KFP – Medicolegal

Sarah Donovan, aged 32, presents to your suburban general practice late on a Friday afternoon. She is visibly distressed and states that she is fleeing an abusive partner. She reports multiple past episodes of physical and psychological abuse but has never previously sought medical help. She has no visible injuries today but states she fears for her safety and that of her two children, aged 3 and 5, who are currently with her. She does not wish to return home. She is currently not taking any medications.

Past history: Nil significant medical or psychiatric history.

Social history: Recently moved to the area; limited local supports; unemployed; partner is currently unaware of her location.

Examination findings: No injuries noted. She appears anxious and tearful. Children appear well and not in distress.

Investigations: Not performed at this stage.

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

Dr Benjamin Watts, a 64-year-old semi-retired GP working in a rural locum capacity, presents to your clinic as a new patient for a renewal of his blood pressure and cholesterol medications. During the consultation, you notice that Dr Watts has minor tremor, subtle word-finding difficulties, and appears occasionally confused when discussing his medications and history. He is otherwise physically well and has a valid driver’s licence. He mentions he is still working in a small single-doctor practice one town over, covering weekends and some weekdays, mostly without nursing support. He lives alone and drives to work.

Medications: Perindopril 10 mg daily, Atorvastatin 40 mg daily

Past history: Hypertension, hypercholesterolaemia

Social history: Widowed; no children; no immediate family nearby. Has worked in general practice for over 30 years and moved to the area five years ago.

You are concerned about his cognitive function and the implications for clinical safety and fitness to practise.

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

Chloe Barbour, aged 15, presents to your practice requesting the oral contraceptive pill. She attends alone and appears mature and well-informed. She states that she has recently become sexually active with her 16-year-old boyfriend and wants to ensure she is protected. She does not want her parents to know and insists on confidentiality. She reports no coercion or abuse and denies any STI symptoms. She attends school, has no mental health history, and lives at home with her parents. She is not using any current medications.

Past history: Nil significant medical history.

Social history: Lives with parents; supportive friendship group; attends local high school; plays netball and works casually at a café.

Examination findings: Not clinically indicated at this consultation.

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

David Nolan, aged 47, presents for a scheduled appointment. He has a long history of chronic low back pain and is prescribed oxycodone sustained release 10 mg BD and diazepam 5 mg nocte, which have been prescribed for over 12 months by multiple GPs at your practice. During today’s consultation, you receive a faxed notification from SafeScript (real-time prescription monitoring) indicating that David has obtained multiple prescriptions for oxycodone and diazepam from three different practices over the past two months. He does not volunteer this information and becomes defensive when you raise the concern, insisting that ‘everything is legal’ and that he just sees a lot of doctors because of his pain. He denies selling or misusing medications and asks for a new script today.

Past history: Chronic low back pain, previous injury as a labourer. Intermittent depression and anxiety.

Medications: Oxycodone SR 10 mg BD, Diazepam 5 mg nocte, Paracetamol 1g QID.

Social history: Lives alone, smokes, unemployed. No known drug or alcohol counselling. Denies recent hospital presentations.

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

Amy Tran, aged 28, presents to your clinic as a new patient requesting a medical certificate for the past 10 days off work. She explains that she had ‘severe anxiety and migraines’ during this time but did not see a doctor and self-managed with rest and over-the-counter medications. She is now feeling better and has returned to work but her employer requires a certificate covering the missed period. She is polite and provides no evidence of dishonesty. She works as a dental assistant and is not on any regular medications.

Past history: Intermittent migraines and situational anxiety; never formally treated.

Social history: Lives with partner; no alcohol or drug use; no mental health care plan in place.

Examination findings: Unremarkable.

What are the most appropriate actions to take in this situation? Select two (2) from the following list:

Emily Ross, aged 21, presents to your clinic requesting access to her full medical record, including mental health notes and previous consultation summaries. She has been a patient at the clinic since childhood but is now moving interstate. She states she wants a complete copy for her own use, not just to give to her new GP. Her mother, who previously attended appointments with her, calls the clinic later that day and asks for a copy of the records to be emailed to her instead, saying she has ‘always handled this stuff’ and Emily wouldn’t mind.

