KFP – Migrant, refugee and asylum seeker health

Amina Djamal, aged 32, presents for a new patient health check after arriving in Australia four months ago as a refugee from Somalia. She reports increasing fatigue, poor appetite, and intermittent abdominal discomfort. She has lost 5kg unintentionally in the past three months. Her English is limited, and she attends with a female interpreter. She has not previously accessed regular healthcare.

Medications: None

Allergies: Nil known

Past history: Treated for tuberculosis in Kenya five years ago; no surgical history known

Family history: Mother died in childbirth; no known familial chronic diseases

Social history: Lives in community housing with two children; currently unemployed; limited social support

Travel history: Refugee camp in Kenya for 6 years before resettlement; had multiple episodes of gastroenteritis in the camp

Obstetric/sexual history: Two previous vaginal births; no current contraception; no STI screening recorded

Psychiatric history: Reports occasional nightmares and hypervigilance, worsened since arrival

Preventative Healthcare: Nil documented; no vaccinations recorded since arrival

Examination findings: Pale conjunctiva; BMI 18.2 kg/m²; BP 104/67 mmHg; no abdominal masses or tenderness; no peripheral oedema

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Rahimullah Zadran, aged 45, presents with persistent cough, weight loss and fatigue. He arrived in Australia as an asylum seeker from Afghanistan seven weeks ago and is currently residing in temporary accommodation provided through the Humanitarian Settlement Program. He reports that the cough has been ongoing for several months, often productive of sputum, but he denies haemoptysis. He has lost approximately 6kg in the past two months and is experiencing night sweats. He is a non-smoker and has no known allergies.

Medications: None

Allergies: Nil known

Past history: He recalls being treated for ‘chest infection’ several years ago but is unsure of details. No known history of diabetes or HIV.

Family history: No significant illnesses reported

Social history: Former agricultural labourer; travelled via Indonesia and Malaysia; lives alone; does not speak English and requires an interpreter

Travel history: Multiple refugee camps across Asia in the past 2 years, often in crowded conditions

Psychiatric history: Reports nightmares and poor sleep; not previously assessed

Examination findings: Temperature 37.6°C; BMI 20.4; no lymphadenopathy; scattered crepitations over left upper lobe

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Farida Zahra, aged 28, presents for antenatal care at 16 weeks’ gestation. She is a recent refugee arrival from Syria and this is her first presentation to Australian healthcare. She is gravida 3, para 2, and reports both previous deliveries occurred vaginally in a refugee camp with no documented complications. She has had no antenatal care this pregnancy until now. She reports occasional dizziness and fatigue. She is unsure of her vaccination history.

Medications: None

Allergies: None known

Past history: No known chronic illnesses; history of iron deficiency in prior pregnancies

Family history: Father has type 2 diabetes; no family history of congenital anomalies

Social history: Lives with husband and two children; limited English; husband interprets but prefers female healthcare workers; currently not working

Travel history: Transit through refugee camps in Jordan and Lebanon; no known exposure to TB; last travelled to Syria over 6 months ago

Obstetric/sexual history: No contraception prior to this pregnancy; both previous children born at term

Psychiatric history: Tearful when discussing displacement; has frequent nightmares; never seen a counsellor

Preventative Healthcare: Nil recorded

Examination findings: HR 88 bpm, BP 101/65 mmHg, BMI 20.8, symphysis-fundal height appropriate to dates; no oedema or murmurs; fetal heart heard with Doppler

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and care? Select four (4) from the following list:

Mustafa Al-Kazemi, aged 62, presents to your clinic with a new Medicare card and requests medications for his ‘heart and sugar’. He recently arrived from Iraq on a humanitarian visa. He is accompanied by his adult daughter, who speaks fluent English. He is unable to provide written documentation of his medical history but shows you two blister packs—one labelled ‘metformin 500mg’ and the other a beta-blocker (label unreadable). He reports chest tightness with exertion, frequent urination, and blurred vision. He has not seen a doctor since leaving Iraq nine months ago. He has been living in temporary housing with extended family.

Medications: Unknown beta-blocker, metformin 500mg twice daily (self-managed)

Allergies: Nil known

Past history: Type 2 diabetes and ‘heart problem’ (unspecified)

Family history: Brother had myocardial infarction at 58 years; mother had diabetes

Social history: Lives with family; walks 10–15 minutes daily; no alcohol; no smoking

Travel history: Transit through Jordan and Turkey; undocumented for several months prior to arrival

Preventative Healthcare: Never had bowel or prostate screening; no known vaccinations

Examination findings: BP 148/86 mmHg, HR 72 regular, BMI 29.8, no oedema; fundoscopy: early diabetic retinopathy; peripheral pulses palpable

Investigations: [Insert Image Here]

What are the most appropriate initial actions in this consultation? Select four (4) from the following list:

Lien Nguyen, aged 17, presents with her mother for a school health check. The family arrived in Australia as asylum seekers from Vietnam six months ago. Lien has missed several years of school and has been recently enrolled in Year 10. Her mother is concerned that she is ‘too quiet’ and ‘doesn’t sleep well’. Lien speaks some English but mostly communicates in Vietnamese with her mother. She denies any current medical symptoms but states she has ‘no energy’ and finds it hard to concentrate. She avoids social activities and is often tearful at home. She denies suicidal ideation. Her appetite is low and her weight has decreased over the past year.

Medications: None

Allergies: None known

Past history: Unremarkable; no hospitalisations or surgeries known

Family history: Paternal uncle had depression; mother has hypertension

Social history: Lives with parents and younger siblings; no current employment; limited social support outside family

Travel history: Long overland transit through Cambodia and Malaysia; reports family stress and food insecurity

Psychiatric history: None formally diagnosed; reports frequent nightmares and poor sleep since leaving Vietnam

Preventative Healthcare: Nil vaccinations recorded; no previous mental health screening

Examination findings: Thin appearance, BMI 17.2, pale conjunctiva; flat affect; answers questions quietly with good eye contact; no self-harm scars noted

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Abukar Warsame, aged 51, presents to your clinic after recently arriving in Australia from Somalia under the humanitarian refugee program. He has been referred for a general health assessment. He appears slightly withdrawn and speaks minimal English. An interpreter is used for the consultation. He reports persistent right upper abdominal discomfort, fatigue, and dark urine over the past few months. He denies alcohol use. He reports a past diagnosis of ‘liver infection’ in a refugee camp but received no ongoing treatment. He has not seen a doctor since arriving in Australia three months ago.

