This issue of Australian Journal of General Practice (AJGP), including the articles and clinical challenge, is an RACGP Continuing Professional Development (CPD) program-approved activity (Activity ID: 457763) and is allocated a total of seven CPD hours. CPD points are self-declared.
Therefore, completion of all AJGP CPD activities equates to 77 hours per calendar year.
This includes:
• two hours’ Educational Activity: Reading the journal
• two hours’ Measuring Outcomes: Completion of the clinical challenge
• three hours’ Reviewing Performance: Self‑reflection.
Answers to the clinical challenge are published in the following edition of AJGP, and are available immediately following successful completion online at www.racgp.org.au/education/professionaldevelopment/
online-learning/gplearning.
To complete this activity, go to the RACGP website. Once logged in, click on the My Account button and select the gplearning link from the drop-down.
These questions are based on the Focus articles in this issue. Please choose the single best answer for each question.
Case 1
Costa, a man aged 63 years, presents to your clinic to obtain his repeat prescriptions for hypertension.
Question 1
Which one of the following is recommended in nature prescribing?
- verbal counselling
- intermittent fasting
- ketogenic dieting
- strength training
Question 2
Prescriptions for nature prescribing, whether written or verbal, could include the type of activity, frequency and:
- limitation
- contraindication
- duration
- indication
Question 3
Which one of the following is a facilitator of nature prescribing?
- electronic devices
- link workers
- indoor plants
- written information
Case 2
Margaret, a woman aged 91 years, presents for routine review after a recent hospital admission for urinary tract infection.
Question 4
Deprescribing is a safe and effective method of reducing polypharmacy and:
- Alzheimer’s disease
- rheumatoid arthritis
- high-risk prescribing
- restrictive lung disease
Question 5
Patient-related barriers for deprescribing includes which one of the following?
- competing priorities
- personal beliefs and attitudes
- lack of clinician time
- lack of funding
Question 6
Polypharmacy might lead to the underprescribing of which one of the following?
- complementary medications
- nutritional supplements
- sedative medications
- indicated medications
Case 3
Nazia, a woman aged 39 years, presents with chronic pain and fatigue, in the setting of fibromyalgia.
Question 7
The precise pathogenesis of fibromyalgia remains unclear, but includes which one of the following?
- thyroid hormone derangement
- chronic substance abuse
- peripheral neurogenic inflammation
- psychiatric disturbance
Question 8
Patients with fibromyalgia often experience reduced:
- chronic disease
- oral hygiene
- social engagement
- appetite
Question 9
Low-dose naltrexone might improve symptoms in patients with fibromyalgia by changing the processes of central and peripheral:
- perception
- sensitisation
- somatisation
- categorisation
Case 4
Levi, a man aged 26 years, who is a body builder, would like to discuss the adverse effects of non-prescribed performance- enhancing drugs at his next consultation.
Question 10
Extremely common side effects of non-prescribed performance-enhancing drugs include which one of the following?
- depression
- eczema
- schizophrenia
- psoriasis
These questions are based on the Focus articles in this issue. Please write a concise and focused response to each question.
Case 1
Costa, a man aged 63 years, presents to your clinic to obtain his repeat prescriptions for hypertension.
Question 1
State what is meant by the term ‘nature prescribing’.
Question 2
State the difference between ‘green space’ and ‘blue space’ interventions in nature prescribing.
Question 3
List two facilitators of nature-based prescribing.
Case 2
Margaret, a woman aged 91 years, presents for routine review after a recent hospital admission for urinary tract infection.
Question 4
Define what is meant by the term ‘prescribing cascade’.
Question 5
State what is meant by the term ‘deprescribing’.
Question 6
Define what is meant by the term ‘polypharmacy’.
Question 7
Define what is meant by the term ‘potentially inappropriate medicines (PIMs)’.
Case 3
Nazia, a woman aged 39 years, presents with chronic pain and fatigue, in the setting of fibromyalgia.
Question 8
State the mechanism of action of low‑dose naltrexone.
Question 9
List three side effects of low-dose naltrexone.
Case 4
Levi, a man aged 26 years, who is a body builder, would like to discuss the adverse effects of non-prescribed performance-enhancing drugs at his next consultation.
Question 10
List three non-medical reasons why people might self-administer performance- and image-enhancing drugs (PIEDs).
March 2023 Clinical challenge answers
Answer 1: A
The most commonly diagnosed cancer in Australia and the most commonly diagnosed cancer among Australian men is prostate cancer.
Answer 2: D
The majority of low-risk prostate cancer in Australia and New Zealand is now treated with active surveillance or watchful waiting.
Answer 3: B
The negative predictive value and sensitivity of diagnosing clinically significant prostate cancer is increased with PMSA PET scans and MRI.
Answer 4: A
If the PI–RADS score is ≥3, mpMRI followed by a targeted prostate biopsy is superior to standard biopsy for detecting clinically significant cancers.
Answer 5: C
Men who have a raised PSA (>3) should undergo a second test ensuring that sexual activity did not take place for three to four days before the test, as ejaculation can result in a false positive.
Answer 6: B
The possibility of an asymptomatic urinary tract infection should be excluded in men with a PSA >3.
Answer 7: A
The European Association of Urology (EAU) guidelines suggest that biopsy may be omitted following negative MRI results (PI-RADS ≤2) after shared decision making.
Answer 8: D
Transperineal biopsies significantly reduce the risk of sepsis compared with transrectal biopsies; however, urinary retention occurs in 1.6–24% of patients following transperineal prostate biopsy.
Answer 9: A
Studies report rates of erectile dysfunction in up to 24% of patients following transperineal biopsy; however, this is usually transient and resolves within three months.
Answer 10: C
Risk-stratified recommendations based on the European Association of Urology (EAU) guidelines suggest offering early PSA testing to men with an elevated risk of having prostate cancer, such as men aged >45 years with a family history of prostate cancer.