Past history: Mild anxiety, past eating disorder in adolescence, no history of self-harm or suicide.

Medications: None currently.

Social history: University student, now living independently; mother remains involved but does not have power of attorney or guardianship.

What are the most appropriate actions in response to these requests? Select three (3) from the following list:

Jacob Petrou, aged 53, presents to your rural general practice for follow-up after a workplace incident in which he sustained a minor laceration to his hand. He is an experienced livestock handler at a local abattoir. At today’s review, he discloses that he often feels ‘pressured’ to process animals too quickly and has witnessed unsafe practices, including untrained staff using equipment. He reports that a co-worker was seriously injured last month but the incident wasn’t reported to Worksafe. He expresses fear of retaliation if he makes a formal complaint and asks you not to record anything that might ‘get him into trouble’.

Past history: Hypertension and type 2 diabetes; both well-controlled. No mental health history.

Social history: Lives with wife and two teenage children; no drugs or alcohol; enjoys fishing and community involvement.

Examination findings: Healing wound, no signs of infection or complications. Fit for normal duties.

What are the most appropriate actions in this situation? Select three (3) from the following list:

John Kamal, aged 62, presents for a follow-up after undergoing an abdominal ultrasound ordered by another GP in your clinic. He tells you that when he came for the scan last week, the sonographer mentioned they found ‘something on the liver’. However, John states that no one from the practice has called him with results, and he’s been worried since. You check the record and find that the scan report, showing a probable hepatic haemangioma, was uploaded to the inbox five days ago but was not reviewed or actioned. John expresses frustration and asks why no one followed up with him.

Past history: Hypertension, hyperlipidaemia. No known liver disease.

Medications: Perindopril 10 mg, Atorvastatin 20 mg daily.

Social history: Non-smoker, drinks alcohol occasionally; lives with partner.

Investigations: Abdominal ultrasound: 2.5 cm hyperechoic lesion in segment VII of liver, consistent with probable haemangioma. No other abnormalities noted.

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Margaret Llewellyn, aged 83, is brought in by her son for a review of her medications. She lives independently but has had increasing forgetfulness over the past 6 months. Her son expresses concern about her ability to manage medications and finances. Margaret insists she is managing well and says her son ‘worries too much’. She is alert and pleasant, though she struggles with details about her medications. She declines a cognitive screen today, stating she is in a rush and will come back next week. Her son asks you privately to send him a copy of her medication list and ‘keep an eye on her’.

Past history: Osteoarthritis, hypertension, mild hearing loss

Medications: Irbesartan 150 mg daily, Paracetamol 1 g PRN

Social history: Lives alone, still drives, has supportive neighbours. No formal carer in place.

What are the most appropriate actions to take? Select three (3) from the following list:

Dr Priya Nair, a 37-year-old GP registrar, books an urgent private appointment with you, her supervisor, at the end of the day. She is visibly distressed and explains that she accidentally accessed the wrong patient’s file during a busy clinic session yesterday and entered clinical notes in the wrong chart. The patient was notified by the receptionist due to a print-out discrepancy and has since made a formal complaint to the practice manager. Dr Nair is concerned about the implications for her registration and wants to know what to do next.

Past history (for context): No prior performance concerns; well-regarded by patients and colleagues.

Social history: Lives with partner, two young children; nearing the end of her registrar term.

Practice environment: High-volume clinic using electronic health records (EHR); support staff in place.

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

Samuel Nguyen, a 45-year-old man, presents for a mental health review under a GP Mental Health Care Plan. During the consultation, he discloses that he has recently purchased a firearm and has started target shooting as a hobby. He also mentions having intrusive thoughts and occasional urges to hurt himself, though he denies any current plan or intent. His mood is low but stable, and he is engaged with a psychologist. He is not under the care of a psychiatrist and has no past psychiatric admissions.

