KFP – Disaster health

David Kirkland, aged 44, presents to your rural general practice two days after a major bushfire swept through his regional town in northern Victoria. He was involved in volunteer firefighting efforts, working long shifts under extreme heat and smoke conditions. He reports increasing fatigue, persistent dry cough, and mild shortness of breath, especially at night. He denies chest pain. He feels “shaky” and emotionally overwhelmed since returning home, where he discovered his backyard shed and several neighbours’ homes had been destroyed. He is currently staying with friends, as his own property sustained minor damage and is without power or clean water. He reports trouble sleeping and says he keeps replaying images of injured animals and frantic evacuation scenes.

Medications: Salbutamol inhaler (used occasionally in the past for seasonal asthma)

Allergies: Nil known

Past history: Mild asthma as a teenager, no hospitalisations

Social history: Lives alone in a semi-rural property. Non-smoker. Works part-time as a landscape gardener.

Examination findings: Vitals: T 37.4°C, HR 92 bpm, BP 132/78 mmHg, RR 20/min, SpO2 95% on room air. Moderate wheeze on auscultation, especially expiratory. No crackles. No signs of infection or trauma. Alert, but visibly distressed and tearful during consultation.

Investigations: Peak expiratory flow 300 L/min (normal for age/sex ~540 L/min), no prior spirometry on record.

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

Amina Said, aged 32, presents to your GP clinic, which has been operating from a temporary facility in a local school gymnasium following a severe flood that destroyed the town’s health centre. She is 26 weeks pregnant with her second child and reports experiencing frequent abdominal cramps, poor appetite, and difficulty sleeping since the evacuation five days ago. She is also concerned about potential infections as she has been using public toilets and sleeping on a gym mat. Amina reports that she has been feeling increasingly anxious and has had several crying episodes. She is worried about the health of her unborn child and about the future of her home, which remains flooded.

Past history: Normal vaginal delivery 3 years ago. No prior mental health history. No gestational complications so far in this pregnancy.

Medications: Routine antenatal supplements

Allergies: Nil known

Social history: Lives with husband and 3-year-old daughter. Non-smoker. Both she and her husband are displaced and staying in the same shelter.

Examination findings: BP 118/70 mmHg, HR 88 bpm, RR 16/min, Temp 36.7°C. Abdomen soft, non-tender. Fundal height 26 cm. Foetal heart rate 140 bpm. No uterine contractions palpated. No vaginal bleeding or discharge. She appears tearful during the consultation.

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

Jeremy Foster, aged 56, presents to your metropolitan clinic one week after being evacuated from a residential aged care facility that was damaged during a widespread power outage and heatwave affecting South Australia. He has a background of type 2 diabetes, hypertension, and mild cognitive impairment. His carer reports he has become increasingly confused, lethargic, and is eating and drinking less than usual. During the power outage, air conditioning failed for over 48 hours. Jeremy has been relocated to a temporary care facility with limited staffing and minimal air circulation.

Medications: Metformin, perindopril, atorvastatin

Allergies: Nil known

Past history: T2DM, hypertension, mild cognitive impairment

Social history: Previously independent in assisted living unit. Currently in shared room with three others. Carer reports inadequate access to usual routines and environment.

Examination findings: T 37.9°C, HR 104 bpm, BP 98/64 mmHg, RR 22/min, SpO2 97% on room air. Dry mucous membranes. Capillary refill 3 seconds. Alert but disoriented to time and place. GCS 14. No focal neurological signs. BSL 5.2 mmol/L.

Investigations: Not yet performed

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

Leila Abdulrahman, aged 24, presents to your inner-city general practice clinic that has been converted into a walk-in health service for recent evacuees from a major apartment building explosion due to a suspected gas leak. She is a recent migrant from Syria and had moved into the building only three months ago. She was on the third floor when the explosion occurred and was rescued from debris two hours later with only minor abrasions. Since the event (six days ago), she reports intrusive thoughts about the explosion, difficulty falling asleep, irritability, and feeling constantly ‘on edge’. She is also struggling with the loss of her belongings and lack of stable housing.

Past history: Nil significant medical history

Medications: Nil

Allergies: Nil known

Social history: Living in temporary emergency housing in a community centre. No family locally. Speaks conversational English.

Examination findings: Vitals stable. No physical injuries requiring treatment. She maintains eye contact, is tearful when discussing the explosion, and appears hypervigilant. MoCA screen performed with no evidence of cognitive impairment.

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

Tom Bellamy, aged 13, presents to your regional clinic accompanied by his mother. They were evacuated from their home two days ago following a fast-moving grassfire in northern New South Wales. Tom had been separated from his parents for several hours during the evacuation and was briefly treated at an evacuation centre for minor smoke inhalation. His mother reports that since returning to temporary accommodation, Tom has become withdrawn, refuses to speak about the event, startles easily, and has experienced repeated nightmares. He refuses to go outside or attend the local temporary school program. He also complains of daily headaches and abdominal discomfort.

Past history: Unremarkable. Healthy child. No prior mental health issues.

Medications: Nil

Allergies: Nil known

Family history: Paternal uncle has PTSD related to military service

Social history: Lives with mother and younger sister. Father is interstate for work. Entire home and belongings were lost in the fire. They are staying in a donated caravan at a showground evacuation site.

Examination findings: Vitals normal. Tom is cooperative but quiet, avoids eye contact, and clings to his mother. Abdomen soft, non-tender. Neurological examination normal.

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

Michael Huang, a 47-year-old paramedic, presents to your suburban clinic three weeks after responding to a train derailment incident that involved multiple fatalities and critical injuries. Michael was one of the first on scene and describes it as ‘the worst event’ he has witnessed in his career. He has been off work for the past week on stress leave. He reports poor sleep, emotional numbing, flashbacks, and a feeling of detachment from his family. He avoids driving near the site of the derailment and becomes irritable when discussing the incident. He has no suicidal ideation but says he feels ‘emotionally flat’ and unsure if he can return to work. He denies substance use.

