OCTOBER 2025 Recalls Compilation
28 lady with family hx of BRCA2+ breast ca (mother dx @ 48yo, GM also w/ ca). No genetic testing done yet. Wants to know personal breast ca risk. Advice?
a/ ↑ risk of other cancers (eg. pancreatic) if BRCA2+
b/ 25% chance of inheriting BRCA2 from mother
92 old lady bedbound in RACF, declining, now not drinking x24h, ↓UO, no pain/distress. EOL care plan in place, only comfort care desired. Nurse asks about starting SC fluids. Hydration at EOL?
a/ Avoid SC fluids — risk of overload, limited benefit
b/ If hypo, give SC fluid bolus 250ml over 1hr
29 lady planning Fiji trip, no PMHx, all routine vax up-to-date, no travel vax before. Will be in resort + local islands. Wants travel vax + prophylaxis advice. Recommend?
a/ Typhoid, flu, Hep A, DTP vax
b/ Hep A, typhoid, cholera vax + malaria ppx
4mo w/ 2d hx of fever, cough, wheeze, ↓feeding. ↑WOB, tracheal tug, SpO2 92% RA. Bilat crackles + expiratory wheeze. Mx advice?
a/ Amox 15mg/kg PO 8hrly x5d
b/ Pred 1mg/kg PO daily x3d
84M w/ 3rd gout flare this yr, L MTP joint. PMHx: T2DM, HTN, CHF, CKD (eGFR 50). On allopurinol 200mg but urate still ↑, can’t tolerate 300mg. Mx?
a/ Treat flare w/ indomethacin, stop allo, start febuxostat
b/ Treat flare w/ colchicine, ↑ allo to 300mg/d
49M, no PMHx, found w/ BP 210/110, no sx. No improvement w/ serial BPs. Possibly missed FU for HTN yrs ago. Secondary HTN – correct stmt?
a/ Common causes: OSA, adrenal/endocrine disorders
b/ FHx ↑ risk of secondary HTN
23M MSM, no sx, wants STI screen. Last HIV test 2y ago. Recent partner has other partners, sex was protected. STI screening freq?
a/ 3 monthly
b/ 6 monthly
23M w/ sudden L groin/scrotal pain + vomiting after camp. Exam: L hydrocele, erythema, neg Prehn’s. Abd soft. Most imp dx?
a/ Torsion of the left testis
b/ Left-sided epididymitis
62M reluctant for check-up, wife concerned after MI in her brother. Asks if at ↑CV risk today. Had bloods 1y ago. Auto high CV risk factor?
a/ Systolic blood pressure 180 mmHg
b/ Diastolic blood pressure 100 mmHg
59M w/ OA, HTN, HL, gout. Has tophi, urate 0.58, eGFR normal. Starting allopurinol 50mg + naproxen. Needs target urate for titration. Target?
a/ Less than 0.30mmol/L
b/ Less than 0.40mmol/L
45M w/ 12mo hx of fatigue + MCP joint pain. LFTs deranged, ferritin + sat ↑. Found C282Y homozygous. Initial Mx advice?
a/ Weekly-fortnightly venesections
b/ Low iron diet, recheck in 3mo
56F w/ 24h hx dysuria + freq, urine nitrites + blood + WCC, E. coli sensitive to TMP. First time RBCs seen on micro. Asymptomatic post-Tx. Follow-up?
a/ Repeat urine microscopy in 6–12 wks
b/ Urology referral for cystoscopy <3mo
55F w/ COPD, 3d fever + cough w/ sputum. CXR: RLL consolidation. Has ↑RR, febrile, ↓SpO2. Red flag sign?
a/ RR 32
b/ Temp 38.5°C
98F in RACF, cognitive decline, recent delirium, now palliative care plan in place. Sudden large haematemesis, distressed, in pain. Comfort-focused care only. Immediate Mx?
a/ SC line + haloperidol, morphine, midazolam
b/ SC line + 1000ml NS over 4hrs
50F routine CST, no abdo sx, no bleeding. HPV 16/18 detected, normal cytology. No response to recall after 3mo. Next step?
a/ Send reg. mail w/ results
b/ Call police for welfare check
63M w/ 3wk chest/back rash, mild itch, unresponsive to hydrocortisone. Rash started in winter. Dx?
a/ Transient acantholytic dermatosis
b/ Seborrhoeic dermatitis
56M w/ IHD, cat owner, R index finger pain, swelling x24h, febrile. Finger red, swollen, flexed, very tender. Stopped allopurinol 6mo ago. Next step?
a/ Urgent hospital referral for drainage + IV abx
b/ PO diclofenac + discuss restarting allo
12mo F, 3d fever, irritable, vomiting. Lethargic, mottled, no rash or neuro signs. No fever source on exam. Most likely cause?
a/ Urinary tract infection
b/ Pneumonia
34F, 32w preg, 2d pleuritic CP + SOB, 1wk L calf swelling post travel. Vitals stable, mild tachycardia, SpO2 94%. Mod L leg swelling, no fever. Next step?
a/ Urgent L leg venous duplex
b/ Urgent D-dimer
15F w/ 18mo hx binge-purge, daily exercise, stable wt, short stature. Labs normal. Referred to ED clinic. Additional test?
a/ Calcium, magnesium, phosphate
b/ Faecal calprotectin
33F lawyer, wants kids later, worried freezing eggs too early. Regular periods, healthy, no PMHx. Asking if now’s too soon. True stmt?
a/ Best to freeze eggs <35yo due to ↓ egg quality
b/ Age less imp. than BMI for fertility
47M heavy smoker, ?COPD, CXR ordered. Asked what’s true re: CXR in COPD dx. Imaging accuracy for COPD. True stmt?
a/ CXR helps rule out other dx like pneumonia
b/ Hyperinflation on CXR is specific for COPD
22F given B12 inj script, later realises wrong pt called in. Found Medicare details didn’t match. You realise error. Next step?
a/ Apologise to Sarah for error
b/ Notify practice manager
33F w/ fair skin, works indoors, limited sun. Asks about Vit D and bone health. What’s the recommended Vit D level end of winter?
a/ >50nmol/L
b/ >25nmol/L
40F w/ 2d R facial droop, recent URTI. Forehead involved, normal sensation, no neuro signs. OCP use. Most likely dx?
a/ Bell’s palsy
b/ Guillain-Barré syndrome
70M w/ 1d dysuria, months of slow stream + LBP. DRE: tender enlarged prostate. Dipstick: haematuria + leukocytes. Next step?
a/ Start trimethoprim 300mg PO daily x14d
b/ Wait for MCS results before starting abx
63M w/ snoring + apnoeas, wife reports. No lab study access, home sleep study possible. On perindopril. Criteria for Medicare rebate?
a/ OSA50 >5 or STOPBANG >4 + ESS >8
b/ OSA50 >6 or STOPBANG >5 + ESS >10
35M w/ 3mo L scrotal mass, h/o torsion + orchidopexy. Nontender + enlarging. Most common testicular Ca?
a/ Germ cell tumour
b/ Leiomyosarcoma
35M park ranger, felt tap on leg, saw 2 bite marks, ?snakebite. No snake seen. Asking about main complication. Common complication?
a/ Venom induced consumption coagulopathy
b/ Myotoxicity
42M wants abx before wisdom tooth removal, prev dry socket. No PMHx, penicillin allergy. Asking for prophylaxis. Most appropriate advice?
a/ Advise abx won’t prevent dry socket
b/ Start amox/clav 875/125mg BD 2d pre-procedure