Past history: Generalised anxiety disorder, moderate depression (no suicide attempts)

Medications: Sertraline 100 mg daily

Social history: Lives alone, works full time, no close family nearby

Mental state exam: Coherent, low affect, no psychosis, denies intent or plan, agrees to safety plan and follow-up

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Layla Botros, aged 36, presents for review of chronic pelvic pain. During the consultation, she becomes tearful and discloses that she experienced sexual assault during a recent overseas trip. She has not told anyone else, including her partner, and does not want to involve police. She requests a full STI screen and advice on contraception. She declines a formal mental health referral for now but agrees to return for follow-up. You are her regular GP and this is her first disclosure of any trauma.

Past history: Mild endometriosis, previously well-controlled. Nil mental health history.

Medications: None currently

Social history: Lives with partner, no children, works as a graphic designer

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Peter Giles, a 68-year-old man with a history of type 2 diabetes and coronary artery disease, is brought to your clinic by ambulance after collapsing at home. He is now alert and oriented, with no neurological deficit. ECG and vital signs are stable. After assessment and discussion, you recommend urgent hospital admission for further cardiac workup. Peter firmly declines, stating he does not trust hospitals and would prefer to be managed at home. His wife appears anxious but says ‘he’s always been stubborn’. He is not confused and is able to clearly articulate his decision.

Past history: Type 2 diabetes, CABG 5 years ago, hypertension

Medications: Metformin, Bisoprolol, Aspirin, Atorvastatin

Social history: Lives with wife; previously independent with activities of daily living

What are the most appropriate actions in this consultation? Select three (3) from the following list:

Anna Kostecki, aged 25, presents for her first antenatal visit at 10 weeks’ gestation. She is visibly nervous and discloses that her partner, who is also the father of the baby, has been emotionally abusive and increasingly controlling. She says he insists on attending all her medical appointments and reads her messages and emails. She fears that if he finds out she spoke about him, he may become violent. Today she has come alone and asks if her partner will be told what she shares.

Past history: Nil significant medical history

Social history: Lives with partner in a rental property; no other local supports

Examination findings: Normal early pregnancy findings; no injuries

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

Nicholas James, a 17-year-old Year 12 student, attends your clinic for review of acne treatment. During the consultation, he confides that he has been feeling overwhelmed and recently started using cannabis several times a week to ‘help sleep and switch off’. He denies suicidal ideation or psychosis. He lives at home with his parents, who are unaware of his substance use. He asks you not to tell them and does not want their involvement. He has no previous mental health history and remains engaged at school.

Past history: Acne vulgaris, mild asthma

Medications: Topical retinoid cream

Social history: Lives with both parents; supportive school environment; part-time work at a café

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Dr Aisha Malik, a 58-year-old GP with over 25 years of experience, contacts you confidentially as a colleague. She discloses that she has been drinking heavily in the evenings due to stress and feels her functioning has declined. She admits to forgetting details of recent patient consultations and occasionally writing notes the next day. She has not yet taken time off work and is concerned that patients or staff may soon notice. She asks if you think she should stop practising and insists you not tell anyone else ‘yet’.

Past history (disclosed): Mild anxiety; no known medical illness or psychiatric diagnosis

Social history: Lives alone; estranged from family; no recent leave taken; no criminal history

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

Elena Georgiou, a 34-year-old secondary school teacher, attends your practice requesting a copy of her 6-week postnatal consultation notes. She says she is in a legal dispute with her ex-partner over custody of their infant and wants to submit documentation about her physical and mental health. The notes include discussion of low mood, sleep difficulty, and concern about her relationship. There is also mention of a brief history of past anxiety, not previously disclosed to her partner. Elena asks for a printed copy but does not want any part of the record shared with her ex-partner or their legal team.

Past history: Mild generalised anxiety disorder (diagnosed several years ago)

Social history: Single mother, living with her own parents; ongoing family court proceedings

Consultation summary (not disclosed to partner): Low mood, concern about partner’s emotional control, no risk issues identified

What are the most appropriate actions in this situation? Select three (3) from the following list:

Aaron Shepherd, a 41-year-old man, presents with worsening knee pain. During the consultation, you note that he is filming the interaction on his phone without having asked for your consent. When questioned, he says he ‘likes to keep a record of things’ and has done this at other clinics. He refuses to stop recording and becomes defensive, saying he has a right to film in case he is misled or mistreated. He insists on continuing the consultation while filming.