Medications: None

Allergies: None known

Past history: Diagnosed with hepatitis B in Somalia; no formal follow-up or monitoring

Family history: Father died of ‘liver cancer’; mother has hypertension

Social history: Lives with extended family; unemployed; attends mosque regularly; no smoking or alcohol use

Travel history: Prolonged time in multiple refugee camps in Ethiopia and Kenya

Preventative Healthcare: No immunisation records; no prior cancer screening; not enrolled in a GP until now

Examination findings: BP 124/78 mmHg, HR 76 bpm, BMI 23.1, no jaundice, mild right upper quadrant tenderness, no hepatosplenomegaly

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and care? Select four (4) from the following list:

Shahrzad Gholami, aged 25, attends your clinic requesting contraception. She arrived from Iran on a bridging visa six months ago and has limited access to Medicare. She speaks basic English but requests a female interpreter for sensitive matters. Shahrzad has never used contraception before and is unsure what is available. She has been in a stable relationship for two years and is sexually active but does not want children at this stage. She is concerned about confidentiality and cost, and is unfamiliar with Australian healthcare systems.

Medications: None

Allergies: Nil known

Past history: Irregular menses since menarche; no known chronic conditions

Family history: Mother has type 2 diabetes and hypertension

Social history: Lives with partner; unemployed; uncertain visa status; no private health insurance

Obstetric/sexual history: Nulliparous; no STIs diagnosed; no cervical screening ever performed

Psychiatric history: No formal diagnosis; appears anxious in clinic

Preventative Healthcare: Nil recorded; no immunisation documentation

Examination findings: Normal BMI; normal pelvic exam; no signs of infection or pathology

Investigations: [Insert Image Here]

What are the most appropriate actions to take during this consultation? Select four (4) from the following list:

Dragan Petrovic, aged 47, presents with worsening lower back pain. He is a recently arrived refugee from Bosnia and has been living in a temporary accommodation centre for the past two months. He previously worked as a construction worker but has been unemployed since arriving in Australia. He reports that the pain began years ago but has worsened with recent stress and poor sleep. He denies any recent trauma. He is hesitant to take medications and asks for ‘strong pills only if absolutely necessary’. He speaks limited English and attends with a male interpreter.

Medications: Occasionally uses over-the-counter ibuprofen

Allergies: Nil known

Past history: War-related injuries to his lower back in the 1990s; treated conservatively at the time

Family history: Non-contributory

Social history: Lives alone; sleeps poorly; eats irregularly; does not smoke or drink alcohol

Psychiatric history: No formal diagnosis, but reports nightmares, irritability, and difficulty concentrating

Preventative Healthcare: Nil vaccinations or screenings recorded

Examination findings: Tenderness over lumbar paraspinal muscles; straight leg raise negative bilaterally; reflexes and power intact; mildly antalgic gait

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Fatima Al-Rashid, aged 33, presents for review after being notified of a positive hepatitis C antibody result from her refugee health screen. She arrived in Australia from Iraq nine months ago and was screened as part of the standard refugee health protocol. She is asymptomatic and reports no known history of hepatitis C. She is monogamous, has no history of injecting drug use or tattoos, and denies receiving any blood transfusions. She has two young children and is currently breastfeeding her six-month-old.

Medications: None

Allergies: Nil known

Past history: Nil chronic illnesses; delivered both children vaginally

Family history: Nil known liver disease

Social history: Lives with husband and children; unemployed; speaks limited English; uses interpreter support regularly

Preventative Healthcare: Up to date with childhood vaccines; no cervical screening recorded

Examination findings: Normal BMI; no hepatosplenomegaly; no jaundice; vital signs normal

Investigations: Hepatitis C antibody: positive; Hepatitis B: immune; HIV: negative; LFTs: mildly elevated ALT

What are the most appropriate next steps in managing this patient? Select four (4) from the following list:

Nurcan Demir, aged 6, is brought in by her father for a general health check before starting school. The family arrived in Australia from Türkiye on a humanitarian visa five months ago. Nurcan appears shy and does not speak English. Her father reports she has not seen a doctor since leaving Türkiye. She had all her childhood vaccines according to their local schedule, but they have no written records. Her father is concerned she is underweight and not sleeping well. He denies any acute symptoms but says she has occasional nightmares and avoids playing with other children.

Medications: None

Allergies: None known

Past history: Unremarkable; no previous hospitalisations or chronic illness

Family history: Mother has mild asthma; no other known conditions

Social history: Lives with both parents and older brother; family is currently in transitional housing; father is seeking employment

Travel history: Long migration journey via refugee camps in Greece; limited access to food and clean water for several months

Preventative Healthcare: No documented immunisations; no prior hearing or vision screening

Examination findings: Height and weight below 5th percentile; BMI 14.6; pale conjunctiva; dental caries noted; behaviour shy but cooperative

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Ravi Prakash, aged 52, presents for follow-up after a positive Mantoux tuberculin skin test (TST) result performed during refugee screening. He arrived in Australia from Nepal six months ago on a humanitarian visa. He is asymptomatic and denies cough, fever, night sweats or weight loss. He works part-time at a food processing plant and lives with his adult daughter and son-in-law. He has no known history of tuberculosis or prior TB treatment. A screening chest X-ray performed at the time of his visa medical was reported as normal.

Medications: None

Allergies: None known

Past history: Hypertension, controlled with lifestyle measures

Family history: Brother treated for TB many years ago

Social history: Lives in a multigenerational household; non-smoker; no alcohol use

Preventative Healthcare: No documented vaccinations in Australia; no recent screening tests

Examination findings: Vital signs normal; BMI 24.5; no lymphadenopathy; chest clear

Investigations: TST positive at 18 mm induration; CXR (performed 6 months ago) reported as normal

What are the most appropriate next steps in managing this patient? Select four (4) from the following list:

Sofia Karam, aged 29, presents requesting advice about pregnancy planning. She arrived from Lebanon eight months ago on a spouse visa and has not previously accessed Australian healthcare. She is married, healthy, and keen to start a family soon. Sofia reports that she has never had cervical screening or pre-pregnancy blood tests. She is unsure of her immunisation history but recalls having chickenpox as a child. She takes no regular medications and has no known allergies. She is fluent in English and appears well engaged in her care.

