KFP – Disability care

Michael Langford, aged 46, presents with his support worker for a routine review. He has a diagnosis of moderate intellectual disability and autism spectrum disorder. He lives in supported accommodation with 24-hour care. His support worker is concerned about a change in behaviour over the past 2 weeks — Michael has been increasingly irritable, avoiding meals, and spending more time in bed. He has also been touching his lower abdomen and vocalising distress when carers assist with toileting.

Medications: Risperidone 1mg daily, Sertraline 50mg daily

Allergies: Nil known

Past history: Constipation, Gastro-oesophageal reflux, Epilepsy (well controlled)

Social history: Supported accommodation with NDIS support workers. Non-verbal and communicates via gestures and picture board. Requires assistance with all ADLs.

Examination findings: Afebrile, HR 92, BP 128/84, abdomen soft but mild suprapubic tenderness. No CVA tenderness. PR: small amount of stool in rectum. No abdominal masses.

Investigations: Urinalysis: +++ leucocytes, + nitrites, trace blood

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

Katie Jennings, aged 32, attends with her mother for a GP review. Katie has Down syndrome and a moderate intellectual disability. She lives at home with her ageing parents and works part-time in a local supported employment program. Her mother is concerned about recent changes in Katie’s behaviour — she has been increasingly withdrawn, avoiding work, and occasionally incontinent of urine at night. Katie has been more forgetful, often misplacing items and forgetting familiar tasks such as brushing her teeth. Her speech has also become less fluent over the past month. There is no history of recent illness or trauma.

Medications: None

Allergies: Nil known

Past history: Congenital heart disease (repaired AVSD), hypothyroidism, mild hearing loss

Family history: Nil of note

Social history: Lives with mother and father, both aged in their 70s. No recent changes in routine. Non-smoker. No alcohol or drug use. Attends a community day program twice weekly.

Examination findings: BP 126/78, HR 82, Temp 36.7°C. Cranial nerves intact, no focal neurological deficits. No signs of infection. Gait slightly unsteady, no cerebellar signs. Affect flat. Speech effortful.

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

David Ritchie, aged 58, presents with his sister for a routine GP review. He has a history of spastic quadriplegic cerebral palsy, profound intellectual disability, epilepsy, and severe scoliosis. David is non-verbal, has gastrostomy feeding via PEG, and uses a wheelchair for mobility. He lives in a supported group home with 24-hour care. His sister, who is his legal guardian, notes that over the last 10 days David has become more unsettled, moaning frequently and refusing PEG feeds. Staff have increased his PRN paracetamol, but there has been little effect. His bowels last moved 3 days ago.

Medications: Sodium valproate 1000mg BD, Baclofen 10mg TDS, Paracetamol PRN

Allergies: Nil known

Past history: Recurrent constipation, gastro-oesophageal reflux disease, hip subluxation

Social history: Lives in NDIS-funded supported accommodation. Non-verbal. Full assistance with ADLs.

Examination findings: HR 104, BP 112/68, Temp 37.8°C. Grimaces with abdominal palpation. Abdomen moderately distended. PEG site clean. No signs of aspiration. Chest clear.

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

Lisa Martineau, aged 27, presents with her carer for a health assessment. She has a diagnosis of severe autism spectrum disorder, sensory processing disorder, and mild intellectual disability. She lives in a shared supported accommodation setting and requires assistance with most activities of daily living. Lisa has a history of food refusal and is described as an extremely ‘fussy eater’. Her carer reports that she only eats a limited range of beige-coloured foods and refuses fruits, vegetables, and meat. She has been losing weight over the last 6 months and has become increasingly fatigued and pale. Her menses stopped 3 months ago.

Medications: Nil regular

Allergies: Nil known

Past history: Anxiety, constipation, food aversion

Social history: Lives in NDIS-funded group home. Attends supported day program 3 days/week.

Examination findings: BMI 16.8, pale conjunctivae, dry skin, brittle nails. No lymphadenopathy. No oral lesions. HR 98, BP 100/65. Neurological exam: normal tone and reflexes. Mild unsteadiness on tandem gait.

Investigations:

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

Helen Samson, aged 73, presents with her daughter for a review. Helen has a diagnosis of moderate Alzheimer’s dementia and Parkinson’s disease. She lives in a supported living unit with daily visits from her daughter and home care workers twice a day. Her daughter reports increasing difficulty managing Helen’s medications and notes several missed doses over the past fortnight. Helen has become more rigid, with a noticeable decline in mobility and two recent falls. She is alert but often disoriented, and struggles to operate the dosette box. Her daughter is feeling overwhelmed and is seeking advice.

Medications: Levodopa-carbidopa 100/25mg QID, Donepezil 10mg nocte, Macrogol sachets PRN

Allergies: Nil known

Past history: Hypertension, Osteoporosis, Recurrent UTIs

Social history: Widowed, lives alone in aged care unit. Receives home care twice daily through CHSP (Commonwealth Home Support Program). Daughter is primary informal carer.

Examination findings: BP 138/76, HR 80, Weight stable, gait slow with festination and reduced arm swing, MMSE: 19/30

What are the most appropriate next steps in managing Helen’s care needs? Select three (3) from the following list:

James Holland, aged 19, attends with his support coordinator. He has a diagnosis of severe intellectual disability, autism spectrum disorder, and epilepsy. James is non-verbal, communicates using gestures and visual aids, and lives in a specialist disability accommodation with 24/7 support. Over the past 2 months, staff have noticed a significant increase in his agitation and aggressive outbursts, particularly during personal care tasks and dressing. He has also started banging his head against the wall, especially in the mornings. There have been no witnessed seizures. James has not had any recent medical reviews.

Medications: Sodium valproate 500mg BD, Melatonin 3mg nocte

Allergies: Nil known

Past history: Epilepsy (well-controlled), constipation, sensory hypersensitivity, anxiety

Social history: Supported accommodation with 1:1 care. Non-smoker. No alcohol or drugs. Attends supported day program.

Examination findings: Cooperative with carer assistance. No focal neurological signs. No visible injuries. Mild halitosis. Abdomen soft, non-tender. Weight stable. Behavioural cues suggest discomfort when his face and mouth are approached.

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

Amira El-Haddad, aged 41, presents for follow-up after a recent hospital admission for pneumonia. Amira has multiple sclerosis with spastic paraparesis and uses a wheelchair full-time. She also has a neurogenic bladder managed with an indwelling catheter. Since discharge, her carers have noted increased confusion and drowsiness, particularly in the late afternoon. She is eating less than usual and has not opened her bowels for 4 days. Her current care is provided via an NDIS-funded home care package with a mix of informal and agency support workers. Her speech is mildly slurred, but this is stable from baseline.

