We’re excited to share this special edition of RVTS4GPs with you, featuring the recording of the recent 2019 RVTS Grand Round “Stump the Chump” with Dr Casey Parker. 

The case presented is a 16 year old girl who comes in with her Aunty. Casey is asked to unravel the puzzle.

Dr Casey Parker is based in Broome in WA and is well known for his blog and podcast broomedocs.com. He discusses various aspects of this case that need to be considered, with input from Marlene Drysdale (RVTS’s Cultural Educator) and Dr Jacki Mein (a previous RVTS registrar based in Cairns).

It was a challenging case, with an interesting discussion, and plenty of learning points.

Listen to the recording before reading further if you don’t want to have the answers before the time.

There are so many aspects to this case discussion. You may want to consider and explore these further – possibly with your supervisor if you’re a registrar.

The problem list was long and included high risk pregnancy; impaired glucose tolerance – gestational diabetes; anaemia; Acute Rheumatic Fever; secondary syphilis (as well as chlamydia and gonorrhoea). Important factors noted were the social situation; possible domestic violence and lack of supports. 

Points that were highlighted by this case to consider further:

  • The cultural context and considerations in caring for Aboriginal teenagers
  • Patients may require extensive assistance in navigating the health system
  • Establishing patient and family priorities, and aligning these with your treatment goals is necessary to achieve the best outcome
  • Consider broad differentials when there are multiple presenting complaints 
  • The more complex the presentation, the more thorough the history and examination should be, looking for important positive and negative findings based on the differentials
  • Multiple co-morbidities can and do co-exist
  • There are many considerations in managing high risk pregnancies: patient engagement is an important one
  • Recognising, diagnosing and managing Acute Rheumatic Fever
  • Recognising, diagnosing and managing secondary syphilis. 
  • If a single STI is identified, screen for multiple sexually transmitted infections
  • Determine the best place to investigate and manage complex patients: it may or may not be locally, depending on the services and expertise available
  • Identify individuals and support services who can assist in achieving the best patient outcomes in your practice

We hope that you enjoyed the discussion. Feel free to comment below. 

References and useful resources:

  1. Australian Indigenous Health Infonet – https://healthinfonet.ecu.edu.au
  2. Australian STI Management Guidelines – http://www.sti.guidelines.org.au
  3. ARF RHD Guidelines – https://www.rhdaustralia.org.au/arf-rhd-guideline
  4. Jarisch–Herxheimer reaction – https://en.wikipedia.org/wiki/Jarisch–Herxheimer_reaction