KFP – Abuse and violence

Olivia Kennedy, aged 82, is brought in to your suburban general practice by her neighbour. The neighbour is concerned about Olivia’s appearance and reports that she found her wandering the street in her nightgown the previous evening. Olivia appears confused, dishevelled, and has visible bruising on her forearms and left cheek.

Medications: Ramipril 5 mg daily, Paracetamol 1 g TDS, Temazepam 10 mg nocte

Allergies: Nil known

Past history: Hypertension, osteoarthritis, insomnia

Family history: Not available

Social history: Olivia lives with her adult son who is unemployed. She no longer drives and is financially dependent on her son. The neighbour notes that Olivia has become increasingly withdrawn over the last few months and has missed several social events she previously enjoyed.

Psychiatric history: No previous diagnosis of dementia or psychiatric illness

Examination findings: Olivia is oriented to person only. She has multiple ecchymoses in varying stages of healing on both upper limbs, and a tender swelling over the left zygomatic arch. No other injuries are noted. Blood pressure is 140/78 mmHg, heart rate 82 bpm, afebrile. No focal neurological signs are noted.

Investigations: CBC and electrolytes within normal limits; non-contrast head CT arranged and pending

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

Layla Mahmoud, aged 26, presents to your regional general practice for a repeat prescription for sertraline. You note from her file that she has not attended for the past six months and has had multiple missed appointments. During the consultation, she appears anxious and tearful. When asked how she has been coping, she hesitates before disclosing that her partner has been increasingly controlling, monitoring her phone and limiting contact with her friends and family.

Medications: Sertraline 100 mg daily

Allergies: Nil known

Past history: Generalised anxiety disorder, previous miscarriage (18 months ago)

Family history: Nil significant

Social history: Layla works part-time at a local café. She has no children and lives with her partner of three years. She has no family nearby and has recently deactivated her social media accounts. She does not drive.

Psychiatric history: No history of suicidal ideation or self-harm

Examination findings: Layla appears withdrawn, avoids eye contact, and is visibly distressed. No physical injuries are noted. Observations are within normal limits. When gently prompted, she admits to feeling unsafe but is unsure what to do or whether she can leave her relationship.

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

Ayaan Osman, aged 14, presents to your outer-metro general practice with his aunt for a routine asthma review. During the consultation, you notice multiple healed linear scars on both forearms and a fresh abrasion on his left wrist. He is quiet, avoids eye contact, and responds with short answers. His aunt mentions that he has recently moved in with her after a family breakdown but is vague on details. She requests a script for salbutamol and says he is doing ‘fine now’.

Medications: Salbutamol inhaler PRN

Allergies: Nil known

Past history: Asthma (mild, well-controlled), previously lived with biological parents, no psychiatric history on record

Family history: Father with depression, paternal uncle with schizophrenia

Social history: Recently changed schools. Previously lived in a rural town with parents, now living with aunt in the city. No contact with parents for 3 months. No regular friends or extracurricular activities.

Examination findings: Appears underweight and withdrawn. Vitals normal. Arms reveal multiple old self-harm scars and one healing abrasion. No other injuries. No wheeze or respiratory signs noted.

What are the most appropriate next steps in managing this patient? Select three (3) from the following list:

Angela Petersen, aged 45, presents to your bulk-billing general practice in an inner-city suburb for management of chronic neck pain. She is hesitant during the consultation and becomes tearful when asked about how she’s coping. She quietly discloses that her partner recently began pushing her during arguments, and last week she was slapped. She states, ‘He didn’t mean it – he’s under a lot of stress,’ and asks you not to tell anyone.

Medications: Ibuprofen 400 mg PRN, escitalopram 10 mg daily

Allergies: Nil known

Past history: Depression, migraine, neck strain (post-MVA)

Family history: Mother with osteoarthritis; father deceased (lung cancer)

Social history: Angela is employed part-time as an admin assistant. She has two teenage children at home. She has limited social contacts and no extended family locally. Her partner is unemployed and has a history of alcohol dependence.

Psychiatric history: Managed depression, no past admissions or self-harm

Examination findings: Angela is visibly anxious, avoids prolonged eye contact, and is reluctant to undress for examination. Mild cervical paraspinal tenderness noted. No visible bruises or other acute injuries identified.

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

Thomas Lang, aged 72, presents to your rural general practice with his daughter-in-law, who states he needs a repeat prescription for his blood pressure medications. During the consultation, you observe that Thomas appears withdrawn, avoids eye contact, and has a large bruise on his upper arm. He has some difficulty answering questions and frequently defers to his daughter-in-law, who answers on his behalf.

Medications: Amlodipine 5 mg daily, atorvastatin 20 mg daily

Allergies: Nil known

Past history: Hypertension, type 2 diabetes (diet-controlled), mild cognitive impairment

Family history: Nil of note

Social history: Widowed for 2 years. Previously lived independently but moved in with his son and daughter-in-law six months ago following a hospital admission. No longer drives and has limited social contact.

Psychiatric history: No history of depression or psychiatric illness

Examination findings: Thomas appears subdued and slightly disoriented to time. There is a large ecchymosis over the left deltoid and some early skin tears on both forearms. No other acute findings. BP 142/76 mmHg, HR 76 bpm, capillary BGL 6.1 mmol/L.

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

Sophie Wallace, aged 32, presents to your mixed billing general practice for her first antenatal visit. She is 10 weeks pregnant with her first child. During routine history-taking, she becomes tearful when asked about her support system and discloses that her partner has recently become verbally aggressive and has shoved her during arguments. She expresses fear that he may escalate but insists she wants to stay ‘for the baby’.

Medications: Elevit® prenatal multivitamin

Allergies: Nil known

Past history: Nil significant

Family history: Mother with hypertension, father deceased (MI at 56)

Social history: Sophie recently moved to a new city with her partner and has no close friends or family nearby. She is currently not working. Her partner controls the finances and drives her to appointments. She does not have a phone in her own name.