Medications: Baclofen 10mg TDS, Oxybutynin 5mg BD, PRN paracetamol

Allergies: Nil known

Past history: Multiple sclerosis (progressive), recurrent UTIs, constipation, pressure injury (healed)

Social history: Lives alone with daily support workers. NDIS plan includes 40 hours/week of personal care and therapy support.

Examination findings: Temp 36.8°C, HR 96, BP 110/66. GCS 14 (drowsy but rousable). Abdomen mildly distended with reduced bowel sounds. No suprapubic tenderness. Catheter draining cloudy urine. No pressure areas. Neurological signs consistent with known MS diagnosis.

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

Benjamin Law, aged 10, presents with his foster carer for review. Benjamin has a diagnosis of fetal alcohol spectrum disorder (FASD), mild intellectual disability, and ADHD. He was placed in long-term foster care at age 4 after removal from his biological parents. His carer is concerned about increasing outbursts at school, including aggression and oppositional behaviour, and a recent suspension. She reports he is struggling academically, has poor sleep, and is socially isolated. He is currently not under the care of any specialist service. His carer is seeking support and direction.

Medications: Methylphenidate 10mg BD (school days only)

Allergies: Nil known

Past history: Intrauterine alcohol exposure, developmental delay, attachment trauma, hearing loss (mild, corrected with aids)

Social history: Lives in stable foster care placement. Attends mainstream school with limited learning support. No current NDIS plan. Child protection caseworker involved.

Examination findings: Engaged but distractible. Height and weight at 25th percentile. No dysmorphic features noted. ENT, cardiac, and neurological exams normal. Carer presents school behavioural report documenting multiple behavioural incidents over the past term.

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

Joanne Edwards, aged 65, presents with her supported accommodation worker for a routine health check. She has a diagnosis of moderate intellectual disability and type 2 diabetes mellitus. Her support worker reports that Joanne has been increasingly withdrawn and irritable over the last month, often refusing meals and avoiding group activities. She is non-verbal but usually communicates using facial expressions and hand gestures. Joanne has a long-standing history of constipation and osteoarthritis, and recently completed a course of antibiotics for a urinary tract infection.

Medications: Metformin XR 1g daily, Paracetamol 1g TDS, Movicol PRN

Allergies: Nil known

Past history: Type 2 diabetes, osteoarthritis, chronic constipation, previous UTI, hearing impairment

Social history: Lives in supported group home with 24-hour care. Attends day program three times a week. NDIS plan includes assistance with ADLs and allied health support.

Examination findings: BMI 29, Temp 37.4°C, HR 88, BP 128/72. Abdominal exam reveals mild tenderness in the left lower quadrant. No guarding or rebound. Bowel sounds present. No spinal or joint tenderness. Mood appears flat. Joanne avoids eye contact and is minimally responsive to staff.

What are the most appropriate next steps in her assessment and care? Select three (3) from the following list:

Matilda Johnson, aged 54, presents with her brother, who is her primary carer. Matilda has a diagnosis of moderate intellectual disability and schizophrenia. She has lived with her brother in the family home since their mother passed away 3 years ago. Her brother reports that Matilda has become increasingly suspicious and withdrawn over the last few weeks, refusing food at times and expressing fears that ‘the food is poisoned’. She is also sleeping poorly and occasionally talking to herself. Matilda has a history of non-compliance with medication but has been stable for the past 2 years. Her brother is concerned she may be relapsing.

Medications: Risperidone 2mg nocte

Allergies: Nil known

Past history: Schizophrenia (diagnosed age 26), osteoporosis, obesity, hyperlipidaemia

Social history: Lives with brother. Not eligible for NDIS at last assessment. No current support worker. Limited community engagement since COVID-19 restrictions. No substance use.

Examination findings: BP 132/78, HR 82, BMI 33. Speech tangential. Answers some questions but becomes guarded. Poor eye contact. No neurological abnormalities. No signs of self-harm or aggression noted.

What are the most appropriate next steps in Matilda’s care? Select three (3) from the following list:

Pauline Sharpe, aged 39, presents with her support worker due to recent weight loss and ongoing diarrhoea. Pauline has a diagnosis of mild intellectual disability and coeliac disease. She lives in supported independent living with two other residents and has limited literacy. Her support worker notes that Pauline has been complaining of frequent abdominal bloating, loose stools, and fatigue over the past month. She has lost 4 kg over that period. The group home recently changed food suppliers, and Pauline now helps with her own grocery shopping but requires assistance with reading labels.

Medications: Sertraline 50mg daily, Paracetamol PRN

Allergies: Nil known

Past history: Coeliac disease (diagnosed age 25), depression (stable), iron deficiency anaemia

Social history: Lives in shared disability housing with drop-in support. Attends day program twice a week. No alcohol or smoking. Receives NDIS support for daily living and transport.

Examination findings: BMI 18.2, HR 92, BP 116/74. Pale conjunctivae, soft abdomen with mild diffuse tenderness. Bowel sounds active. No signs of peritonism. Neurological exam normal.

Investigations:

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

Lucas Fraser, aged 23, presents with his mother for review of his transition to adult care. Lucas has spina bifida with hydrocephalus, a ventriculoperitoneal (VP) shunt, and neurogenic bladder. He uses a wheelchair full-time and has mild intellectual disability. He was previously followed by a paediatric multidisciplinary team but has not seen a specialist in over 12 months. His mother reports increasing urinary incontinence, despite intermittent catheterisation, and one recent episode of pyelonephritis requiring hospitalisation. Lucas is unsure when he last saw a urologist or had renal imaging. His mother is concerned about long-term kidney health.

Medications: Oxybutynin 5mg BD, Trimethoprim 100mg nocte (prophylaxis)

Allergies: Nil known

Past history: Spina bifida (myelomeningocele), hydrocephalus with VP shunt, recurrent UTIs, scoliosis (surgically corrected), developmental delay

Social history: Lives with parents. Completed high school in special education setting. Receives NDIS support for personal care and physiotherapy. Independent in upper limb function. No substance use. Sexual activity: nil disclosed.

Examination findings: BP 144/88, HR 84, Temp 36.6°C. Abdomen soft. VP shunt site intact. No CVA tenderness. Lower limb spasticity with contractures. No pressure areas.

