Other Components

A 27-year-old man with congenital deafness presents to the emergency department with rigors and a temperature of 39.2°C. When the treating doctor introduces themselves, the patient simply nods in response. His parent, who has accompanied him, explains that he normally communicates using Auslan (Australian Sign Language) but 'is reasonably good at lip-reading.' The doctor completed a short Auslan course as part of an elective subject two years ago. What is the most appropriate way to proceed with taking this patient's history?

A final-year medical student is doing an emergency medicine term and is asked to see a 68-year-old man who presents with 45 minutes of crushing central chest pain radiating to the left arm, associated with diaphoresis and nausea. He has a history of hypertension and type 2 diabetes and is a current smoker. Observations show BP 148/92 mmHg, HR 112 bpm, SpO2 96% on room air, and he appears pale and unwell. The student obtains a 12-lead ECG showing 3 mm ST-elevation in leads V1–V4 with reciprocal changes inferiorly, consistent with an anterior STEMI. The student shows the ECG to the supervising consultant, who states 'it's probably just reflux' and instructs the nursing staff to prepare a discharge letter with antacids, declining to activate the cardiac catheterisation pathway despite the student's attempt to raise the ECG findings. What is the MOST appropriate next action for the student?

A 34-year-old male emergency department nurse presents to the occupational health service 20 minutes after sustaining a deep needlestick injury to his left index finger while resheathing a hollow-bore cannula needle used on a patient with known HIV infection on antiretroviral therapy with an unknown viral load. There was visible blood on the device and bleeding from the puncture site. The nurse is asymptomatic, his hepatitis B immunisation status is up to date with documented immunity, and he has no known allergies or comorbidities. Vital signs are normal. On examination there is a single puncture wound to the finger pulp with no ongoing bleeding. What is the most appropriate immediate management?

An 82-year-old woman is brought to the emergency department by ambulance after being found on the floor of her lounge room by her daughter. She lives alone and mobilises with a four-wheeled frame. Her past history includes hypertension, type 2 diabetes, mild cognitive impairment and osteoarthritis, and she takes eight regular medications. This is her third fall in three months; she was previously independent with shopping and meal preparation but her daughter reports she now needs help with these tasks. On examination she is alert, oriented to person and place but vague about the date, with no focal neurological deficit and no fracture on plain films. Observations are BP 132/78 mmHg, HR 78 bpm, RR 16, SpO2 97% on room air, temperature 36.6°C, and BSL 8.2 mmol/L. Her Clinical Frailty Scale is assessed as 6 (moderately frail). She has no acute medical illness identified to explain the fall. What is the MOST appropriate disposition consideration for this patient?

A 35-year-old transgender woman presents to the emergency department after being unable to obtain a timely GP appointment. She reports three months of worsening low mood and gender dysphoria and wishes to commence feminising hormone therapy. She has been self-sourcing oestrogen online but ceased this three weeks ago due to cost. She has no past medical history, does not smoke, and has no personal or family history of venous thromboembolism or breast cancer. Observations are normal and physical examination is unremarkable. She asks the emergency physician how she should proceed with safely starting hormone therapy.

A 60-year-old man presents to the emergency department with abdominal pain and is found to have newly diagnosed metastatic pancreatic cancer on CT, confirmed by outpatient biopsy results reviewed today. He is alert, fully oriented, and formally assessed as having intact decision-making capacity. He is haemodynamically stable (BP 128/76 mmHg, HR 88 bpm, RR 16, SpO2 98% on room air, afebrile) and is awaiting admission for further oncology work-up. His parents, both in their late 80s, are waiting outside and repeatedly approach staff asking for full details of their son's diagnosis, prognosis and treatment plan. The patient has not yet indicated how much information he wishes disclosed to his family, and no formal discussion about this has taken place. What is the most appropriate next step in managing communication with the parents?