Obstetric history: First pregnancy, no previous miscarriages or terminations

Examination findings: Sophie is normotensive and reports no physical symptoms or bleeding. There are no visible injuries. Dating scan arranged. Emotional distress evident.

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

Jayden Tran, aged 11, presents with his mother to your suburban GP clinic with complaints of persistent abdominal pain over the past 3 months. The mother states it started shortly after Jayden changed schools. She describes him as increasingly ‘clingy’, having trouble sleeping, and frequently complaining of feeling sick on school mornings. Jayden is quiet during the consultation and avoids eye contact. When asked privately, he becomes tearful and says some boys at school have been calling him names, pushing him, and threatening him if he tells anyone.

Medications: Nil

Allergies: Nil known

Past history: Previously well, immunisations up to date

Family history: Father with type 2 diabetes

Social history: Lives with both parents and a younger sister. No history of child protection involvement. No known learning difficulties.

Examination findings: Jayden appears withdrawn but physically well. No abdominal tenderness or other abnormal findings on examination. Growth and weight tracking normally. Vitals are within normal limits.

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

Elena Markovic, aged 58, presents to your metropolitan general practice with a long-standing history of poorly controlled type 2 diabetes. During the consultation, she appears fatigued and dishevelled. On gentle questioning, she discloses that she is the sole carer for her husband who has advanced Parkinson’s disease with dementia. She reports feeling overwhelmed, rarely sleeping through the night, and notes that her husband sometimes becomes verbally aggressive and lashes out physically during care tasks. She insists she is ‘managing’ but becomes tearful when asked about her own support network.

Medications: Metformin 1 g BD, Lantus 24 units nocte, Atorvastatin 20 mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hypertension, dyslipidaemia

Family history: Mother had stroke at 65, father with ischaemic heart disease

Social history: Retired nurse. Lives with husband. No children. No formal supports in place. No home care package. Minimal contact with extended family or friends.

Examination findings: BP 148/88 mmHg, HR 72 bpm, HbA1c 8.9%, BMI 32. Appears fatigued and emotionally labile. No physical injuries noted.

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

Nathan Broome, aged 17, presents to your regional general practice after an episode of self-harm. He has superficial cuts on both forearms which he reports were inflicted following an argument with his stepfather. Nathan is reluctant to talk, initially saying it was ‘just a fight’ but later discloses that his stepfather has been physically threatening and has punched walls during arguments. He states he doesn’t feel safe at home but doesn’t want to get anyone into trouble. He currently lives with his mother, stepfather, and two younger siblings.

Medications: Nil

Allergies: Nil known

Past history: No previous mental health diagnoses or hospitalisations

Family history: Mother with anxiety; paternal uncle died by suicide

Social history: Year 11 student. Lives in regional town. No known drug or alcohol use. Previously engaged in sport but recently withdrawn from activities.

Examination findings: Nathan is subdued, avoids eye contact. Forearm lacerations are superficial and healing. Vitals within normal limits. No signs of intoxication.

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

Maria Gonzalez, aged 39, presents to your outer-urban general practice with worsening low back pain. She has attended three times in the last month with similar complaints. Today, she is accompanied by her partner who is noticeably controlling, answers questions for her, and insists on remaining in the room during the consultation. When you ask to speak to Maria privately, her partner becomes agitated. Once alone, Maria quietly reveals that her partner has recently become violent, and she has been slapped, shoved, and prevented from accessing her phone. She says she is scared to leave because of financial dependence and their shared young child.

Medications: Paracetamol 1 g PRN

Allergies: Nil known

Past history: Migraines, iron deficiency anaemia

Family history: Nil significant

Social history: Migrated to Australia from Chile 6 years ago. No family locally. Limited English. Works casually in a cleaning job. Has a 3-year-old daughter. Financially dependent on partner, who manages their Centrelink payments.

Examination findings: Maria appears anxious. Mild tenderness over the lumbar paraspinal muscles. No neurological deficits. Vitals normal.

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

Clare Richardson, aged 67, presents to your general practice in a regional town with vague symptoms of insomnia, fatigue, and intermittent headaches. She appears anxious and frequently glances at the door. On routine review of her medication history, you note she has not filled her prescriptions for antihypertensives in several months. When gently questioned, Clare discloses that her adult son, who recently moved in with her, has become increasingly aggressive, demanding money, and sometimes threatens her when she refuses. She is hesitant to call the police, stating she doesn’t want to ‘ruin his life’.

Medications: Perindopril 5 mg daily (not collected recently)

Allergies: Nil known

Past history: Hypertension, osteoarthritis

Family history: Father had stroke at 70; mother with dementia

Social history: Retired schoolteacher. Widowed. Lives alone except for her son (aged 33) who is unemployed and has a history of substance use. No other close relatives. No formal supports in place.

Examination findings: Clare appears anxious and guarded. BP 158/90 mmHg. No physical injuries or red flags. No signs of cognitive impairment.

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

Devika Sharma, aged 29, presents to your metro-based general practice for follow-up of first trimester blood tests. During the consultation, you notice she is unusually quiet and her husband answers all the questions. When you ask to speak to her alone, her husband insists on staying. Once you manage a brief private conversation, Devika tearfully discloses that her in-laws and husband have been restricting her movements, monitoring her phone, and yelling at her for minor things. She says she is not allowed to leave the house alone or speak with her family overseas. She has not experienced physical violence but feels ‘trapped’.

Medications: Elevit® prenatal multivitamin

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: First pregnancy, 11 weeks’ gestation, no complications

Family history: Nil significant

Social history: Devika migrated to Australia from India 2 years ago after arranged marriage. Lives with husband and in-laws. No local support system. Dependent visa. No income of her own.

Examination findings: BP 110/70 mmHg, HR 76 bpm, no physical signs of injury. Appears emotionally distressed and avoids eye contact when discussing family.

