AKT – Disability care

Joseph Nguyen, aged 48, presents with increasing fatigue and mobility difficulties over the past 3 months. He has a long-standing diagnosis of secondary progressive multiple sclerosis.

Relevant Medications, allergies: Baclofen PRN, oxybutynin; no known drug allergies

Relevant Past history: Multiple sclerosis diagnosed 15 years ago, transitioned to secondary progressive phase 3 years ago

Relevant Social history: Lives alone in a unit, receives NDIS support including a cleaner and weekly physiotherapy

Relevant examination findings: Power in lower limbs 3/5 bilaterally, reduced proprioception, uses a walking frame. Recent weight loss noted

What is the MOST appropriate next step in his care?

Linda Collier, aged 32, presents with menstrual irregularities and weight gain. She has a known diagnosis of Prader-Willi syndrome and lives in supported accommodation with 24-hour care.

Relevant Medications: Levothyroxine 50mcg daily

Relevant Past history: Prader-Willi syndrome, hypothyroidism, mild intellectual disability

Relevant Social history: Staff note she has been more irritable lately and eating food from housemates’ fridges

Relevant Preventative Healthcare: Last cervical screening test 2 years ago; vaccinations up to date

What is the MOST appropriate next step in assessment?

George Evans, aged 67, presents with his daughter who is concerned about his recent incontinence. He has moderate vascular dementia and has recently moved into her home after being discharged from residential aged care due to funding changes.

Relevant Medications: Aspirin, amlodipine, donepezil

Relevant Past history: Vascular dementia, hypertension, prior stroke

Relevant Social history: Lives with daughter who is primary carer, NDIS package being reviewed

Relevant examination findings: Alert but disoriented, unaware of incontinence episodes, no evidence of UTI or neurological deterioration

What is the MOST appropriate initial management step?

Mohammed Khan, aged 26, presents with behavioural issues and disrupted sleep. He has autism spectrum disorder and a mild intellectual disability. His mother reports increasing aggression in the evenings and that he often stays awake until 3am, disturbing other family members.

Relevant Medications: None

Relevant Past history: ASD diagnosed at age 4

Relevant Social history: Lives at home with parents and two younger siblings

Relevant Psychiatric history: None previously diagnosed

What is the MOST appropriate initial management approach?

Emily Parsons, aged 58, presents for review of her support needs. She has an acquired brain injury from a motor vehicle accident 8 years ago and has left hemiplegia, cognitive impairment, and expressive aphasia.

Relevant Medications: Sertraline, baclofen

Relevant Social history: Lives with husband who is full-time carer; receives support via NDIS for OT and physiotherapy

Relevant Examination findings: GCS 15, moderate left-sided weakness, difficulty expressing words but follows commands

What is the MOST appropriate action to optimise her communication?

Brent Holloway, aged 19, presents with his support worker due to new onset of aggressive outbursts. He has moderate intellectual disability and epilepsy controlled on valproate. His worker reports no changes in environment or routine. He has been more tired during the day and gained weight recently.

Relevant Medications: Sodium valproate 500mg BD

Relevant Past history: Intellectual disability, epilepsy diagnosed at age 12

Relevant Social history: Lives in group home with 24-hour care

What is the MOST appropriate investigation to consider first?

Danielle Brewster, aged 36, presents with constipation and abdominal discomfort. She has cerebral palsy with spastic quadriplegia and is non-verbal. Her disability support worker states that she usually opens her bowels every 2–3 days but has not passed a stool for 5 days. She appears uncomfortable and is not eating well.

Relevant Medications: Baclofen, macrogol PRN

Relevant Social history: Lives in supported accommodation

Relevant examination findings: Abdomen distended, mild tenderness in lower quadrants, no signs of peritonism

What is the MOST appropriate initial management step?

Terry Wilson, aged 72, presents with increasing confusion and reduced mobility over the last 2 weeks. He has a known diagnosis of Down syndrome and Alzheimer-type dementia.

Relevant Medications: Donepezil, paracetamol PRN

Relevant Past history: Hypothyroidism, cataracts, Alzheimer-type dementia diagnosed 2 years ago

Relevant Social history: Lives in supported residential care; staff concerned about recent increased sleepiness

What is the MOST appropriate initial investigation?

Angela Carr, aged 42, is brought in by her case manager for a GP review. She has a history of schizophrenia and moderate intellectual disability and lives in supported accommodation. The case manager is concerned that Angela has stopped attending her day program and is becoming more socially withdrawn.

Relevant Medications: Risperidone 2mg daily

Relevant Psychiatric history: Schizophrenia since age 20

Relevant examination findings: Appears drowsy, responds minimally, blood pressure 105/64, pulse 78 regular

What is the MOST appropriate initial approach?

