Learnings | AME-ACADEMY

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1. Scenario: A 45-year-old Aboriginal man presents for a routine check-up. He has type 2 diabetes diagnosed 5 years ago. His HbA1c is 8.5%, blood pressure is 140/90 mmHg, and his BMI is 32 kg/m². He smokes 10 cigarettes daily and drinks alcohol occasionally. He is on metformin 1000 mg twice daily but is often non-adherent. He reports a high intake of sugary drinks and fried food. He lives in a remote community with limited access to healthcare services.

Question: Which of the following are appropriate steps in the management of this patient? Select 4 options

Arrange a care plan with an Aboriginal Health Worker.

Prescribe a GLP-1 receptor agonist.

Refer for smoking cessation support.

Screen for complications, including retinopathy and nephropathy.

Discontinue metformin due to poor adherence.

2. Scenario: A 3-year-old Aboriginal boy is brought to the clinic by his grandmother. He has had persistent ear discharge for two weeks despite oral antibiotics. Examination reveals a perforated tympanic membrane with purulent discharge. The child has a history of recurrent ear infections and delayed speech development. He lives in a crowded household in a remote area.

Question: Which of the following interventions are appropriate for managing this child? Select 4 options

Refer to an ENT specialist for tympanostomy tube placement.

Prescribe topical ciprofloxacin ear drops.

Discuss improving household hygiene and reducing overcrowding.

Perform a hearing test to assess for conductive hearing loss.

Delay further management as the condition is likely to self-resolve.

3. Scenario: A 52-year-old Aboriginal woman presents for a health check. She has hypertension and hyperlipidemia but is not on regular medications. She smokes 15 cigarettes per day and reports stress related to family and financial issues. Her BMI is 34 kg/m², blood pressure is 150/95 mmHg, and her total cholesterol is 6.8 mmol/L. She lives in a regional town with a local Aboriginal Medical Service (AMS).

Question: Which of the following interventions are appropriate for reducing her cardiovascular risk? Select 6 options

Prescribe an ACE inhibitor (e.g., perindopril).

Initiate a high-intensity statin (e.g., atorvastatin).

Refer her to a smoking cessation program through the AMS.

Offer dietary counseling with a focus on traditional foods.

Screen for chronic kidney disease with eGFR and urine ACR.

Delay treatment of hypertension until lifestyle changes are trialed.

Conduct an absolute cardiovascular risk assessment.

4. Scenario: A 19-year-old Aboriginal woman presents with worsening shortness of breath, fatigue, and leg swelling over the past 2 weeks. She has a history of acute rheumatic fever at age 12 but has not attended follow-up appointments. Clinical examination reveals a pansystolic murmur at the apex, bilateral pitting edema, and a raised JVP. She lives in a remote community with limited access to healthcare.

Question: Which of the following are appropriate management strategies for this patient? Select 6 options

Perform an echocardiogram to assess the severity of valve disease.

Refer to a cardiologist for further evaluation and management.

Initiate secondary prophylaxis with regular benzathine penicillin injections.

Prescribe diuretics for symptomatic relief of heart failure.

Educate the patient about the importance of ARF prophylaxis and follow-up.

Screen her close contacts for group A streptococcal infections.

Delay initiation of prophylaxis until valve repair surgery is performed.

Discuss relocation to a larger town for better access to medical services.

5. Scenario: A 15-year-old Aboriginal boy is brought to your clinic by his school counselor due to withdrawal and poor school attendance. He has experienced family breakdown and bullying. He denies suicidal thoughts but appears tearful during the consultation. His family lives in a regional town with a strong local Aboriginal community.

Question: Which of the following are appropriate steps in managing his mental health? Select 6 options

Engage an Aboriginal Mental Health Worker in his care.

Refer to a local psychologist for cognitive-behavioral therapy (CBT).

Prescribe an antidepressant immediately to address his symptoms.

Explore his connection to culture and community supports.

Develop a safety plan, including identifying supportive adults.

Refer to Child Protective Services due to family breakdown.

Screen for substance use and its impact on his mental health.

Provide resources about Headspace, a youth mental health service.