Medications: None

Allergies: None known

Past history: Nil significant; regular menstrual cycles; no surgeries

Family history: Mother has hypothyroidism; no genetic conditions known

Social history: Lives with husband; recently started work in childcare

Obstetric/sexual history: Nulligravida; no history of STIs; not using contraception

Preventative Healthcare: No screening or immunisation records available

Examination findings: Healthy appearance; BMI 22; normal pelvic exam

Investigations: [Insert Image Here]

What are the most appropriate next steps in pre-pregnancy care? Select four (4) from the following list:

Aung Myint, aged 40, presents to your clinic requesting help with insomnia and frequent headaches. He arrived in Australia as a refugee from Myanmar nine months ago. He reports poor sleep, early morning waking, and persistent fatigue. He often feels anxious, especially in crowded places, and avoids public transport. He has no prior mental health diagnosis. He mentions that he lost several family members during the conflict and becomes tearful when discussing this. He lives alone in community housing, is unemployed, and has no regular social support. His English is limited, and a male interpreter is present for the consultation.

Medications: Occasionally uses paracetamol for headaches

Allergies: Nil known

Past history: Nil major medical conditions reported

Family history: Mother died from stroke; father deceased (unknown cause)

Social history: Lives alone; limited community connection; minimal income

Psychiatric history: No prior assessments; describes frequent nightmares and hypervigilance

Preventative Healthcare: No vaccinations recorded; no screening performed since arrival

Examination findings: Alert; tense posture; BMI 21; cardiovascular and neurological exams normal

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Mahboubeh Rezaei, aged 54, presents for review after a recent diagnosis of type 2 diabetes. She arrived in Australia 12 months ago as an asylum seeker from Iran and has recently been granted a bridging visa. She is worried about her diagnosis and asks if her condition will prevent her from remaining in Australia. She reports fatigue and occasional dizziness but is otherwise well. She eats irregularly due to food insecurity and finds it difficult to access healthy foods on a limited income. She lives alone and does not drive, relying on public transport to attend appointments. Her English is limited and she prefers to speak Farsi with the help of a female interpreter.

Medications: Metformin 500 mg once daily (recently started)

Allergies: None known

Past history: Nil significant chronic illness previously diagnosed

Family history: Mother had diabetes and hypertension; father died of heart disease

Social history: Lives alone in government housing; low income; limited social support

Preventative Healthcare: No recent screening; no immunisation records available

Examination findings: BP 146/84 mmHg; BMI 30.2; no peripheral oedema; fundoscopy deferred

Investigations: HbA1c: 7.9%; eGFR: 72; ACR: mildly elevated; Lipids: LDL 3.2 mmol/L

What are the most appropriate next steps in managing this patient’s condition in the context of her background? Select four (4) from the following list:

Nguyen Thi Hoa, aged 72, is brought in by her daughter for a health assessment. She recently arrived from Vietnam under a family reunion visa and has not had prior medical care in Australia. Her daughter notes that Hoa has become forgetful, sometimes leaves the stove on, and gets lost when walking near their home. Hoa denies any problems but struggles to recall recent events and occasionally confuses her grandchildren’s names. She speaks only Vietnamese and appears passive during the consultation. Her daughter is concerned about her safety at home and is seeking advice on what to do next.

Medications: None

Allergies: Nil known

Past history: Treated for hypertension overseas (no documentation); no known history of stroke or psychiatric illness

Family history: No known familial cognitive conditions

Social history: Lives with daughter’s family; does not engage in activities outside home; no formal education; no English proficiency

Preventative Healthcare: No immunisation or screening recorded since arrival

Examination findings: BP 152/84 mmHg; pulse 78 bpm; BMI 23; alert but disoriented to date; no focal neurological signs

Investigations: [Insert Image Here]

What are the most appropriate next steps in managing this patient? Select four (4) from the following list:

Mina Jafari, aged 35, presents with concerns about irregular vaginal bleeding and pelvic discomfort. She arrived in Australia two years ago from Afghanistan on a humanitarian visa. She has had no cervical screening in Australia and is unsure if she ever had a Pap smear in the past. Her menstrual cycles are irregular, and she reports intermenstrual spotting for the past 3 months. She is married with two children and is not currently using contraception. She speaks limited English and requests a female interpreter for all consultations.

Medications: None

Allergies: Nil known

Past history: Two uncomplicated vaginal deliveries; no surgical history

Family history: Mother died from an unknown gynaecological cancer in her 50s

Social history: Lives with husband and children; not currently employed; has no GP until this visit

Obstetric/sexual history: Gravida 2, Para 2; sexually active; monogamous relationship

Preventative Healthcare: Nil vaccinations or screenings documented since arrival

Examination findings: BMI 26; abdomen soft, mild suprapubic tenderness; speculum examination deferred pending patient comfort and interpreter presence

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and care? Select four (4) from the following list:

Abdi Hassan, aged 24, presents with low mood, poor concentration, and difficulty sleeping. He arrived from Somalia as a refugee three years ago and is currently studying at TAFE while working part-time. He says he feels overwhelmed and isolated, has little energy, and struggles to connect with others. He denies suicidal ideation but reports frequent thoughts of hopelessness. He has no prior mental health diagnosis or treatment. He is reluctant to discuss his emotions and says ‘we don’t talk about these things back home’. His English is functional, but he agrees to an interpreter being present for more sensitive discussions.

Medications: None

Allergies: Nil known

Past history: No chronic illness or hospitalisation

Family history: Father died in conflict; no known mental health history

Social history: Lives alone; no close family in Australia; low income; minimal community support

Psychiatric history: Nil formal assessment; possible past trauma during migration

Preventative Healthcare: No mental health screening since arrival

Examination findings: Tired appearance; flat affect; no psychomotor agitation or retardation; BMI 21

Investigations: [Insert Image Here]

What are the most appropriate steps in managing this patient? Select four (4) from the following list:

Layla El-Masri, aged 10, is brought to your clinic by her mother for a general health check. The family recently arrived in Australia from Syria on a humanitarian visa and are living in temporary accommodation. Layla has had no previous medical assessment in Australia. Her mother is concerned that Layla often complains of abdominal pain, especially after meals, and has missed several days of school due to feeling unwell. She also appears anxious and withdrawn. Her mother reports that Layla experienced several traumatic events during the war and the migration journey, including loss of close family members.

