AKT – Military and veteran health

Anthony Goodwin, aged 42, is a former infantry soldier who served in Afghanistan. He presents with persistent insomnia, hypervigilance, and difficulty concentrating. He reports nightmares of combat and avoids situations that remind him of his service. These symptoms have persisted for over 8 months and are causing significant distress. He does not use alcohol or drugs and has no past psychiatric history.

His PHQ-9 score is 17. He has not expressed any suicidal ideation. He is not currently on any medications.

What is the MOST appropriate next step in management?

Karen Fielding, aged 55, is a retired navy officer presenting with progressive bilateral shoulder pain and stiffness over several months. She reports difficulty dressing and combing her hair. There is no history of trauma. She has a past history of hypertension and osteoarthritis of the knees. She does not smoke or drink.

On examination, she has symmetrical reduced range of movement in both shoulders, especially abduction and external rotation, with discomfort at the end of range.

What is the MOST likely diagnosis?

Samuel Jacobs, aged 38, is a veteran recently discharged from the army. He presents requesting help to quit smoking. He smokes 25 cigarettes daily and has made several unsuccessful quit attempts. He previously used nicotine patches and lozenges with limited success. He is otherwise well and takes no regular medications.

He has no history of depression or cardiovascular disease. BP is 122/78 mmHg, and BMI is 27.

What is the MOST appropriate pharmacological option to support smoking cessation?

Lee Thompson, aged 49, is an ex-military logistics officer who now works in a civilian warehouse. He presents with persistent low back pain for 9 months. The pain is worse at night and improves slightly with activity. He reports early morning stiffness lasting more than 30 minutes. There is no history of trauma.

On examination, Schober’s test is reduced and sacroiliac joint tenderness is present. ESR is elevated.

What is the MOST likely diagnosis?

Nicole Weston, aged 31, is an active-duty army medic who presents for pre-deployment health assessment. She has no significant past medical history. She is up-to-date with immunisations and has good dental health. She mentions recent fatigue and increased bruising. On examination, you note pallor and petechiae.

Her FBC shows: Hb 88 g/L, WCC 3.2 x10^9/L, platelets 46 x10^9/L. LFTs and renal function are normal.

What is the MOST appropriate next step?

Pauline Richards, aged 34, is a current serving air force flight officer. She attends for follow-up of a recent head injury sustained during a routine parachute training drill. She did not lose consciousness but reports ongoing headaches, difficulty concentrating and irritability for the past 2 weeks. There are no focal neurological findings and her CT brain was normal.

What is the MOST likely diagnosis?

Matthew O’Donnell, aged 60, is a retired SAS soldier who served in Vietnam. He presents for routine review. He is on no regular medications and his cardiovascular risk is low. He mentions concerns about multiple friends recently diagnosed with cancer and asks if he is at increased risk from Agent Orange exposure during his deployment.

What is the MOST appropriate response?

Jordan Ellis, aged 28, is a combat engineer who presents with low mood, poor appetite, and disturbed sleep for the past 6 weeks. He reports decreased enjoyment in activities and difficulty concentrating during daily tasks. He denies suicidal ideation. His K10 score is 31. There are no psychotic symptoms. This is his first episode of mental illness. He requests a medication to help as he is struggling with daily functioning.

What is the MOST appropriate treatment to initiate?

Amanda Nguyen, aged 36, is an active-duty army nurse who presents with severe left heel pain, especially with her first steps in the morning. She has recently increased her training load in preparation for a fitness assessment. Examination reveals tenderness at the medial calcaneal tuberosity and pain on dorsiflexion of the foot during palpation of the plantar fascia.

What is the MOST likely diagnosis?

David Beaumont, aged 47, is a former artillery operator who presents with chronic tinnitus and progressive bilateral hearing loss. He reports difficulty understanding conversations in noisy environments. He served for 20 years and was frequently exposed to loud explosions and gunfire.

What is the MOST likely underlying cause of his symptoms?

