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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Clayton’s grandmother, Shirley Dixon. When you are ready, ask the facilitator to give you the results of an appropriate examination. No further investigations are available at this time.

Outline your differential diagnosis and management plan to the facilitator. The consultation takes place as a single session.

Scenario

Clayton Dixon is an 8-year-old Indigenous boy who lives with his grandmother, Shirley. They have been in the area for several years and often attend the accident and emergency department (ED) of the local hospital or a bulk-billing medical centre in town. You have some letters summarising his presentations to the ED but have no other notes. You have seen him for boils, scabies, chest infections and discharging ears, and he has been seen for similar presentations in the ED as well. Past medications include Flopen (flucloxacillin), Amoxil (amoxycillin), Kenacomb Otic (triamcinolone acetonide, neomycin, nystatin, gramicidin), Sofradex (dexamethasone, framycetin and gramicidin), Ascabiol (benzyl benzoate) and Lyclear (permethrin).

The following information is on his summary sheet:

  • Age

  • Eight

  • Past medical history

  • Chronic suppurative otitis media

  • Recurrent boils

  • Scabies

  • Upper and lower respiratory tract infections

  • Medication

  • No regular medications

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Lives with his grandmother, Shirley.

INSTRUCTIONS FOR THE PATIENT’S GRANDMOTHER, SHIRLEY DIXON

You are Shirley Dixon, a 47-year-old married Indigenous woman who is bringing her 8-year-old grandson, Clayton, to the doctor because his ears are running again and you need more ear drops.

Clayton is assumed to be present.

Your opening line should be, ‘I’ve got my grandson, Clayton, with me, Doctor. His ear is running again.’

You often look after Clayton and his little sister, Taneka, who is six years old. His mother struggles with alcohol and drugs and for the time being is living in another city. The authorities have never had any concerns about Clayton’s welfare because you and your husband have stepped in whenever needed.

Clayton has always been thin. He has had recurrent boils, chesty coughs and runny ears. You have taken him to this clinic, another medical centre and the hospital emergency department. Currently his right ear has been running for the past two to three weeks. It’s a thick, yellow discharge that comes out and stains his pillow and sheets. He says it sometimes hurts when he has infections, but he usually doesn’t get a temperature.

If asked, Clayton’s hearing hasn’t been so good for the past few weeks. He does seem to get into trouble at school and has been suspended for poor behaviour a couple of times. He enjoys sport and playing outside with his friends but has never really liked school and doesn’t do very well.

If asked, ...

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