Medications: None

Allergies: None known

Past history: No chronic illness documented; immunisation records unavailable

Family history: No known hereditary illness; father deceased during conflict

Social history: Lives with mother and two siblings; newly arrived in Australia; minimal school attendance to date

Psychiatric history: Not previously assessed; possible trauma exposure

Preventative Healthcare: No prior screenings or catch-up vaccinations in Australia

Examination findings: Height and weight below 10th percentile; mild epigastric tenderness; no organomegaly; withdrawn affect; answers questions quietly in Arabic

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Ahmed Al-Farsi, aged 61, presents for a new patient health check. He recently arrived in Australia from Iraq on a humanitarian visa and is living with his adult daughter. He has not seen a doctor in over 10 years. He reports occasional breathlessness when walking uphill and a chronic morning cough, which he attributes to years of smoking before quitting five years ago. He also mentions increasing fatigue. He has no medical records and speaks limited English, requiring an Arabic-speaking interpreter.

Medications: None

Allergies: Nil known

Past history: Smoked for 30 years (ceased 5 years ago); no formal diagnoses

Family history: Brother died of myocardial infarction at 59; father had hypertension

Social history: Lives with daughter; not working; limited physical activity

Preventative Healthcare: No screening or vaccinations recorded since arrival

Examination findings: BP 150/86 mmHg, HR 78, BMI 27, chest clear to auscultation; mild ankle oedema

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessing this patient? Select four (4) from the following list:

Sahar Qureshi, aged 30, presents to your clinic for a women’s health check. She arrived in Australia from Pakistan on a partner visa 18 months ago. She has not had a health check since arrival and has never had a cervical screening test. She reports no current symptoms but says she wants to ‘make sure everything is okay’ before trying to conceive. She is otherwise well, has regular menses, and has never used contraception. Her husband is supportive but usually attends appointments with her. Today she presents alone and requests a female doctor and interpreter for the consultation.

Medications: None

Allergies: Nil known

Past history: Nil chronic illness or surgeries

Family history: Mother had gestational diabetes

Social history: Lives with husband; no children; not working; socially isolated; English comprehension limited

Obstetric/sexual history: No previous pregnancies; sexually active; no known STIs

Preventative Healthcare: No cervical screening or immunisation history in Australia

Examination findings: Well-appearing; BMI 24; normal external genitalia; speculum and bimanual exams deferred pending interpreter-assisted consent

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Yonas Tekle, aged 19, presents to your clinic requesting a check-up. He arrived in Australia from Eritrea 9 months ago on a humanitarian visa and is now living in supported accommodation while studying English. He is asymptomatic but says he wants to ‘stay healthy’. He has not seen a doctor since arriving and is unsure of his vaccination or past medical history. He speaks basic English but prefers to use a Tigrinya interpreter for medical discussions. He denies drug or alcohol use and says he has no sexual partners. He appears thin but well-kempt.

Medications: None

Allergies: Nil known

Past history: Unknown; no medical records available

Family history: Father died of unknown illness in a refugee camp

Social history: Lives with other young refugees; not working; studies full-time; no regular GP

Preventative Healthcare: No vaccinations recorded; no prior screening tests since arrival

Examination findings: BMI 18.1; BP 106/68 mmHg; pulse 74 bpm; no abnormalities on general exam

Investigations: [Insert Image Here]

What are the most appropriate steps in this initial health assessment? Select four (4) from the following list:

Maryam Binte, aged 27, presents for review following a recent positive pregnancy test. She arrived in Australia from Bangladesh 7 months ago on a temporary protection visa and this is her first pregnancy. She has not yet accessed antenatal care and is unsure how to engage with the healthcare system. She is unsure of her vaccination status and reports fatigue and poor appetite. She lives in shared accommodation with extended family and has limited English. She is visibly anxious during the consultation and requests a female interpreter.

Medications: None

Allergies: Nil known

Past history: No known chronic illnesses

Family history: Mother had gestational diabetes; no known congenital conditions

Social history: Lives in shared housing; not working; no Medicare access confirmed

Obstetric/sexual history: Gravida 1, Para 0; regular menses before pregnancy

Preventative Healthcare: No cervical screening or vaccinations recorded

Examination findings: BMI 19.2; BP 102/68 mmHg; appears tired; mild pallor noted

Investigations: [Insert Image Here]

What are the most appropriate next steps in this consultation? Select four (4) from the following list:

Farouk Mahmoud, aged 48, presents with persistent fatigue and unintentional weight loss of approximately 5kg over the past three months. He arrived in Australia from Sudan 10 months ago on a humanitarian visa and works casually as a delivery driver. He denies fever, night sweats, or cough. He has no known medical conditions and does not take any regular medications. He has not accessed any healthcare in Australia until this consultation. His English is limited, and a male Arabic-speaking interpreter is present.

Medications: None

Allergies: None known

Past history: Unknown; no access to prior health records

Family history: Father had diabetes and died of ‘kidney disease’; no other known illnesses

Social history: Lives with cousins; limited income; irregular meals; no smoking or alcohol

Preventative Healthcare: No vaccinations or screening tests recorded in Australia

Examination findings: BMI 20.1; BP 138/84 mmHg; mild pallor; no lymphadenopathy or organomegaly; cardio-respiratory exam unremarkable

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Samira Abdi, aged 38, presents with chronic pelvic pain and dyspareunia. She migrated to Australia from Somalia 2 years ago on a humanitarian visa and has not accessed regular healthcare since arrival. She reports the pain has been ongoing for years but worsened in the past 6 months. It is deep, persistent, and affects her ability to have sexual intercourse. She has two children born overseas and is not using contraception. On further discussion, she reveals she underwent female genital cutting (FGC) as a child. She is reluctant to discuss details and appears anxious during the consultation. She agrees to have a female interpreter present for future visits.