Past history: None of significance

Medications: Nil

Allergies: Nil known

Social history: Married with two teenage children. Long-standing role as emergency responder. Supportive family and employer. No history of mental illness.

Examination findings: Vitals within normal limits. Michael is alert, oriented, but flat in affect. He becomes tearful when recounting the scene. No cognitive deficits noted.

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

Lucy Tran, a 29-year-old schoolteacher, presents to your GP clinic two days after being involved in a chemical spill incident at a local industrial site, which prompted evacuation of nearby homes and schools. She reports developing a persistent dry cough, eye irritation, and tightness in her chest since the exposure. She was approximately 300 metres from the spill site and remained outdoors for 45 minutes before being relocated. She denies wheeze or haemoptysis. No other members of her household are symptomatic. Lucy is otherwise healthy and non-smoking.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with her partner and works full-time. No children. No previous occupational chemical exposure.

Examination findings: Vitals: T 36.8°C, HR 84 bpm, BP 122/76 mmHg, RR 18/min, SpO2 97% on room air. Mild bilateral conjunctival injection. Chest clear on auscultation. No rash, burns or oropharyngeal lesions. No lymphadenopathy.

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

Samuel Ellis, a 72-year-old retired farmer, presents to your rural practice two weeks after returning to his property following a severe flood event in western Queensland. He reports persistent headaches, fatigue, and nausea. He has also noticed a foul smell from his water tank and says he has been using this water for drinking, cooking, and brushing his teeth since returning. He lives alone and has had limited contact with services since the flood. He denies fevers, rash, or diarrhoea. No history of similar symptoms prior to the flood.

Past history: Hypertension, hyperlipidaemia

Medications: Amlodipine, atorvastatin

Allergies: Nil known

Social history: Non-smoker, occasional alcohol. Self-manages a small property with livestock. Flooding affected septic tank and nearby dam. No power for several days post-flood. Not vaccinated for leptospirosis.

Examination findings: T 37.2°C, HR 82 bpm, BP 128/76 mmHg, RR 16/min, SpO2 98% on room air. Mild scleral icterus. Abdominal exam: soft, mild epigastric discomfort, no guarding or rebound. Neurological exam normal.

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

Aleksandar Petrovic, aged 67, presents to your regional general practice clinic four days after a magnitude 6.0 earthquake struck the area. He was involved in rescue efforts, helping neighbours trapped under debris, and sustained a minor laceration to his right forearm, which he cleaned himself. Since then, he reports increasing redness and pain at the wound site, feverishness, and night sweats. He also complains of stiffness in his jaw and mild muscle spasms in his back. He is up to date with most of his vaccinations but is unsure about his tetanus status.

Past history: Type 2 diabetes, diet-controlled

Medications: Nil

Allergies: Nil known

Social history: Retired builder, lives with wife. No recent overseas travel. No immunisation record available. No private transport; community access limited due to damage to roads.

Examination findings: T 38.6°C, HR 94 bpm, BP 138/84 mmHg, RR 18/min. Right forearm: 3cm laceration with surrounding erythema, warmth, and purulent discharge. No crepitus. Jaws slightly rigid on opening. Mild paraspinal muscle tightness. No rash or lymphadenopathy.

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

Fatima Noor, a 36-year-old refugee mother of four, presents to your general practice in an urban disaster recovery centre three weeks after a major apartment fire that destroyed her public housing unit. She and her children were unharmed physically, but since the event, she reports worsening insomnia, frequent panic attacks, and a sense of hopelessness. She cries daily and says she is struggling to look after her children, aged between 2 and 10 years. Her youngest has also become clingy and refuses to sleep alone. Fatima arrived in Australia four years ago from Afghanistan and speaks limited English. A bilingual support worker is present.

Past history: Previous diagnosis of postnatal depression. No psychiatric hospitalisations. No current medications.

Medications: Nil

Allergies: Nil known

Social history: Sole parent. Receiving Centrelink payments. Temporarily housed in a community shelter. No extended family support in Australia. History of exposure to trauma in home country.

Examination findings: T 36.6°C, HR 82 bpm, BP 118/70 mmHg. Fatima appears withdrawn but cooperative. Tearful during consultation. No psychosis, suicidal ideation, or cognitive deficits noted.

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

Peter McAlister, a 59-year-old powerline technician, presents to your rural clinic five days after working continuous 14-hour shifts during a regional storm disaster response. He reports generalised muscle aches, dark urine, and extreme fatigue. He mentions that he worked in heavy rain and high humidity wearing insulating gear, and had limited access to water or rest breaks. He initially attributed his symptoms to physical exertion, but they have worsened despite resting since returning home.

Past history: Hypertension, controlled with medication

Medications: Perindopril

Allergies: Nil known

Social history: Lives alone, non-smoker, drinks 2-3 beers on weekends. No recent illness. No recreational drug use.

Examination findings: T 37.4°C, HR 98 bpm, BP 132/78 mmHg, RR 16/min, SpO2 98% RA. No rash. Mild muscle tenderness in calves and shoulders. Urine sample visually dark. Neurological examination normal.

Investigations: Point-of-care urinalysis: blood +++, protein +, nitrites negative. No leucocytes. Dipstick Hb positive without red cells on microscopy.

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

Jasmine O’Connor, a 7-year-old girl, is brought in by her father to your GP clinic operating from a temporary tent at a local showground following a cyclone in Far North Queensland. Her father reports that Jasmine has developed a fever, headache, and rash over the past 48 hours. She also has mild nausea but no vomiting. She has no known recent bites, but the family has been sleeping in an open-sided shelter near stagnant water. Several others in the shelter have reported similar symptoms. Jasmine is normally fit and well, with no chronic illness.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Displaced by cyclone-related flooding. Family staying at an evacuation centre. No access to usual GP or school nurse. Not vaccinated for Japanese encephalitis.

