RACGP KFP 2016.1.16 – Jane requests Pethidine

Originally derived KFP Cases from the RACGP Public Exam Report for KFP 2016.1

Jane, aged 43 presents as a new patient to your clinic.  She is in distress and reports an acute on chronic migraine, the same as previous migraines.  She gets them 1-2 times a month.  She also has nausea.  She has a letter from her old GP stating she requires “pethidine” for the migraines as no other treatments work.  She denies any other medical history or medications.  She gets side effects to neurofen and has an allergy to panadol.  She does not smoke and drinks “socially”. 

What should be included of your initial assessment of Jane?  List 5

  1. Telephone reference check with previous GP
  2. Written reference check with previous GP
  3. DDU Verification
  4. Medicare Verification – Dr Shopper Hotline
  5. Telephone reference check with pharmacy
  6. Assess analgesic effect of pethidine
  7. History of Illicit drug use
  8. Mental health assessment
  9. Examination for track marks

RACGP – A good answer in this case required candidates to demonstrate a safe and systematic as well as a professional approach to patients presenting with drug seeking behaviours.  This included the appropriate contact with her previous GP and agencies monitoring ‘doctor shopping’ as well as assessment of the presenting symptoms.

How will you manage Jane appropriately?  List 4

  1. Decline pethidine initially
  2. Offer Metoclopramide 10mg IM
  3. Offer Sumatriptan PO 50-100mg stat
  4. Book follow up appointment to discuss possible opioid use disorderRACGP –

RACGP – Candidates again provided lists of management options with justifications and were not concise at all and so were penalised with extra codes.  If the candidates gave pethidine then they score zero for that part of the case, not the whole case but for that part of the case as this is definitely not appropriate management

 

RACGP Feedback

This case presents a new patient presenting wit a migraine and letter from a previous GP stating that she requires pethidine for these migraines.  The case focuses on the initial assessment of the patient and subsequent appropriate management.

A good answer in this case required candidates to demonstrate a safe and systematic as well as a professional approach to patients presenting with drug seeking behaviours.  This included the appropriate contact with her previous GP and agencies monitoring ‘doctor shopping’ as well as assessment of the presenting symptoms.

Candidates again provided lists of management options with justifications and were not concise at all and so were penalised with extra codes.  If the candidates gave pethidine then they score zero for that part of the case, not the whole case but for that part of the case as this is definitely not appropriate management