Medications: None

Allergies: Nil known

Past history: No surgeries other than childbirth

Family history: Non-contributory

Social history: Lives with husband and children; homemaker; limited English

Obstetric/sexual history: Gravida 2, Para 2; no antenatal care in previous pregnancies

Preventative Healthcare: No cervical screening; no STI screening recorded

Examination findings: Not performed; patient declines pelvic exam until interpreter present

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Ali Rehman, aged 63, presents with increasing shortness of breath on exertion and reduced exercise tolerance over the past three months. He arrived in Australia from Pakistan on a family reunion visa 6 months ago and has limited English proficiency. He has not seen a doctor since arriving and has no documented medical history. He reports a long history of smoking but quit 8 years ago. He denies chest pain but describes a chronic cough productive of white sputum. He has never been screened for cardiovascular risk or lung disease. He lives with his daughter and grandchildren and prefers an Urdu-speaking interpreter.

Medications: None

Allergies: Nil known

Past history: Long-term smoker (40 pack-years); no known diagnoses or surgeries

Family history: Father had hypertension and died of heart failure

Social history: Lives with family; retired; limited mobility; no alcohol

Preventative Healthcare: No vaccinations or chronic disease screening recorded

Examination findings: BP 144/86 mmHg; HR 88 bpm; RR 18; SpO₂ 96% on room air; bilateral expiratory wheeze; prolonged expiration

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Noura Al-Hamadi, aged 22, presents requesting contraception. She recently arrived from Yemen on a partner visa and has limited knowledge of contraceptive options. She has never used contraception before and is unsure about local health services. She is in a monogamous relationship and does not plan to conceive for several years. She reports no current symptoms and has never had a cervical screening test. She is unfamiliar with the Australian healthcare system, has limited English, and requests a female Arabic-speaking interpreter for discussions involving sexual and reproductive health.

Medications: None

Allergies: Nil known

Past history: Nil significant medical history

Family history: Non-contributory

Social history: Lives with husband; not working; socially isolated; minimal engagement with health services

Obstetric/sexual history: Gravida 0; regular menses; sexually active; no STIs

Preventative Healthcare: No recorded vaccinations or cervical screening

Examination findings: BMI 22; no clinical concerns noted; pelvic examination not requested

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Reza Ghorbani, aged 46, presents for a new patient check. He arrived in Australia from Iran 7 months ago on a bridging visa after applying for asylum. He has been experiencing frequent gastrointestinal symptoms including upper abdominal discomfort, bloating, and early satiety. He also reports intermittent diarrhoea and has unintentionally lost 4kg in the last three months. He describes a stressful migration journey and ongoing uncertainty about his visa status. He lives in temporary housing, has limited English, and attends today with a Farsi interpreter.

Medications: Occasional use of paracetamol

Allergies: None known

Past history: No known chronic conditions; no previous surgery

Family history: Father had diabetes; mother had ‘stomach ulcers’

Social history: Lives in shared housing with other asylum seekers; unemployed; eats irregularly

Preventative Healthcare: No prior screening or vaccinations in Australia

Examination findings: Mild epigastric tenderness; no palpable masses or organomegaly; BMI 19.8; vital signs normal

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Aleksandra Nowak, aged 31, presents for a mental health assessment. She arrived in Australia from Ukraine 10 months ago on a temporary humanitarian visa and lives with a host family. She reports ongoing insomnia, hypervigilance, and episodes of panic, particularly when hearing loud noises or sirens. She also experiences recurrent intrusive memories of war-related trauma. She has not previously sought mental health support and says she avoids crowded places and feels emotionally numb. Her English is conversational but she requests a Polish-speaking interpreter for emotional discussions.

Medications: None

Allergies: Nil known

Past history: Nil known chronic medical or psychiatric conditions

Family history: No history of mental illness

Social history: Unemployed; separated from family; lives with community sponsor family; socially isolated

Psychiatric history: No prior diagnosis; describes persistent symptoms since arriving

Preventative Healthcare: No screening recorded since arrival

Examination findings: Alert, tense posture; no psychomotor retardation; flat affect; no suicidal ideation

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and care? Select four (4) from the following list:

Omar Suleiman, aged 7, is brought in by his mother for behavioural concerns at school. He recently started year 2 after arriving in Australia from Iraq with his family on a humanitarian visa 6 months ago. His teacher reports that he struggles to focus, becomes easily agitated, and often isolates himself during class. At home, his mother notes he has difficulty sleeping, startles easily at loud noises, and avoids playing with other children. There is no known history of developmental delay or behavioural problems before migration. He has not had any formal health or developmental assessments since arrival. His mother speaks limited English and a male Arabic interpreter is present.

Medications: None

Allergies: Nil known

Past history: Normal early development per maternal report

Family history: No psychiatric history

Social history: Lives with both parents and three siblings in public housing; father works night shifts; low-income household

Psychiatric history: None documented; suspected trauma exposure during conflict and displacement

Preventative Healthcare: No prior Australian health checks, immunisation records unknown

Examination findings: Alert; cooperative but restless during consultation; growth parameters within normal range

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessment and care? Select four (4) from the following list:

Fatoumata Diallo, aged 56, presents with ongoing joint pain affecting her hands, wrists, and knees. She migrated to Australia from Guinea on a humanitarian visa 9 months ago and has not had prior medical assessment since arrival. She describes morning stiffness lasting over an hour, swelling of several joints, and difficulty preparing food and dressing. She reports fatigue and mild weight loss. Her English is limited, and she attends today with her adult daughter, who wishes to act as interpreter.

Medications: None

Allergies: Nil known

Past history: Nil documented; no known chronic illness or surgeries

Family history: Unknown due to limited records

Social history: Lives with daughter; not employed; receives income support

Preventative Healthcare: No vaccinations or chronic disease screening documented since arrival

Examination findings: Tender, swollen MCPs and PIPs bilaterally; reduced grip strength; knees mildly warm with small effusions

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Thuy Nguyen, aged 59, presents for a general health check after arriving in Australia from Vietnam on a parent visa 8 months ago. She has no known chronic medical conditions but reports feeling tired, especially in the mornings, and occasionally lightheaded. She denies chest pain, cough, or shortness of breath. She lives with her daughter and helps care for her grandchildren. She has not had any recent medical reviews and is unsure of her vaccination or screening history. She speaks limited English and requests a Vietnamese-speaking female interpreter.

