Each issue of the Australian Journal of General Practice (AJGP) has a focus on a specific clinical or health topic. Many GPs find the entire issue of interest and of relevance to their practice; some GPs find one or more articles in the journal relevant.
You can use AJGP for your CPD. If you want to use the entire issue for CPD, you must work your way carefully through each article in the issue and complete the Clinical challenge. When you do this, take time to read the articles carefully and critically, and think carefully about how you might adjust your practice in response to what you have learned.
We recommend that you access AJGP, the articles and the Clinical challenge through gplearning (Activity ID: 520279). Then, when you complete the articles and the Clinical challenge, your CPD hours are automatically credited to your CPD account. If you work through the full issue of AJGP and complete the Clinical challenge, you will receive 10 CPD hours (five hours’ Educational Activities and five hours’ Reviewing Performance).
If you do not want to do the full AJGP issue, and you prefer to select one or more articles to read, you can QuickLog the CPD hours directly through your myCPD dashboard. As guidance, each article in AJGP would provide 1–2 CPD hours, split half Educational Activity and half Reviewing Performance.
These questions are based on the Focus articles in this issue. Please choose the single best answer for each question.
Case 1
Jerry, a retired general practitioner (GP) aged 84 years, reflects on his career in general practice to currently enrolled GP registrars.
Question 1
Two generalist skills that assist effective collaborative deliberation include owning yourself and:
A. social connection
B. capable engagement
C. time management
D. sustainable practice
Question 2
For the clinician, calm sense making involves clinical wisdom (phronesis), the discipline of tolerating uncertainty and avoiding premature:
A. categorisation
B. prescribing
C. goal setting
D. termination
Case 2
Kaleb, a man aged 44 years, presents for a routine annual health check up to your clinic.
Question 3
Barriers to the access of healthcare services for men may include attitudes towards health and health services utilisation, a lack of ‘male-friendly’ healthcare settings and concepts of:
A. care
B. cost
C. masculinity
D. enterprise
Question 4
The leading cause for mortality in men is:
A. prostate cancer
B. bowel cancer
C. heart disease
D. suicide
Case 3
Ashwin, your senior registrar, would like to discuss the potential for artificial intelligence (AI) systems to improve clinical practice at your next tutorial.
Question 5
An AI approach, known as deep learning, has demonstrated success in detection and:
A. diagnosis
B. accuracy
C. classification
D. clarity
Question 6
In improving clinical practice, AI may be hampered by the risk of replicating:
A. biases
B. patterns
C. data
D. systems
Case 4
Yong, a new practice owner and GP registrar supervisor aged 44 years, is keen to implement strategies to provide culturally safe care to all patients.
Question 7
Decolonisation in education settings seeks to critique practice through counteracting:
A. biomedicine
B. facts
C. opinions
D. stereotypes
Question 8
Supervisor relationship can influence attitudes and beliefs, and promote decolonised approaches through:
A. direct instruction
B. role modelling
C. practice software
D. goal setting
Case 5
Priya, a female domestic violence victim aged 35 years, presents for ongoing review for severe depression.
Question 9
Research studies demonstrate that if women have negative experiences when accessing mental health services, this can affect the likelihood of disclosing:
A. supports
B. distress
C. identity
D. poverty
Question 10
Mainstream mental health screening tools are not helpful for some women due to a deductive approach that reduces opportunities for active:
A. integration
B. deliberation
C. recruitment
D. listening
These questions are based on the Focus articles in this issue. Please write a concise and focused response to each question.
Case 1
Jerry, a retired general practitioner (GP) aged 84 years, reflects on his career in general practice to currently enrolled GP registrars.
Question 1
Define what is meant by the term ‘generalism.’
Question 2
List the four priorities of the craft of ‘generalism.’
Question 3
List five practical skills associated with the priorities of the craft of ‘generalism.’
Case 2
Kaleb, a man aged 44 years, presents for a routine annual health check up to your clinic.
Question 4
List four reasons for engaging men in sexual and reproductive health.
Case 3
Ashwin, your senior registrar, would like to discuss the potential for artificial intelligence (AI) systems to improve clinical practice at your next tutorial.
Question 5
Define what is meant by the term ‘algorithmic bias.’