Isaac Morrison, aged 33, is a returned army veteran who presents for review of chronic right knee pain. He sustained a blast injury 8 years ago resulting in ligamentous injury and multiple surgeries. He now reports constant dull pain, swelling after activity, and occasional giving way. Imaging reveals joint space narrowing and osteophyte formation.

What is the MOST likely diagnosis?

Sarah Connelly, aged 29, is a military police officer who presents with frequent episodes of abdominal bloating, diarrhoea and urgency, especially during times of stress. These symptoms have persisted for over 6 months. There is no weight loss or bleeding. Her coeliac serology, CRP and faecal calprotectin are all normal.

What is the MOST likely diagnosis?

Luke Anderson, aged 41, is a recently discharged veteran who served in East Timor and Afghanistan. He reports chronic fatigue, joint aches, and difficulty sleeping. He is worried about “Gulf War Syndrome”. All investigations to date have been normal. He asks if his symptoms are real or psychological.

What is the MOST appropriate response?

Rebecca Lin, aged 38, is a logistics officer in the ADF. She presents following a workplace incident where she witnessed a colleague sustain a severe crush injury. Since the event, she reports flashbacks, emotional numbness, and difficulty sleeping. These symptoms have persisted for 2 weeks. She is currently on leave and asks if she has PTSD.

What is the MOST appropriate diagnosis at this stage?

Jason Wu, aged 50, is a retired submariner who presents with chronic cough and exertional dyspnoea. He smoked for 20 years but quit 10 years ago. He denies chest pain or haemoptysis. On examination, he has prolonged expiratory phase and scattered wheeze. Spirometry shows FEV1/FVC ratio of 0.65 and reduced FEV1.

What is the MOST likely diagnosis?

James Wilcox, aged 45, is a veteran presenting with worsening anxiety, nightmares and avoidance of social situations. He was recently discharged after a medical board and is struggling to adjust to civilian life. He admits to frequent alcohol use to cope. He denies suicidal ideation but appears emotionally labile during the consult.

What is the MOST appropriate next step?

Helen Forrester, aged 52, is the wife of a retired army officer. She presents with concerns about her husband’s memory. She reports he has been forgetful, irritable, and recently became lost driving to a familiar location. He sustained a significant head injury during service 15 years ago. MMSE in the clinic is 24/30. There are no focal neurological signs.

What is the MOST likely diagnosis?

Andrew Smith, aged 31, is an ADF veteran who presents with right hip pain. He was previously treated for femoroacetabular impingement and underwent arthroscopic surgery 2 years ago. He now reports groin pain with prolonged sitting and activity. FADIR test reproduces the pain.

What is the MOST likely current diagnosis?

Ben Carter, aged 39, is a combat veteran experiencing irritability, hypervigilance, poor sleep and anger outbursts. His wife reports he becomes easily startled and has difficulty concentrating. He refuses to see a psychologist and believes talking “won’t help.” He asks for something to help him “calm down.”

What is the MOST appropriate next step?

Liam Walker, aged 26, is a serving infantry member who presents with acute right anterior shoulder pain after completing a weighted pull-up during training. He felt a sudden pop and now has pain and weakness on resisted elbow flexion. Examination reveals a palpable defect in the biceps and reduced supination strength.

What is the MOST likely diagnosis?

Felicity Grant, aged 40, is a former RAAF aircraft technician who presents with concerns about infertility. She has been trying to conceive for 18 months. Her cycles are regular. She served for 15 years, often working night shifts and around aviation fuel and solvents. Her partner has normal semen analysis.

What is the MOST appropriate initial investigation for her?

George Robinson, aged 66, is a Vietnam veteran with a history of hypertension and type 2 diabetes. He presents with nocturia, poor urinary stream and dribbling. His PSA is 3.6 ng/mL (normal range for age), and DRE shows a moderately enlarged, smooth prostate.

What is the MOST appropriate initial management?

