Case 1: Kasey Kox

INSTRUCTIONS FOR THE DOCTOR

This is a long case.

Please take a history from Kasey. When you are ready, request examination findings and the results of surgery tests from the examiner and outline your differential diagnosis. Outline your immediate investigations and negotiate a management plan with Kasey. Please answer the examiner’s questions.

The following is on her summary sheet:

• Past medical history

• Grommets as a child

• Medications

• Etonorgestrel contraceptive implant (Implanon)

• Allergies

• Nil known

• Immunisations

• As per schedule

• Family history

• Nil recorded

• Social history

• From Balgo in WA

• Moved to Melbourne last year for boarding school.

INSTRUCTIONS FOR THE PATIENT, KASEY KOX

You are a 17-year-old Aboriginal girl from Balgo in WA who has a scholarship to complete year 12 in Melbourne. Over the past few days you have been unwell with aches and pains. Five days ago, your left wrist was sore and warm. Then both wrists were affected, but they have improved.

Now your right knee has become really painful. It is difficult to walk or bend your knee so you couldn’t go to school today. You have a headache and feel thirsty.

You feel cold even though it’s warm outside. You have had no skin sores, no diarrhoea or vomiting, no abdominal pain, and no urinary symptoms.

You like boarding school but you do get homesick. You spend a lot of time on social media connecting with your family back home.

You’ve recently been at home for the holidays and, if asked, you did have a sore throat a few weeks ago. As usual your three-bedroom house was packed; there are often 12 people living there, depending on who is in the community.

Sexual health

You were sexually active with a boyfriend last year (aged 16) and would accept an STI check if offered.

You had the cervical cancer vaccines at school and haven’t had any screening tests yet.

Your periods are regular and very light since the contraceptive implant went in.

Social (home and education)

You are one of five children. Your older sister is studying medicine in Melbourne and you hope to be a teacher. You are fit and a keen Aussie rules footballer.

Drugs and alcohol

You don’t smoke.

You’ve tried marijuana and alcohol at parties but take nothing regularly.

Family history

Your dad has diabetes and kidney problems.

Your mum had a heart operation in her 30s for her valves. If asked ...