Medications: None

Allergies: None known

Past history: Nil documented; never hospitalised

Family history: Father had type 2 diabetes; mother had gastric cancer

Social history: Lives with family; assists with childcare; socially active within Vietnamese community

Preventative Healthcare: No record of screening tests or vaccinations in Australia

Examination findings: BP 136/76 mmHg, HR 72 bpm, BMI 23.1; conjunctival pallor noted; otherwise unremarkable exam

Investigations: [Insert Image Here]

What are the most appropriate next steps in assessing this patient? Select four (4) from the following list:

Daniel Tesfaye, aged 17, presents with chronic cough, fatigue, and weight loss. He arrived in Australia from Ethiopia on a humanitarian visa 5 months ago and lives with an older cousin. He reports a dry cough for over 6 weeks, especially at night, and has lost approximately 6kg since arrival. He denies haemoptysis or chest pain. He attends school but struggles with fatigue. He has not seen a doctor in Australia until today. He speaks basic English but prefers a Tigrinya interpreter for medical discussions.

Medications: None

Allergies: Nil known

Past history: No known medical history; no prior hospital admissions

Family history: Uncle treated for TB several years ago

Social history: Lives in shared housing; attending high school; limited income; socially isolated

Preventative Healthcare: No documented vaccinations or screening since arrival

Examination findings: BMI 18.5; temperature 37.8°C; respiratory rate 20; chest auscultation clear; no lymphadenopathy

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Hiba Saeed, aged 33, presents to your clinic requesting a general women’s health check. She arrived in Australia from Syria on a spouse visa 10 months ago and has not previously accessed healthcare in Australia. She reports no significant symptoms but has not had any cervical screening or vaccinations in many years. She is planning to have children in the next year. She reports occasional pelvic discomfort but denies any abnormal bleeding or discharge. She speaks minimal English and has brought her sister to interpret but agrees to the use of a female Arabic-speaking professional interpreter when offered.

Medications: None

Allergies: None known

Past history: Nil significant; regular menstrual cycles

Family history: Mother had diabetes; no gynaecological cancers reported

Social history: Lives with husband; homemaker; not currently employed

Obstetric/sexual history: Gravida 0; sexually active in a monogamous relationship

Preventative Healthcare: No prior cervical screening; no immunisation records available

Examination findings: BMI 24.5; normal external genitalia; pelvic exam deferred pending consent and interpreter support

Investigations: [Insert Image Here]

What are the most appropriate next steps in her care? Select four (4) from the following list:

Kamal Uddin, aged 45, presents with increasing difficulty managing his diabetes. He arrived from Bangladesh 12 months ago on a humanitarian visa and was diagnosed with type 2 diabetes five years ago. He reports poor glycaemic control since arriving, difficulty understanding medication instructions, and limited access to healthy food due to financial constraints. He has not seen a diabetes educator or dietitian since arriving in Australia. His English is limited and a Bengali interpreter is present. He is concerned about fatigue and occasional blurry vision.

Medications: Metformin 1g BD, gliclazide 60mg daily (when available)

Allergies: Nil known

Past history: Type 2 diabetes; no known cardiovascular or renal disease

Family history: Father had diabetes and died of stroke at age 60

Social history: Lives with wife and children in public housing; unemployed; limited social support

Preventative Healthcare: No eye checks or formal diabetes education in the past 2 years

Examination findings: BP 138/84 mmHg; BMI 30; no retinopathy or neuropathy on basic screening; fundoscopy not performed

Investigations: HbA1c: 8.6%; eGFR: 80; ACR: 3.5 mg/mmol; Total cholesterol: 5.4 mmol/L

What are the most appropriate next steps in managing this patient? Select four (4) from the following list:

Sofia Petrovic, aged 27, presents to your clinic requesting help with sleep and anxiety. She arrived from Bosnia on a humanitarian visa 9 months ago and is currently unemployed. She reports difficulty falling asleep, frequent waking, and nightmares. She describes constant worry about her family back home and a feeling of detachment from those around her. She is often irritable and avoids going outside alone. She has no prior psychiatric diagnosis. She speaks basic English but prefers to use a Bosnian interpreter for detailed emotional discussions.

Medications: None

Allergies: Nil known

Past history: Nil documented medical or psychiatric history

Family history: No history of psychiatric illness

Social history: Lives alone; limited social contact; receives income support; no current supports engaged

Psychiatric history: No prior assessments; reports high stress since resettlement

Preventative Healthcare: Nil recorded since arrival

Examination findings: Appears tired and anxious; no suicidal ideation; normal speech and cognition

Investigations: [Insert Image Here]

What are the most appropriate next steps in this consultation? Select four (4) from the following list:

Mohammed Al-Karim, aged 51, presents for a general health check. He arrived in Australia from Iraq on a humanitarian visa 7 months ago and has not had prior medical care in Australia. He reports no current symptoms but says he has a history of high blood pressure “many years ago” and was told he had hepatitis. He does not have medical records and is unsure of his vaccination history. He speaks limited English and prefers to use a male Arabic-speaking interpreter for medical consultations.

Medications: None currently

Allergies: None known

Past history: Self-reported hypertension and hepatitis diagnosis overseas

Family history: Father died of stroke at 60; no other known conditions

Social history: Lives with wife and children in public housing; unemployed; smokes 10 cigarettes per day

Preventative Healthcare: No recorded immunisations or screening in Australia

Examination findings: BP 152/94 mmHg; HR 82 bpm; BMI 29.5; no signs of chronic liver disease

Investigations: [Insert Image Here]

What are the most appropriate next steps in this patient’s care? Select four (4) from the following list:

Elena Popova, aged 68, presents for the first time after arriving in Australia from Ukraine on a special humanitarian visa 6 months ago. She is accompanied by her adult son and uses a Russian-speaking interpreter. She reports feeling tired, with occasional shortness of breath on exertion and reduced appetite. She has not seen a doctor since migrating and has no medical records. She recalls being told she had ‘low blood’ in the past and was given iron tablets intermittently. She denies chest pain, bleeding or recent illness.