Sophie Tan, aged 30, is a serving army officer who presents with amenorrhoea for 5 months. She is highly active, running 10 km daily and follows a restrictive low-fat diet. Her BMI is 18.5. Pregnancy test is negative. TSH and prolactin are normal.

What is the MOST likely cause of her amenorrhoea?

Tom Fraser, aged 36, a returned special forces soldier, presents with chronic right elbow pain. He reports pain during lifting and grip activities, with tenderness over the lateral epicondyle. There is no history of trauma.

What is the MOST likely diagnosis?

Marcus Webb, aged 44, is a former ADF diver who presents with fatigue and joint pain. He is concerned about long-term effects of his diving exposure. He has no history of decompression illness. Examination is unremarkable, but he is anxious and requests extensive investigations.

What is the MOST appropriate management?

Alan Davidson, aged 62, is a Vietnam veteran with a known diagnosis of PTSD. He presents with new onset of cognitive decline, including forgetfulness and difficulty concentrating. He is compliant with sertraline and denies current alcohol use. MMSE is 23/30. Physical exam is unremarkable.

What is the MOST appropriate initial investigation?

Kylie Robertson, aged 35, is an ex-navy logistics officer with long-standing pelvic pain, worse around menstruation. She has no children and is trying to conceive. Examination shows mild tenderness in the lower abdomen. Pelvic ultrasound reveals an endometrioma.

What is the MOST likely diagnosis?

Eric Chan, aged 57, served in the navy for 25 years and now reports chronic sleep difficulties. He sleeps for 4–5 hours and feels unrefreshed. He uses his phone in bed, naps during the day and drinks coffee in the evenings. He is otherwise well and not on medications.

What is the MOST appropriate initial management?

Bianca Hughes, aged 42, is a serving ADF physical trainer. She presents with right foot pain following a 10 km march in boots. Pain is localised over the dorsum of the foot and worsens with activity. Examination shows point tenderness over the second metatarsal. X-ray is normal.

What is the MOST likely diagnosis?

Nathan White, aged 39, is a veteran referred for a compensation claim review. He has a well-documented history of PTSD and depression. He now reports ongoing concentration issues affecting his work. He feels unsupported in his workplace and is becoming increasingly socially isolated.

What is the MOST appropriate management approach?

Michelle Tang, aged 30, is an ADF medic who presents with irregular, heavy menstrual bleeding for the past 6 months. Her iron levels are borderline low. She is sexually active, not using contraception, and denies intermenstrual bleeding or pelvic pain. Pelvic ultrasound is normal.

What is the MOST appropriate initial management?

Andrew Lane, aged 48, served in artillery and presents with long-standing tinnitus and mild hearing loss. Audiometry confirms bilateral high-frequency hearing loss. He asks about compensation options and next steps.

What is the MOST appropriate immediate action?

Samira Hassan, aged 29, is an air force member who presents with increasing fatigue, low mood, and reduced performance at work. She has had multiple overseas deployments and admits to recent poor sleep and social withdrawal. Screening reveals moderate depressive symptoms and subthreshold PTSD.

What is the MOST appropriate initial management?

Dean Fletcher, aged 58, served in the navy and was exposed to asbestos during ship maintenance duties in the 1980s. He presents with progressive dyspnoea and dry cough. Chest X-ray shows pleural plaques and a right-sided effusion. He is a lifelong non-smoker.

What is the MOST likely diagnosis?

Rachel Yeo, aged 24, is an army cadet reporting frequent musculoskeletal injuries and amenorrhoea for 7 months. She is a high performer, very lean (BMI 17.8) and exercises rigorously twice daily. She is worried about gaining weight.

What is the MOST likely diagnosis?

Victor Tang, aged 51, is a veteran who was involved in a motor vehicle accident during deployment and sustained a spinal cord injury resulting in paraplegia. He now presents with new fever and rigors. He uses intermittent catheterisation. On examination, suprapubic tenderness is noted. Urinalysis shows nitrites and leukocytes.

What is the MOST appropriate management?