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

Callum Waters, aged 8, is brought to your suburban general practice by his stepfather for a review of eczema. During the examination, you notice several bruises on Callum’s upper arms and thighs in various stages of healing. When you gently ask Callum how he got the bruises, he becomes visibly anxious and shrugs. His stepfather quickly responds that Callum is ‘clumsy’ and ‘always falling over’. You observe that Callum becomes increasingly withdrawn and avoids eye contact for the remainder of the consultation.

Medications: Hydrocortisone 1% cream PRN, cetirizine 5 mg nocte

Allergies: Nil known

Past history: Atopic dermatitis

Family history: Mother with asthma

Social history: Lives with mother and stepfather. Attends year 3 at local primary school. No previous child protection involvement noted in history.

Examination findings: Multiple bruises over the upper arms and inner thighs in various stages of healing. No signs of active infection or eczema flare. Growth and development are appropriate for age. Vitals are within normal limits.

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

Greg Douglas, aged 52, presents to your regional general practice with chronic insomnia and fatigue. He states that he has difficulty concentrating at work and feels constantly on edge. When asked about his home life, Greg discloses that his wife frequently shouts at him, controls all their finances, and has recently threatened to destroy his belongings if he ‘steps out of line’. He says he feels ‘worthless’ and is scared to leave because he doesn’t want to lose contact with his children. There is no reported physical violence.

Medications: Nil

Allergies: Nil known

Past history: Mild depression in his twenties, no recent mental health care

Family history: Father had depression, mother with hypertension

Social history: Greg works full-time in a logistics role. Married for 18 years. Two children aged 12 and 15. No current social supports. Wife is not employed. He has not disclosed these issues before.

Examination findings: Greg appears anxious, fatigued, and guarded. No physical injuries. PHQ-9 score: 18 (moderate to severe depression). No suicidal ideation expressed.

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

Sara Al-Khatib, aged 24, presents to your metropolitan general practice requesting emergency contraception. She appears tense and avoids eye contact. On gentle inquiry, she discloses that she recently had unprotected sex with her boyfriend who pressured her despite her saying no. She says this has happened multiple times, and he often threatens to break up with her if she refuses sex. She adds, ‘It’s not rape—we’re in a relationship,’ but says she feels scared and doesn’t know how to say no anymore.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Not discussed

Social history: International university student. Lives in shared accommodation. No family in Australia. Financially dependent on her partner for transport and meals. Does not have Medicare but holds student OSHC (Overseas Student Health Cover).

Examination findings: No physical injury noted. Appears anxious, speaks softly. No signs of intoxication or acute distress. BP 108/70 mmHg, HR 78 bpm.

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

Michael Evans, aged 81, presents to your general practice for a routine review of his hypertension and osteoarthritis. He has been a long-term patient but missed his last two appointments. When he arrives today, he appears dishevelled and has several bruises on his forearms. He states he recently moved in with his grandson following a fall at home. When asked about the bruises, he avoids answering directly and says, ‘I’m just getting clumsy in my old age.’ He seems hesitant and changes the subject when asked about his new living arrangements.

Medications: Perindopril 5 mg daily, paracetamol 1 g TDS

Allergies: Nil known

Past history: Hypertension, osteoarthritis, previous hip fracture

Social history: Widowed. Previously lived alone with community nursing support. Now living with grandson (age 25). No formal aged care package in place. No known cognitive impairment.

Examination findings: Multiple bruises of varying colour and size on both forearms and shins. No acute injury. BP 146/82 mmHg. Gait steady. Alert and oriented to time, place, and person.

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

Judith Coleman, aged 76, presents to your suburban general practice complaining of increased joint stiffness and difficulty sleeping. You note she has attended less frequently over the past year and appears more subdued than usual. When gently asked how things are at home, Judith shares that her stepdaughter recently moved in and has taken over managing her bank accounts. Judith mentions her pension disappears quickly, she no longer has access to online banking, and she is often left alone for long periods without food or transport. She becomes tearful and says, ‘Maybe I’m just being paranoid. She says I’m old and confused.’

Medications: Paracetamol 1 g TDS, fish oil capsules

Allergies: Nil known

Past history: Osteoarthritis, hypothyroidism (well-controlled)

Family history: Husband deceased 3 years ago, no biological children

Social history: Retired librarian. Lives with adult stepdaughter (aged 45). Previously active in community groups but has stopped attending. No known cognitive impairment. No formal aged care package in place.

Examination findings: Judith appears underweight and flat in affect. BP 138/74 mmHg, HR 76 bpm. No physical signs of injury. MoCA score 26/30. Mild stiffness in knees and hands, consistent with osteoarthritis.

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

Thomas Blake, aged 43, presents to your inner-city general practice for a medical certificate due to work-related stress. During the consultation, he breaks down and reveals that he has been sleeping in his car for several nights. He reports that his long-term male partner became physically violent during a heated argument and threw a glass at him, cutting his arm. He has not returned home since. Thomas expresses shame and embarrassment, stating, ‘People like me aren’t taken seriously when we ask for help.’

Medications: Nil

Allergies: Nil known

Past history: Mild anxiety, no prior psychiatric admissions

Family history: Nil significant

Social history: Works as a chef. In a same-sex relationship for 10 years. No children. Limited social support due to estrangement from family. Not currently linked with community or LGBTQIA+ support services.

Examination findings: Thomas has a healing 3 cm linear scar on his left forearm. No signs of infection or other injuries. BP 132/78 mmHg, HR 84 bpm. Appears tired, emotionally distressed. No suicidal ideation disclosed.

