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INSTRUCTIONS FOR THE DOCTOR

This is a long case.

This consultation may be conducted as if it is more than one session.

Please take a history from Vinay. Examination findings are available from the facilitator. When you are ready, outline your diagnostic impressions and initial management to Vinay. Investigation results will then be available from the facilitator. Discuss these results with Vinay, together with any further management, if required.

Scenario

Vinay Singh is a 35-year-old management consultant whom you’ve seen a few times for minor ailments. His wife and children are regular patients of yours. His wife rang the surgery this morning to say Vinay is sick with the flu and has a strange non-itchy rash on his palms and soles. Upon arrival Vinay is put in a spare consulting room for quarantine purposes. His wife and children are in the waiting room.

The following information is on his summary sheet:

  • Past medical history

  • Nil significant

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • None recorded

  • Social history

  • Married, two children (aged four and six), management consultant.

INSTRUCTIONS FOR THE PATIENT, VINAY SINGH

A week ago you started feeling unwell—joint pains, fatigue, malaise—as though you were getting the flu. You weren’t particularly worried until a rash developed on your palms and soles. It is not itchy or painful. You looked on the internet and self-diagnosed hand, foot and mouth disease but the rash does not look like the picture on the internet and has now started spreading to your chest. Having returned from a business trip to the northern United States a month ago, you were also wondering about Lyme disease.

On specific questioning

You travel overseas about five times per year, for one to two weeks, to either the United States or South-East Asia for work. Your family does not accompany you on these trips. Not uncommonly on these overseas trips you’ll have sex with male and/or female sex workers (vaginal, oral and anal—receptive and penetrative). You use condoms ‘most’ of the time. You have never had a sexually transmitted infection (STI) screening or any previous STI (to your knowledge).

You see these trips as well-deserved opportunities to let your hair down and have some fun. You compartmentalise your life: you see yourself as a ‘different person’ when working overseas and believe that your trips away enhance your ability to be a good husband and father, as they allow you to ‘blow off steam’. You categorically see yourself as a heterosexual loving father and husband. You deny any mood problems or guilty feelings—while life has its ups and downs, you see yourself as a relatively happy and confident person.

You were born in India and have lived in Australia since the age of 10. You are not religious and don’t ...

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