Examination findings: T 38.8°C, HR 110 bpm, BP 100/60 mmHg, RR 20/min. Mild conjunctival injection. Fine blanching maculopapular rash on trunk and arms. No neck stiffness. No focal neurological signs. Alert but tired.

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

Angela Roberts, aged 45, presents to your temporary outreach clinic in a small coastal town in the aftermath of a tsunami that affected the northern Queensland shoreline. She has returned to her partially damaged home to begin cleaning up and reports developing a painful red area on her left lower leg that has spread rapidly over 24 hours. She also describes mild fever, chills, and malaise. She had a small cut on her shin from stepping on debris in floodwaters. The area is now warm, swollen, and extremely tender to touch.

Past history: Obesity (BMI 34), no other chronic disease

Medications: Nil

Allergies: Nil known

Social history: Lives alone. Staying at home without access to running water or refrigeration. No power or phone service in the area.

Examination findings: T 38.5°C, HR 102 bpm, BP 110/70 mmHg. Left lower leg: erythematous, warm, oedematous area extending 20cm proximally from shin with ill-defined margins and intense tenderness. No fluctuance. No crepitus. No lymphadenopathy.

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

Ismail Khan, aged 51, presents to your temporary general practice clinic in an urban evacuation centre two weeks after a large-scale urban chemical warehouse fire. He is concerned about a persistent dry cough, throat irritation, and worsening wheezing that began two days after the incident. He did not seek medical attention initially, as he assumed symptoms would settle. Ismail has a history of mild asthma that is normally well-controlled. He was exposed to thick smoke for several hours while assisting neighbours evacuate.

Past history: Mild intermittent asthma

Medications: Salbutamol inhaler (used as needed)

Allergies: Nil known

Social history: Lives with elderly mother, non-smoker. His home is still within the fire-affected zone. He has had difficulty accessing pharmacies for repeat inhalers.

Examination findings: T 36.9°C, HR 92 bpm, RR 22/min, BP 124/82 mmHg, SpO₂ 94% on room air. Mild expiratory wheeze bilaterally. No signs of consolidation. Speaking in full sentences but with occasional cough. Peak expiratory flow: 60% of predicted.

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

Daniela Moretti, a 32-year-old nurse, presents to your general practice two weeks after assisting at an evacuation centre following a severe flood in her rural New South Wales community. She reports ongoing fatigue, disrupted sleep, palpitations, and difficulty concentrating at work. She becomes tearful during the consultation and says she feels ‘guilty for not doing more’ during the disaster response. She is having intrusive memories of the event, particularly of a young patient who deteriorated rapidly. She has no prior psychiatric history but reports a family history of anxiety.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Married with one child. Still living in temporary accommodation after flood damage to home. Supportive partner but limited time for rest or recovery. Previously enjoyed her nursing work.

Examination findings: T 36.7°C, HR 86 bpm, BP 126/74 mmHg. Daniela is alert, oriented, but visibly distressed. Tearful when discussing the disaster. No psychosis or suicidal ideation. No cognitive impairment.

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

Eric Walters, a 70-year-old man, presents to your mobile GP unit deployed to a rural town affected by recent bushfires in central Victoria. He reports worsening shortness of breath, a persistent productive cough, and wheezing. Symptoms started a week ago when the bushfire smoke was at its peak and have not resolved. He has a 40-pack-year smoking history and was diagnosed with COPD three years ago but is poorly adherent to medications. He lives alone and had limited access to healthcare during the disaster period.

Past history: COPD, hypertension

Medications: Irregular use of tiotropium and salbutamol inhalers. No corticosteroid use.

Allergies: Nil known

Social history: Former farmer, lives on a property affected by fire damage. Smoker (still 10/day). No local pharmacy open post-disaster.

Examination findings: T 37.1°C, HR 96 bpm, RR 24/min, BP 130/76 mmHg, SpO₂ 92% on room air. Prolonged expiratory phase and widespread wheeze. Mild accessory muscle use. No cyanosis or peripheral oedema.

Investigations: Peak expiratory flow: 45% of predicted. No access to spirometry. Chest X-ray unavailable in mobile clinic.

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

Sophie Leung, a 28-year-old early childhood educator, presents to your GP clinic one month after a major flood affected her community in northern New South Wales. She reports ongoing low mood, poor appetite, and difficulty sleeping. She finds herself avoiding the childcare centre where she worked before the flood, as it was severely damaged and many families she worked with were displaced. She says she feels constantly ‘on edge’, struggles to find joy in daily activities, and feels overwhelmed by simple decisions. She denies suicidal ideation but describes emotional numbness and guilt about not doing more during the disaster.

Past history: History of generalised anxiety disorder, well-managed with psychological therapy in the past

Medications: Nil

Allergies: Nil known

Social history: Lives with her partner. Their home was not damaged, but her workplace was. Supportive relationship but limited financial stability since the flood.

Examination findings: Alert, oriented, tearful during consultation. Flat affect. No evidence of psychosis. No suicidal ideation. MoCA score 29/30. Vitals within normal limits.

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

George Willard, a 78-year-old man, presents to your temporary medical clinic in a community centre following a widespread power outage due to storm damage in South Australia. He reports light-headedness, increased fatigue, and difficulty managing his type 2 diabetes since the power failure six days ago. He lives alone and has not been able to refrigerate his insulin or access his usual meals. He has been eating mainly non-perishable food and drinking less due to concerns about water safety. He says he feels ‘foggy’ and weak but has not had chest pain or falls.

Past history: Type 2 diabetes (on insulin), hypertension, hyperlipidaemia

Medications: Basal insulin (glargine), metformin, amlodipine, atorvastatin

Allergies: Nil known

Social history: Widowed, no nearby family, independent pre-disaster. No power, phone, or internet since the storm. No access to diabetes educator or usual GP.