Medications: None

Allergies: Nil known

Past history: No documented conditions; previous ‘anaemia’ treated overseas

Family history: Mother had heart failure in later life; father died in war

Social history: Lives with son and grandchildren; limited mobility; relies on family for transport; no English proficiency

Preventative Healthcare: No recent screening or vaccinations since arrival

Examination findings: Conjunctival pallor; BP 124/74 mmHg; HR 88 bpm; no peripheral oedema; cardiopulmonary exam normal

Investigations: [Insert Image Here]

What are the most appropriate next steps in her care? Select four (4) from the following list:

Bilal Khan, aged 15, presents with persistent headaches and difficulty concentrating at school. He and his family arrived from Afghanistan on a humanitarian visa 6 months ago. His mother reports that he has been more withdrawn since arrival, sleeps poorly, and avoids social situations. He has no prior medical or psychological history documented and has not yet engaged with a GP or school counsellor. He speaks some English but prefers to use a Dari-speaking interpreter for medical appointments.

Medications: None

Allergies: Nil known

Past history: No known chronic illness; immunisation records unavailable

Family history: Father has hypertension; no psychiatric history known

Social history: Lives with parents and three siblings; attends local high school; limited extracurricular involvement

Psychiatric history: Not previously assessed; reports exposure to conflict prior to migration

Preventative Healthcare: No health checks or vaccinations since arrival

Examination findings: Appears subdued; BMI 21; normal neurological exam

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Miriam Habte, aged 34, presents to your clinic seeking advice about planning a pregnancy. She arrived in Australia from Eritrea on a humanitarian visa 10 months ago and is currently working part-time. She reports no medical issues and has regular menstrual cycles. She is unsure of her vaccination history and has not had any recent health checks. She speaks basic English but prefers to use a Tigrinya interpreter for health discussions. She has not previously accessed reproductive health services in Australia.

Medications: None

Allergies: Nil known

Past history: Nil documented; reports normal prior pregnancies (2 home births overseas)

Family history: No known hereditary conditions

Social history: Lives with husband; stable housing; no financial stressors

Obstetric/sexual history: Gravida 2, Para 2; sexually active; no contraception used for past year

Preventative Healthcare: No cervical screening or vaccinations recorded in Australia

Examination findings: Healthy appearance; BMI 23; no clinical abnormalities noted

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Amadou Traoré, aged 41, presents to your clinic after recently arriving in Australia from Mali on a humanitarian visa. He reports no specific symptoms but is attending for a general health check. He has not had any formal medical review since arrival and is unsure of his vaccination status. He recalls being diagnosed with high blood pressure a few years ago but has not taken medication consistently. He also mentions having been treated for schistosomiasis and malaria in the past. He speaks limited English and prefers a French-speaking interpreter.

Medications: None currently

Allergies: Nil known

Past history: Self-reported hypertension; history of parasitic infections

Family history: Brother has type 2 diabetes; no known cardiovascular disease

Social history: Lives in shared accommodation; no employment; limited income; no smoking or alcohol

Preventative Healthcare: No vaccinations or health screening since arrival

Examination findings: BP 148/92 mmHg; BMI 22.5; no peripheral oedema; cardiovascular and respiratory exams normal

Investigations: [Insert Image Here]

What are the most appropriate next steps in managing this patient? Select four (4) from the following list:

Layla Hassan, aged 29, presents requesting advice regarding a positive home pregnancy test. She recently arrived in Australia from Sudan on a humanitarian visa and this is her first pregnancy. She has not engaged with any antenatal care and is unsure how to access services. She speaks limited English and attends the consultation with a female Arabic-speaking interpreter. She denies any bleeding or abdominal pain but reports fatigue and occasional nausea. She is unsure of her vaccination history and has never had cervical screening.

Medications: None

Allergies: Nil known

Past history: No chronic illnesses reported; no prior surgeries

Family history: Mother had diabetes in pregnancy

Social history: Lives with husband in temporary accommodation; recently arrived; financially limited

Obstetric/sexual history: Gravida 1, Para 0; sexually active in a monogamous relationship; no known STIs

Preventative Healthcare: No cervical screening or immunisation documented

Examination findings: Appears well; BMI 24.2; mild pallor; no abdominal tenderness

Investigations: [Insert Image Here]

What are the most appropriate next steps in her care? Select four (4) from the following list:

Ngozi Okeke, aged 36, presents to your clinic for the first time. She arrived in Australia from Nigeria on a partner visa 8 months ago and is currently breastfeeding her 4-month-old infant. She reports pain and cracking of the nipples during breastfeeding and is worried about possible infection. She has not seen a healthcare provider since arriving and is unsure of her vaccination and cervical screening status. She has no regular GP and speaks basic English, but requests an Igbo-speaking interpreter for medical consultations.

Medications: None

Allergies: Nil known

Past history: Nil chronic illness; unremarkable delivery overseas

Family history: Non-contributory

Social history: Lives with husband and infant; no extended family support; not working

Obstetric/sexual history: Gravida 1, Para 1; vaginal delivery; no contraception

Preventative Healthcare: No cervical screening or vaccinations documented in Australia

Examination findings: Mild erythema and fissuring of both nipples; no fluctuance or systemic signs; afebrile

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Hussein Yilmaz, aged 62, presents for a routine health check. He arrived in Australia from Türkiye 11 months ago on a humanitarian visa and lives with his adult children. He has no current complaints but mentions he hasn’t seen a doctor in several years. He recalls being diagnosed with ‘sugar problems’ years ago but did not take medications regularly. He has not had any health screening or vaccinations in Australia. He speaks limited English and requests a male Turkish-speaking interpreter for the consultation.

Medications: None currently

Allergies: None known

Past history: Self-reported type 2 diabetes, no known complications

Family history: Father had heart disease and stroke

Social history: Lives with family; retired; helps care for grandchildren; no alcohol or smoking

Preventative Healthcare: No documented screening, vaccinations or diabetes follow-up since arrival

Examination findings: BP 146/86 mmHg; BMI 28.4; mild peripheral neuropathy on monofilament testing; no foot ulcers

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Rania Haddad, aged 26, presents for contraceptive advice. She arrived in Australia from Lebanon on a spousal visa 7 months ago and this is her first interaction with the Australian healthcare system. She is recently married and not planning to conceive in the near future. She is unfamiliar with local contraceptive options and has never used contraception previously. She denies any current symptoms and has no chronic medical conditions. She speaks limited English and prefers a female Arabic-speaking interpreter for all medical discussions.