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

Susan Yeo, aged 47, presents with her partner for review. She has a diagnosis of moderate intellectual disability and type 2 diabetes mellitus. Her partner expresses concern about Susan’s recent mood swings, increasing fatigue, and weight gain. Susan has become withdrawn and is no longer interested in her regular activities at the local disability support centre. She is sleeping more than usual and often complains of feeling cold. She has also gained 6kg over the past three months despite no change in diet or activity level. She is independent in most ADLs and takes her medications with prompting.

Medications: Metformin XR 1g daily, Atorvastatin 20mg nocte

Allergies: Nil known

Past history: Type 2 diabetes mellitus, hyperlipidaemia, mild hearing loss

Social history: Lives with long-term partner. Attends a supported workplace. NDIS-funded for social support and allied health. No tobacco or alcohol use.

Examination findings: BMI 32, BP 138/82, HR 62, T 36.1°C. Mild facial puffiness and dry skin noted. Reflexes slow to relax. Mood subdued but cooperative. No focal neurological deficits.

What are the most appropriate next steps in Susan’s care? Select three (3) from the following list:

David Milos, aged 62, presents with his supported living coordinator for a comprehensive health assessment. He has a diagnosis of severe intellectual disability and epilepsy. He is non-verbal, lives in a supported group home with 24-hour staff, and requires full assistance with personal care. His coordinator is concerned about progressive mobility decline over the past year. David now walks with difficulty and requires two staff members for transfers. He has also had two minor falls in the past month. Staff report no seizures in the last 18 months. There is no formal physiotherapy support in his current NDIS plan.

Medications: Sodium valproate 500mg BD, Vitamin D 1000 IU daily

Allergies: Nil known

Past history: Epilepsy (well controlled), constipation, vitamin D deficiency, long-term institutionalisation (until age 45)

Social history: Lives in NDIS-funded supported accommodation with 3 other residents. Day program attendance has reduced due to mobility issues. Non-smoker. No alcohol or drugs.

Examination findings: BMI 30. HR 76, BP 130/80. Lower limb muscle wasting noted with spasticity and reduced ankle reflexes. Gait is wide-based and unsteady. No spinal tenderness. Upper limbs normal. No pressure injuries or joint deformities.

What are the most appropriate next steps in managing David’s care? Select three (3) from the following list:

Isobel Tane, aged 36, presents with her support coordinator for review. She has a diagnosis of autism spectrum disorder, generalised anxiety disorder, and mild intellectual disability. Isobel lives in supported independent living and works part-time in a disability employment service. Her coordinator reports that Isobel has become increasingly distressed about attending her job, complaining of loud noises, bright lights, and difficulty concentrating. She is frequently overwhelmed and has begun refusing to leave the house on workdays. Her anxiety appears worse in the mornings. Isobel is articulate but easily flustered and avoids eye contact during the consultation.

Medications: Sertraline 100mg daily

Allergies: Nil known

Past history: Anxiety, sensory processing disorder, recurrent migraines

Social history: Lives with one housemate and receives NDIS supports for community access and psychological therapy. No smoking or alcohol. Limited informal supports.

Examination findings: BP 122/78, HR 80, BMI 25. Speech clear but hesitant. Affect anxious. Neurological exam normal. No photophobia or neck stiffness. No obvious physical cause of distress noted.

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

Raymond Liu, aged 59, presents with his niece for review following an episode of aspiration pneumonia three weeks ago. He has a diagnosis of Down syndrome, moderate intellectual disability, and hypothyroidism. He lives in a supported group home and receives full assistance with meals, medications, and personal care. His niece is concerned about his increasing coughing during meals and a recent weight loss of 3kg. Staff report that Raymond often pockets food in his cheeks and tires during meals. He has no formal swallowing supports or speech therapy input in his NDIS plan.

Medications: Levothyroxine 100mcg daily, Paracetamol PRN

Allergies: Nil known

Past history: Hypothyroidism, gastroesophageal reflux, previous aspiration pneumonia (recent)

Social history: Lives in supported group home. Non-verbal. Attends day centre twice weekly. Supported under NDIS with daily living and transport assistance.

Examination findings: BMI 20.4 (previously 23.4), Temp 36.4°C, HR 78, BP 118/70. Chest clear. Mild oral candidiasis noted. Slow chewing observed when offered water during assessment.

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

Emily Harkness, aged 30, presents with her father for review. She has a diagnosis of cerebral palsy (spastic diplegia) and mild intellectual disability. Emily uses a manual wheelchair outside the home and walks short distances indoors with a frame. Her father reports increasing difficulty managing her personal care needs due to his own declining health. Emily is keen to move into supported accommodation to become more independent but does not currently have an NDIS plan that includes supported independent living (SIL). She works part-time in a supported role and is otherwise medically stable.

Medications: Baclofen 10mg TDS, Paracetamol PRN

Allergies: Nil known

Past history: Cerebral palsy (non-progressive), GORD, anxiety

Social history: Lives with elderly father who is primary carer. No siblings. Accesses day program once a week. No current formal care services in place. Interested in increasing independence.

Examination findings: BP 122/78, HR 82, BMI 24. Lower limb spasticity with good upper limb strength. Gait with frame short and slow but safe. Speech clear. Cognitively engaged and expresses desire for more independence.

What are the most appropriate next steps to support Emily’s transition? Select three (3) from the following list:

Nathan Reid, aged 45, presents with his disability support worker for a routine review. He has a diagnosis of moderate intellectual disability and generalised tonic-clonic epilepsy. He lives in a supported group home and works two days a week in a local packaging facility. His support worker reports that Nathan has had three seizures in the past month, after being seizure-free for over a year. He has also appeared more tired and has missed his usual morning routine on multiple occasions. Nathan takes his medications independently but has recently started refusing tablets in the mornings.

Medications: Sodium valproate 500mg BD

Allergies: Nil known

Past history: Epilepsy, constipation, intellectual disability since birth

Social history: Supported group home. No family contact. NDIS plan includes daily living support and allied health input. No known substance use.

Examination findings: BP 122/76, HR 78, afebrile. No focal neurological signs. Responds slowly to questions but is oriented and cooperative. Mild tremor in hands. Oral exam: no lesions, but medication residue noted on tongue. Weight stable.

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

Aaron McKenzie, aged 68, presents with his case manager for a comprehensive review. He has a diagnosis of severe intellectual disability and early-stage dementia. Aaron is non-verbal and lives in a supported residential facility. Over the past two months, staff have noted increasing agitation in the late afternoons, pacing, shouting, and resistance to care tasks such as showering. He has also been more drowsy in the mornings. No seizures or acute medical issues have been reported. His sleep-wake cycle appears reversed. His current NDIS plan includes 1:1 day support but no behavioural interventions.

Medications: Donepezil 10mg nocte, Paracetamol PRN

Allergies: Nil known

Past history: Intellectual disability since childhood, dementia diagnosed 1 year ago, GORD, osteoporosis

Social history: Lives in supported care with 24-hour staffing. No known family involvement. Case manager is public guardian representative.

Examination findings: BP 128/74, HR 70, afebrile. No focal neurological deficits. Appears tired but ambulant. No pressure areas. Chest and abdomen normal. Responds to simple gestures but resists physical contact in the afternoon.

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

Chloe Barrett, aged 27, presents with her support coordinator for a follow-up after a recent diagnosis of borderline personality disorder (BPD). Chloe has a history of mild intellectual disability and has been living in supported accommodation for the past 2 years. She has recently engaged in self-harm by superficial cutting and has made multiple emergency department presentations following interpersonal conflicts with peers and staff. Her support coordinator reports that Chloe becomes easily overwhelmed, particularly when her routine changes or she feels rejected. Chloe expresses a strong desire to remain in her current home but says she feels ‘out of control’ at times. She is not currently linked with a psychologist.

Medications: None

Allergies: Nil known

Past history: Mild intellectual disability, GORD, recent BPD diagnosis, multiple previous self-harm events

Social history: Lives in supported accommodation with shared staffing. Receives NDIS supports for daily living but no therapeutic supports. No family involvement. Limited community engagement.

Examination findings: Well-kempt. Cooperative but emotionally labile during consultation. No active suicidality. Superficial healing wounds on forearms. No signs of infection. Vitals stable. Cognitively appropriate for developmental level.

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

Samuel Knox, aged 33, attends with his support worker for a routine review. He has a diagnosis of Fragile X syndrome, mild intellectual disability, and generalised anxiety disorder. He lives in a shared supported accommodation and works at a supported gardening program. His support worker notes increasing avoidance of community activities and difficulties coping with change. Samuel has started refusing to leave the house on days when his usual support worker is unavailable and becomes visibly anxious and tearful when asked about upcoming events. He previously enjoyed swimming and bowling but now declines to attend. There have been no reported self-harm or aggression.

Medications: Escitalopram 10mg daily

Allergies: Nil known

Past history: Fragile X syndrome, anxiety, sensory processing difficulties

Social history: Lives in supported accommodation, has structured daily routine. NDIS-funded for community access and transport. No family contact. No history of substance use.

Examination findings: Engaged when accompanied by familiar support worker. Speech hesitant. Avoids eye contact. No signs of distress at rest. Vitals within normal limits.

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

Patricia Rowe, aged 70, presents with her niece, who is also her guardian. Patricia has a history of moderate intellectual disability and osteoarthritis. She lives in an aged care facility with other older adults with disability. Her niece is concerned about recent weight loss, increased confusion, and a marked decline in mobility. Patricia, who previously walked with a frame, now requires assistance for transfers and has had two recent falls. Staff have noted that she often refuses meals and is increasingly withdrawn. There have been no reported infections or recent medication changes.

Medications: Paracetamol 1g TDS, Calcium + Vitamin D daily

Allergies: Nil known

Past history: Intellectual disability, osteoarthritis (knees and hips), vitamin D deficiency, hearing loss

Social history: Lives in residential aged care with 24-hour support. Limited verbal communication. Attends occasional music and art activities. No history of smoking or alcohol use.

Examination findings: BP 110/64, HR 78, afebrile. Mild dehydration noted. Alert but minimally responsive. Weight has dropped from 65 kg to 58 kg over 3 months. Bruising noted on forearms and legs. No joint swelling or erythema. Gait assessment unable to be performed safely.

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

Liam O’Donnell, aged 29, presents with his disability support worker after an incident at his supported employment placement. Liam has a diagnosis of moderate intellectual disability and type 1 diabetes mellitus. His support worker reports that Liam was found confused and drowsy at work last week, requiring ambulance attendance. Paramedics treated him for hypoglycaemia on site. Liam self-administers insulin with some prompting and prepares his own meals with support. Staff report that he often skips meals when distracted and may incorrectly count carbohydrates. He recently started new shift hours at work, which may have disrupted his insulin routine.

Medications: Insulin glargine (Lantus) 20 units nocte, Insulin aspart (NovoRapid) 6 units TDS with meals

Allergies: Nil known

Past history: Type 1 diabetes (diagnosed age 14), mild hearing impairment, past DKA admission 3 years ago

Social history: Lives in supported accommodation. NDIS-funded for daily living and transport. Works three days/week in supported packaging role. No alcohol or tobacco use. No family involvement.

Examination findings: Alert and cooperative. Vitals stable. No injection site issues. Weight stable. HbA1c from 3 weeks ago was 6.8% (51 mmol/mol).

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

Olivia James, aged 25, presents with her mother for review. Olivia has a diagnosis of Rett syndrome and profound intellectual disability. She is non-verbal, wheelchair-dependent, and requires full assistance for all activities of daily living. She lives at home with her parents, who are her full-time carers. Her mother reports that Olivia has been increasingly irritable and appears to be in pain, arching her back and moaning more than usual. She is eating less and seems more withdrawn. Olivia has a known history of scoliosis and gastro-oesophageal reflux disease (GORD). She is on a soft diet with thickened fluids. No seizures have been reported.

Medications: Omeprazole 20mg daily, Paracetamol PRN

Allergies: Nil known

Past history: Rett syndrome, scoliosis, GORD, hip subluxation

Social history: Lives at home with parents who provide full-time care. Attends a disability day program twice a week. Receives NDIS support for personal care and allied health.

Examination findings: HR 96, BP 120/74, Temp 37.2°C. Appears uncomfortable when moved. Grimaces on palpation over the right lower abdomen and right hip. No rash or redness. No signs of aspiration. Bowel sounds present. No oral lesions. Weight stable.

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

Tyson Hill, aged 38, presents with his support coordinator following multiple missed appointments over the past six months. Tyson has a diagnosis of schizophrenia and mild intellectual disability. He lives in a shared supported accommodation and has a history of poor engagement with mental health services. Staff report increasing paranoia, social withdrawal, and one incident where Tyson accused a housemate of ‘stealing his thoughts’. He has refused his medications for over two weeks and has not attended his supported employment role. His last psychiatric review was over a year ago. The support coordinator is concerned about safety and deterioration in functioning.