Examination findings: T 36.2°C, HR 88 bpm, BP 110/70 mmHg, RR 18/min, SpO₂ 98% RA. Mildly dehydrated. Capillary BGL: 18.6 mmol/L. Alert but slow to respond. No focal neurological deficits. Weight stable.

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

Claire Jensen, a 5-year-old girl, is brought to your mobile GP clinic by her father. They were recently evacuated from their home due to a bushfire in regional Victoria. Claire had to leave suddenly with her family and has since developed bedwetting, clinginess, and frequent nightmares. Her father says she refuses to be alone and cries when he leaves the room. She has no physical complaints and no history of psychological or developmental concerns prior to the evacuation. Her father is concerned about her ‘regressing’ and asks whether she should see a psychiatrist.

Past history: Unremarkable. Healthy, fully immunised

Medications: Nil

Allergies: Nil known

Social history: Lives with both parents and two older siblings. Currently staying at a caravan park while waiting for assessment of their home. Attending local temporary school program.

Examination findings: Alert, cooperative but quiet. No signs of physical illness or injury. Appears developmentally appropriate for age. Engages with you while seated on her father’s lap.

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

Nguyen Tran, a 42-year-old disability support worker, presents to your inner-city clinic five days after returning to work in a flood-damaged community housing complex. He reports a persistent dry cough, nasal congestion, and worsening shortness of breath over the last 72 hours. He states that the property where he’s been assisting residents still has visible mould, water damage, and a strong musty odour. He has a history of allergic rhinitis and eczema but no diagnosed asthma. Several other workers have reported similar symptoms.

Past history: Allergic rhinitis, eczema

Medications: Loratadine as needed, topical steroid for eczema

Allergies: Dust mites, grass pollens

Social history: Non-smoker. Lives with his partner. Works in community-based disability housing support. No overseas travel or COVID-19 exposure.

Examination findings: T 36.9°C, HR 86 bpm, BP 124/76 mmHg, RR 20/min, SpO₂ 97% RA. Bilateral nasal congestion. Mild expiratory wheeze. No fever, no lymphadenopathy. Chest clear to percussion.

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

Maryam Al-Sharif, a 36-year-old woman, presents to your general practice pop-up clinic in a regional shopping centre three weeks after her home was severely damaged by a landslide following torrential rains. She reports worsening anxiety, palpitations, and difficulty sleeping since the event. She is constantly worried about her children’s safety and checks on them repeatedly at night. She avoids leaving the temporary accommodation for fear another disaster will happen. Maryam has a history of obsessive-compulsive disorder (OCD), previously managed well with fluoxetine, which she stopped during pregnancy two years ago. She has not resumed medication since and is currently not seeing a psychologist.

Past history: OCD, postnatal anxiety

Medications: Nil currently

Allergies: Nil known

Social history: Married, two children aged 3 and 6. Living in temporary housing provided by disaster recovery services. No previous psychiatric admissions.

Examination findings: Appears anxious but cooperative. Vitals normal. No signs of psychosis or suicidal ideation. No cognitive impairment. Expresses insight and distress over compulsive checking behaviours.

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

Thomas Rayner, a 61-year-old man, presents to your coastal GP clinic one week after a major storm surge that led to the contamination of local water supplies. He reports three days of profuse watery diarrhoea, nausea, and cramping abdominal pain. He denies vomiting or fever. He has been drinking from a rainwater tank that may have been affected by runoff during the storm. He has not eaten much over the past two days and is concerned about ongoing weakness. He has a history of hypertension and takes daily medication.

Past history: Hypertension

Medications: Perindopril

Allergies: Nil known

Social history: Lives alone on a semi-rural property. No recent overseas travel. No others in his area have presented with similar symptoms (to his knowledge).

Examination findings: T 36.8°C, HR 98 bpm, BP 104/64 mmHg, RR 18/min, SpO₂ 98% RA. Dry mucous membranes, reduced skin turgor. Abdomen soft, mildly tender in the lower quadrants. Bowel sounds present. No peritonism. Alert but tired.

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

Elena Papadakis, a 63-year-old woman with chronic schizophrenia, is brought to your temporary disaster-response clinic by a community support worker after being displaced by a major urban earthquake. She has run out of her regular medications and has not taken them for five days. Her support worker reports that she has become increasingly withdrawn and has begun muttering to herself. Elena reports trouble sleeping, believes that the earthquake was a targeted message to her, and is fearful of government intervention. She has no history of aggression or suicide attempts but appears increasingly paranoid. There is no family contact, and her usual mental health team is currently unavailable due to infrastructure damage.

Past history: Chronic schizophrenia, hypertension

Medications: Risperidone (previously compliant), amlodipine

Allergies: Nil known

Social history: Lives in supported housing. No current access to psychiatric services. Currently staying in shared evacuation accommodation with unfamiliar residents.

Examination findings: T 36.5°C, HR 90 bpm, BP 134/80 mmHg. Appears anxious, guarded, speaking softly. Limited eye contact. No obvious thought disorder, but vague persecutory ideation noted. No overt hallucinations or suicidal ideation.

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

Hamid Reza, a 50-year-old man, presents to your regional general practice clinic operating in a school hall after a recent major flood event. He is a volunteer with the State Emergency Service (SES) and spent several days wading through floodwaters helping with evacuations. He now reports a fever, headache, muscle aches, and conjunctival redness. He also has some mild nausea and lower back pain. He denies cough, chest pain, or diarrhoea. He is concerned because one of his colleagues was recently admitted to hospital with suspected leptospirosis.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Non-smoker, physically active. No recent overseas travel. No pets but significant exposure to floodwater in recent days.

Examination findings: T 38.5°C, HR 96 bpm, BP 122/74 mmHg, RR 16/min, SpO₂ 98% RA. Mild conjunctival suffusion. No meningism. Abdomen soft, mild tenderness in right upper quadrant. No rash or lymphadenopathy.