Medications: None

Allergies: Nil known

Past history: Nil significant; regular menstrual cycles

Family history: Non-contributory

Social history: Lives with husband; not working; socially isolated; limited knowledge of healthcare access

Obstetric/sexual history: Gravida 0; sexually active in monogamous relationship

Preventative Healthcare: No cervical screening or vaccinations recorded in Australia

Examination findings: Appears well; BMI 21.3; no pelvic exam performed at this visit

Investigations: [Insert Image Here]

What are the most appropriate next steps in care? Select four (4) from the following list:

Abdullahi Mohamed, aged 38, presents to your clinic reporting persistent fatigue, mild abdominal discomfort, and unintentional weight loss of 5kg over the last 3 months. He arrived in Australia from Somalia on a humanitarian visa 7 months ago. He has not had any medical assessments since arrival. He denies fevers or vomiting but reports occasional bloating and a history of intestinal worms in the refugee camp. He eats irregularly and lives in shared housing. He speaks basic English but prefers a Somali interpreter for medical consultations.

Medications: None

Allergies: Nil known

Past history: No known chronic disease

Family history: Unremarkable

Social history: Lives with other refugees; limited income; not employed; no alcohol or tobacco use

Preventative Healthcare: No vaccinations or screening tests documented

Examination findings: Mild pallor; BMI 19.2; no hepatosplenomegaly or lymphadenopathy

Investigations: [Insert Image Here]

What are the most appropriate next steps in this patient’s care? Select four (4) from the following list:

Farzana Rahimi, aged 30, presents with recurrent urinary tract symptoms and is concerned about her reproductive health. She arrived in Australia from Afghanistan on a humanitarian visa 9 months ago and has had three previous episodes of dysuria and frequency since arrival. She reports no vaginal discharge or pelvic pain but is worried about possible complications. She is married with two children and does not currently use contraception. She has never had cervical screening or STI testing. Her English is limited and she prefers a female Dari-speaking interpreter.

Medications: None

Allergies: Nil known

Past history: No documented chronic illness

Family history: Non-contributory

Social history: Lives with husband and children; no paid work; financially constrained

Obstetric/sexual history: Gravida 2, Para 2; last childbirth 3 years ago; no contraception used

Preventative Healthcare: No previous cervical screening or vaccinations recorded

Examination findings: Mild suprapubic tenderness; no vaginal discharge; afebrile

Investigations: [Insert Image Here]

What are the most appropriate next steps in this patient’s care? Select four (4) from the following list:

Samir Javed, aged 52, presents for follow-up after a recent diagnosis of latent tuberculosis infection (LTBI) found during refugee screening. He arrived in Australia from Pakistan on a humanitarian visa 4 months ago and has no current symptoms. He is unsure of his previous TB treatment history and was unaware of any TB exposure. He lives with his wife and teenage children. His English is limited and a male Urdu-speaking interpreter is present. He has no known chronic diseases and no history of smoking or alcohol use.

Medications: None

Allergies: Nil known

Past history: Nil significant; BCG scar present

Family history: Non-contributory

Social history: Lives in public housing with family; seeking employment; socially connected with local community

Preventative Healthcare: Initial refugee screening completed; no vaccinations documented

Examination findings: Normal clinical exam; afebrile; no lymphadenopathy or respiratory findings

Investigations: IGRA positive; Chest X-ray: Normal

What are the most appropriate next steps in managing this patient? Select four (4) from the following list:

Asha Warsame, aged 5, is brought in by her father for a general health check. The family arrived from Somalia on a humanitarian visa 4 months ago. Asha appears well but has not had any prior health assessments in Australia. Her father reports that she has had no recent illnesses but is unsure about her vaccination history. She attends kindergarten and is adapting well. A professional Somali interpreter is present for the consultation.

Medications: None

Allergies: None known

Past history: No documented illnesses or hospitalisations

Family history: Mother has type 2 diabetes; otherwise non-contributory

Social history: Lives with parents and two siblings; in stable accommodation; father is primary carer

Preventative Healthcare: No vaccinations or screening since arrival

Examination findings: Healthy appearance; height and weight at 50th percentile; no abnormalities noted on general exam

Investigations: [Insert Image Here]

What are the most appropriate next steps in managing this child? Select four (4) from the following list:

Lina Alvarez, aged 21, presents with general fatigue and amenorrhoea. She arrived in Australia from Venezuela 6 months ago on a temporary protection visa and has not had any medical care since arrival. She reports that her periods stopped about 4 months ago and that she has felt increasingly tired and cold. She has lost weight unintentionally and notes some hair thinning. She speaks fluent Spanish and requests a female Spanish-speaking interpreter for medical consultations. She has no current medications and is unsure of her family’s medical history.

Medications: None

Allergies: Nil known

Past history: No chronic illnesses reported

Family history: Unknown due to lack of contact with relatives

Social history: Lives in shared accommodation; recently started studying; minimal financial resources

Preventative Healthcare: No vaccinations or screening since arrival

Examination findings: BMI 18.2; dry skin; slow speech; bradycardia (HR 54 bpm); otherwise normal cardiorespiratory exam

Investigations: [Insert Image Here]

What are the most appropriate next steps in managing this patient? Select four (4) from the following list:

Ngoc Tran, aged 63, presents for a routine health assessment. She arrived from Vietnam on a parent visa 7 months ago and lives with her adult daughter. She has no current symptoms but has never had regular medical care. She is unsure of her vaccination history and has not undergone cancer screening. Her daughter accompanies her but a professional Vietnamese-speaking interpreter is also present. She reports eating well, taking daily walks, and feeling generally well, but says she feels nervous about medical tests.

Medications: None

Allergies: None known

Past history: Nil documented; never hospitalised

Family history: Sister had breast cancer; no other known conditions

Social history: Lives with daughter and grandchildren; retired; no alcohol or tobacco use

Preventative Healthcare: No screening or vaccinations since arrival

Examination findings: Appears well; BMI 24.8; BP 132/78 mmHg; no abnormalities on general exam

Investigations: [Insert Image Here]

What are the most appropriate next steps in this patient’s care? Select four (4) from the following list: