Master Specialist Community Medicine (SCO6012)
for DHA Speciality

A 28-year-old woman attends a community sexual health clinic at 10 weeks' gestation requesting influenza vaccination. She has no fever, no respiratory symptoms, and her pregnancy is uncomplicated. She reports a documented anaphylactic reaction to neomycin, which is present in some influenza vaccine formulations. She has never received influenza vaccine before. Vital signs are normal: BP 112/70 mmHg, HR 78/min, temperature 36.8?C. What is the most appropriate management?

A 54-year-old man with type 2 diabetes and a history of myocardial infarction is reviewed in a community cardiology clinic. His current medications include aspirin, atorvastatin, metformin, and ramipril. His blood pressure is 138/84 mmHg, HbA1c is 7.2%, and eGFR is 62 mL/min/1.73m?. He has no history of bleeding, peptic ulcer, or stroke. He asks about adding a second antiplatelet agent for cardiovascular protection. What is the most appropriate management?

A 32-year-old woman is seen in a community antenatal clinic at 36 weeks' gestation. She has a history of a previous caesarean section and now requests external cephalic version (ECV) for a breech presentation. She has had no vaginal bleeding, her membranes are intact, and ultrasound shows a single fetus with normal amniotic fluid. Her blood pressure is 118/76 mmHg, and cardiotocography is normal. What is the most appropriate management?

A 68-year-old man with chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m?) attends a community diabetes clinic. His HbA1c is 7.8% on metformin and gliclazide. He has no history of heart failure, and his blood pressure is 142/86 mmHg. His clinician considers adding a sodium-glucose co-transporter-2 (SGLT2) inhibitor. What is the most appropriate management?

A 45-year-old woman presents to a community clinic with a 3-day history of dysuria, frequency, and suprapubic pain. She is 20 weeks pregnant. She has no fever, no flank pain, and no vaginal discharge. Urinalysis shows nitrites and leucocytes. Her temperature is 36.9?C, BP 110/70 mmHg, and she has no allergies. What is the most appropriate management?