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

Lisa Tang, a 30-year-old Aboriginal woman, presents to your remote general practice clinic three weeks after a major cyclone that damaged infrastructure and disrupted services in her community. She reports persistent low mood, fatigue, disrupted sleep, and a sense of disconnection from her family and community. She says, ‘I just don’t feel right in myself.’ Lisa has no history of mental illness and has been actively involved in community clean-up efforts. She expresses cultural distress about being unable to access traditional lands and spiritual practices due to damage and restricted access after the cyclone.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Lives with extended family. Community access roads remain damaged. No substance use. Deeply connected to Country and cultural practices.

Examination findings: Vitals normal. Lisa is quietly spoken, cooperative, flat in affect. No psychosis, suicidal ideation, or cognitive impairment. Tearful when discussing recent losses and community impact.

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

David Lang, a 46-year-old logistics coordinator, presents to your inner-city general practice five days after being involved in coordinating emergency relief during a major warehouse fire. He reports chest tightness, fatigue, and dry cough that developed after spending multiple hours on-site near smoke without respiratory protection. He has a past history of well-controlled hypertension and seasonal allergies. He denies fever, sputum production, or wheeze but feels breathless on exertion and slightly light-headed.

Past history: Hypertension, allergic rhinitis

Medications: Ramipril, loratadine

Allergies: Nil drug allergies

Social history: Non-smoker. Lives with wife and children. No history of asthma or occupational lung disease. No previous similar episodes.

Examination findings: T 36.8°C, HR 92 bpm, BP 128/82 mmHg, RR 18/min, SpO₂ 96% on room air. Chest clear on auscultation. No wheeze or crackles. Peak expiratory flow 75% of predicted. No cyanosis or clubbing.

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

Paulina Gomez, a 35-year-old primary school teacher, presents to your general practice two weeks after surviving a flash flood in regional Queensland. She was rescued from her car after being trapped in rapidly rising water and describes intense fear and helplessness during the event. Since then, she reports hypervigilance, poor sleep, irritability, and difficulty concentrating at work. She avoids driving or being near creeks and becomes anxious during rainfall. She has supportive family but feels ‘ashamed’ for not coping better. She denies suicidal thoughts but says she ‘feels stuck’ and struggles to enjoy time with her children.

Past history: Nil psychiatric history

Medications: Nil

Allergies: Nil known

Social history: Married, two children. Teaching full-time. House was not damaged. No known substance use. Previously active and social.

Examination findings: Calm but tearful. No psychosis or cognitive impairment. PHQ-9: 12 (moderate). PCL-5 score: 42 (consistent with PTSD).

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

Abdul Rahman, a 62-year-old man with known ischaemic heart disease, presents to your temporary GP clinic in a community hall following a prolonged heatwave and local power outage. He reports dizziness, fatigue, and dark-coloured urine after spending two days in an unventilated home with no air conditioning or access to cool fluids. He has not taken his regular medications, including aspirin and atenolol, for two days due to nausea. He lives alone and was reluctant to leave his home during the blackout. He denies chest pain but feels ‘wobbly’ when standing.

Past history: Ischaemic heart disease, hypertension

Medications: Aspirin, atenolol, perindopril, atorvastatin

Allergies: Nil known

Social history: Lives alone. Limited community engagement. Power restored 24 hours ago. No known mental health issues. No alcohol or drug use.

Examination findings: T 37.9°C, HR 104 bpm, BP 92/58 mmHg, RR 20/min, SpO₂ 97% RA. Mucous membranes dry, skin warm. Capillary refill slightly delayed. ECG: sinus tachycardia. No chest pain or crackles. No focal neurological signs.

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

Charlotte Reid, a 26-year-old paramedic, presents to your general practice two weeks after working in the aftermath of a mass casualty bus crash on a remote highway. She was one of the first on scene and assisted with triage and resuscitation. Since then, she has had vivid flashbacks, nightmares, and now avoids anything that reminds her of the incident, including wearing her uniform. She is exhausted, irritable, and has started drinking alcohol nightly to help her sleep. She reports feeling ‘numb’ and disconnected from friends and family. She denies suicidal ideation but feels she’s ‘not coping’ and is unsure whether she can return to work.

Past history: Nil significant mental health history

Medications: Nil

Allergies: Nil known

Social history: Lives with partner. No children. Previously enjoyed her work. No prior trauma. No past psychiatric care.

Examination findings: T 36.6°C, HR 82 bpm, BP 118/72 mmHg. Charlotte is alert but tearful. No psychosis or suicidal ideation. Appears emotionally blunted. Screening with PCL-5 score: 48 (consistent with PTSD).

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

James Hooper, a 4-year-old boy, is brought to your rural general practice clinic by his mother four days after their home was destroyed in a bushfire. They are now staying at a temporary evacuation centre. His mother is concerned because James has become clingy, refuses to sleep alone, and is having frequent tantrums and bedwetting, despite having been toilet-trained for over a year. He startles easily at loud noises and becomes distressed when he sees images of fire on television. His mother says, ‘He just hasn’t been himself since the fire.’

Past history: Full-term birth, no medical issues

Medications: Nil

Allergies: Nil known

Social history: Lives with parents and older sister. No family history of mental illness. Parents are emotionally overwhelmed but supportive and engaged.

Examination findings: James is alert and physically well. Engages hesitantly during play. No abnormal neurological signs. Normal growth and development. No evidence of abuse or neglect.

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

John Daniels, a 69-year-old retired builder, presents to your general practice clinic established in a town hall following a severe storm that damaged multiple homes. He reports worsening shortness of breath, chest tightness, and wheeze over the past week. He has a 40-pack-year smoking history and was previously diagnosed with mild COPD, which he manages with occasional salbutamol. Since the storm, he has been sleeping in a damp room in a relative’s house, where there is visible mould on the walls and a musty odour. He has not accessed his usual medications and denies any fever, cough, or sputum.

Past history: Mild COPD, hypertension

Medications: Salbutamol as needed, perindopril

Allergies: Nil known

Social history: Non-drinker. Former smoker. Lives alone, temporarily displaced due to storm damage. Staying in crowded accommodation with family.