Past history: Osteoarthritis of the right knee, managed conservatively

Social history: Works as a delivery driver; no known mental health issues; self-manages his care; frequent user of multiple general practices

What are the most appropriate actions to take? Select three (3) from the following list:

Bridget O’Donnell, a 59-year-old woman, attends for review of a new breast lump. During the consultation, she mentions that she has recently seen a post on social media claiming that mammography causes cancer and that many GPs are ‘paid by pharma’ to push screening. She expresses reluctance to have further investigations and says she’s considering ‘natural’ therapies instead. She agrees to examination, which confirms a firm, mobile 2cm lump in the upper outer quadrant of the left breast. She declines imaging referral today, stating she wants to ‘research it more online’.

Past history: Hypothyroidism; well-controlled on thyroxine

Social history: Lives with partner; no family history of breast cancer; moderate alcohol use; uses complementary therapies

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Timothy Blake, aged 28, presents to your clinic after recently being released from prison. He requests a renewal of his antidepressant medication and also asks for a letter stating that he is ‘fit to return to work’ as a construction labourer. He has no documented consultation at your practice prior to this. He says he was diagnosed with depression in custody but has not yet seen a psychiatrist outside. He appears well and cooperative but becomes frustrated when asked about past records. He insists the letter must be done today as his employer is ‘chasing him’ for clearance.

Past history: Major depressive disorder (per patient); no records available

Medications: Sertraline 100 mg daily (custodial prescription previously)

Social history: Lives with brother; no drug or alcohol use disclosed; seeking to return to full-time construction work

What are the most appropriate actions to take? Select three (3) from the following list:

Francesca Long, a 45-year-old woman, presents for a follow-up regarding her recent referral to a rheumatologist. She appears upset and explains that the specialist was rude and dismissive, refused to examine her properly, and made comments that she felt were discriminatory. She asks you to write a formal complaint to the hospital and demands that you ensure the doctor ‘never sees anyone again’. She says she does not want to return to that clinic and is unsure whether she should continue with any specialist care.

Past history: Seronegative arthritis, fibromyalgia

Medications: Duloxetine, naproxen, PRN tramadol

Social history: Lives with teenage son; works part-time; English is her second language

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Jordan Ellis, a 31-year-old non-binary person, presents for management of generalised anxiety. They have been attending your clinic for over a year and are now requesting a letter confirming their gender identity for purposes of updating their Medicare and passport records. Jordan has socially transitioned and uses they/them pronouns. They do not currently wish to commence hormonal therapy or undergo surgical procedures. They ask for your support in completing the necessary government forms.

Past history: Generalised anxiety disorder, no psychiatric admissions

Medications: Sertraline 50 mg daily

Social history: Employed full-time; in a supportive relationship; has not disclosed gender identity to family

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Ravi Singh, aged 52, presents for a work-related injury follow-up. He is currently on modified duties after a shoulder strain. During the consultation, he tells you that his employer has been pressuring him to return to full duties despite ongoing pain. He says he was asked to sign a blank return-to-work form and feels intimidated but doesn’t want to ‘make trouble’. He requests a clearance for full duties today, saying he’s worried about losing his job if he doesn’t comply. On examination, shoulder range of motion is limited and painful, and he is not yet functionally ready for heavy lifting.

Past history: Type 2 diabetes, controlled with metformin

Medications: Metformin 1g BD, paracetamol PRN

Work history: Employed as a warehouse assistant; lifting and overhead work involved

What are the most appropriate actions in this consultation? Select three (3) from the following list:

Leah Carmichael, a 19-year-old university student, presents requesting a medical certificate for missing an exam due to severe period pain. She did not attend a consultation at the time but now asks you to provide a certificate stating that she was medically unfit on the day. She reports long-standing dysmenorrhoea but has never sought formal care. Her university requires a certificate for missed assessments. She appears distressed and says she will fail the subject without it. She is not currently on any medications and denies significant systemic symptoms.