Kevin Rawiri, aged 52, presents with ongoing pain in his right shoulder. He has spina bifida and uses a manual wheelchair for mobility. The pain has worsened over several months and affects transfers. He reports difficulty dressing and doing transfers independently.

Relevant Medications: Paracetamol PRN

Relevant Past history: Spina bifida, hydrocephalus with VP shunt in childhood

Relevant Social history: Lives independently in modified unit

What is the MOST appropriate next step in management?

Kylie Atkinson, aged 28, presents for contraception advice. She has a diagnosis of moderate intellectual disability and lives in a group home. Her carer accompanies her and states there is concern about her vulnerability in the community but no known sexual activity to date.

Relevant Medications: Sodium valproate

Relevant Social history: Kylie attends a local adult learning centre and requires supervision for ADLs

What is the MOST appropriate approach to contraception?

Peter Lawson, aged 64, presents with a pressure injury on his sacrum. He has advanced Parkinson’s disease and has been bedbound for several weeks after a recent hospital admission for pneumonia.

Relevant Medications: Levodopa/carbidopa, sertraline, amlodipine

Relevant Examination findings: 3cm stage 2 ulcer with surrounding erythema, no discharge

What is the MOST appropriate initial management step?

Anna Papadopoulos, aged 30, presents for a mental health review. She has a diagnosis of mild intellectual disability and major depressive disorder. She lives independently with some support and has recently ceased work due to low mood and fatigue.

Relevant Medications: Sertraline 100mg daily

Relevant Psychiatric history: Depression diagnosed 6 months ago; no hospitalisations

Relevant Social history: Supported by a disability employment service, minimal family involvement

What is the MOST appropriate next step in her care?

Samuel Tennant, aged 11, presents with his parents for review of learning and attention difficulties. He has a diagnosis of autism spectrum disorder and ADHD. He attends a mainstream school with an integration aide but continues to struggle with transitions and classroom behaviour.

Relevant Medications: Methylphenidate long-acting 20mg daily

Relevant Educational history: Struggles with routine changes and peer interaction

What is the MOST appropriate additional intervention?

Thomas O’Neill, aged 58, presents with recurrent falls. He has moderate Huntington’s disease and lives in a supported residential home. Staff report that he is having increasing difficulty with coordination and choking on meals.

Relevant Medications: Risperidone, sertraline

Relevant Examination findings: Ataxic gait, dysarthria, involuntary movements

What is the MOST appropriate next step in management?

Nathan Jeffries, aged 45, presents for review. He has a diagnosis of chronic schizophrenia and has lived in supported accommodation since being discharged from long-term inpatient care 3 years ago. His support worker reports he has been less interactive and often stays in bed all day, eating minimally.

Relevant Medications: Clozapine 350mg daily

Relevant Past history: Treatment-resistant schizophrenia

Relevant Examination findings: Pale, BP 100/60, HR 96, temp 36.8°C

What is the MOST important investigation at this stage?

Amelia Tran, aged 9, presents with increasing irritability and sleep disturbance. She has Rett syndrome and is non-verbal. Her mother reports she has been moaning at night and arching her back. She has no recent illness and is not constipated.

Relevant Medications: Melatonin, baclofen

Relevant Examination findings: Scoliosis with increased lumbar tenderness on palpation

What is the MOST appropriate next step?

Sandra McLeod, aged 51, presents with fatigue, poor appetite and weight loss. She has a diagnosis of quadriplegia following a spinal cord injury 20 years ago. She uses a power wheelchair and receives full support with ADLs. Her regular carer notes Sandra has been more withdrawn and is not eating her usual meals.

Relevant Medications: Oxybutynin, vitamin D, macrogol

Relevant Social history: Lives in NDIS-supported unit with 24-hour care

What is the MOST appropriate initial investigation?

Declan Wood, aged 16, presents with his father for review of seizure control. Declan has tuberous sclerosis and has been having more frequent absence seizures over the past two months. He attends a special school and receives NDIS support.

Relevant Medications: Sodium valproate, levetiracetam

Relevant Past history: Global developmental delay, epilepsy since age 4

What is the MOST appropriate next step in management?

Karen Willis, aged 61, is brought in for review. She has advanced multiple system atrophy and her daughter is concerned about weight loss and frequent coughing during meals. Karen has difficulty initiating swallowing and often needs assistance with feeding.

Relevant Medications: Levodopa-carbidopa, domperidone

Relevant Examination findings: Weak cough reflex, gurgly voice post-swallow

What is the MOST appropriate next step?

Melanie Fraser, aged 24, presents for review of epilepsy management. She has cerebral palsy with mild intellectual disability and generalised tonic-clonic seizures, usually occurring monthly. Her mother notes recent increased drowsiness and imbalance since a dose increase in her medication two weeks ago.

Relevant Medications: Lamotrigine increased from 100mg BD to 150mg BD 2 weeks ago

What is the MOST appropriate next step in management?

