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This is a long case.

Please take a history from Tanya Hardy, who is a 23-year-old patient of your practice. Conduct any relevant physical examination and discuss an appropriate management plan with Tanya.


Tanya is a nursing student who has generally been very healthy but has presented in the past for immunisations, an episode of bronchitis and once for emergency contraception.

The following information is on her summary sheet:

  • Past medical history

  • Lower respiratory tract infection

  • Cervical screen

  • Normal this year

  • Medication

  • Ethinyloestradiol 30 mcg/levonorgestrel 150 mcg (Microgynon 30)

  • Allergies

  • Nil known

  • Social history

  • Nursing student

  • Single

  • Smokes 10–15 cigarettes per day

  • Immunisations

  • Up-to-date.


You are coming to the doctor today because you and a friend are planning a backpacking holiday after you both graduate. In two months you will go to Thailand, Laos, Vietnam and then party in the Thai islands before going to Malaysia and finishing in Singapore.

You have read about a backpacker track where you can get food and accommodation for a couple of dollars a day and alcohol is ‘super-cheap’. If asked, you are hoping to do some jungle trekking, see wild monkeys, ride an elephant, learn to ride a scooter, try scuba diving and do lots of partying.

You have never travelled overseas before and aren’t big on planning. Nothing is booked apart from your flights. You’re very excited about the trip but haven’t thought much about any health issues. You are receptive to issues the doctor raises and listen attentively to their advice, asking the sort of practical questions you think the real Tanya would ask.

Your health is good, and your only regular medication is your contraceptive pill. Your family are all healthy but live interstate.

If asked, you are not currently sexually active, having broken up with your boyfriend six months ago. You’ve heard men in Asia are very friendly and fun-loving so you’re looking forward to making new friends on your trip. You have used marijuana in the past and ecstasy on occasion when you’ve gone dancing. You’ve heard about the magic mushroom shakes you can get in Asia and can’t wait to try them.

You had various immunisations three years ago when you started nursing. You’re not exactly sure which ones, but you think they included hepatitis B, pertussis and measles/mumps/rubella. You currently smoke about 10 to 15 cigarettes a day and have done so since you started nursing. You plan to give up one day, but certainly not on your big holiday. You don’t drink alcohol every day but about once a week you go out with your friends and drink up to 10 to 12 drinks. This doesn’t really bother you, apart from ...

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