Altitude medicine often centres around visitors — climbers, trekkers, and lowland travellers — but far less attention is given to the chronic health challenges faced by people who live permanently at high elevations. This presentation focuses on altitude-related ailments in rural mountain communities, particularly chronic mountain sickness (CMS), high-altitude cor pulmonale, polycythemia, and vitamin D deficiency.

Drawing on over 1,000 haemoglobin studies from both highlander (Sherpa) populations and lowlanders who have migrated to high altitude, this session highlights how altitude adaptation varies between groups and how these differences manifest in disease burden. The presentation is informed by nearly a decade of clinical practice in remote Himalayan clinics where formal infrastructure is limited, requiring practical, locally adapted approaches to care.

Through a blend of clinical observation and data, the talk aims to bring attention to the hidden burden of chronic illness in high-altitude residents. Participants will gain insights into the recognition and management of CMS and related conditions in resource-limited environments, as well as the broader implications for rural and remote medicine. The goal is to expand the dialogue on altitude health beyond acute illness and adventure medicine, toward a more comprehensive understanding of long-term impacts on mountain communities.

Background:
Facial nerve palsy (FNP), caused by dysfunction of the seventh cranial nerve, significantly affects facial function and appearance. The House-Brackmann (HB) Scale is widely used for grading FNP, though it was originally designed for patients one year post-acoustic neuroma surgery. Its broad application across varying FNP etiologies may reduce grading accuracy. Studies have shown inter-assessor variability and frequent underestimation of severity, especially in cases with tonal eye closure. This study evaluated clinicians' proficiency with the HB scale and the impact of a brief educational intervention on grading accuracy.

Methods:
De-identified images of ten FNP patients of varying severity were selected from a consented image database. Junior doctors from different specialties assessed each case using the HB scale. After completing a short educational module focused on tonal eye closure, they repeated the grading exercise. Feedback was collected before and after the intervention.

Results:
Initial grading showed variability, with most participants correctly grading only 4 to 5 of the 10 cases. Accuracy improved post-intervention.

Conclusions:
The HB scale showed limited reliability among junior clinicians. While education improved consistency, persistent challenges suggest the need for a clearer and more adaptable grading system for FNP in diverse clinical settings.

Background:
Neuroendocrine carcinomas of the head and neck are rare and aggressive, especially when occurring with synchronous squamous cell carcinoma (SCC) in situ. This case describes metastatic large cell neuroendocrine carcinoma of the hypopharynx and larynx with coexisting SCC in situ.

An 83-year-old male with a history of smoking, COPD, and hypertension presented with dysphagia, odynophagia, weight loss, otalgia, and a neck mass. Nasendoscopy revealed a large tumor involving the right aryepiglottic fold, piriform sinus, and pharyngeal wall with impaired right vocal cord mobility. Imaging showed a T3N2cM1 lesion, bilateral cervical lymphadenopathy, lung nodule, and bone metastases. Biopsy confirmed large cell neuroendocrine carcinoma with SCC in situ and early invasion.

A multidisciplinary team recommended palliative chemoradiotherapy with immunotherapy for the SCC component.

Methods:
A literature review was conducted on metastatic large cell neuroendocrine carcinoma with synchronous SCC in situ.

Results:
Fewer than 50 cases of concurrent neuroendocrine carcinoma and SCC have been reported. One study identified 13 synchronous cases, all in males. This dual pathology is highly aggressive with early metastasis.

Conclusion:
This case highlights the need to consider dual malignancies in head and neck cancers, especially in advanced or atypical presentations.

Purpose:
Papillary thyroid carcinoma (PTC) is typically slow-growing, but rare cases may show aggressive local invasion, including the airway. This case outlines the diagnosis and management of locally advanced PTC with tracheal invasion.

A 64-year-old man presented with a neck mass. CT showed a large thyroid mass invading the trachea and abutting the thyroid cartilage. PET scan showed uptake in the tumor and a right level IV node, with no distant disease. Endoscopic biopsy confirmed PTC. The patient underwent total thyroidectomy, tracheal reconstruction with primary closure, and bilateral neck dissection. Histopathology revealed poorly differentiated PTC, focal thyroglobulin positivity, and BRAF mutation. The multidisciplinary team recommended adjuvant radioactive iodine and radiotherapy.

Methods:
A literature review was performed on PTC with airway invasion.

Results:
Tracheal invasion by PTC is uncommon. Most cases are managed with surgical resection followed by radioactive iodine. One case series reported tracheal cartilage involvement in nearly half of cases.

Discussion:
This case highlights the importance of thorough workup, including imaging and endoscopy, to assess disease extent. Recognizing airway invasion early is vital for surgical planning and improving outcomes in aggressive thyroid cancer.

Background:
Recent legislative changes in Western Australia have improved access to medical termination of pregnancy (MTOP) up to 63 days gestation. While MS-2 Step is reported to have high efficacy with minimal failure and complication rates, clinical experience suggests these may be higher than previously expected.

Objective:
To assess MTOP outcomes in a single regional GP clinic for a 12-month period.

Methods:
An audit of MTOP prescriptions issued between 01/01 -30/12/2024 was conducted using Best Practice software. Patient data including age, gestation, BMI, and reproductive history were analysed to identify outcome trends and potential influencing factors.

Results:
Of 101 prescriptions, 61 had follow-up data. There were 50 successful terminations and 11 failures, including 6 requiring D&C. Overall failure rates were 1.5 times higher than literature estimates, with D&C rates up to 2.45 times higher. Greater success rates were observed in patients aged 25–34 and those with BMI ≥30. A small subset with >4 prior terminations had a 100% failure rate.

Conclusion:
MTOP remains a vital medication for women, however this audit suggests it may have a higher than expected rate of failure and post-MTOP intervention in the clinical setting, requiring vigilant and robust follow-up practices for optimal patient outcomes.