Examination findings: T 36.7°C, HR 88 bpm, RR 20/min, BP 130/78 mmHg, SpO₂ 94% RA. Mild expiratory wheeze. No crackles. PEFR 60% of predicted. No signs of infection.

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

Imran Siddiqui, a 52-year-old man, presents to your general practice clinic in a temporary health facility one week after surviving a building collapse following an earthquake. He sustained minor abrasions but did not require hospitalisation. Since the incident, he reports difficulty sleeping, recurring intrusive memories, and feeling ‘on edge’ all the time. He startles easily and avoids walking near damaged buildings. He feels guilty for surviving when others did not and describes a persistent sense of dread. He has no history of mental illness but says he has barely been able to concentrate on anything since the quake.

Past history: Nil psychiatric or medical history

Medications: Nil

Allergies: Nil known

Social history: Works as a retail manager. Married, two teenage children. Currently staying in temporary accommodation. No substance use. Family supportive but also affected by the disaster.

Examination findings: Alert, oriented, mildly anxious appearance. No psychosis or suicidal ideation. Speaks coherently. No physical injuries requiring intervention. PCL-5 score: 33 (mild to moderate symptoms).

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

Sylvia Martin, a 44-year-old woman with insulin-dependent type 2 diabetes, presents to your general practice clinic in a suburban recovery centre two weeks after a major flood. She reports difficulty maintaining stable blood glucose levels since the disaster. Her fridge was destroyed, and she had no access to refrigeration for over a week. She continued using her insulin, which had been stored in a warm room. Over the past 10 days, her BGL readings have ranged between 16 and 22 mmol/L. She reports lethargy, dry mouth, and blurry vision, but no vomiting or abdominal pain. She is still living in temporary housing and has been unable to see her usual diabetes educator.

Past history: Type 2 diabetes (insulin and metformin), hypertension, obesity (BMI 32)

Medications: Insulin glargine, metformin, candesartan

Allergies: Nil known

Social history: Lives alone. Temporarily housed at local showground accommodation. No local family support. Diet irregular since the flood.

Examination findings: T 36.7°C, HR 92 bpm, BP 128/76 mmHg, RR 18/min, SpO₂ 98% RA. Dry oral mucosa. No signs of infection or foot ulceration. No abdominal tenderness.

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

Leo Armstrong, a 58-year-old emergency electrician, presents to your temporary GP clinic in a flood-affected town complaining of a painful foot ulcer that has worsened over the last week. He sustained a minor foot abrasion while working barefoot in wet conditions during flood repairs. He reports increasing redness, foul-smelling discharge, and difficulty weight-bearing. He has not seen a doctor due to access issues and has continued working in wet boots. He is concerned as the wound is not healing.

Past history: Type 2 diabetes, hypertension

Medications: Metformin, perindopril

Allergies: Nil known

Social history: Lives locally. No recent medical review. Smokes 10 cigarettes/day. Currently working 10–12 hour shifts on flood restoration.

Examination findings: T 37.8°C, HR 94 bpm, BP 134/84 mmHg. Right foot shows a 2.5cm ulcer over the lateral plantar surface with surrounding erythema, mild oedema, and purulent discharge. Mild warmth. Peripheral pulses palpable. Sensation reduced in both feet.

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

Natalie Cheng, a 23-year-old university student, presents to your general practice clinic operating from a temporary health hub following a large-scale cyclone in northern Australia. She has developed a fever, rash, arthralgia, and myalgia over the past three days. The symptoms began approximately one week after helping clean up debris in a low-lying, flood-prone area. She also reports fatigue and mild conjunctival redness. She has no gastrointestinal or respiratory symptoms. Several others in the clean-up team have reported similar symptoms. She is concerned because her symptoms are worsening, and her joints are becoming increasingly stiff.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Non-smoker. Previously well. Staying in shared accommodation with limited mosquito protection. No recent overseas travel.

Examination findings: T 38.4°C, HR 90 bpm, BP 118/76 mmHg. Maculopapular rash over trunk and limbs. Bilateral wrist and ankle joint tenderness without effusion. Mild conjunctival injection. No lymphadenopathy. No hepatosplenomegaly.

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

Wendy Griffiths, a 73-year-old woman with moderate chronic kidney disease (CKD), presents to your outreach general practice van operating in a fire-affected rural town. She reports reduced urine output, nausea, and mild confusion over the past 24 hours. She has been staying in a hot, smoke-affected area without access to air conditioning or reliable drinking water since being displaced from her home. Her medications include ramipril, frusemide, and calcium carbonate. She has had limited food and fluid intake due to nausea. Her daughter notes she has been less responsive than usual today.

Past history: CKD stage 3b, hypertension, osteoarthritis

Medications: Ramipril, frusemide, calcium carbonate, paracetamol

Allergies: Nil known

Social history: Lives alone. Currently housed in temporary shelter without refrigeration. Poor fluid intake and limited mobility.

Examination findings: T 36.4°C, HR 96 bpm, BP 94/62 mmHg, RR 20/min, SpO₂ 97% RA. Mildly confused. Mucous membranes dry, skin turgor reduced. No focal neurological signs. Chest clear.

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

Raymond Wallace, a 47-year-old firefighter, presents to your GP clinic for review two weeks after responding to a major industrial fire involving chemical storage. He reports persistent throat irritation, episodic wheezing, and a dry cough that worsens with exertion. He wore a respirator mask during the early stages of the incident but removed it for prolonged periods due to communication needs. He has never smoked and has no past respiratory illness. He is currently back at work but finds he is easily short of breath during physical activity.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Lives with partner and two teenage children. No pets. No recent illness. No prior asthma.

Examination findings: T 36.9°C, HR 84 bpm, BP 126/80 mmHg, RR 18/min, SpO₂ 96% RA. Mild expiratory wheeze on auscultation. Peak expiratory flow 65% of predicted. No cyanosis or clubbing. Chest clear to percussion.

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

Amira Hassan, a 34-year-old woman, presents to your general practice clinic four days after escaping a house fire. She sustained no physical injuries but was rescued by emergency services after being trapped in a bedroom. Since the incident, she reports persistent insomnia, hypervigilance, and a feeling of panic whenever she smells smoke or hears sirens. She says she is unable to return home and is now staying with relatives. She feels constantly anxious and reports irritability and poor concentration. She has never had mental health issues before but is worried she is ‘losing control’.

Past history: Nil mental health history

Medications: Nil

Allergies: Nil known

Social history: Lives alone, works as a hospitality manager. No children. Non-smoker. No alcohol or drug use. Currently on leave from work.

Examination findings: Alert, oriented, mild tremor in hands. Tearful. No evidence of psychosis or suicidal ideation. PHQ-9 score: 14 (moderate). PCL-5 score: 32 (suggestive of acute stress reaction).

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

Eric Ma, a 29-year-old delivery driver, presents to your mobile GP clinic two weeks after assisting with recovery work in a flood-affected rural town. He reports developing a painless, slowly enlarging ulcer on his left lower leg. He noticed a red papule after being bitten by an insect while clearing debris and standing in floodwater. Over several days, it progressed to a central ulcer with raised edges. He denies systemic symptoms such as fever or chills. The wound is not tender but has not healed despite basic first aid. He is otherwise well and has no chronic health conditions.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Non-smoker. No recent travel outside Australia. Exposure to contaminated water and vegetation during post-flood clean-up. No known contacts with similar wounds.

Examination findings: Afebrile. BP 122/78 mmHg, HR 76 bpm, RR 14/min. 1.5 cm ulcer with undermined edges and a clean base on the lateral aspect of the left lower leg. No surrounding cellulitis. No lymphadenopathy. No other skin lesions.

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

Barbara Kelly, a 78-year-old woman with mild dementia, is brought to your general practice clinic operating from a community evacuation centre after being relocated due to a bushfire evacuation in regional New South Wales. Her carer reports that Barbara has become increasingly agitated, disoriented, and irritable since arriving at the centre three days ago. She is not sleeping well, often wanders at night, and becomes distressed when she cannot locate familiar belongings. She was previously well managed at home with support services and routines. There is no report of falls, fever, or incontinence. Her usual medications have been continued.

Past history: Mild Alzheimer’s dementia, hypertension

Medications: Donepezil, amlodipine

Allergies: Nil known

Social history: Lives with daughter (carer), previously received community aged care package. Evacuated with daughter during bushfires. Currently sleeping in shared hall with limited privacy or routine.

Examination findings: T 36.8°C, HR 88 bpm, BP 130/74 mmHg, RR 16/min, SpO₂ 98% RA. Alert but disoriented to place and time. No focal neurological deficits. No signs of infection or dehydration.

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

Samuel White, a 40-year-old plumber, presents to your rural general practice clinic two weeks after helping with emergency repairs to sewage systems following extensive flooding. He reports low-grade fever, malaise, and muscle aches for five days. Over the past two days, he has developed a persistent dry cough and is experiencing increasing fatigue. He denies sore throat, runny nose, or gastrointestinal symptoms. Several of his co-workers are experiencing similar symptoms. He has not travelled recently and has not received his annual influenza vaccination.

Past history: Asthma (mild, intermittent)

Medications: Salbutamol inhaler as needed

Allergies: Nil known

Social history: Non-smoker. Lives with wife and two children. Frequently works in flood-affected areas. No pets or livestock exposure reported.

Examination findings: T 37.8°C, HR 90 bpm, BP 124/78 mmHg, RR 18/min, SpO₂ 97% RA. Chest clear on auscultation. No rash, lymphadenopathy, or focal signs. Mild conjunctival injection.

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

Emily Nguyen, a 6-year-old girl, presents to your general practice tent clinic set up near a bushfire-affected regional town. Her mother reports that since returning to their partially damaged home two days ago, Emily has had a persistent cough and is complaining of shortness of breath when playing. Emily has a history of mild intermittent asthma, previously managed with occasional salbutamol. The family lost their usual inhalers during the evacuation and has been without medication for over a week. Her mother notes that the air in the area is still smoky, and the house smells of burnt materials.

Past history: Mild asthma, eczema

Medications: Nil currently (salbutamol lost)

Allergies: Dust mites (mild)

Social history: Lives with parents and younger brother. No pets. Returned home two days ago after staying in temporary evacuation centre for one week.

Examination findings: T 36.6°C, HR 110 bpm, RR 24/min, SpO₂ 96% RA. Mild wheeze on auscultation. No fever, no signs of infection. Appears mildly short of breath on exertion.

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

Ahmed El-Sayed, a 31-year-old man recently resettled as a refugee, presents to your general practice clinic two months after surviving a major flood that displaced his housing and disrupted his social supports. He reports persistent nightmares, poor concentration, and increasing irritability. He becomes hyperalert when hearing rain or sirens and avoids going near bodies of water. He struggles to sleep and has started isolating himself from community groups he used to attend. He has no history of mental illness but mentions exposure to past traumatic events in his country of origin, including war and forced displacement.

Past history: Nil documented psychiatric history

Medications: Nil

Allergies: Nil known

Social history: Lives in government-provided housing. Speaks conversational English. Attends local mosque. No alcohol or substance use. Limited family support.

Examination findings: Calm but withdrawn. No suicidal ideation or psychosis. PHQ-9 score: 18 (moderate to severe). PCL-5 score: 50 (consistent with PTSD).

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

Daniel Fraser, a 54-year-old farmer, presents to your rural general practice one week after being bitten by a snake while moving livestock during floodwaters. He reports that he did not seek immediate medical attention, assuming it was a non-venomous bite, but now complains of generalised muscle pain, fatigue, and dark-coloured urine. He has also developed mild swelling around the bite site, but no bleeding or neurological symptoms. The bite occurred on his left ankle, which is mildly tender and bruised. He cannot identify the snake species. He has no significant past medical history.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Works alone on a property in a flood-affected region. No mobile signal at time of incident. Returned to routine farm work immediately after the bite.