Past history: Nil significant; never investigated for pelvic pain

Social history: Lives in student accommodation; no supports present at the time of the episode

What are the most appropriate actions to take in this consultation? Select two (2) from the following list:

Oscar Delaney, a 74-year-old man with mild dementia, is brought in by his daughter for review. She is his appointed Enduring Power of Attorney (Medical) and has been managing his medications and appointments. Oscar appears cheerful but confused about the reason for the visit. His daughter states that she wants him started on a new supplement advertised online to ‘boost memory’ and asks for a script or recommendation. The product is not listed on the ARTG and contains unverified herbal compounds. Oscar does not express any desire to take the supplement but smiles and nods throughout the discussion.

Past history: Mild Alzheimer’s disease, hypertension

Medications: Donepezil 10 mg daily, amlodipine 5 mg daily

Social history: Lives with daughter and son-in-law; requires support with shopping, cooking, and medications

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Sandra Beattie, a 39-year-old woman, presents for a routine review of her asthma. During the consultation, she tells you that she has recently started dating again and wants to ensure she is ‘clean’ before becoming sexually active with a new partner. She requests a full STI screen but strongly insists that her Medicare card not be billed because she doesn’t want the visit showing up in any family-linked statements. She is listed on her ex-husband’s Medicare Safety Net family group and has concerns about her privacy.

Past history: Asthma (well controlled), no known STIs

Medications: Salbutamol and budesonide/formoterol inhalers

Social history: Divorced, co-parenting two children; living independently; no current partner disclosure of STI risk

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Michael Rourke, a 68-year-old man, attends for review of a recent spirometry report. During the consultation, you notice that the pathology system has returned a cervical smear result for a different patient mistakenly filed under his name. The result includes identifiable information for a female patient with abnormal cytology. Michael has not seen this result but asks casually whether all his test results are back. You realise this is a system error from the pathology provider’s interface.

Past history: COPD, hypertension, ex-smoker

Medications: Salbutamol, tiotropium, ramipril

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Henry Tomlinson, a 56-year-old farmer from a remote area, presents for review of his type 2 diabetes and recent weight loss. During the consultation, he mentions he has been seeing a naturopath in town who has advised him to stop his metformin and ‘detox’ using herbal infusions. He shows you a bottle of unlabelled liquid, claiming it has helped his energy. His blood glucose readings have been erratic, and he admits to skipping meals. He asks you to write a letter supporting his decision to stop pharmaceutical treatment so he can give it to his private health insurer, who is covering his alternative therapy sessions.

Past history: Type 2 diabetes, hypertension, dyslipidaemia

Medications: Ceased metformin and atorvastatin 2 weeks ago as advised by naturopath

Social history: Lives on a rural property alone; limited access to health services

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Amira El-Zein, a 15-year-old high school student, attends your clinic alone seeking a prescription for the oral contraceptive pill. She states she is sexually active with a partner her own age and wants to take control of her sexual health. She does not want her parents to know and becomes visibly anxious when asked about involving them. She appears well, articulate, and demonstrates an understanding of the medication and safer sex practices. There are no red flags for coercion or abuse.

Past history: Nil significant medical history

Medications: Nil

Social history: Lives with both parents; supportive school environment; no risk factors for exploitation identified

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Richard Zhao, a 64-year-old retired engineer, presents for a routine review of his hypertension. During the consultation, he requests a copy of his full medical record to take to a new GP interstate, as he is relocating. He asks that you exclude certain consultations from the printout—specifically visits related to a mental health diagnosis he does not want to disclose to the new doctor. He insists that this is his right and says he will only authorise transfer if those records are removed. He is calm and articulate, with no signs of distress or confusion.