Medications: Previously on risperidone 2mg nocte (non-adherent)

Allergies: Nil known

Past history: Schizophrenia, mild intellectual disability, previous hospital admission for psychosis at age 34

Social history: Lives in NDIS-funded supported accommodation. Limited family involvement. Previously engaged in supported work program. No known substance use.

Examination findings: Dishevelled appearance. Minimally communicative. Suspicious and guarded. Responds slowly and gives short answers. No physical health red flags. Vitals within normal limits. No acute self-harm behaviour reported but significant deterioration noted.

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

Angela Thompson, aged 58, presents for a review accompanied by her long-time disability support worker. She has a diagnosis of moderate intellectual disability and chronic constipation. Angela lives in a group home and follows a soft, low-fibre diet due to past issues with dental extractions and choking concerns. Over the last month, staff have noticed reduced appetite, irritability, and abdominal bloating. Angela has required multiple doses of PRN laxatives. She is non-verbal but appears distressed when moved or during toileting. There have been no reported episodes of vomiting or fever.

Medications: Paracetamol PRN, Coloxyl with senna PRN

Allergies: Nil known

Past history: Intellectual disability, chronic constipation, past dental trauma, osteoporosis

Social history: Lives in NDIS-funded group home with shared supports. Requires full assistance for ADLs. No known family. Attends a local supported activity group twice weekly.

Examination findings: Abdomen distended and tympanic. Mild tenderness in the lower abdomen, no rebound or guarding. Bowel sounds present. No signs of dehydration. Weight unchanged. No acute neurological signs.

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

Harriet Collins, aged 46, presents for review accompanied by her disability support worker. Harriet has a diagnosis of moderate intellectual disability and generalised anxiety disorder. She lives in a supported accommodation setting and attends a day program three days a week. Her support worker reports that Harriet has recently been excessively concerned about her appearance, frequently asking for reassurance, and avoiding mirrors. She now refuses to attend her day program because she believes her ‘face looks wrong’. These behaviours began around six weeks ago and have been escalating. Harriet is otherwise physically well and has no history of psychosis or self-harm.

Medications: Sertraline 50mg daily

Allergies: Nil known

Past history: Anxiety disorder, moderate intellectual disability, past bullying at school

Social history: Lives in shared NDIS-funded housing. No family contact. Engages well with familiar staff. No drug or alcohol use.

Examination findings: Anxious affect. Speech clear and coherent. Repeatedly seeks reassurance about her facial appearance. No hallucinations or delusions. No suicidal ideation. Physical examination unremarkable.

What are the most appropriate next steps in Harriet’s care? Select three (3) from the following list:

Martin Gallagher, aged 61, presents with his support worker for a general health review. He has Down syndrome and moderate intellectual disability. He lives in a supported group home and is generally well, but his support worker notes increasing fatigue, snoring, and morning headaches over the last six months. Martin has fallen asleep during daytime activities and no longer participates in his usual gardening program. He has also gained 4 kg over the past 3 months. He has no history of seizures or heart disease. His last thyroid function test was normal 12 months ago.

Medications: Multivitamin daily

Allergies: Nil known

Past history: Down syndrome, moderate intellectual disability, mild hearing loss, GORD (resolved)

Social history: Lives in NDIS-funded shared accommodation. Supported in ADLs and attends community activities three times weekly. No smoking or alcohol use.

Examination findings: BP 124/76, HR 70, BMI 29. Neck circumference increased. Mild macroglossia and low nasal tone. No focal neurological findings. Cardiovascular and respiratory exams normal. Appears drowsy in consultation.

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

Ruby Lane, aged 35, presents with her mother for a review of her menstrual symptoms. Ruby has a diagnosis of autism spectrum disorder and moderate intellectual disability. She lives at home and requires support with hygiene, routines, and communication. Her mother reports that Ruby becomes significantly distressed around her menstrual period — including self-injurious behaviour (biting her hand), crying, and refusing to attend her day program. This has occurred monthly for over a year. Ruby has limited verbal communication but points to her lower abdomen during these times. She has regular periods and is not sexually active.

Medications: None

Allergies: Nil known

Past history: Autism, moderate intellectual disability, anxiety

Social history: Lives with her mother, attends supported employment and a weekly music program. Receives NDIS support for behaviour intervention and community access. No history of substance use or trauma.

Examination findings: Cooperative with support. Appears anxious. No signs of infection or pelvic mass. No bruising or injury noted. Vitals stable. Abdominal exam unremarkable.

What are the most appropriate next steps in managing Ruby’s symptoms? Select four (4) from the following list:

Daniel Nguyen, aged 52, presents with his disability support worker for a medication review. He has a diagnosis of severe intellectual disability and epilepsy. He is non-verbal and lives in a supported group home. His support worker reports increased drowsiness, reduced engagement with activities, and two recent near-falls. Daniel has not had any seizures in over 3 years. He takes several regular medications but has had no recent changes. The staff have become concerned that he is ‘less like himself’ and spend more time assisting him with basic tasks he previously managed with minimal help.

Medications: Sodium valproate 500mg TDS, Clonazepam 0.5mg nocte, Vitamin D3 daily

Allergies: Nil known

Past history: Epilepsy (well controlled), severe intellectual disability, osteoporosis, constipation

Social history: Lives in supported accommodation. No family involvement. Attends day program twice per week. Requires assistance with ADLs but is usually cooperative and alert.

Examination findings: BP 118/70, HR 64, afebrile. Appears drowsy but rousable. Gait slow and cautious with support. No focal neurological findings. No signs of acute illness.

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

Sophie Rayner, aged 31, presents with her father for review. She has a diagnosis of mild intellectual disability and type 2 diabetes. Sophie has recently started a new job in a supported retail environment and is enjoying the work but has been feeling unwell in the afternoons, often reporting dizziness, shakiness, and sweating. These symptoms resolve after she eats something sweet. Her father is concerned that her diabetes may be ‘getting worse’. Sophie manages her own oral medications with assistance from a phone reminder and takes lunch with her to work, but sometimes forgets to eat it. She has no history of seizures or loss of consciousness.

Medications: Gliclazide MR 60mg daily

Allergies: Nil known

Past history: Type 2 diabetes (diagnosed 4 years ago), overweight, no known complications

Social history: Lives with her father. Independent with transport and most ADLs. Receives limited NDIS support for allied health and employment mentoring.

Examination findings: BMI 28, BP 122/76, HR 74. No neurological deficits. Capillary BGL in clinic 5.6 mmol/L. Fundoscopy normal. No peripheral neuropathy.

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

Victor Abebe, aged 40, presents with his sister, who is also his guardian. He has a diagnosis of moderate intellectual disability and moderate bilateral sensorineural hearing loss. He communicates using basic signs and gestures. His sister reports that Victor has become increasingly isolated over the past six months, avoiding group activities and appearing frustrated when trying to communicate. Staff at his supported day program have noticed he is less engaged and more irritable. He was previously sociable and enjoyed gardening and music. His last audiology review was over three years ago. He has no known mood disorder and is not on any regular medications.

Medications: None

Allergies: Nil known

Past history: Sensorineural hearing loss (diagnosed in childhood), moderate intellectual disability

Social history: Lives with his sister. Attends a supported day program three days per week. Communicates using key word sign and gestures. No known behavioural issues previously. No smoking or alcohol use.

Examination findings: Alert, cooperative, but slow to respond. Appears frustrated when asked questions. No focal neurological deficits. No signs of acute illness. ENT exam unremarkable.

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

Jeremy Black, aged 48, is brought in by his support worker following several episodes of urinary incontinence over the past month. Jeremy has a diagnosis of cerebral palsy (spastic quadriplegia), mild intellectual disability, and uses a powered wheelchair for mobility. He lives in a supported accommodation setting and requires assistance with personal care. His support worker notes that Jeremy is usually continent with routine toileting but has recently had three daytime accidents and one overnight. He has also been more withdrawn, less interested in outings, and reluctant to leave the house. He is non-verbal but uses a communication device. No signs of infection have been noted, and his fluid intake and diet are unchanged.

Medications: Baclofen 10mg TDS, Paracetamol PRN

Allergies: Nil known

Past history: Cerebral palsy, mild intellectual disability, scoliosis (stable), constipation

Social history: Lives in NDIS-supported housing. Attends community centre twice weekly. No family contact. Uses communication device effectively with familiar staff.

Examination findings: Alert, cooperative. Abdomen soft. No suprapubic tenderness. No flank pain. Catheter not in use. Gait not applicable. Perineal skin intact. Urinalysis: clear, negative for leukocytes/nitrites.

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

Aisha Noor, aged 36, presents with her support coordinator for a review of her physical health. She has a diagnosis of Prader-Willi syndrome and moderate intellectual disability. Aisha lives in a supported group home and attends a cooking and literacy program three days per week. Her support coordinator is concerned about Aisha’s recent weight gain of 8 kg over six months, increasing fatigue, and difficulty mobilising. Aisha uses a walking frame and is now struggling with short distances. She has a history of type 2 diabetes and obstructive sleep apnoea (OSA) but has not attended recent follow-up appointments due to anxiety about clinical settings.

Medications: Metformin XR 1g daily, CPAP (poor adherence)

Allergies: Nil known

Past history: Prader-Willi syndrome, type 2 diabetes, OSA, anxiety disorder

Social history: Lives in NDIS-supported accommodation. Avoids healthcare settings. Attends community day programs with support. No smoking or alcohol use.

Examination findings: BMI 42, BP 134/82, HR 76, RR 16. Oedema to mid-shin bilaterally. Appears tired. Chest clear, heart sounds dual. No signs of DVT. No joint deformities. Gait slow and effortful with frame.

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

Leo Tran, aged 63, presents for review accompanied by his group home manager. He has a diagnosis of severe intellectual disability and limited expressive language. Leo has epilepsy, well controlled on medication, and lives in a supported shared accommodation setting. His manager reports a gradual decline in Leo’s participation in daily activities, increasing passivity, and refusal to engage in grooming or meals without prompting. He now often stares blankly and requires more support with dressing and toileting. This has developed over the last three months. He has no history of psychiatric illness and no seizures reported in the past year.

Medications: Sodium valproate 500mg BD, Vitamin D3 daily

Allergies: Nil known

Past history: Epilepsy (well controlled), constipation, severe intellectual disability, past dental surgery

Social history: Lives in NDIS-supported shared housing. Non-verbal. Attends a day program twice a week. No family contact.

Examination findings: BP 116/70, HR 72, afebrile. Appears withdrawn. No motor deficits. Responds to touch and brief verbal prompts. No signs of dehydration. Weight stable. No signs of infection.

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

Isla Kennedy, aged 28, presents with her support worker after a recent fall at her day program. Isla has a diagnosis of mild intellectual disability and autism spectrum disorder. She tripped while walking on uneven ground and sustained a minor ankle sprain. This is her third fall in the past year. Her support worker reports that Isla has a wide-based, unsteady gait and appears to tire quickly when walking longer distances. She does not use a mobility aid. Isla is verbal and cooperative but has difficulty processing complex instructions and tends to avoid medical settings. There is no history of seizures or acute illness.

Medications: Nil

Allergies: Nil known

Past history: Autism, mild intellectual disability, developmental delay in childhood

Social history: Lives with her mother, attends day program four days a week. Independent with basic ADLs. NDIS-funded for transport and community access.

Examination findings: BP 114/68, HR 74. Normal neurological exam. Gait is broad-based with occasional foot drag. Muscle tone normal. Mild pes planus noted. No joint deformity. No signs of acute injury. Ankle stable. Basic footwear with minimal support.

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

Benjamin Ross, aged 55, presents with his sister, who is also his guardian, for a general health check. Benjamin has moderate intellectual disability and a history of obesity, hyperlipidaemia, and hypertension. He lives in supported accommodation and enjoys daily walks and group activities. His sister is concerned about his ongoing consumption of sugary drinks and processed snacks despite previous dietary advice. She reports that staff often give him food to manage behaviours or as a reward. Benjamin is non-verbal but communicates via gestures and symbols. His weight has increased by 6 kg in the past year despite stable medication and activity levels.

Medications: Atorvastatin 20mg nocte, Perindopril 4mg daily

Allergies: Nil known

Past history: Obesity, hypertension, hyperlipidaemia, moderate intellectual disability

Social history: Lives in shared NDIS-funded group home. Attends day program. No smoking or alcohol. Diet managed by staff and family. Uses pictorial communication board.

Examination findings: BP 138/84, HR 72, BMI 36. Waist circumference 112 cm. Vitals stable. No oedema. No neurological or musculoskeletal deficits. Fundoscopy and cardiovascular exam unremarkable.

What are the most appropriate next steps in managing Benjamin’s health and behaviours? Select four (4) from the following list:

Charlotte Yilmaz, aged 46, presents with her long-time disability support worker for review of recent behavioural changes. Charlotte has a diagnosis of moderate intellectual disability and a long-standing seizure disorder managed with sodium valproate. Over the past two months, her support worker reports that she has become increasingly aggressive during transitions between activities and has had two incidents of physical outbursts toward staff. She is non-verbal but previously communicated well with gestures and visuals. Staff report no recent seizures. Her routines have not changed significantly, but one of her familiar staff members recently left. Her current NDIS plan includes limited behaviour support and no psychology input.

Medications: Sodium valproate 600mg BD

Allergies: Nil known

Past history: Epilepsy (well controlled), moderate intellectual disability, constipation

Social history: Lives in supported group home with four other residents. Attends a supported day program. No family contact. No substance use.

Examination findings: Calm during consultation. Vitals normal. No signs of pain or infection. Appears alert and responsive with familiar support worker. No focal neurological signs.

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

Emily Saunders, aged 34, presents with her mother for a review of her mobility and bone health. Emily has Down syndrome and mild intellectual disability. She has recently complained of vague leg pain and has become more cautious when walking. Her mother reports that Emily has stopped attending dance classes, which she previously enjoyed, and avoids stairs due to fear of falling. Emily had a low-impact wrist fracture two years ago. She spends most of her day indoors and dislikes dairy. She is not taking any supplements. Her mother is concerned about her long-term bone health and functional independence.

Medications: None

Allergies: Nil known

Past history: Down syndrome, wrist fracture (age 32), mild hypothyroidism (resolved), intellectual disability

Social history: Lives at home with her parents. Attends supported employment program three days per week. Independent with most ADLs. No smoking or alcohol use.

Examination findings: BMI 24, BP 110/68, HR 72. Gait slightly cautious but steady. No joint deformity. No muscle weakness. Spine straight. No tenderness to palpation of long bones or joints. No signs of inflammation or bruising.

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

Hassan Almasi, aged 42, presents with his support worker for review following behavioural incidents at his supported accommodation. Hassan has moderate intellectual disability and post-traumatic stress disorder (PTSD) from early-life trauma. He has recently become agitated in the evenings, shouting, pacing, and refusing to enter the bathroom. These episodes have occurred three times in the past fortnight and have disrupted other residents. His support worker reports that a new male staff member was present during each episode. Hassan has no known history of aggression prior to this. He is verbal but has limited insight into his emotional triggers. He is not currently linked with psychological services.

Medications: None

Allergies: Nil known

Past history: Intellectual disability, PTSD (childhood trauma), constipation (managed with diet)

Social history: Lives in supported group accommodation. Attends a local men’s group. Receives NDIS-funded support for personal care and transport. No contact with family.

Examination findings: Calm and cooperative during consult. Oriented. No signs of psychosis or cognitive decline. No evidence of physical illness or injury.

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

Grace Patel, aged 62, presents with her niece for a comprehensive health review. Grace has a diagnosis of moderate intellectual disability and has lived in the same supported accommodation for over 20 years. Over the past six months, her niece has observed that Grace has become more withdrawn, is eating less, and has lost 5 kg. Grace is verbal but speaks in short phrases and has difficulty expressing feelings. She has no reported medical illnesses, but staff note that she now prefers to stay in her room, has stopped attending group activities, and appears tired. Grace is up to date with her cancer screening and immunisations.

Medications: None

Allergies: Nil known

Past history: Intellectual disability, no known chronic illness

Social history: Lives in NDIS-funded supported accommodation. Attends community art group weekly. Close relationship with niece. No known history of alcohol or tobacco use.

Examination findings: BMI 22 (previously 25), BP 116/70, HR 72, afebrile. Grace is quietly spoken, appears tired but cooperative. No focal neurological signs. No abdominal tenderness or lymphadenopathy. Cardiorespiratory exam unremarkable.

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

Samuel Boyd, aged 37, presents with his disability case manager due to increasing concerns about dental hygiene and oral discomfort. Samuel has a diagnosis of mild intellectual disability and autism spectrum disorder. He lives independently in a public housing unit with drop-in support workers. His case manager reports that Samuel has been avoiding hard foods, complaining of ‘tooth pain’, and becoming more irritable over the past month. Samuel brushes his teeth once a day but finds it difficult to manage flossing or dental appointments due to sensory sensitivities. He has not seen a dentist in over five years and is not currently linked with a dental service.

Medications: None

Allergies: Nil known

Past history: Mild intellectual disability, autism spectrum disorder, anxiety, lactose intolerance

Social history: Lives alone with drop-in support twice daily. Receives NDIS funding for daily living and community access. No alcohol or smoking. Eats mostly soft processed foods. Minimal fruit or vegetable intake.

Examination findings: Appears anxious. No facial swelling or systemic signs of infection. Mild halitosis noted. Visible dental plaque and several carious teeth. Gums mildly inflamed. Weight stable. Vitals normal.

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

Mark Latu, aged 29, presents with his support worker for a review following a recent transition from school to adult disability services. Mark has a diagnosis of moderate intellectual disability and limited expressive communication. Since finishing school six months ago, he has become increasingly withdrawn, has stopped participating in activities he previously enjoyed, and has started refusing meals on some days. His support worker notes that Mark appears disengaged and often sits alone. There have been no reported medical issues, and his living situation has not changed. He lives in a supported group home with 24/7 staffing and attends a new day program.

Medications: Nil

Allergies: Nil known

Past history: Moderate intellectual disability, asthma (childhood, resolved)

Social history: Lives in NDIS-funded supported accommodation. Recently transitioned from a school-based program. No family contact. Non-verbal but communicates using gestures and facial expressions.

Examination findings: BP 112/74, HR 68, afebrile. Appears quiet but cooperative. No signs of malnutrition. No signs of acute illness. Weight stable. No focal neurological deficits.

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

Alison King, aged 67, presents with her supported accommodation manager for review after a recent episode of choking on food. Alison has a diagnosis of moderate intellectual disability and early Parkinson’s disease. She lives in a supported group home with four other residents and has recently begun eating more slowly and coughing during meals. Staff have noticed she avoids dry or hard foods and drinks water with difficulty. Alison is able to communicate verbally but tires easily. She has no recent weight loss or signs of aspiration pneumonia. Her medications have not changed in over 12 months.