Examination findings: T 37.6°C, HR 96 bpm, BP 122/78 mmHg, RR 18/min, SpO₂ 98% RA. Mild swelling and bruising at left ankle. No lymphadenopathy. Chest clear. Urine dipstick: +++ blood, no leukocytes or nitrites.

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

Jasmine Barlow, a 25-year-old early childhood educator, presents to your general practice clinic four days after returning to her home, which was severely damaged by a major flood. She reports red, itchy eyes, a blocked nose, frequent sneezing, and a dry cough that started after moving back into the house. She also complains of headaches and fatigue. Several members of her household are experiencing similar symptoms. She says the house still smells musty, and there is visible mould on walls and ceilings despite surface cleaning. She has no past history of asthma or allergies.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Lives with parents and younger brother. All returned to the house recently. No pets. Working part-time post-flood.

Examination findings: T 36.7°C, HR 78 bpm, BP 118/70 mmHg, RR 16/min, SpO₂ 99% RA. Nasal mucosa congested. Conjunctiva mildly injected. Chest clear. No skin rash or wheeze.

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

Muhammad Fahim, a 65-year-old man with known ischaemic heart disease, presents to your temporary GP clinic in a rural evacuation centre two days after experiencing mild chest discomfort while clearing debris following a bushfire. He describes a dull, central chest ache during exertion that resolved with rest. He did not call emergency services at the time, attributing it to fatigue. He has no previous history of angina symptoms but has had a stent inserted five years ago. He has been without his regular medications for three days due to displacement and limited pharmacy access.

Past history: Ischaemic heart disease, hyperlipidaemia, hypertension

Medications: Aspirin, atorvastatin, perindopril, bisoprolol

Allergies: Nil known

Social history: Lives with wife, both evacuated due to fire. Has been sleeping in shared emergency accommodation. Minimal physical activity recently until clean-up began.

Examination findings: T 36.9°C, HR 84 bpm, BP 138/82 mmHg, RR 16/min, SpO₂ 98% RA. Cardiovascular and respiratory exams unremarkable. No ongoing chest pain. ECG shows normal sinus rhythm, no ST changes.

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

Liam Ritchie, a 17-year-old student, presents to your temporary clinic set up at a school following a cyclone that displaced his family. He reports frequent stomach aches, trouble sleeping, and reduced appetite over the past two weeks. His mother notes that he has become withdrawn, irritable, and is avoiding contact with friends. He denies any suicidal ideation but states he ‘just feels numb’. Liam had no prior medical or psychiatric history. He is attending school sporadically and says he ‘can’t focus on anything anymore’.

Past history: Nil known

Medications: Nil

Allergies: Nil known

Social history: Lives with parents and two younger siblings. Family home severely damaged during cyclone. Currently staying with relatives in crowded housing. Previously active and engaged in sports. No substance use. No significant trauma history before the disaster.

Examination findings: Alert, cooperative, low affect. No psychotic features or suicidal ideation. PHQ-A (Adolescent version): 16 (moderate depression). Appears tired and emotionally flat.

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

Helen Zhou, a 72-year-old woman with chronic obstructive pulmonary disease (COPD), presents to your temporary GP clinic operating from a community centre after her local medical clinic was closed due to recent bushfires. She reports worsening breathlessness over the past five days and increased use of her salbutamol inhaler. She ran out of her regular preventer and has been exposed to persistent bushfire smoke in her area. She denies fever or sputum production but notes her breathing is more laboured than usual, especially overnight.

Past history: COPD (moderate), osteoporosis

Medications: Tiotropium (inhaler), budesonide/formoterol (preventer) – ran out 5 days ago, salbutamol (as needed)

Allergies: Nil known

Social history: Lives alone in bushfire-affected semi-rural area. Currently without air purifier or mask. No current support services.

Examination findings: T 36.8°C, HR 92 bpm, RR 20/min, SpO₂ 95% RA. Mild expiratory wheeze. Chest clear to percussion. No cyanosis or peripheral oedema.

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

Thalia Petrou, a 33-year-old woman, presents to your general practice clinic two weeks after being involved in the evacuation of her childcare centre during a flash flood. She now reports frequent headaches, difficulty sleeping, and feeling ‘on edge’ constantly. She startles easily and avoids walking near stormwater drains. She has begun missing work due to exhaustion and has withdrawn from her usual social activities. She denies suicidal ideation but admits to feeling overwhelmed and irritable. She has no prior mental health history.

Past history: Nil significant

Medications: Nil

Allergies: Nil known

Social history: Lives alone, non-smoker, no alcohol use. Previously active and socially engaged. No family history of psychiatric illness.

Examination findings: Alert and oriented. No psychosis. Tearful at times. PHQ-9: 17 (moderate), PCL-5: 41 (suggestive of PTSD). No cognitive deficits.

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

Greg Hunter, a 45-year-old volunteer rescue worker, presents to your general practice clinic three weeks after assisting in the aftermath of a landslide in a remote Australian region. He was involved in recovering bodies from collapsed homes and reports recurring intrusive thoughts, nightmares, and emotional numbness. He says he feels detached from his family and unable to enjoy activities he used to love. He is increasingly irritable and has had outbursts at work. He tried to resume volunteering but became overwhelmed and left early. He denies suicidal thoughts but says he feels ‘not right in my head.’

Past history: Nil mental health history

Medications: Nil

Allergies: Nil known

Social history: Married, two children. Works full-time. Previously well and highly functional. No prior trauma exposure.

Examination findings: PHQ-9: 19 (moderate to severe), PCL-5: 55 (consistent with PTSD). Alert, emotionally blunted, no psychosis or suicidal ideation.

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