Geoffrey Tan, aged 54, presents for diabetes review. He has a mild intellectual disability and is supported by a community disability support service. His HbA1c has risen from 7.4% to 9.1% over the past 6 months.

Relevant Medications: Metformin 1g BD

Relevant Social history: Lives in supported independent accommodation, meals provided by carers

What is the MOST appropriate next step?

Isla Jenkins, aged 39, presents with new onset dysmenorrhoea and heavy periods. She has a diagnosis of autism spectrum disorder and requires carer assistance to attend appointments. Her support worker notes she becomes very distressed by pelvic examinations.

Relevant Medications: None

Relevant Past history: Nil significant

What is the MOST appropriate investigation to begin with?

Stephen Boyd, aged 74, presents with increased confusion. He has moderate Alzheimer’s dementia and type 2 diabetes. His daughter reports he was recently prescribed antibiotics for a UTI. He now seems drowsier and less responsive.

Relevant Medications: Metformin, glibenclamide, amoxicillin-clavulanate (completed 3 days ago)

Relevant Examination: BGL 2.8 mmol/L, BP 112/70, pulse 74

What is the MOST likely cause of his presentation?

Yasmin El-Amin, aged 22, presents with her carer following a witnessed seizure. She has Rett syndrome and is usually well controlled on levetiracetam. Her carer reports that Yasmin recently had a febrile illness and missed her last two doses of medication.

Relevant Medications: Levetiracetam 750mg BD

Relevant Past history: Seizures, scoliosis, non-verbal

What is the MOST likely precipitating factor?

Grace Holloway, aged 63, presents for review of worsening mobility. She has post-polio syndrome and reports increased fatigue, frequent tripping, and occasional falls at home. She currently uses a walking stick but finds it increasingly difficult to get around independently.

Relevant Medications: Vitamin D, paracetamol PRN

Relevant Social history: Lives with husband, NDIS package for personal care and domestic assistance

What is the MOST appropriate next step in management?

Isaac D’Souza, aged 47, presents for routine review. He has a diagnosis of moderate intellectual disability and is supported by a shared care arrangement. His carers have noted increasing breathlessness on exertion and a chronic productive cough over the past 3 months.

Relevant Medications: None

Relevant Past history: Recurrent respiratory tract infections as a child

What is the MOST appropriate investigation to order first?

Emily Walters, aged 37, presents for management of worsening menstrual pain. She has spastic diplegic cerebral palsy and uses a wheelchair. She finds it difficult to attend frequent appointments due to transport and mobility issues. Her cycles are regular but painful, impacting her ability to engage in daily activities.

Relevant Medications: Baclofen, paracetamol

What is the MOST appropriate management option?

Leo Campbell, aged 30, presents with low mood and lack of motivation. He has autism spectrum disorder and works part-time in supported employment. He reports feeling flat for several months and finds it harder to enjoy his usual hobbies. He has no suicidal ideation.

Relevant Medications: None

Relevant Social history: Lives independently with minimal family contact

What is the MOST appropriate first step in management?

Margaret Li, aged 81, presents with memory issues and difficulty managing her medications. She has a mild cognitive impairment and lives alone in a retirement village. She has type 2 diabetes, hypertension, and osteoarthritis.

Relevant Medications: Metformin, perindopril, paracetamol

Relevant Social history: No regular family support

What is the MOST appropriate strategy to support her independence?

Lara Dutton, aged 50, presents with worsening anxiety. She has moderate intellectual disability and recently started a new day program. Her support worker reports she has been pacing more, refusing to attend and has trouble sleeping. There are no safety concerns.

Relevant Medications: None

What is the MOST appropriate initial approach?

Callum Ford, aged 43, presents with difficulty sleeping and early morning waking. He has paraplegia after a spinal cord injury and reports increased pain in his hips at night, which makes turning in bed difficult.

Relevant Medications: PRN paracetamol, baclofen

Relevant Social history: Lives with partner, uses manual wheelchair

What is the MOST appropriate next step?

Brian Ho, aged 58, presents with increasing agitation and restlessness. He has advanced frontotemporal dementia and lives in a residential care facility. Staff report he is becoming more physically aggressive and refuses meals. He recently had a respiratory tract infection treated with antibiotics.

Relevant Medications: Rivastigmine, paracetamol

What is the MOST appropriate initial management?

Charlotte Young, aged 28, presents for cervical screening. She has Down syndrome and mild intellectual disability. Her mother reports she has never been sexually active. Charlotte understands the procedure but is very anxious and requests more time to prepare.

What is the MOST appropriate next step?

Dean Rangi, aged 35, presents with new onset of urinary urgency and incontinence. He has cerebral palsy with mixed tone and uses a wheelchair. He has been previously continent with no urological issues.