Medications: Levodopa/carbidopa 100/25mg TDS, sertraline 50mg daily

Allergies: Nil known

Past history: Parkinson’s disease (diagnosed 2 years ago), intellectual disability, anxiety

Social history: Lives in NDIS-funded group home. Attends community activities twice weekly. Receives support with ADLs and medication administration.

Examination findings: Alert and cooperative. Mild resting tremor, reduced facial expression, voice soft. No focal neurological signs. BMI 23. Chest clear, no signs of infection.

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

David Chen, aged 51, presents with his long-time support worker for a review following reports of frequent urinary incontinence and nocturnal enuresis. David has a diagnosis of moderate intellectual disability and spina bifida. He ambulates with a frame and lives in supported accommodation. His support worker notes that David has had increasing difficulty with toileting, requiring changes during the night, and now wears continence pads daily. He appears embarrassed and has refused to attend community outings twice in the last month. There is no history of urinary tract infections or fever. David last saw a urologist over 5 years ago.

Medications: Oxybutynin 5mg BD

Allergies: Nil known

Past history: Spina bifida with neurogenic bladder, moderate intellectual disability, constipation, left foot drop

Social history: Lives in NDIS-funded group home with 24/7 care. Previously active in community social groups. Support worker assists with ADLs.

Examination findings: Alert and cooperative. Abdomen soft. No suprapubic tenderness. Lower limb reflexes reduced. No spinal tenderness. Mild sacral scarring. Perineal hygiene adequate. No flank pain. Vitals normal.

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

Naomi Fielding, aged 39, is brought in by her house supervisor due to concerns about increasing agitation and restlessness during the evenings. Naomi has a diagnosis of Fragile X syndrome with moderate intellectual disability and sensory processing difficulties. She lives in a supported group home and attends a structured day program. Over the past month, staff have observed that Naomi begins pacing, flapping her hands, and verbalising loudly in the early evening. She struggles to settle and sometimes refuses dinner or becomes tearful. There have been no changes to her medication or routine. Staff suspect overstimulation or fatigue but are unsure how to support her. No aggression or harm has been reported.

Medications: Melatonin 2mg nocte

Allergies: Nil known

Past history: Fragile X syndrome, moderate intellectual disability, sensory processing disorder, constipation

Social history: Lives in NDIS-funded accommodation. Supported in ADLs. Attends community art and music groups. No family contact.

Examination findings: Calm and cooperative in clinic. No distress. Vitals within normal limits. No signs of infection or illness. No new gastrointestinal or neurological symptoms reported.

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

Connor Ibrahim, aged 45, presents with his sister for a routine health review. Connor has mild intellectual disability and is non-verbal. He lives in shared supported accommodation and works part-time in a supervised warehouse environment. His sister reports that Connor has developed increasing avoidance of work over the past two months, occasionally refusing to get out of bed, and has become more withdrawn. He has also had some episodes of irritability and head-holding. Staff initially thought this was behavioural, but there is now concern it may be due to undiagnosed pain. Connor has no history of migraines or epilepsy. He had a dental check 18 months ago and no recent infections.

Medications: Paracetamol PRN (used twice in past month)

Allergies: Nil known

Past history: Mild intellectual disability, childhood glue ear (resolved), no other chronic conditions

Social history: Lives in NDIS-supported shared housing. Works part-time. Communicates using gestures and facial expressions. Support workers assist with ADLs and appointments.

Examination findings: BP 120/74, HR 78, afebrile. Calm and cooperative during exam. Grasps head intermittently but no focal neurological signs. Cranial nerves intact. Ears, throat, and teeth appear normal. No photophobia or neck stiffness. No rash.

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

Lara Simmons, aged 57, presents with her disability advocate for a care plan review. Lara has moderate intellectual disability and type 2 diabetes. She lives in supported accommodation and has recently been diagnosed with early diabetic retinopathy. Staff report that Lara has started misjudging steps and knocking over items in the kitchen. She continues to manage basic ADLs with support but has recently withdrawn from her weekly cooking group, saying she ‘can’t see properly anymore’. Lara has no history of falls or mental illness. Her last HbA1c was 7.8% (62 mmol/mol).

Medications: Metformin XR 1g daily, Lisinopril 5mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hypertension, moderate intellectual disability

Social history: Lives in NDIS-funded supported accommodation. Engaged with her community centre for many years. Support provided for medications and finances. No family involved.

Examination findings: BP 128/76, HR 72, BMI 29. Alert, ambulant. No peripheral neuropathy. Fundus examination consistent with early background diabetic retinopathy. No focal neurological signs.

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

Nathan Wallace, aged 61, presents with his residential nurse for review of new-onset nocturnal agitation. Nathan has a diagnosis of moderate intellectual disability and dementia. He resides in a high-support group home and is usually calm and settled. Over the past three weeks, staff report that Nathan has been waking during the night, pacing the halls, calling out, and attempting to open external doors. These behaviours occur around 2–4am and last for 30–60 minutes. There are no signs of pain or infection, and his bowel routine is unchanged. He has not experienced any recent seizures. Nathan is not currently taking any sedating medications.

Medications: Donepezil 5mg nocte, Paracetamol PRN

Allergies: Nil known

Past history: Dementia (diagnosed 2 years ago), moderate intellectual disability, constipation, osteoporosis

Social history: Lives in NDIS-funded supported accommodation with 24/7 staffing. Non-verbal. Attends supported activities during the day.

Examination findings: BP 122/76, HR 68, afebrile. Calm during consult. No distress or focal signs. Chest clear. No urinary retention or faecal impaction. No skin breakdown. Weight stable.

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

Olivia Burns, aged 33, presents with her mother for review of her weight and physical activity. Olivia has Down syndrome and mild intellectual disability. She lives at home and attends a supported employment program four days a week. Over the past year, her mother reports that Olivia has gained 10 kg, and is now experiencing shortness of breath when climbing stairs and reluctance to attend social activities. Olivia enjoys cooking and dancing but has not participated in group exercise since COVID-related service closures. She has no known cardiac history and is up to date with her thyroid screening, which was normal six months ago.

Medications: None

Allergies: Nil known

Past history: Down syndrome, mild intellectual disability, childhood otitis media

Social history: Lives with her mother. Attends a supported job placement. Participates in weekend outings. Supported by NDIS for community access.

Examination findings: BMI 34, BP 118/72, HR 76, RR 16. No oedema. Heart sounds dual. Chest clear. No murmurs. Gait slow but steady. Appears happy and engaged. Fundoscopy normal.

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