Past history: Hypertension, generalised anxiety disorder (managed intermittently over the past 5 years)

Medications: Perindopril, escitalopram

Social history: Divorced, living alone, no known cognitive impairment

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Joanne Pearson, a 47-year-old woman, presents after receiving a letter from your clinic advising her that a cervical screening test performed three months ago was never followed up. The result, which was abnormal (HPV 16 positive, cytology showing HSIL), was reviewed only yesterday during an audit. Joanne is understandably upset and asks why she wasn’t contacted earlier. She had assumed no news was good news. She now requires urgent colposcopy and is anxious about the delay and possible harm.

Past history: Normal cervical screening four years ago, mild depression

Medications: Sertraline 50 mg daily

Social history: Lives with partner; works as a librarian; regular clinic attendee

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Dr Liam Peterson, a 35-year-old GP registrar, presents to you, his supervisor, requesting feedback about a recent consultation where a patient became agitated after being refused an early repeat prescription for oxycodone. The patient lodged a formal complaint, claiming Dr Peterson was rude and refused to treat his pain adequately. Dr Peterson is concerned the complaint may affect his training assessment. He states that the patient had no clear indication for opioids, no evidence of malignancy or palliative need, and displayed drug-seeking behaviour.

Past history (as per Dr Peterson): Chronic back pain, previous opioid use, no red flags on recent imaging

Registrar context: Term 2 GP registrar; competent clinical performance to date

What are the most appropriate actions to take as the supervisor? Select three (3) from the following list:

Claire Nguyen, a 44-year-old secondary school teacher, presents requesting a certificate for a ‘mental health day’ after experiencing workplace stress. She is not currently under treatment for a mental health condition and has not been diagnosed with depression or anxiety. She reports fatigue, poor sleep, and irritability over the past week due to increased workload and student behaviour. She is still functioning at work but feels she needs a short break to reset. She requests a certificate to cover two missed days earlier in the week when she stayed home.

Past history: Nil significant mental health history

Medications: Nil

Social history: Lives with partner; reports supportive personal environment; no substance use

What are the most appropriate actions to take in this situation? Select two (2) from the following list:

David McAllister, a 51-year-old man, presents for removal of a sebaceous cyst on his back. You discuss the procedure, including local anaesthetic, risks of bleeding, infection, scarring, and recurrence. He agrees and signs the clinic’s standard minor procedure consent form. The excision proceeds without complication. Two days later, David returns with mild redness and bruising. He is concerned that he wasn’t told bruising could happen and says he wouldn’t have had the procedure if he’d known. He asks whether his consent was valid and says he is considering a complaint.

Past history: Hyperlipidaemia, previous minor skin excisions

Medications: Atorvastatin 40 mg daily

Social history: Works in administration; no known allergies or bleeding disorder

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Vincent Bradley, a 39-year-old man, attends your clinic requesting a copy of his child’s full medical records to support a family court case. He shares custody of his 7-year-old daughter, Mia, with his ex-partner. He states that he wants to use the records to demonstrate that she is not receiving adequate care from her mother. Mia is currently listed as a regular patient at your practice, and most consultations have occurred with her mother present. You have not been provided with any court orders or parenting plans that clarify parental rights to health records.

Past history (Mia): Mild asthma, normal development, no safeguarding concerns

Family history: Parents separated two years ago; shared care arrangement per patient history

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Farah Khalid, a 62-year-old woman with a long-standing history of rheumatoid arthritis, presents to your clinic for her routine methotrexate script. You note that she has not had recent blood tests and that her last pathology form was issued six months ago but never completed. When you raise this, she says she ‘didn’t get around to it’ and asks you to reissue the prescription anyway, saying she feels fine. She insists she has never had side effects. You are concerned about the risks of prescribing without updated monitoring.

Past history: Rheumatoid arthritis, hypertension

Medications: Methotrexate 20 mg weekly, folic acid, perindopril

Social history: Lives with husband, retired nurse, supportive home environment

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Jenny Park, a 33-year-old primary school teacher, attends your clinic for a follow-up of a workplace injury claim involving repetitive strain injury (RSI) of her dominant wrist. She tells you she’s feeling pressured by her employer to return to full duties even though her symptoms are ongoing. She also discloses that she was contacted by the employer’s insurance representative who asked her specific questions about her pain, medication use, and daily activities. She is unsure whether she was obligated to answer and asks if the insurer has access to her full medical file.