Emma Boyd, aged 46, is a retired army cook who reports breathlessness on exertion and fatigue. She has a 30-pack-year smoking history. Chest auscultation reveals bilateral basal crackles. Chest X-ray shows diffuse reticular opacities. Pulmonary function tests show reduced DLCO.

What is the MOST likely diagnosis?

Amelia Rawlings, aged 33, is a current ADF officer who has just returned from deployment in the Middle East. She presents with abdominal bloating, intermittent diarrhoea, and flatulence ongoing for 3 months. She denies fever or blood in stool. Stool culture is negative.

What is the MOST likely diagnosis?

Jason Lowry, aged 36, is a recently discharged veteran who presents for support with transition to civilian employment. He has been struggling with interview anxiety and lack of confidence. He is motivated to work but feels lost in navigating civilian systems.

What is the MOST appropriate referral?

Isobel Kerr, aged 39, is a veteran who served in East Timor and presents with vague abdominal discomfort, low-grade fever, and weight loss. She has returned to Australia 4 months ago. Physical examination reveals hepatomegaly. LFTs show raised ALP and GGT. Ultrasound shows multiple hypoechoic liver lesions.

What is the MOST likely diagnosis?

Daniel Frey, aged 44, is a former combat engineer who presents with persistent right ankle pain. He sustained an inversion injury during deployment 9 months ago. Pain persists despite physiotherapy. Examination reveals tenderness over the anterior talofibular ligament and a positive anterior drawer test.

What is the MOST likely diagnosis?

Julie Adams, aged 31, is a serving signals officer who presents with severe premenstrual mood swings, irritability, and breast tenderness. These symptoms resolve with menstruation. She is otherwise well. Her cycles are regular, and she is not using hormonal contraception.

What is the MOST appropriate first-line management?

Grant Wilson, aged 58, served in logistics and now presents for review of his DVA claim for osteoarthritis of both knees. He worked extensively on concrete flooring and carried heavy loads. He asks what supports the claim.

Which factor MOST strongly supports a service-related contribution?

Naomi Lester, aged 40, is a veteran presenting with weight gain, poor concentration and fatigue. She is on venlafaxine for past depression and PTSD. Examination reveals dry skin and mild bradycardia. TSH is 11 mIU/L, and free T4 is low.

What is the MOST appropriate management?

Lucas Peng, aged 36, a former rifleman, reports severe jaw pain and clicking when chewing. It started during a high-stress period post-discharge. Examination shows tenderness over the temporomandibular joint (TMJ) and restricted jaw opening. There is no fever or dental abscess.

What is the MOST likely diagnosis?

Steven Cook, aged 43, is a recently discharged infantry soldier who presents with worsening nightmares, poor sleep, and increased alcohol consumption. He reports re-experiencing traumatic events and significant hyperarousal. He is not currently on treatment. He asks for a ‘sleeping tablet’.

What is the MOST appropriate response?

Olivia Tran, aged 27, is a logistics officer who returned from deployment in the Solomon Islands 3 weeks ago. She presents with fever, myalgia, and a maculopapular rash. She also complains of conjunctivitis. Her partner is well. No cough or urinary symptoms. Dengue and malaria tests are negative.

What is the MOST likely diagnosis?

Harold Simmonds, aged 67, is a Vietnam veteran with chronic PTSD and type 2 diabetes. He presents for routine care but mentions feeling increasingly hopeless and withdrawing from activities. He denies active suicidal ideation. HbA1c is 7.4%.

What is the MOST appropriate next step?

Ella Bishop, aged 32, is an ADF member seeking contraception prior to deployment. She wants something reliable, long-lasting, and low maintenance due to unpredictable access to medical services overseas.

What is the MOST appropriate option?

Chris Walters, aged 40, is a former combat medic who presents with frequent flashbacks, poor sleep, and irritability. He also describes feeling emotionally numb and disconnected from his family. He has not previously sought help. You suspect PTSD.

What is the MOST appropriate screening tool to use?