Relevant Medications: Baclofen, PRN oxybutynin

What is the MOST appropriate initial investigation?

Felicity Watson, aged 69, presents with a chronic wound on her left heel. She has type 2 diabetes and peripheral neuropathy. She has Parkinson’s disease and moderate cognitive impairment. Her home support worker changes the dressing daily.

Relevant Medications: Metformin, carbidopa-levodopa, aspirin

Relevant Examination findings: 2cm ulcer with clean base, peripheral pulses palpable, loss of protective sensation

What is the MOST important next step?

Benji Tran, aged 12, presents with increasing frequency of meltdowns at school. He has autism spectrum disorder and is in a mainstream class with an aide. His teacher reports difficulty managing transitions and sensory triggers such as noise. His parents are worried he might need to move schools.

Relevant Medications: None

What is the MOST appropriate next step in supporting Benji?

Edward Kennedy, aged 59, presents with increasing hoarding behaviour and social withdrawal. He has a long-standing history of schizophrenia and mild intellectual disability. His case manager reports his unit is unsafe due to clutter and hygiene issues.

Relevant Medications: Olanzapine 10mg daily

What is the MOST appropriate next step in management?

Chloe Brown, aged 31, presents for preconception counselling. She has mild cerebral palsy and walks with a limp. She works part-time in retail and lives with her partner. She is concerned about her ability to care for a child and wants to know what supports are available.

Relevant Medications: None

What is the MOST appropriate next step?

Thomas Zhang, aged 22, presents for review of attention difficulties. He has mild intellectual disability and was recently diagnosed with ADHD. He is enrolled in a TAFE course but is struggling to meet deadlines and focus in class.

Relevant Medications: None

What is the MOST appropriate next step in his management?

Susan Kerr, aged 60, presents with a chronic non-productive cough and increasing fatigue. She has severe scoliosis secondary to childhood polio and uses a manual wheelchair. On examination, she has mild bibasal crepitations and reduced chest expansion.

Relevant Medications: Paracetamol PRN, vitamin D

What is the MOST likely cause of her symptoms?

Daniela Petrova, aged 46, presents for a routine check. She has an intellectual disability and lives in a shared supported accommodation. Her support worker says she has gained 6kg in the last 3 months and has been less active since her hydrotherapy service ceased.

Relevant Medications: Olanzapine 5mg daily

What is the MOST appropriate next step?

Hassan Ali, aged 71, presents with increasing difficulty managing his colostomy bag. He has hemiplegia from a stroke 5 years ago and mild cognitive impairment. His wife is no longer able to assist due to her own health issues.

Relevant Medications: Perindopril, aspirin, atorvastatin

What is the MOST appropriate next step?

Jackie Smith, aged 34, presents with back pain and reduced mobility. She has a diagnosis of myelomeningocele and uses a wheelchair. Her pain has been worsening over the past month, particularly at night, and she reports occasional leg spasms.

Relevant Medications: Baclofen, paracetamol

What is the MOST appropriate investigation?

Michael Green, aged 56, presents for a medication review. He has an acquired brain injury and a history of agitation. He is currently prescribed risperidone 2mg BD and has gained 12kg in 6 months. His carer reports he remains stable and calm.

Relevant Social history: Lives in supported group home

What is the MOST appropriate next step?

Samantha Johns, aged 62, presents for review of ongoing fatigue and lethargy. She has multiple sclerosis and is currently in a progressive phase with bilateral lower limb weakness. She uses a scooter for mobility and reports sleeping poorly.

Relevant Medications: Sertraline, baclofen, amitriptyline

What is the MOST appropriate next step in management?

Andrea Peters, aged 45, presents with a new diagnosis of breast cancer. She has a mild intellectual disability and is supported by her sister, who is her legal guardian. Andrea can verbalise basic needs but has limited understanding of complex information.

What is the MOST appropriate way to proceed with discussing treatment options?

Trevor Nolan, aged 66, presents with breathlessness and peripheral oedema. He has advanced Parkinson’s disease and moderate cognitive impairment. He recently had a hospital admission for pneumonia. He is now mostly bed-bound and fully dependent on carers.

Relevant Medications: Levodopa-carbidopa, sertraline

What is the MOST appropriate approach to his care?

Georgia West, aged 25, presents with severe period pain and vomiting during menses. She has autism spectrum disorder and a sensory processing disorder. She becomes non-verbal when distressed and is often unable to communicate pain clearly during episodes.

Relevant Medications: Paracetamol PRN

What is the MOST appropriate next step in management?

Pauline Rivers, aged 39, presents for NDIS planning review. She has a spinal cord injury and uses a wheelchair. She has ongoing difficulties accessing appropriate allied health due to transport limitations and recent carer turnover.

Relevant Medications: Oxybutynin, vitamin D, paracetamol

What is the MOST appropriate GP role in this context?