Past history: Anxiety, RSI under active WorkCover claim

Medications: Occasional ibuprofen and sertraline 50 mg daily

Social history: Lives with partner; no known legal representation yet

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Simone Blackwell, a 23-year-old university student, attends for a review of her mental health care plan. During the consultation, she discloses she has recently been researching how to access her own health records and expresses concern about a previous GP at the clinic writing what she describes as ‘judgemental and incorrect’ notes about her anxiety. She asks to see a copy of everything in her file and wants to know if she can have those sections removed or changed.

Past history: Generalised anxiety disorder, no hospital admissions

Medications: Sertraline 100 mg daily

Social history: Lives alone, full-time university student, supportive friendship group

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Jacob Warner, a 72-year-old man, presents with his daughter to discuss concerns about his memory. During the consultation, he is quiet but cooperative, and you note inconsistencies in his recall of recent events. His daughter states she wants to arrange a ‘capacity letter’ so she can take over managing his finances. She asks you to state that he is no longer capable of handling his affairs. Jacob appears confused about the discussion and says, ‘I think I’m doing okay.’ You have not yet completed a formal cognitive assessment.

Past history: Hypertension, type 2 diabetes

Medications: Metformin, amlodipine

Social history: Lives alone with family support; previously independent in managing bills and medications

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Melissa Ryan, a 29-year-old woman, attends for emergency contraception after unprotected intercourse the previous night. During the consultation, she reveals that she is on a temporary protection visa and is concerned about whether seeking this service could affect her immigration status. She requests that no Medicare item be billed and asks whether the visit will be recorded anywhere that the government can access. She is visibly distressed and hesitant to proceed with any written documentation.

Past history: Nil significant; no regular GP

Medications: Nil

Social history: Asylum seeker; lives in community housing; limited social support; speaks fluent English

What are the most appropriate actions to take in this consultation? Select three (3) from the following list:

Dr Alice Sutton, a GP working in a small rural practice, receives an email from a local solicitor requesting a medical report for one of her former patients, Tom Kingston, a 46-year-old man who died six weeks ago in a motor vehicle accident. The solicitor states they are acting for the family in a compensation claim. No consent or documentation is attached. Dr Sutton remembers Tom had a complex history including mental health concerns and substance use, but she has not been contacted by the coroner or any legal authority. She is unsure whether she can respond.

Past history (from records): Depression, past amphetamine use, chronic back pain, hypertension

Social history: Lived with partner; worked in logistics; no next-of-kin documentation on file

What are the most appropriate actions for Dr Sutton to take? Select three (3) from the following list:

Monique James, a 16-year-old high school student, presents requesting initiation of the combined oral contraceptive pill. She reports being in a consensual relationship with her 17-year-old boyfriend and has not yet been sexually active. Her mother, who is in the waiting room, is unaware of the nature of the visit. Monique is articulate and demonstrates a clear understanding of contraception, risks, and benefits. She specifically asks that her mother not be informed.

Past history: Nil significant; no mental health diagnoses or chronic conditions

Medications: Nil

Social history: Lives with both parents; attends Year 11; no concerns raised at school

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Samuel Thomas, a 59-year-old man, presents for his routine driving medical. He holds a commercial driver’s licence and operates a heavy vehicle. During the assessment, he discloses that he recently had a ‘blackout’ episode at home but hasn’t told anyone as it hasn’t happened since. He appears well and his cardiovascular examination is normal. He requests that you not include the episode in your report to the transport authority, stating, ‘If they find out, I could lose my job.’

Past history: Hypertension, hypercholesterolaemia

Medications: Perindopril, atorvastatin

Social history: Lives with partner, no alcohol or drug use, long-haul driver

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Angela Robbins, a 36-year-old woman, presents to your clinic requesting a letter stating that she is exempt from wearing a face mask. She explains that she experiences anxiety when her mouth and nose are covered and that she was recently denied entry to a shopping centre. She does not have a formal mental health diagnosis or any current treatment. She insists she needs a letter immediately and becomes agitated when you ask for more details.