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

Amina Noor, aged 35, presents to your metropolitan general practice for worsening abdominal pain and irregular periods. During history taking, she appears anxious and guarded. You notice she flinches slightly during abdominal palpation. When asked privately about her home life, Amina discloses that she was brought to Australia on a partner visa and has been living with her husband and his extended family. She is not permitted to leave the house without permission, has no access to money, and is not allowed to enrol in English classes. She says her husband regularly threatens to have her deported if she ‘disobeys’ or talks to anyone.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Not discussed

Social history: Recent migrant from East Africa. On a temporary partner visa. No family in Australia. No income. Husband manages all communication with immigration and Centrelink. Speaks limited English (interpreter used).

Examination findings: Mild lower abdominal tenderness. No palpable mass. No peritonism. No vaginal bleeding. Appears anxious, underweight. BP 110/68 mmHg, HR 72 bpm.

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

Kyle Anderson, aged 5, is brought to your general practice by his mother with complaints of fatigue and frequent headaches. During the consultation, you observe that Kyle is unusually quiet for his age, avoids eye contact, and startles easily at loud noises. His mother appears tense and interrupts frequently. She mentions that Kyle’s behaviour has changed at home—he has been wetting the bed again and is frightened to be left alone. When you ask Kyle directly in a developmentally appropriate way, he whispers, ‘Daddy yells a lot and throws things when he’s mad.’

Medications: Nil

Allergies: Nil known

Past history: Healthy child, fully immunised, normal development

Family history: Non-contributory

Social history: Lives with mother and father. Attends preschool three days per week. No previous child protection involvement. Mother does not work and has no extended family nearby.

Examination findings: Kyle is underweight for age (10th percentile) but vital signs are normal. No physical injuries noted. Neurological examination normal. Appears emotionally flat and anxious.

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

Natasha Freeman, aged 47, presents to your outer-urban general practice requesting help for chronic headaches and fatigue. During the consultation, she appears tense, speaks softly, and frequently glances at the door. When asked about her home life, she hesitates, then discloses that her brother, who recently moved in with her after being released from prison, has become increasingly controlling. He monitors her phone, isolates her from friends, and has recently taken her bank card without permission. She adds, ‘He yells a lot… he hasn’t hit me, but I feel like I can’t breathe at home.’

Medications: Paracetamol 1 g TDS

Allergies: Nil known

Past history: Migraine, iron deficiency anaemia

Family history: Mother with type 2 diabetes

Social history: Lives alone with her brother since their father died 6 months ago. No children. Works part-time. Previously socially active. No current partner. No history of substance use or mental health diagnosis.

Examination findings: BP 126/74 mmHg, HR 72 bpm. Mild pallor. No focal neurological findings. No visible bruises or injuries. Appears anxious and withdrawn. PHQ-9 score 17 (moderate depression).

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

Isobel Tan, aged 31, presents to your general practice for a routine check-up during her second trimester of pregnancy (22 weeks). Her partner accompanies her and is polite but insists on staying in the room. During the antenatal history, you notice Isobel hesitates before answering questions and glances at her partner before responding. When you excuse the partner for a urine test, Isobel appears visibly anxious and discloses that he has been increasingly controlling—monitoring her calls, deciding what she eats, and criticising her appearance. She denies physical violence but says she feels ‘trapped’ and has thought about self-harm.

Medications: Elevit® prenatal vitamin, iron supplements

Allergies: Nil known

Past history: Nil significant

Family history: Mother with hypothyroidism

Obstetric history: First pregnancy, no complications

Social history: Employed part-time. Lives with partner. No family in Australia. Financially dependent. Has a few friends but rarely sees them now.

Examination findings: BP 122/74 mmHg. Fundal height appropriate for gestational age. No physical injuries noted. PHQ-9 score 15 (moderate depression). Fetal movements present.

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

Leo Harrison, aged 62, presents to your rural general practice for review of poorly controlled type 2 diabetes. During the consultation, he appears withdrawn and unusually hesitant when discussing his medications. When asked about his living situation, Leo explains that he lives with his adult daughter, who moved in to ‘help out’ after his wife passed away last year. He quietly adds that his daughter has taken over his bank accounts, rarely allows him to leave the house alone, and becomes verbally aggressive if he challenges her. He has missed several recent appointments and says, ‘She gets angry when I go out too often.’

Medications: Metformin 1 g BD, gliclazide 60 mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hypertension, hyperlipidaemia

Family history: Wife deceased (breast cancer), daughter with history of anxiety

Social history: Retired teacher. Lives with adult daughter. No extended family locally. Limited community engagement since his wife’s death. Previously independent.

Examination findings: BP 142/86 mmHg, HbA1c 8.6%. No physical injuries. Appears emotionally flat. No cognitive impairment noted. Gait steady. Weight stable.

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

Zara Mahmoud, aged 27, presents to your general practice with insomnia and anxiety. She recently gave birth to her first child eight weeks ago. During the consultation, she appears visibly distressed and tearful. On gentle inquiry, she discloses that her husband has become increasingly critical, controlling her access to the baby, belittling her parenting, and refusing to allow her to attend mother’s groups or see friends. She says, ‘He hasn’t hit me. He just says I’m a bad mother and maybe the baby would be better off without me.’

Medications: Iron supplement, Elevit®

Allergies: Nil known

Past history: Iron deficiency in pregnancy

Family history: Nil of note

Social history: Lives with husband and infant daughter. Recently moved interstate. No family nearby. On maternity leave from work. First child.

Examination findings: Zara is tearful, appears fatigued, with flat affect. Edinburgh Postnatal Depression Scale (EPDS) score: 18. Baby is reported to be feeding well. No physical injuries observed.

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

James O’Malley, aged 14, presents to your general practice with his grandmother for evaluation of abdominal pain and sleep issues. During the consultation, his grandmother expresses concern that James has become withdrawn, refuses to go to school, and has recently lost interest in sport. When gently asked privately, James discloses that his mother’s new partner has been shouting at him regularly, calling him names, and once pushed him against a wall. He says he hasn’t told anyone because he doesn’t want to upset his mother, who is struggling financially. He has been staying with his grandmother more often to avoid going home.

Medications: Nil

Allergies: Nil known

Past history: Asthma (mild, resolved), no prior mental health diagnoses

Family history: Mother with history of depression

Social history: Lives with mother and her partner; sees father intermittently. Attends secondary school. No previous child protection involvement. Currently staying at grandmother’s house several nights per week.

Examination findings: James appears quiet and anxious. Growth and development within normal range. No physical injuries observed. No signs of acute illness. Vitals normal.

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

Alejandro Ruiz, aged 38, presents to your city-based general practice with chronic back pain and low mood. On further discussion, he discloses that he has been working in Australia under a temporary skilled visa and recently lost his job due to company downsizing. He adds that he is currently staying in overcrowded accommodation provided by his employer, where his supervisor withholds his passport and has threatened to report him to immigration unless he continues unpaid ‘training shifts.’ Alejandro says he is scared to go to authorities and believes he has no options.

Medications: Nil

Allergies: Nil known

Past history: Previously well, no mental health or chronic disease history

Family history: Lives alone in Australia, family overseas

Social history: Migrant worker on a temporary skilled visa. No Medicare access. Financially strained. Limited English. No union or community contacts. Emotionally withdrawn.

Examination findings: Alejandro appears anxious and fatigued. No signs of physical injury. Musculoskeletal exam shows mild paraspinal tenderness, full range of motion. PHQ-9 score: 19 (moderate to severe depression).

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

Linda Park, aged 68, presents to your general practice with worsening control of her type 2 diabetes and recent unintentional weight loss. She lives with her adult son, who she says helps her with shopping and appointments. During the consultation, you notice she appears anxious and has difficulty answering questions freely. When gently asked about her home life in private, Linda discloses that her son becomes angry when she asks about money, restricts her access to her own pension, and sometimes refuses to buy her medications or food. She adds, ‘He says I’m lucky he’s looking after me.’

Medications: Metformin 1 g BD, gliclazide 60 mg daily, atorvastatin 20 mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hypertension, hyperlipidaemia

Family history: Father had stroke at 72

Social history: Widowed. Lives with adult son. No other family in Australia. Previously independent but reliant on her son since recent hip fracture.

Examination findings: BMI 19 kg/m². BP 150/88 mmHg. HbA1c 9.1%. Appears undernourished. Mild tremor. No cognitive impairment on 6CIT. No signs of trauma or injury.

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

Chantelle Morris, aged 19, presents to your regional general practice requesting the contraceptive pill. During the consultation, she appears nervous and reluctant to answer questions freely. On gentle inquiry, she discloses that her boyfriend monitors her phone and social media, tells her who she can speak to, and becomes angry if she spends time with friends or family. She says he recently insisted they stop using condoms, despite her concerns, and she felt pressured into sex. She adds, ‘He says I belong to him, so I shouldn’t need privacy.’

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Nil relevant

Social history: Lives with boyfriend in rental accommodation. Recently moved out of her family home. Not currently working or studying. Has become socially withdrawn. No drug or alcohol use.

Examination findings: BP 114/68 mmHg. No physical injuries. Appears anxious. No signs of cognitive impairment or intoxication. Pregnancy test negative. STI screen ordered.

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

Robert Ng, aged 72, presents to your general practice with worsening shortness of breath and fatigue. He has a history of COPD and mild heart failure. During the consultation, he seems hesitant and disoriented about his medications. His niece, who is also his carer, arrives late and appears irritated, stating ‘He’s always forgetting things.’ Robert avoids eye contact and becomes visibly anxious when she enters the room. After arranging a brief private moment, he discloses that his niece has been neglecting his care, regularly forgets to give him medications, and has recently threatened to place him in a nursing home if he ‘complains’.

Medications: Salbutamol inhaler PRN, tiotropium daily, frusemide 20 mg daily

Allergies: Nil known

Past history: COPD, mild congestive heart failure, osteoarthritis

Family history: Wife deceased, no children. Limited extended family involvement.

Social history: Retired mechanic. Lives with niece who became his primary carer after his wife’s death. No formal home care services in place. No Power of Attorney documented.

Examination findings: BP 136/82 mmHg, HR 88 bpm, O2 sat 94% RA. Mild bilateral pedal oedema. Appears anxious and underweight. Alert, oriented. MMSE 28/30.

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

Fatima Ali, aged 16, presents to your metropolitan general practice accompanied by her uncle for a school immunisation catch-up. During the consultation, she appears unusually quiet and does not engage when asked about school or home life. When you briefly speak to her alone while her uncle steps out to take a call, she discloses that her parents plan to take her overseas during school holidays for a ‘family visit’, but she suspects she may be forced to marry someone she has never met. She says she is scared and doesn’t want to go, but is afraid of disappointing her family and being disowned.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Not discussed

Social history: Born in Australia. Lives with both parents and two younger siblings. Attends Year 11. Parents born overseas. No previous contact with police or child protection services.

Examination findings: Fatima is physically well. Vitals are normal. Appears emotionally flat and guarded. No signs of physical injury or distress. No suicidal ideation disclosed.

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

Samuel Cooper, aged 49, presents to your general practice in a semi-rural town complaining of worsening chronic back pain and poor sleep. During the consultation, he discloses that his wife has recently become physically aggressive during arguments, including slapping and throwing objects at him. He reports she regularly insults him in front of their teenage children, threatens to ‘ruin him’ financially if he ever leaves, and has restricted his access to joint bank accounts. Samuel becomes tearful, saying, ‘No one believes men like me… I’m ashamed to even bring it up.’

Medications: Paracetamol 1 g TDS, ibuprofen PRN

Allergies: Nil known

Past history: Chronic low back pain, hypertension

Family history: Father died by suicide in his 50s

Social history: Lives with wife and two teenage children. Works full-time as a mechanic. No history of mental illness. Financially dependent on his wife’s salary during recent unemployment. No known support networks outside of work.

Examination findings: No physical injuries noted today. BP 134/78 mmHg, HR 76 bpm. Samuel appears emotionally distressed. PHQ-9 score: 21 (severe depression). No suicidal ideation disclosed but reports feeling ‘trapped’.

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

Layla Hassan, aged 11, is brought to your suburban general practice by her father for abdominal pain and poor concentration at school. Her father does most of the talking and says she’s just ‘going through a phase’. During the examination, you ask to speak to Layla alone. In private, she quietly discloses that her father gets angry easily, yells at her and her mother, and recently smashed her iPad during an argument. She says she often hides in her room when he’s home and has trouble sleeping. She adds, ‘Mum cries a lot but tells me not to talk about it.’

Medications: Nil

Allergies: Nil known

Past history: Mild asthma

Family history: Nil of note

Social history: Lives with both parents. No known involvement with child protection services. Attends Year 6 at local primary school. Previously good academic performance.

Examination findings: Appears withdrawn and anxious. Normal growth and development. No signs of physical injury. Abdomen soft, non-tender. No other abnormalities noted.

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

Ravi Desai, aged 59, presents to your metropolitan general practice for follow-up of his recently diagnosed type 2 diabetes. During the consultation, he appears withdrawn and reluctant to engage. You recall that in previous visits he was accompanied by his adult son, who answered most questions on his behalf. When you ask to speak with Ravi alone today, he admits that his son has become verbally abusive, frequently yells at him, and has stopped bringing him to appointments if he ‘argues’. Ravi says he no longer has access to his bank account and has not been able to buy his medications this month. He appears distressed and says, ‘Maybe I’m just a burden.’

Medications: Metformin 1 g BD (non-adherent past 2 weeks)

Allergies: Nil known

Past history: Type 2 diabetes, hypertension, recent diagnosis of mild depression

Family history: Nil of note

Social history: Lives with adult son and daughter-in-law. Recently widowed. No extended family nearby. Financially dependent. Previously worked as a taxi driver, retired 2 years ago.

Examination findings: BP 146/88 mmHg, HR 78 bpm, HbA1c: 8.7%. Appears sad and hesitant. No physical injuries. Alert, oriented. MMSE 29/30.

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

Asha Patel, aged 26, presents to your inner-city general practice requesting a medical certificate for work. During the consultation, she discloses symptoms of anxiety, sleep disturbance, and trouble concentrating. On further exploration, Asha reveals that her partner frequently criticises her, controls what she wears, tracks her location via her phone, and has recently prevented her from seeing friends. She reports that he has never physically harmed her but says, ‘He scares me when he gets angry. I don’t know who I am anymore.’

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Not disclosed

Social history: Lives with partner. Works full-time in retail. Limited family contact. Reports social withdrawal over the past six months. No drug or alcohol use.

Examination findings: Asha appears anxious and tearful. No signs of injury. Vitals normal. PHQ-9 score: 16 (moderate depression). No suicidal ideation disclosed.

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

Daniel Thompson, aged 7, is brought to your general practice by his mother for behavioural issues and poor sleep. During the visit, his mother describes frequent tantrums, bedwetting, and school refusal. She seems fatigued and becomes tearful when discussing their home life. In a private moment, she discloses that her ex-partner—Daniel’s father—has been showing up unannounced, yelling at her outside the house, and sending threatening messages. She says Daniel witnessed him breaking a window last week. She adds, ‘He’s never hurt Daniel, but Daniel’s terrified whenever he hears his voice.’

Medications: Nil

Allergies: Nil known

Past history: Uncomplicated birth and development. No prior behavioural or mental health concerns.

Family history: Paternal depression. No known genetic disorders.

Social history: Lives with mother. No siblings. Father does not have court-ordered visitation but contacts the child irregularly. School reports declining engagement and increased anxiety.

Examination findings: Daniel is quiet, avoids eye contact. Growth and vitals are normal. No physical injuries. Behavioural screening indicates high anxiety levels for age. Appears fearful during consultation.

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

Monique Richards, aged 53, presents to your regional general practice for fatigue, low mood, and worsening control of her hypertension. On further discussion, she reveals that her adult son, who has a history of substance use and recently lost his job, moved back in with her six months ago. Since then, he has become increasingly volatile—shouting, demanding money, and damaging property during outbursts. She says he has taken her bank card several times, and she feels frightened in her own home. She adds, ‘He’s my son… I just don’t know what to do.’

Medications: Amlodipine 10 mg daily, sertraline 50 mg daily

Allergies: Nil known

Past history: Hypertension, depression, osteoarthritis

Family history: Father died of stroke. Mother had depression.

Social history: Divorced. Lives alone except for her adult son. Works part-time. No contact with ex-husband. Limited social supports.

Examination findings: BP 158/94 mmHg. Appears fatigued, emotionally flat. No physical injuries. PHQ-9 score: 19 (moderate-severe depression).

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

Nicole Fraser, aged 22, presents to your general practice with symptoms of recurrent urinary tract infections. During history-taking, she becomes visibly uncomfortable when discussing her relationship. After gentle inquiry in a private consultation, she discloses that her partner refuses to use condoms, even when she requests it, and has previously discarded her oral contraceptive pills. She says he becomes angry when she brings up contraception and accuses her of not wanting to have his child. Nicole adds, ‘He says if I love him, I should trust him.’

Medications: Oral contraceptive (inconsistently used)

Allergies: Nil known

Past history: Recurrent UTIs over past 6 months, no other significant history

Family history: Non-contributory

Social history: Lives with partner. Works part-time. No children. Socially isolated. No drug or alcohol use.

Examination findings: Afebrile. Abdomen soft, mild suprapubic tenderness. No vaginal discharge or signs of STI. Urinalysis: positive leukocytes and nitrites. Appears anxious. No signs of physical injury.

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

Peter Wallace, aged 82, presents to your urban general practice with weight loss, confusion, and a request for more frequent prescriptions. He is accompanied by his grandson, who insists on speaking for him. During the physical examination, you ask to speak to Peter alone. In private, Peter expresses concern that his grandson has started taking his medications and occasionally leaves him without food. He adds that money has been disappearing from his bank account, and he’s afraid to say anything because his grandson gets ‘very angry’.

Medications: Perindopril 5 mg daily, atorvastatin 20 mg daily, paracetamol PRN

Allergies: Nil known

Past history: Hypertension, osteoarthritis, mild cognitive impairment

Family history: Wife deceased. No other children. Grandson is sole carer.

Social history: Lives in private home with grandson. Previously independent but now requires assistance with daily tasks. No formal home care in place.

Examination findings: BP 138/76 mmHg, HR 80 bpm. Appears undernourished. MoCA: 23/30 (mild cognitive impairment). No physical injuries.

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

Jasmine Leung, aged 15, is brought to your general practice by her mother for fatigue and school absenteeism. During the consultation, Jasmine appears withdrawn and avoids eye contact. After gently creating a safe space to speak alone, she discloses that she has been receiving repeated, unwanted messages from a male teacher at her school. She says he recently began commenting on her appearance and asking to meet her outside of school hours. She hasn’t told anyone because ‘he said no one would believe me’ and she’s afraid of getting in trouble.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Non-contributory

Social history: Lives with both parents. Year 10 student. Previously high academic performer. No known child protection history.

Examination findings: Jasmine is quiet and appears anxious. No physical injuries. Vitals within normal limits. No suicidal ideation disclosed. PHQ-A: Moderate depressive symptoms.

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

Melissa Tran, aged 40, presents to your general practice requesting a repeat script for sertraline. During the consultation, she appears agitated and tearful. On further discussion, she discloses that she has recently separated from her partner after 15 years of emotional abuse. She reports that since moving out, her ex-partner has been sending her dozens of messages daily, showing up at her workplace, and contacting her friends to ‘get her back’. She says, ‘He hasn’t touched me, but I feel like I’m always being watched.’ She has blocked his number but continues to receive messages from unknown accounts.

Medications: Sertraline 50 mg daily

Allergies: Nil known

Past history: Generalised anxiety disorder, depression (stable on current medication)

Family history: Mother with bipolar disorder

Social history: Recently moved into private rental. Works in administration. No children. Limited support network since separation.

Examination findings: Melissa is tearful but coherent. No signs of physical injury. PHQ-9: 14 (moderate depression). Vitals within normal limits.

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

Benjamin Clarke, aged 61, presents to your outer-metropolitan general practice with poorly controlled type 2 diabetes and insomnia. During the consultation, he appears withdrawn and anxious. On private discussion, he discloses that his live-in partner has recently become emotionally and financially controlling. She restricts his access to joint finances, frequently insults him, and has threatened to have him evicted from their home if he disagrees with her. He says, ‘I don’t have anywhere else to go. I’m walking on eggshells.’

Medications: Metformin 1 g BD, gliclazide 60 mg daily, ramipril 10 mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hypertension, hyperlipidaemia

Family history: Father with ischaemic heart disease

Social history: Lives with female partner of 8 years. No children. Retired. Limited social support. Financially reliant on partner due to recent redundancy.

Examination findings: BP 148/86 mmHg, HbA1c 9.3%. No physical injuries. Appears tense and fatigued. PHQ-9 score: 17 (moderate-severe depression)

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

Sofia Haddad, aged 30, presents to your general practice for a routine cervical screening test. During the consultation, she becomes emotional and discloses that her husband forces her to have sex even when she says no, often after arguments. She reports that he apologises afterward but says he has ‘needs’ and that ‘marriage means not saying no’. She has not told anyone and says she thought this was ‘just part of being a wife’. She says she feels ashamed, avoids intimacy, and has begun experiencing intrusive memories and nightmares.

Medications: None

Allergies: Nil known

Past history: Nil significant

Family history: Not discussed

Social history: Married 6 years. No children. Lives with husband. Recently moved interstate and has no local support network. Unemployed. Financially dependent on her husband.

Examination findings: Cervical screening deferred due to distress. Appears tearful and withdrawn. No physical injuries. PHQ-9: 20 (moderate to severe depression). No active suicidality disclosed.

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

Adrian Wells, aged 34, presents to your regional general practice with difficulty sleeping, frequent headaches, and anxiety. During the consultation, he discloses that he is in a same-sex relationship where his partner has become increasingly controlling—isolating him from friends, monitoring his phone, and threatening to out him to his employer and family if he tries to leave. He says his partner has pushed him during arguments and once locked him in their apartment overnight. Adrian adds, ‘I thought it was just passionate love, but now I feel trapped.’

Medications: Nil

Allergies: Nil known

Past history: None reported

Family history: Not discussed

Social history: Lives with male partner. Recently moved to the area for partner’s work. Employed full-time. No local support network. Closeted to family and employer.

Examination findings: BP 124/76 mmHg. HR 80 bpm. Appears anxious and sleep-deprived. No physical injuries. PHQ-9 score: 15 (moderate depression). No suicidal ideation disclosed.

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

Elena Petrova, aged 47, presents to your general practice requesting help for persistent insomnia and panic attacks. On further discussion, she shares that she recently moved to Australia on a partner visa and feels increasingly isolated. Her partner, who is an Australian citizen, controls all finances, monitors her phone and email, and has told her she will be deported if she disobeys him. He restricts her access to English classes and insists on attending all her medical appointments. She says, ‘I feel like a prisoner… but I don’t want to be sent back.’

Medications: Nil

Allergies: Nil known

Past history: Nil reported

Family history: Not disclosed

Social history: Migrated from Eastern Europe 8 months ago. No family or friends in Australia. Unemployed. Dependent on partner for housing and income. Limited English proficiency.

Examination findings: Appears anxious and tearful. BP 122/74 mmHg. HR 92 bpm. No signs of physical injury. PHQ-9 score: 18 (moderate depression). GAD-7: 15 (moderate to severe anxiety).

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

Trent Dawson, aged 17, presents to your general practice with complaints of chronic abdominal pain and difficulty concentrating at school. When asked about his home life, he hesitates, then shares that his stepfather often calls him names like ‘useless’ and ‘a waste of space’, especially when his mother isn’t around. He also describes being locked out of the house for hours after arguments and being made to skip meals as punishment. He says, ‘He hasn’t hit me, but I try to stay out of the way as much as I can.’

Medications: Nil

Allergies: Nil known

Past history: Unremarkable. No prior mental health diagnoses.

Family history: Mother with depression. No known medical conditions in other family members.

Social history: Lives with mother and stepfather. Attends Year 11. No involvement with child protection services. No drug or alcohol use.

Examination findings: Trent is underweight (BMI 17.8), appears tense and anxious. Abdomen soft, non-tender. Vitals stable. No physical injuries. PHQ-A: Moderate depressive symptoms. No suicidal ideation.

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

Angela Moretti, aged 62, presents to your general practice with poorly controlled hypertension and recent weight loss. During the consultation, she appears hesitant and tearful. After gently exploring psychosocial factors, she discloses that her adult daughter, who moved in with her six months ago, has become verbally aggressive, controls her Centrelink payments, and often ‘borrows’ her pension card. Angela says she hasn’t had enough money to fill all her prescriptions this month and sometimes goes without meals. She adds, ‘She’s my daughter—I don’t want to get her in trouble.’

Medications: Amlodipine 10 mg daily, perindopril 5 mg daily, atorvastatin 20 mg daily

Allergies: Nil known

Past history: Hypertension, hyperlipidaemia, osteoarthritis

Family history: Mother had dementia, father died of stroke

Social history: Widow. Lives alone, daughter recently moved in after relationship breakdown. No formal home care. Financially reliant on pension.

Examination findings: BP 162/92 mmHg. BMI 19. Appears anxious and undernourished. No physical injuries. Alert and oriented. MoCA: 26/30.

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

Imran Yousaf, aged 31, presents to your general practice with worsening eczema and insomnia. During the consultation, he appears distracted and tense. When gently asked about stressors, he discloses that he has been experiencing ongoing verbal and emotional abuse from his older brother, with whom he shares a rental home. He describes being called names, humiliated in front of visitors, and having his personal belongings damaged. Recently, his brother threatened to throw him out if he complained. Imran says he can’t afford to move out and is afraid of being isolated from the community if he speaks up.

Medications: Topical corticosteroids PRN

Allergies: Nil known

Past history: Eczema, anxiety (previously managed without medication)

Family history: Nil relevant

Social history: Lives with older brother. Works part-time. Financially dependent. Migrated to Australia 3 years ago. Limited social support outside immediate family.

Examination findings: Mild eczema flare on arms and neck. No physical injuries. PHQ-9: 15 (moderate depression). No suicidality disclosed.

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

Grace O’Connor, aged 36, presents to your suburban general practice with worsening asthma symptoms. During the consultation, she reveals that she is finding it hard to manage her medications and care for her two young children. When asked about supports at home, she discloses that her ex-partner, who has shared custody, has started refusing to return the children after visitation, threatens to report her to child protection if she doesn’t comply with his demands, and sends abusive messages daily. She says, ‘I feel like he’s still in control, even though we’re not together.’

Medications: Salbutamol PRN, budesonide/formoterol 200/6 µg BD

Allergies: Nil known

Past history: Asthma, anxiety (currently untreated)

Family history: Non-contributory

Social history: Mother of two. Separated 1 year ago. Shared parenting arrangement in place. No family support nearby. Works part-time. Living in rented housing.

Examination findings: Mild wheeze on auscultation. No physical injuries. Appears anxious. PHQ-9: 16 (moderate depression). No suicidal ideation. Peak flow 380 L/min (baseline 450).

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

Liam Jones, aged 13, presents to your general practice accompanied by his aunt for worsening eczema and social withdrawal. During the consultation, the aunt expresses concern that Liam is becoming increasingly anxious, refuses to attend school, and has started wetting the bed again. When asked to speak privately, Liam discloses that his father—who has primary custody—yells at him daily, calls him names, and has threatened to ‘send him away’ if he doesn’t behave. He says he’s scared to talk to anyone and adds, ‘I don’t think anyone would believe me anyway.’

Medications: Topical corticosteroids PRN

Allergies: Nil known

Past history: Atopic dermatitis, mild asthma

Family history: Mother deceased. Lives with father. Recently began spending weekends with aunt.

Social history: Year 8 student. No prior child protection involvement. No contact with school counsellor.

Examination findings: Liam appears anxious, avoids eye contact. Moderate eczema on arms and neck. No physical injuries. Vitals stable. No suicidal ideation disclosed.

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

Aaliyah Ahmed, aged 28, presents to your general practice with headaches, fatigue, and trouble concentrating at work. During a routine psychosocial history, she discloses that she has recently escaped a violent relationship. She has since received anonymous threatening messages and suspects her ex-partner is following her to and from work. She has moved house twice and changed her number, but continues to feel unsafe. She says, ‘I don’t know what he’ll do next. I’m scared to leave the house.’

Medications: None

Allergies: Nil known

Past history: Migraine, previously treated PTSD from childhood trauma

Family history: Nil of note

Social history: Lives alone. Recently relocated to a new suburb. Works full-time in retail. No contact with family. Minimal support network.

Examination findings: Appears anxious, constantly looking around room. BP 124/72 mmHg. HR 84 bpm. PHQ-9: 20 (moderate to severe depression). No suicidality or self-harm disclosed.

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