Question 6
Define what is meant by the term ‘clinician bias.’
Question 7
Define what is meant by the term ‘availability bias.’
Case 4
Yong, a new practice owner and GP registrar supervisor aged 44 years, is keen to implement strategies to provide culturally safe care to all patients.
Question 8
List two approaches that supervisors could employ to promote culturally safe practice.
Case 5
Priya, a female domestic violence victim aged 35 years, presents for ongoing review for severe depression.
Question 9
List two barriers that reduce the likelihood that practitioners will explore the links between trauma and mental health.
Question 10
State the aim of a feminist perspective on mental health.
June 2023 Multiple choice question answers
Answer 1: A
Low dairy intake in pregnancy is associated with small-for-gestational-age neonates and spontaneous abortion and maternal bone fragility.
Answer 2: D
Healthy Bones Australia recommends 1000 mg/day of calcium, equating to four serves of dairy.
Answer 3: B
The principles of trauma-informed care include safety, trust, choice, collaboration, respect for diversity and empowerment.
Answer 4: C
Withdrawal symptoms arise when a person’s brain neuroadapts to a drug; this affects the hypothalamic–pituitary–adrenal axis and amygdala.
Answer 5: C
Cessation of a drug creates acute brain stress and the dumping of key feel-good hormones, such as dopamine, serotonin and oxytocin.
Answer 6: B
Eruptive xanthoma is a significant indicator of systemic metabolic disorders, including dyslipidaemia and diabetes.
Answer 7: A
Secondary factors that contribute to hypertriglyceridaemia can include medications, obesity, alcohol abuse, uncontrolled diabetes and hypothyroidism.
Answer 8: D
Paracetamol ingestion may be associated with acute liver injury and a child should be referred to hospital for blood tests and assessment if acute ingestion exceeds 200 mg/kg.
Answer 9: B
Some individuals are at greater risk of toxicity than others due to advanced age, comorbidities, alcohol use, nutritional status (eg prolonged fasting), genetic predisposition or concurrent medications.
Answer 10: C
Pharmacokinetic complementary medicine drug interactions can alter drug absorption, metabolism, elimination and distribution.
June 2023 Short answer question answers
Answer 1
- It should be taken with water and on an empty stomach.
- It should be taken at least 30 minutes and preferably 60 minutes before the intake of any food or other medications.
Answer 2
Planning for a successful withdrawal involves four steps:
- ‘Who’: Careful patient selection
- ‘Prepare’: Optimising the dimensions of whole-person care and preparing for withdrawal
- ‘Withdrawal’: Providing supportive care during the withdrawal attempt
- ‘Follow-up’: Providing a structured aftercare program.
Answer 3
Multiple withdrawal attempts should be avoided and can result in a phenomenon called ‘kindling’, whereby neuronal sensitivity appears to increase and the severity of withdrawal symptoms such as seizures, especially for alcohol, increases with each withdrawal attempt.
Answer 4
- Significant tolerance to benzodiazepines can occur in as little as two weeks.
- Chronic benzodiazepine use is associated with pervasive cognitive impairment that persists despite withdrawal.
- Benzodiazepines, in combination with alcohol and other drugs, are dangerous and are a lead pharmaceutical responsible for accidental polysubstance overdose and death.
Answer 5
Differential diagnoses of eruptive xanthoma can include drug eruption, viral exanthem, generalised granuloma annulare and xanthogranuloma.
Answer 6
In patients who have ingested a dose of paracetamol that puts them at risk of liver injury, the liver enzyme, alanine aminotransferase (ALT), is specifically measured to determine if treatment with N-acetylcysteine (NAC) is required.
Answer 7
There is an increased risk of severe liver toxicity and death in patients who present late (>8 hours) after a paracetamol overdose, in those who take very large overdoses (>30 g) and when a modified-release paracetamol preparation is ingested.
Answer 8
Drug interactions can occur when two or more compounds taken within a certain period of time alter the pharmacokinetics or pharmacodynamics of either compound.
Answer 9
Pharmacodynamic interactions occur when the compounds have negative, additive or synergistic effects on drug targets.
Answer 10
Pharmacokinetic interactions change the systemic concentration of a compound and/or its active metabolites by altering absorption, distribution, metabolism or excretion.