Past history: Mild intermittent anxiety (self-reported)

Medications: Nil

Social history: Lives with partner; working part-time; no regular mental health follow-up

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Kevin Doyle, a 42-year-old man, presents to request a copy of his entire medical file as he is changing GPs. You provide a standard release form for him to sign, but he insists on taking a photo of the screen showing his consultation notes instead. He becomes irritated when you explain that this is not standard procedure and says he has a legal right to all his records immediately. He refuses to sign the consent form and demands that the records be printed on the spot. You are the only GP working that day and have a full waiting room.

Past history: Hypertension, low back pain, alcohol use (documented in notes)

Medications: Amlodipine 5 mg daily

Social history: Lives alone, no current support services in place

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Francesca Leone, a 61-year-old woman, presents for an urgent appointment. She reports that her adult son, who has schizophrenia, has been behaving erratically and has left the family home. She is worried he may be off his medications and is concerned for his safety. She asks you to check his recent prescriptions and share any information that might help her locate him. You have previously seen her son at the clinic, but he is not present today, and you have not been authorised to share his health information.

Past history (son): Schizophrenia, cannabis use disorder

Medications: Aripiprazole depot injection, PRN diazepam (last seen 3 months ago)

Social history: Francesca is listed as next of kin but no formal consent is on file

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Dr Nathan Koh, a GP at a suburban clinic, is treating Alex Ferris, a 24-year-old man who has been referred for ongoing management of ADHD. During the consultation, Alex asks Dr Koh to complete a Centrelink medical certificate stating that he is unable to work due to his condition. He reports difficulty concentrating and occasional anxiety but does not appear functionally impaired during the consultation. He is currently not on treatment, having stopped stimulants several months ago. He insists the certificate is needed urgently to access payments and becomes frustrated when asked for further details about his functional capacity.

Past history: ADHD diagnosed in adolescence; previously trialled methylphenidate

Medications: Nil currently

Social history: Lives with parents; recently unemployed; no regular psychologist or psychiatrist

What are the most appropriate actions for Dr Koh to take in this situation? Select three (3) from the following list:

Joanna Lim, a 47-year-old woman, attends for a review of her type 2 diabetes and requests that her health records not be shared with My Health Record. She is concerned about data breaches and does not want her pathology results or specialist letters uploaded. She is worried that employers or insurance companies could access her health information. She asks you to permanently block her My Health Record access and to ensure her data is not uploaded automatically by the clinic.

Past history: Type 2 diabetes, hyperlipidaemia

Medications: Metformin, atorvastatin

Social history: Works in administration, private health insurance holder

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Thomas Fielding, a 70-year-old man, attends for follow-up of chronic knee pain. He has previously been prescribed meloxicam but now requests a repeat prescription for oxycodone, saying it’s the only thing that gives him relief. You review his notes and find that oxycodone was trialled briefly 18 months ago but discontinued due to drowsiness and concerns about dependence. He insists he’s ‘not an addict’ and becomes agitated when you express hesitation. He asks you not to write anything about this request in the notes and warns that he’ll lodge a complaint if you ‘make it look like I’m drug-seeking.’

Past history: Osteoarthritis, hypertension, mild renal impairment

Medications: Perindopril, paracetamol

Social history: Lives alone; retired; previously self-managed medications

What are the most appropriate actions to take in this situation? Select three (3) from the following list:

Jessica Monroe, a 38-year-old woman, presents to discuss fertility options. She is single and wishes to explore accessing donor insemination through a private fertility clinic. She asks you to write a referral stating that she has ‘medical infertility’ to avoid paying higher out-of-pocket costs, even though she does not have a medical diagnosis of infertility. She says her friend did this and it made the process ‘a lot cheaper’. She assures you no one will check and says she won’t go ahead unless you write the referral as requested.

Past history: Nil significant; normal menstrual cycles; no prior pregnancies

Medications: Nil

Social history: Lives alone; works full-time; no known barriers to natural conception other than not having a partner

What are the most appropriate actions to take in this situation? Select three (3) from the following list: