, is brought into the Emergency Department after becoming suddenly short of breath with associated wheezy breathing. She is distressed but speaking in long sentences.
D/O: Respiratory Medicine (•••), Respiratory System (•••), Immunology (••)
PTT: Respiratory
Sudden painless loss of visionA 74 year old South African male presents with sudden painless loss of vision in his right eye. This occurred shortly after waking. He has no associated symptoms and no past ocular history of note. His medical history includes hypertension, atrial fibrillation, and he is a smoker. On examination, the best visual acuity was measured at 'count fingers only' in the right eye and 6/9 in the left eye. There was a right relative afferent pupillary defect. On ophthalmoscopy of the right eye, there was narrowing of the retinal arterioles, whitening of the retina and a cherry-red spot at the macula.
D/O: Ophthalmology (•••)
PTT: Eyes
Superficial injuriesA 64 year old NZ European woman attends the Emergency Department after cutting her hand when the knife slipped while slicing vegetables. She is expecting to have sutures. You are a medical student who goes to see the patient with the junior doctor, who asks you to take a history.
D/O: Emergency Medicine (•••)
PTT: Skin
Swollen and tender jointsA 40 year old Fijian Indian woman presents to her GP with a several week history of painful, stiff joints in her hands and feet. It takes her over an hour in the morning to 'get going'. She is feeling much more tired than usual and has lost 3 kg in weight over the last 2 months. Clinical examination revealed 22 swollen joints (all the MCP, PIP and wrist joints) and 22 tender joints (all the MCP, PIP and wrist joints). The metatarsal squeeze test was positive.
D/O: Musculoskeletal System (•••), Rheumatology (•••)
PTT: Musculoskeletal
TeachingTowards the end of a teaching session with medical students, you are discussing one of the patients you took the students to see; a 63 year old Māori man with chronic obstructive pulmonary disease. One of the students starts questioning why the hospital is pouring resources into helping this man when he can't be bothered looking after himself; he continues to smoke and it is claimed he does not take his medications as recommended. The student observes that many Māori are like this, and wonders what is wrong with their culture that makes them so non-compliant and fatalistic.
D/O: Hauora Māori (•••)
PTT: General duties
Tremor and parkinsonismA 68 year old NZ European man presents complaining of trembling in his right hand progressing over the last 2 years. His wife has noticed that his writing has got worse and that he is 'slowing down', especially when getting up from his chair. Past medical history includes gastro-oesophageal reflux disease and hypertension, for which he takes omeprazole, metoclopramide and bendrofluazide.
D/O: Nervous System (•••), Neurology (•••), Geriatric Medicine (••), Ethics (•)
PTT: Neurological
Type 1 diabetes mellitusA 35 year old NZ European male with a 15 year history of type 1 diabetes mellitus presents with repeated low blood glucose levels. In the past he felt sweaty and irritable when his glucose was low, but these symptoms seem to have stopped. He has nearly lost consciousness on a couple of occasions and is worried that this might happen when driving.
D/O: Digestive System (•••), Endocrinology (•••)
PTT: Digestive, Homeostasis
Type 2 diabetes mellitusA 53 year old Māori man, who is obese, visits the diabetic nurse for a routine review. You are asked to see him first. He says he feels well and is managing his medications but complains that no matter what he does he continues to gain weight and has been unsuccessful in his attempts to quit smoking.
D/O: Endocrinology (•••), General Practice (•••), Renal Medicine (•••)
PTT: Homeostasis
Unexplained loss of consciousnessAn 87 year old NZ European woman is brought to the Emergency Department by ambulance. She is unconscious and was found on the floor by a cleaner. You have no other history.
D/O: Cardiology (•••), Cardiovascular System (•••), Emergency Medicine (•••), Nervous System (•••), Neurology (•••), Respiratory Medicine (•), Respiratory System (•)
PTT: Cardiovascular, Neurological
Unwell neonateA NZ European baby presents at 24 hours of age with grunting, respiratory distress and poor feeding. The pregnancy was unremarkable but there was prolonged rupture of membranes before the baby was born at term.
D/O: Paediatrics (•••), Respiratory System (•••), Emergency Medicine (••)
PTT: Child health, Seriously ill patient
Upper airway diseaseA 65 year old Chinese man is seen by a GP on a house call. His breathing has become more difficult over time. Now he is making a harsh noise when he breathes in.
D/O: Emergency Medicine (•••), Otorhinolaryngology (•••), General Practice (••), Ethics (•)
PTT: Seriously ill patient
Upper gastrointestinal bleedingA 45 year old Indian man presents after vomiting blood. He is pale and feels awful. He is rushed to the Emergency Department by ambulance.
D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Emergency Medicine (••)
PTT: Digestive, Seriously ill patient
Upper respiratory tract symptomsA 4 year old NZ European girl is brought to your practice by her mother because she has had a 'runny nose' for two days and is now complaining of a sore throat. She has presented to the practice with similar problems twice in the last 6 months. On both previous occasions another doctor has prescribed antibiotic treatment (amoxycillin/clavulanate on one occasion and cefaclor on another). Her mother is concerned that there may be something wrong with her immune system. The child is up to date with all her immunisations.
D/O: General Practice (•••), Infectious Diseases (•••), Otorhinolaryngology (•••), Paediatrics (•••), Respiratory Medicine (•••), Respiratory System (•••), Microbiology (••)
PTT: Child health, Infectious disease, Respiratory
Urinary incontinence in womenA 53 year old NZ European woman presents to her GP with a 2 year history of losing control of her bladder. She had three vaginal births. She has to wear urinary incontinence pads daily. This has had a negative impact on her work and mood.
D/O: Genitourinary System (•••), Obstetrics & Gynaecology (•••), Urology (••)
PTT: Women's health
Vaginal bleeding late in pregnancyA 26 year old NZ European woman presents to the Emergency Maternity Assessment area, in her second pregnancy. She is 31 weeks pregnant and has developed vaginal bleeding and lower abdominal pain. She had a Caesarean section for her first pregnancy.
D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Haematology (••)
PTT: Women's health
Valvular heart diseaseA 38 year old Māori woman sees her GP because she is getting very short of breath, even at rest. On examination the GP hears a cardiac murmur. They ask you to listen and suggest a management plan.
D/O: Cardiology (•••), Cardiovascular System (•••)
PTT: Cardiovascular
Watery eye in an infantAn 8 month old NZ European child presents with a history of a watery, sticky right eye.
D/O: Ophthalmology (•••), Paediatrics (•••)
PTT: Eyes
Worsening shortness of breathA 70 year old NZ European man presents to your clinic due to worsening shortness of breath on exertion. You arrange a chest X-ray which shows a diffuse abnormality of both lung fields.
D/O: Respiratory Medicine (•••), Respiratory System (•••), Radiology (••)
PTT: Respiratory
TitleDescription